We live in a country where though 65 of every 1000 people suffer from mental disorders; there are just 0.4 psychiatrists, 0.04 psychiatric nurses, 0.02 psychologists and 0.02 social workers per 100,000 people. [Sources: Indian Journal of Community Medicine, Vol 26, 2001 and WHO’s Atlas: Country Profiles on Mental Health Resources 2001, respectively.
WHO released the report that mentally ill in India have almost outnumbered the HIV+ patients in the country, while with the survey it comes across that those infected with HIV are at increased danger of having mental disorder?
Not surprising that country here to lacks a National policy for dealing with those who are afflicted with mental disorders and HIV.
HIV and mental disorders
Reason as noted by the experts that all such individuals are doubly disadvantaged as they do not display expected health seeking behavior and are prone to a diminished state of responsiveness. The New Oxford Textbook of Psychiatry (Oxford University Press, ed. 2000) notes: “Patients infected with HIV are at an increased risk for a variety of mental disorders”. These stem both from the direct infections of the central nervous system by the virus or from infections precipitated by the virus. In addition, the knowledge of a positive diagnosis will leave patients with intrusive, brooding thoughts, panic attacks, social isolation, and verbal expressions of rage or feelings of desperation, altered behavior, depression and even suicidal tendencies.
Such correlations have been well borne out by research. One such study of “Suicidal Ideation in HIV positive patients”, (CSSMU, September 2008) tracked 250 patients in the 18-60 age group to conclude that almost half of them displayed suicidal tendencies. The pre-disposition became more pronounced in those who also had depression, adjustment disorders, indulged in substance abuse or displayed other mental illnesses. Such tendencies are also more marked in females, those who are unemployed, unmarried and those who come from low socio economic status families (family income less than Rs.5000 a month).
Care and Ignorance
It has been seen that often women will display the worst of these symptoms but receive the least care because they are not the breadwinners and also prone to neglecting their health. And situation becomes more vulnerable with the educated one, where there is a great sense of rage and betrayal at having contracted the infection from their husbands. They are also burdened by a stronger sense of guilt.
Though now the profile of this inevitably fatal infection has been changed to a chronically manageable condition, experts believe that the role of the counseling should be re-examined. Most of the time counselors think that patients will die anyway and counseling will not do much while we have learned how to welcome life, we have failed to prepare for death. This is not a healthy mould for counseling. While most of the counseling limited to: washing hands, cleaning and safe sex.
Fortunately, medical intervention and a will to get better salvaged some but many more continue to be lost to ignorance and shame.