The document discusses mental health and economic conditions in India. It notes that around 70 million Indians suffer from serious to mild mental illnesses, but only 50-70% can access treatment. Poverty is linked to higher rates of mental disorders as it increases stress, hopelessness, and health risks. However, India's strong family and social support networks also promote resilience. The government aims to improve access to affordable mental healthcare.

1. SOME ASPECTS OF MENTAL HEALTH AND ECONOMIC CONDITIONS IN INDIA DR. B. J. PRASHANTHAM PROFESSOR OF COUNSELLING PSYCHOLOGY AND DIRECTOR INSTITUTE FOR HUMAN RELATIONS COUNSELLING AND PSYCHOTHERAPY CHRISTIAN COUNSELLING CENTRE, VELLORE, INDIA

2. OUTLINE OF THE PRESENTATION 1.Introductory comments 2.Mental health in India 3.Economic situation in India 4.Relationship between 2 and 3 5.Efforts by Public and Private Sector 6.Conclusion 7.Q and A

3. JAWAHARLAL NEHRU, 1944 INDIA IS A LAND OF CONTRASTS, OF SOME VERY RICH AND SOME VERY POOR PEOPLE, OF MODERNISM AND MEDIEVALISM…. INDIA IS NOT A POOR COUNTRY. SHE IS ABUNDANTLY SUPPLIED WITH EVERYTHING THAT MAKES A COUNTRY RICH, YET HER PEOPLE ARE VERY POOR

5. India’s districts There are 28 states and 7 union territories 612 Districts 600,000 Villages 35% people live in the Cities 65% live in Villages

6. Story of creation according to Puranas Monkey (1-14) curious, active, mischief's Horse (14-28) energetic, difficult to control

7. Story of creation….. Donkey (24-56) patient, burden-bearing, humble Python (57 – till life ends) physically slow, symbol of wisdom

8. DSM IV INCIDENCE RATE Epidemiology of different disorders according to DSM IV TR1) Delirium-0.4% 2)Dementia-1.5% over the age 65 3)Substanc abuse-lifetime prevelance is 20%4) Schizophrenia-lifetime prevelence in 1%5)

9. DSM Other Psychotic Disorders-lifetime prevalence is 0.2% 6)Mood disorders-lifetime prevelance is about 15% 7)Anxiety Disorders-One in four persons 8)Somatoform dicorder-0.2% 9)Eating Disorder-4% in adolescents

10. EPIDEMIOLOGICL STUDY OF Prevalence of Mental disorders in India Bt Murali Madhav S, Indian Journal of Community Medicine. Vol 26, No 4 (2001-10 -2001-12) Analysis of 10 major Indian studies in the field having similarity of design and conducted in three phases

11. Results: National Prevalence rates for all Mental disorders (per 1000 population) : 18-207 24-207 18-142 Range 65.4 66.4 64.4 Median Combined Urban Rural

12. Prevalence rates for specific disorders 14 – 25.3 18.5 Anxiety Neurosis 0.5 - 63 31.2 Affective disorder:Depression 1.1 – 14.2 2.3 Schizophrenia Range Median

13. Prevalence of Mental Disorders in India prevalence context Shamsunder et al 1980, Bangalore General Practice 35.9% Harding et al 1980 Raipur Primary Health Centre(PHC) 17.7% Murthy et al 1976 Vellore Hospital clinic 27% Author

14. Prevalence of Mental Disorders in India Channabasavanna et al 1995, Jigani PHC 23.9% Sriram et al 1988, Sakalwara PHC 17.3% Sheshadri et al 1988 Sakalwara PHC 11.8% Author context prevalence

15. Pothen et al ,2003, 2002, Vellore PHC 33.9% Nambi et al,2002 Vellore PHC) 44.0% Patel et al 1998 Panjim, Goa , PHC 46.5% Author Context Prevalence

16. NIMHANS : 70 million SUFFER FROM SERIOUS TO MILD FORMS OF MENTAL ILLNESSES The National Institute of Mental Health and Neuro-Sciences (NIMHANS) further says that over 20 million Indians suffer from serious mental ailments and 50 million more from milder forms. .

