Need for a realistic mental health programme in India.

India, with a population of a billion, has very limited numbers of mental health facilities and professionals in providing mental health care to all the people. The disability associated with mental or brain disorders stops people from working and engaging in other creative activities. Gradual implementation of district mental health programme in a phased manner with support of adequate managerial and financial inputs is the need of the day. Trained mental health care personnel, treatment, care, and rehabilitation facilities should be made available and accessible to the masses. The voluntary organizations should be encouraged to participate in mental health care programme.

INTRODUCTION

In India, at a given point of time, nearly 15 million people suffer from serious psychiatric illness, and another 30 million from mild/moderate psychiatric problems.[1] The disability associated with mental or brain disorders stops people from working and engaging in other creative activities.[2]

COMMUNITY CARE OF MENTALLY CHALLENGED INDIVIDUALS[3]

Early in the 1960s and 1970s, it was beginning to be realized that long-term institutional care of all the needy mentally ill was neither possible nor desirable. The answer was deinstitutionalisation and community care. At that time, the best we could hope for was compassionate custodial care within the four walls of a mental asylum. These ill people were left there, often for life, by their relatives and community, who would then forget about them. It says a lot for the progress made over the years, even in our country, that we talk not only of treating mentally challenged patients in their own surroundings, but also of involving the community in preventing as well as in promoting mental health.

NEED FOR A REALISTIC MENTAL HEALTH PROGRAMME IN INDIA[4–6]

India, with a population of a billion and very limited numbers of mental health facilities and professionals (one bed per 40,000 population and three psychiatrists per million population), is confronting the complex issues of providing mental health care to its entire people. There are a few steps taken in the right direction, namely the launching of the National Mental Health Programme-NMHP (1982), adoption of Mental Health Act (1987), persons with disability Act (1995), and integration of the mental health with primary health care at district level.

Though the implementation of the NMHP had an initial spurt, but later, there were delays in its expansion. Any programme howsoever well planned cannot succeed unless there are no takers. There is an urgent need for proper IEC, i.e. information, education, and communication about the mental illness among the masses. This will not only help in breaking the age-old myths and false beliefs about the mental illness but also prevent the neglect of mentally ill and there abandonment at places like Erwadi, in Tamil Nadu.

Inspiration to this effect can be taken from the fact of extreme popularity of programmes like DATE on Radio in 1992 and Mindwatch on TV in 1997. The widespread availability and reach of media can be further utilized for this purpose. Also extra care should be taken to prevent misuse of media like films and television for wrong depiction of mentally ill persons and methods of treatment such as ECT.

The role of psychiatrists will be central in any effort that is intended to be of benefit for the mentally challenged. They should keep themselves updated about every new change happening in the field of diagnosis and treatment. The practice of evidence-based psychiatry not only benefits patients but also increases the self-confidence of the professionals in this field about this specialty and its scope.

The delay in development of support materials and models at the district level and lack of facility for the initiation and coordination of the large-scale expansion of the mental health programme pose a serious problem. The programme lacks an in-built evaluation mechanism and has no space for continuous research and community participation at the functional level. The absence of a central organization for mental health has been a serious constraint in postindependence planning in India. Twenty out of twenty-five states have not set up the State Mental Health Authority, as in March 1996. A similar lag has been noticed in the implementation of the Mental Health Act, in spite of the fact that it was accepted by the parliament in 1987 and became operational since April 1993.

The impact of economic structural adjustment in impoverishing people, the breakdown of traditional community and family relationships caused by urban migration, and the myriad adverse effects of newer diseases like AIDS are likely to cause a greater impact on people's psychosocial health. In addition, these programmes do not incorporate proper preventive measures, even curative and rehabilitative services provided are inadequate in terms of the estimated needs. It is also clear that mental illness is a significant cause of disability in India, which has been largely ignored, in health related development activities.

There have been innovative initiatives in the private sector in a number of areas of mental health. The most notables of these are crisis intervention, rehabilitation of the mentally challenged, and care of the elderly and street children. However, this has mostly been at the local level without adequate evaluation and expansion to cover the rest of the country.

Gradual implementation of district mental health programme in a phased manner with support of adequate managerial and financial inputs is the need of the day. Trained mental health care personnel, treatment, care, and rehabilitation facilities should be made available and accessible to the masses. This can only be made possible by the sharing of responsibility by government and nongovernment organizations dedicated to the cause of mental health. The voluntary organizations should be given greater importance, and encouraged to participate to a larger extent in mental health care programmes.