Community Mental Health Services in india At Nmhans Power Point Students.


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Community Mental Health Services in india At Nmhans Power Point Students.

  1. 1. Community Mental Health Services Presenter: Ms. Sini Mathew Dept. of PSW NIMHANS Bangalore.
  2. 2. BHORE COMMITTEE REPORT 1947 “…………….even if the proportion of patients be taken as 2 per thousand population in India, hospital accommodation should be available for 8,00,000 mental patients as against the existing provision for a little over 10,000 beds for the country as whole”
  3. 3. MUDLIAR COMMITTEE REPORT 1964 <ul><li>“……… . Reliable statistics regarding the incidence of mental morbidity in India are not available…. as against the total need of the number of beds available in mental hospitals in india is only 15,000………” </li></ul>
  4. 4. MENTAL HOSPITAL STUDY <ul><li>Three Mental Hospital Study (Wing and Brown) </li></ul><ul><li>Direct relationship between quality of care and chronicity </li></ul><ul><li>Institutionalism </li></ul><ul><li>Institutional Neurosis </li></ul>
  5. 5. ATTITUDE TO FAMILY <ul><li>Prior to 1970 – Family as toxic </li></ul><ul><li>1970 -Family as cause of relapse (EE) </li></ul><ul><li>1980 – Family as carer </li></ul><ul><li>1990 - Family as partners </li></ul>
  6. 6. INTEGRATION OF MENTAL HEALTH CARE WITH PHC - 1975 <ul><li>Raipur Rani Experiences, 1975, Chandigarh </li></ul><ul><li>RMHC services, Sakalawara, 1975, Bangalore </li></ul><ul><li>Shiv Gautam, Rajasthan </li></ul><ul><li>Karthikeyan Krishna Murthy, Andhrapradesh </li></ul>
  7. 7. National Mental Health Program (1982) <ul><li>1. Availability and accessibility of services </li></ul><ul><li>2. Application of knowledge to general health care </li></ul><ul><li>3. Community participation </li></ul>
  8. 8. NMHP APPROACHES 1982 <ul><li>1. Diffusion of mental health skills </li></ul><ul><li>2. Task distribution </li></ul><ul><li>3. Equity </li></ul><ul><li>4. Integration of services </li></ul><ul><li>5. Linkage with community development </li></ul>
  9. 9. 1995-2002 <ul><li>Extension of DMHP to 25 districts in 25 states </li></ul><ul><li>Fully centrally funded </li></ul><ul><li>Mental Health care as part of Primary Health care. </li></ul>
  10. 10. COMMUNITY PSYCHIATRY 1995-2002 <ul><li>Extension of DMHP to 25 districts </li></ul><ul><li>25 states </li></ul><ul><li>Fully centrally funded </li></ul><ul><li>Mental Health care as part of </li></ul><ul><li>Primary health care. </li></ul>
  11. 11. ERWADI TRAEDY August 2001 <ul><li>Belief in Supernatural </li></ul><ul><li>Concept of incurability </li></ul><ul><li>Lack of services </li></ul><ul><li>Lack of recognition of human rights </li></ul>
  12. 12. SUPREME COURT INITIATIVES AUGUST 2001 <ul><li>Enlarge the scope to whole country </li></ul><ul><li>Emphasis on human rights </li></ul><ul><li>Responsibility of the state for mental health care </li></ul>
  13. 13. INTERNATIONAL DEVELOPMENTS <ul><li>Deinstitutionalisation (Italy, 1978) </li></ul><ul><li>Care in the community </li></ul><ul><li>Partnership with consumers </li></ul><ul><li>Partnership with families </li></ul><ul><li>Human rights </li></ul>
  14. 14. WORLD HEALTH REPORT 2001 <ul><li>MENTAL HEALTH </li></ul><ul><li>NEW UNDERSTANDING </li></ul><ul><li>NEW HOPE </li></ul>
  15. 15. RECOMMENDATIONS OF WHR 2001 <ul><li>Provide treatment in primary care </li></ul><ul><li>Make psychotropic medicines available </li></ul><ul><li>Provide care in the community </li></ul><ul><li>Educate the public </li></ul><ul><li>Involve communities, families and consumer </li></ul><ul><li>Establish National Policies, Legislation </li></ul><ul><li>Develop human resources </li></ul><ul><li>Link with other sectors </li></ul><ul><li>Monitor community mental health </li></ul><ul><li>Support more research </li></ul>
  16. 16. PARTNERSHIP WITH FAMILIES <ul><li>AMEND, BANGALORE </li></ul><ul><li>ASHA, CHENNAI </li></ul><ul><li>RASHMI, DELHI </li></ul>
  17. 17. MILESTONES OF MENTAL HEALTH CARE IN INDIA <ul><li>1950 – Amritsar-family involvement </li></ul><ul><li>1960 – GHPU’S </li></ul><ul><li>1970 - Integration of MH care with PHC. </li></ul><ul><li>1980 - DMHP </li></ul><ul><li>1990 - NGO’s </li></ul><ul><li>2000 – Human Rights </li></ul>
