Spatial Variation in Mental Illness in Uttar Pradesh

TABLE OF CONTENTS

CHAPTER 1: Introduction

CHAPTER 2: Literature review

CHAPTER 3: Data and methods

CHAPTER 4: Results

CHAPTER 5: Discussion

CHAPTER 6: Conclusion

References

ACKNOWLEDGEMENT

It's my immense sense of pleasure to present this dissertation work on this occasion, I would like to thank the whole cementing forces behind this work.

First and foremost, I would like to express my immense sense of gratitude to my teacher for his conveyance of copious knowledge, prop er guidance and continuous support at each and every step in completing my dissertation. His guidance helped me in all the time of writing my dissertation. I am fortunate enough to having a better supervisor and mentor for my dissertation.

Besides my teacher, I would also like to express my gratitude to, Head of the Department of Geography for being kind and helpful.

I would also like to thank my friends and classmates.

Last but not the least I would like to extend my gratitude to my grandfather and my parents for support and guidance throughout my life.

LIST OF FIGURES AND CHARTS

1. Mental illness in India and Uttar Pradesh, 2011

2. Mental illness in India and Uttar Pradesh by type of residence, 2011

3. Mental illness in regions of Uttar Pradesh, 2011

4. Sex differential in mental in Uttar Pradesh, 2011

5. Sex differential in mental illness in rural Uttar Pradesh, 2011

6. Sex differential in mental illness in urban Uttar Pradesh, 2011

7. Rural-urban differential in mental illness in Uttar Pradesh, 2011

8. Rural-urban differential in mental illness among males in Uttar Pradesh, 2011

9. Rural-urban differential in mental illness among females in Uttar Pradesh, 2011

CHAPTER 1: INTRODUCTION

Throughout history, intense debate has raged on the nature of mental disease. Plato was the first to invent the term "mental health," which was conceived as reason helped by temper and dominating over passion in ancient Greece, advocating a mentalist concept of mental disorder. Geisinger was the first to say that "mental sickness is brain illness" approximately two centuries ago.

Mental illness refers collectively to all diagnosable mental disorders, health conditions involvingsignificant changes in thinking, emotion and behavior, distress and problems functioning in social, work or family activities. The American Psychiatric Association defines mental illness as a healthcondition that involves “changes in emotion, thinking, or behavior or a combination of these.” If left untreated, mental illnesses can have a huge impact on daily living, including your ability to work, care for family, and relate and interact with others.

Mental illnesses take many forms. Some are mild and only interfere in limited ways with daily life, such as certain phobias. Mental illness does not discriminate; it can affect anyone regardless of age, gender, geography, income, social status, race or ethnicity, religion or spirituality, sexual orientation, background or other aspect of cultural identity.

Types of Mental illness

Anxiety disorders: People with anxiety disorder respond to certain objects or situations with fear anddread, as well as with physical signs of anxiety or panic, such as a rapid heartbeat and sweating. Anxiety disorders include generalized anxiety disorder, panic disorder, social anxiety disorder and specific phobias.

Mood disorders: These disorders, also called affective disorders, involve persistent feelings of sadnessor periods of feeling overly happy, or fluctuations from extreme happiness to extreme sadness. Themost common mood disorders are depression, bipolar disorder, and cyclothymic disorder.

Psychotic disorder: Psychotic disorders involve distorted awareness and thinking. Two of the mostcommon symptoms of psychotic disorders are hallucination the experience of images or sounds thatare not real, such as hearing voices and delusion, which are false fixed beliefs that the ill person acceptsas true, despite evidence to the contrary. Schizophrenia is an example of a psychotic disorder.

Eating disorders: Eating disorders involve extreme emotions, attitudes, and behaviors involving weight and food. Anorexia nervosa, bulimia nervosa, and binge eating disorder are the mostcommon eating disorders.

