Mental Health and Mental Health Work Force in India: An Overview

The advances in physiological research and other health sciences bring new development that enhances the concept of health and illness into a more extensive understanding. The new idea of health views the human ill experience as combination of the biological, psychological, social, and spiritual factors that need the biopsychosocial-spiritual assessment alongside treating the physical pain symptoms. According to the World Health Organization (WHO), health is not merely the absence of disease symptoms alone. It is the whole person's wellbeing regarding the individual physical, psycho-emotional, mental, and socio-spiritual wellbeing. The psychological understanding of illness and symptoms surpassed the biomedicine knowledge in delivering the whole person treatment that produces the quality of life. The modern holistic concept makes the role of psychologists in health sciences a growing concern that draws special attention as health expand from its bio-medicinal realm to the psychosocial-spiritual wellbeing. Unfortunately, the role of psychologists in health science remains unclear in many clinical practices in the country. None is more effective than assessing the patient's emotional sufferings and mental disharmony for the whole's quality of life and wellbeing. The psychological approach to health care is also an essential effective treatment plan and policy in clinical practices.


Introduction
With the emergence of psychotherapeutic intervention in clinical practices, the interplay between psychologists and health in medical sciences has become a growing topic of interest.The psychological assessment is visible in enhancing the quality of life and wellbeing in clinical practices.Health requires interdisciplinary team assessments in addressing the holistic needs of the individual.The biomedicines alone are not adequate to meet and maintain the modern definition of health and wellbeing.Since the patients are not mere recipients, the drug's use in the treatment alone cannot produce heath; it requires examining a person's attitudes, expectations, beliefs, and psycho-emotional assessment.
On the other hand, psychologists as trained professionals understand the patient's emotional sufferings and mental disharmony through its mind-body dualism approach (Cho et al., 2011).The psychological approach to care in clinical settings helps maintain the clinicians' emotional stability, quality health care management and work in the best interest of the patient and family.The role of clinical psychologists is to examine and understand how environmental factors like biological, social, economic, and psychoemotional feelings affect individual health and wellbeing.The psychological assessment helps the individual do a personal life review that would enable them to modify their goals and lifestyle, giving them the ability to deal, adjust, and recover from their ill condition (Vaiphei & Sisodia, 2018).Thus, understanding the cognitive process will help understand how to prevent body dysfunctions through any possible means.

The New Era of Mental Health
The world has changed, so understanding specific terms and definitions in medical health sciences also transforms alongside human evolution.Looking back to the origin of medical science, recognizing mental health as the recognized model of care begins only after 1948 with the formation of the Mental Health Association by the World Health Organization (WHO).The WHO mental hygiene movement includes inner instinct conflicts, mental instability, and other environmental factors that disturb the individual state of mind.The concept of mental health diagnosis aims to minimize the social stigma and discrimination to deliver positive health outcomes.The focus of mental health has shifted from diseaseoriented to person-centered approach psychotherapy that restores and maintains the patient psychological dysfunction mainly cause by the disease symptoms (WHO, 2003).The advances in physiological research and other health sciences bring new development that enhances the concept of health and illness into a more comprehensive approach.The new idea of health views the human ill experience as combining the biological, psychological, social, and spiritual factors that need the biopsychosocial-spiritual assessment alongside treating the physical pain symptoms.The biopsychosocial-spiritual model of care enhanced the patient's quality of life and wellbeing and succeeded in reducing the disease risks that usually develop the symptoms to produce organ disabilities.

