A third of world’s mentally ill in China & India – The Lancet

New Delhi : A third of the global burden of disease for mental, neurological and substance use disorders occurs in India and China - more than in all high-income countries combined - yet most people with mental disorders in these countries do not receive needed treatment. Three new papers, published in The Lancet and The Lancet Psychiatry, mark the launch of the China-India Mental Health Alliance, a long-term project bringing together experts from China and India to look at the current status of mental health and mental health services in both countries. The authors say that community engagement, increased support for community health workers and collaboration with traditional and alternative medicine practitioners are key to providing more accessible, affordable, and acceptable mental health care in India and China. With a combined population of over two and half billion, China and India make up 38 per cent of the world population. The aim of the Alliance is to identify evidence-based solutions to their shared problems. The burden of mental illness will increase more rapidly in India than in China over the next ten years, the researchers warn. In 2013, 36 million years of healthy life were lost to mental illness in China, and 31 million in India.
Estimates suggest that by 2025, 39 point 6 million years of healthy life will be lost to mental illness in China (10 per cent increase), and 38 point 1 million in India (23 per cent increase). In both countries, substance use disorders were more common in men than women - the burden of drug dependence disorders was more than twice as high for men as women, and the burden of alcohol use disorders was nearly seven times higher for men as women. Dementia is a growing problem for both countries. From 2015 to 2025, it is estimated that the number of healthy years lost due to dementia will increase by 82 per cent in India (from 1 point 7 million to 3 point 2 million) and by 56 per cent in China (from 3 point 5 million to 5 point 4 million). In China, less than 6 per cent of people with common mental health disorders (mood or anxiety disorders), substance use disorders, dementia and epilepsy seek treatment.
Among people with psychotic disorders, 40 per cent have never sought treatment from mental health professionals.
In India, only about 1 in 10 people with mental health disorders are thought to receive evidence-based treatments.
Both countries have very few trained mental health professionals, poor access to mental health services (especially in rural areas), low investment, and high levels of stigma which may prevent people from accessing services.
At the same time, both countries have large numbers of traditional, complementary and alternative practitioners - such as yoga practitioners in India and Traditional Chinese Medicine practitioners in China - whose clients include many individuals with mental health problems. People use alternative medicine for a number of reasons including faith, culture, cost and a belief they are safer, and the authors say that more research is needed to fully understand the effectiveness and potential risks of these therapies. Since the medical system cannot address the mental health treatment gap alone, the authors suggest that traditional medicine practitioners could be trained to recognise and refer patients who pose a risk to themselves and others, or to advise patients against stopping their medication. Mental health experts could, in turn, promote the values of traditional healers - for instance by advising on the effectiveness of different forms of therapy that recognise cultural ideas about distress, and facilitate social support through things like diet or exercise . While India has progressive policies regarding mental health care, the actual implementation of comprehensive community oriented services is patchy and the treatment gaps, especially in rural areas, are very large,” said Professor Vikram Patel from Public Health Foundation of India and the London School of Hygiene & Tropical Medicine, London, UK. Innovators have shown how these gaps might be reduced, for example through task-sharing with front-line workers and engagement of the community,” Prof Patel said.

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