Occupational Medicine & Health Affairs
Open Access

South Asian nations such as India, Nepal, and Pakistan are home to approximately 1.8 billion people, and 150-200 million have a mental illness. However, the severity of the issues relating to mental health are often overlooked in the south Asian region and this results in leaving out millions without any treatment and support. According to the World Health Organisation, approximately one-third of the population which is suffering from depression resides in the South Asian region, making it the home for the majority of depressed people. It has been clearly stated by Professor Dinesh Bhugra who is a mental health expert at London's King’s College that “the people of South Asia carry a bigger notion of shame as compared to the people of another ethnicity. The people belonging to the South Asian religious and cultural influences usually do not consider mental health a medical issue, and they further refer to it as a “superstitious belief.” It is a fact that discussing mental health in Asian countries is considered taboo and should be socially normalised as it is the need of the hour.

In the field of medicine as well it has been observed that depression is a major contributor to the perpetuation of various other diseases. The WHO as well found a correlation between depression and the physical health of an individual, as depression in certain cases has also led to cardiovascular diseases. The factors that contribute to pushing a person into depression might be domestic violence and poverty and in south Asian countries it might also the gender of the baby. One of the major victims of the above-mentioned issues is women and due to the social stigma surrounding mental healthcare, they do not receive any form of mental healthcare support.

Efforts are being made at the national as well as international levels to address mental health issues. Recently, the World Health Organisation has lauded work and certain important steps to be taken to treat and normalise depression. In certain countries where due to lack of economic support the government is unable to make mental health a priority, NGOs are making efforts to provide crucial support to the people who are suffering from mental health issues. Certain international level NGOs are extending their support to the South Asian nations and are providing specialised mental health services, taking the example of the Maldives, where several NGOs have offered life-skills training, rehabilitation services and “resilience building around social issues” training to people of the country. The said effort has brought a drastic increase in accessible mental healthcare in South Asia.

According to reports by WHO mental health is the most neglected area of health globally. This has drastically increased post the pandemic period. There are several reasons for ignorance towards mental health such as associated stigma, it is also not considered an actual illness. Currently, nearly 1 billion people in the world live with a mental disorder and approximately 75 per cent of the people in low-income countries do not receive treatment. By the age of 14, 50 per cent of people suffer mental health disorders and every 40 seconds a person dies due to suicide. According to the data presented above, not only the developing but also the developed countries need to shift their focus towards these soft issues of mental health diseases and mental healthcare.

Recently, the World Bank has employed strategies to help the countries in accelerating to achieve Universal Health Coverage both mentally and physically. Various mental health programmes have been a part of the World Bank’s developmental projects. The focus of various countries has been on the most urgent and immediate needs of the pandemic, however mental health assistance has been included in their programmes. Scaling up and speeding up the addressing of mental illness is essential to achieve the Sustainable Development Goals of ensuring healthy lives and well-being for all of all ages by 2030. Failure of this could have devastating socio-economic impacts. Further investment in health reaps the benefits both within and outside of the health sector. The entire dynamic of mental healthcare has changed drastically over the last decade, people have become more aware as they now believe that the world might face the consequences of ignoring it.

To make the entire world a better place, the need of the hour is to introduce such awareness spreading campaigns, which educate people and introduce them to the concept of mental health issues and how to take care of the said issues. Across the globe, many mental healthcare institutions are constantly trying to create pressure on the governments to identify and bridge the gaps that are causing mental health issues. The countries must recognise these strategies to make mental healthcare a necessity.

Legislative Aspect of Mental Health

In the rapidly advancing environment of technology, human needs, values, and cultures, there is something, some element, that is causing a very deep and everlasting impact on the emotional, psychological and mental well-being of mankind. The transformation from becoming good to better to the adamant perseverance of becoming the best has caused much intellectual damage to the human race and has derailed it from the path of mental fitness and welfare. The race to become the most superior and dominant has converted the human mind from being creative, spontaneous, emotionally capable, and cerebral to becoming extra practical, emotionless, parsimonious, and highly selfish. All that a human brain now focuses on is innovation and development with total disregard for the fact that it also comes at the cost of the environment, natural human bonds, or even human life. Mankind has transformed its brain and its psychology into a selfish, egocentric, and self-absorbing wish-granting factory. However, does not purport or allegedly indicate that mental health issues are a result of only rapid technological development, it simply corroborates the fact that in today’s day and age, technology plays a very crucial role in perpetrating mental health issues.

Mental health circumscribes emotional, spiritual, psychological, and civic welfare and safety. Along with this, it also ascertains and shapes how individual manoeuvres and handles stress, personal relationships, and social contingencies. The mental health of a person determines his or her social perception, understanding, and behaviour. It is a key aspect of how a person reacts to his surroundings on different occasions. It influences its behaviours in many different ways at the different junctures of her life. The kind of mental health an individual has cajoles his understanding of his life and his relations in general and in specific. It makes him react accordingly. Thus, a person’s mental health plays an extremely important and crucial role in shaping his or her life.

Let us focus on the topic of prime importance in this section of the document and that is mental health legislation. Now, before we start comprehending what the mental health legislation of India states, let us first throw some light on what mental health legislation is? The law regarding mental health encompasses a diverse and heterogeneous assortment of legitimate subject matters and discussions. It directly relates to and concerns those persons who are detected or have a rather likely chance of being diagnosed with a mental health issue or condition. In addition to this, mental health legislation also focuses on and lays out a framework for the treatment and management of those suffering from it.

