Seeking a Paradigm Shift in Mental Health Care

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    The WHO “Guidance on community mental health services: promoting person-centred and rights-based approaches” emphasized on community-based mental health care.

    About

    • As defined by WHO, Mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community.
    • WHO stated that mental health care needs to be both respectful of human rights and focused on recovery.

    Image Courtesy: Sites.psu

    Determinants of Mental Health

    • Multiple social, psychological, and biological factors determine the level of mental health of a person at any point of time. 
    • For example, violence and persistent socio-economic pressures are recognized risks to mental health. The clearest evidence is associated with sexual violence.
    • Poor mental health is also associated with 
      • rapid social change, 
      • stressful work conditions, 
      • gender discrimination, 
      • social exclusion, 
      • unhealthy lifestyle, 
      • physical ill-health and 
      • human rights violations.
    • There are specific psychological and personality factors that make people vulnerable to mental health problems. Biological risks include genetic factors.

    Mental health in India: Data

    • WHO estimates that about 7.5 per cent Indians suffer from some mental disorder and predicts that by the end of this year roughly 20 per cent of India will suffer from mental illnesses. 
    • According to the numbers, 56 million Indians suffer from depression and another 38 million Indians suffer from anxiety disorders.
    • WHO states that there is a huge shortage of psychiatrists and psychologists in India. 
    • India also accounts for 36.6 percent of suicides globally.
    • As per the National Mental Health Survey 2015-16, conducted by the NIMHANS, Bengaluru, it was revealed that 9.8 million teenagers in the age group 13-17 years suffer depression and other mental health disorders and are “in need of active intervention”. 

    COVID-19 and Mental Health

    • People are experiencing fear, worry, and stress due to the pandemic.
    • The fear of contracting the virus has led to significant changes in the daily lives of people.
    • The new realities of working from home, temporary unemployment, home-schooling of children, and lack of physical contact with other family members, friends and colleagues, are creating mental health issues.

    WHO response

    • WHO supports governments in the goal of strengthening and promoting mental health. 
    • It has evaluated evidence for promoting mental health and is working with governments to disseminate this information and to integrate effective strategies into policies and plans.
    • In 2013, the World Health Assembly approved a “Comprehensive Mental Health Action Plan for 2013-2020″
      • The Action Plan’s overall goal is to promote mental well-being, prevent mental disorders, provide care, enhance recovery, promote human rights and reduce the mortality, morbidity and disability for persons with mental disorders. 
    • It focuses on 4 key objectives to:
      • strengthen effective leadership and governance for mental health;
      • provide comprehensive, integrated and responsive mental health and social care services in community-based settings;
      • implement strategies for promotion and prevention in mental health; and
      • strengthen information systems, evidence and research for mental health.

    Government of India Initiatives 

    • National Mental Health Programme (NMHP) in 1982
      • To ensure the availability and accessibility of minimum mental healthcare for all in the foreseeable future, particularly to the most vulnerable and underprivileged sections of the population.
    • Mental Healthcare Act, 2017
      • It was passed in 2017, came into effect in May 2018 and replaced the Mental Health Act of 1987. 
      • To the joy of most Indian medical practitioners and advocates of mental health, the act decriminalised suicide attempts in India. 
      • It also included WHO guidelines in the categorisation of mental illnesses
      • The most significant provision in the act was “advanced directives”, which allowed individuals with mental illnesses to decide the course of their treatment and also appoint someone to be their representative. 
      • It also restricted the use of electro-convulsive therapy (ECT), and banned its use on minors, finally introducing measures to tackle stigma in Indian society.
    • Rights of Persons with Disabilities Act, 2017
      • The Act acknowledges mental illness as a disability and seeks to enhance the Rights and Entitlements of the Disabled and provide effective mechanism for ensuring their empowerment and inclusion in the society
    • Manodarpan Initiative
      • An initiative under Atmanirbhar Bharat Abhiyan, aims to provide psycho-social support to students for their mental health and well-being.
    • Kiran Helpline
      • The helpline is a giant step towards suicide prevention, and can help with support and crisis management.
      • The helpline aims to provide early screening, first-aid, psychological support, distress management, mental well-being, and psychological crisis management and will be managed by the Department of Empowerment of Persons with Disabilities (DEPwD).

     

    Ways to Promote Mental Health

    • Support children through life skills programmes, child and youth development programmes, mental health promotional activities in schools.
    • Socio-economic empowerment of women by improving access to education and microcredit schemes. Mental health interventions at work (e.g. stress prevention programmes).
    • Social support for elderly populations befriending initiatives, community and day centres for the aged.
    • Programmes targeted at vulnerable people, including minorities, indigenous people, migrants and people affected by conflicts and disasters (e.g. psycho-social interventions after disasters)
    • Promoting an environment that respects and protects basic civil, political, socio-economic and cultural rights.
    • Community development programmes (e.g. integrated rural development); poverty reduction and social protection for the poor; anti-discrimination laws and campaigns.
    • National mental health policies should be concerned both with mental disorders and with broader issues that promote mental health. 
      • Mental health promotion should be mainstreamed into governmental and nongovernmental policies and programmes. 
      • In addition to the health sector, it is essential to involve the education, labour, justice, transport, environment, housing, and welfare sectors.

    Best Practice : Thiruvananthapuram, Kerala

    • Since 1999, Thiruvananthapuram District has been integrating mental health services into primary care. 
    • Trained medical officers diagnose and treat mental disorders as part of their general primary care functions. 
    • A multidisciplinary district mental health team provides outreach clinical services, including direct management of complex cases and in-service training and support of primary care workers. 
    • The free and ready availability of psychotropic medications in the clinics has enabled patients to receive treatment in their communities, thus greatly reduc-ing expenses and time spent travelling to hospitals.
    • Starting in 2002, primary care centres began to assume responsibility for operating their mental health clinics with minimal support from the mental health team. 
    • Currently, mental health clinics are operating in 22 locations throughout the district. Services provided include diagnosis and treatment planning for newly-identified patients, review and follow-up for established patients, counselling by the clinical psychologist or psychiatrist, psychoeducation and referrals as needed.

    Practice of Open Dialogue

    • It is a therapeutic practice that originated in Finland,
    • This practice, conducted in homes or in service settings, combines individual and systemic family therapy with a focus on the centrality of relationships and promotion of connectedness through family and support networks.

    Sources: TH