Mental Illness Stigma and Poverty in India

Mental illness is a global burden with approximately 450 million people affected worldwide of which 80% live in middle and low income countries. Globally, mental health conditions account for 13% of the total burden of disease, and 31% of all years lived with disability(World Health Organization, 2010). Literature shows that people with mental illness in low and middle income countries are among the poorest of the poor (Das et al., 2007). Furthermore, this relationship has been found to hold, in some cases even more strongly, in low-income countries. In 11 developing-country community-based studies, significant associations between poverty indicators and common mental disorders were found in all but one study (Patel & Kleinman, 2003).

Yet, research about mental illness in developing countries has been largely dominated by the application of primarily western developed tools adapted to the local setting, by biomedical interventions of psychiatric disorders, and through the lens of individual factors alone determining the intensity of the illness (Warner, 2004). Cultural validity of concepts, instruments, and methods of studying mental illness in low income countries remain surprisingly unquestioned and un-researched. This significantly compromises our understanding of local categorization of mental disorders (Jadhav, 2009). Research procedures deploying medical anthropological approaches are appropriate to explore explicit categorizations and to establish the link between severe mental disorders and stigma, particularly in the context of India (Jadhav et al., 2007; Littlewood, Jadhav and Ryder, 2008; Weiss, Jadhav, Raguram, Vounatsou and Littlewood, 2001).

A better understanding of mental illness and of the existing social response may establish social factors shaping the prognosis of severe mental illness. This would offer newer avenues for public health interventions to complement biomedical treatment (Krieger, 2008). Biomedical care is by no means an exclusive and comprehensive solution for severe mental illness (Kleinman and Hall-Clifford, 2009). In the international disability research literature, as well as in popular culture it is argued that stigma is caused by mental illness. The biomedical approach argues that stigma is conflated with mental illness alone and that treating mental illness will therefore abolish the stigma associated with it. We argue that non-mental illness factors, chiefly multidimensional poverty, may have a significant bearing on the stigma of severe mental illness and on the ability to address the issues of mental disability at both the individual and the household level.

A first study was carried out in New Delhi in partnership with Dr Smita Deshpande from the Department of Psychiatry, Dr Ram Manohar, Lohia hospital, New Delhi, and Dr Sushrut Jadhav, University College London. We used mixed methods to show that: 1) there is a difference in depth and intensity of multidimensional poverty between mentally ill and non-mentally ill subjects, 2) the association between stigma and multidimensional poverty is stronger in the group of mentally ill subjects compared to the control group.

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