Economic and Financial Implications of Mental Illness - An Open Letter to the Prime Minister

Economic and Financial Implications of Mental Illness

An Open Letter to the Prime Minister

Some Time in May, 2010-Abridged part of this Article was Published in the Economic Times on the OP-ED Page (Editorial) Page on 1st June,2010

Respected Dr. Singh,

In the Life of a Nation some dates are defining. For India, August 6, 2001 was one, when dozens of hapless chained mentally ill were roasted alive at Erwadi, Tamilnadu, when fire engulfed the Moideen Badusha Mental Home. Sadly, as we enter the decadal year of the monumental tragedy, Lessons of Erwadi largely remain unlearnt.

This letter solicits your attention to the existential, institutional and policy implications of the grave malady of Mental Illness inflicting the nation. It also appeals, on behalf of muted millions, to intellect, erudition and conscience of the Prime Minister. And, there is urgency -seldom do nations get second shot at deliverance after squandering the first - 7th May, 2010 was one such date, on which following two coincidently happened simultaneously:

First, an open letter reached Union Minister of Health, architect of the letter being Hon’ble Justice Ajit Prakash Shah, retired Chief Justice of Delhi High Court. Six page letter is a factual account of state of rightlessness and non-person status of mentally ill in India. One paragraph of the letter is reproduced verbatim here “discrimination against people on the basis of diagnosis of mental illness is common place in India and even in the laws in India. If the multiple laws which sanction the discrimination are not addressed simultaneously then the persons living with mental illness will continue to be incarcerated in institutions”.

Second, latest issue of Tehelka has come out with the headline: “Someone close to you is screaming for help-LISTEN” and the byline “unattended, ignored, millions of families are struggling with someone who is mentally ill. But India has virtually no mechanisms to deal with this”. Its cover story “Mind Snare” traces the tragic debris of destroyed lives in a well-researched and objective manner. You will find the story heart wrenching and as one which brings the Naked-Naked-Truth of the suffering of mentally ill and their equally hapless care-givers. But, I doubt the article will have any lasting impact on our conscience, so deep rooted and exasperatingly imbedded is the stigma against psychiatric illness in our national psyche.

Sir, through most of human existence, 99.99% people, leave the world, having embattled their life as a symbol of inertia and cultural statis, some how managing to keep their life and family together. Dr. Manmohan Singh, over two decades has proved to be one from among that 0.01% people, who disrupt equilibrium and to whom posterity accords the status of world changers. Today the subject of Psychiatric Illness begs your personal attention, if not for the reasons of rights and inclusion as brought out by Justice Shah or for the sheer state of desperation as brought out by Tehelka, then for the sound economic and financial reasons brought out here. I dare say Sir, psychiatric illnesses as a group have turned serious deflators of Indian Economy, and the impact is 2-3% of GDP per annum.

The task of making difference to life and times of sufferers of psychiatric illness is humongous and shall remain non-starter unless championed by you. I do understand your compulsions- governmental resources are finite, and the buck stops at your level to exercise the hard choice between alternative uses of same resource. But Sir, how can the dream of Indian century be actualized if we persistently refuse to or are unable to use Whole Mind of the Nation.

I trust this letter ignites the mind of humane development economist in you and my aim is definitely not to elicit sympathy or empathy quotient for the mentally ill. Assuming we ascribe zero value to human costs of psychiatric illness, the economic costs themselves-both direct and indirect are staggering. Given the famine of even homegrown etiological and epidemiological studies of mental illness in India, for analyzing complex issue of economic and financial implications, I have relied on the external wisdom. Nevertheless, they do provide insight and replicable lessons for informed public policy:

One, during your tenure as Finance Minister, the World Bank in its 1993 World Development Report, highlighted Mental Illness as major contributor to the Global Burden of Disease. Also in 1995, a study by the Massachusetts Institute of Technology found depression costing American industry $43.7 billion annually, including $23.8 billion in lost time due to absenteeism and reduced productivity, $7.5 billion in lost earnings due to depression related suicide and $12.4 billion in direct care costs

