This article presents information about the psychological health of India after rapid economic and social changes during the last decade. A mental health crisis, with major focus on a very disturbing trend of suicides throughout the country, especially among students and farmers is highlighted. A social and public health response to the psychological problems of the masses is described as inadequate and limited only to problems relating to psychosis, while problems relating to neurosis are simply ignored. Author’s efforts as Fulbright-Nehru senior research scholar to launch mental health movement in India through establishing Association of Mental Health Counsellors and Post Graduate Diploma in Mental Health Counselling at the Guru Nanak Dev University Amritsar are described for others to follow.
Problems do not go away. They must be worked through or else they remain, forever a barrier to the growth and development of the spirit.
M. Scott Peck
We can't stop the waves, but we can learn to surf.
Jonathan Kabat-Zinn
Upon the cusp of the new millennium, it is encouraging to see India emerging as one of the leading economic powers of the world. Remarkable performance in manufacturing and professional services has provided a great economic impetus to help India join the galaxy of the strongest economies of the world. Clearly, there are many indicators of economic progress all around the major urban places. Some of the rural areas are also witnessing positive economic changes. According to the Reserve Bank of India (RBI), real per capita gross domestic product (GDP) in India has grown steadily for last ten years and it is hoped that in 2011, GDP will grow at least 8.6 percent.
A person returning to India after ten years will definitely be shocked with pleasant surprises of life style changes and economic prosperity. New roads, new constructions everywhere, new restaurants, e.g. McDonald, Kentucky Fried Chicken, Pizza Hut, etc. makes one wonder whether he or she is in India or in the United States. While economic progress is a welcome news, unfortunately it does not portray the complete picture of a nation’s health. The mental health, the emotional strength, and psychological well-being of the citizens cannot be ignored at the expense of economic gains. At the core of economic advances, lies an agenda of transforming the society to become more psychological healthy, spiritually sublime, and above all more humanitarian, egalitarian, and a just society.
If the economic gains widen the barriers among the rich and the poor and disregard people’s mental health and cause marginalization through inequities, there is a stunning warning to re-examine the lopsided economic progress. People are rich not only because they possess economic resources but also because they are psychologically and mentally healthy and enjoy fulfilling lives.
Mental Health Crisis in India: Scope of the Problem
As a part of the economic and social changes in India due to rapid industrialization and urbanization, people are experiencing significant multiple stressors in their lives, caused by social and cultural upheaval. Some of these stressors are causing some very serious mental health concerns including, clinical depression, anxiety, mental stress, marital discords, domestic violence, and serious alcoholism and substance abuse problems. Naturally, several psychosomatic and physical health problems develop such as hypertension, cirrhosis of the liver, heart problems, psycho-social phobias.
During my most recent visit to India in spring 2010 as Fulbright-Senior research scholar, I noticed with sadness a high rate of mental disturbances behind the soaring economic gains. The National Mental Health Programme estimates at least 30 million people in India in dire need of mental health services. The elderly, women, migrants, refugees, street children and newly coming out of the shadows gays and lesbian populations are particularly vulnerable.
Severity of the Mental Health Problems
If suicide is an ultimate indicator of psychological distress and psychopathology, it sends a stunning warning that something is seriously wrong with the psychological health of India. Vijayakumar [6] the founder SNEHA, a non-government organization to combat suicides at Chennai, pointed out that suicide rate has increased in India by 43% during the last three decades. As 71% of suicides in India are committed by young persons below the age of 44 years, the scourge of suicides imposes a huge emotional, social, and economic burden on the Indian society. A very worrisome trend of escalation of suicides in the states of Sikkim and Pondicherry with 48.2 and 46.9 per lakh respectively, prompted Sandhu to declare India as the suicide capital of the world, available at, (http://ipsnews.net/news.asp?idnews=54057).
At this time, there is clearly a mental health crisis in India when hardly any day goes by when there is no news about suicides. While I was in India from January, 2010 to June, 2010, I was troubled to read headline news almost on a daily basis about students, farmers, and housewives hanging themselves, jumping before trains, taking poison, and committing self-immolation
In a recent article published in Times of India, Sinha [1] reported that every year, 1.25 lakhs people succeed in ending their own lives from an estimated 5 million suicide attempts. I believe that at least ten times more Indians have suicide ideations. A meta-analysis of several published studies reveals that suicide prone behaviors among the Indian masses are much more pervasive than officially reported for the fear of litigations, shame, and guilt upon failed suicide attempts.
