Tuberculosis globally claims more lives than any other infectious disease. With India at the epicentre, the scale of the crisis is monumental. Yet, there is one issue that often goes unnoticed – the pervasive mental health challenges intertwined with tuberculosis.
The World Health Organization estimates that 40%-70% of TB patients are also struggling with mental health, a dual burden that amplifies their struggle. Despite this interconnection, the approach to tackling TB has focused on clinical interventions, overlooking how mental health can affect treatment, its outcomes and life after being cured.
In India, these twin epidemics have a devastating combined effect, and require a comprehensive and innovative framework to address them.
Those with mental health concerns are at a higher risk of contracting tuberculosis. Factors such as compromised immune function, socioeconomic disparities and healthcare service accessibility increase the vulnerability of mental health patients to tuberculosis. Conversely, those battling tuberculosis frequently grapple with substantial mental health challenges.
The psychological toll of TB treatment, including stigma, side effects and prolonged recovery, exacerbates mental health problems such as anxiety and depression. Integrating mental health within TB care programmes is critical for improving health outcomes and quality of life.
This, of course, is not without several challenges. First, the health system is overburdened and insufficiently skilled to address mental health. Second, the stigma around TB and mental health, coupled with the lack of a guiding framework, resources and limited awareness, are barriers that make it hard to have effective programmes.
How can these problems be addressed?
There has to be a policy recognition of the bidirectional relationship between mental health and tuberculosis. There is an urgent need for a TB-mental health framework with care guidelines that explicitly acknowledge the effect of mental on TB outcomes and prioritise mental health support within TB programmes and the health system.
Additionally, this framework must go towards tackling the stigma around TB and mental health, with a focus on addressing gender disparities in communities and within the health system.
It should include standardised mental health screening protocols that must be implemented in TB-care settings to ensure early detection and intervention. The framework should also highlight how healthcare professionals should be trained in basic mental health care through large-scale capacity building and sensitisation. This training should include strategies for identifying mental health concerns, providing support and resources, ensuring referrals where needed and fostering empathy and understanding in patient interactions.
Another ignored aspect is mental health support for the caregivers of TB patients. Peer support networks and groups should be established for TB patients and their caregivers. Through an institutionalised mechanism, these groups can provide opportunities for individuals to access community avenues for support, share experiences, receive emotional support and access practical advice in managing TB and mental health challenges.
Overall, a framework will only be effective with prioritised funding to integrate mental health care with TB care for capacity building, sensitisation and up-skilling of health workers and community engagement efforts. There should also be routine monitoring and evaluation to assess the effectiveness of mental health interventions in TB care programmes and ensure continuous quality improvement.
Stakeholder participation and engagement should be the bedrock of all interventions in such a framework. Engaging all stakeholders, including policymakers, healthcare providers and TB survivors, in advocacy efforts is vital for addressing these twin epidemics effectively through policy reform and programmatic interventions. Listening and building on community inputs, culturally-sensitive material and community-based channels should be used to reach remote and vulnerable populations.
Integrating mental healthcare with TB care can improve health outcomes, reduce stigma and enhance the wellbeing of TB patients and survivors. It is imperative to act decisively and collaboratively to mitigate the devastating impact of TB and mental health issues for millions of Indians.
Chapal Mehra is a public health specialist and the Convenor of Survivors Against TB (SATB), a collective of survivors, advocates and experts working on TB and related comorbidities. Vashita Madan is the communications lead with SATB.