17. 50-90% not able to access help Thus, a shocking 70 million people suffer from mental ailments and yet, 50-90% of them are not able to access corrective services. Awareness of mental health, experts say, is just not enough

18. Place of Human Resources for Mental Health and Approaches to its Development in India The existing mental health professionals in the country, as per the survey conducted by the Govt. of India in 2002, and submitted to the Supreme Court on July 15 th is Public Private Total Sector Sector Psychiatrists 896 1437 2333 Clinical Psychologists 171 234 405 Psychiatric Social Workers 180 148 328 Psychiatric Nurses 462 273 735

19. POVERTY OF MENTAL HEALTH HUMAN RESOURCES But countrywide there are only 37 government-run mental hospitals, 3,500 psychiatrists, 1,000 psychiatric social workers and 1,000 clinical psychologists - all serving a population of one billion

20. AWARENESS AND HOPE IN THE 21 ST CENTURY SURGEON GENERAL’S REPORT ON MENTAL HEALTH IN THE USA 2001 WORLD HEALTH DAY: STOP EXCLUSION, DARE TO CARE 2001 WHO REPORT:NEW UNDERSTANDING , NEW HOPE 2001, 27 CHARRED TO DEATH IN EWARAWADI

21. OTHER DEVELOPMENTS IN INDIA RECOGNITION OF THE AWEFUL CONDITIONS OF MENTAL ASYLUMS NATIONAL DISABILITY ACT EMBRACING MENTAL ILLNESS NGO’S SCARF AND BANYAN COMPLETE 25 AND 20 YEARS CARING FOR THE HOMELESS MENTALLY ILL JUDICIAL INTEREST AND HUMAN RIGHTS MONITORING MEDIA INTEREST INVLOVEMENT OF PRIVATE SECTOR

22. Community mental health: Deinstitutionalization Availability Accessibility Affordability Primary prevention Secondary prevention Tertiary prevention

23. Population of India total population: 1.06 billion people (mar 2004) - daily population increase: about 50,000 people - one baby born in India: every 1.25 seconds - India's working age population (15-60 years): 610 million (estimate 2003)

24. - population dependent on agriculture for livelihood: 65 % - population living in approx 600,000 villages countrywide: 722.8 million people [2001] - population living in cities: 277.8 million people [2001] - population living a significant distance from a road: nearly 40 percent [Sahara Time, Mar 2004]

25. - population growth per year (1991 - 2001): India: 1.9 % -- Rajasthan: 2.5 % -- Kerala: 0.9 % - population growth in India within decade 1991-2001: 21.4 % [HT Mar 04] - population growth in Kerala within decade 1991-2001: 9.42 % [HT Mar 04]

26. - population density in Kerala: 819 people per sq km (3rd highest in India, after West Bengal and Bihar) [HT Mar 04] - population density in Ladakh: 1.3 people per sq km - Delhi population: 1981: 6.2 million -- 2003: 13.5 million - population of Bangalore approx 2 decades ago: approx 2 million [BBC, Jan 2006] - current population of Bangalore: approx 8 million [BBC, Jan 2006]

27. Poverty in different forms Female adult literacy still at 48%. Literate mothers are the most important Food and nutritional insecurity – a major issue Recent UN report says that 40% of children under the age of three are underweight and a third of all men and women suffer from chronic energy deficiency

28. 456 million below #1.25 a day The number of people living below a dollar a day is down from 296 million in 1981 to 267 million people in 2005. However, the number of poor below $1.25 a day has increased from 421 million in 1981 to 456 million in 2005 . This is the biggest challenge facing India today.

29. One-third of world’s poor India is home to roughly one-third of all poor people in the world . It also has a higher proportion of its population living on less than $2 per day than even sub-Saharan Africa.

