Advances In Psychiatry Rehabilitation: Government NGO Collaboration In South India: The Unique Navaj

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Advances 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.

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WHO 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

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THE WORLD HEALTH REPORT - 2001

• Mental Health New Understanding, New Hope
• World Health Day Theme (2001)
• Stop Exclusion Dare to Care

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MENTAL 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

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AIM OF DE-INSTITUTIONALISATION

• No inappropriate admissions in mental hospitals
• Discharge to community - after preparation
• Community support systems.

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DELIVERY 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

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DELIVERY 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.

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SHIFT 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

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IDEAL 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

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MENTAL 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

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MENTAL 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.

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POLICY 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

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SCENARIO 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.

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SCENARIO 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

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India 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.

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The 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

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Health 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

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Mental 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

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Mental 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

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A 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.

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Services 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

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Services from Med. College (Contd)

• Psycho education for the volunteers
• Various types of rehabilitation measurers
• Training facilities
• Out reach community services

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Features 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

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Features 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.

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SOCIO-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

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Table 1 Age and sex groups
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Table 2 Educational Status
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Table 3 Marital status
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Table 4 Source of referral
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Table 5 Native place
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Table 6 Prevalence of psychiatric disorders
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Table 7 Comorbid medical disorders
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Table 8 Mental status examination
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SOCIO-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

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Table 1 Age and sex groups
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Table 2 Educational Status
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Table 3 Marital status
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Table 4 Source of referral
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Table 5 Native place
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Table 6 Prevalence of psychiatric disorders
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Table 7 Comorbid medical disorders
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Table 8 Mental status examination
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THE 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

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Nature has provided everything to satisfy the
need of everyone, but not enough to satisfy the
greed of anyone - Mahatma
Gandhi
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