Even though it is widely stated that a healthy mind stays in a healthy body, the former is given very little or no attention in most cases and many countries, including the developed ones as well. When we specifically focus on our country India, we experience the same careless attitude of people towards taking care of their mental wellbeing, as if the well-being of the mind carries little to no importance at all in their daily routine life. Most families in India, even the highly educated ones pay almost no heed to the rising concern of mental health that may be suffered by a child, a teenager, or a grown person in the family. Serious mental health issues like anxiety, depression, and even suicidal tendencies are invalidated by statements like mood swings and are a result of being over-sensitive rather than taking things seriously. This stubborn attitude is what has led India to be amongst one of the unhappiest countries in the world. India is placed in 136th position out of 146 countries that were assessed in the current year, that is 2022, United Nations World Happiness Report. Previously, it was ranked 139th in this same report in 2021. By looking at these numbers, we can easily assess how grim and tense the situation in India is.

The above facts will be very well corroborated by the data provided by the National Mental Health Survey conducted in the year 2015-16. It highlights that just about 15% of adults in India require immediate and active medical intervention for one or more likely than one mental health issue. And, it also states that one in twenty Indians, unfortunately, struggle with depression. In a country as populated as this one, the mathematical figure of one in twenty is very frightening. This means that all of us must be in contact with someone who may be suffering from depression that we may or may not have even the slightest idea about.

The reason for this can be the social stereotypes and taboos that surround mental health issues. Most people, with very minute knowledge and information on the subject, make uninformed comments and label the person suffering as crazy or mad. They project it to be a kind of disorder that can only be treated in a mental asylum with harsh electric shocks. Although a few years ago, there was less information available about the topics of mental welfare and the need for the same, however, as times are changing, there is a lot of knowledge that people can gather from the internet itself. The path to reaching a counsellor or psychologist has become easier than ever and the path to bringing help to someone in need has also become possible. Thus, the way Indians viewed mental health issues has transformed miraculously and possibly for the best.

The Indian heritage and customs since ancient times have viewed the connection that exists between the mind, body, and soul as a crucial one and also the resultant impact of the same on mental health. It broadly narrates how to strengthen the bond between all three aspects of a human’s life and live to the fullest, in the healthiest way imaginable. The government of India strongly surmises that mental health is an indispensable proportion of a person’s wholesome approach to achieving overall fitness.

As a result, India launched its ‘National Mental Health Programme’ in 1982. This policy was formulated in obedience to the World Health Organisation’s (WHO) guidance on providing and implementing mental health services to people who were covered in the ambit of the framework of the general health care system. Back then, India was one of the major WHO’s member countries to take a step ahead in the wake of mental health awareness and policies.

In the year 2013, the 65th world health assembly was organised, during which the WHA 65.4 Resolution was adopted. This resolution is on the worldwide implication of mental suffering and affliction and the necessity for an extensive, synchronised reaction from the health and civilised provinces at the local and regional levels. India had been one of the prime sponsors of this event. The ‘NMHP’ has now been formulated and designed following the intentions of the WHA Resolution. The motive of ‘NMHP’ is to nurture and develop mental health, intercept mental sickness, empower the recuperation from mental sickness, de-disparage, and dis-condemn mental health taboos. It also includes taking affirmative actions to make sure social and economic incorporation of all those suffering from mental maladies by providing them reachable, inexpensive standard health and civil care as per the formulated framework.

Apart from this, India passed its Mental Healthcare Act 2017’ on the 7th of April, 2017. It was enforced from the 29th of May, 2018. This act was in one way historic because it successfully decriminalized attempted suicide, which was regarded as an offence under section 309 of the Indian Penal Code (IPC – 1860). [iii]The law was described in its opening paragraph as "An Act to provide for mental healthcare and services for persons with mental illness and to protect, promote and fulfil the rights of such persons during delivery of mental healthcare and services and for matters connected therewith or incidental thereto." This Act superseded the previously existing Mental Health Act of 1987, which was passed on 22 May 1987. This act corroborates that mental sickness should be regulated in agreement with the national and internationally undertaken medical excellence and standard that also comprises the International Classification of Disease of the WHO. This act also postulates that no individual or institution shall declare a person with mental sickness except for when it is in direct relation to the treatment of the sickness. Above all, India made the consistent endeavour to position its disability and mental health laws following the United Nations Convention on the Rights of Persons with Disabilities. This is very much apparent in the Rights of Persons with Disabilities Act, 2016, and the Mental HealthCare Act, 2017.

India, as a country, has a very long route ahead of itself to achieve the perfect euphoric phase where mental health issues are seen and given equal value as physical health issues are. Sure, it will take time, maybe another decade for things to become as normal as we perceive them to be. However, in the wake of the National Mental Health Policy and the Mental Healthcare Act, 2017, India is not far away from achieving its goal of mental health awareness and seriousness being spread to every nook and corner of the country and the help for the same being available to everyone in the shortest period. With proper implementation of the policies and the law, it would not take much time for India to become a global precedent for setting the example of tackling and treating mental health problems in the most innovative, technical, and friendly manner.

