Mental Health is not a destination, it is a process.

इस ब्लॉग को हिंदी में पढ़ने के लिए, यहाँ क्लिक करें।
हा ब्लॉग मराठी मध्ये वाचण्यासाठी, येथे क्लिक करा.

Recent news and daily updates about suicides and mental health related issues have increased a lot. It has become a reason for all of us to talk about mental health, talk about anxiety and depression, and to talk about suicide. Every time I hear about suicide and the increase in mental health problems, it makes me think about what our  roles are in other people’s lives. It makes me wonder how we as a society or culture are, or may not be recognizing or acknowledging the various people and groups who are/have been experiencing various forms of psychosocial  distress , whether it is anxiety, or depression. As Noam Shpancer , The Good Psychologist says that,“mental health… is not a destination but a process.” In this article we will read a little bit  about the suicide rates in India at different times and the increase in it. We will also talk about mental health and how it is a spectrum and what kinds of interventions are used at different places on the spectrum.  

Facts and figures

Agriculture is one of the largest contributors to the GDP in India. Looking at the data of distress among the farmers and the incidents of suicide in farmers is a matter of concern for all of us.   The Ministry of Home Affairs (MHA) has confirmed, in the ‘National Crime Records Bureau’s accidental deaths and suicides in India report’ released on Friday 08th of November 2019, that 11,379 farmers died by suicide in India in 2016. This translates into 948 suicides every month, or 31 suicides every day. (Source: Thewire.in)

Every hour one student dies by suicide in India, with about 28 such suicides reported every day, according to data compiled by the National Crime Records Bureau (NCRB). The NCRB data shows that 10,159 students died by suicide in 2018, an increase from 9,905 in 2017, and 9,478 in 2016. (Source: The Hindu) 

The NCRB data obtained by this newspaper shows that Christians have the highest suicide rate at 17.4, as compared to Hindus at 11.3 — the national average stands at 10.6. Muslims and Sikhs, at 7 percent and 4.1 respectively, record the lowest rates. In this context, rate refers to the number of suicides per population of one lakh. (Source: The Indian EXPRESS)

Close to 800,000 people die due to suicide every year, which is one person every 40 seconds. Suicide is a global phenomenon and occurs throughout the lifespan. Suicide is the third leading cause of death in 15-19 year olds. 79% of global suicides occur in low and middle-income countries. (Source: World Health Organization)

While looking at this data on Suicide rates in India, let’s also look at the dominant causes of suicide. In India, the top 10 causes or correlates of suicide in 2009 were family problems (23.7%), illness (21%) [including insanity/mental illness (6.7%)], unemployment (1.9%), love affairs (2.9%), drug abuse/addiction (2.3%), failure in examination (1.6%), bankruptcy or sudden change in economic status (2.5%), poverty (2.3%), and dowry dispute (2.3%). (Source: NCBI)

When we view this data as just statistics, it is easy to miss the point. The movement from experiencing trauma or distress to suicide is a journey that we may neglect completely when we are caught in the sensationalization that the media triggers around suicide. Mental health is not a destination but a journey. Let us break this down a bit more to understand what is mental health and why it might help to see it  as a journey or a spectrum. 

What is mental health:-

“Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” – World Health Organization (WHO). 

“Mental health can be defined as “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community” (WHO,2014). The WHO looks at mental health as an integral part of holistic health and not merely as an absence of illness. (Source: NCBI)

Mental Health is a key part of an individual’s capacity to lead a fulfilling life – it influences the ability to form and maintain relationships, study, work, pursue leisure interests, and make day-to-day decisions about education, employment and housing.(Source: Mind The Gap – Dasra Report)

What is crucial to note here is that the influence of some of these systems that people live their lives in itself can be the cause for individuals to experience psycho-social distress. Let us take the example of the education system to understand this. If the education system itself continues to reinforce discrimination or oppression, that can be the cause for psyho-social distress thereby impeding the ability to make decisions about further eduational opportunities. Linking this back to the suicide numbers we saw earlier we may now be able to establish connections between the marginalization caused by the education, occupation, employment, housing one has access to, and its impact on one’s mental health. 

