Following the birth of her third child, Delhi-based entrepreneur Smita* found herself feeling “disconnected and depressed”, often for days at a stretch. “Much later I was told it was severe post-partum depression but at the time it wasn’t properly diagnosed,” she told IPS.

“My marriage was in trouble and after my symptoms showed no signs of going away, my husband was keen on a divorce, which I was resisting.”

After a therapy session, Smita was diagnosed as bi-polar

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One day after she suffered a particularly severe panic attack, Smita found 10 policemen outside her door. “I was taken to a prominent mental hospital in Delhi where doctors sedated me without examination. When I surfaced after a week I found that my wallet and phone had been taken away.”

All pleas to speak to her husband and parents went unheeded.

It was the beginning of a nightmare that lasted nearly two months, much of it spent in solitary confinement. “The nurses were unkind and cruel.
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“There were women there who told me they had been abused and molested by the staff.”

Not all the women languishing in these institutions even qualified as having mental health problems; some had simply been put there because they were having affairs, or were embroiled in property disputes with their families.

Days after she was discharged her husband filed for a divorce on the grounds that Smita was mentally unstable.

“I realised then that my husband was building up his case so he would get custody of the kids.”

Isolated and afraid, Smita did not find the strength or support to fight back. Her husband won full custody and left India with the children soon after. “My doctor says I am fine and I am not on any medication but I still carry the stigma. I have no access to my kids and I no longer trust my parents,” she told IPS.

Smita’s story points to the extent of violence women face inside mental health institutions in India. The scale was highlighted in a recent Human Rights Watch (HRW) report, ‘Treated Worse than Animals’, which said women often face systematic abuse that includes detention, neglect and violence.

Ratnaboli Ray, who has been active in the field of mental health rights in the state of West Bengal for nearly 20 years, says on average one in three women are admitted into such institutions for no reason at all. Ray is the founder of Anjali, a group that is active in three mental institutions in the state.

“Under the law all you need is a psychiatrist who is willing to certify someone as mentally ill for the person to be institutionalised,” Ray told IPS. “Many families use this as a ploy to deprive women of money, property or family life. Once they are inside those walls they become citizen-less, they lose their rights.“

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“One can’t help but notice the stark contrast between the male and female wards,” points out Vaishnavi Jaikumar, founder of The Banyan, an NGO that offers support services to the mentally ill in Chennai, capital of the south Indian state of Tamil Nadu.

“You will find wives and mothers coming to visit male patients with food and fresh sets of clothes, while the women’s wards are empty.” Experts also say discharge rates are much lower when it comes to women.

The indifference towards patients is evident not just in institutions, but also at the policy level, with mental health occupying a low rung on the ladder of India’s public health system.

According to a WHO report the government spends just 0.06 percent of its health budget on mental health. Health ministry figures claim that six to seven percent of Indians suffer from psychosocial disabilities, but there is just one psychiatrist for every 343,000 people.

That ratio falls even further for psychologists, with just one trained professional for every million people in India.

Furthermore, the country has just 43 state-run mental hospitals, representing a massive deficit for a population of 1.2 billion people. With the District Mental Health Programme (DMHP) present in just 123 of India’s 650 districts, according to HRW, the forecast for those living with mental conditions is bleak.

“Behind that lack of priority is the story of how policymakers themselves stigmatise,” contends Ray. “The government itself thinks [the cause] is not worthy enough to invest money in. Unless mental health is mainstreamed with the public health system it will remain in a ghetto.”

http://www.ipsnews.net/2015/01/dumped-abandoned-abused-women-in-indias-mental-health-institutions/

India’s health care delivery mechanism is defined by shortcomings; the doctor-patient ratio is skewed, over 75 per cent of India’s population has no health insurance, there is a shortage of two million hospital beds compared with the global requirement of 2.5 beds per 1000 people and the spending on health is abysmally low at a little over one per cent of the GDP.

These statistics however, are not the only illustration of the gaps that exist in the system; the inability to utilise the available infrastructure worsens the problem. This was endorsed by the Union Health and Family Welfare Minister J.P. Nadda’s recent admission that “there are health centres where there is an X-ray machine, but nobody who knows how to operate it.”

Extremely high out-of-the-pocket expenses on diagnostics and medicines, poor quality of services in government-run hospitals and lack of human resource to deliver the services have been identified as the major lacunae that the government needs to address with alacrity.

Also counted as failures of the system are insufficient attention to research (including developing newer medicines and vaccines) and preventable nutritional disorders, maternal and child mortality and reduction in the burden of non communicable diseases.

A white paper ‘Aarogya Bharat 2015’, released by NATHEALTH, Healthcare Federation of India this past week shows India requires $3 trillion in cumulative funding and has the potential to generate 15 to 20 million jobs by 2025.

Yet, less than one per cent of delivery providers are accredited and although rural India accounts for about 70 per cent of the population, it has less than one-third of the nation’s hospitals, doctors and beds resulting in huge disparities in the health outcomes.

Under spending on health care and pharma sectors has been flagged thus in the report; compared to the U.S. (8,895 $) and China (322 $), India (58 $) had the lowest per capita health care expenditure in 2012; the per capita spending on pharma products and medical devices in 2013 stood at $15 as against $ 1440 in the U.S. and $90 in China. The doctor-patient ratio too is among the lowest with a mere 0.5 doctors for every 1000 patients in large parts of the country.

India’s GDP spending on health brackets it with lower income countries, the Sub Saharan Africa, Afghanistan, Haiti, Azerbaijan and Georgia says a World Bank report of 2012. A consequence of out patient treatments and direct payments is individuals being pushed below the poverty line.

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Despite 98 per cent of drugs needed for treatment of various disorders manufactured in India, 65 per cent of the population does not have access to essential and life-saving drugs says the WHO 2012 World Medicine Situation Report.

Every State procures medicines for free distribution to patients, but the free medicine model has been slow to pick pace; with Rajasthan, Kerala and Tamil Nadu being the only States that have a better record to show.

As the Centre gets ready to roll out its ambitious Universal Health Assurance Mission (UHAM), there are doubts about how it will ensure quality health care for Indians.

Recently, there was a downsizing of the health budget after the revised estimates for the last quarter showed that States have failed to utilise what was earmarked for spending on healthcare. While the Ministry was quick to defend that none of its flagship programmes would be affected by the cuts, it raised questions on why States have been dragging their feet on executing the spending.

All eyes now rest on the Health Minister’s commitment that the UHAM will not merely be limited to pumping more money into the system, but removing the bottlenecks that choke the health care system.

“There is no dearth of funds, the issue is optimum utilisation of resources and assurance of services,” he said promising to fill the gaps in the health delivery system.

http://www.thehindu.com/news/national/gaps-in-health-delivery-systems/article6822138.ece