Although, just laws and policies will not be sufficient enough to change the ground reality in the country. It is equally very important to acknowledge that kind of lack in the domain of value-based education. This means that just being literate enough will not change the mindset of a person because he will never be able to understand the value behind treating mental health just like any other normal health issue. The reason for this is most likely to be that he was never taught the same. Thus, it becomes of high significance to inculcate the importance of taking care of one’s mental health from a very young age. So, education on mental health should be included in the school curriculums and even textbooks, so that all beings, from a very early age, know and understand and value the importance of mental well-being and fitness. This knowledge, being disseminated to the citizens from a very young age, will help them treat the issue with much more rationality, and practicality and will also evolve the society as a whole. People will stop creating myths, taboos, and stereotypical notions about mental health issues. They will rather become more understanding of the same and show the same respect for the issue as any other health issue.

Mental health and the problems relating to the same are one of the major crises that the globe is facing in the twenty-first century. It is very important to deal with it in the most convenient, analytical, and systematic manner. Globally and country-wise as well, a lot of legislations are being made to tackle the issue; however, all of this will only show expected good results when they are properly implemented and modified from time to time, based on the changing needs and requirements. India is doing its best to handle mental health matters most logically and it should be able to inspire other nations to do the same, however, there is always room for improvement, for things to get from good to better, and ultimately to the best. And India, as always, will do and achieve its best in this domain as well.

Economic Aspect of Mental Health

Mental health is considered a disease of the working generation. It causes not only because of the individual’s suffering but also because of the economic wastes directly or indirectly linked to that individual’s action. The Social Determinants of Mental Health correlate the condition of a poorer mental health situation with high economic disparities, societal disadvantage and lack of opportunities and rights for the marginalised groups. According to the World Health Organisation (WHO) report, the estimated indirect economic cost of mental health disorders constitutes the income loss due to mortality, care-seeking, and the decline in productivity due to early retirement or work absence turned out to be USD 1.7 trillion. The cost was much higher than the costs of diseases like cancer. By 2030, the economic direct and indirect cost of mental health is expected to rise by double.

An individual’s financial status could be considered a relevant factor in determining a mental health condition. The ones facing a bargained financial security with a low income or poverty status are more likely to fall under the trap of mental illness. The consequence of mental illness not only affects individuality but also equally affects the societal parameters of a country. It is predicted that the employment rate will increase by 4 per cent if the individuals with mental illness contribute the same as those individuals without mental illness. The working hours would elevate by 1 per cent if the individuals suffering from mental illness cover their sick leaves and be present as that of healthy individuals. In developed countries, almost 35-40 per cent of absenteeism is due to mental illness. Poor mental illness is also associated with wage rates. A man with a mental illness often has a reduction in the wage rate. This is not only because of the low productivity level but also because of the hidden costs that are associated when an individual with a mental illness is present in the workplace. These costs take the shape in terms of low stress and frustration tolerance, low communication and attention. The caregivers of the patients with mental illness suffer the equivalent consequences. This marks a huge loss for society’s productivity and efficiency standards.

The relationship between physical and mental illness imposes a substantial burden on the economy. Studies have shown that depression turns out to be a root cause of cardiovascular diseases and diabetes and hence the total health cost due to the amalgamation of physical and mental illness is predicted to rise by 45 per cent. On the contrary, it has been seen that people with mental illness consume more than 60 per cent of the physical health care services than equally ill people without any mental illness. The ones suffering from any mental condition are more likely to pay multiple visits to the doctor than the other, which results in massive consultation and medication costs.

To grow and flourish with full potential, every child deserves good mental health. Poor academic success directs to serious economic costs as several parents picture education as an investment. A child with mental illness thus is most likely to underachieve which results in the loss of investments and productivity in the economy. The consequences of criminal justice further explain the gravity of the economics of mental health. Several mental illnesses are known to be associated with the crimes like homicide, suicide, sexual assault and harassment. Crime is considered to be an economic cost and the overall cost of crimes is considered to be 5 per cent of the overall national income of the UK.

There is a certain emotional burden that is associated with the economics of mental health that cannot be measured in monetary terms. The emotional stress of prolonged suffering and ill-treatments gets amplified when an individual faces any societal isolation, disability, stigma or poverty. The outbreak of the stress then results in an increased number of suicide attempts.

In India, the economic disparities due to mental health have taken a toll on the people’s standard of living. We are very well aware of the sufferings and riots of the farmers in India. The reason behind the massive suicide attempts of farmers is undeniable crop failure and a debt trap. From the reports of the National Crime Records Bureau, there has been a 10 per cent rise in suicide rates due to COVID in the year 2020. More than 1.54 lakh people were dead, out of which 1.4 deaths were due to the pandemic. In comparison to the NCRB 2019 report, the suicide attempt by daily wage workers and unemployed labours has massively increased. The past two years of pandemics have been nothing but an economic and mental burden on the citizens of India. Due to the involuntary unemployment, several low and middleincome countries faced psychological disorders to a great extent. The higher degree of work distress causes a huge degree of depression and anxiety that are mostly seen in the people who are bearing able to make their ends meet. With the work-from-home culture, the ones who can work have shown signs of mental disorders as they are completely isolated from any physical movement of the body and have low social tolerance in society. The short-term economic crisis with the recession has fueled the intensity of the psychological impact on an individual during the pandemic.

