COMMUNITY MENTAL HEALTH PAST, PRESENT AND FUTURE IN INDIA

Presentee: Tanaya Roychaowdhury Discussant: Priya Puri Introduction:

Community mental health (CMH) has "een the ma#or mental health policy and treatment initiati$e o% more then %i$e decade. &t emer'ed in the early 1()0s as an alternati$e to treatment in centrali*ed state mental hospitals+ callin' %or a decentrali*ed+ non-coerci$e system that promoted patients, ri'ht to sel%determination within collecti$ist reco$ery settin's -.erlim et al.+ !00/0. Community mental health is a decentrali*ed pattern o% mental health+ mental health care+ or other ser$ices %or people with mental illnesses. Community-"ased care is desi'ned to supplement and decrease the need %or more costly inpatient mental health care deli$ered in hospitals. Community mental health care may "e more accessi"le and responsi$e to local needs "ecause it is "ased in a $ariety o% community settin's rather than a''re'atin' and isolatin' patients and patient care in central hospitals -Thornicro%t et. 1l.+ !0110 Component o! communit" ment#$ %e#$t%: &denti%yin' a 'rass root le$el or'ani*ation Trainin' community $olunteer wor2ers 3peratin' periodic mental health clinics in the community &ncreasin' awareness o% mental health pro"lems in the population Trainin' the community wor2ers to implement simple psychosocial reha"ilitation measures 4etwor2in' with other medical and social ser$ice or'ani*ation 5sta"lishin' %amily and community support -Thara and Padma$ati+ !0060

Chairperson: Sri. Kamlesh Kr. Sahu Date: 14-0 -!01!

Hi toric#$ &#c'(round o! Communit" Ment#$ He#$t%: World-wide development:

Pre-deinstitutionali*ation Si'nin' o% the 4ational 7ental 8ealth 1ct "y President Kennedy in 1(4) that lead to the %oundin' o% the 4ational &nstitute o% 7ental 8ealth -4&780 in 1(4(. Deinstitutionali*ation: Phillepe Pinel played a lar'e role in the ethical and humane treatment o% patients+ while Dorothea Di9 was 'reatly in%luenced "y Pinel and ad$ocated the e9pansion o% state psychiatric hospitals %or patients who were at the time "ein' housed in #ails and poor houses. Post- deinstitutionali*ation: 1%ter deinstitutionali*ation+ many o% the mentally ill ended up in #ails+ nursin' homes+ and on the streets as homeless indi$iduals. &t was at that point in history that modern community mental health ser$ices started to 'row and "ecome in%luential. -http:::en.wi2ipedia.or':wi2i:Community;mental;health;ser$ice0 The <Declaration o% 1lma 1ta=- to achie$e <8ealth %or 1ll "y !000= "y uni$ersal pro$ision o% primary health care -1(6>0 -&saac+ !0110

History of community mental health from the Indian perspective: Bhore committee (1946): it recommended the importance o% manpower de$elopment in the %ield o% mental health Mudaliar Committee (1962): &t made recommendations in the 'eneral pre$enti$e and curati$e %ield+ trainin' and research. Srivastava Committee (1974): the purpose o% this committee was to su''est policy approaches to achie$e "etter health care in the country -4ational &nstitute o% 8ealth ? @amily Ael%are+ !0110 There ha$e "een some lon' standin'+ well 2nown community-"ased pro#ects in &ndia. 3ne o% them is the ai!ur ani e"!eriment (197#$19%2)+ and the other well 2nown community study has "een at Sa&al'ara in (arnata&a (197#)) *ational Mental Health +ro,ramme (19%2) -istrict mental Health !ro,ram which currently co$ers 1!6 districts -7urthy+ !0100 *ational Human i,hts Commissions (1999): The 48RC has ta2en up se$eral issues related to hospital and community mental health care. -4a'ara#a and 7urthy+ !00>0 *ational Mental Health +olicy (2..1): &t outlines the prioriti*ed a'enda %or e9tendin' within a pra'matic time-%rame "asic mental health care %acilities to all sections o% the population across the country "y the year !0!0. 11th #$year !lan (2..7$2.12): To address the shorta'e o% Buali%ied mental health pro%essionals it was thou'ht necessary to ha$e dedicated manpower de$elopment schemes in addition to continuin' with the community care approach adopted under D78P.