The Union Health and Family Welfare Minister Ghulam Nabi Azad, portrayed a very dismal but an accurate picture that described the overall status of the mental health status of India as follows,
“In India, at a given point of time, nearly 15 million people suffer from serious psychiatric illness, and another 30 million from mild/moderate psychiatric problems… According to the NIMHANS estimates, we have a burden of nearly 100 million people with neuropsychiatric and substance abuse problems” [2].
Of course, these figures are limited only to severe psychiatric problems relating to psychosis. The number of mental health problems relating to neurosis are way too high. I believe that every tenth person in India faces a mental health challenge. Thus, number of people suffering from psychological problems in India is more than 100 million. It seems to me that the mood disorders among the masses are quite prevalent and salient among all other mental health problems.
Nature and Causes of the Mental Health Problems in India
After conducting in-depth focus group interviews with 12 different groups, each group consisting of eight participants (N=96), I identified six major categories of mental health problems in India. These main categories included, psychosomatic disorders; drugs and alcohol abuse; domestic violence; inter-generational conflicts; mood disorders and mood swings; superstitions problems relating to black magic, supernatural forces, and witchcraft. Disturbed interpersonal relationships, physical and mental illness, mental depression, academic stress, and economic difficulties seem to be the major leading reasons for suicide contemplations and completions.
At present, students and farmers are special populations at risk to commit suicides. Starting from 1997 until now, more than 200,000 poor farmers have committed suicides in India because of painful debts and despairs. When these farmers faced the tough decision of losing their land because of costly fertilizers and seeds, they chose to drink the same pesticides which were purchased to save their crops from the insecticides. In India, on an average, one farmer committed suicide every 32 minutes.
On May 6, 2008, the Indian Health Ministry (IHM)[4] reported more than 16,000 suicidal deaths of college age students within previous three years. The tremendous parental pressure to excel in academics, combined with unfulfilled relationship and substance abuse has caused havoc for this population. On an average, 125 persons below 29 years of age are committing suicide on a daily basis in India. Among these persons, at least 51 per cent are graduate or college students. In many cases, these students commit suicide after failing their exams or when they do not get admission to the colleges of their choice.
Most of India’s Problems Start with Letter “P”
Furthermore, it is interesting to note that most of India’s problems start with letter “p” such as population, prejudice, pollution, and poverty [3]. These problems are perpetuating and permanent in nature. In addition, there are some non-permanent or temporary and sometime problems which include police, politicians, preachers and Pakistan.
Most of these problems are at the societal level but they do have the real potential to add to the mental health afflictions or emotional problems of the individuals at the personal level. For instance, all p problems mentioned earlier, could create, aggravate or exacerbate mental depression, stress, anxiety, fear, and suicide ideations.
Without a doubt, there is truly a mental health crisis in India. Lack of availability and access to trained professionals, are making things worse. To cope with the psychological and mental health challenges of life, a large number of people visit priests, spiritual healers, mystics, and indigenous practitioners as the field of mental health counselling is still at a very initial stage.
Indian Government’s Response to the Mental Health Problems
The District Mental Health Programme (DMHP), is a flagship initiative of Indian Government to help people cope with their mental health problems. The DMHP is designed to integrate mental health services into primary health care and is presently implemented in 125 districts. A budgetary allocation of Rs. 28 crore was made during the Ninth Plan for the National Mental Health Programme.
The India Mental Health Act of 1987
It is commendable that in response to growing psychological problems in the country, the Government of India drafted Mental Health Act of 1987 which came into effect in all states, including the union territories, in April 1993. While I applaud Government of India’s efforts, but Mental Health Act of 1987 is limited only to the treatment and care of mentally ill persons who suffer specifically from diseases such as schizophrenia, bipolar and obsessive- compulsive disorders. Most of these problems are psychiatric problems, generally caused by the psychosis. The India Mental Health Act of 1987 is beneficial only at laying down guidelines for establishment and maintenance of psychiatric hospitals and nursing homes.