Impulse control and addiction disorders: People with impulse control disorders are unable to resist urges, or impulses, to perform acts that could be harmful to themselves or others. Pyromania (startingfires), kleptomania (stealing), and compulsive gambling are examples of impulse control disorders.Alcohol and drugs are common objects of addictions. Often, people with these disorders become soinvolved with the objects of their addiction that they begin to ignore responsibilities and relationships.

Obsessive-compulsive disorder (OCD): People with OCD are plagued by constant thoughts or fearsthat cause them to perform certain rituals or routines. The disturbing thoughts are called obsessions,and the rituals are called compulsions. An example is a person with an unreasonable fear of germs whoconstantly washes their hand.

Post-traumatic stress disorder (PTSD): PTSD is a condition that can develop following a traumaticand/or terrifying event, such as a sexual or physical assault, the unexpected death of a loved one, or a natural disaster. People with PTSD often have lasting and frightening thoughts and memories of theevent, and tend to be emotionally numb.

Schizophrenia: Schizophrenia is a serious mental disorder in which people interpret reality abnormally. Schizophrenia may result in some combination of hallucinations, delusions, and extremely disordered thinking and behavior that impairs daily functioning, and can be disabling.

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Mental illness across the world and in India

According to the World Health Organization (WHO), mental illness accounts for approximately 15% of all disease conditions worldwide. Mental illnesses are on the rise all around the world. In the recent decade, there has been a 13 percent increase in mental health and substance use disorders, owing primarily to demographic shifts. Around 20% of the world's children and adolescents suffer from mental illness, with suicide being the second largest cause of mortality among those aged 15 to 29. In post -conflict contexts, about one out of every five people suffers from mental illness.

Table 1:

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Source: WHO

As for India, the WHO has labelled the country as the world's ‘most depressing country'. Moreover, between 1990 to 2017, one in seven people from India have suffered from mental illness ranging from depression, anxiety to severe conditions such as schizophrenia, according to a study.It is no exaggeration to suggest that the country is under a mental health epidemic.

A report published in The Lancet Psychiatry in February 2020 indicates that in 2017, there were 197.3 million people with mental disorders in India.

This situation was generally worse in the southern States compared to the northern States due to the nature of development, modernization, urbanization and other factors not understood yet. Depressive disorders were more prevalent among females than males which could be due to sexual abuse, gender discrimination, stress due to antenatal and postnatal issues and other reasons.

A number of previous studies have studied mental illness in India and have presented their estimates. Until recently state-level estimates for mental disorders were not available. Still India does not have reliable estimates of mental illness at district level. This is one of the reasons why geography of mental illness at district level is yet to be examined. Geography of mental illness is an important aspect which should be examined in order to decide which population is to be targetedfor what kind of policy and program implementation. In this study, I have made therefore an attempt to examine the district wise variation in mental illness in the state of Uttar Pradesh, the most populous state of India. The data has been taken from the Census of India, 2011.

Before moving further, let us go through the summary of what has already been done in India in this regard. The next chapter therefore presents an overview of what has already been done in Indiaand what is remaining to be done.

CHAPTER 2: LITERATURE REVIEW

The World Health Organization (WHO) declares that health is "A state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”. Mental health isa state of well-being in which individual realizes his or her own abilities. Mental illness affects individual /WHO estimated that globally over 450 million people are suffers from mental disorder.Mental disorder was the second leading cause disease burden in terms of years lived with disability(YLD) and sixth leading cause of in terms of disability-adjusted life-years (DALYs) in the world in 2017 posing a serious challenge to health system, particularly in low-income and middle-income countries.

Mental health is being recognized as one of the priority areas in health policies it also included insustainable development goals (SDGs). Currently mental and behavioral disorder account for 12 percent of global burden of diseases. This was likely to increase by 15 percent by 2020. There are many forms of social inequality that may shape mental health in India.