30. Women Issues Gender discrimination continues to be an enormous problem within Indian Society. Traditional patriarchal norms have relegated women to secondary status within the household and workplace. This drastically affects women’s health, financial status, education,, and political involvement

31. Gender Justice Only 54 per cent of Indian women are literate as compared to 76 percent of men. Women receive little schooling and also suffer from unfair and biased inheritance and divorce laws. These laws prevent women from accumulating substantial financial assets, making it difficult for women to establish their own security and autonomy.

32. Impact of global economic crisis on India 10 million direct job losses Instances of suicide, depression and despair Many more job losses in the ancillary services Many thousands of farmers committed suicide due to burden of debt Many Indian diaspora returning to India from US, Europe, Gulf countries Prices of daily commodities very high Real estate down*Sense of gloom

33. Impact of economic crisis Some of the industrial sector which are dependent on export market have been affected negatively. Starting with Textile and Garments, Small and Medium Enterprises that provide products and services to automobile, machine tools, etc.. These are largely urban/ semi-urban oriented. Due to this, staff, particularly contractual labourers have been sent out of these companies/ factories. Largely the urban poor are affected.

34. Vikram Patel1 & Arthur Kleinman2 Poverty and common mental disorders in developing countries Abstract A review of English-language journals published since 1990 and three global mental health reports identified 11 community studies on the association between poverty and common mental disorders in six low- and middle-income countries. Most studies showed an association between indicators of poverty and the risk of mental disorders, the most consistent association being with low levels of education.

35. Mental and poverty… A review of articles exploring the mechanism of the relationship suggested weak evidence to support a specific association with income levels. Factors such as the experience of insecurity and hopelessness, rapid social changeand the risks of violence and physical ill-health may explain the greater vulnerability of the poor to common mental disorders.

36. Poverty.. The direct and indirect costs of mental ill-health worsen the economic condition, setting up a vicious cycle of poverty and mental disorder. Common mental disorders need to be placed alongside other diseases associated with poverty by policy-makers anddonors. Programmes such as investment in education and provision of microcredit may have unanticipated benefits in reducing therisk of mental disorders. Secondary prevention must focus on strengthening the ability of primary care services to provide effectivetreatment.

37. POVERTY AND MENTAL HEALTH? Debate sparked off by a study by Dr Vikram Patel of London's Institute of Psychiatry. Patel's 1996 study, Poverty, Inequality & Mental Health in Developing Countries, an updated version of which has been published in a book, investigates the relationship between poverty, disability and depression in the Indian state of Goa.

38. PATEL STUDY.. He found that more than 40 per cent of adults attending primary health care clinics had a common mental disorder (CMD) such as anxiety or clinical depression. Women were two to three times more likely to have CMDs than men.

39. BI-DIRECTIONAL 'Being poor means you are more likely to experience such events and you will have fewer resources to draw upon,' Patel says. 'The relationship between impoverishment and mental illness is bi-directional. Thus poverty can lead to mental illness which can worsen the economic circumstances of the person and their families.'

40. ANXIETY AND CLINICAL DEPRESSION Importantly, not all mental disorders are increasing in India. Patel specifically attributes India's growing incidence of anxiety and clinical depression to rising inequality, as witnessed in many other developing countries.

41. WHO REPORT CONFIRMS WHO report on mental health, Stop Exclusion, Dare to Care, agrees. 'Mental disorders occur in persons of all genders, ages, and backgrounds ... poverty, war and displacement can influence the onset, severity and duration of mental disorders.'

42. RESILIENCY FACTORS However, Dr Mohan Isaac, FORMER Head of Psychiatry at India's prestigious National Institute of Mental Health and NeuroSciences (NIMHANS), points to the resilience of India's family and social support networks. He cites numerous studies of schizophrenia which have shown better recovery results in developing countries like Nigeria and India, largely because of their strong social support systems.

