Title: Advances In Psychiatry Rehabilitation: Government NGO Collaboration In South India: The Unique Navaj
1Advances In Psychiatry Rehabilitation Government
- NGO Collaboration In South India The Unique
Navajeen-Mariasadan Experience
- Roy Abraham Kallivayalil MD, DPM
- Gen. Secretary, Indian Psychiatric Society
- Secretary General, SAARC Psych. Federation
- Associate Professor of Psychiatry
- Medical College, Kottayam, Kerala, India.
2WHO STATEMENT ON MENTAL HEALTH
- Mental health neglected for too long in
crucial to the over all well-bring of
individuals, societies and countries and must be
universally regarded in a new light. -
- Mental illness is not a personal failure. It
doesnt happen only to other people. - - Gro Harlem Brundtland
- D.G., WHO-2001
3THE WORLD HEALTH REPORT - 2001
- Mental Health New Understanding, New Hope
- World Health Day Theme (2001)
- Stop Exclusion Dare to Care
4MENTAL HEALTH ISSUES- FAILURE OF ASYLUMS
- Illtreatment of patients
- Geographical and professional isolation
- Weak reporting and accounting
- Bad management
- Poorly targeted financial resources
- Lack of staff training
- Inadequate quality assurance procedure
5AIM OF DE-INSTITUTIONALISATION
- No inappropriate admissions in mental hospitals
- Discharge to community - after preparation
- Community support systems.
6DELIVERY OF IDEAL MENTAL HEALTH SERVICES
- High quality, affordable medical care for all
citizens - Promoting medical research
- Encouraging new technologies
- Social and economic factors, however
significantly affect a nations health status and
the delivery of health services
7DELIVERY OF MENTAL HEALTH SERVICES (CONTD)
- Not different from general health services.
- Protection from catastrophic financial risk.
- Minimise out-of-pocket payments.
- Prepayment methods options
- Mandatory social insurance
- Voluntary private insurance
- General taxation
- The healthy/well off to subside the sick/poor.
8SHIFT IN MENTAL HEALTH CARE PARADIGM
- Due to progress in psychopharmacology
- New forms of psycho-social intervention
- Human rights movements
- A mental health component was firmly incorporated
into the concept of health
9IDEAL MENTAL HEALTH POLICY
- Identify major issues and objectives
- Define the role of public and pvt. sector
- Identify requirements in public sector
- Prompting action for capacity building
- Guidance for prioritising expenditure
- Link analysis of problems to decisions about
resource allocation
10MENTAL HEALTH POLICY (CONTD)
- 7. Highlight vulnerable groups with special
mental health needs. (Eg children, the elderly,
the women, refugees/displaced persons) - 8. Include suicide prevention. (Reduce access to
poisons /fire-arms etc.) - 9. Care for individuals at risk (with
depression, schizophrenia, alcohol dependence) - 10. Control of alcohol illicit drugs
11MENTAL HEALTH POLICY (CONTD)
- 11. Coherent alcohol and drug policies.
- 12. Involve all stake holders.
- 13. Ensure respect of human rights.
- 14. Mass media and public awareness.
- 15. NGOs and consumer groups are involved.
12POLICY FORMULATION
- Up-to-date and reliable information about
- Community
- Mental health indicators
- Effective treatments
- Prevention and promotion strategies
- Mental health resources
- Review the Policy periodically
13SCENARIO IN INDIA
- Mental health policy formulated in 1982.
- Substance abuse policy absent.
- National Mental Health Programme 1982.
- Essential list of drugs Yes
- Mental Health Legislation MHA 1987.
- 0.83 of Health Budget on Mental Health.
- Disability benefits Yes
- NGOs involved in advocacy, promotion, prevention,
treatment and rehabilitation.