  18. 18. IMPORTANT MILESTONES – LEGAL <ul><li>Narcotic and Psychotropic Substance Act (1985). </li></ul><ul><li>Mental Health Act (1987) </li></ul><ul><li>Persons With Disability Act (1995) </li></ul>
  19. 19. LOOKING AHEAD - CHALLENGS <ul><li>Very uneven distribution of resources across states/UTs. </li></ul><ul><li>Low human resources for mental health care </li></ul><ul><li>Poor training in psychiatry </li></ul><ul><li>Lack of welfare programmes </li></ul><ul><li>Public ignorance </li></ul><ul><li>Growth of private sector </li></ul>
  20. 20. OPPORTUNITES <ul><li>Build on community resources </li></ul><ul><li>Community tolerance </li></ul><ul><li>Family commitment </li></ul><ul><li>Limited barriers for professional work </li></ul><ul><li>Partnerships with wide variety of community resources </li></ul><ul><li>Integration of services </li></ul>
  21. 21. HISTORY <ul><li>Community psychiatry unit started at NIMHANS on October 1975 </li></ul><ul><li>Aim :to develop suitable training programme for doctors and multipurpose workers from PHCs </li></ul><ul><li>Objectives: </li></ul><ul><li>Organizing services </li></ul><ul><li>Human resource development-develop training materials and conducting training programs </li></ul>
  22. 22. <ul><li>Developing community based research </li></ul><ul><li>Developing various models of care. </li></ul><ul><li>Initial activities </li></ul><ul><li>Team studied the needs of the rural population one PHC(1975-80) </li></ul><ul><li>Identified the mentally ill persons at their home through key informants and those attending general hospital care. </li></ul><ul><li>Initiated pilot experiment of integrating mental health with general health care in one PHC with one lack population. </li></ul>
  23. 23. <ul><li>Followed by the successful </li></ul><ul><li>implementation of the similar programme in another district with 2 million population </li></ul><ul><li>The result of this project is completed in 1981 and now used as the model district mental health programme. </li></ul>
  24. 24. Initial activities at a glance <ul><li>Primary health centre based rural mental health programme </li></ul><ul><li>General practitioner based urban mental health programme </li></ul><ul><li>School mental health programme </li></ul><ul><li>Home based follow ups of psychiatric patients </li></ul><ul><li>Community based rehabilitation of minor mentally ill persons. </li></ul>
  25. 25. Ongoing activities <ul><li>Service </li></ul><ul><li>Teaching &Training </li></ul><ul><li>Research </li></ul>
  26. 26. NEUROPSYCHIATRIC EXTENSION SERVICES <ul><li>Started in 1981 </li></ul><ul><li>Five clinics-Gunjur(25),Madhugiri(115),Maddur(75),Kanakapura(50),Gowribidanur(75) </li></ul><ul><li>Objectives </li></ul><ul><li>Availability of service </li></ul><ul><li>Accessibility of Service </li></ul><ul><li>Affordability of Service </li></ul><ul><li>Community participation </li></ul><ul><li>Integration of Mental health into Primary </li></ul><ul><li>Health Care </li></ul>
  27. 27. NEUROPSYCHIATRIC EXTENSION SERVICES <ul><li>Services </li></ul><ul><ul><ul><li>Brief intake </li></ul></ul></ul><ul><ul><ul><li>Psychosocial assessment </li></ul></ul></ul><ul><ul><ul><li>Psycho education </li></ul></ul></ul><ul><ul><ul><li>Supportive therapy </li></ul></ul></ul><ul><ul><ul><li>Referral </li></ul></ul></ul><ul><ul><ul><li>Mobilization of resources </li></ul></ul></ul><ul><ul><ul><li>Marriage and Family Counseling </li></ul></ul></ul><ul><ul><ul><li>Health education </li></ul></ul></ul><ul><ul><ul><li>Making social welfare measures available </li></ul></ul></ul><ul><ul><ul><li>Brief Cognitive therapy for depressed clients </li></ul></ul></ul>
  28. 28. RURAL M H SERVICES <ul><li>Rural Mental health Center at Sakalwara (1976) </li></ul><ul><li>Take care of Physical as well as Psychiatric cases </li></ul><ul><li>Trained GDMO, PSW, Cl. Psychologists and psychiatric nurses </li></ul><ul><li>one satellite clinic-Anekal </li></ul><ul><li>Training center/ Laboratory </li></ul>
  29. 29. SATELLITE CLINIC <ul><li>Objective </li></ul><ul><li>Availability of Service </li></ul><ul><li>Anekal 22 km from Sakalwara </li></ul><ul><ul><li>Every Tuesday </li></ul></ul><ul><ul><li>Last Tuesday- for epilepsy(500-900) </li></ul></ul><ul><ul><li>50-70 psy. Cases/clinic </li></ul></ul>