Two, Dr. Kathleen Merikangas of NAMI and Ronald Kessler of Harvard Medical School in a study published in Archives of General Psychiatry in 2007, concluded, annual loss of 1.3 billion working days in U.S. due to mental disorders, 50% to all chronic physical conditions combined. Subsequently, in, 2008 the American Journal of Psychiatry, extrapolating from another study by Kessler et. estimated total annual economic cost of serious mental illness in US having doubled from US $ 156 to 317 billion between 1992-2002 excluding costs of comorbidity, incarceration, homelessness, and mortality. By, 2010, this annual loss is, expected to be nearly half of annual GDP of India

Three, WHO in its 2005 Report “Economies of Mental Health’’ concluded that economic costs related to mental illness accounted for 3-4% of GNP in EU nations. Also, Sainsbury Centre for Mental Health in UK estimated this cost to English Economy as Pound Sterling seventy seven billion per annum. Both these numbers are dated today.

BY 2020, the pandemonium of Mental Illness will engulf one member of every family in the country and we need Indian Next Practices and the golden touch of Manmohanomics to combat the scourge. Present dysfunctional paradigm which perpetuates incarceration of sufferers needs speedy burial. The CHOICE program of WHO provides some hope- 300 to 500 million years of healthy life could be gained for every US$ 1 million invested on mental care. The pay back period is nano-low and rate of return exponentially high. You can make tomorrow come today.

Yours Truly,
Akhileshwar Sahay
Principal Instigator
Whole Mind India Foundation

When a Turbulent Mind found its CALLING of LIFE

When I landed at Chennai Airport in early hours of 1st July, 2010, I was unaware, the visit would again alter the course of my five decades of Roller Coaster Life lived with Turbulent Mind. I was greeted on arrival with warm and triumphant smile by the person carrying a placard “The Banyan” and was escorted to a vehicle which said “I Exist Therefore I am”. The normal calling of the vehicle was to ferry rescued wandering Mentally Ill women from Chennai Roads to transit care hospital run by the Banyan. It was befitting that in this extraordinary trip I would have fortune to board the vehicle-It was poetic justice to my Life and Times lived with debilitating Manic Depressive Insanity, secularly called Bipolar Disorder, diagnosed 13 years ago. Unlike my usual corporate journeys to Chennai when I would stay in luxurious star hotels and driven in swanky cars, this special journey for three days was a humbling experience. In my abode for three day stay, Asha Niwas, the room was devoid of luxuries of modern life, except a noisy air-conditioner. Still it was soothing and heartwarming and I had a room companion, the person representing Sir Ratan Tata Trust for the three day event: “National Seminar on Mental Health organized by The Banyan and BALM (The Banyan Academy of Leadership in Mental Health) supported by Navajbai Ratan Tata Trust.


I was listed as one of the speakers on the first day in the inaugural session under the category “User Survivor”. I was humbled and honored at this magnanimity of organizers as a late gate-crasher to the event. This was more so because, instead of being a domain expert on Mental Illness, I thus far was a hapless sufferer of one of the worst forms of insanity known to mankind, an illness where there is only temporary tenuous illusory remission and no permanent recovery and whose etiology and cure has belied the medical and scientific community for more than two millenniums since Hippocrates. The seminar schedule was packed, I was self invited with promise to organizers to finish my presentation within ten minutes. I was there primarily for immersion in the subject which I needed to understand for existential reasons and learn from luminaries, experts and activists working for decades against all odds.

What stuck me most at the Seminar, was presence of an old gentle man of ninety years, intently absorbing full three days of proceedings- he turned out to be one B. Aravind Vellody, India’s past ambassador to world at large, writer of the book “Around the World in Eighty Years” and past-chairperson of the Board of Trustees of the Banyan. Also among delegates was a warrior of rights for disabilities, in wheelchair due to his cerebral palsy, a mental illness cause champion, who sacrificed her marital bliss to be a care giver to a Schizophrenic brother and a petite girl, who had happily assumed arduous role of care giver to the mentally ill sister of her husband.

