Need for a Realistic Mental Health Programme in India

48 Indian J Psychol Med | Jan - Jun 2009 | Vol 31 | Issue 1
Department of Community Medicine, Sikkim-Manipal Institute of Medical Sciences, Tadong, Gangtok, Sikkim, India
Address for correspondence: Dr. Ankur Barua,
Block-EE, No.-80, Flat No.-2A, Salt Lake City, Sector-2, Kolkata-700 091, West Bengal. India. E-mail: ankurbarua26@yahoo.com
DOI: 10.4103/0253-7176.53316
community in preventing as well as in promoting
mental health.
Need for a realistic mental health
programme in India[4-6]
India, with a population of a billion and very limited
numbers of mental health facilities and professionals
(one bed per 40,000 population and three psychiatrists
per million population), is confronting the complex
issues of providing mental health care to its entire
people. There are a few steps taken in the right direction,
namely the launching of the National Mental Health
Programme-NMHP (1982), adoption of Mental Health
Act (1987), persons with disability Act (1995), and
integration of the mental health with primary health
care at district level.
Though the implementation of the NMHP had
an initial spurt, but later, there were delays in its
expansion. Any programme howsoever well planned
cannot succeed unless there are no takers. There is an
urgent need for proper IEC, i.e. information, education,
and communication about the mental illness among
the masses. This will not only help in breaking the
Introduction
In India, at a given point of time, nearly 15 million
people suffer from serious psychiatric illness, and
another 30 million from mild/moderate psychiatric
problems.[1] The disability associated with mental or
brain disorders stops people from working and engaging
in other creative activities.[2]
Community care of mentally
challenged individuals[3]
Early in the 1960s and 1970s, it was beginning to be
realized that long-term institutional care of all the
needy mentally ill was neither possible nor desirable.
The answer was deinstitutionalisation and community
care. At that time, the best we could hope for was
compassionate custodial care within the four walls of
a mental asylum. These ill people were left there, often
for life, by their relatives and community, who would
then forget about them. It says a lot for the progress
made over the years, even in our country, that we
talk not only of treating mentally challenged patients
in their own surroundings, but also of involving the
India, with a population of a billion, has very limited numbers of mental health facilities and professionals in providing
mental health care to all the people. The disability associated with mental or brain disorders stops people from working
and engaging in other creative activities. Gradual implementation of district mental health programme in a phased
manner with support of adequate managerial and financial inputs is the need of the day. Trained mental health care
personnel, treatment, care, and rehabilitation facilities should be made available and accessible to the masses. The
voluntary organizations should be encouraged to participate in mental health care programme.
Key words: Community care, mentally challenged, realistic
Need for a Realistic Mental Health Programme in
India
Ankur Barua
ABSTRACT
New Horizon
Indian J Psychol Med | Jan - Jun 2009 | Vol 31 | Issue 1 49
Barua: Mental health programme
age-old myths and false beliefs about the mental illness
but also prevent the neglect of mentally ill and there
abandonment at places like Erwadi, in Tamil Nadu.
Inspiration to this effect can be taken from the fact
of extreme popularity of programmes like DATE on
Radio in 1992 and Mindwatch on TV in 1997. The
widespread availability and reach of media can be
further utilized for this purpose. Also extra care should
be taken to prevent misuse of media like films and
television for wrong depiction of mentally ill persons
and methods of treatment such as ECT.
The role of psychiatrists will be central in any effort that
is intended to be of benefit for the mentally challenged.
They should keep themselves updated about every
new change happening in the field of diagnosis and
treatment. The practice of evidence-based psychiatry
not only benefits patients but also increases the selfconfidence
of the professionals in this field about this
specialty and its scope.
The delay in development of support materials and
models at the district level and lack of facility for the
initiation and coordination of the large-scale expansion
of the mental health programme pose a serious
problem. The programme lacks an in-built evaluation
mechanism and has no space for continuous research
and community participation at the functional level.
The absence of a central organization for mental health
has been a serious constraint in postindependence
planning in India. Twenty out of twenty-five states
have not set up the State Mental Health Authority, as
in March 1996. A similar lag has been noticed in the
implementation of the Mental Health Act, in spite of
the fact that it was accepted by the parliament in 1987
and became operational since April 1993.
The impact of economic structural adjustment in
impoverishing people, the breakdown of traditional
community and family relationships caused by urban
migration, and the myriad adverse effects of newer
diseases like AIDS are likely to cause a greater impact
on people’s psychosocial health. In addition, these
programmes do not incorporate proper preventive
measures, even curative and rehabilitative services
provided are inadequate in terms of the estimated
needs. It is also clear that mental illness is a significant
cause of disability in India, which has been largely
ignored, in health related development activities.
There have been innovative initiatives in the private
sector in a number of areas of mental health. The most
notables of these are crisis intervention, rehabilitation
of the mentally challenged, and care of the elderly and
street children. However, this has mostly been at the
local level without adequate evaluation and expansion
to cover the rest of the country.
Gradual implementation of district mental health
programme in a phased manner with support of
adequate managerial and financial inputs is the need
of the day. Trained mental health care personnel,
treatment, care, and rehabilitation facilities should be
made available and accessible to the masses. This can
only be made possible by the sharing of responsibility
by government and nongovernment organizations
dedicated to the cause of mental health. The voluntary
organizations should be given greater importance, and
encouraged to participate to a larger extent in mental
health care programmes.
REFERENCES
1. The World Health Organization. Psychiatry and mental
health in India. Regional Office for South-East Asia: The
institute.
2. The World Health Organization. The World Health Report.
Geneva: The Institute; 1995.
3. Desai NG, Mohan I. Mental Health in South-East Asia:
Reaching out to the Community. Regional Health Forum. Vol. 5.
Southeast Asia Region: The World Health Organization.
4. Trivedi JK. Implication of Erwadi tragedy on mental
health care system in India. Indian Journal of Psychiatry
2001;43:292.
5. Murthy RS. Lesson from the Erwadi tragedy for mental
health care in India. Indian J Psychiatry 2001;43:362-78.
6. Selvaraj K, Kuruvilla K. In the aftermath of Erwadi incident.
Indian J Psychiatry 2001;43:362-78.
Source of Support: Nil, Conflict of Interest: None.