There have been many studies on status of mental illness India as well as in Uttar Pradesh follows:

The burden of mental disorders across the states of India: The Global Burden of Disease Study 1990-2017 in which findings are: In 2017, 197^3 million people had mental disorders in India, including 457 million with depressive disorders and 44^9 million with anxiety disorders. In 2017, depressive disorders contributed the most to the total mental disorders DALYs (33^8%), followed by anxiety disorders (197%) idiopathic developmental intellectual disability (10-8%), schizophrenia (9^8%), bipolar disorder (6^9%), conduct disorder (5^9%), autism spectrum disorders (37%), eating disorders (2-2%).

- In 1999, a study stated that the prevalence of mental disorders in child and adolescent population was 9.4 percent. Similarly, another study from Bangalore in 2005 documentedthe burden of mental disorders to be 12.4 percent. The study also showed the prevalence of metal disorders in urban middle class, slum, and rural areas with annual incidence of 18percent population. The prevalence of metal disorders among 0-3 years old children was 13.8 percent, most commonly due to breath holding spells. Pica, behavior disorder NOS,expressive language disorder and mental retardation. The prevalence rate in the 4-16 yearsol children was 12.0 percent mainly due to enuresis, specific phobia, hyperkinetic disorders, stuttering and oppositional defiant disorder.
- Prevalence and pattern of mental illness in Uttar Pradesh, India findings from the National Family Mental Health Survey 2015-16. In which studies finding are: Current and lifetime prevalence of 'any mental morbidity' (excluding tobacco use disorders) was 6.08% and 7.97%, respectively. The prevalence of substance use disorders, was 16.36%, of which tobacco use disorders alone contributed 16.06%. Neurotic and depressive disorders were the next most common morbidity. Schizophrenia and other psychotic disorders had a current prevalence of 0.09%. High-risk for suicide was reported to be 0.93%. Treatment gap varied between 75 and 100% for different disorders.
- In 2002, the prevalence rate of mental disorders in the industrial population was estimated to be 14 to 37 percent.
- Violence against women, especially childhood sexual abuse, wife beating and rape have pathological sequelae. Women respond to domestic violence by becoming depressed .

The most frequently observed disorder in the case of rape victims is post­traumatic stressdisorder (PTSD). Hysteria and somatization disorder might well have to do with childhoodsexual abuse.

Objectives:

- To examine spatial variation in mental illness in UP.
- To examine district wise rural-urban variation in mental illness in UP.
- To examine age and sex differential in mental illness across districts of UP.

CHAPTER 3: DATA AND METHODS

This aim of this study is to examine the pattern of prevalence of mental illness in Uttar Pradesh. The data for this study comes from the Census of India, 2011 which collected data on various socioeconomic and demographic issues. The data collected in Census 2011 also includes information on various types of disability, namely seeing, hearing speech, mental retardation and mental illness.

This data is available in disability tables which are codenamed as C tables and range between C- 20 and C-30. The data available for public use on the website of Census of India. I downloaded the excel file C-20 from https://censusindia.gov.in/2011census/C- series/c-20.html. This table provides district wise population with mental illness for all the states separately for rural and urbanareas.

When the Census was conducted in 2011, the state of Uttar Pradesh had 71 districts. There were 722,880 mentally ill people in India in 2011 and in Uttar Pradesh the number was 76,603. Using the numbers for each district, age group, sex, type of place of residence, I estimated the rate of mentally ill people i.e., the number of mentally ill people per 100,000.

In order to get this rate, one has to divide the number of mentally ill people by total population ofthat segment or area. For example, the rate of mental illness for males in a district would require division of the number of mentally ill males in that district by total number of males in that district.The outcome is then multiplied by 100,000 to turn the rate per person into rate per 100,000 people.

Census also collects data on mental illness by age and sex. Using census data from table C14 (available here https://censusindia.gov.in/2011census/C-series/C-14.html) that provides total population by age and sex for various states and districts of India, I calculated the rate of mental illness by age and sex and attempted to examine sex and age differentials in mental illness in UttarPradesh.