As pointed out earlier, Indian Mental Health Act of 1987 is limited in scope and services that precludes persons who suffer from numerous other mental health problems such suicide ideations, alcoholism and substance abuse problems, family, and community violence, anxiety and stress disorders, to name a few. Unfortunately, all these unresolved psychological problems become the underlying reasons for many untold numbers of suicides, homicides, family and marital difficulties, school-related problems, and workplace incompetence and violence.
While Indian Mental Health Act 1987 and the District Mental Health Programme (DMHP) are applauded which focus mainly on psychiatric services in hospitals and institutions, regrettably they do not address issues relating to psychological mental health of the masses.
An Urgent Need for Mental Health Counselling
Historically in the past, psychological problems were resolved within the family. But now extended family system is eroding fast, resulting in very little guidance and psychological help from the elders of the family. In addition, current mental health challenges are tremendous both in urban and rural areas of India which need specialized mental health training in personal, interpersonal, and intrapersonal issues. These psychological problems are really beyond the training and competence of the elderly who lack knowledge and skills to deal with serious problems of clinical depression, psychosocial stressors, anxiety, addictive behaviors, marital dissatisfaction, obesity, eating and sleeping disorders, to name a few.
An Acute Shortage of Mental Health Professionals in India
There is an acute shortage of trained mental health professionals in India, a country of 1.2 billion people [5]. There are only 37 mental health institutions, 3500 psychiatrists, 1000 clinical psychologists to serve such a huge population. Most recently, it was reported by the Indian Government that there is only 1 psychiatrist for every 400,000 people. It is one of the lowest ratios anywhere in the world. A country like the United States has 64 psychiatrists for every 400,000 persons.
I strongly believe that there is an urgent and immediate need of trained mental health care professionals and counseling facilities such as university and community mental health counseling centers to help people of India to meet their guidance and counselling needs. It is important to note that all p-problems of India, such as population, poverty, prejudice, etc. are amenable to professional counselling to alleviate psychological pains of millions people in India.
Historic Beginning of Mental Health Counselling in India
Keeping in mind the current mental health crisis in India, I strongly believed that a mental health movement all across India should be launched immediately. This was my immediate call for an urgent action during my affiliation with the Guru Nanak Dev University Amritsar as the Fulbright-Nehru Senior Research Scholar.
As depression is looming large, suicide attempts and completions are escalating, and Indian society is afflicted with numerous other mental health problems such as domestic violence, alcohol and substance abuse, child and sexual abuse, suicides, homicides, etc., it is high time that mental health counselling is afforded to our citizens by the trained mental health professionals.
I also believed that establishing the Association of Mental Health Counsellors (AMHC) was the first step in this direction. It was proposed that specialized degree or diploma programs in mental health counselling are instituted in all Indian universities to train mental health professionals to meet the current crisis. There is a dire need for both Government and Non-Government (NGOS) agencies to work together to provide mental health awareness and mental health help in all urban and rural communities. Generally, many people go to a medical doctor for tension headaches and upset stomach for medicines, but they do not consult a mental health professional for mental stress which could be the underlying reason for their problem.
While psychiatric services are medically required for psychiatric patients, Mental Health Counselling Services are urgently and increasingly needed for psychological problems. Mental Health Counselling (MHC) is mostly based on the psycho-educational model that emphasizes prevention in addition to treatment. If needed, it also readily employs traditional medical strategies for diagnosis and assessment. Thus, mental health counseling’s (MHC) holistic approach could be quite effective to yield desired results. In the spirit of preventing and addressing mental health problems throughout India, I as Fulbright-Nehru Senior Research Scholar at the Guru Nanak Dev University with the collaborative efforts of the United States-India Educational Foundation in New Delhi (USIEF) and Psychology Department under the chairmanship of Dr. Navdeep Singh Tung, took an important initiative on May 4, 2010 to start the Association of Mental Health Counsellors to combat mental health problems in India. Also, with the encouragement and financial support of Vice-Chancellor, Dr. Ajaib Singh Brar, a post-graduate diploma in mental health counselling has already started at Guru Nanak Dev University in July 2010.
