I was reading the world mental health day theme for 2021 and came across “Mental health in an unequal world”. I placed down my coffee and looked up from my bed, where I have been advised to rest for an acute low back issue. I have been homebound for the last 3 weeks with almost zero mobility. Despite that, I have had access to three square meals, requisite pharmacotherapy and psychosocial support.
My mind wandered to a time when I was returning home from the gym in a cycle rickshaw. The rider told me in partial jest that for him, each and every day of his work was equivalent to being in a gym. We both laughed, but it stayed with me.
As a physician working in the public health system, I am no stranger to the extent of health inequities that exist in our country. The working people of this country have so many barriers to healthcare access.
Distance to be travelled to reach a decent healthcare provider, travel expenses, loss of wages on said days, long queues, waiting periods in the harsh weather conditions, cost of medications and investigations, waiting periods for investigations, difficulty in follow up due to aforementioned reasons, etc., to just name a few.
Once we bring further intersections like caste, gender and sex to this discussion, the barriers further amplify.
It is to such a situation that we bring in the issue of mental health and access. Imagine the lower socio-economic society, caste, gender and sexual minorities. Imagine them grappling with an issue of mental health.
When we speak about women, there is a tendency to call everything “hysteria“. It’s simple and convenient. A young girl’s parents are unlikely to seek treatment for mental illness due to the unbearable stigma. This is true more so for girls of “marriageable age”. Can they be blamed? Have we as a society been able to destigmatise mental illness?
Then comes the cost of actual therapy. With the abysmal doctor-patient ratios in India, it’s no surprise that psychiatrists and psychologists are also difficult to come by. With the waiting period in public hospitals, many are forced to seek help in the private sector. Access to psychotherapy is yet another barrier.
First and foremost is the issue of finding sensitive, non-judgmental therapists. If one is lucky enough to find this elusive person, then there is the issue of session costs. Most therapists in the private sector charge between ₹1000–₹2000 for a session that lasts 45–60 minutes. Generally, one requires 1–2 sessions per week. This is a cost that is unthinkable for many, including the ones with privilege.
There are, however, some therapists who do pro-bono work. Knowledge of these therapists is also difficult to come by. Pharmacotherapy, of course, continues to remain a challenge, be it a physical or mental illness.
With so many odds stacked against them, how does the unequal world gain access to mental health? What is the answer?
Increase the number of psychiatrists? Increase the number of psychotherapists? Improve mental health coverage in schools and colleges? Improve mental health coverage in all workplaces? Improve mental health coverage as a part of primary and primordial health?
Incentivise mental health advocates who speak about their mental health journey and help destigmatise mental illness? Create patient support groups for healing and also for dissemination of knowledge regarding available avenues of care? Increase spending on health?
Maybe a combination of the above?
And here I lay in bed, resting as prescribed, even as a person rides a weighted cycle in the world’s unequal gym.