Aspects of mental health and programs in India, Mauritius, and South Africa

1. MENTAL HEALTH
“I'M NOT FAKING BEING SICK. I'M ACTUALLY FAKING BEING WELL.”
Dhruv Kumar
SSR Medical College
Belle Rive,
Mauritius

2. WHAT IS HEALTH?
• Health is defined as a state of complete physical, mental, and
social well-being and not merely the absence of disease or
infirmity.
• A sound mind in a sound body has been recognized as a social
ideal for many centuries.

3. ACCORDING TO WHO
• Mental health, as the commitee understands it, is influenced by
both biological and social factors.
• It is not a static condition but subject to variations and fluctuations
of degree.

4. CHARACTERISTICS OF A MENTALLY HEALTHY PERSON
• He/she feels comfortable about himself/herself i.e he/she feels
reasonably secure and adequate. He/she has self respect and
doesnt under or overestimate himself/herself.
• He/she feels right towards others i.e he/she feels love and has
freindships that are satisfying and lasting.
• A mentally healthy person is abe to meet the demands of his/her
life. The ability to take decision is there and does not get
overwhelmed by emotions of fear, anger, love or guilt.

5. WARNING SIGNALS
Always worried?
Not able to concentrate?
Continuosly unhappy without justification?
Lose temper easily?
Troubled by regular insomnia?
Wide fluctuations in mood?
Prefer to be alone?
Upset if routine gets disturbed?
Afraid without real cause?
Are you always right and the other person always wrong?
Numerous aches and pains for which the doctor finds no physical cause?

6. INTERNATIONAL CLASSIFICATION OF DISEASE
• Organic including symptomatic : Alzheimer.
• Due to psychotropic substances: Alcohol,dependence syndromes.
• Delusional disorders: Schizophrenia
• Mood disorders: Bipolar affective disorders.
• Neurotic , stress related and somatoform disorders:GAD, OCD,
Hypochondriasis.
• Behavioural Syndromes: eating disorders.
• Adult personality disorders: Trans-sexualism.
• Childhood psychological development disorders:Hyperkinetic disorders,
Autism. 11

7. • Mental illness is a vast subject, broad in its limit and difult
to define precisely.
• There are major and minor illnesses.
• The major illnesses are caled psychoses. Here the person
is insane and out of touch with reality.
• THERE ARE 3 MAJOR ILLNESSES AND THEY ARE:-

8. 1. SCHIZOPHRENIA
• SPLIT PERSONALITY DISORDER
• The patient lives in a dream world of his own.

9. 2. MANIC DEPRESSIVE PSYCHOSIS
• In this disease the symptoms vary from heights of excitement to
depth of depression.

10. 3. PARANOIA
• Which is associated with undue and extreme suspicion and a
progressive tendency to regard the whole world in a framework of
delusions.

11. MINOR
NEUROSIS OR
PSYCHONEUROSIS
PERSONALITY
AND
CHARACHTER
ARE LEGACY OF
UNFORTUNATE
CHILDHOOD
EXPERIENCES
NOT ABLE TO
REACT PROPERLY
TO LIFE
SITUATIONS.

12. CAUSES OF MENTAL ILLHEALTH
• Causes of Mental Illness: Multifactorial.
• 1. Organic condition:
• cerebral arterioslerosis, neoplasms, chronic diseases etc
• 2. Heridity:
• Child of schizophrenic parents more likely to develop same
condition.

13. • 3. Social patholgical causes:
• Emotional stress , anxieties, broken marriages and homes, Cruelty,
rejection, neglect..
• Industrialization, Urbanization, migration, poverty.
• 4. Others:
• Toxic substances, Psychotropic substances,
• Nutritional factors, Minerals, Infective agents,
• Trauma and Radiation.

15. CRUCIAL POINTS IN LIFE CYCLE
• Prenatal period.
• First 5 years child requires love and care. Broken homes produce
disorders.
• Schooling climate should be good.
• Adolescent period most important.
• Old age.
• Need for affection, belonging, independence are needed for all
ages.

16. PREVENTION
• Primary: community basis improving social enviroinment.
• Secondary: early diagnosis of mental illness by screening
programs.
Provision of tretment facility and community
resources.
Family based health services with counselling.
• Tertiary: Reduced duration of illness, prevent further breakdown

18. MENTAL HEALTH SERVICES
• Early diagnosis and treatment
• Rehabilitation.
• Group and individual psychotherapy.
• Mental health education
• Use of Modern Psychoactive drugs
• After care services.

19. COMPREHENSIVE MENTAL HEALTH PROGRAMME
• Integration of Psychiatric services with other health services.

20. COMMUNITY MENTAL HEALTH PROGRAMME:
• In-patient services
• Out patient services
• Partial hospitalization
• Emergency and diagnostic services
• Education, Training and research

21. MENTAL HEALTH PROGRAMS IN INDIA
• 1. NATIONAL MENTAL HEATH PROGRAM
• Launchedd in 1982 in keepin with the heavy burden of menta illnesses in
the community and the absolute inadequacy of mentall health care
infrastructure in the country to deal with it.
• Integrates it with primary health care.

22. • 2. DISTRICT MENAL HEALTH PROGRAMS
• Training programs for all the workers in the mental health team at the
identified nodal institute in the state
• Public awareness to reduce stigma and and increase awareness.
• Providing valuable data and exxperience at the level of community to the
state and centre for future planning.

23. MENTAL HEALTH PROGRAMS IN MAURITIUS
• The Minister of Health and Quality of Life, Dr Anwar Husnoo, on
12th october 2017 announced a shift in mental health care from
long-term institution to community-based care through the
implementation of community psychiatric care.
• Initially, mental health services were centred at the main
psychiatric hospital, the Brown Sequard Mental Health Care
Centre.

24. • Health promotion activities have been carried out widely to create
awareness regarding mental health in the population, following
the National Plan for Mental Health through WHO funded
programmes.
• A ‘focal person’ for mental health was appointed who acted as a
coordinator for all mental health activities, including health
promotion at all levels

25. TRAINING
• Training is carried out at different levels:
• Postgraduate training in psychiatry is being given to six doctors
with the collaboration of the University of Bordeaux, France. The
programme comprises 3 years in Mauritius with regular teaching
by visiting French professors and clinical supervision by local
psychiatrists followed by 1 year in Bordeaux. After regular
assessments and examinations a degree will be awarded. Another
batch of six may be trained at a later stage

26. MENTAL HEALTH PROGRAMS IN SOUTH AFRICA
• There is officially no mental health policy present in the country.
Although South Africa’s first mental health policy was developed in
1997, the document did not follow more recently adopted policy
development protocols and was not published for dissemination.
• Currently the national Directorate: Mental Health and Substance
Abuse is drafting a new mental health policy, which it plans to
circulate for comment. A major reform in legislation has led to the
adoption of the Mental Health Care Act (2002), which is currently
being implemented

27. • A national mental health authority exists which provides advice to the
government on mental health policies and legislation, namely the national
Directorate: Mental Health and Substance Abuse. All health services and
budgets are decentralised to the 9 provinces.
• Mental health services are organized in terms of catchment areas in all
provinces. There are 3,460 outpatient mental health facilities; 80 day
treatment; 41 psychiatric inpatient units located in general hospitals with a
total of 2.8 beds per 100,000 population; 63 community residential with a
total of 3.6 beds per 100,000 population.

28. SUMMARY
• Mental health condition is stigmatizing.
• Wide spectrum of disorders.
• Multifactorial with psychosocial and environmental determinants.