In India, mental health is often considered taboo. People are forced to remain silent and keep the issues under the carpet. It is estimated that 71 per cent of Indians still associate mental illness with stigma. From a global perspective, an estimate of overall mental health costs amounts to 7 per cent in the US, 3.2 per cent in China and 1.8 per cent in Australia. The direct cost of the diseases like depression and schizophrenia is estimated at 1-2 per cent of the national health care expenditure which is primarily less than the indirect costs. Thus the negative economic consequence of mental illness exceeds the cost of the treatment.

Low socioeconomic status is often associated with frequent mental health problems. The people who have low economic status are 2-3 per cent more likely to have a mental illness than the people with high SES. The above statement is elaborated with a help of a theory that studies the response of stress to demand and resource imbalance. People with low socioeconomic status are more vulnerable to exposures that impose a greater threat to their health and economic conditions. They are accompanied by few resources to cope with the vulnerabilities. Work-life is one such factor that directly affects the economic status of the individual and mental disorders if there is an imbalance. The work-life conflict has recently been in light of the steady increase in the number of females in the working population. The balance between the professional and the personal worlds has somewhat been unsteady for both genders but in females mostly. As the world is rapidly progressing, individuals are practically evolving and thus the bleak line of distinction between work-life balance is diminishing.

Mental health and poverty have a cyclic link between them in India. It has been seen that people with low mental health have low social status and work performance as mentioned above. As they negatively contribute to the work culture, the income generated by them is extremely low, which is hard enough for the huge households of India. This pushes the people into the poverty debt trap and mental health disorders such as anxiety and depression fuel up their living. Females preferably the mothers representing the low marginalised groups have been seen to have diminishing mental health. They are not even given the right to exercise the therapy plans that are implemented by the government. A child’s health is very much linked with the mother’s physical and mental health. A healthy mother is most likely to have a healthy child who would contribute effectively and efficiently to the economic parameters of the country.

To cover such huge economic direct and indirect costs, no country spends more than 1 per cent of the national income on mental health care. The countries that are developed and advanced spend approximately 0.5 per cent and the poorer ones spend even less. There has been an improvement in the mental health department in terms of evidence-based psychological therapies. These therapies are those that are randomly analysed and are considered to be on average.

People with a chronic anxiety disorder or clinical depression have mostly benefited due to these therapies as they estimate to have 50% recovery rates. Such therapies also have a possibility of relapse and are more addictive than drugs. Yet, the facilities of therapies are only given to a fraction of people in most countries. In 2007, only 1% of the people with anxiety and depression received such therapies in the UK. Such cost-effective therapies possess no net cost to the public fund. As this therapy prevents people from working, mental illness costs the countries a fortune. Hence to pay for the treatment costs, a country must save a lot and the financial savings must be taken into consideration. The mechanism should be set in such a way that it puts the distressed people back to work and the ones who are not employed, the treatment would give them the necessary strength and confidence to face the hustle of the work culture. Not only this, the cost of physical healthcare would decrease as the ones who have improved their mental health would visit their primary care doctor less than before. Hence efficient physical health care would only go to the emergency cases and the ones who incur direct economic costs.

Cost-effectiveness in terms of mental health is extremely important even though the sector receives both private and public spending. In 2020, the contribution of public and private will amount to 280 billion. Still, the finding is limited when it comes to the magnitude of the issue. Mental Health is considered to be one of the major projections of life satisfaction. When the impact of mental health is compared to life satisfaction, it has been noticed that mental health expenditures are comparatively low compared to the other sectors of government expenditure.

The consequences of mental health can therefore impose dissatisfaction in terms of standard of living: absenteeism, poor quality of life, loss in productivity, academic underachievement, hospitalisation and negative effects on physical health.

There are certain challenges and responses under the economics of mental health. Firstly, there are certain leakages in the evidence-based study. There is only a limited understanding of the short-term effects of the impacts of mental illness. The prevention and early intervention have been neglected by the researchers. The economics of mental health limits the research study based on the behavioural aspects of family. The factors such as discrimination, isolation and stigma impact are still not valued efficiently by the government to evaluate the expenditures on mental health. Thirdly, cost-effective therapies have certain setbacks as it is not affordable to every citizen of the country. The country lacks proper research and development teams in this field of economics and hence proper staff and experts are hard to find who could deliver the services of therapies effectively.

Lastly not all economic effects of mental illness are included. The impact of the mental illness has thus interfered with the individual’s intellectual abilities, financial strength and/her participation in the workplace. Hence there are certain invisible effects of the economics of mental health that impose a wider perspective and consequences in society. India being a diversified country has its cultural and economic effects of mental illness that arose out of discrimination to a great extent. The cost-effective policies and implications could be a betterment for a certain group of people or caste and on the other hand, others might see that policy as ineffective. Hence policymaking needs to take a wider eye to cover a considerable amount of people.