The seminar turned out to be defining three days for mental health movement with erudite speakers, their zeal, passion and proven track record in preventing, treating, managing, rehabilitating and improving the life and time of mentally ill. The roll-call of speakers was headed by a learned sitting judge of High Court, a doctor Minister from Tamilnadu, relevant government officials, President Elect of Indian Psychiatric Society, leading psychiatrists, other professionals, academia, front line NGOs, advocacy groups, media, caregivers and users. Most impressive were those working with passion at the bottom of the pyramid with destitute and home less mentally ill on the streets of Chennai, Kolkata, Delhi, with tribal’s in Nilgiri range and at beggars home of Mumbai and Delhi. My own contribution was limited setting bizarre process precedence by consuming 90 minutes of proceedings against allotted 10 minutes bringing chaos to Seminar schedule.

The Chennai visit proved chastening, learning, exhilarating, living and extraordinarily humbling journey for me. But what changed the facts of my life for ever, was listening to the wrenching story of the valiant warrior Thiruchelvi who, in last six and half years renewed herself with a miraculous turnaround in life - from the stage of a mental wreck in readiness to sell her two and half year old baby son for a bowl of rice, to the one who was deserted by her husband in her mentally ill state, the one who was rescued from Marina beach and rehabilitated back to normalcy by the Banyan and the one who today gives transformational lectures on bringing new meaning to Life Lived with Madness and Sadness and Mental Wellbeing. Thiruchelvi taught me “There is Life Beyond Madness and Sadness even in extremities of Penury and Hopelessness”. Thank u Thiruchelvi, my teacher, for imparting this one of the greatest learning of life.

I had gone to Chennai with the greed of sharing my own story “Of Madness and Sadness” and the rainbow coalition of my Life, which had given me the status of a relatively successful knowledge worker in the country, despite leading a disrupted undulating life alternating between the abyss of depression and high of Mania. What I came back with, was the indelible impression of gratitude and the lingering memory of a rainbow coalition provided for restoration and giving dignity to the Life to Thiruchelvsi. A sense of I can.

I found new meaning and new calling to my Life midway of the seminar and left Chennai with new found faith – “I would not let my Audacious Dreams for Whole Mind India Foundation (WMIF) die young or unsung, even if it takes my own life prematurely to the grave in the process. The dream of WMIF is to become ultimate rainbow coalition for aggregating all the non-governmental efforts to achieve illusory Total Mental Health Status and to dedicate balance years of my uncertain life to capacity building of all the stakeholders to fight the unequal war of removing stigma, darkness of veil and discrimination from which mentally ill suffer. Chennai enhanced my adrenal to Fight, to envision more than what I was capable of. It also gave me the strength; I found fellow travelers and many of them walking the thorny path for quite a while.

The task assumed by WMIF is daunting and path has blind alleys. Sadly, my own life is fragile, Consensus research, puts my expected life-span ten year lesser than a normal Indian, owing to the complexities of my bipolar disorder & co-morbidities, including substance abuse ( obsessive compulsive smoking) and/or side effects of life and mind saving psychotropic Medication (choice is between life long medication or insanity). This realization of fragility of my life, combined with the constitutional status of a person “with unsound mind” and a non-person status under various statues of the country due to my manic depressive insanity, I have taken a conscious call. And the call is: “I might have been the Principal Instigator of WMIF, but would not hold any position in the governance structure of the Foundation ever. Having been certified as one suffering from serious mental disorder by AIIMS, I, as a responsible citizen, would not take refuse under the legalistic position that I have not been declared of “Unsound Mind” by a court. I accept the reality of my life- my semblance of sanity, is handiwork of medication and other enabling conditions, and will be there is there only till the tenuous Remission lasts. Last, it remains daily battle with violent undulating moods of my SAD (seasonally affective disorder) Bipolar Disorder. My madness can strike back any time with undefined severity.

