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Susan duke springproject


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Susan duke springproject

  1. 1. 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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  4. 4.  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
  5. 5. ElderlyYouth 5
  6. 6. 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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  8. 8. 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
  9. 9. 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
  10. 10. Stigma Mitigation ProgramsLife Skills TrainingStepped CareCognitive Behavioral TherapyTask Shifting 10
  11. 11. 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
  12. 12. 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
  13. 13.  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
  14. 14. • 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
  15. 15. Drive Research BasedDrive Research Based Public Policies Public Policies 15
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  17. 17. 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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  19. 19. 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
  20. 20. Implementation OutlinePart (a) 2012 2013 2014123 21
  21. 21. Implementation OutlinePart (b) 2012 2013 2014456 22
  22. 22. Implementation OutlineAggregate 2012 2013 2014 Statewide Governance Population Studies Community Awareness Enhance Medical Resources Stepped Care Family Care 23
  23. 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
  24. 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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