Mental health has become an inextricable part of a country’s development policy. In 2021, a total of 13% of people all over the world were affected by mental health disorders. The two important paradigms of a Mental health policy are undoubtedly economic support and the inclusion of mental health as a vibrant part of the ever-evolving definition of Human rights. Both these aspects are indeed related to the country’s state of development. And so, there are differences in how a country perceives mental health or how it is forced to see mental health in its own country. Another analogy that can be equated with a country’s perception of mental health and its relation to the state of development is how people from different sections see mental health, the poor don’t even know the definition of mental health but that doesn’t mean that they don’t suffer from it, the middle class know the definition of mental health but pay no heed to it as it is considered a luxury they can’t afford to have, and the rich care too much about mental health. In the same way, a country’s trajectory to development plays an important role in its perception of mental health which in turn affects the government’s policies and directly affects the people.

Developed Countries

The developed nations have experienced a different trajectory to development. They were the first set of nations to achieve the status of developed nations because they had a head start as compared to other under-developed nations. They started the process of industrialization and colonised the African and Asian nations which provided an impetus to modernization in these nations. Having attained a considerable boost in development, these nations were able to focus on various aspects of human development which would ultimately grow to include various facets of healthcare like mental health. However, there is a substantial difference when we talk about policies for a better mental healthcare system and how people view them, like if it is an issue worth taking treatment for or if it is something that gets better with passing time or even defenestrates the whole issue to begin with. It must thus be noted that many mental health conditions, at least in the beginning stages, can be treated with a lesser expenditure as compared to other health conditions. So, what stands between an efficient system for mental health and its benefits? It is how ultimately people perceive mental health.

Most developed countries have a well-laid-out plan for mental health. Since the very beginning, the Western nations have been proponents of individualism and liberalism, so the stress given to individual rights and freedom is a reason why these countries have been doing comparatively better in terms of policies for mental health, which has immensely contributed to destigmatizing the condition. Providing an efficient system for mental health is only the first step that should be taken toward setting up an adequate mental healthcare system. As we know there are many criteria for ensuring the improvement of mental health in a country, as mental health is directly related to many other aspects like a stable economic, political, and social atmosphere for the nation as well as for an individual. For example- The countries which have a higher rank on the Human Development Index (HDI) are more likely to have better mental health than Germany and Finland.

However, if we are to compare data, developed countries have more mental health issues as compared to other countries. Countries like Australia, the UK and New Zealand which are all relatively developed nations have high rates of mental health conditions like depression and anxiety. On the other hand, countries like Nigeria, Ghana and Cambodia have lesser rates of mental health conditions. There has been a significant increase in the percentage of mental health conditions- a study in England found people reporting mental health problems has increased to 9% in 2014 as compared to 7% in 1993.

The main reason behind this significant increase can be attributed to the readily available resources for people who suffer from mental health conditions. Apart from the country’s ability to provide the people with such resources, the first step that comes to play is dealing with the stigma when it comes to getting help for a mental health condition. The developed countries have been reasonably successful when it comes to destigmatizing several aspects of mental health. The spreading of cognizance is possible due to the flexible nature of society and also because there are lesser issues to deal with when it comes to the nation as a whole. Due to this awareness, people are aware of their rights and duties which provokes them to ask for their rights from the designated authorities. The current status of mental health perception in these countries owes its endowment to the countless social movements that have hastened the destigmatizing process like the Mental Health Hygiene Movement in the early 20th century. The role played by social media has further ushered the cause. It has acted as a medium through which celebrities have talked about their struggles with mental health and has encouraged people to ask for help and normalise the issue. This has helped the developed nations fight efficiently against the biggest problem that people face when it comes to mental health conditions. Most of the time people keep these problems bottled up because they worry about what other people might think of them. Even though the stigma has reduced in developed countries there is still a long way to go. There is a lot of prejudice among people, studies show that only 5 out of 10 people in developed countries are willing to interact with a person who has Schizophrenia. Discrimination is very much present in these countries.

The corporate world is the primary source of economy building in developed countries. Without their effort to address mental health conditions the developed countries won’t be able to make much progress. Nowadays, many MNCs have a separate branch to deal with mental health problems like anxiety or depression. After the COVID-19 pandemic, this effort has doubled because the pandemic has deeply affected the mental health of employees who had to work from home thus making their lives monotonous. And so these MNCs made a concerted effort to help their employee’s mental health which would have a direct effect on their company overall.

Mental healthcare is way more easily available in developed countries. The Mental Health Atlas 2020 by WHO shows that High-income countries have twenty times more beds assigned for mental health patients and more healthcare workers for mental health conditions. The expenditure on mental health is also more in developed nations (more than $50 per capita). There are more investment opportunities because the private sector is also equally involved. There is increasing mobility with telehealth facilities available for people who are dealing with any mental health condition. The main credit is reducing taboo regarding the topic. People are more open than ever, everyone has a personal psychiatrist and it is considered highly important, even the courts also order mandated therapy sessions, in any case, they find necessary.

The developed countries however still suffer a curse from their gift of awareness, there are more cases of mental health conditions than ever, which has given way to an obsession which often leads to unnecessary wastage of resources.

Developing Countries

The developing countries were earlier referred to as the thirdworld nations, which was used to describe the countries that shared a common history of colonisation and were newly independent in the 1950s. These countries shared a lot of commonalities because of their diverse culture that acted as roadblocks in their path of development clubbed with their robbed economy. After facing harsh conditions under foreign control these countries were desperate to speed up the process of economic development after independence. Some scholars referred to their approach to human rights as the third-world approach, for development was the priority and the state’s prime responsibility was to ensure that the concept of the state as a guardian of rights was not given much importance.

