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Mental health is a serious issue in rural India

Linking mental health issues to urbanisation creates barriers for people in rural India to access the treatment that they need, say experts

The notion that folks in rural areas don't have mental health issues doesn’t help them access the care they need
The notion that folks in rural areas don't have mental health issues doesn’t help them access the care they need (iStock)

Last week, the internet schooled actor Nawazuddin Siddique for calling depression “an urban concept”, and rather confidently stating that people in villages don’t get depressed. With this comment, Siddique joined a list of well-known figures reducing mental health issues to a Western or urban trend. In October 2022, at an event former cricketer Kapil Dev said that he doesn’t understand “these American words, like ‘pressure’ and ‘depression.’” 

“It is misleading to say people in villages don’t have mental health issues. People in cities and rural areas might be dealing with different problems but mental health problems are prevalent in both areas. In rural areas, the lack of facilities leaves people to fend for themselves. Moreover, people often have an unkind view about mental health and such stigma makes it difficult for them to talk about it freely,” says Dr Roy Abraham Kallivayalil, professor and head of the Department of Psychiatry, Pushpagiri Institute of Medical Sciences, Tiruvalla.

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A 2022 paper, Social Exclusion and Mental Health Among Older Adults: Cross-Sectional Evidence From a Population-based Survey in India published in BMC Psychiatry, found that almost one-third (31%) of the rural-dwelling older adults reported depressive symptoms, while a 2015-16 survey conducted by the National Institute of Mental Health and Neurosciences found that 10% to 12% of people who require mental healthcare in rural areas had access to relevant services.

A 2018 study conducted in 12 villages of the West Godavari district of Andhra Pradesh among over 20,000 people found that anxiety, depression and suicidal ideation affected 10.8%, 14.4% and 3.5% of participants respectively. These were more common among women, and among those who were aged 30–59 years, uneducated, or divorced/ separated/ widowed. Stress due to financial loss was also significant, the study reported in the paper Common mental disorders and risk factors in rural India: baseline data from the SMART mental health project.

Kallivayalil says that instead of the rural-urban debate, the focus should be on building awareness about mental illnesses and improving access to treatment. His research paper Prioritizing Rural and Community Mental Health in India, published in 2018, highlighted that the failure to provide treatment for mental illness varies between 70% and 92% across several states in India. Moreover, it showed that there are only 0.3 psychiatrists, 0.07 psychologists, and 0.07 social workers per 100,000 people in India.

“When people in rural areas need help, often there isn’t any available. In most district or taluk levels, primary health centres don’t have a therapist or a psychiatrist, making access difficult. When people, including children, have depression or anxiety or ADHD, which can often be invisible, it is more difficult to recognise and get help,” Kallivayalil says. Furthermore, caste also determines access to help, , further pushing those in the periphery away from support.

In this environment, dismissive statements that suggest that mental illnesses are an ‘urban concept’ can further restrict access to treatment, especially in a country where about 56 million Indians have been diagnosed with depression, and 38 million have anxiety disorders, according to World Health Organisation. 

Moreover, offhand statements such as these can invalidate a person's pain, further exacerbate depression and add shame to the equation, according to a 2020 study published in Frontiers of Psychology. The study observes, “When these invalidating and shame-provoking events become central to one’s sense of self, people are then increasingly likely to experience more intense symptoms of depression.”

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