In what is possibly a first of its kind initiative, a report has compiled the mental health burden in Karnataka in terms of common as well as severe mental health issues, suicide ideation, alcohol and substance use, and segregated it district-wise. A report, prepared by CHD Group, a global health organisation, has collated data from state-run institutions, and found that over a million people sought consultation in Karnataka for mental health issues in 2018-19.
There were over 10 lakh mental health consultations in public health institutions in Karnataka in 2018-19. Thirty-four percent of these people were found to have common mental health issues like depression and anxiety; 18% had severe mental health issues like schizophrenia and bipolar disorder; 12% were reported to be alcohol (18.4%) and substance use (11.2%) cases; and three percent (29,005) cases of suicide thoughts.
Worth noting is that 29% of mental health consultations were reported from just three districts – Raichur (12.1%), Bidar (8.9%), and Chikkaballapur (7.9%) – which were also the districts that had the highest incidence of alcohol and substance use at public health institutions at a cumulative 1,11,877 cases.
Alcohol use and mental health
Speaking to TNM, Dr Edmond Fernandes, CEO of CHD Group, says that the high incidence of alcohol use is linked to higher rates of domestic violence, and subsequently, mental health issues.
That alcohol abuse in many north Karnataka districts including Raichur, Bidar, and is rampant – especially in rural areas – is corroborated by various reports of women demanding prohibition in these districts time and again.
One such organisation that has been working to demand a ban on alcohol sale is Madhya Nisheda Andolan (MNA). Swarna Bhat, who has been working with MNA, says that they have seen horrific cases of domestic abuse arising out of alcohol use and addiction in these districts. “This affects physical as well as mental health of people living in these districts. There could be a connection between mental health issues being reported in higher numbers too in these districts,” she says, when asked about the CHD report’s findings on Raichur, Bidar, and Chikkaballapur.
Explaining that alcohol being easily available here is due to pressure on excise officials to show more revenue through liquor sale. “It leads to so many other problems – poverty, abuse, a host of physical ailments. We have had horrible stories of abuse arising from alcohol addiction. And we’ve been noticing more and more teens getting hooked to alcohol in many north Karnataka districts,” Swarna says. “The government needs to address the alcohol abuse problem too. Mental health issues don’t exist in a vacuum.”
The CHD report also reveals that an alarming 44% of all cases of suicide ideation reported in public health institutions from Haveri and Hassan districts.
There were over 3.40 lakh common mental health issues reported in public institutions in Karnataka, which included depression, generalized anxiety disorder (GAD), panic disorder, phobias, social anxiety disorder, obsessive-compulsive disorder (OCD) and post-traumatic stress disorder (PTSD). Lowest numbers were reported in Bijapur (0.6%), Yadgir (0.7%) and Kodagu (0.8%).
Meanwhile, at 5.2% Bengaluru Urban had twice as many cases than Bengaluru Rural district (2.4%). However, Dr Edmond says that this could be because of better reporting in Bengaluru Urban, and the population of the district being higher than Bengaluru Rural too.
Interestingly though, the report also talked about how mental health issues spike when disaster strikes. “There is extensive evidence from research on disaster victims that report high risk for mental disorders diseases, particularly depressive disorders, generalized anxiety, disorders of sleep and post-traumatic stress disorder (PTSD). Moreover, there is increased risk of substance use disorders among adolescents and young adults post disaster,” the report says.
Kodagu was one of the worst affected districts by the Karnataka floods, which seems to be contrary to the minimal number of mental health issues being reported from there.
Dr Edmond explained, however, that in many places, the incidence is higher simply because of better reportage and willingness to seek treatment.
The CHD report also calls for the need for priority attention to be given to populations affected in the Karnataka floods of 2019, as well as those living in places that have been suffering longstanding droughts, which could be seen as possible triggers for mental health deterioration.
Spending on mental health in Karnataka
While the conversation on mental health in India is growing, there is still want for funding to address the magnitude of the same. The National Mental Health Survey 2015-16 revealed that less 1% of the total budget was allocated for mental health in most Indian states.
“Karnataka's budgeted expenditure in the Health and Family Welfare sector in the year 2018-19 was INR 9299 crores (USD 1.32 billion), of which INR 2708 crores (USD 383 million) was budgeted for medical education. Only 0.37% (INR 2,434,19,000 | USD 3.45 million) of the remaining state expenditure for health was allocated to mental health. Of the funds allocated to DMHP (District Mental Health Programme) and Manasadahra, only 74.4% and 62.4% respectively, were utilized,” the CHD report said.
However, the report does highlight some best practices taken by the Karnataka government to address mental health such as Manasadhara (Day Care) Centres – Community Mental Health Day Care programme – announced in the 2013-14 budget. Another scheme is the Manochaitanya (Super Tuesday Clinic), where a psychiatrist from DMHP/Medical College/District or Private Hospital provides specialist services to the mentally ill at Taluka level hospitals, community health centres, and primary health centres on selected Tuesdays.
Private sector’s involvement crucial
The report stresses on the need to involve private sector as well as NGOs to address the mental health burden, considering there are only 1.4 beds per 1,000 population in psychiatric hospitals, and 0.82 beds in general hospitals -- with the exception of the Central government-run NIMHANS in Bengaluru which has 1000 beds. Further there are only three psychiatrists per million persons.
CHD recommends that the private sector should support the construction of community hospitals which have specialty wards for psychiatry. CSR can also contribute.
Further, NGOs can benefit the focus on mental health because they not only deliver healthcare in remote and disaster affected areas, but also offer flexibility of operation and close relationship with communities. “Involving the NGOs for health system strengthening may eventually reflect increased efficiency, more equity and good governance. Karnataka government, in return, can support NGOs' vulnerable financial base by providing regular financial support,” the report says.
There is also a need to come up with customised programmes solutions for the worst-affected districts, keeping in mind their social conditions as well, Dr Edmond said.