Current cen#rio o! communit" ment#$ He#$t% in Indi#: *MH+ 2.11: at present+ the national mental health pro'ramme in india has the %ollowin' %eatures:

1. District mental health pro'ramme as already "ein' carried out. !. &5C 1cti$ities: &nno$ati$e &5C strate'ies in$ol$in' 5lectronic: Print:local media at Central le$el to reduce sti'ma attached to mental illness and increase awareness re'ardin' a$aila"le treatment and health care %acilities. /. 7onitorin' ? 5$aluation 4. Trainin' and research -7inistry o% 8ealth ? @amily Ael%are+ !0110.

1.

-MH+ 2.11: the e"istin, com!onents -7inistry o% 8ealth ? @amily Ael%are+ !0110 5arly &denti%ication and Treatment o% 7ental &llness near patients doorsteps

!. /. 4.

Trainin' o% 8ealth and Community Aor2ers %or / years only &5C acti$ities at district le$el ) mem"er D78P team %or 10th plan districts+ 11 mem"er D78P team %or (th plan districts

*on /overnment 0r,ani1ations:

4on-Co$ernmental 3r'ani*ations -4C3s0 are institutions+ reco'ni*ed "y 'o$ernments as non-pro%it or wel%are oriented+ which play a 2ey role as ad$ocates+ ser$ice pro$iders+ acti$ists and researchers on a ran'e o% issues pertainin' to human and social de$elopment. 4C3s ha$e "een stron'ly committed to e9tendin' care into community -Patel and Thara+ !00/0. The plannin' and e9ecution o% 4C3 operated community outreach pro'ramme depends on certain critical %actors such as: Community acceptance 7ana'ement strate'ies 4etwor2in' Sustaina"ility -Thara and Padma$ati+ !0060

Future o! Communit" Ment#$ He#$t% in Indi#:

The pro$ision o% community-le$el+ decentrali*ed ser$ices should "e 'i$en primacy in mental health pro'rammes. The D78P has to "e at the centre o% the mental health pro'ramme. The current De9tension clinic, approach has to "e replaced with true inte'ration o% mental healthcare with primary healthcare personnel -similar to that in the case o% tu"erculosis+ leprosy+ etc.0. There is an ur'ent need to de$elop speci%ic indicators to monitor the D78P. Similarly+ there is a need to enhance technical inputs to or'ani*e the trainin' o% primary healthcare personnel+ and to pro$ide essential medicines+ support and super$ision to health personnel "y pri$ate sector mental health pro%essionals+ administrati$e support necessary %or monitorin' and periodically e$aluatin' the pro'ramme+ and pu"lic mental health education. There should "e technical ad$isory committees at the national and state le$els to 'uide the D78P constantly. Third+ the importance 'i$en to the de$elopment o% human resources %or mental healthcare in the 5le$enth @i$e-Eear Plan+ in the %orm o% the esta"lishment o% centres o% e9cellence+ constitutes an important initiati$e. This should "e supported with the creation o% employment opportunities %or the additional pro%essionals trained at these centres to pre$ent "rain drain o% trained pro%essionals. @ourth+ the pu"licFpri$ate partnership needs to "e impro$ed and enhanced. The in$ol$ement o% the pri$ate sector can ran'e %rom 'i$in' support to train personnel+ monitorin' wor2 locally+ ta2in' up speci%ic care pro'rams such as the maintenance care o% chronic patients+ to sharin' o% in%ormation on their clinical wor2 so that the state:country statistics re%lect the total picture and not that o% the pu"lic sector alone. 1 serious dialo'ue should ta2e place in the comin' years+ and acti$ities %or pri$ate sector in$ol$ement should "e identi%ied. @undin' support must "e made a$aila"le %or such acti$ities. @i%th+ there is a need to support 4C3 initiati$es %or "etter de$elopment and pro'ress.

