Monday, April 08, 2019
What India must do to solve its mental health crisis
There is a desperate need for mental health literacy. An ecosystem of care, empathy and inclusion requires involvement of politicians, celebrities, activists, scholars and citizens. Only then can we change the way we address mental illnesses. The conversation must start.
We just don’t know what she went through,” a friend told me when we lost a close friend – who struggled with poor mental health for years – to suicide. This remains one of India’s biggest challenges in addressing mental illness: a general lack of mental health literacy. Mental illnesses – anxiety, depression, Post-traumatic Stress Disorder, Obsessive Compulsive Disorder, bipolar disorder, schizophrenia among many others – are neglected in India.
Today, April 7, marks World Health Day, on which the World Health Organization (WHO) in 2019 is focusing on universal health coverage. India has taken a step in the right direction, specifically towards mental health insurance and through the Mental Health Act, 2017. But why does India rank poorly in treating mental illnesses?
In April 2018, a study titled How India Perceives Mental Health across eight cities with 3,556 respondents provides an insight. It revealed that although 87% of the respondents were aware of mental illnesses, 71% used terms associated with stigma - “stupid”, “mad”, “crazy” and even “retard” – to describe mental illnesses. Recently, politician Akhilesh Yadav was criticised for calling the BJP “schizophrenic”.
In a comprehensive piece titled “Generation Stress” in Foreign Affairs, Sylvia Mathews Burwell looked at three factors behind the mental health crisis on American college campuses. These factors intersect in a country with a complex socio-cultural setup like ours. They are: safety, economics and technology.
Examining the factors:
Safety: In India there are two cohorts which greatly lack safety: gender and certain castes. While India is making strides towards inclusion, it is time to push the boundaries. It should start with the recognition that depression is more common in women than in men (World Mental Health report, WHO). But gender isn’t just about women. India celebrated the historic Supreme Court verdict decriminalising homosexuality. But questions of equal opportunity and social inclusion remained. The civil rights of the LGBTQ+ community continue to be limited. Caste further exacerbates the problem. “The pervasive socioeconomic exclusion faced by the LGBTIQA+ community in intersection with caste, class and gender sets up a structural baseline of insecurity. Social exclusion, shaming and abuse can constitute serious blows to one’s mental health”, said Karthik Bittu Kondaiah, a trans-activist and scientist. Gender and caste determine access and opportunity, and therefore, one’s place in society. Lower castes face intergenerational trauma through social exclusion, oppression and negative stereotyping, leading to poor mental health and stigma.
Economics: In many low-to-middle income countries, there are many hurdles in the way of upward mobility. This is especially true for India, with a vast rural-urban divide, a growing unorganised sector and little to no dignity of labour. Writing for The Hindu in October 2018, Jacob Koshy and Bindu Shajan Perapaddan observe that the rural youth’s mental health is most neglected. Interestingly, since villages are more community-oriented than cities, the environment is more conducive to address such issues. However, India’s dismal ratio of one psychiatrist per every 100,000 persons (National Mental Health Survey, 2015-16) proves that even if there is access, options for professional intervention are severely limited and unaffordable. Dr Purnima Nagaraja, a therapist and psychiatrist, believes that people need to move away from an “anti-psychiatry” attitude and seek help. “But due to entrenched patriarchy, vulnerable groups, such as women and children, are often deemed to be overreacting or seeking attention. There is no support system for women since it involves time and money, causing them to believe that they’re a burden on the family.”
Technology: Over-dependence on technology has been shown to be harmful to the mind. A study by Amy L Gonzales (Cornell University) proves technology helps social diversification. It pushes disadvantaged communities to virtual conversations which they would otherwise prefer not to have. Technology can push people into categories of haves and have-nots, but can serve as a problem and a solution. Dr Rajneesh Choubisa, an assistant professor at BITS Pilani, who works on technology and wellbeing believes that “technical and digital literacy” can help spread awareness. “We can solve issues through carefully-crafted interventions to rationalise and control the problem.” For instance, since viral content registers and plays up in one’s psyche, positive content on mental health can trigger a change in attitudes.