International Journal for Multidisciplinary Research (IJFMR)
E-ISSN: 2582-2160, Volume 4, Issue 5, September-October 2022 It also has scientific and practical benefits with several positive outcomes (Vaiphei & Sisodia, 2018, 2019).The model seeks medical treatment through interdisciplinary team interventions that include physicians, psychologists, social workers, and well-trained nurses.However, the role of psychologists in clinical practices was least known as the world before was purely a biomedical assessment alone, which primarily focuses on the biological aspect of health and illness.The following Figure 1 provides the total definition of health is adapted from (World Health Organization, 2003).The advance of the mind-body-behavioral aspect in human ill diagnosis brought a new paradigm towards the modern medical health sciences and practices.The primary aim is to focus on the holistic approach for the wellbeing of the whole.The acknowledgment of stress, depression, emotional suffering, beliefs, and social assessment in ill diagnosis becomes the universal model of health care recognized by the WHO.It stood as the most effective coping mechanism in dealing with a mental health problem and other related health issues in clinical practices (Thirunavukarasu, 2011).The WHO declaration of mental health stated: "a state of wellbeing in which the individual realizes his/her abilities, can cope with the normal stresses of life events, the ability to work productively and be fruitful, having the sense of responsibility to contribute to the community or society he/she belongs" (WHO.2004).Identifying the individual psycho-emotional sufferings to diagnose the non-pain symptoms through holistic assessment becomes the core concern of the new world approach in health science.However, the minimal availability of psychologists and other workforces in the country is visible as a serious threat to effective mental health diagnosis.Mental health demands multidimensional approaches to address the existing stressors and other environmental factors that need proper preventive measures.It requires the active involvement of both the psychologists and the medical professionals to be interchangeably administered and dedicate to achieve mental wellbeing through its holistic approach (Bertolote, 2008).

