Brief Handout

8/13/2019 Brief Handout

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COMMUNITY MENTAL HEALTH

PAST, PRESENT AND FUTURE IN INDIA

Presentee: Tanaya Roychaowdhury Chairperson: Sri. Kamlesh Kr. Sahu

Discussant: Priya Puri Date: 14-0-!01!

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/. 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 ratherthan a''re'atin' and isolatin' patients and patient care in central hospitals Thornicro%t et. l.+ !011

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

etwor2in' with other medical and social ser$ice or'ani*ation

5sta"lishin' %amily and community support Thara and Padma$ati+ !006

Hitoric#$ c'(round o! Communit" Ment#$ He#$t%:

World-wide development:

Pre-deinstitutionali*ation Si'nin' o% the ational 7ental 8ealth ct "y President Kennedy in

1(4) that lead to the %oundin' o% theational &nstitute o% 7ental 8ealth&78 in 1(4(.

Deinstitutionali*ation: Phillepe Pinel played a lar'e role in the ethical and humane treatment o%

patients+ while Dorothea Di9was '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: %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'wi2iCommunity;mental;health;ser$ice

The


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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 ational &nstitute o% 8ealth ? @amily Ael%are+

!011

There ha$e "een some lon' standin'+ well 2nown community-"ased pro#ects in &ndia. 3ne o%

them is theai!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,ramwhich currently co$ers 1!6 districts 7urthy+ !010

*ational Human i,hts Commissions (1999): The 8RC has ta2en up se$eral issues related to

hospital and community mental health care. a'ara#a and 7urthy+ !00>

*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 tocontinuin' 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 cti$ities: &nno$ati$e &5C strate'ies in$ol$in' 5lectronic Printlocal 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+ !011.

-MH+ 2.11: the e"istin, com!onents 7inistry o% 8ealth ? @amily Ael%are+ !011

1. 5arly &denti%ication and Treatment o% 7ental &llness near patients doorsteps


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!. Trainin' o% 8ealth and Community Aor2ers %or / years only

/. &5C acti$ities at district le$el

4. ) mem"er D78P team %or 10th plan districts+ 11 mem"er D78P team %or (th plan districts

*on /overnment 0r,aniations:

on-o$ernmental 3r'ani*ations 3s are institutions+ reco'ni*ed "y 'o$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$elopment. 3s ha$e "een stron'ly committed to

e9tendin' care into community Patel and Thara+ !00/.

The plannin' and e9ecution o% 3 operated community outreach pro'ramme depends on certain

critical %actors such as:

Community acceptance

7ana'ement strate'ies

etwor2in'

Sustaina"ility Thara and Padma$ati+ !006

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

e9tension 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.. 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 statecountry statistics re%lect the total picture

and not that o% the pu"lic sector alone. 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$ities. @i%th+ there is a need to support 3 initiati$es %or "etter de$elopment and

pro'ress.

Conc$uion:


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&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'edmar'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. !006 Deinstitutio nali*ation and reinstitutionali*ation: ma#or chan'es in

the pro$ision o% mental healthcare Psychiatry+ )+ >+ /1/-/1). ccessed %rom:

http:lin2in'hu".else$ier.comretrie$epiiS146)16(/060010> on 7ay )+ !01!.

7orrissey+ G.P.+ ? oldman+ 8.8. 1(>4. Cycles o% Re%orm in the Care o% the Chronically 7entally

&ll.+sychiatric Services 3#>+ 6>-(/.

7orrissey+ G.P.+ ? oldman+ 8.8. 1(>). Care and Treatment o% the 7entally &ll in the Hnited States:

8istorical De$elopments and Re%orms. nnals o5 the merican cademy o5 +olitical and

Social Science 4%4+ 1!-!6.

Aorld 8ealth 3r'ani*ation press release !006 Community mental health ser$ices will lessen social

e9clusion+ says A83 ccessed %rom:

http:www.who.intmediacentrenewsnotes!006np!eninde9.html on 7ay )+ !01!.

erlim+ 7.T.+ @lec2+ 7.P.+ ? Shorter+ 5. !00/. otes on ntipsychiatry. uro!ean archives o5

!sychiatry and clinical neuroscience 2#3!+ )1-6.

Thara+ R.+ Padma$ati+ R. !006 Community mental health care in &ndia: Role o% non-'o$ernment

or'ani*ation+astern ournal o5 !sychiatry+ $ol 10+ no. 1 and !+ @e"ruary-au'ust

7urthy+R.S. !011 7ental health initiati$es in &ndia 1(46F!010+ 8he *ational Medical ournal 05

ndia Iol. !4+ o. !+Salhan+ R..+ Thara+ R. Community 7ental 8ealth in &ndia

Sar2ar+ S.+ ational 7ental 8ealth Policy

7ali2+ S.C.+ 7ental 8ealth Pro'ramme ? Je'islation in &ndia: Some 3"ser$ations and 59periences+

ndian ournal o5 +sychiatry!004+ 4)& 1-!4

'arwal+ S. P.+ oel+ D. S.+ &chhpu#ani+ R. J.+ Salhan+ R. .+ Shri$asta$a+ S.+ 7ental 8ealth n

&ndian Perspecti$e 1(4)F!00/+-irectorate /eneral o5 Health Services Ministry o5 Health ;

*ational Human i,htsCommission *e' -elhi and *ational nstitute o5 Mental Health and *euro Sciences

an'alore.

7urthy+ R. S.+ ational 7ental 8ealth Pro'ramme 78P 3% &ndia+ !010Mental Health Care in

ndia >+ast +resent and


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http:en.wi2ipedia.or'wi2iCommunity;mental;health;ser$ice

http:nih%w.or'DCDocumentationSer$icesCommitte;and;commission.html
http://en.wikipedia.org/wiki/Community_mental_health_servicehttp://nihfw.org/NDC/DocumentationServices/Committe_and_commission.htmlhttp://en.wikipedia.org/wiki/Community_mental_health_servicehttp://nihfw.org/NDC/DocumentationServices/Committe_and_commission.html

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