For some analyses, the state of UP has also been divided into four regions, namely Western UP, Eastern UP, Awadh, and Bundelkhand). District were grouped into regions and estimates for thesegroups were worked.

In order to compare and contrast, I used bar and line graphs and prepared district wise maps to spatial variations in the outcome of interest, the rate of mental illness. Line graphs have been usedto show how mental illness varies across age groups.

Mapping has been done to examine patterns of spatial variation in mental illness. The rate of mental illness per 100,000 for rural and urban areas and male and female populations have been mapped across districts and spatial patterns have been analysed. All the maps were created using ArcGIS 10.4.1. Shapefile of districts of Uttar Pradesh was createdas per the boundaries given in 2011 Census of India. District wise data on mental illness was addedto attribute tables and then maps were created using symbology tab.

It must be noted that this data is based on the information provided by the household head or the respondent. It is not based on standard screening done by a trained medical staff. Therefore, this self-reported data may not be as accurate as it should be. It must be mentioned that the data captured by the Census of India may be severe underestimate of the size of the problem. This is sobecause two major mental illnesses, namely depression and anxiety are not considered as mental illness by an overwhelming majority of people in our society.

Another important thing that must be mentioned for the readers of this report is that census does not give any definition for mental illness, nor does it provide any separate data for various types of mental disorders or illness. All that is available is number of population mental illness as one category. This is the reason why this study does not examine mental illness by its constituent parts.

All the data used in this study was aggregated at several levels and no personally identifiable information was linked with this data. This data is open to public for its use. Anyone can downloadand use this data. Therefore, no permission was required to use this data. Census of India 2011 is conducted by the Government of India as per the rules and regulations, and hence, hence there wasno need for any ethical review for conducting this study. No ethical Review was conducted for thisstudy.

of mental disorders or illness. All that is available is number of population mental illness as one category. This is the reason why this study does not examine mental illness by its constituent parts.

All the data used in this study was aggregated at several levels and no personally identifiable information was linked with this data. This data is open to public for its use. Anyone can downloadand use this data. Therefore, no permission was required to use this data. Census of India 2011 is conducted by the Government of India as per the rules and regulations, and hence, hence there wasno need for any ethical review for conducting this study. No ethical Review was conducted for thisstudy.

CHAPTER 4: RESULTS

The main aim of this study was to examine socioeconomic, demographic, geographic differentialin mental illness in Uttar Pradesh. I have first looked into overall rates of mental illness. Figure 1depicts the mental disease rate per 100,000 people in India and Uttar Pradesh. In India, 60 peopleper 100,000 suffer from mental illness, while 38 people per 100,000 suffer from mental disease inUttar Pradesh.

Figure 1: Mental illness in India and Uttar Pradesh, 2011

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It has been noted previously that rates of mental illness often vary between rural and urban areas, therefore I made an attempt to compare rural and urban rates of Uttar Pradesh with rural and urban rates of mental illness of India as a whole. Figure 2 depicts the rate of mental illness per 100,000 people in India and Uttar Pradesh, broken down by whether they live in rural or urban areas. Mentalillness affects roughly 56 persons per 100,000 in rural India, and 37 people per 100,000 in rural Uttar Pradesh. Mental illness affects roughly 60 persons per 100,000 in urban India, and 43 people per 100,000 in urban Uttar Pradesh. As a result, the prevalence of mentally sick people in both rural and urban UP is lower than in India. The prevalence in urban UP is slightly higher than ruralUP (37 vs 43 persons per 100,000)

