“We got married when she was very young. After
a few years of our marriage, she started behaving oddly. She used to get panic
attacks, but the situation worsened after her father died,” said Chagan Baman,
40, who lives in Chikhli village, 30 km from Indore in Madhya Pradesh and does
labour jobs for a living.
“I lock her up
in a room when I leave for work. She keeps looking at me through the window when
I leave her behind,” he added.
Chagan was
married to Dali Bai, 30, who is suffering a psychotic disorder from past five
years. She was married off at an early age of 15. Her father’s sickness and
death affected her mental health. Chagan told Gaon Connection that his wife
gets violent and throws things around and sometimes she sets quilts and mattresses
on fire. She doesn’t sleep at night and keeps staring at the ceiling all night.
She suffers from mood swings – she laughs some times, and cries the next
moment. Her kids get scared of her when she starts howling.
His wife
clearly suffers from some sort of mental illness. Under normal circumstances,
she would have been taken to a psychiatrist. But in rural India, mental
health-related awareness is still sparse and most of the villagers still opt
for tantriks and ojhas (quacks or fake doctors) for treatment as patients
suffering from schizophrenia or bi-polar disorders are considered to be
possessed by evil spirits.
When Gaon
Connection spoke to doctors from primary and community health centers and ASHA
workers, we got an impression that mental health related issues are still a
taboo in rural India.
Dali Bai is suffering a psychotic disorder from past five years.
“India is
the most depressed in the world”
According to
the World Health Organisation, India is the most depressed country in the
world, followed by China and the USA. India, China and the US are the most
affected countries by anxiety, schizophrenia and bipolar disorder, according to
WHO. A study reported in WHO, conducted for the National Care Of Medical Health
(NCMH), states that at least 6.5% of the Indian population suffers from some
form of the serious mental disorder.
According to
a study, only one in 10 people in India with mental health disorders receive
treatment. There are less than 4,000 psychiatrists in the country. Low budget to mental
healthcare, shortage of psychiatrists in villages make people suffer in
silence.
Talking
about the shortage of psychiatrists, availability and affordability of drugs,
Dr Saif Ali, a medical officer in a community health center (CHC) in Barabanki
district of Uttar Pradesh, said: “Medicines are available. These medicines are not very costly
and some have been made available for free, but there’s a shortage of
specialists in our country.” When we spoke to him, there were over 250 patients
waiting outside his clinic.
As there is
a lack of specialists in rural India, camps are organized once or twice a month
in villages. In between these camps, the villagers remain devoid of any help.
At least
13.7% of the country’s population is suffering from several mental disorders,
while 10.6 % of them require immediate intervention, says report of National
Institute of Mental health and Neurosciences (Nimhans). The study also
suggested that nearly 150 million people in India need active medical
intervention.
“They
don’t even know if they are mentally sick”
Taking about
a particular case, Dr Saif Ali told Gaon Connection that he once treated a
woman who had lost her child. She said she would lose her consciousness and had
frequent headaches.
“People here
in villages fail to explain their problem. They make symptoms up on their own.
They complain about headaches and fainting. It becomes difficult for us to
diagnose their problems,” he said.
As per the National
Mental health survey (2015-16) in India, one in 20 people over 18 years of age
suffered from depression. As per this data, there were over 45 million depressed
people in the country in 2015.
Dali Bai (left) and her husband Chagan Baman (right) with their children.
Villagers
prefer babas over medicines
Chagan told
Gaon Connection that he takes his wife to a baba living in the outskirts
of Jaora village in Madhya Pradesh. The baba is well-known in the region
for curing mental illness. “I took her to a dargah in a nearby village in
Pathan Pipalaya. Baba gave us a sacred
thread and holy water. He told me that my wife was given food which was fed
to an evil spirit.”
Even now, mental
health disorders in villages are interpreted as karmic punishments.
Superstitious beliefs, family’s dignity, and reliance on babas make it difficult
for rural patients with mental disorders to get the care they need.
Sometimes Chagan
takes her to Simrol, the small town, for treatment. The doctors give her an IV
drip or saline (which is given in case of dehydration). Chagan says that after
she is given the IV drip, she feels better for a while.
Even though
villages of India are home to nearly 70% of the country’s population, yet it has
a miserable low mental healthcare treatment rates compared to cities.
Chagan was
told that there’s a doctor who cures mentally ill people by charging Rs 2,500. But
since he does labour jobs, he can’t afford to spend so much on her. “I am saving
money and then I will take her to the doctor,” said Chagan.
How to reduce
mental health care gap in rural India?
“This
illness should be treated like any other physical illness,” said Dr Saif Ali.
“Earlier,
people were not aware about TB. They had several misconceptions related to TB.
But with increasing awareness people have now accepted this as a disease. If we
want people to treat mental health disorders, we need to spread awareness with
the help of advertisements,” added Dr Saif Ali.
Explaining
the symptoms of depression and anxiety, he added: “A person suffering from
depression will start avoiding social gatherings. He/she will either eat a lot
or eat nothing. However, in anxiety people say that they remain restless, and
report high blood pressure.”
Family’s
support plays a major role, say psychiatrists, ASHA workers, and NGOs. “We offer
emotional support to them and stay with them as they go through emotional
trauma. We help them explore their feelings and look at options,” said Vanita
Naval, who
works with Mitram Foundation – a suicide prevention helpline for the stressed
and depressed people. She told Gaon Connection that even now the reported cases
are far lower than the actual cases.
“The
callers who call us are mostly depressed, in distress and suicidal. We
come across callers who are across the spectrum of mental health from
depression, anxiety, fear, and bipolar disorders. It is very important to get
access to quality mental health care, secondary health care workers and
counselors,” added Vanita.
“Our
services are free of charge and people who call us may remain anonymous if they
wish,” said Vanita
Naval.
Dr Saif Ali, a medical officer, believes that there’s a lack of psychiatrists in villages
“They
call them doctors of crazy”
People often
neglect mental health care as they consider it socially awkward. They hesitate
to seek help. They always think – What will people say? They’re afraid that if
word about their illness gets out, it may affect their social lives.
“People call
us the doctors of mad. Mental health care has not been socially accepted even
now,” added Saif Ali.
When
Gaon Connection reporter asked the medical officer if drugs should be made
available over the counter like they are for fever and cold, he said: “These medicines
can’t be made over the counter as they are dangerous to consume without
prescription.”
(Inputs taken from Pushpendra Vaidya and Mohit Shukla)