The Current State of Mental Health Issues and The Role of Psychologists
It is the fact that mental health is hugely affected by the individual system of beliefs and the cultural background, which seeks inclusive definition to recognize the unique social role and social support alongside the interventions of the biomedicines.It also acknowledges the necessity of preserving the value, feelings, and dignity to respect the environment and the autonomy in the best possible ways.The concept does recognize the importance of the human differences in the reality of life epochs, the search for internal equilibrium, and restoring its dynamic state of balance (Galderisi et al. 2015).The following figure will show the mental health status and the factors that cause mental health issues in the country from 1990-2020.The following Figure 2 is adapted from (WHO India, 2019, 2020;UNICEF India, 2021;India Today, 2021;Statista Research Department, 2021).substance use disorders.The common challenges are visible in the inadequate funding and the rapid growth of the mental health-affected population.Out of 4.16%, only 0.06% of the mentally ill population in the country were allocated at the national level psychiatric care as an outpatient in 2011.
The finding also suggested that India has the minimal availability of only 2.15 beds per 100,000 compared to 6.5 global figures (Mala, 2018).Thus, the current insufficient amount of mental health workforce and care centers gave rise to the emerging needs of psychologists for patient advocacy, counselor, evaluator, educators, providing quality treatment plans and supporting the patient and family stressful events through their person-centered psychotherapy.
The roles of psychologists are not confining within the educational or research realm alone.The psychotherapeutic approach to ill mental experience is a patient preference structure of care that examines and addresses the nature of distress, anxiety, hopelessness, and burdensome feelings with positive outcomes.Unlike any other diagnosis, a mentally ill diagnosis demands extensive multidimensional assessments to deal with several unwanted emotional consequences.The medical professionals alone failed to encounter the patient emotional suffering and mental disharmony without the intervention of the well-trained psychologists in its clinical practices (Vaiphei & Sisodia, 2018).Mental ill diagnosis requires neuroscientific explorations to understand the psychotic and unstable conditions of the human brain and the nervous system.Mental illness, on the other hand, has no age bar and cultural background.And the psychologists can have a deeper look at cognitive processing issues with a better trauma management policy.The psychological assessment helps understand the value of the human relationship, promotes quality of life, and extends research on mental health and happiness.
On the other hand, psychologists understand the neurological basis of human psychological disorders, the functioning of the human heart-mind, identifying how the brain dysfunctions, and guiding in intercepting the physiology of mental disorders (Bertolote, 2008;Galderisi, 2015).Thus, understanding human mental disorders' neurological and biological functions will help provide quality treatment plans and policies for better treatment outcomes.
With the development of multidisciplinary team assessment in mental health diagnosis, the involvement of professional psychologists becomes the universal norm rather than exceptional to meet the existential challenges in clinical practices.The psychological approach to mental health strengthens the individual emotion, personality, and support and enhances positive life goals.Psychologists can develop new systems to care for and a significant role to play in working with people of diverse cultural backgrounds.They assist the patient in primary and secondary care, including community services, illness prevention, behavior health promotions, rehabilitation services to meet the particular needs of those with learning disabilities, brain dysfunction, and other mental disorders-related issues (Chowdhury, 2019;Pliszka, 2003).In clinical assessment, the standardized psychometric testing instruments are the prime mechanism in identifying and addressing the patient's needs.It helps in delivering appropriate treatment, prognosis, monitoring, and informing quality risks management policy.As an unlimited realm of exploration, the development of psychological standardized diagnostical instruments provides absolute validity and reliability in clinical practices.The testing instruments are effective both in biological and psychological assessment to overcome mental disorders or stressors, having a certain positive impact on patient physical health (Deshpande, 2019).In most cases, psychiatric patients are usually with severe mental disorders like distress, depression, anxiety, suffering from hallucinations, which are in the conditions of violence, and inappropriate behaviors.Their state of health conditions demands multidisciplinary team interventions for comprehensive assessment, evaluations, and formulating appropriate treatment plans and policy.In understanding the mental disorder diagnosis, the psychological tools are the core mechanism to understand the patient's psycho-emotional disorders.On the other hand, psychologists are well-trained to conduct such psychometric tastings and assist in the diagnostic process in clinical practices (Saeed & Sychol, 2005;Miller, 2019).The psychological instruments are an effective tool in administering, reducing, and relaxing the patient existential stress and depressive moods alongside the psychiatric medicines.According to the American Psychological Association, the psychological assessment intervention is the integral domain of care in a clinical setting in the following fields: assessing the neuropsychological aspect of human behavior, quality decision making, psychopathology, emotional wellbeing, and group dynamics.None is better than the psychologists in addressing the patient behavioral health issues, helping the patient adjust to the environment, modifying the life challenges, managing non-pain symptoms, sleep disorders, and reducing inconveniences (APA, 2019).
As the medication used in chronic and psychiatric treatment usually produces specific unwanted side effects, the psychological assessment intervention becomes essential in the diagnostic process.The psychopharmacological assessment has increasingly become people's preference treatment, which is considered adequate and a safer domain of care.In a recent collaborative experimental survey, the psychological intervention is visible enormously effective in addressing the patient depressive stressors, individual anxiety, chronic disease management, personality disorder, dementia, drug abuse, traumatic stress disorder, and factors associated with severe mental illness.The psychotherapeutic approach to care is competently efficient in developing personal wellbeing, mindfulness of the environmental demands, cognitive awareness, overcoming suicidal activity, and fluidity in enhancing the patient's mental recovery process (Brehm, 2019;APA, 2020;APA, 2009).Positive psychotherapy is another effective coping mechanism against mental disorders that gives meaning to challenging life events.It formulates and converts the inner energy to invest in productive ways in the individual daily life events.The psychological assessment encounters the patient interpersonal challenges with minimal medications.The psychotherapeutic session is also a process of finding ways to enhance social support emotionally and financially.It also helps assess and supervise the clinicians' performance in evaluating patient needs, offering the patient the freedom of choice and quality decision-making regarding treatment plans and policy (Slade, 2010).

