Mental illness still a taboo in India

Sufferers struggle to find medical attention as increasing stress levels risk making the disorder the country's most common ailment.

Dr Puneet Dwevedi is a psychiatrist in the Max Healthcare hospital in Delhi.

GURGAON, INDIA // The bright neon sign atop one of Gurgaon's new, state-of-the-art hospitals is a beacon for the city - bring us your sick. Patients who arrive confused and alone at the Max Healthcare facility look for Dr Puneet Dwevedi. They have no idea what to expect from the mild-mannered 39-year-old doctor, sitting in a solitary room at the end of a gleaming hallway.

He is, after all, no ordinary doctor, but a psychiatrist. And this is India, where mental illness is typically kept secret and almost exclusively managed at home. "There is a taboo," Dr Dwevedi said, sitting at his desk. "With globalisation, we're getting closer to the world, but the mentality remains the same. A psychiatrist still means a person who is related to mind diseases. Nobody wants to go to someone when he will be declared a mentally ill person."

Last month, the United Nations observed World Mental Health Day - calling on countries around the world to promote awareness and highlight mental health issues. According to the World Health Organization, 75 per cent of those suffering from mental disorders in developing countries receive no medical attention at all. And in India, World Mental Health Day was greeted with the same stony silence reserved for people with such disorders.

Social attitudes are changing, Dr Dwevedi contends, even if at a glacial pace. When he began practising psychiatry a decade ago, the doors to his office swung open far less frequently than they do today - even if the faces of patients remain as furtive and nervous as ever. On average, he sees between 20 and 25 people per shift at Max Healthcare. While accurate figures are difficult to gauge in this country of more than 1.2 billion people, a recently released report by the National Human Rights Commission of India pegs the number of Indians suffering from serious mental illness at more than 20 million.

In the report, the New Delhi-based organisation decried a severe shortage of hospital spaces for the mentally ill. "The huge treatment gap with 50 to 90 per cent of people not being able to access services is a serious human rights issue," it stated. By the year 2010, the report concluded, mental illness will overtake heart disease as the nation's most common ailment. For its part, the central government has been scrambling to stem the tide of mental illness. In 1982, it unveiled the National Mental Health Programme - an ambitious strategy to tackle mental disorders through public initiatives, education and co-operation with schools across the country. The programme's budget was multiplied several times in intervening years, while its mandate was broadened.

Indian media - from television to newspapers to radio - has also been significantly more vocal about psychiatric issues in recent years. "Every now and then you'll find a psychiatrist on television or in the newspaper talking about various issues so that also bridges the gap between society and mental health," Dr Dwevedi said. "That has been a great help. "It's much more open now. In 10 years, the taboo has decreased."

But he also happens to work on one of India's psychological fault lines - where the environment is particularly ripe for mental illness. The hi-tech hub of Gurgaon bears little resemblance to its sister-city, New Delhi. Here, endless business parks, shopping malls and condominiums set the pace, as young couples scramble up the corporate rungs. While the West - thanks to cheaper operating and labour costs - can farm out its call centre work to India, the country also receives an unexpected by-product: a world-sized case of stress.

Low wages and long hours already make call centre jobs a demanding career but, most significantly, with North America at the other end of those calls, time zones inevitably clash. Cue the zombification of masses of Indian youth, toiling through the night. And ratchet up the stress. "That obviously alters your biological rhythm," Dr Dwevedi said. "Stress starts happening." Appropriately, Dr Dwevedi's schedule is becoming as cluttered as the Gurgaon skyline.

Recently, he spoke to employees at Hero Honda, a major automotive firm with 5,000 to 7,000 employees, about smoking. Since a nationwide ban was imposed on smoking in public places this autumn, companies have been scrambling to persuade their employees to kick the habit "Suddenly, you can't stop smoking out of the blue. So that's an issue." He also visits companies to talk about relationships, while counselling drug and alcohol addicts.

But stress remains, far and away, the most frequent spectre at his door. Perhaps India would still be able to cope with all that anxiety - if it had a serviceable number of mental health professionals. But the same attitudes that keep many people from visiting a psychiatrist also keep many people from becoming one. There are about 3,500 psychiatrists in India for 1.2 billion people. Schools may be churning out doctors and engineers, but psychiatrists remain chronically underrepresented. One of the country's most prestigious medical schools, the All India Institute of Medical Sciences, boasts two seats every year for psychiatry students. Delhi University offers an additional eight seats, with the nearby Shahdara mental hospital chipping in with a couple more study positions.

"I think 15 to 16 psychiatrists will be graduating from Delhi this year," Dr Dwevedi said. But even if schools began training psychiatrists in earnest, the question remains: outside such stress points as Gurgaon, would anyone use them? After all, Dr Dwevedi said, Indians may be embracing the modern world, but, "where they come from, their social background and the notions they carry, still remain the same. The word psychiatrist still hits the wrong chord."