43. Cost of drugs The government view on the availability and cost of drugs for primary health centres is yet again optimistic. Anxiolytics, a common drug to treat depression, is said to cost less than the treatment for tuberculosis. Dr K Sokar of NIMHANS cites a 2000 India and Pakistan study of rural patients that shows that half a month's wages of approximately $16 goes towards treatment. But 'treatment need not always be a medical response,' says Dr Jan, reiterating that family and community support systems need to be reinforced

44. 200000 farmers commit suicide Suicides by farmers in Punjab 'Major issue' National Crime Records Bureau statistics say close to 200,000 farmers have committed suicide in India since 1997 due to debt problems from private lenders and failure of crops

45. National Human rights commission According to the National Human Rights Commission (NHRC), which released a report last month on mental health , morbidity on account of mental illness is all set to take over from cardiovascular diseases as the number one health risk in India in the next two years

46. Times of India:Clinic that provides healthcare to beggars Clinic that provides healthcare to beggars 1 Nov 2008, 0000 hrs IST, Nirmala M Nagaraj, TNN

47. Jeffrey Sachs, advisor to UN Secretary-General New Delhi, Feb 3 (IANS) Hailing India’s improvement in the health sector, Jeffrey Sachs, chairperson of the international advisory panel of the National Rural Health Mission (NRHM), Tuesday said there should be more investment in the sector.”India should step up the budgetary allocation in health sector to four to five percent of the GDP,” Sachs told reporters after a meeting with Health Minister Anbumani Ramadoss.

48. India's tech hub is a stressed out city30 Aug 2008, 1100 hrs IST, IANSNews By Industry BANGALORE: India's technology hub is being racked by more and more suicides

49. India's tech hub is a stressed out city30 Aug 2008, 1100 hrs IST, IANSNews By Industry BANGALORE: India's technology hub is being racked by more and more suicides

50. Government to lay stress on mental health services under the 11 th five year plan Friday, 20 February 2009 | http://www.nerve.in/news:253500207002 | channel: India " Under the District Mental Health Programme -, the central government is upgrading the psychiatric wings of medical colleges and hospitals in states and strengthening and modernising the mental hospitals to make them therapeutic units. "

51. Resources available at NIMHANS… The following information is available: Manuals Medical officers Health workers IEC manual

52. Resources available Operational manual Counseling manual for college teachers Life skills education manual Stress management manual Suicide prevention manual Training modules (workbooks) – medical officers, health workers, program officers, nodal officers, nurses, psychologists, social workers, college and school teachers.

53. CCC – 40 years of service to humanity:Examples Alcoholism rehabilitation with the poor in the community (Sunil Datta et al, 1991 Indian Journal of Psychiatry)87% sobriety rate after 18 months (Indian Case Studies by B J Prashantham – Ch 17) Pre-treatment motivation Multi-disciplinary Team work Involvement of spouses and families,peers. Economic component through Bank Loans

55. Trying to identify relatives

67. Recent news and views in APA Journals in 2008 PTSD among returning soldiers Katrina – the pain lingers on Significance of virtual trauma The importance of prevention of generational transmission of trauma Paucity of longitudinal studies and their necessity in the developing world. The challenge of compassion fatigue

68. THE SITUATION IN MYANMAR AND CHINA CONSTRASTING EXPERIENCE OF MYANMAR CHINA MYANMAR, TRAGEDY COMPLICATED BY GOVERNMENTAL NON-COOPERATION CHINA OPEN TRANSPARENT :DALAI LAMA

69. DALAI LAMA’S STATEMENT

70. 31 % 69 %

72. Long term Evaluation of First Batch who had Counselling – PTSD status * Six cases were absent for evaluation. Symptomatic No. % Asymptomatic No. % 149 0 149 100 % 20 – Months After Counselling ( Nov – Dec 2007) * 246 59 24.0% 187 76.0 % Immediately After Counselling ( May 2006 ) 252 203 80.6% 49 19.4 % Before Counselling ( August to Dec 05) Total P TS D Status Period of Evaluation

