The State of Mental Health in India

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hello everyone

my name is satha janan and i’m the

curator of tedx bangalore

the coronavirus has altered life as we

know it across the planet

but as you can imagine there are many

india’s living in india

and the true impact of covet 19 has been

felt differently

based on income levels age gender cost

and a whole host of other qualifiers

in today’s conversation we’re joined by

manoj chandran ceo

of white swan foundation to understand

how a billion indians are living with a

fragile critical mental

healthcare ecosystem this may be india’s

achilles heel when it comes to covet 19.

so let’s try to understand the multiple

realities playing out in india as well

as

what can we possibly do about it both at

a personal as well as a systemic level

thanks so much manoj for choosing to

join us today um

could you tell us a little bit more

about the white swan foundation what’s

it all about

thank you sartaj and thanks for the

having me here for the program

and so to begin with white swan

foundation is a not-for-profit

organization

that was created with the objective of

delivering

knowledge services for mental health and

well-being

now in mental health care what we saw

when we started

our life seven years ago was that of of

all the problems and challenges that we

have seen are evident in mental health

care

the most fundamental was lack of access

to knowledge

which was uh in many ways not empowering

people to be able to make right

decisions

when i say people people would be across

all profiles people with the problem

uh their caregivers and the bystanders

also and when they were not empowered to

make the right decisions

we said how can we do that how do we

change the whole community there

bring in about a system exchange throw

knowledge so that they know that okay

this is how i decide how

i make decision based on the profile

that i carry around mental health care

so it’s been now seven years and we have

by

created by far the largest knowledge

knowledge repository on mental health

in india and we do a lot of community

outreach programs across communities

um we’ve done that for a little bit for

mental health care workers

we’ve done a lot with college students

and we currently focus a lot on

school teachers and workplace mental

health

and the third part of our work is the

mass communications

programs because as i pointed out the

most powerful

element or stakeholder in mental health

care is a bystander

they have a view on the subject and

their view is not necessarily always

very positive and inclusive

so mass communication program of white

swan foundation is to engage the

common man the community people uh into

the fold of mental health care and get

them to

have a very different mindset and uh the

empathy around people with mental health

you are you are sensitizing

the the general public so that the the

stigma probably that they used to carry

or they inherited probably from previous

generations is

is eliminated um so with that

world view and with that position that

you’re occupying at least the indian

ecosystem what is the state of mental

health care in india today

you know we’ve been going through the

pandemic it’s it’s quite more complex

now

so what is what what would you say where

where do we stand sure

sir we’ll have to look at answering that

question from different perspectives to

begin with uh

the fact remains that there is a huge

prevalence of mental health issues so

the

data that is always thrown at us is that

one in five of us

will have a mental health issue in our

lifetime now that’s a sizable number if

you look at an indian

context it will be 300 million people

and so the

the problem is large then the on the

other hand we have this whole

narrative that the number of men

professionals in mental health care is

abysmally low

and we will we need to ramp up our

service infrastructure

now that certainly is a requirement but

that probably is not the only solution

and we can’t look at solving the problem

of mental health care by only

ramping up the of the service

infrastructure and wait for that to

happen

so uh so that’s the other perspective to

it the third more powerful according to

me

is the social context to mental health

care which is about

how much again how much are we allowing

people

with the problem to open up and seek

help and

create an environment for them which is

inclusive which is more empathic

now so are we therefore targeting to

change the social narrative

the social construct around mental

health care

now we have to look at all these three

aspects to be able to come up with

innovative solutions to the problems of

mental health care

yeah so allyship you know we’ve seen it

play out in the lgbtq community in

in pwds and lots of other spaces

how is that a for example for viewers

who don’t know and even mike is

how does allyship manifest in the mental

health space is there a

is there an organization are there uh

neighborhood communities how how does

this

great point great point so we we often

get into discussions

on this subject and this is so important

because at the root of solving any

problem in mental health care

sartaj i think it is about creating a

world where everyone is a mental health

ally

and you know the moment the reason is

because the moment i know i have a view

on mental health and i have an attitude

towards somebody who has a mental health

issue

i am a stakeholder of maintenance yeah

now am i a positive

