Mental Health in Poor Communities
Home to over 17% of the world’s population, India is a poor country with 1.24 billion people. Nearly 42% of the population of India lives below the poverty line, and 35% lives on less than $1 per day.
Sociologist offers two definitions of poverty-
- Absolute poverty
- Relative poverty
Absolute poverty refers to lack of basic necessities such as food, shelter and income. Relative poverty refers to a situation in which some people fail to achieve the average income or lifestyle enjoyed by the rest of the society (M.U. Quareshi, 2004).
In addition to high rates of poverty, there are wide disparities in the distribution of wealth and health between the rich and the poor. Important indicators, such as the infant mortality rate (IMR) and having an institutional delivery, highlight these wide disparities.
Among the poorest wealth quintile in India, the IMR is near 82 per 1,000 live births, yet only 34 infants in 1,000 live births die in the richest quintile, where pregnant women are six times more likely to deliver in an institution. The private sector, the largest segment of the country, accounts for 58% of India’s hospitals and 81% of its doctors.
The attitude towards mental health and understanding it per se is very blurry and even so in poorer communities.
The Chart shows the attitude of people towards Mental Illness:
The next chart shows the attitude of people towards the mentally ill patients:
The relationship between poor mental health and the experience of poverty and deprivation has been well studied and an association between the two factors has been established (Kuruvilla & Jacob, 2007). Lund, Breen et all conducted a systematic review of the epidemiological literature in Low and Middle Income Countries (LMIC), with the aim of examining relationship between poverty and common mental disorders. Of 115 studies that were reviewed, most reported positive associations between a range of poverty indicators and CMD (Lund et al., 2010).
Poor mental health linked to severe mental disorders has been associated with poverty during the recent economic crisis in middle-income and low-income countries, particularly India and China (Chatterjee, 2009; Kuruvilla & Jacob, 2007; Li, Pang, Du, Chen, & Zheng, 2012).
The poor suffer worse health and die younger. They have higher than average child and maternal mortality, higher levels of disease, more limited access to health care and social protection, and gender inequality disadvantages further the health of poor women and girls. For poor people especially, health is also a crucially important economic asset. Their livelihoods depend on it. When a poor or socially vulnerable person becomes ill or injured, the entire household can become trapped in a downward spiral of lost income and high health care costs.
The World Bank report clearly shows that India’s OOP health expenditure, which is 89.2%, is a significant barrier to healthcare utilization. Due to the lack of financial protection, approximately 20-28% of diseases in India remain untreated. Nearly 39 million people in India become impoverished every year due to high OOP health expenditures and only 11% of India’s population is protected by any form of health insurance.
India is undergoing a period of epidemiological transition with 53% of deaths and 44% of DALYs lost attributable to non-communicable diseases including mental health conditions.
The National Mental Health Program mainly focused on severe mental disorders, but CMDs were not prioritized. Even after mental health was prioritized under the GOI’s Twelfth Five-Year Plan, no specific plans for addressing CMDs and poverty were established. Access to healthcare facilities and financial protection mechanisms are necessary to dismantle poverty and treat CMDs.
Access is affected by the lack of mental health workers and financial barriers. India has only 3500 psychiatrists (75% of which are located in urban areas), and needs 9000 psychiatric nurses and 1600 social workers. The Medical Council of India is taking steps to increase the mental health manpower, but those steps are in nascent phases.
Most CMDs could be treated as outpatients, but the National Health Insurance Program for the indigent, Rashtriya Swasthiya Bima Yojana (RSBY), provides financial coverage only for hospitalizations and does not cover any outpatient services. Given the high OOP healthcare costs related to CMDs, this causes significant access barriers. Many psychological and pharmacological interventions to reduce CMDs have been proven to be effective and cost-effective, but they still have not been adopted by national policy-makers. Poverty alleviation through the provision of micro-credit using self-help groups are done in some parts of India.
With 23,391 PHC centres and 145,894 sub-centres, India has an extensive public health infrastructure.
Integrating the treatment of CMDs into the routine PHC has good outcomes.51-54 The World Health Organization (WHO) recommends that effective mental healthcare can be provided at the PHC level if the country has a well-functioning PHC system. WHO recommends that specialists supervise PHC physicians wherever possible.
With high levels of poverty, high OOP costs of private healthcare expenditures, low public health expenditures, poor facilities, and shortage of manpower for mental healthcare, the GOI should allocate more resources to improving access to mental health and take appropriate poverty alleviation measures.
The relationship between poverty and mental health can be explored under various headings.
The economic burden for psychiatric disorders: The existence of mental health problems results in huge financial burden on individuals, their families and society as a whole. In India, mental health is not prioritized in the community and the family, thus it is the role of the government to make it a priority. Helping people with mental illness is vital irrespective of the background- for protecting human rights.