73. Village Perumalpettai

75. Uric Bronfen Brenner:An Ecological Approach Macrosystem Exosystem Mesosystem Microsystem

76. Odds Ratios of Risk Factors for PTSD, before and after Adjusted by Logistic Regression Note: Total number of cases = 1404 @ Reference Category * Odds Ratio ** Adjusted using Logistic Regression + PTSD Prevalence % # 95% Confidence Intervel 1.967 – 6.516 0.000 1.0 3.520 0.000 1.0 4.102 1316 56.3% 88 84.1% 6. Family Problem No @ Yes 1.081 –1.842 0.011 1.0 1.411 0.000 1.0 1.815 333 46.8% 1071 61.5% 5. Family Structure Joint @ Nuclear 0.377 – 0.907 0.017 1.0 0.585 0.003 1.0 0.540 117 70.9% 1287 56.9% 4. Professional Stability Stable @ Unstable 0.696 – 1.204 0.325 – 0.642 0.521 0.000 1.0 0.915 0.471 0.126 0.000 1.0 0.809 0.343 418 67.0% 618 62.1% 368 41.0% 3. Economic grade (Monthly Income, Rs.) upto, 499 @ 500 – 4999 5000 + 1.491 – 2.357 0.000 1.0 1.874 0.000 1.0 2.075 647 48.5% 757 66.2% 2. Gender Male @ Female 1.031 – 1.712 1.389 – 2.766 1.559 – 4.631 0.028 0.000 0.000 1.0 1.329 1.960 2.687 0.023 0.000 0.000 1.0 1.328 1.980 2.970 579 51.5% 525 58.5% 217 67.7% 83 75.9% 1. Age 18 – 29 @ 30 – 44 45 – 59 60 + 95% C.I # Sig. P O.R. * Sig. P O.R. * Adjusted ** Unadjusted PTSD N Prev + Risk Factors

77. Mental health and social change: PRASHANTHAM GUNNAR MYRDAL MODEL ADAPTED ATTITUDINAL INSTITUTIONAL TECHNOLOGICAL ADMINISTRATIVE POLITICAL APPLIED FIRST TO JUVENILE JUSTICE SYSTEM AND THEN EXPANDED TO OTHER AREAS

78. CCC EXAMPLES The young boy of 13 who want to end his life overwhelmed by economic responsibility for the family A widow whose husband died in an accident runs around from pillar to post to get compensation from government Warden of a poor children’s boarding home

79. CCC Examples … A study on the positive change in the self concept of leprosy patients and participation in rehabilitation A study on empowerment of Dalit women through counselling Impact of Counselling on Coping of Tsunami survivors

80. Psychology Scientific study of behavior by: Describing Explaining Controlling Predicting improving

81. Health Health is not merely absence of illness.It is a state of physical, psychological,social and spiritual well being(The term spiritual was introduced by an Indian) Saukhyam: The word Saukhyam , a derivation of Saukhya , has various meanings – health, happiness, comfort, felicity, enjoyment. Saukhyam, therefore, refers to a quality of life that is not only from stress and strain but also one that reflects inner peace and repose, enabling a person to function at maximum potential.

82. CROSS-CULTURAL ISSUES MISTRUST HELP-SEEKING BEHAVIORS STIGMA COST CLINICIAN BIAS ETHNOPHARMACOLOGY

83. ASPECTS OF CULTURE AFFECTING MENTAL HEALTH :Professor Verghese TOO MUCH FREEDOM(NUCLEAR FAMILIES)TOO MUCH LACK OF FREEDOM (JOINT FAMILIES) Over valuation of one sex like male or female Early weaning leading to habit disorders Practices resulting in under nutrition Inbreeding – consanguinity More single persons in the west More married persons in the east

84. Dr. R. Srinivasa Murthy, Who consultant’s suggestions: Categorization of mental health problems Non-pharmacological therapies Pharmacological therapies Certification for legal purposes Training of other personnel Need for supervision in routine work Licensing to practice by an official body

85. 7 Questions: To what degree should the workers be involved in early identification and diagnosis? To what degree they should be given the responsibility for non-pharmacological methods of treatment? To what degree the worker should be given pharmacological and biological interventions? (Indian Journal of Psychological Counselling Volume 12 No 1 Dec 2003)

86. To what degree these workers can work independently or only under the direct and continuous supervision of other professionals? 5. To what degree can they be involved to training of other workers? 6. To what degree should these people be given the responsibility for certification of various types for legal as well as welfare benefits? 7. To what extent should these workers come under the system of licensing for taking up the work?