am i carrying a positive or constructive

view there i’m a

constructive stakeholder there or an

ally there there are two

very broad very basic ingredients

required to be an ally

one is empathy and i have seen this that

empathy does not get executed if you

don’t have the right knowledge

yeah many a time and when most of the

time when i am discussing having

sessions with or

conversations with people they will say

that i have a colleague who has had a

mental health issue but i don’t know how

to approach the person

i don’t know what to speak how to

communicate to the person

so i i’m actually you know by nature

empathic

but i don’t know how to demonstrate that

empathy i need to know therefore

first is to permit yourself to say that

i want to be a mental health ally now

let me pick up the right knowledge

to say that what does it mean what is

the objective of me being an ally

or me deciding to do something for my

colleague or my family member or my

neighbor who may probably demonstrate

some emotional distress

the moment i have begun to pick up the

right knowledge white swan foundation

is just the right place because they

have i mean we have huge amount of

content and

information about being an ally about

knowing what is the objective

of your action and what is that the

person with the problem

expecting of you as an ally yeah this is

what is the

what is required yeah allyship is

sometimes uncomfortable

because you’re forced to occupy a

position where you don’t have all the

answers but you still need to be present

for the other person second it is a role

of service leadership

i think you know this this touches upon

a big topic we’ve

broadly seen that a lot of mental health

is this loss of sense of control

you feel that you are no longer in

control of your own life

your own thoughts your own situation and

that that helplessness

uh often emerges internally

um allyship is one way uh access to

mental healthcare professionals is

another way what else can people do in

this current context especially of

because we never know when we could have

another lockdown or a

situation like that is there something

people can do to regain that sense of

control

from maybe a self-care perspective yes

so uh

while we spoke until now about mental

health from

a curative perspective which means that

if there is a person who has a problem

what can be done that the person reaches

out and seeks professional help

there is certainly a preventive element

to mental health care

mental health issues and

this is extremely important i would say

from in indian perspective

and countries like india which has huge

shortfall of

professionals and service infrastructure

because if you really have to solve the

problem

we have to probably also equally focus

on not allowing the problem to become

big yeah

which is about getting people to

understand the importance of preventive

steps towards mental health care so i

think it is important for

communities at every level from a family

unit

to organizations and any other

community unit that we could pick up to

begin to have this conversation around

prioritizing mental well-being

because then you are helping people who

may be

at risk and then you are allowing people

who could potentially be allowed to say

that i’m going to encourage people

to focus on well-being leaders i have

been saying this that

leaders have an extremely important role

to

encourage mental well-being and getting

people to prioritize understand what

needs to be done about

mental well-being and mental wellness so

manoj

we spoke a lot about you know the the

impact that’s being felt by the

knowledge worker and a little bit about

what the informal economy is also

feeling

it’s not possible to scale and ramp up

our our mental health care delivery

infrastructure at least

so what’s the role of technology and all

of this how can technology

hopefully play a a scale-up factor right

in this

so that’s a great angle or perspective

we must start to look at particularly

countries like india which

cannot only rely on ramping up the

service infrastructure to solve the

problems

we need technology to be able to help us

innovate and come up with solutions

which

disrupt the way we are looking at

addressing the problems

and i feel that in mental health care

particularly in india we have not we’ve

just crashed the surface in terms of the

possibilities and potential that uh it

has uh

of course in the last two three years

there’s been a slight spurt in

the uh you know uh kind of tele

consulting or delay uh counseling that

has been happening over the internet and

a lot of people have become more

comfortable with that and which is very

good

and uh so access to professionals at

least

from that perspective has increased a

little bit so you don’t have to

now rely only on mental health

professionals in university or in your

town

you can reach out uh but

and then there are of course like from

our perspective we were talking about um

you know we are a web portal essentially

at the base of what we do

and all our content goes up on the

portal and

we’ve seen the way people reach out and

seek

knowledge and seek to find what they

need to do about mental health care

we have content in english and five

indian languages

we get fifty percent of our traffic for

an english portal and fifty percentage

for our

other five uh languages bangla and hindi

are the

largest uh kind of traffic

uh you know places such as platforms uh

so much so that

um eleven percent of our traffic comes