Let us try and examine mental health the same way  we see our physical health. When we get a small cut or fracture we go to the doctor, have a cast or bandage put on the fracture,  take medicine if required, and move towards feeling better. We can also explain the distress we notice in our minds in a similar way. The Mental Health spectrum talks about 3 phases. 

• Phase 1 is the Wellness phase, where we function in a ‘perceived normal manner’. Our diet, body systems function well. We have a good concentration level and experience a level of happiness and wellbeing in day to day lives.
• Phase 2 is Psycho-Social Distress where we start experiencing difficult emotions such as mood fluctuations, stress, aggression or nervousness, etc.
• Phase 3 is of Mental Illness where the difficult emotions are at peak, extreme feelings of stress, anxiety, depression, compulsive behavior symptoms start being visible. In this phase, one needs medical attention.

The first 2 phases are where most interventions are classified as promotive and preventive. Many of the promotive or preventive interventions may be used ‘universally’ or selectively based on the part of the spectrum they are used for.  Interventions in the third phase are typically curative in nature. Irrespective of whichever phase we are in, one may benefit from the  support of a counselor, psychologist or mental health professional based on the need.

While we look at the spectrum we can infer that there is a possibility of a person to shift his or her gears on mental health and hence we can possibly work on the mental well being of a person. Let’s try and further understand the promotive, preventive, and curative parts of the spectrum. Let us look at this from an example of adolescence and how the image of mental health continuum or spectrum looks in their life.

• Adolescents, who may be emotionally healthy and adapting well to their social context, may not be in need of mental healthcare services. However, these young individuals require continuous support and a safe environment to maintain their emotional state of well-being and prevent them from sliding to the other end of the spectrum. 
• Adolescents who may experience some psycho-social concerns—such as exam anxiety or difficulty in a romantic relationship—are likely to feel distressed and in need of special support to feel better. This support, provided by structures within the systems, will help the adolescents to cope with the difficult circumstances and prevent them from experiencing mental illness. 
• The other end of the spectrum includes common and severe mental disorders such as depression, psychosis, substance abuse, and self-harm. Adolescents experiencing such concerns are in need of specialized mental health services including psychotherapy, crisis care, or in some cases, psychiatric medication. In such situations, it is important to ensure that once the problem is addressed, efforts are also made to prevent the young individual from experiencing similar concerns in the future and to enhance his/her well-being.

(Sources:  Duggal and Bagasrawala, 2018, Critical Role of School in Adolescent mental health)

Reference: Duggal and Bagasrawala, 2018, Critical Role of School in Adolescent mental health

What can you do:

It may now be abundantly clear that mental health is more than just the absence of mental disorders or disabilities. People with mental health problems often fluctuate along the spectrum in their experience. This fluctuation may happen as often as on a daily basis, regardless of whether or not the individual has a pre-existing mental health condition. (Source: Mind The Gap – Dasra Report). As members that make up communities for each other, we can collectively  create safe and caring environments that nurture wellbeing. A large part of universal prevention can be supported by us if we actively seek and offer safe spaces within systems that we access everyday such as within families, peer groups, schools, workplaces etc.   

Looking at the current situation with the ongoing coronavirus pandemic, it is clear that many are experiencing a high level of distress. Here are a few small steps you can take to take care of your mental health and well being as well as offer safe spaces to others. 

Steps:

• Talk about your feelings 
• Eat well
• Take breaks between activities
• Do something you are good at and/or love doing
• Ask for help/support
• Take care of your body
• Check in on people to see how they are doing
• Express gratitude and appreciation 

Please know that these are only suggestive, and given that each of us is an expert on living our own lives, we may use our discretion based on what works for us. Many of us may also use our own unique ‘jugaads’. Is there anything you do to take care of yourself and others  do tell us in the comments section. 

About the Author

Shahbaan Shah is a  Programme Facilitator at Apni Shala Foundation. In his role, he facilitates social-emotional learning for children, educators, and parents in a variety of settings and supports Research & Development initiatives. He holds a Bachelors in Sociology and is an alumnus of Apni Shala Fellowship.

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