Figure 2: Mental illness in India and Uttar Pradesh by type of residence, 2011

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Uttar Pradesh is a huge state characterized by contrasting social, economic, demographic and developmental conditions, hence, it is often divided into four regions viz. Awadh, Eastern UP or Purvanchal, Bundelkhand, and Western UP. It is expected that these regions would differ in termsof rate of mental illness as they do in other health indicators. Therefore, I decided to calculate therate of mental illness for each of these four regions broken by rural and urban categories. Figure 3depicts the rate of mental illness per 100,000 in Uttar Pradesh's various areas. It also depicts the prevalence of mental disease in urban and rural areas of these regions of Uttar Pradesh. In Awadhabout 37 people per 100000 are mentally ill and in rural area and urban area of Awadh region is about 35 and 48 people per 100000 respectively are mentally ill people. In Eastern U.P. the rate of mental illness per 100000 is about 40 people per 100000 and in rural and urban area of Eastern UPthe level of mentally ill people is about 39 and 48 respectively. In Bundelkhand region, the rate of mental illness is about 34 people per 100000. And in rural and urban area of this region, the rate of mental illness is about 32 and 48 people per 100000, respectively. In the Western UP, the rate of mental illness in about 36 people per 100000 and in rural and urban areas of this region, the rates of mental illness are about 35 and 38 per 100,000, respectively. Thus, it is clear that rural urban gap in mental illness is higher in three out of the four regions of the state. Rural urban gap in the western UP region is smaller than rest of the regions.

Figure 3: Mental illness in different regions of Uttar Pradesh, 2011

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Geographical variation in the rate of mental illness in Uttar Pradesh

Rate of mental illness may vary from district to district. Hence, it is important for the policy makersto know which district have a higher rate of mental illness and which have a lower rate of mental illness. This is important to know because it can help policy maker decide which district should get how much resources to tackle the mental illness. Therefore, I decided to examine the rate of mental illness using a district wise map of the rate. Map 1 depicts district wise variation in the rateof mental illness in Uttar Pradesh. The lowest rate of mental illness per 100000 which is less than30 people per 100000 is mostly found in both Western UP and Eastern UP districts such as Budaun, Moradabad, Agra, Mainpuri, Firozabad, Lalitpur, Shrawasti, Bahraich, Ballia, and kushinagar. Districts with the rate of 50 to 59 people per 100000 are mostly concentrated in Eastern UP region.Saharanpur is only districts with 60 and above per 100000 mentally ill people in Uttar Pradesh.

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Map 1: District wise variation in mental illness in Uttar Pradesh, 2011
Map 2: District wise variation in mental illness in urban Uttar Pradesh, 2011
Map 3: District wise variation in mental illness in rural Uttar Pradesh, 2011

Map 2 shows district wise variation in the rate of mental illness in urban Uttar Pradesh. The rate of mental illness highest (over 60 people per 100,000) in Kanpur Dehat, Shaharanpur, Siddharth Nagar, Faizabad, Ambedkar Nagar, Sultanpur, Deoria, and Ballia. Except Saharanpur and KanpurDehat, most of these districts come under Eastern UP. A number of districts from Awadh region including Lucknow, Hardoi, Kanpur, Fatehpur, and Raebareli, also registered a higher rate of mental illness (50-60 people per 100,000). Agra, Aligarh, Kushinagar, Shravasti were the districtwith a low rate of mental illness (less than 30 people per 100,000).

Map 3 depicts district wise variation in rate in mental illness per 100000 in rural Uttar Pradesh. the lowest rate in mental illness which is less than 30 per 100000 are in the following districts Ballia, Kushinagar, Balrampur, Shrawashti, Baharich, Kheri, Badaun, Moradabad, Jyotiba Phule Nagar, Agra, Mathura, Firozabad, Jhansi and Lalitpur. the districts with rate 50 to 60 per 100000 in mental illness are highly concentrated in the Eastern UP region. there are only three districts where the rate is 60 and above prevalent namely Varanasi, Lucknow and Saharanpur.

Age and sex differentials in mental illness in Uttar Pradesh

Mental illness may vary across demographic characteristics such as age and sex. It has been previously noted that some mental illnesses begin early in life during childhood and some later in life during adulthood. It has also been found that there are differences in prevalence of mental illness between males and females. In order to check whether such differentials exist in UP or not,I decided to explore the rate of mental illness across age groups and sexes.