Mental health is gaining increasing importance in developing countries, but it is nowhere near where it should be. There are numerous reasons for these countries to fall behind the developed countries in numerous parameters. Even the general healthcare system has a long way to go. In the same way, there are a lot of reasons which contribute to the worsening mental health conditions in these countries and ageold policies which have failed the common man. Some of the reasons are as follows-

● Poverty- is a cause of both physical and mental health deterioration in a developing country. There is still a significant population of people who are living below the poverty line and they often get ignored in the tussle between the government and the private sector. Poverty can force a person to live in poor conditions which may unknowingly generate mental health disorders, research has shown that mental health disorders are exacerbated by poverty. A povertyridden person is forced to live with such disorders without even proper diagnosis which only worsens with time.

● Stigma- In developing countries, the gap between the rich and the poor is significantly much higher than in developed or underdeveloped countries. The main reason behind this is the stratification of people into rich, middle-class and poor in a developing society. And here the dilemma faced by the middle-class community is the grimmest one. If someone from a middle-class community is found to be seeking medical help for mental illness, they are treated differently. The stigma associated with mental health is widening because of a lack of awareness regarding the issue.

● Not at par with physical health- In developing countries, most households don’t go to the doctor unless there is a physical symptom of a disease. And so, mental health conditions are often overlooked because they are considered not as harmful. However, approximately 73% of the suicides in the world happen in developing countries, considering that most of the suicides go unreported. People often tend to let superstition eclipse their mental condition, where, many times, such illnesses are cured by finding a religious or spiritual solution. It not only gives rise to misconceptions but also harbours a patient to get appropriate medical attention when they might need it most.

● Competition and complex social structures- The competition and the will to be on the top is the primary reason behind depression, anxiety and other mental health issues in the developing world. The perpetual risky status of the economy forces people to get into a do-ordie situation that increases the level of stress in their lives thus causing mental health problems. For example, competitive exams like JEE in India, Gaokao in China, etc. cause immense stress in students which often ends up in suicide. The same goes for jobs, the stress starts from getting a job then shifts to getting a promotion then shifts to making it last. This coupled with the complex social structures like casteism, racism, sexism, etc., further makes life difficult for a common man in developing countries.

In developing countries, the effect of poverty is the prominent cause of mental health illness. Not only does it bar the person from getting medical help but also makes him/her isolated from society. Lack of equal opportunities and rampant nepotism often becomes the source of mental health problems. The stigma then contributes to further worsening of the condition

If we talk about the Mental healthcare system in developing countries, the government is not putting nearly enough effort to help the people because other health conditions often steal the limelight. There is a substantial dearth of psychiatrists in developing countries because medical professionals often prefer other branches and there is also a lack of qualified nurses for mental health conditions. The growing population also increases the mental health complexities for both the government and the people.

The improvement of mental health conditions in developing countries lies thus on the twin pillars of central mental healthcare planning and investment and the second would be changing the narrative that mental health conditions have in these countries, for that awareness programs and campaigns in the rural parts of the country would help indefinitely. There needs to be a nexus between mental health services and the needs of the people. Because still there are many followers of superstition who don’t even consider going to expert medical professionals. This practice is directly linked to the expensive treatments that doctors follow and mental healthcare is poorly equipped in government hospitals. So, the low to middle-class people in developing countries prefer taking the cheaper alternative which is a traditional or religious healer. This whole industry solely thrives on the disbelief of people which emerges from their distrust of anything Western. Their colonial pasts are irretrievably latched to their psyche to a degree that it even clouds scientific truths like proper medical attention. This gave rise to many alternatives, most of them just built on the premise of fooling people.

In many developing countries, the government has been increasing its efforts to build a holistic mental healthcare system. With the increasing permeability of technology, developing countries are forming a consensus on a need to focus on a scientific path to cure mental health conditions in these countries. Countries like India, China, Iran, Bangladesh, etc. have made efforts in this area. But the task ahead of them is enormous and will take plenty of years to make a change, so the effort by the people to change their outlook regarding mental health has to also go simultaneously.

Underdeveloped Countries

For a long period, it was believed that depression, anxiety, and other mental health illnesses were considered to be a thing of the rich or the developed nations. Even now this is a largely believed theory by many people. Thus, according to this theory, underdeveloped countries are immune to mental illness. Even the data support that there are more cases of depression in high-income countries (15% population) as compared to low-income countries (11% population). However, there is a huge discrepancy in this data because in underdeveloped countries there is hardly any record of data for mental health. The people in underdeveloped countries have a wide range of issues to fight against and when it comes to mental health, it's not just that people are not aware of the lethal condition but also that they often get mixed with other conditions like poverty, lack of resources, injustice, etc.

The underdeveloped countries are still suffering from the ills of colonisation that are causing a rippling effect even now. They failed to emerge from the post-colonial aftershock and have since been fighting the ghosts of a ruined economy. There is a significant lack of capital which directly affects any policies of the government. Many of these nations are still fighting ethnic wars amongst themselves like in Somalia, Rwanda, Syria, etc. The unstable economical and political situation of the country has left the country in perpetual war mode which has worsened the condition of civilians in these areas. The people have to often rely on foreign aid for any support of the economy but due to a lack of a stable government, the aid fails to achieve anything in these countries. The perception of people is thus directly associated with what position the country has given to Mental health. And when there are so many issues to deal with, both the perception and priority of mental health get lost.

