Case Study Report: Systemic Failures in Mental Healthcare and the Sustainable Development Goals

Introduction and Subject Profile

This report details the case of Naina Mishra, a 21-year-old woman whose death in October 2024 highlights critical gaps in mental health support systems. The case is analyzed through the framework of the United Nations Sustainable Development Goals (SDGs), demonstrating failures in achieving key targets related to health, education, gender equality, and institutional efficacy. Ms. Mishra was a high-achieving individual, a graduate of Northwestern University with experience at Goldman Sachs and McKinsey, whose severe mental health crisis went largely unaddressed by the community and institutions she encountered.

Chronology of Mental Health Decline and Institutional Contact (2019-2024)

1. January 2019: Initial trauma disclosure. Ms. Mishra reported a sexual assault to her mother, an event that precipitated a noticeable change in her demeanor and a strain on familial relations. This event directly relates to the challenges addressed in SDG 5 (Gender Equality), specifically Target 5.2 concerning the elimination of violence against women.
2. February 2022: Diagnosis and estrangement. While in London, Ms. Mishra began psychotherapy, was diagnosed with PTSD, and subsequently severed contact with her mother, Vandana Luthra. This marks a critical point where formal health systems engaged but failed to create a supportive family framework, a key component of SDG 3 (Good Health and Well-being).
3. November 2023 – August 2024: Observable deterioration and paranoia. Upon returning to London, Ms. Mishra exhibited increasingly erratic behavior, including delusions and paranoia, as observed by her yoga instructors. She reported being followed and changed her contact information multiple times, isolating herself from potential support networks.
4. January 2024: Failed institutional interventions. Ms. Luthra’s attempts to engage support systems were unsuccessful.
   • The Metropolitan Police conducted a welfare check but took no further action, citing Ms. Mishra’s adult status and right to privacy, despite her delusional claim that her mother was deceased. This represents a failure of institutional responsibility under SDG 16 (Peace, Justice and Strong Institutions).
   • McKinsey & Company declined to provide information on her well-being, citing privacy laws, highlighting a gap in corporate duty of care relevant to SDG 8 (Decent Work and Economic Growth).
   • Legal and therapeutic professionals were unable to intervene without the subject’s consent.
5. October 2024: Final contact and death. Ms. Mishra contacted her mother in a state of crisis. Despite a brief family reunion, she ended her life, a tragic outcome representing a failure to meet SDG Target 3.4, which aims to reduce premature mortality from non-communicable diseases and promote mental health.

Analysis of Failures in Relation to Sustainable Development Goals (SDGs)

SDG 3: Good Health and Well-being

The case of Naina Mishra is a stark illustration of the failure to ensure healthy lives and promote well-being for all. The primary challenge was the inability of her community and formal systems to recognize and act upon the signs of severe psychosis.

• Lack of Mental Health Literacy: Friends, acquaintances, and yoga instructors observed alarming behavior but lacked the knowledge to identify it as a psychotic crisis or the resources to intervene effectively. This points to a societal gap in public health education.
• Inaccessible Crisis Care: Despite Ms. Luthra’s persistent efforts, no institution was able to provide the urgent care Ms. Mishra required. The system prioritized individual privacy over life-preserving intervention, demonstrating a critical flaw in public health safety nets.
• Premature Mortality: Ms. Mishra’s death by suicide is a direct failure to achieve Target 3.4. Her case underscores that mental illness is a life-threatening condition that requires proactive and robust healthcare responses.

SDG 16: Peace, Justice and Strong Institutions & SDG 5: Gender Equality

The inability of institutions to provide aid demonstrates a weakness in developing effective, accountable, and transparent systems. The crisis was rooted in trauma from a sexual assault, linking institutional failure to the broader context of gender equality.

• Institutional Inaction: The police response, which respected the subject’s wishes despite clear evidence of delusion, shows a procedural rigidity that fails vulnerable adults. This lack of effective intervention undermines the goal of SDG 16 to build strong institutions that protect all citizens.
• Corporate and Legal Barriers: The refusal of McKinsey and the therapist to share information, while legally compliant, contributed to the information vacuum that prevented a coordinated family or state response. This highlights a conflict between privacy laws and the public health mandate of SDG 3.
• Root Cause in Gender-Based Violence: The subject’s PTSD stemmed from a sexual assault (a violation of SDG 5). The subsequent mental health spiral shows how a failure to address the consequences of such violence can have fatal outcomes.

SDG 4: Quality Education & SDG 8: Decent Work

The case reveals a paradox where high educational and professional achievement masked extreme vulnerability, pointing to a need for a more holistic approach to education and workplace well-being.

• Call for Mental Health in Education: Vandana Luthra’s plea to integrate psychosis recognition into high school curricula aligns directly with SDG Target 4.7, which calls for education that promotes a culture of peace and human rights, including health and well-being.
• Failure of Workplace Support: Ms. Mishra was on disability leave from McKinsey, yet this status did not appear to trigger a robust welfare monitoring or support mechanism. This falls short of the principles of SDG 8, which advocates for safe and secure working environments for all workers.

Conclusion and Recommendations for SDG Alignment

The death of Naina Mishra was a preventable tragedy resulting from systemic failures across healthcare, law enforcement, corporate policy, and community support. Her story demonstrates that achieving the Sustainable Development Goals requires not only policy but also practical, integrated systems capable of protecting vulnerable individuals. The following actions are recommended to address the gaps identified:

• Integrate Mental Health Literacy: Educational institutions should incorporate mandatory mental health literacy, including psychosis recognition, into curricula to fulfill the holistic vision of SDG 4.
• Reform Institutional Protocols: Police and healthcare bodies must develop clearer protocols for intervention in cases of suspected psychosis in adults, creating a better balance between privacy rights and the duty to protect life, in line with SDG 3 and SDG 16.
• Enhance Corporate Responsibility: Corporations must strengthen employee wellness programs to include proactive outreach and support for individuals on mental health-related leave, advancing the objectives of SDG 8.
• Foster Community Partnerships: Public health initiatives should focus on empowering community hubs (such as workplaces, fitness centers, and universities) with the knowledge and resources to act as first responders in a mental health crisis, supporting SDG 17 (Partnerships for the Goals).

