Tackling Kerala’s mental health challenge

Deaths by suicide have become a subject of discussion in Kerala. The topic entered public discourse after several individuals, including police officers, ended their lives due to political and administrative pressures. There is no doubt that those responsible for the immediate causes of these tragedies must be held accountable. However, this debate cannot be restricted to politics alone; we must acknowledge that the underlying cause of the rising suicide rate is the fragile mental health of the Kerala population, and adopt urgent remedial measures.

Kerala has among the highest suicide rates in the country. According to the 2022 National Crime Records Bureau report, the national average suicide rate per one lakh population was 12.4, while in Kerala, it was 28.5. Only Sikkim (43.1) ranked higher.

Studies conducted on the mental health status of Kerala’s population present a worrying picture. There was a dramatic increase in mental health issues, from 272 per thousand in 2008 to 400 per thousand by 2018, as stated by the 2021 study, ‘The burden of mental health illnesses in Kerala: a secondary analysis of reported data from 2002 to 2018’, conducted by Jaison Joseph, D. Hari Shankar and Devaki Nambiar. This suggests that a vast section of Kerala’s population is facing severe mental health challenges, with an estimated 12% suffering from severe mental illnesses that necessitate hospital treatment and care. The contrast with the national trend is stark, where the number of individuals with mental health issues either decreased or remained stable in the same period. This suggests that while the mental health sector has seen progress nationally, the problem has intensified in Kerala. The National Mental Health Survey 2015-16 too shows that rates of depression, anxiety disorders, and suicidal tendencies are significantly higher in the State than the national average. Further, Kerala’s poor mental health status is a primary contributing factor to growing social evils, such as drug addiction, violence against women, alcoholism, aggression/violence, and superstitions.

Resolving this crisis requires the implementation of comprehensive mental health programmes from childhood to old age. Health programmes in educational institutions need to be revamped to protect both mental and physical health, providing students with necessary health education. The functioning of existing counselling centres at the school and college levels needs to be scientifically evaluated. Teachers and parents need to receive training, and counsellors need to undergo refresher training appropriate for the modern age. The operations of the Health Department, medical colleges, hospitals such as the Mental Health Centre in Thiruvananthapuram and the Government Mental Health Centre in Kozhikode, the Institute of Mental Health and Neurosciences in Kozhikode, and the State Mental Health Authority need coordination and strengthening. Also, the services offered by the private sector and voluntary mental health organisations need to be strategically utilised to broaden the support network.

Critically, the severe shortage of mental health practitioners requires attention. While the recommended global norm is three professionals each per 10,000 people (Psychiatrists, Clinical Psychologists, Psychiatric Social Workers, and Rehabilitation Workers), the actual numbers in Kerala are distressingly low: 0.12, 0.06, 0.006, and 1, respectively. Urgent steps, such as increasing the number of seats in existing courses and launching new programmes in additional centres, are necessary to bridge this deficiency in trained manpower.

Kerala does not accord the same priority to mental health issues that it gives to communicable and non-communicable lifestyle diseases, and the surge in the suicide rate is a direct consequence of this neglect. Given that the increase in deaths by suicide have become a widespread topic of debate, society must recognise this problem as a major public health crisis. The government, the Health Department, health experts, and professional organisations need to advance comprehensive and long-term action plans to improve mental health.

B. Ekbal is an academic, a neurosurgeon, and a public health expert. Email: ekbalb@gmail.com. People in distress or having suicidal thoughts can seek counselling by calling the suicide prevention helpline number: DISHA – 0471-2552056, 1056 or any of the numbers found in this link.