Physician Heal Thyself: ‘Mental Health is a Universal Human Right’

World mental health day is an important health awareness event celebrated every year on 10 October to create acceptance, awareness, healing and promote the importance of sound mental health in one's life and society. This day aims to educate people including physicians about the stigma of mental illness, and encouraging people around the world to support and help the cause, and establish a healthy environment in all aspects of life.

World mental health day was first organized on October 10, 1992, by World Federation for Mental Health, a global mental health organization having a presence in more than 150 countries. The initiative was proposed by Richard Hunter, Deputy Secretary General of the World Federation for Mental Health, in 1992. Till 1994, the day was observed without any specific theme; it was mainly focused on educating people about the general issues of mental health. Later in 1994, the day was celebrated based on the theme and the theme for the year 1994 was “Improving the Quality of Mental Health Services throughout the World”. Since then, World Federation for Mental Health has announced a particular theme to promote and educate people about mental health issues, its preventions and supports to create a better opportunity for mentally affected people.

The 2023 World Mental Health Day theme is 'Mental health is a universal human right'.

Discrimination in various forms, harmful stereotypes set by the society and heavy work with stigma in the community, family, medical schools and the workplace prevent healthy relationships, free social interactions and the inclusive environments needed for the well-being of all members of society. The global campaign aims to place mental health in a human rights framework to re-cast the aspiration for sound mental health as a fundamental human right.

Key Facts in India

• Affordable, effective and feasible strategies do exist to promote, protect and restore mental health.

• The need for action on mental health is indisputable and urgent.

• Mental health has intrinsic and instrumental value and is integral to our well-being and performance.

• Mental health is determined by a complex interplay of individual, social and structural stresses and vulnerabilities.

Indian Scenario of College Students

What are the statistics of students’ mental health in India?

Indian Council of Medical Research (ICMR) survey in 2021 revealed that 12–13 per cent of students in India suffer from severe psychological, emotional and behavioural conditions. The stigma is due to lack of awareness in students themselves, their parents and friends, denying mental health symptoms which manifest, poor or inadequate treatment among college students, and it contributes to the persistence of mental health problems in this population. UNICEF conducted a 21-nation survey the same year on help-seeking behaviour and found out that only 41 per cent of young people in India seek support for mental health problems, compared to an average of 83 per cent for 21 countries.

Identifying protective factors, early symptoms identification, and treatment of psychiatric conditions will have a favourable impact on the prognosis of the disorder. Some of the protective factors that can buffer the effect of stress are loving caregivers, safe home, school and college environments and healthy peer relationships. The stigma and poor funding of mental health services come in the way of experiencing positive mental health or accessing the support they need.

It is necessary to sensitise teachers and make them aware of the psychological conditions and the available interventions so that they can help students. Workshops on identifying basic mental health issues and psychological first aid can help in achieving this objective.

Is Medical College in India Different?

Doctors have been revered in Indian communities, and medicine is cherished as a dream profession among young students. Nevertheless, Indian medical students are not immune to the stress of medical life and its lifestyle. The battle begins much before admission to medical colleges while preparing for admission tests itself.

A recent Right to Information (RTI) response from the National Medical Commission (NMC) in 2022 said that 64 MBBS and 55 postgraduate medicos died by suicide in the last five years in India. Additionally, 1,166 students dropped out of medical colleges. Of these, 160 were studying MBBS and 1,006 were pursuing postgraduate courses. Concerned over the incidents of suicide and suicidal ideation among medical students, the NMC, India’s apex medical education regulatory authority, late in 2022, asked all medical colleges in the country to compile data on suicides, and drop-outs among undergraduate and postgraduate students over the past five years.

In medical colleges, the prevalence of depression and anxiety among students is very high. The incidence of depression ranged from 1.4% to 73.5%, and the anxiety ranged from 7.7% to 65.5% among medical students. Female medical students were more vulnerable to anxiety and depression than male students. The associated factors with depression and anxiety are female gender, economic condition, academic pressure, etc. Furthermore, the rate of depression and anxiety among medical students fluctuates across the academic years. This probably due to the difference in academia and student life from one school to another. Depression and anxiety cause hindrance to medical students’ academic career and later to their social life. It is suggested that these factors should be considered among medical students, and students should be provided psychological counseling in their early academic years. Students’ support unit should help them in alleviating their associated factors that may jeopardize their bright career [1].

One-fourth of the medical students were detected to have depression and/or anxiety disorders. Establishing student mental health services, taking into account the perceived barriers, will go a long way in improving medical students' mental well-being. Preference for informal consultations, concerns about confidentiality, and preference for self-diagnosis were the most commonly reported barriers to mental healthcare seeking. Students with psychiatric disorders perceived more barriers to mental healthcare seeking than students without psychiatric disorders [2].

Anaesthesiology (22.4%) followed by obstetrics-gynaecology (16.0%) had the highest suicide deaths. Academic stress among medical students (45.2%) and residents (23.1%), and marital discord among physicians (26.7%) were the most noticeable reasons for suicide. Mental ill-health was the next most common reason in medical students (24%) and physicians (20%), while harassment (20.5%) was a cause for residents. Up to 26% had exhibited suicide warning signs, and only 13% had ever sought psychiatric help before ending their lives [3].

Burnout, defined as a syndrome caused by chronically stressful work environment, is a significant finding across samples of medical students. Burnout can further lead to full-blown mood or anxiety disorders, suicidality, and substance abuse. It can also have physical consequences such as hypertension, diabetes, weight changes, and headaches and occupational consequences such as absenteeism and quitting [4].

Drug use is a common phenomenon in medical colleges, and it has been seen that students may abuse substances to make themselves feel better, deal with stress, and sleep.

Preventive Tips & Effective Ways to Promote Mental Health Awareness in Practising Gynaecologists

• 1. Be Vocal if you identify anyone with mental health issues and have open (accepting) mindset towards Mental Health Issues.

• 2. Keep yourself informed about the warning Signs and Symptoms of Mental Illnesses. Some of the prominent indications includes changes in sleep and eating patterns, persistent sadness, antisocial behaviour and mood changes.

• 3. Be kind and compassionate towards others working with you.

• 4. Don’t hesitate to avail and promote free mental health screening.

• 5. Participate in Awareness campaign and support the cause.

• 6. Learn and implement proper healthy lifestyle to improve the mental wellbeing of your family and yourself.

• 7. Encourage and support the affected one to get diagnosed and avail proper mental health programs based on their signs and symptoms.