Mental health in underdeveloped countries is often linked to external factors like social injustice, poverty, malnutrition, pandemic, war, etc. When a psychiatrist named Vikram Patel during his study in Zimbabwe asked locals what their perception of mental health was, they called it an extreme concern regarding any problem which can be thought of as social injustice. However, there is a largely believed narrative among the people that mental health problems are a source of cultural hegemony used as a modern tool of neo-colonialism, which repels many people who are still bitter about colonisation by the rich. They believe that such cases are not possible in countries where a strong communal feeling is present. This adversity of perception is the reason why there is close to no medical help available for mental health in underdeveloped countries.

Mental illness is among the 25 leading causes of the Global Burden of Diseases. The underdeveloped countries have an amplified effect of any negative change because they have the lack resources to withstand it. Climate change is also emerging as a major cause of mental illness in many countries, for example in Bangladesh after the 2019 floods 57.5% of the survivors had suicidal tendencies. With the effects of climate change and diversity, people can lose their livelihood which can be a source of anxiety and depression thus causing mental health disruption. And this effect is much more staggering in underdeveloped countries.

Absolute poverty is an indicator of health, so it is tacit that mental health in underdeveloped countries comes with poverty. Childhood poverty causes inadequate literacy which leads to a lack of awareness and knowledge about mental health. There is usually generational poverty that follows then which causes the youth to indulge in rogue activities like drugs and violence ultimately causing the whole country to fall prey to the wide term of mass poverty. Studies suggest that low social and economic conditions have eight times more chances of causing Schizophrenia, which in turn shows that they won’t be able to gain employment due to the largely prevalent prejudice.

In Low- and Middle-Income Countries (LMIC), the budget for mental health was less than 3% of the health budget. The plight of underdeveloped and developing countries overlap when it comes to poverty, it is just the scale that differs. In developing countries, some rich people enjoy a mental healthcare system like that of the developed countries and the government is also trying to link technology and mental healthcare and releasing schemes that can help people with mobile phones. There is a lack of equity in developing countries but when it comes to underdeveloped countries there are only a handful of rich people and the majority of people live in poverty. Mental health is like a far-off concept to them much like living in luxury.

People in underdeveloped countries are more susceptible to mental health conditions because they have a lot of stress in life and are often forced to take steps that they don’t want to. There is a perpetual feeling of injustice which has become a budding cause for terrorism in many countries, it has also become a source of tension in society. The youth is brainwashed and made to join such terrorist institutions which affect their fragile state of mind thus increasing susceptibility to mental health problems.

Ultimately the problem is linked to the economic condition of the country that has affected all the people equally in underdeveloped countries. The burden falls on the world to support these countries and to provide them with a basic healthcare system that could help pull out these countries from the verge of poverty to at least the status of a developing country. The growing importance of mental health has further accentuated because of the ongoing COVID-19 pandemic. And the underdeveloped countries were badly affected because of the pandemic and once again the mental health of the people worsened because of the falling economy. Though mental illness is more prevalent in high-income countries because there is effective infrastructure in place to deal with such conditions and people are also more accommodating. The developing and underdeveloped countries still have a large population of people who are suffering quietly.

Mental Health Conditions in the Below-Mentioned Nations

Globally mental health illness is reaching an unprecedented level. According to the reports of the World Health Organisation, mental health problems account for 30 per cent of the total burden of diseases that are non-fatal and an estimate of 10 per cent of the overall burden of diseases that include disability and death. According to reports by WHO mental health is the most neglected area of health globally. This has drastically increased post the pandemic period. There are several reasons for ignorance towards mental health such as associated stigma, it is also not considered an actual illness. Currently, nearly 1 billion people in the world live with a mental disorder and approximately 75 per cent of the people in low-income countries do not receive treatment. By the age of 14, 50 per cent of people suffer mental health disorders and every 40 seconds a person dies due to suicide.

Across the globe, many mental healthcare institutions are constantly trying to create pressure on the governments to identify and bridge the gaps that are causing mental health issues.

Caribbean Nations

A combination of reasons are the cause of neglect towards mental health issues, these might be economic, cultural, social or political. The degradation in mental health is also a result of the socio-economic situation of Caribbean Nations which has allowed income inequality, poverty and unemployment to be deeply rooted in their society. The countries of the Caribbean only spend 4.3%[1] of the healthcare budget allotted to them for mental healthcare. Another factor that contributes to reoccurring mental health issues in the said nation is the social stigma and taboo that revolves around it.

Further, it has been suggested that all the Caribbean Nations need to introduce certain policies and practices in mental healthcare. Countries like Guyana and Suriname have the highest rates of suicides in the entire world. Communities at the grassroots level and local NGOs such as Swarnapath and the Guyana Foundation come into force and bridge this gap, the results of their efforts are impressive and they continue to be resilient.

Pacific Nations

The Covid-19 pandemic has led to unemployment in several countries in the Pacific. Though it has been observed that there is an increase in the number of people who are now accessing mental health services, however, it has also been highlighted that the alarming spike in the suicides committed across the Pacific Nations is disturbing. The International Committee of the Red Cross provides funding that enables the Red Cross Societies to develop programmes to spread awareness on Psychological support and mental health.

