The Himachal Pradesh Mental Health Authority’s Chief Executive Officer, Dr SANJAY PATHAK, who is also Senior Medical Superintendent at Himachal Hospital for Mental Health and Rehabilitation in Shimla, is a behaviourist with a keen interest in psychology and psychiatry.
Since the reconstitution of the Authority two years ago in the wake of the new central Mental Healthcare Act 2017, he has been at the forefront of grappling with key challenges in mental healthcare in HP and addressing them.
The Covid-19 pandemic and the lockdown have thrown up formidable challenges for mental healthcare, especially given the sharp rise in suicides in the course of this continuing crisis.
In an interview with ARCHANA PHULL, Dr Pathak touched upon a range of these matters.
Q. Do you think mental health is the focus area of any government?
A. Plainly speaking, mental health has not received as much attention as required all through despite the fact that there can’t be any health without mental health.
We need serious focus at policy level and all other levels in the government and society to fill the gaps in mental healthcare in the field, especially after the enforcement of a new Act which involves a major shift from the treatment to rights-based approach in mental illness.
There has, however, been a lot of emphasis on awareness on mental health and prevention of mental illness through different means. Yet, a lot needs to be done to put the things in place for mental healthcare.
Q. What are the mental health issues amid the changing society and expectations?
A. The modern lifestyle seems to be the breeding ground for mental illness in changing times. The socio-economic factors and individual distress are leading to more anxiety and depression.
Generally, the spectrum of anxiety and depression can go up to 10-15 per cent of the population and of major mental illnesses to 1-2 per cent of the population. One out of four people suffer from depression any time during life for different reasons.
This may be due to a gap in the expectation and achievement, mainly owing to a lack of realistic assessment, changing expectation (self-assessment of what it means to be an achiever) or conflicting family situation. The social cues that smoking, alcohol or drugs, particularly in the case of youngsters, are stress busters are increasing the mental health problems.
On the whole, it is a continuing process from mental wellness to illness and back.
Q. Do you think a rural state like Himachal also has similar mental health issues?
A. Yes. The world has shrunk into a global village. Mobile connectivity, access to internet and the social media is impacting the behaviour of people in Himachal in the same manner as in any other part of the country or world.
The general environment in the hill state of Himachal may be clean, but the emotional and psychological connectivity with the outer world is the same. The internet has actually given a new temperament and thought process.
So the overall stimulants remain the same in the rural state as well. The shift in lifestyle, desires, eating habits — everything is affecting mental health.
Q. What do you think about the rising number of suicides?
A. It’s a serious issue. Suicides are increasing across the globe and are the second leading cause of death in the age group between 15-29 years. Behind one completed suicide, there are attempts by 20 persons.
Globally, females attempt more suicides, but because of the methods they use, the completed suicide rate is lower in females. As per data, two persons commit suicide in Himachal Pradesh every day. Depression leads to suicidal tendencies.
So the coping skills to deal with stress, depression and anxiety play an important role in taking a person out of this situation. More so, a suicidal person is not suicidal every time. They have life instincts like any other normal human being, but they are overwhelmed for a moment and once that moment is handled, a person can be saved.
Family, friends and colleagues have a significant role to play as they are the first one to notice the shift in language, expression and negative state of mind etc and should intervene fast.
Q. What is HP Mental Health Authority doing to prevent suicides?
A. The state is concerned about it. We have recently constituted a panel of experts, including Dr Dinesh Sharma, a senior psychiatrist from Indira Gandhi Medical College, Shimla and a clinical psychologist, to plan and design strategies for suicide prevention in HP.
We have also publicised that anyone can get in touch with us on the hospital or the Authority website or through e-mail to discuss any issue related to mental health illness and seek advice.
Q. The number of suicides during the Covid pandemic has risen in HP? What is your analysis?
A. Covid has certainly thrown up new mental health issues. During the Covid-19 lockdown, the figure of suicides in Himachal Pradesh has shown an increase seemingly due to employment loss and anxiety over getting infected or infecting others.
We are conducting a study on the assessment of stress levels in the community due to Covid-19 pandemic, wherein we have picked up three districts of Mandi, Chamba and Shimla.
The mobile-based study, which would include messages to around two lakh people in these three of HP’s 12 districts, is being done to analyse anxiety, depression, suicidal tendencies and its gravity among the community due to Covid-19.
The forms are being sent to three age groups — less than 25 years, 26-60 years and above 60 years — considering different parameters.
Q. What are the challenges facing mental healthcare?
A. Social stigma is one of the challenges as people with mental illness don’t come out. For instance, depression is a mental illness, but two-thirds of the people suffering from depression do not consult a psychologist or a psychiatrist either due to social stigma or unawareness.
The situation in HP is better, but many times patients who get treatment at the Hospital for Mental Health and Rehabilitation are disowned by families.
They are then sent to HalfWay Homes (only two in HP) run by the Social Justice and Empowerment Department. In HP, we only have 26 psychiatrists and there is no clinical psychologist.
If we have to meet the international standards laid down in the new Mental Healthcare Act, we require huge trained manpower. It’s a long way to go.