Status and Requirements of Geriatric Mental Health Services in India: An Evidence-Based Commentary

By Tiwari, S.; Pandey, Nisha | Indian Journal of Psychiatry, January-March 2012 | Go to article overview

Status and Requirements of Geriatric Mental Health Services in India: An Evidence-Based Commentary


Tiwari, S., Pandey, Nisha, Indian Journal of Psychiatry


Byline: S. Tiwari, Nisha. Pandey

In view of appreciable improvements in health care services in India, the longevity and life expectancy have almost doubled. As a result, there is significant demographic transition, and the population of older adults in the country is growing rapidly. Epidemiological surveys have revealed enormous mental health morbidity in older adults (aged 60 years and above) and have necessitated immediate need for the development of mental health services in India. The present population of older adults was used to calculate psychiatric morbidity based on the reported epidemiological data. The demographic and social changes, health care planning, available mental health care services and morbidity data were critically examined and analyzed. The service gap was calculated on the basis of available norms for the country vis-a-vis average mental health morbidity. Data from a recent epidemiological study indicated an average of 20.5% mental health morbidity in older adults. Accordingly, it was found that, at present, 17.13 million older adults (total population, 83.58 millions) are suffering from mental health problems in India. A differing, but in many aspects similar, picture emerged with regard to human resource and infrastructural requirements based on the two norms for the country to meet the challenges posed by psychiatrically ill older adults. A running commentary has been provided based on the available evidences and strategic options have been outlined to meet the requirements and minimize the gap. There is an urgent need to develop the subject and geriatric mental health care services in India.

Introduction

Ever since independence, India is passing through a phase of rapid transition in almost all areas, be it social, demographic, health care or economic. The effects are reflected in social change, emerging nuclear family systems, increase in population due to improving health care services, economic growth reflected in industrialization, urbanization, infrastructural developments, etc. The 21 [sup]st century India is quite different from the India around independence in late `40s and `50s. The transformed India has newer and newer challenges in almost all walks of life. A very rapidly emerging issue relates to developing services and care for the grey segment of the population whose numbers are growing every year.

The Greying India: Demographic Changes

Aging of the population is one of the most significant components of demographic change besides other changes like rapid population movements, increase in life expectancy at birth, improving vital statistics, etc. A look at the vital statistics indicate that the infant mortality rate (under 1 year) reduced from 80/1000 in 1991 to 52/1000 in 2008; the crude death rate reduced from 160/1000 in 1970 to 80/1000 in 2008; the life expectancy increased from 49 years in the `70s to 64 years in 2008. [sup][1] The net result is growth in the greying sector of the Indian population and the consequent change in the demographic pyramid.

The pace with which the population of older adults in India is growing (1951-5.3%, 1981-6%, 1991-6.8%, 2001-7.4%, 2006-7.5%; and projected for 2026-12.4%) is likely to become a challenge in the very near future. [sup][2],[3],[4] The population projections and changing demographic scenario of India indicate that the growth of older Indian adults in absolute numbers is comparatively faster than that in the other regions of the World. The population of older adults aged 60 years and above increased from about 20 million in 1951 [sup][2] to 77 million in 2001 [sup][3] to 83.58 million in 2006, and is expected to increase to 173 million in 2026. [sup][4] Thus, the number of older adults will approximately be doubled by the year 2026 (173 million) in comparison with the year 2006 (83.6 million) in India.

Social Changes

India traditionally lived in joint family set ups with agrarian economy where everyone shared responsibilities, financial gains, social obligations, etc. …

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