Mental health stigma in India
How does mental health stigma in India compare to the UK? And do the class and caste systems here affect treatments?
Before we return to find out about Babu's follow up the next day, I wanted to explore mental health stigma in India, to find out how it compared to the UK, and if class and caste systems here affect treatment.
Dutt - Alakananda Dutt. I'm a psychiatrist working in the Institute of Neurosciences Kolkata. Psychiatry is a problem that affects all classes of the society and we attend to almost all these psychiatric patients. But care-seeking attitude will depend upon the social class. For example, if you are from a lower socio-economic class and your main breadwinner is suffering from a psychiatric illness like say, depressive illness or Schizophrenia, they'll be more forthcoming and seeking treatment. Because once they get better, they can get back to work. Family is very supportive in these cases which is one of the main reasons why we have a very good outcome in psychotic illnesses in India in general. So, the family supports them through and through.
And now, it comes to the middle classes - they try to hide but again, when the dysfunction becomes very severe, they do come.
But it's the upper classes who are the main problem. They will continue to rationalise, use logical reasons for extreme severe cases. The Google has become a big problem. They seem to learn everything from the Google and after that it becomes difficult to treat but they tend to hide their symptoms but at times, they do end up in the psychiatry clinic.
Hannah - And how much does it cost if a patient that's in a lower income bracket and the reason that they're presenting themselves to you is because they need to go back work? How much will it cost for them to be treated by you?
Dutt - Actually over here, our consultation fees are fixed at around 1,000 rupees per consultation.
Hannah - So, 1,000 rupees would be the equivalent for maybe 6 months work for the average low income person.
Dutt - But they don't pay 1,000. Usually, what happens is they are given concessions. They either pay 100 or 500 rupees. So, that for them makes up and the medicines, we try to give them the low cost medicines because there are different pharmaceutical companies were available and some of them do make the medicines at a cheaper rate. So, we try to sort of prescribe that sort of medicines because in India, we do not prescribe generic names. We go by the pharmaceutical names in the prescriptions.
Hannah - So, in the UK for example, a pharmaceutical company might have the intellectual property for a drug and the GPs will prescribe that drug at a higher price. And then once that intellectual property has gone off license after about 15 years of patenting law and companies can develop cheaper alternatives that are based on that and you're prescribing those cheaper alternative?
Dutt - Yeah, we do that especially for the people who are poor, who cannot go for a more costlier drug, we have to do that. because most of these drugs are available in India at a cheaper price.
Hannah - So, those drugs that you're talking about for example are drugs that will help treat depression or treat Schizophrenia?
Dutt - Yeah. We are talking about those drugs. We use those drugs. Apart from that, we also use a lot of psychological treatment in our hospital because especially in depression, when we have mild or moderate depression, we can use cognitive behaviour therapy and a lot of help comes up out of helping the family to understand. They're usually very caring in India. The families are huge then you want to look after your parents, your siblings and they do go out of their way once they realise that they're really suffering from a serious illness, and their presence can make a difference. So, those factors also come in when we put some time in explaining to the family.
Hannah - Thanks to you, Alakananda Dutt.