India’s Mental Healthcare Act (2017) provides, protects, promotes and fulfils the rights of persons with mental illnesses. The Mariwala Health Initiative, Bridge the Care Gap wants to prioritise mental health in policymaking. “As political parties are currently working on their manifestos, this is the right time to intervene and make a difference in the lives of millions of people affected by psychosocial disabilities”, Harsh Mariwala, chairman of Marico says on their website. While this move is welcome, policy alone won’t work. There is a need for mental health literacy. An ecosystem of care, empathy and inclusion requires involvement of politicians, celebrities, activists, scholars and citizens. Only then can we change the way we address mental illnesses. The conversation must start. “The conversation is slowly beginning, both in rural and urban India. But once help-seeking behaviours change, that is, when people start to look at mental illnesses the way they would their physical health and destigmatise it by asking for help, we can move from conversation to treatment”, Dr Purnima adds.
As the first director-general of the WHO, Brock Chisholm declared in 1954, “Without mental health there can be no true physical health.” So, even though Mental Health awareness has its own day (October 10), it’s important to keep the two together.
Source: Hindustan Times, 7/04/2019
Instruments Of Bhakti
Bhakti is the Hindu concept of supreme love and devotion to the Divine, one of the popular ways of achieving salvation. Translated in Jewish, bhakti connotes the idea and practice of undivided dedication to a single universal Creator of all life and things in the unbounded universe. To be meaningful, dedication has to be expressed in thought, word and deed. In Judaism, the core of prayer is the Amidah or silent prayer, which consists of deep meditation and thanksgiving for the gift of life and all its benefits. Bhaktas express a constant feeling of reverent gratitude for the joy and blessings of life that the Almighty has bestowed upon us. Among Jews, the Hasidim — the pious ones — are those who devote their lives to deeds of charity and strict observance of traditional precepts. The system of Hasidim stresses the virtues of serving the Lord with gladness and singing and of prayerful devotion. It emphasises the importance of ecstatic prayers, humility, cheerful optimism, communion with God and love of fellow creatures. The Shema — the central Jewish prayer proclaiming the Unity of God and the oneness of Creation — is recited with the right hand covering closed eyes, so that attention is closely concentrated on the sublime thought it embodies. The basis of prayer is that man can communicate with his Maker, a personal God who can be sought, found and moved with human entreaty
Source: Economic Times, 8/04/2019
Friday, April 05, 2019
Antyajaa: Indian Journal of Women and Social Change: Table of Contents
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First Published October 30, 2018; pp. vii–viii
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Articles
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First Published October 30, 2018; pp. 147–162
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First Published October 30, 2018; pp. 163–180
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First Published October 30, 2018; pp. 181–193
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First Published October 30, 2018; pp. 194–206
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First Published October 30, 2018; pp. 207–217
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First Published October 30, 2018; pp. 218–229
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Interrogating culture
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First Published October 30, 2018; pp. 230–239
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Photo Essay
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First Published October 30, 2018; pp. 240–248
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Making sense of NYAY
It is best read as a political promise for social security. There is more than one way of redeeming it
Written by Jean Drèze |
Guaranteed minimum income is a powerful idea that has already made some headway in various countries. Some European countries, for instance, guarantee a minimum income to their citizens. This requires extensive data collection as well as an effective cadre of welfare officers and social workers tasked with enquiring into the circumstances of people who claim to need income support.
It would be nice if India could achieve something similar, but the obstacles are daunting. Starting with the financial burden, a recent brief of the World Inequality Lab by Nitin Bharti and Lucas Chancel presents some useful figures. The authors essentially estimate the “minimum-income gap”, that is, the gap between minimum income and actual income summed over all households with actual income below the minimum. With a minimum income of Rs 72,000 per year, the gap turns out to be 1.3 per cent of GDP. This information is helpful, but it does not tell us much about what it would cost to guarantee a minimum income of Rs 72,000 per year to everyone. All it says is that if this could be done through perfectly targeted and costless top-up transfers, it would cost 1.3 per cent of GDP.
In an earlier avatar, the Congress party’s minimum income guarantee (MIG) proposal was based on this sort of top-up model. The idea was that the government would simply fill the gap — if any — between minimum income and actual income, household-wise. This is impractical, if only because it requires household-specific income data that are virtually impossible to collect, at least for now. It also creates obvious incentive problems. One possible response is that the basis for calculation of the gap should not be actual income but some sort of “imputed income” — an estimate of what a household is expected to earn based on observable characteristics such as education and land ownership. Imputed-income estimates, however, are bound to lack precision, leading to large inclusion and exclusion errors.
