Actress, BSF soldier and IT worker: Depression and anxiety on the minds of many in India

It is not a sight we see very often in the Indian context. I am referring to Deepika Padukone speaking openly about her battle with depression a while ago. “When I was in pain, suffering alone… I was going about my day, posing for cameras… signing autographs. What nobody saw was that I would break down for no reason …getting out of bed was a struggle,” she wrote in Hindustan Times earlier this week. What made a successful actor, the daughter of a badminton world champion, go out on a limb and discuss her struggle to overcome depression? When I was reading about Deepika Padukone’s encounters with mental problems, I was reminded of the virtually unknown RK Shukla.

Unlike Padukone, Shukla never got a chance to face up to his anxieties and survive to tell the tale. Driven to tipping point by workplace stress, the Madhya Pradesh police head constable committed suicide when he was asked to clean drains on Gandhi Jayanti. Two days later, BSF jawan Dharam Singh shot himself with his service rifle at Sukma in Chhattisgarh, a hotbed of Naxalite insurgency. A few months before this, in separate incidents, three other Central Reserve Police Force jawans killed themselves in a similar fashion at camps in Bijapur, Dhamtari and Sukma.

This spate of suicides in the ranks of India’s police and central armed forces reminded me of a statement that BSF director general KK Sharma made during a workshop on mental health a few months ago: More BSF personnel are dying of mental illnesses than in the line of duty, Sharma had said. What is driving this cycle of depression, melancholy and subsequent suicide? In a demanding profession that entails putting in inhumanly long hours along with the responsibility of safeguarding the nation’s frontiers, the added burden of mental illness could prove to be the proverbial last straw that breaks the soldiers’ back.

Our policemen and soldiers are not the only ones fighting the demons in their heads. India has one of the highest prevalence of mental illnesses in the world, and the highest suicide rate among its youth. So, anybody from the IT professional chasing deadlines, the insurance executive struggling to meet stretch targets, the journalist doing graveyard shifts or that teenager glued to the tablet seated next to you in the Metro — could be nurturing a mental health condition. The incidents of depression have become so frequent that you and I could be walking around with what shrinks describe as a “common mental disorder” – what ordinary folks like us call depression and anxiety – and our loved ones might not have an inkling about it. Or perhaps they want to be deluded into believing that nobody in their family needs help from a psychiatrist.

If you think I am being alarmist, take a look at these numbers. According to WHO statistics, more than 58 million people in India are grappling with depressive disorders. Anti-depressant sales in the country have shot through the roof, growing from Rs 760 crore in 2013 to Rs 1,093 crore in 2016. But clearly, just medication is not enough to cure or mitigate a mental health condition. Some of this can be blamed on the gap between those suffering from these conditions and the facilities available to treat them. More than 90% of those suffering from mental health conditions don’t even receive elementary mental healthcare in India. The country has only 0.301 psychiatrists for every 100,000 people suffering from mental illnesses. These are just some of the reasons.

Traditionally the stigma that our society attaches to seeking psychiatric help dissuades most people from visiting mental health practitioners. Among these are parents who often ignore danger signals in their children until it is too late. Speak to counsellors in schools and you realise how even the most progressive professionals are most reluctant when it comes to actually seeing a psychiatrist for their child.

But this seems to be changing, though far too slowly. Many more Indians, particularly the well-travelled ones, appear to be catching up with the West when it comes to seeking help. This generation of Indians wielding smartphones is more open to newer approaches to mental health. This along with greater awareness and the proven efficacy of drugs that help you regulate mood swings have all played a part in helping change mindsets.

The other day I was speaking to a psychiatrist friend, a behavioural science specialist based in Gurugram. The next wave of solutions to overcome the gap between mental health practitioners and the millions suffering from depression in India could come from the Internet itself, he says. Think tele-psychiatry, webinars and anti-suicide helplines: Or being on the couch, virtually. He recalled the case of a 13-year-old from Jammu who called his hospital’s anti-depression helpline to say playing the Blue Whale Challenge was making him suicidal. Within minutes of saying that he had reached a level where he was about to inflict harm on himself, chatting with a counsellor dissuaded the eighth-grader from taking up the next challenge. Within hours, he called back to say he wants the counsellor to speak to his friend as well. Often, a friendly but anonymous voice on the other end of the webcam is all this asocial, net-savvy generation of kids needs to deal with their anxieties.

How invested are we as a nation, in tackling our mental health woes, I asked my friend. He gave me a WHO report. Compared to developed nations that spend more than 4% of their health budget on creating infrastructure for mental healthcare, India’s expenditure is an abysmal 0.06%, less even than Bangladesh (0.44%).

Still, passing the Mental Healthcare Act, 2017 (Act) indicates that the government’s heart is in the right place. Prime Minister Narendra Modi emphasised the need to bring depression out of the closet in his Mann Ki Baat programme. “We (in India) are afraid to talk about it (depression) openly…If depressed, share your feelings with others, it will make you feel better,” he had said.

I tend to agree with the perception that the new mental health Act is a patient-centric piece of legislation. To begin with, it decriminalises the attempt to suicide, bans the use of electric shock therapy for children with mental conditions and sets out to ensure that the dignity of people with mental illness is dealt with sensitively at all stages of treatment. Also, by recognising the “right to access mental healthcare” regardless of a person’s income, gender, sexual orientation, place of living, or any other factor, it puts the onus of providing mental healthcare on the state by January 2018, when the Act is likely to come into force.

For this to happen, the State will have to really push its boundaries. A 2016 study says India has just 40 mental health institutions (of these only nine are equipped to provide treatment for children). Beyond the creation of physical infrastructure, a greater barrier to breach could still be the psychological one. Awareness programmes that dispel prejudices about going to a shrink and the ease with which a mix of medication and counselling can help people keep anxiety at bay, can help.

It is here that a little nudge from public personalities and experts can help. So, when an Anushka Sharma admits she is on medication for anxiety or a Raju Hirani makes a case for dyslexic children in the film Tare Zameen Par, I, like millions of others, can relate to those living with mental conditions. Once we cross the mental barrier, the real fight against problems like depression can begin in right earnest.

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