Future of psychiatry: Challenges and opportunities

Abstract

Most of us equate health as a state of physical well being but remain ignorant of social, spiritual and psychological aspects of health. Using the disability adjusted life year (DALY) as the basic statistic, the World Development Report concludes that mental health problems accounted for 13.46% of the global burden of disease in 2001, projected to be 14.14% by 2020 [1] . Depression, alcohol use disorders & suicide rank in the top 20 causes of DALYs due to all diseases of all ages [2] . In India it is estimated that 10 million are suffering from severe mental illness & 10 times that number have mild mental disorders [3] . Therefore subjective and objective burden related to caring for people with mental disorder is substantial. Even then mental health is not a priority as mental health policy exists in only 62% of the WHO countries [1]. In developed countries, tax based payment constitutes 63%, out of pocket payment accounts for 30-38% of mental health services whereas in developing countries patients and their family members has to bear all the cost for treatment of mental illness [2] . Mental health resources are centralized in and near big cities. 80% of the rural population has no access to mental health services [2, 3] . Moreover there are 42 mental hospitals with 20000 beds and another 2000-3000 beds are available in psychiatric unit of institutions/ general hospitals [3] . There are 4000 psychiatrist and 2000 psychiatrist nurses whereas UK has 110 psychiatrist per million, 24.8 nurse /100000 population [2, 3] . 69% of low income countries have less than 1 psychologist per 100000 populations[2] .