Some people overreact to simple statements and situations, some have difficulty in relating to other people, some often find fault with their colleagues and family members and feel threatened, and others seem to experience hallucinations and delusions.

Often we dismiss these people sometimes casually and sometimes with fear, as “mad” or eccentric.

Morbidity on account of mental illness is set to overtake cardiovascular diseases as the single largest risk in India.

According to NIMHANS, there are over two crore people in India who are in need of treatment for serious mental disorders and about five crore people who are affected by common mental dis­order.

About 30 to 35 lakh people need hospitalization at any time for mental illness. Mohandas (2009) has observed the situation is alarming.

It was noted that a meta-analysis of 13 epidemiological studies consisting of 33,572 persons reported a total morbidity of 58.2 per 1000.

Another meta-analysis of 15 epidemiological stud­ies reported a total morbidity of 73 per 1000.

The saddest aspect is that the bulk of the affected falls in the 15 to 45 year age group.

The existing facilities in the country fall short of the required norms which makes the situa­tion still worse. The number of psychiatric beds in the country is only about 0.2 per 1, 00,000 population and there are only two psychiatrists per 10 lakh population”.

Math and Srinivasraju (2010) have estimated that about 20 per cent of the adult population in the community is affected with one or the other psychiatric disorder.

In particular female gender, children and adolescents, students, aged people, people suffering from chronic medical conditions, disability, disaster survivors, people in custodial care, marginalized persons, refuges and individuals with a poor family, social and economic support are found at high risk of developing psychiatric disorders.

To a psychologist, the problems related to mental disorders are as fascinating as they are disturbing.

But what, precisely, are mental disorders?

This question is much harder to answer than you might at first assume because in fact there is no hard-and-fast dividing line between behavior that is normal and behavior that is somehow abnormal rather than these simply endpoints on an unbroken dimension.

That said most psychologists do agree that mental disorders include the following features.

First, they involve patterns of behavior or thought that are judged to be unusual or atypical in society. People with these disorders don’t behave or think like most others and these differences are often apparent to the people around them.

Second, such disorders usually generate distress negative feelings and reactions in the persons who experience them.

Third mental disorders are maladaptive. They interfere with individual's ability to function normally and meet the demands of daily life.

Combining these points we can define mental disorders as disturbances of an individual’s behavioral or psychologi­cal functioning that are not culturally accepted and that lead to psychological distress behavioral disability and impaired overall functioning.

Models of Abnormality- Changing Conceptions of Mental Disorders

The pendulum of history swings, and like other pendulums it does not move in only one direction. Over the course of the centuries and in different societies mental disorders have been attributed to natural factors or forces for example, to imbalances within our bodies or alternatively to supernatural ones such as posses­sion by demons or gods. Let’s take a look at a few of these historical shifts and then turn to the modern view of mental disorders models of abnormality that provide comprehensive accounts of how and why mental disor­ders develop and how they can best be treated.

Modern Perspectives: Biological, Psychological, Sociocultural, and Diathesis-Stress Models:

So how are mental disorders viewed today? The answer involves several perspectives that should be viewed as complementary to one another. Together these approaches provide a more accurate and complete picture of how such disorders arise and how they can be treated than any single perspective does alone.

One of these approaches, the biological model emphasizes the role of the nervous system in mental disorders. This approach seeks to understand such disorders in terms of malfunctioning portions of the brain imbalances in various neurotransmitters and genetic factors.

For example, many mental disorders show a high degree of concordance among close relatives. If one family member develops a disorder then others are at increased risk for developing it too.

It is clear however that biological factors are not the entire story where mental disorders are concerned often such disorders occur without any apparent underlying biological cause. This suggests that psychological factors too can be important. The psychological perspective emphasizes the role of basic psychological processes in the occurrence of mental disorders.

For instance, many psychologists believe that learning plays a key role in many disorders. An example- is phobias, or excessive fears of objects or situations. According to the psychological view a boy who is humiliated in front of classmates by an insensitive teacher may acquire a fear of all social situa­tions in which he is the centre of attention and may avoid them on future occasions. The psychological perspective also emphasizes the role of cognitive factors in mental disorders.

