Spare a Thought for Psychiatric Caregivers too

Context:

According to National Health Mission estimates, 6%-7% of India’s population suffers from mental disorders.

Reasons of Mental Suffering:

• Ignorance & Social Stigma: Most of the cases remain untreated due to ignorance and social stigma.
• The absence of Visible Proof of Illness: Without proof, deviations in behavior are generally attributed to attitudinal issues, marital troubles, financial problems or job stress, while love affairs and examination stress are cited as the usual culprits in the case of teenage behavioral issues. 
• Treated as Myths, Stigmas and Taboos: Without proper diagnosis, the patient and their families keep suffering as mental health responses remain mired in myths, stigmas, and taboos.
• Intensified during COVID-19: The situation worsened during the COVID-19 pandemic as long periods of isolation, the fear of losing loved ones, financial difficulty, and uncertainty about the future increased stress levels across social segments.

Causes for Caregiver Stress:

• Physical, Emotional & Behavioural Shooking: The caregiver is under considerable stress because of the physical and emotional caregiving along with the social isolation, financial difficulties and troublesome behavior of the patient. 
• Non-Adherence to treatment of Patient: A patient’s non-adherence to treatment further exacerbates caregiver stress. 
• Sole Responsibility exacerbating as Burden: In larger families, the primary caregiver burden is shared among family members, but with reducing family sizes, the role falls on the spouse. 
  • Chronic mental illness in a nuclear household disrupts daily life and drains family resources. 
• Lack of Psychiatric Treatment: Moreover, women caregivers face challenges in balancing caregiving, career, child rearing, and household chores, and are less likely to receive informal support for psychiatric treatment.
• Psychological Effect: Prolonged caregiving negatively impacts the psychological well-being of caregivers. 
• Unhealthy Coping Mechanisms: Caregivers use various strategies to cope which include sharing, spirituality, hobbies and self-gas lighting, but unhealthy coping mechanisms can negatively impact both caregivers and patients. 
• Lack of Structured Intervention Programme (SIPs): SIPs like National Mental Health Programme and the decentralized District Mental Health Programme remain focused on the patient but neglect the caregiver. 

What are the Concerns?

• Insufficient Budget Allocation: This insufficiency for mental health patients raises concerns of developing intervention for psychiatric care-givers.
• A Lack of Trained Specialists: It hinders cost-effective intervention model implementation. 
  • India has 43 State-run mental health institutions with 3,800 psychiatrists and 900 clinical psychologists — i.e., one psychiatrist and psychologist for every four lakh and 16 lakh citizens, respectively. 
• Very Expensive: Though private mental health institutions provide some fillip, their services are expensive and beyond reach for many.
• Insurance Gap: Mental illnesses are excluded from the list of ailments covered by leading medical insurers in India. 
  • The Mental Healthcare Act 2017 provided a corrective step with the mandate to treat mental disorders on a par with physical disorders for insurance coverage. 
  • Government schemes provided by public sector insurance companies such as the flagship Ayushman Bharat provide coverage for mental disorders. However, coverage by private insurers remains limited.
• High Severity: In Spite of working of several non-governmental organizations and community movements like Mindroot, Lonepack, and the White Swan Foundation in the desired direction, the severity of the issue, their scale remains insignificant.

Facilities Available: 

• Counseling services: Currently provided to caregivers on their request. 
  • Insufficient: Such counseling services are not sufficient as the situation of the caregiver is similar to that of the ‘boiling frog’ where the individual might not be aware of the emotional strain, and hence will not request for support.

Initiatives taken by the Government of India towards Betterment of Mental Health:

• National Mental Health Program (NMHP): Adopted by the Indian Government in 1982 in response to the large number of mental disorders and shortage of mental health professionals.
• The Mental Health Care Act, 2017:  The act effectively decriminalized attempted suicide which was punishable under Section 309 of the Indian Penal Code.
• Kiran Helpline: It is a 24/7 toll-free helpline launched in 2020, by the Ministry of Social Justice and Empowerment to provide mental health support.
• Manodarpan Initiative: It is to provide psychosocial support to students, teachers and family members during the Covid-19 pandemic.
• MANAS Mobile App: Launched by the Government of India in 2021 for promotion of mental wellbeing across age groups.

Why is the Structured Intervention Programme getting Prominence? 

• For Providing Education & Support: It is essential to introduce a structured intervention programme to educate and support the caregivers of psychiatric patients.
• Helps to Cope: It helps them to educate them about the illness and their roles and responsibilities, leading to a better sense of control over their own life and helping to cope with the caregiver role. 
• Helps to Deal with Psychiatric Illness: Studies in developed countries show that providing support to family caregivers at the onset of the psychiatric illness of loved ones is crucial for the success of the intervention. 
• Multifaceted Approach: Successful intervention models include cognitive behavioral therapy, psychoeducational skill building, family counseling and peer-support. 
• Behavioral Interventions and Helplines: Caregivers receive behavioral interventions, counseling, and helplines to manage anxiety and stress.

Way Forward:

• Sufficient Budget Allocation: It’s a high time to increase spending on Caregiver Stress, otherwise it can lead to a grave situation.
• Need to Induct more Trained Specialists: It could be one of the major positive steps in this direction.
• Need of a Legislative Backing: Laws should be made and enforced in the direction to control its expensiveness. To counter the issue, there is a need that the expense should be in reach of everyone.
• Need of Strict Enforcement: The provisions of Mental Healthcare Act 2017 should be implemented in a strict manner, and if not complied by anyone, serious punishments should be imposed. 
• Need to Fill the Insurance Gap: Mental illnesses should be included in the list of ailments covered by leading medical insurers in India. 
• Time for Comprehensive Treatment: To overcome this serious matter, there is an urgent need for comprehensive treatment of severe psychiatric illnesses in the future would need building effective partnerships between health-care professionals, informal caregivers, and psychosocial interventions, where required.

News Source: The Hindu