Draft 2.0 August 2, 2018.
Prof. N. N. Wig Oration, PGIMER, Chandigarh, September 16 2018.
Future of mental health
SUMMARY
Care of persons identified as suffering from mental disorders, over the course of human
history, has been an evolving process. The processes to recognise who are suffering from
mental illness and where and how they should be cared for and what will be their position in
the society after recovery has been influenced by social, economic and political factors of the
time.
There was a time, earlier to the 17 century, where even the organised church had an official
document, ‘malleus maleficorum’ , authorising identifying and punishing the persons, who
will be diagnosed as mentally ill today. In the 19th century, Dorethea Linde Dix, pioneered
building ‘asylums’ as it was felt homes are the wrong places for the ill to be in. Clifford
veers, author of ‘A Mind that found itself’(1908) brought home the horrors of mental
hospitals and started the ‘mental hygiene’ movement. The advent of psychoanalysis enlarged
the canvas of mental health to include nearly every one both in terms of the need and the
people who could address the needs. The world wars followed by the welfare movements in
Europe, along with the discovery of the pharmacological agents to influence ‘behaviour’ led
to massive ‘deinstitutionalisation’ . This process has brought us to current situation of
recognising the human rights of the persons with mental disorders. A remarkable change
from viewing ill persons as bad, to mad, sad and ; like anybody in the community’. Al, of
these changes were associated with many changes in the places of care and place of ill
persons in the society.
Prof. Wig was a person ahead of his time. More than three decades back he expressed the
then radical view,
“Mental health is too important to be limited to mental health professionals”.
This vision of mental health implies that, (i)mental health is a subject of interest to all people,
all aspects of society, (ii)wide range of interventions are needed for mental health of the
society, and (iii) all people in the society could be part of the mental health movement.
This vision of Prof.Wig, is relevant to the world mental health and of special interest for
mental health in India in the current times. The subject of my oration will be examine the
applicability of this visionary viewpoint in the current context and present some thought for
future of mental health.
The current challenges of mental health in India are:
‘Unmet need’ mental health care continues to be high, over 80%;
Societal changes in India, like the increasing urbanisation, break up of the joint
family, both working parents, aspirational youngsters and the impact of the mass
media have been well recognised to have mental health implications.
Issues like farmers suicide, substance abuse, domestic violence, are discussed in the
public domain, but often in economic/legal terms and not in terms of the mental
health dimensions.
Enhanced recognition of wide range of systems of health care (Ayurveda, yoga,
naturopathy, homeopathy, etc) presents both an opportunity and a challenge, in
providing the community with evidence based mental health care.
There is inadequate leadership of the mental health professionals in the social issues,
though the recent position of IPS with regards to Section 377 is a welcome one.
For mental health to be a PEOPLE movement rather than being limited to professionals, there
is need to examine evidence in seven areas.
1. Evidence for mental health relevance to society beyond clinically diagnosable mental
disorders;
2. Evidence from the biological(brain) basis of mental disorders and mental health
issues;
3. Evidence of the social factors for mental disorders and mental health issues;
4. Evidence of mental health interventions, beyond ‘medical’ interventions;
5. Evidence for ‘non-professionals’ to be part of mental health movement;
6. Evidence of societal interventions for mental health of all people; and
7. Feasibility of applying this vision and mission in the current world.
The scientific evidence for each of these statements arising from the vision of Prof.Wig
would be critically presented.
The second part will focus on what does this vision Prof.Wig will mean for the immediate
future of mental health of the world and India in particular.
I would like to see the following in the coming decades:
1. Mental health should receive higher position in the hierarchy of needs of individuals,
families, communities and the Government.
2. Mental health care will be seen beyond clinical conditions and will include
promotion of mental health and prevention of mental disorders;
3. Most of the mental health care will occur at the level of individuals, families, in the
community and not in ‘institutions’;
4. There will be greater efforts at empowering individuals, families and communities
towards ‘self-care’ for mental health;
5. There will be recognition and response to mental health implications of
developmental processes;
6. There will be leadership of mental health professionals to work with the sectors
beyond health, like education, welfare, labour, law and justice, environment and
human rights;
7. There will be increased multi-disciplinary and multi-dimensional initiatives for
understanding all aspects of mental health .
Prof. Wig was an Institution and his thinking was far ahead of thinking of his
contemporaries. His view “ Mental health is too important to be limited to mental health
professionals” is appropriate to our times. We all will do well to follow his broader approach
to mental health. This will be the best tribute and celebration of his life, by each one of us.
