WRITE A NOTE ON MENTAL HEALTH ORGANIZATION IN INDIA ?
A 5
1 The organization of mental health services demands a wide variety of interventions such as -
A ) Public Awareness
B ) Early Identification
C ) Treatment of acute illness
D ) Family education
E ) Long Term Care
F ) Rehabilitation
G ) Reintegration and Ensuring of human rights of mentally ill patients
2 Other factors responsible for organization of mental health services are to classify a particular condition ( v imp ) such as -
A ) Self limiting Acute condition such as ( acute stress reaction ) and
B ) Lifelong Conditions ( Mental Retardation )
C ) Unawareness or unwillingness of the mentally ill person
3 It has 3 Broad Categories -
A ) The mental health needs of the community -
It includes -
( i ) Serious disorders in the community -
A ) major depression
B ) schizophrenia
C ) bipolar affective disorder
D ) dementia
In view of the limited services available in the community, especially in the rural areas, it can be expected that there will be a large number of persons with these disorders without any or incomplete treatment and rehabilitation who will be brought for care when services are made available.
(ii) persons with Acute conditions -
A ) fresh episodes of acute psychoses would be 3 per 10 000 population
B ) Treatment of these conditions is important as they cause significant distress to the ill individual, burden of care to the family and sometimes social disruption
C ) More importantly, they are all treatable and recovery is possible to a great extent.
V imp D ) Equally important is the observation that early interventions give better outcome with less of possibility for long-standing illness (chronicity
E ) Most of this treatment can be undertaken as ambulatory care by general medical practitioners with only short-term hospitalization in some patients.
(iii) persons with long-standing(chronic) mental disorders -
A ) group of disorders include schizophrenia, bipolar affective disorders, dementia.
B ) It is estimated that the point prevalence of this group would be about 5-8 per thousand population.
C ) The “chronicity” is mostly contributed by the lack of early treatment and absence of rehabilitative services, besides a small group due the non-response to treatment(eg. schizophrenia) or the progressive nature of the illness(dementia).
D ) The “chronic” patients of schizophrenic illness have demonstrated to be responsive to treatment even in late stages of illness.
E ) The treatments are simple to administer .
1 - The requirements in these group of patients are regular medication
2 - support of the family
3 - training to the family in caring skills
4 - support in crises and respite care rehabilitation
5 - acceptance and integration into the community.
So , The primary health care personnel, health workers and medical officers can provide this care.
6 - In bipolar affective disorder, prophylactic treatment can prevent relapses and recovery.
7 - In dementia, support to the family, symptomatic treatment and guidance to accommodate the failing mental functions can reduce the distress, disability and burden to the family.
(iv) mental disorders in primary health care -
A ) This group forms the biggest group of persons with mental disorders.
B ) In normal circumstances about 20% of those seeking primary care are known to suffer from different mental disorders .
C ) This group represents an important group for four reasons.
1 - Firstly, when not correctly diagnosed, often they are subjected to inappropriate treatments which are non-specific(vitamins, tonics etc) and form a group where investigations are wasteful
2- Secondly, these persons can be effectively cared for by the physicians at the level of primary health care
3 - Thirdly, by providing care at this level the stigma of mental disorders are reduced or absent
4 - Fourthly, this approach is cost-effective.
5 - Specific measures known to be effective to care for this group are
A )correct diagnosis with explanation
B ) avoiding unnecessary investigations
C ) listening to the patients
D ) relaxation techniques
E ) guidance about daily routines and activities
F ) mobilising the family resources
G ) use of medicines for short periods and formation of groups of patients for self-help
(v) mental health of women -
1 - represent a special group for mental health care.
2 - The needs of women from mental health point is well recognized in all populations.
3 - Though the overall prevalence of mental and behavioral disorders are not different between men and women, anxiety and depressive disorders are more common among women.
4 - Almost all studies show that depressive disorders are 1.5 to 2 times that in men, during the adult life.
A ) The reasons for these differences are partly biological, partly social and psychological
5 In addition women are more often the victims of domestic violence.
A ) Studies in developed countries have shown that women experiencing domestic violence have higher symptoms of psychological distress and greater frequency of contemplation of suicide.
B ) From all these perspectives, mental health needs of women are greater, of special nature and need interventions that are sensitive to their needs.
6 Specific measures to care of this group would include the following strategies -
A ) greater number of women health personnel
B ) specific training to health personnel on gender issues
C ) mental health education about self-care for mental health
D ) support to women to form self-help groups
E ) emotional support at individual and family levels and income generating activities.
(vi) children and adolescents- school going and out of school -
1 - form a very important group for mental health care.
2 - Besides the needs of children in peace conditions, CAA have been exposed and experience intense trauma in form of wars, displacement, disability and disruption of childhood
3 - There are three broad mental health needs requiring urgent attention.
A ) Firstly, the emotional problems relating to developmental processes. This number is likely to be about 10% of the children.
B ) Secondly, mental retardation. Estimates place this to be about 5 per thousand with severe mental retardation and a total of 3% with all degrees of mental retardation.
C ) This group requires early identification, home based stimulation, special education, behavioural training for self-care and daily activities and at a later age vocational training.
