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  • WHO conservatively estimated in 2008 that Kerala had a mental disorder prevalence of 58 per 1000 population and a severe mental disorder prevalence of 10-20 per 1000 population. However there is a limit to relative measures. The diversity of education, health facilities and public information on illness and remedies across India make relative morbidity rates unreliable. There is however a limitation in validating absolute numbers. Epidemiological studies over the last forty years in India have tended to focus only on general psychiatric morbidity in small-to-medium populations, with often varying selection and identification criteria and inappropriate statistical procedures. Only one longitudinal study for all mental disorders has ever been conducted in India. However in 2009 Kerala also recorded the fourth highest suicide rate in comparison to all other Indian states that was two and a half times the national average. This emphasizes the need for greater attention towards mental health in Kerala by its next elected State General Assembly.
  • Kerala ’s contextual environment continues to impose a greater biological, social and psychological strain upon its population. The rapid urban development in Kerala is placing more stress on society, precipitated by social isolation, insecurity, dissolution of family relations and cultural conflicts (Prakash 2008). The per capita consumption of alcohol is consequently the highest in Kerala (KSMHA 2011). There is growing unemployment in real sectors like agriculture and industry and increasing inequalities in income and land distribution (Raman 2010). Women continue to be treated as subordinates in terms of work participation, gender equality and freedom of expression (Raman 2010). Often poorly educated young men obtain the most lucrative jobs in Gulf countries and marry more educated Kerala women. The unequal education between couples often leads to domestic problems and violence and results in long periods of absence where the wife must take full responsibility for the family (Mitra 2007). Kerala has the highest divorce rate of any other Indian state (KSMHA 2011). Indebtedness and poverty levels are increasing, health status indicators are reversing and there is a growing incidence of vector-borne diseases (Raman 2010). Kerala ’s environmental damage threatens the quality of life and has reduced its resource base, with only 10% of its natural forests remaining (Paravil 2000). Kerala ’s population is also aging at a rapid pace, which is anticipated to increase the number of dementia cases (Mathurananth 2009).

Susan duke springproject Susan duke springproject Presentation Transcript

  • An Analysis of the Mental Health Challengesin the State of Kerala, IndiaPresented to: Dr Manoj Mohanan and Dr Joanna (Asia) Maselko6th April 2011 SUSAN CHEN Duke University 1
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  •  Morbidity rate for Kerala is double the national average. Inadequacy of past epidemiological and community based surveys in India. Kerala suicide rate is 2.5 times the national average. National Average: 10.9 per 100,000 Suicide Rate per 100,000: Less than 10 10-20 20-30 30+ 4
  • ElderlyYouth 5
  • Community Workers Community Centers Hospitals / Colleges Private / Private /Private Cooperative Cooperative Centers* Hospitals* Community Health Mental Health Anganwadi Centers Centers* General / Public DMHP Clinics* District / Taluk ASHA Hospitals* Primary Care Medical Centers Colleges* *Provide some level of psychiatry, social services, counseling and psychiatric drugs. 6
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  • State Government of Kerala - Minister for Health And Social WelfareKerala State Mental Health Authority District Panchayaths District Panchayaths Block Panchayaths Block Panchayaths (Community Health Centres and Taluk (Community Health Centres and Taluk Hospitals) Hospitals) Village Panchayaths Village Panchayaths (Primary Care Centers) (Primary Care Centers) 8
  • Anga nwa / ASHA di / RSBY School CHIS Health NGOs Program / ISIS KR ACE SP DMHP DMHP HM IS Assw A waa a sIMHA Kiriaa sa K r nn m NS a Scch am S hee e me m KMSC
  • Stigma Mitigation ProgramsLife Skills TrainingStepped CareCognitive Behavioral TherapyTask Shifting 10
  • 1. Prevalence of Mental Illness 5. Mental Health Governance Department of Research Structure Health – KSMHA Private / Private / Cooperative Cooperative 6. Local Centers Mental Health Hospitals Initiatives 3. Mental Health Care System Community Health Mental Health Centers Centers Anganwadi DMHP Clinics General / District / Taluk Hospitals ASHA 2. Contextual Environment 4. Mental Health Care Primary Care Centers Medical Colleges Professionals 7. Global Mental Health Initiatives
  • 1. Establish statewide governance structure.2. Undertake rigorous population studies.3. Launch statewide community awareness and life-skills campaign.4. Increase the number of local psychiatric resources and enhance mental health education programs.5. Implement a stepped care model.6. Enhance support to family care givers. 12
  •  Maximize effectiveness of prevention, identification, diagnosis and treatment interventions targeting mental illness. Maximize public access to mental health services. Minimize costs to the public and State of Kerala associated with improving mental health services. Minimize time required to improve mental health services. 13
  • • Reports to Kerala Health Minister.• Sets Kerala mental health policies and regulations.• Coordinates and monitors initiatives.• KMHSA enforces regulations. • Quarterly meeting between Medical Colleges, Mental Health and District Hospitals. • Reports to State Level Coordinator. • Leverages social media and mobile technology to highlight public concerns and promote accountability. 14
  • Drive Research BasedDrive Research Based Public Policies Public Policies 15
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  • Community Workers Community Centers Hospitals / Colleges Private / Private /Private Cooperative Cooperative Centers* Hospitals* Mental Health Anganwadi Community Health Centers* Centers* General / Public District / Taluk ASHA Primary Care Hospitals* Centers* Medical Colleges* *Provide some level of psychiatry, social services, counseling and psychiatric drugs. 18
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  • State Level Coordinator & KSMHA 1. Establish Statewide Governance Structure Mental Health Advisory Mental Health Advisory Public Focus Group Public Focus Group Research Research Committee Committee 2. Undertake State- wide Population Studies Private / Private / Cooperative Cooperative Centers Hospitals Anganwadi Mental Health Centers Community Health Centers 3. Community General / District /Awareness and Life- ASHA Taluk Hospitals Skills Campaign Primary Care Centers 6. Support Family Care Medical Colleges 5. Implement Stepped Care Model 4. Enhance Available Medical Resources
  • Implementation OutlinePart (a) 2012 2013 2014123 21
  • Implementation OutlinePart (b) 2012 2013 2014456 22
  • Implementation OutlineAggregate 2012 2013 2014 Statewide Governance Population Studies Community Awareness Enhance Medical Resources Stepped Care Family Care 23
  • Aggregate AnalysisAction Steps Enhance Capabilities Expand Technology Research Resources Non-MH Investment Grants Anganwadi ASHA Teachers Prof.1. Establish Statewide X X Governance Structure2. Undertake Statewide X Population Studies3. Launch Community Awareness and Life Skills X X X Campaign4. Enhance Available X X X X Medical Resources5. Implement Stepped Care X X X X X Model6. Support Family Care X 24
  • Aggregate AnalysisCost and Benefit Analysis (Rupees) Projections of Benefits Productivity Per Capita Saved (Half Impact) 1,658,335,815 Estimate of Available Funds Allopathy Un-utilized budget (Based on 2007/08) 273,500,000 2011-12 Kerala Budget Extract School Health Program 1,000,000 ASHA Allowance 111,500,000 DMHP 2,000,000 PHC & CHC 9,000,000 Hospitals 40,000,000 25
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