Asian Continent:- India, China, Burma, and the Middle East Part of Asia

The largest continent i.e. Asia in terms of an area that exceeds a population of 3.5 billion people cannot be considered a homogeneous continent. Therefore mental health across this continent is not standardised and is extremely varied. According to the World Health Organisation, approximately one-third of the population which is suffering from depression resides in the South Asian region, making it the home for the majority of depressed people.

Some aspects of mental health such as community care for the mentally ill people, social security for the mentally disturbed, and free treatment for mental health patients, are usually taken for granted in developed countries that are not available in the vast region of Asia. Despite the emphasis put on mental health internationally during the time of the pandemic, Asian countries are still in slumber. The reforms that are needed in the Asian society concerning mental healthcare need to be preceded by building blocks of change in the perception of society towards it.

Hopefully, shortly this will eventually trigger the awareness that is lacking in Asian countries such as Pakistan, India and China. Along with spreading awareness the institutional image of mental healthcare should also be reformed. Lastly, the people of Asian countries are to be educated and involved in NGO work about healthcare. This will in turn boost and improve the understanding among the people about the basics of mental health and mental illness. The factors that contribute to pushing a person into depression might be domestic violence and poverty and in south Asian countries it might also be the gender of the baby. One of the major victims of the above-mentioned issues is women and due to the social stigma surrounding mental healthcare, they do not receive any form of mental healthcare support. In certain countries where due to lack of economic support the government is unable to make mental health a priority, NGOs are making efforts to provide crucial support to the people who are suffering from mental health issues. Certain international level NGOs are extending their support to the South Asian nations and are providing specialised mental health services, taking the example of the Maldives, where several NGOs have offered life-skills training, rehabilitation services and “resilience building around social issues” training to people of the country. The said effort has brought a drastic increase in accessible mental healthcare in South Asia.

It is a fact that discussing mental health in Asian countries is considered taboo and should be socially normalised as it is the need of the hour.

African Continent

Depression is considered the most prevalent mental health issue in the entire world. Presently, an average of 100 million people in Africa alone suffer from clinical depression, of which 60 per cent are women. The Covid-19 pandemic has led to disruption in critical mental health services in 93 per cent of the countries as the demand for mental health programmes has increased over time. For the African continent, depression can be considered a silent epidemic as the majority of African women do not get access to these mental health services.

World Health Organisations has been endorsing interpersonal psychotherapy and front-line mental healthcare for the vulnerable population. In countries like Zambia and Uganda, women are unable to perform essential social responsibilities. The African women who have depression as compared to other healthy peers, suffer more. As a result of this, the women become less productive, have physical health issues and have lower incomes as well.

Suggestions on Mental Health

Mental Health plays a crucial role in determining an individual’s emotional, psychological and social well-being. An individual without any mental illness is likely to contribute positively to the economic aspects of the country, work productively until full potential, cope with the hardships and struggles of life and lastly is more likely to attain selfsatisfaction from the standard of living.

There are certain ways where the mental health of an individual could be improved.

• A Positive Mindset: A healthy individual is more likely to find a balance between positive and negative emotions. It is observed the way we perceive a particular situation through our brain sensibilities, that is how our actions toward the particular situation would correspond. Life’s all about ups and downs. Hence it is necessary to protect our mental health by detoxifying the negative emotions. An individual could isolate himself/herself from sources that could potentially generate negative pieces of information.

• Practice Gratitude: Practising gratitude can help an individual see his/her life differently. Through constant gratitude, one gets aware of the positive aspects of life. An individual starts to evaluate more positives over the negative consequences and hence be thankful for it.

• Prioritizing Physical Health: Physical and mental well-being are directly linked with each other. Hence it is important to take care of the body just like our mind. Regular exercises with good nutrition could increase the productivity of an individual with strong mental health. Having enough sleep could relax your mind and give proper rest to your body. It has been seen that taking proper nutrition helps to reduce depression and anxiety to a great extent.

• Relaxation Techniques: To improve mental health, an individual must perform certain practices that would slow their breathing, and lowers blood pressure and stress. Practices such as deep breathing exercises include taking slow and deep breaths that would improve the concentration of an individual and increase their patience tolerance. In addition to that, progressive relaxation and guided imagery help an individual to focus on positive images.

• Effective Work-Life Balance: Concluding the analysis of reports from different organisations, it has been seen that mental disorders have mostly been detected in people of the working age group. It is due to an ineffective work-life balance. An individual could only have healthy mental well-being when there is an adequate balance between the professional and personal lives. As the world is rapidly progressing, an individual’s contribution in productivity and labour hours are also increasing which eventually results in massive stress and mental pressure. Whereas stress is said to have a nullified effect with positive effects on personal life. Humans are social animals and they thrive on relationships and connections. Thus, the social tolerance of an individual helps to boost the hormones that reduce stress, depression, anxiety and frustration. To help the individual reach its maximum capacity, the corporates have come up with a healthy work environment that is designed specially to protect the mental health of an individual.

Lastly, several experts offer services like therapies that run intending to assist an individual suffering from any mental illness. Like other fields of economics, the economics of mental health has now been one of the prioritised agendas of the country.