Experts suggest that a team consisting of psychiatrist, psychologist, and social worker should be appointed at every educational and administrative institutions
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“I struggled with sleep disorders, was always angry , easily irritable and often exhausted,” says 33-year-old Nazir (name changed) from Calicut, who was diagnosed with bipolar disorder in 2011. It was only after Nazir found the right medication that he was able to function better.
Not everyone in Kerala however, is as fortunate as Nazir. The State, considered, in many ways, a model for the rest of the country when it comes to public health infrastructure, needs to step up in what is often a neglected aspect of the health landscape: mental health, say experts. As per the Kerala state report of the National Mental Health Survey (2015-16), 11.36% of the population suffers from mental disorders. This is compounded by a higher-than-national-average of deaths by suicide. And the major problem? A dire shortage of trained staff.
The mental health landscape in Kerala
“Cases are rising by the day. While some of this has to do with increasing awareness about mental health and better health-seeking behaviour among the public, the causes underlying the high numbers are stress, drugs and other factors,” says Mahesh Kumar K.S., a psychiatric social worker associated with the State’s District Mental Health Programme.
Stress and drugs apart, family issues, substance abuse, and, among students, unsupervised internet exposure and academic pressure are primary triggers, observes T. V. Anilkumar, professor and head of child psychiatry at Ernakulam Government Medical College Hospital.
According to Dr. Anilkumar, state supported counselling centres in every educational institutions needs to be formed. He also points out that strengthening of the existing child mental healthcare facilities like the state funded arts-based psychosocial care, along with traditional forms of therapy and care can help children express themselves.
The shortage of trained professionals
Despite the rising numbers and the growing demand for mental healthcare services, the number of trained staff has not kept pace.
Sandheesh P. T., clinical psychologist at the District Hospital, Pathanamthitta, emphasises that the staff shortage is a major concern, “Currently, there are only 17 psychologists under the Directorate of Health Services (DHS), which is inadequate to address the vast requirements of the population and the increasing number of cases of mental illness emerging in the State. The appointment of a clinical psychologist at every taluk hospital is necessary”, he says.
While the District Mental Health Programme is meant to provide access to services across rural, even this programme is struggling with a lack of staff: “With inadequate staff, it sometimes gets difficult to handle the increasing case load,” says Mr Mahesh. “The availability of qualified people is low; we are managing with the existing staff, but it is tough.”
This lack of availability of enough clinical psychologists can affect the state’s overall mental healthcare system. In response experts urge to fill in the vacancies of healthcare to accommodate more cases. Additionally, doctors suggest grass root level training of primary healthcare workers who can refer cases to mental health hospitals . Vahida Wahab, a psychiatric nurse at the DMHP, Pathanamthitta says that in the centre she works, there are overall four nurses and they work alternately to meet the work load of handling over 60-70 patients per day.
People willing to seek treatment
Stigma has often been one of the hardest things to combat when it comes to mental healthcare. However, growing awareness through programmes, both public and private are bringing more people to the fore, to seek help, experts say.
“New and effective drugs with fewer side effects are available now, and these medicines do not lead to addiction. There is a lot more awareness about the availability of treatment options now, and people are willing to come forward to be treated,” says N Suresh Kumar, professor of phychiatry based in Calicut.
However, all of the gains made through increased awareness and the combating of stigma will not yield fruit if there are not enough personnel to meet the caseload, say doctors.
Another worrying phenomenon is the rise in the number of mental health issues among children. As per a survey conducted in early 2021 by UNICEF and Gallup, across 21 countries, only 41 per cent of young people in India said that they feel good about seeking support for mental health problems, compared to an average of 83 per cent for 21 countries.
The NMHS points out that the treatment seeking pattern in different age groups in Kerala needs to be analysed inorder to strengthen the existing facilities, as Kerala even though currently has a mental health policy does not have a comprehensive written action plan. Experts say that the state can achieve this action plan through mass education on seeking medical treatment for mental healthcare and understanding about the importance of long-term rehabilitation.
Abhish K. Bose is a freelancer, he can be reached at abhishdc@gmail.com
Published – March 13, 2025 12:22 pm IST
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