from bangladesh

and um and you can understand you know

and also the other data is about uh the

geography

of the top ten cities that uh give us

the traffic

only four of them are metros six of them

are non-metros

and so you can clearly see that need for

knowledge

is increasing so much on mental health

care and and the demand is

irrespective of geography they just need

that access yes

do you think do you think the fact that

technology is dehumanizing

is a bit helpful in this context because

you have this shield around you right

because

typically we’ve been growing up with the

stigma of mental health so do you think

that plays a factor in our adoption

there has been i mean yes

people have told us that it i feel more

comfortable in using technology or

technology enabled services like uh

teleconsulting or ai based uh

apps and all uh so that i don’t have to

look at the human access and i don’t

have to interact

uh physically with somebody who in front

of me you know uh i think the other

interesting part where

i think some research also has coalesced

around this is screen addiction

right yes where we’ve seen that it is

essentially the attention economy and if

people are

reliant on technology then maybe that

they’re not spending

15 plus hours a day looking at a screen

so there’s a there’s a

line once you cross that line you you’re

maybe more dependent than reliant and

this and

the things shift we’ve noticed companies

like google apple facebook

suddenly incorporate screen addiction

time spent on screen and wellness as

some parts you know of their product

offering

do you think leaders technology leaders

like microsoft and

google and apple they play an outsized

role because they

ultimately are the platform owners right

do you think there is something

interesting that might happen to engage

uh top down as well uh because it’s not

just top down in government right

sometimes it’s top down in terms of

technocratic institutions as well so

i think the problem of mental health

care is so close to us

that there is no outside role for

anybody everybody has an inside room

at an individual level in my family

i have to be extremely aware of it i

should know okay there are people like

this and all at

organizational level at uh those

organized leader

leading organization level like google

and others to say that what is that i

should do

every time i come out with an extremely

nice innovative

solution product out in the market uh so

i think

everybody has to make sure that all of

us every single person and government

for instance

agencies that mental health must be

one of the priorities uh of

all of us so you

touched upon financing right yes how

we’ve seen green bonds we’ve seen lots

of innovations happen in the social

sector to try to

tap certain types of funding what does

philanthropic or even other funding look

like

in the in the context of mental health

care

uh it’s not enough uh

it’s never enough it’s never enough but

in mental health care given the size of

the problem

given the innovation that we need to see

and uh

then then then look at the kind of money

available it’s it’s not you know

certainly

so i think and i think it is important

for

philanthropic fronts to be able to say

that

whatever i have focus on there is an

element of mental health to that

so i’m i’m not looking for only mental

health explosive funds

but let’s say some funds exist for

education now

is there a part of that education fund

which says that it is about emotional

health of my children

of the students or who i have it uh who

i am

in the geography that i am serving or

sel education or sc

educational sel education is a classic

point i mean am i really investing in

that yes

because we have a very strong uh

teachers training program

we have one day training program we’ve

done that for 750 teachers because

they are the first touch point in most

cases where a problem

in a child will come out and they will

come to know about it

it all depends of the decision of the

child or their parents

in terms of how the teacher has reacted

yeah how the teacher has really

looked at the problem and created an

environment in the classroom for that

child yeah so

can i train teachers can i look at at

risk population in the classroom

yeah and what is it so a lot of data

creation collection so so we know that

probably three to four percent of our

gdp is just allocated on broad

healthcare like that’s the whole

that’s our national allocation i’m not

really sure

how much of that would be for mental

health care as well do you think

similar uh allocations exist probably

in the philanthropic or social sector

like people are thinking about health

care

but probably two to three percent of

those funds are for for mental health

exactly no i i think one is of course

there is a need for us to have exclusive

mental health care

i mean funds for that and we will look

at innovation look at

encouraging people to come out be a

social entrepreneurship area or

even entrepreneurship area and encourage

them to come up with solutions and we

really need

very innovative nice solutions there but

i’m also saying that

we want people who have funds for other

sectors to be able to say that i think

environment for instance what is the

mental health angle to which yeah

disaster natural disasters there are

funds and all what is the material thank

you to it so

so proximate partnerships within their

funding

interests but a grandfathering or at

least involving mental health healthcare

into that

yes yes