87. Meeting the mental health needs of developing countries: NGO innovations in India Shekhar Saxena 1 ; Pratap Sharan Department of Mental Health and Substance Dependence, World Health Organization, Geneva, Switzerland Editors: V. Patel & R. Thara Publisher: New Delhi: Sage Publications India Pvt Ltd; 2003 ISBN: 0-7619-9699-0 (US – hardback); price: US$ 59.95 81-7820-175-4 (India – hardback); price: 675 Indian rupees

88. NGO’s… The book consists of 17 chapters with lucid descriptions of nongovernmental organizations (NGOs) working in various areas of mental health in different parts of India. Each chapter uses the same format: genesis, evolution, current activities, and concerns and future perspectives. This helps to make the content interesting and easily assimilable. It is clear from reading these chapters that Indian NGOs have made useful contributions to clinical care, community outreach, rehabilitation, advocacy, protection of human rights, empowerment, policy change, training and research. It is also evident that the NGOs selected by the editors are driven by high commitment and that they promote active community participation.

89. NGO’s.. Transparency on professional issues (for instance, the qualifications of staff who administer interventions requiring high levels of skill) would serve to increase the credibility of NGOs. This is in addition to fiscal transparency, which is more often the focus of debate. NGOs should be vigilant about the issue of low salaries for their employees, which has implications not only for retention of staff but also for their possible exploitation in an employer driven market.

90. The editors state that from a public health perspective, the strength of "genuine" NGOs lies in their high motivation and social commitment, their sensitivity to the poor, and their flexibility and innovativeness. Their weakness is in lack of accountability, problems of sustainability, and limited scale of operation.

91. PUBLIC HEALTH FOUNDATION OF INDIA PRIME INTERVENTION (launch of the Public health foundation of india is aimed at training 1,000 public health professionals annually) Indian Business Insight, 2 April 2006

92. Some Board Members of PHFI Mr Rajat K Gupta Former Managing Director, McKinsey & Company and Chairman, Global Fund to Fight AIDS, Tuberculosis and Malaria (GFATM)

93. Social determinants of health: WHO report The report concluded that inequities in health, avoidable health inequalities, arise because of the circumstances in which people grow, live, work, and age, and the systems put in place to deal with illness. This refers to inequities between and within countries in conditions of daily living, ‘structural’ conditions like social and economic policies as well as systems in place for surveillance and monitoring of inclusive health care.

94. SOME POSITIVE STEPS TAKEN BY INDIA 1995 DISABILITY ACT INCLUDES MENTAL HEALTH DEBT-RELIEF FOR FARMERS RURAL EMPLOYMENT GUARANTEE SCHEME REVIVING ANF EXPANDING OF DMHP HIGHER PRIORITY FOR MENTAL HEALTH AND ESPECIALLY CHILD MENTAL HEALTH IN THE 11 TH FIVE YEAR PLAN MORE NGO INVOLVEMENT AND PUBLIC PRIVATE PARTNERSHIPS INVOLVEMENT OF HUMAN RIGHTS COMMISSION

95. Still needed actions: Community based, culturally sensitive paradigms View Mental health and Poverty alleviation as issues of Human rights Remove the law regarding suicide Allocate more funds for Health and multi-mental health human resource development. Coordinate better with NGO’s and Private Sector in promoting positive mental health Primary. Secondary and Tertiary care in the community Clarity of goals in training and cooperation among different levels and professionals

