Mental health in an unequal world is the global theme for World Mental Health Day 2021.
Are the social structures, cultural beliefs (stigmatisation), policy directives and infrastructural support systems perpetuating inequalities in mental health care? Studies show linkages between inequality (in income, social position, access and control and decision-making) and increasing poverty, and between poverty and mental illness. For a child’s social and behavioural development, poverty and mental health can be the key determinant for mental well-being. Inequalities in mental health can emerge early in life and get pronounced throughout childhood.
In the context of Nepal, poverty, inequalities and mental health operate in two directions: the state of being poor, or living in a deprived area, and structural discrimination can bring about mental health problems, such as anxiety, depression and other psychiatric disorders. Or mental health problems can lead to poverty due to discrimination in employment, education, work-life balance and other livelihood opportunities.
Mental health care continues to be the most neglected sector in health care, including in the post-COVID-19 scenario. It is estimated that three out of four people suffer from mental disorders.
The sector is challenged by limited diagnostic and treatment facilities and unavailability of human resources. There is a lack of trained community mental health workers, and those trained do not receive regular refresher courses.
During the COVID-19 pandemic, the closure of educational institutes has affected children. And there is growing fear about infection during geriatric care, leading to anxiety and depression.
Policies and health care action plan need to consider the changing health scenario and the intersection of poverty, inequality and mental health problems. Limited attention in addressing mental health care means an increase in poverty conditions, reversing the developmental goals.
Mental health professionals need to incorporate an understanding of poverty stressors and address family and community dynamics, including the differential needs and priorities of different groups of women and men.
When the caregivers feel ashamed, embarrassed and are unable to cope with stigma, it will have a negative impact on mental well-being. There are campaigns and policies to address discrimination against Dalits, but there are no largescale awareness campaigns to address the prejudices and discrimination faced by people and family members with severe mental illness.