1. Which SDGs are addressed or connected to the issues highlighted in the article?

SDG 3: Good Health and Well-being

This is the most central SDG in the article. The narrative revolves around Naina Mishra’s severe mental health crisis, including PTSD, paranoia, and psychosis, which ultimately leads to her suicide. The article explores the challenges in recognizing mental illness, the inadequacy of support systems, and the devastating impact on individuals and families. It directly addresses the importance of mental health and well-being.

SDG 5: Gender Equality

This goal is relevant due to the sexual assault Naina experienced in college. The article states, “In January 2019, during her first year of college, Naina rang Vandana to tell her she had been sexually assaulted.” This event is identified as a key trigger for her subsequent mental health decline and PTSD diagnosis, highlighting the long-term consequences of violence against women.

SDG 16: Peace, Justice and Strong Institutions

The article touches upon the role and limitations of institutions in responding to a mental health crisis. Naina’s mother, Vandana, sought help from the police, lawyers, and even Naina’s former employer (McKinsey), but was repeatedly blocked by privacy laws and institutional policies. The Metropolitan police stated that since Naina was an adult and they had “no concern for her welfare, her wishes were respected,” showcasing a systemic gap in protecting vulnerable individuals who may not be capable of making safe decisions for themselves.

2. What specific targets under those SDGs can be identified based on the article’s content?

1. SDG 3: Good Health and Well-being

   • Target 3.4: By 2030, reduce by one third premature mortality from non-communicable diseases through prevention and treatment and promote mental health and well-being.
     
     Explanation: Naina’s death by suicide at a young age is a clear case of “premature mortality.” The article is a case study of the failure of both “prevention” (friends, yoga teachers, and others did not recognize the signs of psychosis) and “treatment” (Vandana’s inability to get her daughter professional help against her will). Vandana’s final plea, “I want to make sure high schools all over the world teach kids to recognise psychosis,” directly speaks to the need for promoting mental health awareness and prevention.
   • Target 3.8: Achieve universal health coverage, including… access to quality essential health-care services…
     
     Explanation: The story illustrates significant barriers to accessing quality mental health care. Although Naina saw a psychotherapist, her condition deteriorated. More importantly, when she was in deep crisis, the system made it impossible for her family to secure care for her. The therapist cited “patient confidentiality,” and lawyers explained there was “no chance of her getting any kind of guardianship over Naina without firm evidence.” This shows a lack of accessible and effective services for someone in her state.

2. SDG 5: Gender Equality

   • Target 5.2: Eliminate all forms of violence against women and girls in the public and private spheres…
     
     Explanation: The article explicitly details that Naina was a victim of sexual assault by a fellow student in her college dorm. This event is presented as a pivotal moment that led to her PTSD diagnosis and profound changes in her personality and mental state, directly linking violence against women to severe, long-term health consequences.

3. SDG 16: Peace, Justice and Strong Institutions

   • Target 16.3: Promote the rule of law at the national and international levels and ensure equal access to justice for all.
     
     Explanation: The article demonstrates how the “rule of law,” specifically privacy laws for adults, acted as a barrier to providing care. The police respected Naina’s wish for no contact with her mother because she was an adult and did not present an “obvious crisis.” This raises questions about whether the legal framework adequately provides “access to justice” or protection for individuals whose mental illness prevents them from recognizing their own need for help.

3. Are there any indicators mentioned or implied in the article that can be used to measure progress towards the identified targets?

1. For Target 3.4 (Reduce premature mortality and promote mental health):

   • Indicator 3.4.2: Suicide mortality rate.
     
     Explanation: The article’s tragic conclusion is Naina’s death by suicide. Her story is a qualitative data point that contributes to the understanding of this indicator. The narrative shows a young, promising individual whose death could have potentially been prevented with better mental health support, directly highlighting the issue this indicator aims to track.
   • Implied Indicator: Public mental health literacy.
     
     Explanation: The article repeatedly emphasizes the ignorance of those around Naina. Her yoga teacher states, “No one at the yoga studio knew how to recognise psychosis.” Her friend admits, “She needed someone to notice something that the rest of us didn’t.” Vandana’s goal to “teach kids to recognise psychosis” implies the need for an indicator measuring the public’s awareness and understanding of mental health conditions, which is crucial for prevention.

2. For Target 5.2 (Eliminate violence against women):

   • Indicator 5.2.2: Proportion of women and girls… subjected to sexual violence by persons other than an intimate partner…
     
     Explanation: The article provides a specific, narrative account of Naina being sexually assaulted by a fellow student in her dorm. This personal story serves as a powerful illustration of the reality that this indicator measures, grounding the statistic in a real-world consequence (PTSD and subsequent decline).

3. For Target 16.3 (Ensure equal access to justice):

   • Implied Indicator: Effectiveness of welfare checks and mental health crisis interventions by law enforcement.
     
     Explanation: The article describes the police’s interaction with Naina, where they performed a welfare check but concluded there was “no concern for her welfare” based on a brief interaction, despite her mother’s desperate pleas. This implies a need to measure the effectiveness and protocols of such institutional responses, particularly in cases where an individual’s right to privacy conflicts with their need for protection due to a non-obvious mental health crisis.

4. Table of SDGs, Targets, and Indicators

Source: theguardian.com