96. LIBERATION IS ABOUT VICTIMS EVERY WEAK NATION EXPLOITED BY A STRONG NATION IS A VICTIM EVERY MAN AND WOMAN DENIED THE RIGHT TO READ AND WRITE IS A VICTIM EVERY MAN AND WOMAN DENIED THE RIGHT TO ACQUIRE THE SKILLS OF OUR TECHNOLOGICAL AGE IS A VICTIM IS A VICTIM

97. VICTIMS… EVERY MAN AND WOMAN WITHOUT WORK, OR WHOSE WORK IS UNDERPAID, IRREGULAR OR INSECURE IS A VICTIM EVERY CHILD BORN OF SUCH MEN AND WOMEN SUFFERING FROM MALNUTRITION AND DISEASE, FROM OVERCROWDED LIVING CONDITIONS, FROM HOMELESSNESS, DESERTED BY PARENTS OR ORPHANED, WHOSE TALENTS ARE STUNTED BY STARVATION, SUFFERING FROM INSECURITY OR DEPRIVATION OF LOVE IS A VICTIM

98. The Paradox of our Times By H.H. Dalailama Is it that we have taller buildings but shorter tempers Wider free ways but narrower viewpoints We spend more but we have less We have bigger houses but smaller families More conveniences but lesser time We have more academic degrees but lesser sense More knowledge but lesser judgment More experts, more problems, more medicines but lesser health We have multiplied our possessions but reduced our values

99. The Paradox of……. We talk too much, love too seldom and hate too often We have learnt how to make a living but not how to live We have added years to life but not life to years We have been all the way to the moon and back but have trouble crossing the street to meet our new neighbor We have conquered outer space but not inner space We have cleaned up the air but polluted our souls We have split the atom but not our prejudice We have higher incomes but lower morals We have become long on quantity but short on quality

100. The Paradox of……. These are the times of taller men and shorter character Steep profits and shallow relationships These are the times of world peace but domestic warfare More leisure but lesser fun More kinds of food but lesser nutrition These are days of two incomes but more divorces Of fancier houses but broken homes It is a time when there is much in the show window but nothing in the stock room A time when technology can bring this letter to you and a time when you can choose either to make a difference or just hit delete.!

101. SOME REFERENCES Chisholm D, Lund C, Saxena S. Cost of scaling up mental healthcare in low- and middle-income countries. British Journal of Psychiatry.2007; 191:528-535 World health report 2001. Mental health: new understanding, new hope. Geneva, Switzerland: World Health Organization; 2001. Mental health atlas. Geneva, Switzerland: World Health Organization, 2005. Saxena S, Thornicroft G, Knapp M, Whiteford H. Resources for mental health: scarcity, inequity, and inefficiency. Lancet 2007; 370: 878–89

102. India's Five Year Plans I to XI 1951-56 to 2007-12, Vol. l and II/edited by M.M. Sury. New Delhi, New Century Pub., 2008, 1200 p., ISBN 81-7708-177-0. The British Journal of Psychiatry (2007) 191: 528-535. doi: 10.1192/bjp.bp.107.038463 © 2007 The Royal College of Psychiatrists

103. REFERENCES 1. German A. Trends in psychiatry in Black Africa. In: Arieti S, Chrzanowski G, editors. New dimensions in psychiatry – A world view. New York: Wiley; 1975. pp. 409–427. 2. Srinivasa Murthy R, Wig NN. The WHO collaborative study on strategies for extending mental health care, IV: A training approach to enhancing the availability of mental health manpower in a developing country. Am J Psychiatry. 1983;140:1486–1490. [ PubMed ]

104. 3. Agarwaal SP, Goel DS, Ichhpujani RL, editors. Mental health – An Indian perspective (1946-2003). New Delhi: Directorate General of Health Services, Ministry of Health and Family Welfare; 2004. 4. World Health Organization. Mental health in the Eastern Mediterranean region – reach- ing the unreached. Cairo: World Health Or- ganization; 2006.