Conc$u ion:

&n conclusion+ the de$elopment o% mental health ser$ices all o$er the world+ in rich and poor countries ali2e+ has "een the product o% lar'er social situations+ speci%ically+the importance society has 'i$en to the ri'hts o% disad$anta'ed:mar'inali*ed 'roups. There is a need to continue the process "y widenin' the scope o% mental health inter$entions+ increasin' the in$ol$ement o% all a$aila"le community resources+ and "asin' the inter$entions on the historical+ social and cultural roots o% &ndia. This will "e a continuin' challen'e %or pro%essionals and people in the comin' years. The story o% mental healthcare is an un%inished one. 7uch has occurred durin' the past ) decades "ut much more needs to "e done to complete the story. Re!erence : @a2hourya+ A. ? Prie"ea+ S. -!0060 Deinstitutio nali*ation and reinstitutionali*ation: ma#or chan'es in the pro$ision o% mental healthcare Psychiatry+ )+ >+ /1/-/1). 1ccessed %rom: -http:::lin2in'hu".else$ier.com:retrie$e:pii:S146)16(/060010> 0 on 7ay )+ !01!. 7orrissey+ G.P.+ ? Coldman+ 8.8. -1(>40. Cycles o% Re%orm in the Care o% the Chronically 7entally &ll. +sychiatric Services2 3#->0+ 6> -(/. 7orrissey+ G.P.+ ? Coldman+ 8.8. -1(>)0. Care and Treatment o% the 7entally &ll in the Hnited States: 8istorical De$elopments and Re%orms. 4nnals o5 the 4merican 4cademy o5 +olitical and Social Science2 4%4+ 1!-!6. Aorld 8ealth 3r'ani*ation press release -!0060 Community mental health ser$ices will lessen social e9clusion+ says A83 1ccessed %rom: -http:::www.who.int:mediacentre:news:notes:!006:np! :en:inde9.html0 on 7ay )+ !01!. .erlim+ 7.T.+ @lec2+ 7.P.+ ? Shorter+ 5. -!00/0. 4otes on 1ntipsychiatry. 6uro!ean archives o5 !sychiatry and clinical neuroscience2 2#3-!0+ )1-6. Thara+ R.+ Padma$ati+ R. -!0060 Community mental health care in &ndia: Role o% non-'o$ernment or'ani*ation+ 6astern 7ournal o5 !sychiatry+ $ol 10+ no. 1 and !+ @e"ruary-au'ust 7urthy+R.S. -!0110 7ental health initiati$es in &ndia -1(46F!0100+ 8he *ational Medical 9ournal 05 :ndia Iol. !4+ 4o. !+ Salhan+ R.4.+ Thara+ R. Community 7ental 8ealth in &ndia Sar2ar+ S.+ 4ational 7ental 8ealth Policy 7ali2+ S.C.+ 7ental 8ealth Pro'ramme ? Je'islation in &ndia: Some 3"ser$ations and 59periences+ :ndian 9ournal o5 +sychiatry2 !004+ 4)-&0 1 -!4 1'arwal+ S. P.+ Coel+ D. S.+ &chhpu#ani+ R. J.+ Salhan+ R. 4.+ Shri$asta$a+ S.+ 7ental 8ealth 1n &ndian Perspecti$e 1(4)F!00/+ -irectorate /eneral o5 Health Services2 Ministry o5 Health ; <amily =el5are+ !004 Kumar+ 1.+ District 7ental 8ealth Pro'ramme in &ndia: 1 Case Study+ 9ournal health and develo!ment Iol 1 4o 1. !00 + p'. !4-/ 4a'ara#a D.+ 7urthy+ P.+ 7ental 8ealth Care and 8uman Ri'hts -!00>0 *ational Human i,hts Commission2 *e' -elhi and *ational :nstitute o5 Mental Health and *euro Sciences2 .an'alore. 7urthy+ R. S.+ 4ational 7ental 8ealth Pro'ramme -478P0 3% &ndia+ -!0100 Mental Health Care in :ndia >+ast2 +resent and <uture2 Gune 7urthy+ R. S.+ District 7ental 8ealth Pro'ramme-D78P0+ -!0100 Mental Health Care in :ndia >+ast2 +resent and <uture2 Gune &saac+7.+ 4ational 7ental 8ealth Pro'ramme: Time %or reappraisal+ -!0110 8hemes and :ssues in Contem!orary :ndian +sychiatry2 4ew Delhi+ &ndian Psychiatric Society+ Patel+ I.+ Copeland+ G.+ The 'reat push %or mental health: why it matters %or &ndia+ -!0110 :ndian 9 Med es 1/4+ 3cto"er+ pp 406-40( Thornicro%t C.+ S*mu2ler+ C.+ 7ueser K.T.+ and Dra2e+ R+5.++ &ntroduction to community mental health care -!0110 39%ord Te9t"oo2 o% Community 7ental 8ealth+ o9%ord uni$ersity press.

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