Chennai also concretized the idea of commemorating India entering tenth year of Erwadi by observing it as India’s First National Mental Health Awareness Day. The name Re: Mind India and its logo came from the creative mind of Vaishnavi Jaikumar to reminding a nation of the Sacrifice of Erwadi Martyrs and to take a pledge not to let Erwadi happen again. It is a year long inclusive festival to celebrate every step of inclusion and banish every trace of stigma and de-humanization attached to Mental Illness.

Re-mind India starts on 6th August the day we enter 10th year of monumental tragedy of Erwadi. It will ask seminal question “Why people land at Erwadis of India in the very first place and what has changed ten years since Erwadi”. And the only visible answer is, India is increasingly getting disrupted with more and more joining mentally ill bandwagon with psychiatric services for prevention, cure and rehabilitation falling woefully short of requirement. From families, society, government to all other stakeholders, all are lacking in even appreciation of the problem and remain oblivious or turn blind eye to graveness of the situation. While country pays collateral damage in terms of serious psychological, familial, societal, institutional, organizational and national disruptions, including humongous economic and financial costs, the sixty year old festival of denial continues. Leaving all human suffering aside, India is at a cusp where Mental Illness has turned serious deflator of GDP by minimum 2to 3% per annum.

On 6th August, We the People of India take a pledge- “Not to Let Erwadi Happen Again” and we will light CANDLES OF REMEMBRANCE AND HOPE. This 6th August, and every year there after would be observed as National Mental Health Awareness Day, with multi-partisan support of all stakeholders. Broad consensus of stakeholders has decided Re:Mind India will be observed on this 6th August across the country at almost the same time, with symbols of hope and remembrance being CANDLES AND SILENCE. There will be other activities local, regional and national during the year. Re:Mind India Initiative is owned by every Indian, just instigated and powered by Whole Mind India Foundation.

And, here comes the time for some random thoughts and musings of dwelling down the memory lane and why and how Whole Mind India Foundation came into being on 2nd, January, 2010. The cardinal question which often visits my Mind and which repeatedly is asked by friends, family members and well-wishers is, - “What prompted my muddling in the murky Business of Mental Illness, a condition which carries the level of stigma today, worse than that of leprosy in previous century. Further, why I am so fanatically passionate about making difference to the Life of Times of Mentally Ill , when my own life is disrupted beyond repair and needs a daily support system, not only to keep my mood and life even, but also to keep up with the regimen of conformity to mind saving psychotropic medication. And, lastly why and what motivated me to launch Whole Mind India Foundation (WMIF) in the very first place and dream with an unachievable BHAG (Big Hairy Audacious Goal)

These questions are intricate existential questions of my life, and my mis-wired brain does not have any simple answer. One possible explanation (given by my Friend and well wisher Subroto Bagchi, Co-Founder and Gardener of Mind-Tree) is –“probably God sculpted me manic depressive and sent to the Planet Earth with the Bipolar Gift to undertake this mission impossible. The second, probable, explanation is - during my manic high in year 2000, I got a vision to change the world (I then considered myself an incarnation which was a cross between Mahatma Gandhi and J. R. D. “Jeh” Tata, in the hallucination and delusions of manic breakdown) and I indeed set up an umbrella called “Parivartan Foundation” to take forward the vision then. The vision was still born and got lost to my bouts of insanity. Thirdly, it is possible that while asking the fundamental questions “Who I am? And What I want to do in second half of Life”, just before the start of new millennium, thousands of nautical miles away from India, in mentally disrupted state, I got my calling which came to me as “I did not want to be the richest man in cemetery or when I was consigned to flames” .