The very first organizing committee meeting of the scholars from all around India was held at the Guru Nanak Dev University Amritsar from May 2-5, 2010. On May 4, the resolution was passed to start the Association of Mental Health Counselors. Seveal officers were elected to run the work of the AMHC smoothly.
In Figure 2 From left to right: Showkat Ahmad Shah (Joint Secretary) Ashum Gupta( Vice President), Suninder Tung (President) Daya Singh Sandhu (Executive Director) Anup Sud (Secretary and Rajinder Kaur( Treasurer) and
Figure 1: Dr. Daya Singh Sandhu at the first organizing committee meeting of AMHC
Figure 2: A picture of the elected officials of the Association of Mental Health Counsellors is presented here
Curriculum for Post Graduate Diploma in Mental Health Counselling.
In an effort to train mental health counselling professionals, the Post Graduate Diploma in Mental Health Counselling was started at the Guru Nanak Dev University effective July, 2010. Through highly selective process, only nine students were enrolled in this post graduate diploma programme. In 2011, this number of enrollees is increased to 16.
Mental health counselling is considered a distinct profession with national standards for education, training and clinical practice. Mental health counsellors are highly-skilled professionals who can provide dynamic and effective counselling for the beneficial change of their clients.
In order to train mental health professionals at par excellence, several graduate courses are offered in the post graduate diploma program. These courses include, Introduction to mental health counselling; Theories and techniques of mental health counselling; Group processes and procedures; Assessment methods for mental health counselors; Career development counselling; Marriage and family counselling; Spirituality in mental health counselling; Addiction counselling; Crisis counselling; and Internship in mental health counselling [6].
I am hoping that there will be a rapid growth in the field of mental health counselling through which many vistas for educators, trainers, and practitioners will be opened in India. Most importantly, people will benefit from the services of the trained professionals. These skilled professionals will be held accountable for the outcome of their therapeutic services. Of course, it will be a tremendous effort to address the mental health concerns of the huge population of India. It is truly a monumental task.
My Mission
My mission to establish the Association of Mental Health Counsellors in India is to enhance Indian Mental Health Act of 1987 to provide professional services to address psychological problems. I sincerely hope that through mental health services the psychological well-being and the life satisfaction of many people will increase in India. I would also like to expand the profession of mental health counselling in India through education, professional development, research, advocacy, and licensing.
My Vision
I am hoping that mental health counseling in India would gain momentum fast and become a fully recognized and a well-established profession. As we have already established and officially registered the Association of Mental Health Counsellors (AMHC), my next step is to start chapters of AMHC in all states of India that follow consistent standards of education and training and ethics. I would also like to vision strong support and advocacy from both government and non-government agencies to make mental health movement in India a success story. For brevity’s sake, some of the main purposes of this project are listed as follows:
Association of Mental Health Counsellors
Guru Nanak Dev University Amritsar
Plans to Address Mental Health Issues in India
Here are some other ideas that I would personally like to implement to address mental health challenges in India:
To organize resources from psychiatrists and other interested persons residing in USA and other countries to help AMHC.
Sinha, K. “Imbalanced Equation: One Shrink for 4-Lakh Indians.” The Times of India, 10 Apr. 2010, indians/articleshow/5781527.cms.
Sinha, K. “Suicides Rising Due to Mental Health Disorders.” The Times of India, 10 Apr. 2010, disorders/articleshow/5781172.cms.
Sandhu, D.S. “An Ecstatic Visit to a Land of Contrasts and Contradictions.” Beyond Boundaries: Reflections of Indian and U.S. Scholars, edited by Z. Usmani and N. K. Ghosh, Universe, 2007, pp. 547–560.
Indian Health Ministry. “More than 16,000 Student Suicides in the Past Three Years.” Providential, 6 May 2008, http://ww/drvitteli.typepad.com/providential/2008/05/16000-sudents.html.
Barua, A. “Need for a Realistic Mental Health Programme in India.” Indian Journal of Psychological Medicine, vol. 31, 2009, pp. 48–49.
Vijayakumar, L. “Indian Research on Suicide.” Indian Journal of Psychiatry, vol. 52, 2010, pp. 291–296.
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