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What is mental health?

Malini Yadav, Clinical Psychologist , Director -Youth Help Line(YHL)
“Not only Mind Care, Human Care”

There are three ailments that come with the baggage of stigma attached -- HIV/AIDS, mental illness and leprosy. Great strides have been made in eradicating leprosy, while the problem of HIV/AIDS generates enough attention. Mental illness, however, remains orphaned.

When we talk about health it is invariably about our physical health and care. We forget that we are as much mental beings as we are physical beings. Physical is to body as mental is to the mind. Mental health refers to our cognitive, and/or emotional wellbeing - it is all about how we think, feel and behave. Mental health can affect our daily life, relationships, work and even physical health. Mental health also includes a person's ability to enjoy life - to attain a balance between life activities and efforts to achieve psychological resilience.

According to WHO mental health is "a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community". WHO stresses that mental health "is not just the absence of mental disorder". About 2-5% of India's population suffers some form of mental or behavioural disorder.

Around 1% has a serious form of mental disorder requiring urgent care at any one point of time. No less than 10-15% of those attending general health facilities have a common mental disorder. We might try to sweep the mental health issues under the carpet but the fact is that it is affecting Indians in alarming proportion .India should wake up to the new age mantra “mind care”.

 A Doctor Appeals

Dear friends,

Lately I have become very eager to know what my future life would be like and where? It's so difficult to decide what is the best possible use that I can make of my life and of my skills? One part of the mind is afraid of trying something too ambitious/ too unorthodox; while another part is afraid that my insecurities would make me accept a too ordinary life. At the fag end of my life I don’t want to get suffocated with a feeling that, “Life has ended; and I didn’t even give my dreams a passionate try.”

I know that your dreams would be different from mine. But definitely in the 1st year MBBS, at least 2 elements must be there in those dreams:

a) “I want to practice ethically. I don’t want to settle down in a cut-practice based set-up, where the primary aim is not to heal – but to hunt for and retain customers/ victims.” Some time back, had heard about a senior pediatrician who was crying while talking about the set up he had created – an unethical way of practice which neither he wants to continue with; nor he can come out of. None of us wants to end up in such a suffocating mess.

b) “I want to be a part of service-based set up and not of profit-based set up.” But after completion of Post Graduation and on witnessing the widening economical polarization and the commercialized medical scenario, fulfilling these basic 2 elements of our dream also seems to be difficult. Just today I heard from a friend who was a well-settled orthopedic consultant in Thane, but gave up his private practice a month ago – because he realized that in his quest for professional success, he had started doing things that were completely unacceptable to him at one point in time. I assume that some of you might experience the ethical dilemmas that I am experiencing; and so thought of sharing a few thoughts that are going through my head now a days.

My young friends often complain that, “There are no real service based set-ups even if we search for one desperately. They are all the same.” And at 28, I too have been getting a feeling that its high time to decide my commitment. I am feeling the need to commit to some specific goal, a specific place and a specific set-up. And I fear that I may miss the train.

So last month, I and Taru visited a few ethical service oriented set-ups to see if we could join them / learn from them. And upon visiting them myself, I realized - if we are willing to draw a middle class salary or if we are willing to leave metropolitan cities, there are many well-intentioned setups, which are eagerly waiting for doctors to join them !!

Our hopes were reignited just by talking to the docs and management working there. I wish to share with you some insights we gained there –

1) The whole burden of establishing an ethical set-up is not on our heads. There already are good set-ups and just as we are in look out for them, they are looking for us. There are many good set-ups, especially in the interior, providing good service and some of them are even willing to give docs a handsome salary. Their only constraint in continuing/ expanding their services is unavailability of dedicated doctors.

2) Working in a service oriented set-up doesn’t mean that one has to live in poverty. Its just that one can’t hope to become stinking rich over there. Most doctors working in service-based set-ups also have a 4 wheeler and a house of their own. Yes, the make of the car and the size of their house can be different  But their level of satisfaction, inner peace and joy are also different!

3) The biggest determinant of what kind of medical work we would be doing does not lie in our personal values / choices / skills; but lies in the place and institution that we choose to work in – and hence we must choose that with utmost discretion.

To give a general example, how I spend my day is decided in the morning itself at the start of a day when I choose to go the library or to a cricket match or to Essel world. How well it works out is another matter. Similarly, when I choose to work in a government hospital as against in a corporate hospital or again, in some service based hospital, the class of patients that I will serve gets fixed – now only thing left is how good or bad I do that job. Working in a profit- oriented hospital, the maximum I will be able to do for needy patients is a few camps now and then.

Point to be made is: Our choice of institution decides the major part such as the strata of society we are going to serve, the IPD policies and protocols, referral system, etc. Our integrity in day to day affairs cannot undo the implications of our choice of institution. Its the bigger decisions that decide the course of our life – the impact of day to day decisions is secondary.

As we know, many a times doctors are just a tool in the hands of the management. So either we must create our own management or we must choose a very good management under whom we would be happy to serve

4) The life of a doctor practicing outside big towns has its own advantages (You may have read about the Blue ocean business strategy – please read if you haven’t).

Over there one doesn’t have to give any cuts; the respect and the satisfaction earned is more, and even money is more than decent. One doc remarked, why do you feel that struggling in a polluted & overcrowded town is luxury; but living in this peaceful and green environment, in this big apartment, with full job security and job satisfaction – a matter of pain???

5) Its not always necessary to commit for life. The initial commitment can be only for a few years and , future commitments may be decided on the experience.

6) Why not work as independent consultants in service based hospitals rather than working as assistants to established consultants in profit based hospitals, at least in the initial years?

7) We will never be satisfied if we compare our standard of living with the 10% of population richer than us. On the other hand, if we compare our state with the 90% of Indians who are poorer than us, we will always be on the look-out for ways to help. But the problem is – our current lifestyles don’t bring us in any contact with the vast sections of the socio-economically disadvantaged people in the society. And the media also appears to be focused on the glamour world, the corporates and the politicians. So our reference for comparison is always prejudiced.

8) The process of drifting away from our ideals is so gradual that our priorities, opinions and lifestyle,all start changing slowly, without we even realizing it. Hence the need for constant association with good people and good organizations. If I don’t steer my vehicle my way – today’s materialistic society will soon take up the control of my vehicle and I will lose my individual identity; I will become a part of the mob.

9) All doctors vow to not give cuts initially – but in today’s medical system, almost all start to give within a year or two. Working in a good institution or in a rural area can help us avoid giving cuts, and thereby enable us to provide services at affordable rates.

10) If our sincerity is transparent, getting donations and funds is not a big issue in today’s society.

11) To the question that keeps coming to my mind: “Why should I join a service based set-up when I can earn much more in a private set up?”, I have 3 good answers.

a) Because the trees whose fruits I am eating today, were not sown by me 
b) There are both able adults and dependent children in any family. Children consume, adults provide. And this is OK. Similarly in a society, there are 2 types of people – those who are focused on what they are getting so that they grow and those who are focused on what they are contributing so that there is growth. It’s a choice each individual has to make, based on his current level of prosperity and standing!
c) We have the privilege of being a part of some of the most tender moments of people’s lives; we also have the chance to heal some of the deepest emotional and physical wounds – and to witness the joy these actions create. Would it be wise to let go of the nobleness of our profession and reduce ourselves to the category of plain businessmen?
Wherever you are, just look around – you will find service based set-ups which need you as much as you need them…..

warm regards, yours,

Lives of great men remind us
That we can also make our lives sublime;
And departing leave behind us
Footprints in the sands of time…
- Longfellow.