D ) Third need is for promotion of mental health, for example the life skills education(LSE)
1.LSE not only improves immediate functioning of children, but also have the potential to prevent problems of drug abuse, suicide, delinquency and risk taking behaviour (eg.HIV/AIDS).
2.These needs to be addressed in school going children as well as in the non-school going children
3 The latter group requires a lot of innovative approaches, similar to the ones developed for street children in countries like India, Brazil etc.
4 The most important goal would to be to restore childhood to all children
5 create conditions for optimal development at home and society
6 provide healthy adult contacts
7 facilitate life skills education; crisis support
8 friendly non institutional mental health services and
9 create an atmosphere of security and hopeful future.
(vii) special groups like refugees, survivors of disasters -
A ) is well recognized that refugees, disaster affected populations represent a group of persons with special emotional needs.
B ) This is because of the extreme disruption that they have experienced and the lost opportunity for normal life.
C ) All of these groups need opportunity to rebuild their lives and reorganize their life goals.
D ) Some of the well recognized strategies are -
1 recognition of the special needs by community and health personnel
2 community based and ambulant mental health care
3 opportunities to share the trauma
4 formation of self-help groups with common needs
5 crisis support and rehabilitative efforts for vocational and social life.
(viii) persons attempting suicide -
1 Suicide and attempted suicide represent a “cry for help” in a situation perceived as hopeless. Suicide and attempted suicide rates vary across countries.
2 Organising services for suicide prevention has the double advantage of preventing premature loss of lives as well as the sensitization of the community to mental health issues as being relevant to all of the population.(normalcy of emotional distress).
3 Experience in other countries have shown that following measures would be effective in addressing the problems of attempted suicide and suicide
4 recognition of the “normalcy” of suicidal ideation inn specific adverse life situation
5 increasing intra-Family communication to share feelings, experiences and mutual support
6 life skills education to children and adolescents
7 early recognition and treatment of mental disorders by general physicians
8 support for acute crisis support through volunteers in crisis centers
9 support to persons who have attempted suicide to prevent repetition
10 support to families where suicide has occurred and use of religious centers for mental health education.
(ix) public mental health education
(x) persons in institutional settings
(xi) prevention of mental disorders and
(xii) promotion of mental health
B ) International Developments in mental health care
C ) Mental Health Activities
LEVELS OF MENTAL HEALTH PROGRAMME
A )ROLE OF VILLAGE LEVEL -
1 - Early identification and referral of psychiatric problems
2 - Management of psychiatric emergencies
3 - Administration and supervision of maintenance treatment for chronic psychiatric conditions in accordance with guidance by the supervisors
4 - Counseling in problems related to alcohol or drug abuse.
5 - Public education.
B ) ROLE OF PHC / CHC
• Supervision of the MPW’s performances of specified mental health tasks,
• Elementary diagnostic assessment of cases
• Treatment of functional psychosis, anxiety, depressive disorders and alcohol dependence
• Treatment of uncomplicated cases of psychiatric disturbance associated with physical diseases
• Management of psycho-social problems using psychosocial interventions
• Public mental health Education
• Maintenance of care records
C ) ROLE OF DISTRICT HOSPITALS
• Medical consultation to the health center’s medical officer with regard to “difficult” cases of psychiatric disorders
• Admit and provide brief hospital treatment for psychiatric patients including ECT treatment
• Training of medical officers and health personnel
• Support to NGOs
• Linkage with state mental hospital and teaching departments of medical college for further referral facilities.
D ) ROLE OF MEDICAL COLLEGE AND INSTITUITIONS
• Medical consultation to the district psychiatrists, health center’s medical officer with regard to “difficult” cases of psychiatric disorders
• Admit and provide brief hospital treatment for psychiatric patients
• Specialised treatments, eg. Children, drug dependent persons, old age problems, behavior therapy
• Rehabilitation
• Training of specialist mental health human resources, namely, psychiatrists, clinical psychologists, psychiatric social workers and psychiatric nurses
• Training of undergraduate medical students
• Training of medical officers and health personnel
• Training of general practitioners
• Monthly disability certification
• Monthly data of psychiatric care
• Support to NGOs-self help groups, CBO,
• Operational research studies
• Telepsychiatry, through the village resource centres, support to the area mental health care facilities.
ROLE OF REHABILITATION ( v imp )
1 - is an important part of mental health services.
2 - Rehabilitation is an important part of mental health services for a number of reasons such as -
A ) Firstly, in a number of severe mental disorders like schizophrenia, bipolar disorder and substance abuse, there is a proportion of persons who do not fully recover and have limitations in their functioning resulting in disability that needs to be addressed through rehabilitation.
B ) Secondly, chiefly due to the paucity of services, in India, large proportion of the severely ill persons are not under treatment till late in the illness, when there is associated disability along with the symptoms of illness, the disability alleviation requires rehabilitation.
C ) Thirdly, at different stages of the treatment rehabilitation in the form of intervention like activities of daily living, living in a therapeutic community to learn social skills, day care centres, vocational training, sheltered workshops where ill individuals can do productive work under support and supervision and community care facilities for long term stay when there are no family members to support the ill person.
D ) At present in India, the rehabilitation facilities are very limited and largely the result of efforts of individual persons and voluntary organisations