Figure 4 shows the rate of mental illness among male and female by age in Uttar Pradesh. The prevalence of mental illness is lowest in early ages in both sexes. It increases with increase in age,

but the increase in more among the males giving rise to a higher rate of mental illness among malescompared to females in the adulthood. For example, in the age group 30­49, the rate of mental illness among males is almost twice higher than females. One important aspect that should benoted is that the male rate of mental illness declines faster after 50 years of age and ultimatelymeetsfemalerateofmentalillnessaround70years.

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Figure 4: Age-sex differential in mental illness in Uttar Pradesh, 2011

Figure5: Sex differential in mental illnessinrural UttarPradesh, 2011

Figure6:Sex differential inmental illnessinurban Uttar Pradesh, 2011

Figure 5 is showing the rate of mental illness per 100000 in rural Uttar Pradesh among male and female by age. The prevalence of mentally ill people among males is higher than that of females in the adult age. Figure 6 is showing the data on the rate of mental illnessper 100000 in urban Uttar Pradesh among males and females by age groups. The prevalence of mentally ill people is alsohigher thanthat of females in adult age inurbanUP.

Figure 7 depicts the rural-urban differential in mental illness by age groups in Uttar Pradesh. According to the figure, the rate of mentally ill people is almost similar in both rural and urban inbetween the age 0-4 and 50-59 years. In ages beyond 60 years, we see thatthereisadivergenceinrates with urban peopleslightly higherriskof mental illness.

Figure 7: Rural-urban differential in mental illness in Uttar Pradesh, 2011

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Figure 8 is showing the data on the rate of mental illness per 100000 by age with rural­urban differential among males in Uttar Pradesh. The rate of mental illness is almost similar in both ruraland urban male up to the age of 60. After the age of 60yearstherate of mental illness per 100000is declining faster among rural males than that of urban males. Figure 9depictsthe rate of mental

illness per 100000 by age with rural-urban differential among females in Uttar Pradesh. therateofmental illness per 100000 is lower in rural females than that of urban females. The rate of mentalillness per 100000 is increasing with age in both rural and urban females. Butinoldest age groups,it is much higher in urban areas as compared to rural areas.

Figure 8: Rural-urban differential inmental illness among males in Uttar Pradesh, 2011

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Figure 9: Rural-urban differential in mental illness among females in UttarPradesh, 2011

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Map 4 depicts district wise variation in rate of mental illness per 100000 among males in Uttar Pradesh. theprevalence of thelowest rate of mental illness among males which is lessthan30arein the following districts such as Balrampur, Shrawashti, Bahraich, Kheri, Kushinagar, Budaun, Moradabad and Lalitpur. Rate of mental illness 60 to 70 per 100000 is concentrated in central- eastern UP districts. There are only four districts namely Saharanpur, Varanasi, Ambedkar Nagarand Lucknow which has 70 and above per mentally people are found.

Map 4

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Map 5

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Map 5 depicts district wise variation in rate of mental illness per 100000 among females in Uttar Pradesh. the lowest rate of mental illness per 100000 is in the following districts which is less than 20 are Ballia, Kushinagar, Shrawashti, Baharaich, Badaun, Etah, Aligarh and Mahamaya Nagar. The rate of mental illness with 30 to 40 per 100000 are highly concentrated in Central-eastern region districts. Saharanpur is the only district where the rate of mental illness per 100000 is morethan 50 and above.

Map 6

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Map 6 depicts district wise variation in rate of mental illness per 100000 in sex differential in UttarPradesh. the lowest rate of mental illness with sex differential which is less than 5 people per 100000 in the following districts are Kheri, Bahraich, Badaun, Bijnor, Jhansi, and Lalitpur. The districts with the rate 20 to 30 are followings Azamgarh, Mau, Gorakhpur, Sant Kabir Nagar, Sulatanpur, Pratapgarh, Rae Bareli, Unnao, Lucknow, Etawah, and Farukhabad. There are only five districts which has 30 and above person per 100000 mentally ill people namely Varanasi, SantRavidas Nagar, Jaunpur, Ambedkar Nagar, and Mahoba.

