brief handout
TRANSCRIPT
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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