#TheDiaryOfASocialWorker – 3
Outside every major government hospital is a tree, under it is a small street food vendor, nearby is a cold water machine guy, and near that is a bus stop named after that hospital. Hospitals are living communities sustained by the people who visit it and the people who work in it, and the small scale businesses which run because of this interaction. Photostat and chemists, food stalls, autos and cabs, paan- beedi shops and of course temples and dargahs are routine features of life around a hospital.
How much do we know about our country’s hospitals I wonder, I didn’t give it much thought until I had to visit one and then subsequently work in two of them. A government hospital is exactly like a temple. A visit there is a like a pilgrimage for the patient and his or her family. Most people from the internet savvy, blog reading, Facebooking and Instagramming generation would not be familiar to the government hospital culture because we have other options for our health care. Munna Bhai does make it funny when talking about filling casualty forms but the queues outside a hospital are certainly more than a funny comment on the stark picture that health care paints in our country.
Some Numbers And A Grim Picture
The health care system in our country is based on three tiers – the primary health care center, the secondary district hospital and the tertiary level central/state hospital.
The idea of keeping it this way was that resolvable and preventable health interventions could be provided along with required medicines at the nearest PHC. This acts as a screening mechanism so that care required on an in depth matter such as an X ray or a blood test for more severe problems can be done at the district level. The tertiary level hospital was meant for specialized care.
This model is not something that is working for us clearly although it makes a lot of logical sense. Why isn’t it working is a question raised in academia throughout the years. Secondly is to address the silence on the issue of expenditure on mental health, in which India stands behind even Bangladesh at 0.06% (Bangladesh spends 0.44%) of its Gross Domestic Product (GDP).
The standard in the West is to spend at least 4% of their budgets on mental health.
These figures stand in the light that one in four people is estimated to have a mental health problem by 2020. That’s four years away.
There are only 3 psychiatrists to a lakh people in the country, and five psychologists to a crore people. And even then people who know where to seek help are few. Mental illness is one of the important factors behind unemployment, poverty and medical complications. And yet every development venture whether government, non government or corporate does not spend enough time or efforts evaluating this angle of things. The people angle I would call it.
“Mental”: The Language Of Illness
“Mental hai kya?”
“Haan, kyunki tum bhi ho”
Underlying, making the picture murky for Indians is the fact that we hate the word mental unless used in jokes. The word itself carries such stigma! “Mental” is a word like “physical” but you as a reader does not need to be told what it is perceived as. The qualities associated with word also extend to the mental hospital and every service addressing that need. The hospital then symbolizes a deep sense of loss of control, poor hygiene, a smell of disinfectant and being out of touch with reality. Here I would like to point out that being out of touch with reality only happens in certain illnesses. Most common mental health problems such as depression, anxiety, substance related problems, stress related problems do not necessarily mean that one is going to be a chronic patient.
On the other hand medicine, social sciences and research have progressed to an extent that we have treatment and management plans for chronic illnesses like schizophrenia, bipolar illness, dementia and obsessive compulsive disorders. It is a matter now of raising awareness, breaking the silence and extending help whenever required.
If I were to ask you have you seen someone with mental illness, you might not recall someone known. But it is apparently the most invisible phenomenon, because the co-worker who doesn’t like much company, the beggar you chased away or ignored at the signal, the house wife who only cries at night and slogs during the day, and the child who does not concentrate in class and makes a lot of mischief, are characters in your life. These are your family members, your neighbors and your community. And maybe even you.
The funny thing is the extent to which silence pervades the society is that even people who know that these mental health concerns are common and treatable are mum about it, because even within the field it is a black spot on your name to have a depressive episode, to be taking medicines, to be on leave for a while due to anxiety attacks, depressive episodes but not for a fracture.
And your insurance won’t cover it either.
How To Break The Silence Around Mental Health
So what do we do about this silence? Small steps are all it takes for social change to happen. A good example would be how we started breaking silence about gender issues, rights and violence. Similarly, if you stop cracking jokes about people with mental illness, if you stop avoiding the topic calling it “Gyaan” or philosophy and if you start noticing your own mental health concerns and of those around you, you might be able to help someone or seek help when you require it.
In addition, you would be one among the rare few who are sensitive to the secret shame of having a mental health concern, the isolation and pain it creates because others find it difficult to understand. You just might prevent someone from taking their life or someone from not being violent or angry to a person who is undergoing a mental health concern. Take some time out to understand about mental health terms instead of using them frivolously and most importantly, listen actively, and do not judge people because they have an illness.
Liked reading this? Then you might also like to read about Digging The Roots Of Mental Health Problems.
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