14SCENARIO INDIA (WHO Atlas 2001)
- Beds (per 10,000) 0.25
- Beds in Mental Hospitals 0.2
- Beds in General Hospitals 0.05
- Beds (Others) 0.01
- Psychiatrists (per 100,000) 0.04
- Neurosurgeons 0.06
- Psychiatric nurse 0.04
- Neurologists 0.05
- Psychologists 0.02
- Social workers 0.02
15India some general issues
- Mental health is not a priority area
- Only lt1 of health budget for mental health
- Escalating health care costs
- High cost of drugs
- Some Indian states are ahead of others in health
care delivery.
16The Success Story of Kerala
- Kerala is model for developing world.
- High quality health care at low cost.
- 100 literacy
- High female literacy
- Only state where females out number males
- Highly developed social sector
17Health scenario in Kerala
- Lowest Infant Mortality Rate (11)
- Lowest Maternal Mortality Rate (lt1)
- Highest Life Expectancy
- Life Expectancy Males 72 yrs
- Life Expectancy Females 74.5 yrs
- Health statistics comparable to the developed
nations of the World
18Mental Health scenario in Kerala
- One of the best but still a long way to go
- Number of psychiatrists 300
- 1 for 100,000 population
- Inadequate but 2.5 times the national average.
- Large number of General Hospital Psychiatry
Units. - Three Mental Health Centres
19Mental Health Inadequacies
- Rehabilitation centres Few and Far between
- Inadequate half way homes
- Less than adequate facilities at the Govt. sector
- Private sector growing but costs are high
20A Unique Experience in Kerala
- Government NGO Collaboration in rehabilitation
- The Navajeevan Centre 3kms from the Psychiatry
Department - The Mariasadan Centre Out reach rehabilitation
centre 30 kms away.
21Services from Med. College, Kottayam
- 20-30 patients are seen per week
- Follow up and new cases
- No consultation fees, no charges
- Available medications are supplied free
- Post graduate residents are posted
- Community Psychiatry Training
22Services from Med. College (Contd)
- Psycho education for the volunteers
- Various types of rehabilitation measurers
- Training facilities
- Out reach community services
23Features of these NGO centres
- These are not mental health hospitals
- No qualified psychiatrists
- Patients are looked after by volunteers
- No human rights violation
- Individual rights are protected
- Provides dignified living
24Features of these NGO centres (contd)
- Transparency in functioning
- Equity of services
- Patients are not chained up or tied up
- Functions in an open setting
- Continuous supervision by psychiatrist
- Support of the teaching faculty
- Approval by Mahatma Gandhi University as centres
for community psych. Training.
25SOCIO-DEMOGRAPHIC DATA FROM REHABILITATION
CENTRE- NAVAJEEVAN (1-1-2004 31-12-2004)
- Total No. of mentally patients 182
- Total No. of medically ill patients 10
- Males-106
- Females-76
26Table 1 Age and sex groups
27Table 2 Educational Status
28Table 3 Marital status
29Table 4 Source of referral
30Table 5 Native place
31Table 6 Prevalence of psychiatric disorders
32Table 7 Comorbid medical disorders
33Table 8 Mental status examination
34SOCIO-DEMOGRAPHIC DATA FROM REHABILITATION CENTRE
-MARIA SADANAM (1-1-2004 31-12-2004)
- Total No. of mentally ill patients 233
- Total No. of medically ill patients 5
- Males-146
- Females-87
35Table 1 Age and sex groups
36Table 2 Educational Status
37Table 3 Marital status
38Table 4 Source of referral
39Table 5 Native place
40Table 6 Prevalence of psychiatric disorders
41Table 7 Comorbid medical disorders
42Table 8 Mental status examination
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55THE MESSAGE
- Treatment of mental disorders do exist and are
available - Most individuals and families can be helped
- Treatment, rehabilitation and preventive
strategies - Adopt suitable Mental Health Policy
- Progressive Legislation
- There is New Understanding, New Hope
56Nature has provided everything to satisfy the
need of everyone, but not enough to satisfy the
greed of anyone - Mahatma
Gandhi
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