  30. 30. CONSULTATION SERVICES <ul><li>Objective </li></ul><ul><ul><li>Impart professional input when necessary </li></ul></ul><ul><ul><li>Sustaining the project </li></ul></ul><ul><li>NGOs working with </li></ul><ul><ul><li>mentally ill </li></ul></ul><ul><ul><li>Mentally retarded </li></ul></ul><ul><ul><li>Homeless </li></ul></ul><ul><ul><li>Mental health/counseling </li></ul></ul><ul><ul><li>Disaster affected population </li></ul></ul>
  31. 31. HOME CARE SERVICES <ul><li>Started in 1980s (Pai & Nagarajaiah,1981) </li></ul><ul><li>Multidisciplinary team make Home Visits </li></ul><ul><li>Provide drugs/counseling </li></ul><ul><li>Crisis intervention </li></ul><ul><li>Relapse rate is almost nil after two years of F/U </li></ul>
  32. 32. SCHOOL MENTAL HEALTH PROGRAMS <ul><li>Early detection and treatment </li></ul><ul><li>Training of Teachers </li></ul><ul><li>Impart Life skills to children </li></ul><ul><li>To enhance psychosocial competence </li></ul><ul><li>Holistic approach </li></ul>
  33. 33. DISASTER MANAGEMENT PROGRAMS <ul><li>Psychosocial assessments </li></ul><ul><li>Capacity building </li></ul><ul><li>Support provisions </li></ul><ul><li>Working with NGOs </li></ul><ul><li>Development of models </li></ul><ul><li>Evaluation exercises </li></ul><ul><li>Policy implications </li></ul>
  34. 34. TEACHING & TRAINING <ul><li>Students of </li></ul><ul><ul><li>M.Phil in Psychiatric Social Work </li></ul></ul><ul><ul><li>M Phil in Clinical Psychology </li></ul></ul><ul><ul><li>M.Sc and Diploma in Psychiatric Nursing </li></ul></ul><ul><ul><li>MD in Psychiatry </li></ul></ul><ul><ul><li>Diploma in Psychological Medicine </li></ul></ul><ul><ul><li>Placement Students of Social Work, Psychology, Psychiatry, Psychiatric Nursing </li></ul></ul><ul><li>Central/State Govt. Deputed Candidates </li></ul><ul><li>WHO deputed Candidates </li></ul>
  35. 35. TEACHING &TRAINING <ul><li>School & College Teachers </li></ul><ul><li>Lay Volunteers </li></ul><ul><li>Volunteers in Disaster Management </li></ul><ul><li>Primary Care Physicians/GPs </li></ul><ul><li>Health Workers </li></ul>
  36. 36. TRAINING METHODS <ul><li>Manuals </li></ul><ul><li>Flip Charts </li></ul><ul><li>Video Reviews </li></ul><ul><li>Group Discussions </li></ul><ul><li>Workshops </li></ul><ul><li>Didactic Lectures </li></ul><ul><li>Field Visits/Agency Visits </li></ul><ul><li>Case Demonstrations </li></ul>
  37. 37. RESEARCH <ul><li>Epidemiological Research </li></ul><ul><li>Experimental Research </li></ul><ul><li>Evaluative Research/service delivery research </li></ul>
  38. 38. LEADING TO…. <ul><li>Policy Making </li></ul><ul><li>Quality Assurance </li></ul><ul><li>Decreasing Stigma </li></ul><ul><li>Continuity of Care </li></ul><ul><li>Ensure regular follow-ups </li></ul>
  39. 39. ROLE OF PSW IN CMH <ul><li>MICRO LEVEL </li></ul><ul><li>MACRO LEVEL </li></ul>
  40. 40. MICRO LEVEL <ul><li>Individual </li></ul><ul><li>Brief Psychosocial Assessment </li></ul><ul><li>Brief therapies </li></ul><ul><li>Placement services </li></ul>
  41. 41. MICRO LEVEL <ul><li>Group </li></ul><ul><li>Group Psychotherapy </li></ul><ul><li>Group Psycho education </li></ul><ul><li>Group work with Children </li></ul><ul><li>Family </li></ul><ul><li>Family psychoeducation </li></ul><ul><li>Family counselling and Family therapy </li></ul>
  42. 42. MACRO LEVEL <ul><li>Trainer </li></ul><ul><li>Consultant </li></ul><ul><li>Case Manager </li></ul><ul><li>Advocate </li></ul><ul><li>Resource Mobilizer </li></ul><ul><li>Organizer </li></ul><ul><li>Administrator </li></ul><ul><li>Collaborator </li></ul><ul><li>Activist </li></ul><ul><li>Researcher </li></ul>
  43. 43. MENTAL HEALTH -AGENDA FOR ACTION ACTIVITIES <ul><li>Services </li></ul><ul><li>Human resource development </li></ul><ul><li>Support to families </li></ul><ul><li>Suicide prevention </li></ul><ul><li>Services for children and adolescents </li></ul><ul><li>Support to voluntary organisations </li></ul><ul><li>Integration with other sectors </li></ul><ul><li>Research/Monitoring and evaluation </li></ul><ul><li>Administrative structures </li></ul>
  44. 44. MENTAL HEALTH AGENDA FOR ACTION <ul><li>We have at our disposal the knowledge and power </li></ul><ul><li>to significantly reduce the burden of mental disorders. </li></ul>