Mental health related stigma, service provision and utilization in Northern India: situational analysis

Abstract

Stigma, discrimination, poor help seeking, dearth of mental health professionals, inadequate services and facilities all adversely impact the mental health treatment gap. Service utilization by the community is influenced by cultural beliefs and literacy levels. We conducted a situational analysis in light of the little information available on mental health related stigma, service provision and utilization in Haryana, a state in Northern India. This involved: (a) qualitative key informant interviews; (b) health facility records review; and (c) policy document review to understand the local context of Faridabad district in Northern India. Ethical approvals for the study were taken before the study commenced. Phone call in-depth interviews were carried out with a purposive sample of 13 participants (Mean = 38.07 years) during the COVID-19 pandemic, which included 4 community health workers, 4 people with mental illness, 5 service providers (primary health care doctors and mental health specialists). Data for health facility review was collected from local primary health and specialist facilities while key policy documents were critically analysed for service provision and stigma alleviation activities. Thematic analysis was used to analyse patterns within the interview data. We found poor awareness and knowledge about mental illnesses, belief in faith and traditional healers, scarcity of resources (medicines, trained professionals and mental health inpatient and outpatient clinics), poor access to appropriate mental health facilities, and high costs for seeking mental health care. There is a critical gap between mental health related provisions in policy documents and its implementation at primary and district level.

Cultural adaptation of INDIGO mental health stigma reduction interventions using an ecological validity model in north India

“…For instance, a real-life example of successfully treating a person with a mental health condition was narrated by a primary care provider. Based on a situational analyses study and earlier formative research, common myths of mental illness prevalent in the study area were adapted ( 44 , 45 ) and included in the intervention trainings. Policies relevant to MHSUs in the Indian context were included and discussed in the trainings, which is critical in any discussion around MHSUs representation and rights.…”

Non-communicable diseases and the prospects of integrated behavioral health in India: current status and future directions

“…Even the policies and programs have existed for decades in favor of mental health, which evidenced poor and unwelcoming outcomes due to stigma at the grassroots level. Further, the literature points to the significant gap in mental health treatments and health-seeking behavior due to inadequate knowledge and awareness among individuals, belief in traditional healers along with faith without action and scarce resources in terms of trained professionals and facilities in health care services (Kaur et al ., 2023) along with cultural mismatch in psychiatric approaches (Weaver et al ., 2023). Due to these factors, very few individuals seek mental health services as they perceive it as unessential.…”

“…Although the government has taken a few initiatives to bring holistic healthcare services, these are still in their infancy. Further, there is a discrepancy between the policy and its implementation regarding mental health services at the primary level due to a lack of infrastructure, human resources, and political instabilities (Kaur et al ., 2023). In addition, the public health priorities should take different views, establishing and promoting integrated services over conventional health care services.…”

Barriers and facilitators to accessing adolescents’ mental health services in Karachi: users and providers perspectives

“…In terms of care, the literature highlights that utilization of available mental healthcare (MHC) services is influenced by service inaccessibility, health beliefs, chronic illness [ 5 ], and previous experiences [ 6 ]; ultimately resulting in a treatment delay of 8–10 years [ 7 , 8 ]. Several national and international studies provide evidence of barriers that impede service use, such as demographic deprivation, perceived need, inadequate knowledge, stigma [ 9 ], and cultural and traditional associations of mental illness with supernatural powers, evil eyes, or punishment [ 10 , 11 ].…”