CHAPTER 5: DISCUSSION

Health is pivotal for the growth, development and productivity of a society and is vital for a happy and healthy life anywhere in the world. This study examines socio-demographic and geographical patterns of mental illness in the state of Uttar Pradesh. Using data from the Census of India,2011,I calculated the rate of mental illness, which is people suffering from mental illness per 100,000.

It turns out that the rate of mental illness is much lower than the rest of India. This finding is in tune with many other studies conducted at national level. In India, as per the National Mental Health Survey (NMHS) 2015-16 Mental disorders contribute to a significant load of morbidity anddisability, even though few conditions account for an increasing mortality. As per Global Burdenof Disease report, mental disorders accounts for 13% of total DALYs lost for Years Lived with Disability (YLD) with depression being the leading cause.

The weighted prevalence of depression for both current and life time was 2.7% and 5.2%, respectively, indicating that nearly 1 in 40 and 1 in 20 suffer from past and current depression, respectively. Depression was reported to be higher in females, in the age- group of 40-49 years andamong those residing in urban metros. Equally high rates were reported among the elderly (3.5%).Productive age group are most affected from the mental disorder. Male in the age group of 30 - 49 years were the most affected indicating that mental disorders contribute to greater morbidity in the productive population. The prevalence of all disorders peak in this age group affecting work productivity and earning potential, and quality of life. Significant gender differentials exist with regard to different mental disorders. The overall prevalence of mental morbidity was higher amongmales (13.9%) than among females (7.5%).

However, specific mental disorders like mood disorders (depression, neurotic disorders, phobic anxiety disorders, agoraphobia, generalized anxiety disorders and obsessive­compulsive disorders were higher in females. Small number of female alcohol users identified in the present survey werereported to be dependent users. Children and adolescents are vulnerable to mental disorders Prevalence of mental disorders in age group 13-17 years was 7.3% and nearly equal in both genders.

Nearly 9.8 million of young Indians aged between 13-17 years are in need of active interventions.Prevalence of mental disorders was nearly twice (13.5%) as much in urban metros as compared torural (6.9%) areas. The most common prevalent problems were Depressive Episode & Recurrent Depressive Disorder (2.6%), Agoraphobia (2.3%), Intellectual Disability (1.7%), autism spectrumdisorder (1.6%), Phobic anxiety disorder (1.3%) and Psychotic disorder (1.3%).

A recent study among 15 - 24 years in the state of Himachal Pradesh revealed that adolescents suffered from a wide range of mental health conditions like depression (6.9%), anxiety (15.5%), tobacco (7 . 6%), alcohol (7.2%), suicidal ideation (5.5%), requiring urgent interventions13.While the fact that it interferes in their growth, development, education and day to day social interactionsis undisputed, their vulnerability is greater due to several factors within and outside home. Early recognition and intervention will help to realize favorable outcomes. While the overall current prevalence estimate was 10.6% in the total surveyed population, significant variations in overall morbidity are seen across the different surveyed states, ranging from 5.8% in Assam to 14.1 % inManipur.

Three states Assam, Uttar Pradesh and Gujarat reported prevalence rates less than 10%; in 8 of the12 states, the prevalence varied between 10.7% and 14.1%. In context of Uttar Pradesh the prevalence and pattern of mental illness according to census 2011 data there was only 77603 population which was very less. In the recent, studies reveals that at least one among ten is suffersfrom mental illness, The State Mental Health Survey Report suggests that 8.7 per cent of UP population suffers some sort of mental illness that needs attention. The estimates of mental illness in these researches are considerably higher than the estimates from the Census of India because the data in Census is self-reported data and no measurements have been conducted to assess the presence of mental disorders.

Some conditions such as depression and anxiety that are considered normal by lay man are actuallyconsidered mental disorders in psychiatry. This is why self-reported rates of mental illness are often lower than the rates based on data collected by standard diagnostic procedures.

