DIFFERENCES IN MENTAL HEALTH SERVICES UTILISATION ACROSS CASTE AND GENDER: A STATISTICAL STUDY FROM CENTRAL INSTITUTE OF PSYCHIATRY

The study’s conclusions are consistent with earlier investigations in same circumstances. According to Table 1 of the current study, there was a more than 28% rise in patient registration at the OPD level in just ten years. Several factors or variables may be responsible for it, such as the “marked increase in the global burden of disease sharing mental, neurological, and substance use” (WHO, 2004; Haldar et al., 2017), the “notoriety for the rise in mental, neurological, and substance use disorders” (Patel et al., 2016), the “limited availability and accessibility of basic and specialised mental health services at primary and secondary levels in this region of the country,” the “growing awareness about mental illness,” etc. Notedly, men have consistently made up the vast majority of females in both new and follow-up cases (Table 2). Table 2 shows that, when it came to new cases, or patients who were visiting the Institute for the first time, the proportion of male patients nearly doubled between 2012 and 2021 and increased to over 2.5 times at the follow-up. This implies that women receive fewer tertiary-level treatments for mental diseases than men do, and that women patients also attend fewer routine follow-up appointments. Studies on the use of mental health services in metropolitan India have revealed a ratio of one woman to every three men visiting public health psychiatric outpatient clinics. This suggests that afflicted women “under-utilize” available resources. There is a likely greater stigma attached to women’s mental illness that negatively impacts the help-seeking behaviour for public mental health facilities, and/or lesser importance is given to mental health issues pertaining to women in general. The reasons for this gender gap in treatment seeking and follow-up are multifaceted and include both sociocultural and illness-related factors. These include the following: “possible impact of gender on the age of onset of symptoms, clinical features, frequency of psychotic symptoms, course, social adjustment, and long-term outcome of severe mental disorders”; “forms of social support available and accessible to women with mental illnesses”; and, most importantly, “anticipating societal rejection in the forms of stigma, stereotypes, and prejudices for mentally ill women and their carers” (Malhotra & Shah, 2015). The difference between prevalence and use can increase with gender. One possible explanation for this low attendance rate is the dearth of resources designed specifically to satisfy the requirements of women in hospital settings. The sex-based disparity in bed availability indicates that most mental hospitals appear to favourably assign health facilities to men. In government mental health facilities, the male-to-female bed ratio is 73%:27%, whereas the ratio for individuals involved in service, research, and training is 66%:34% (Davar, 1999; Sood, 2008; Malhotra & Shah, 2015). The predominance of males in the utilisation of services, which is observed in the present study, is consistent with previous observations. In relation to diagnoses of discharged patients of the last ten years under study (2012-2021), a preponderance of mainly three types of diagnoses was found viz., ‘Mood [affective] disorders (F30-F39)’, ‘ Schizophrenia, schizotypal & delusional disorders (F20-F29)’ and ‘Mental & behavioural disorders due to psychoactive substance use (F10-F19)’, with ‘Mood Disorders’ being the most common diagnosis, followed by Schizophrenia, schizotypal & delusional disorders’ and ‘Mental & behavioural disorders due to psychoactive substance use’ (Figure-2). Institute being a tertiary or referral one; hence, people with severe mental disorders like the three mentioned above tend to come here to receive intensive treatment. Another possible reason could be that people with other psychiatric diagnoses do not opt for admission into the current study’s assessment of a male preponderance in service use is in line with earlier findings. The diagnoses of patients who were discharged during the last ten years under study (2012–2021) mostly fell into three categories: “Mood [affective] disorders (F30–F39),” “Schizophrenia, schizotypal & delusional disorders (F20–F29),” and “Mental & behavioural disorders due to psychoactive substance use (F10–F19).” The most common diagnosis was “Mood Disorders,” which was followed by “Schizophrenia, schizotypal & delusional disorders” and “Mental & behavioural disorders due to psychoactive substance use” (Figure-2). Inpatient wards and would much rather receive care in an outpatient department. An essentially identical pattern was seen with regard to the age and category of patients admitted throughout the last 10 years (2012–2021), with a preponderance of individuals falling into the 18–45 age groups and the Other Backwards Classes (OBC) category. According to several previous epidemiological studies (Verghese et al., 1985; Fenton & McGlashan, 1991; Thara, Padmavati & Nagaswami, 1993; Wig et al., 1993; Kulhara, Shah & Aarya, 2010; Rao, 2010; Baxter et al., 2016; Murthy, 2017), the preponderance of age group can be attributed to a higher prevalence and incidence of severe and common mental disorders in this age group. According to a National Sample Survey Organisation (NSSO) survey, 40.94% of the population is OBC, 19.59% is SC, and 8.63% is ST. The other 30.80% of people make up the remaining population. Therefore, the population’s demographics can explain the preponderance of persons belonging to the OBC Category in the discharged list.