It had been a year since the Delhi-based college lecturer lost her father. But she still had frequent episodes of anxiety and prolonged sadness. “One of my close friends suggested I see a therapist. I felt weighed down by sadness all the time and it had started affecting my work as I was unable to concentrate," says the 40-year-old.

The therapist suggested that she meet a psychiatrist too. She was diagnosed with bipolar disorder II. Though it’s characterized by extreme mood swings, the cycles are far less intense than in bipolar disorder I, and many people are able to lead normal lives.

“My first thought was how my husband and family would react. Bipolar disorder sounded like a serious mental disability I was unable to associate myself with. I had no idea that it was a common mental disorder," says the lecturer.

The list of what are described as common mental disorders (CMDs) includes personality disorders, milder forms of depression, stress disorders, obsessive compulsive disorder, anxiety, eating disorders, phobias and disorders related to substance abuse.

According to a 2011 World Health Organisation (WHO) report, one in seven people in India, or 15% of the population, is depressed. A 2012 WHO report said India accounted for the highest number of suicides in the world. Experts say mental health issues, like depression, are among the biggest triggers for suicide in India.

Stigma and lack of awareness

Yet CMDs remain closet ailments, both due to lack of awareness and fear of social stigma. Inevitably, then, they are little understood.

“According to various estimates, 13-15% of the Indian population suffers from common mental health disorders, yet 90% of these people go untreated," says Manoj Chandran, chief executive officer of White Swan Foundation, a not-for-profit that works on mental health awareness. People suffering from a CMD may continue to lead a normal though sub-optimal life.

Take the issue of substance abuse. The founder of the Pune-based de-addiction centre Aasra Foundation, Ashesh (who did not want to disclose his surname), is a recovering addict who gave up drugs at least 10 years ago—this is how he describes himself because substance abuse is something people struggle with all their lives, even after they have given it up. “Instead of being seen as a personality and emotional disorder, substance abuse is seen as a social evil," says Ashesh. “Even though donating to the foundation helps obtain tax exemption, people would rather avail that exemption by donating to ‘other respectable causes’," he adds.

The Aasra Foundation is a rehabilitation centre which provides treatment to individuals and helps recovering addicts join the mainstream by organizing group activities and discussions.

This fear of stigma leads to a sense of shame in those who are suffering from a CMD.

“People are not ashamed if they have diabetes or a heart ailment, but when it comes to saying they have had a breakdown, they would never say that. People are afraid they would be colloquially categorized as ‘mad’," says Anna Chandy, a Bengaluru-based transactional analysis practitioner.

The first, most important step is to accept that one is suffering from a CMD. “The later the diagnosis in cases like schizophrenia and depression, the more difficult it becomes to address and manage the problem. Also, the impact on family and friends is huge," says Srividya Rajaram, a clinical psychologist at the Adiva super-speciality care hospital in New Delhi.

Small share of the pie

While there has been some conversation around the topic after Padukone’s outing, philanthropic funding and activity in this field remain scarce.

“The (philanthropy) pie for this sector is very small. We need to sensitize our society to the needs of these people and thereby increase this pie," says Archana Chandra, administrative director of the Jai Vakeel School.

The few donors in this area are usually people who have first-hand experience of managing a mental illness or disorder. For instance, The Research Society For the Care, Treatment and Training of Children In Need of Special Care, also known as Jai Vakeel School, in Mumbai was founded in 1944 by Hormusjee Vakeel and his wife, whose daughter suffered from Down’s syndrome.

“The primary reason (donors shy away) is the stigma attached to mental health. A bigger challenge is the lack of awareness and a fragmented view of what ‘mental health’ as a field encompasses and how it directly affects our physical health," says Harsh Mariwala, chairman of Marico Ltd, maker of Saffola and Parachute oils and founder of the Mariwala Health Initiative (MHI). The MHI supports iCALL, a free counselling helpline run by the Mumbai-based Tata Institute of Social Sciences.

“There is so much stigma attached that donors, especially individuals, do not like to be associated with any such cause," agrees Monica Kumar, managing trustee and clinical psychologist at the Manas Foundation, a New Delhi-based trust founded by a group of mental health professionals that deals with CMDs through counselling services.

Most people have little or no understanding of the importance of mental health—or the range of ailments. And if they do, they may not know how to help. “One of the fundamental issues in the mental healthcare sector today is the lack of access to knowledge," says Chandran.

“The invisibility of mental health concerns, a lack of common framework on the correlation between mental health concerns and effective treatments, and the sheer breadth of what all is defined as mental health dissuades philanthropists from making mental heath a priority," says Mariwala. It’s easier to understand issues related to poverty or education.

Another reason for CMDs being overlooked is that “the language of communication with organizations has not yet evolved in the area of mental health. For instance, donors are unlikely to be able to quantify feelings of loneliness or helplessness," says Kumar. “Funders look at numbers and outcomes, and it is very difficult to evaluate counselling sessions."

The need for a larger pool

Certainly, there is a lot that needs to be done. Donors could help by creating portals, organizing chats, workshops and other awareness modules, setting up more counselling centres and forums for open dialogue, says Kumar.

Currently, “less than 1% of the healthcare budget is meant for mental health. There are only 43 state mental health institutions in the country and for the 1.25 billion people in this country, there are only 3,500 psychiatrists," says Chandy.

“If CMDs remain unattended and untreated, they can create immense economic burden on society and nations, not to speak of the adverse long-term social impact," says Chandran.

The college lecturer would agree. “Before teaching any class, I have to prepare myself for it. There are a lot of readings that need to be done. Students can come up with anything and you have to be prepared to tackle the questions," says the lecturer, who worried about the quality of her interaction with students before she started getting treatment.

Typical reactions to CMDs range from “Snap out of it" to “Use your willpower to fight it". But just like you can’t stabilize your blood pressure merely through willpower, you can’t just snap out of depression or fight a CMD. “The idea is to make mental health a topic that people can talk about openly and freely without being ridiculed," says Rajaram.

The silver lining

Since most CMDs are treatable, timely attention can result in a surge in productivity and overall well-being. “Given the sheer scale of mental illnesses, it cannot and should not be ignored as a focus area for our time and money," says Amit Chandra, managing director of private equity firm Bain Capital. Amit supports Jai Vakeel, with which his wife Archana is involved.

According to WHO’s Mental Health Action Plan 2013-2020, 76-85% of people with severe mental disorders receive no treatment for their disorder in low-income and middle-income countries. The World Bank has categorized India as a lower-middle income country in WHO’s 2014 Mental Health Atlas.

Can that change? “Philanthropy has in the past helped advance public awareness, influence public policies, and catalyse services (in other areas), and all of this can be replicated in the field of mental health," says Mariwala.

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