For example, individuals may attribute positive events and accomplishments to luck and other factors beyond their control but negative outcomes to internal factors such as their own flaws or failings. Finally, the psychological perspective also takes account of unconscious forces and conflicts within individuals—the factors so vividly emphasized by Freud and his followers.

What sociocultural factors do they too play a role in mental disorders? Psychologists and other mental health professionals believe that they do, and point to the important role of such social variables as poverty, unemployment, inferior education, and prejudice as potential causes of at least some mental disorders. In other words, the sociocultural perspective emphasizes the fact that external factors such as negative environ­ments, a disadvantaged position in society, and cultural traditions can play a role in mental disorders.

A third modern perspective on mental disorders is the diathesis-stress model.

CASE STUDY

Kerala is pioneering mental health integration in schools If mental illnesses in children are not accurately diagnosed and treated, there is an increase in the probability of health issues in adulthood. The state administered UNARV, a model for adolescent mental health in schools at a district level in 2007, Students with behavioural and academic problems from Class 8 to 12 were counselled by their teachers who were trained in adolescent developmental psychology and mental health disorders. If their problems persisted they were given cognitive behavioural therapy problem-solving skill therapy, and anger management skills at a clinic. If there were family problems at home such as alcoholism or domestic violence their parents were also given family therapy.

This innovative programme ensured that students who might have been suspended or dismissed from school were now treated for their issues. Within this sample, 95 per cent of the students returned back to school. The fact that this was done by integrating school teachers curtailing possible social stigma and developing a model that can be implemented in areas with resource constraints by any district-level administration. The state has many other mental health programmes at the school level such as ‘The Thalia scheme which focuses on eliminating similar psychological issues in all districts.

Kerala also has one of the highest budgetary allocations for mental health – 1.16% of its total health budget. Most other states do not even allocate separate funds for mental healthcare. In fact, India as a country spends only approximately 0.05% of its total health budget (around Rs. 345 crores) on mental health. To put this in perspective, a cautious estimate of the cost of executing the 2017 MHCA is around INR 94,073 crores. Funding is one of the most significant hurdles when it comes to implementation. Further, a lack of investment is likely to cause a larger financial burden on the government — around 6.5 times more than actually implementing these policies would.

Additionally, Kerala is the only state that meets the requirement of at least one psychiatrist per lakh population and also has the greatest number of clinical psychologists (0.6 per lakh population). In the 12 states that were surveyed in the 2019 National Mental Health Survey, the availability of psychiatrists per a population of one lakh was found to be 0.05 in Madhya Pradesh. In an attempt to bridge this gap, the District Mental Health Programme was created to ensure the availability of minimum mental healthcare by encouraging community participation and self-help. However, Kerala alone has fully implemented this programme in all their districts. The core idea of involving the community in the process of mental health first aid is absolutely necessary for India, where most patients look for help in temples, dargahs, or from traditional healers rather than mental health experts. Hence, it is necessary to also train social workers, community healers, and religious persons in basic mental healthcare and create job opportunities in this field to incentivise more young people to pursue it.

Out of the total states, Kerala and Gujarat are the only states wherein several districts routinely conduct Information Education and Communication (IEC) campaigns to spread awareness on mental health issues. India’s low mental health literacy, high levels of stigma, and large treatment gaps illustrate the need for such efforts. In all other states, mental health education is “isolated, sporadic and invisible in nature and lacks focus and direction”. When state-specific policies and action plans are drafted, it is necessary to include robust mechanisms for IEC activities as well.

CONCLUSION

The mind is one of the most powerful organs in the body, regulating the functioning of all other organs. When our minds are unstable, they affect the whole functioning of our bodies. Being both physically and emotionally fit is the key to success in all aspects of life. People should be aware of the consequences of mental illness and must give utmost importance to keeping the mind healthy like the way the physical body is kept healthy. Mental and physical health cannot be separated from each other. And only when both are balanced can we call a person perfectly healthy and well. So, it is crucial for everyone to work towards achieving a balance between mental and physical well-being and get the necessary help when either of them falters.

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