Addressing Kerala’s Mental Health Challenge

Dsuicides have become a topic of discussion in Kerala. The topic entered the public debate after several people, including police officers, took their own lives under political and administrative pressure. There is no doubt that those responsible for the direct causes of these tragedies must be held accountable. However, this debate cannot be limited to politics alone; we must recognize that the underlying cause of the rising suicide rate is the fragile mental health of the people of Kerala, and we must take urgent remedial measures.

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

Studies on the mental health status of the people of Kerala paint a worrying picture. There was a dramatic increase in mental health problems, from 272 per thousand in 2008 to 400 per thousand in 2018, as shown in 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 indicates that a large section of Kerala’s population suffers from serious mental health problems, with an estimated 12% suffering from serious mental illnesses that require hospital treatment and care. The contrast with the national trend is stark, with the number of people with mental health problems declining or remaining stable over the same period. This suggests that while mental health care has made progress nationally, the problem has increased in Kerala. The National Mental Health Survey 2015-2016 also shows that the rates of depression, anxiety disorders and suicidal tendencies in the state are significantly higher than the national average. Further, Kerala’s poor mental health status is one of the major factors contributing to the rising social evils such as drug addiction, violence against women, alcoholism, aggression/violence and superstition.

Solving this crisis requires the implementation of comprehensive mental health programs from childhood to old age. Health programs in educational institutions need to be revamped to protect both mental and physical health and provide students with the necessary health education. The functioning of the existing counseling centers at school and college level needs to be scientifically evaluated. Teachers and parents must receive training, and supervisors must receive a refresher course that is appropriate for modern times. The activities of the health department, medical colleges, hospitals like Mental Health Center in Thiruvananthapuram and Government Mental Health Center in Kozhikode, Institute of Mental Health and Neuroscience in Kozhikode, and State Mental Health Authority need coordination and strengthening. Also, the services offered by the private sector and voluntary mental health organizations should be used strategically to broaden the network of support.

It is critical that the serious shortage of mental health practitioners requires attention. While the recommended global standard is three professionals per 10,000 people (psychiatrists, clinical psychologists, psychiatric social workers and rehabilitation workers), the actual numbers in Kerala are disturbingly 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 programs in additional centres, are necessary to bridge this skilled labor shortage.

Kerala does not accord the same priority to mental health issues as it does to communicable and non-communicable lifestyle diseases, and the rise in suicide rates is a direct result of this neglect. Given that the increase in deaths from suicide has become a widespread topic of debate, society must recognize this problem as a major public health crisis. The government, the Ministry of Health, health experts and professional organizations should promote comprehensive, long-term action plans to improve mental health.

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