Findings and Discussion
The findings are: (1) In India, the burden of mental health problems is estimated as 2,443 DALYs per 100,000 population by WHO, India, 2020.(2) Minimal availability of mental health care centers and the rapid increase of the mentally ill population.
(3) 70% of mental health patients in India experience a treatment gap due to insufficient funding for mental, neurological, and substance use disorders.(4) Mental ill diagnosis requires a multidisciplinary team for neuroscientific explorations to understand the psychotic and unstable conditions of the human brain and the nervous system.Mental health is a universal phenomenon that hugely affects the maximum number of people of all ages.At present, India turns out to be the hub for mental disorders and dealing with mental health issues in the most unsuccessful ways.There could be no definition of health without mental wellbeing, yet it's the most neglected area of care in the Indian healthcare system.The underlying factor that demands special concern is acknowledging that mental health is the core to human health and wellbeing.Health is more than the mere absence of disorders elements.It is the bi-products of individual biological, environmental, socio-politics, financial, and spiritual factors (Vaiphei & Sisodia, 2019).In WHO 2020 report, the burden of mental health problems in India is estimated as 2,443 DALYs per 100,000 population, in which the suicide rate is 21.1 per 100,000.Moreover, the WHO estimated that the economic loss between 2012-2030 due to mental health issues is visible around 1.03 trillion of 2010 dollars.The following Figure 3 provides the current statistics of mental health and workforces available in the country at present is adapted from (WHO India, 2020): Figure In the 2013-2020 Action Plan, the WHO collaborates with the member of states and the responsible government of each country to take up immediate action plan/policies to uphold and strengthen the goal of mental health with effective strategies as a global goal.The plan seeks to enhance global mental wellbeing by preventing mental disorders through implementing comprehensive social and community services, empowering human rights, reduce mortality, disability, morbidity, and strengthening quality assessment that would enhance recovery rates (WHO India 2020).
In line with the WHO policy, the Community-centered-based care supports by empowering civil society could play a central role in mental health awareness and diagnosis.Alongside the psychiatric medications, the involvement of psychologists can effectively address the challenges like developing and strengthening mental health workforces, traumatic life events, coping skills, interpersonal relationships, and other associated existential challenges.The psychological assessment is essential in helping the individual deal effectively with complex life events, non-pain symptoms and abstains from excessive drugs and alcohol use.Gathering helpful information regarding the patient's cognitive functional abilities and problem-solving skills are the two essential psychological tools for socioenvironmental remodification and cognitive rehabilitation in the most appropriate ways (WHO, 2019; CAMH, 2020).However, the minimal availability of psychologists and another mental health workforce hinders the proper functioning of multidisciplinary teamwork and a quality care assessment.Unfortunately, psychological assessment and support intervention remain an unheard area of care in most parts of the country.The non-pain symptoms like emotional suffering and mental disharmony are still considered as symptoms that need not be treated.
It is to be noted that the psychotherapeutic assessment not only addresses the patient's disorder issues but also works to prevent it from happening in individual experience by identifying several stressor factors with timely and appropriate treatment interventions.The evidence-based cognitive-behavior therapy and the associated psychometric tools that effectively identify and manage the individual adverse thought outcomes, alongside the daily stressful events, are visible as the core contributing factors of the psychologists in a mental illness diagnosis.At present, the unavailability of the psychological approach to care in maximum clinical practices is visible as the most significant challenge against the upcoming mental health concern.Another factor could be the minimal availability of psychologists, which is the ratio of 0.07:100,000.Socio-cultural stigma, lack of education, and awareness that considered consulting a psychologist/psychiatrist a taboo is also another hindrance against the burden of mental health concerns in the country.Thus, focusing on training maximum numbers of mental health workforces to be part of the interdisciplinary team in the clinical practices should be the prime concern for Indians today against the rapidly increasing burden of mental health concerns in the country.Psycho-social support intervention in the early stage at school, college, and community level is also an effective mechanism to fight against the current mental health challenges.Strengthening the awareness and providing treatment options in the primary health care centers in the country's rural areas is the urgent need of the hours.

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Figure 2: Cause of Mental Health Issues in India : 2582-2160, Volume 4, Issue 5, September-October 2022 : 2582-2160, Volume 4, Issue 5, September-October 2022 : 2582-2160, Volume 4, Issue 5, September-October 2022 2: Cause of Mental Health Issues in India per the report given by "India State-Level Disease Burden Initiative Mental Disorders Collaborators-Indian Council of Medical Research" (ISLDBIMDC 2019).Despite the growing challenges of mental health problems in the country, the finding suggested that only 30 million have minimal access to mental health care.The recent finding indicated that 70% of the country's mental health population is experiencing a treatment gap issue mainly due to insufficient funding for mental, neurological, and IJFMR2205015 Website: www.ijfmr.comEmail: editor@ijfmr.comInternational Journal for Multidisciplinary Research (IJFMR) E-ISSN: 2582-2160, Volume 4, Issue 5, September-October 2022 . 3: Mental Health Work Force