Of all the possible reasons I can adduce for setting Whole Mind India Foundation, the one which comes closest to Truth is- “When My World Came Crashing Down- I had help readily available at hand”. There came a protective and enabling “rainbow coalition” a canopy of family, friends, well wishers, colleagues, subordinates and passers by who navigated me through troubled water. With five years of past thirteen years spent with severe disability in a vegetative state, I say this with conviction, Whole Mind India Foundation, got instigated by me just because, I turned out to be one lucky Indian despite my devastating “madness and sadness”, in a country where millions of sufferers of Mental Illness either remain incarcerated at asylums, homes, prisons and homes or still worse die often young and unsung and that too due to self inflicted injuries (scientifically called completed suicide). It is the suffering of millions and the great societal debt I carry in perpetuity in Mind, which gave the calling of life, and a new purpose to the meaning of Second Half or balance ten years of life- this is the story of birth of Whole Mind India Foundation on 2nd January, 2010 in cyberspace. It was only on 2nd April, 2010 that A Lamp was Lit by Users and Caregivers with collateral support of stakeholders at India International Centre, New Delhi, which marked the arrival of WMIF in real space, without a home or registration under any valid statute of India. Whole Mind India Foundation could not have asked for a more auspicious place for its birth- India International- the dream project of Dr. Sarvapalli Radhakrishan, India’s second President, actualized with the visionary support of Pandit Jawaharlal Nehru.

I did not suddenly contract Bipolar Disorder through viral infection (it is substantially inherited with nurture playing the role in triggering the onset). Similarly, Whole Mind India Foundation was not born in a day. Since the idea first came in a flash in “Sunken Garden” in Manila, Philippines in my dazed state like sudden reawakening in year 1999, it has changed contours many a times and has been a still born baby more than once. Even today WMIF is a pre-maturely born child in incubator, running largely out of meager personal savings of a Manic Depressive, whose financial net worth is perpetually in negative. Mentally Ill Indians, those at the bottom of the pyramid, the destitute and homeless survive by wandering on street, even the one with money normally are not welcome as a neighbor. WMIF has existential similarities with home less mentally ill, as it primarily exists as loose confederation of conscientious Indians, joined together with the passion for the cause, with home-base of WMIF being the squatter in the cyberspace with temporary shelters here and there. The only capital WMIF possesses is that of goodwill and my hope is, it will survive and thrive beyond the troubled birth on voluntarism and hundreds of volunteers across India of Re:Mind India Movement and 1500 plus members of WMIF hyper-connected through super connectivity of social networks-Facebook and Twitter

Leading a difficult disrupted life full “of Madness and Sadness” undulating between mania and depression is not easy in any part of the world. It is excruciatingly difficult for me in our part of the world. It is extremely difficult to explain what goes into the mind of mentally ill even to the nearest and dearest. The Constitution of India brands a seriously mentally ill person (of course once declared by court) as one of “unsound mind”. Statutory frame work of Mental Health Act, 1987 remains one of fear of saving the society from lunatics, something deeply engrained in the preamble of statute itself. The societal construct is one of stigma, veil of darkness and discrimination. Life of a mentally ill is one of seclusion not of inclusion; it is one of fear not of love. Is one of incarceration not of accommodation? This has been my life too, except that I have been lucky, I have a rainbow coalition.

If above is the true state of Life and Times of Mentally Ill in India, and if my life has been saved by my rainbow coalition, if instead of stigmatized by all and sundry, I have received love and affection despite my madness and sadness, if marriages break at the first instance of mental illness in this country, still my wife has been a rock solid single source caregiver and therapist, in the process forgetting her own existence, if my children from childhood have directly landed to adulthood bypassing adolescence, if my employers have not abandoned in mental illness, if my clients wait for my blues to go away to serve them, all I can say. There is Life Beyond Madness and Sadness. There is hope amidst hopelessness. Even mentally ill deserve life of dignity; more over given right umbrella they can propel the annual gross domestic product of economy by minimum additional two percent. Even for mentally ill, if the stigma and discrimination vanishes, life can turn from living hell to heaven on planet earth and they can shine like stars in the sky. Just let them be.