This study shows how prevalence and pattern of mental illness per 100,000 varies across districtsin Uttar Pradesh. And it helps in making policy to get rid of this high prevalence of mental illness systematically. The region wise variation, district wise variation, sex differential in mental illnessand variation in type of residence provides policy maker to formulate inclusive policies to eradicatethe problem of mental health in Uttar Pradesh by looking at prevalence and pattern of mental illness and its variation.

According to a 2017 World Health Organization (WHO) Report, major or minor mental illnessesthat require expert intervention are reported for 7.5 per cent of India's population. Also, out of roughly 60 million people in India suffering from mental illnesses, about 90 per cent are currentlynot receiving any treatment . Mental illnesses remain largely untreated in India. Moreover, there is a dearth of data on occurrence/treatment gap for mental disorders. According to NMHS 2016, atreatment gap of 50-60 per cent was reported for schizophrenia whereas it was 88 per cent for depression and was as high as 97.2 per cent for alcohol use disorders. Studies on epilepsy from India have reported a state-wise treatment gap, ranging from 22 to 95 per cent. Overall, only about1 in 10 people with mental health disorders are thought to receive evidence-based treatment in India. The National Mental Health Program (NMHP) was introduced in 1982, in keeping with the WHO's recommendations, to provide mental health services as part of the general healthcare system. Although the program has been successful in improving mental healthcare access at the community level, resource constraints and insufficient infrastructure have limited its impact. The Mental Healthcare Act, 2017 makes several provisions to improve the state of mental health in India. This includes stating access to mental healthcare as a ‘right' and instituting Central and StateMental Health Authorities (SMHA), which would focus on building robust infrastructure includingregistration of mental health practitioners and implementing service-delivery norms. This study will help to strengthen the existing National Mental Health Program and its arm District Mental Health Program.

Government initiatives to combat mental health problem in India:

National Mental Health Programme (NMHP) launched in 1982 three main components:

i. Treatment of mentally ill,
ii. Rehabilitation,
iii. Prevention and promotion positive mental health.

- District Mental Health Programme: It envisages provision of basic mental health services to the community and to integrate these services with other health services.
- The Mental Health Care Act 2017: It is an act to provide for mental healthcare and servicesfor persons with mental illness and to protect, promote and fulfil the rights of such persons during delivery of mental healthcare and services.
- The National Institute of Mental Health (NIMH): It is a leading federal agency for research on mental disorders.

CHAPTER 7: CONCLUSION

Mental health is an integral and essential component of health. Mental illness is one of the biggestproblems which causing a major contribution in death and disease burden in different forms and italso increasing the suicidal death risk among youth. Mental illness is seen to vary across time, within the same population at the same time. Geographical variation in mental illness in UP suggests the need to formulate an inclusive plan that focuses in district with higher mental illness.Despite its enormous social burden, mental health remains a taboo, stigma, prejudice and fears. So, there is a need to educate people about the reality of and illness is more common than the people realize.

References

1. India State-Level Disease Burden Initiative Mental Disorders Collaborators. The burden of mental disorders across the states of India: The Global Burden of Disease Study 1990-2017. Lancet Psychiatry. 2020 Feb;7(2):148-161.

2. WHO? Mental Health Action Plan 2013-2020. Geneva: World Health Organization, 2013

3. Ministry of Health and Family Welfare, Government of India. New Pathways, NewHope: national mental health policy of India. 2014

4. Gururaj G, Varghese M, Benegal V, et al. National Mental Health Survey, 2015­16: prevalence, patterns and outcomes. Bengaluru: National Institute of Mental Health andNeuro Sciences, 2016.

5. R, Pattanayak RD, Chandrasekaran R, et al. Twelve-month prevalence and treatment gap for common mental disorders: findings from a large-scale epidemiological survey inIndia. Indian J Psychiatry 2017; 59: (46-55)

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