For these or other reasons, the top-up formula was dropped and NYAY was announced: Uniform cash transfers of Rs 72,000 per year, equivalent to Rs 6,000 per month, to the poorest 20 per cent households — about 50 crore households based on 2011 census data. Initially, an impression was created that NYAY “guaranteed” Rs 12,000 per month, because most households earn at least Rs 6,000 on their own, but this is incorrect. In fact, Bharti and Chancel estimate that 33 per cent of households earned less than Rs 6,000 per month in 2011-12, and the corresponding proportion today may not be much lower. In short, NYAY is a targeted cash-transfer scheme that guarantees Rs 6,000 per month to the recipients — nothing more, nothing less. It can also be thought of as a massive non-contributory pension scheme.
Naturally, the NYAY proposal is more expensive than the top-up formula. It requires Rs 360,000 crore per year, or close to 2 per cent of today’s GDP. If NYAY is rolled out over five years, and India’s real GDP continues to grow at 7 per cent per year or so, the cost will be around 1.4 per cent of GDP at its peak. If that really goes to the poorest households, NYAY would seem like a good idea. How the NYAY recipients are to be identified, however, is an unresolved puzzle.
Identifying the poor used to be the main purpose of the so-called “below poverty line” (BPL) surveys. The record of BPL surveys, however, is dismal: Three national surveys suggest that about half of all poor households in rural India did not have a BPL card in 2004-5. In recent years, for the purpose of identifying the recipients of food subsidies under the National Food Security Act, some states have adopted a different approach, known as the “exclusion approach”. In this approach, well-off households are excluded using simple and transparent criteria, and everyone else is eligible by default. This approach seems to work much better than the BPL surveys, but mainly when the proportion of households to be excluded is relatively low — say 20 or 25 per cent. Excluding 80 per cent, as NYAY requires, is another matter.
The targeting problem is all the more serious as the income transfers being proposed under NYAY are much larger than anything ever delivered to BPL households. Shocking as it may sound, Rs 6,000 per month is the sort of salary that many informal-sector workers earn in the poorer states — say chowkidars or domestic workers. People struggle, bribe, cheat and fight for this sort of job. Selecting 20 per cent of households for an unconditional monthly pension of Rs 6,000 is likely to be a chaotic exercise.
Perhaps the way forward is to read NYAY as a political commitment to a massive pension scheme, equivalent to cash transfers of Rs 6,000 per month to the poorest 20 per cent households, and explore possible variants of this formula. To illustrate, one possible variant would involve individual pensions of Rs 1,200 per month for 25 crore persons, instead of Rs 6,000 per month for 5 crore households. The NYAY pensioners could include all elderly persons, single women and disabled persons who do not meet well-specified exclusion criteria. That would add up to something like 12 crore persons, leaving substantial room for other vulnerable categories. This would not be perfect, but it would have a chance to work at least.
Other variants are also possible, for instance a mix of household and individual pensions. Politicians need simple slogans, and “Rs 72,000 per year for the poorest 20 per cent” serves that purpose, but it is important not to let this slogan shut the door to other ways of redeeming the political commitment underlying the NYAY proposal.
The writer is visiting professor at the Department of Economics, Ranchi University
Source:Indian Express, 5/04/2019
Death is Not the End
Life is a series of successive states of consciousness with a common thread running through them. Death is visibly a psychophysical disintegration but it cannot reduce our existence to a dead end; rather, it opens a different state of consciousness no longer circumscribed by the limitations of the body-mind complex. At the macro level, consciousness is considered to be the ultimate existence, the Being from which everything else postulates, as has been surmised in quantum physics today. The fundamental question on the working of consciousness after physical death has reached the domain of neurophysiology, cardiology and quantum physics from eastern spirituality, especially Tibetan Buddhism. Extensive neuropsychological research on patients with neardeath experience has shown that they experience an expanding consciousness while their brains register no activity at all. A majority think a hundred times faster with greater clarity than is humanly possible. They go back to their childhood days and experience an intense connection with everything and everyone around them instantly or before. It is now empirically proved that people can think and feel when they are clinically unconscious due to acute pancerebral ischemia. Death, therefore, cannot mean the end of consciousness. Consciousness is separate from body and it survives beyond death. During our waking state, consciousness is limited to psychological reality, but after death, the waking consciousness is exposed to many more realities.
Source: Economic Times, 5/04/2019
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