Community Psychiatry in India

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Monthly Archives: January 2014

A prototype onsite training program – “MINGLE” by Field Psychiatric Team (Kottayam).

The following plan was today put forward for trial roll out at outreach clinics of CMHP-Kottayam. The  purpose is for continued onsite training and hand-holding of General Practitioners who have already received offsite training (one week) at the nodal center (Govt. Medical College, Kottayam). Suggestions are welcome as comments.

MINGLE

Mental-health INto General-practice Linkage Effort

Plan:

Trained-Medical-officer (CHC) and the visiting Field-Psychiatrist (NRHM) to jointly run the monthly mental-health clinics (CMHP) in the respective peripheral centers.  Trial run to be rolled out in selected 5 CMHP clinics. Clinics selected based on trained medical officer present, adequate staff strength at CHC, adequate clinical load for training purpose.

Objective:

  1.  Field Psychiatrist and CHC Medical officer will jointly see new patients registered at clinic. This is for hands-on mutual learning experience and formulating care plan in the periphery setting.
  2.  CHC MO shall independently see stable patients as part of routine follow-up in the clinic. This is for confidence building to see cases independently.

Requirement:

  1.  The Trained MO to spare time from 11.30 AM to 12.30 PM (1 hr) exclusively for CMHP clinic.
  2.  Patronage from MO in-charge of the CHC, DMO/ Deputy DMO for this initiative.

Particulars of a select list of CHCs (Community Health Centers)

Serial no. Name of CHC Trained MO present Adequate no. of patients in clinic
1. xxx1 Dr yyy1 Yes (2z)
2. xxx2 Dr yyy2 Yes (1z)
3. xxx3 Dr yyy3 Yes (1z)
4. xxx4 Dr yyy4 Yes (1z)
5. xxx5 Dr yyy5 Yes (1z)
6. xxx6 Dr yyy6 Yes (1z)
7.
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Lessions to learn from the success story of polio eradication.

From a recent write up (1) on the India’s success story of polio eradication, I have cut pasted an excerpt from the story with highlighted keywords which are probably the key aspects of the strategy used, and compares how these key aspects  stand in comparison with our public-mental-health- program. The idea is to learn from other successful programs and bring about change in our strategy.

 (numbering, italics and boldening added by me in the excerpt)

How has India overcome these hurdles to polio eradication?

1. India’s government and health system collaborated with international organisations including the World Health Organization, Rotary International, and UNICEF in a fine logistical feat to immunise the nation’s children.  Young children under age five are the target for vaccination to eradicate the disease, as they are the most vulnerable.

2. An initial key piece of the puzzle was generating data: who needed vaccination, and where.  In 1997, the National Polio Surveillance Project was established by the World Health Organization and the Indian government.  Data from this surveillance system informed the country’s medical surveillance officers, government officials, and thousands of volunteer vaccinators of where the areas of highest risk where, and in turn where to distribute the vaccine (6, 7).

3. A major victory in the eradication was the targeting of marginalised and mobile communities within India.  For example, families in Uttar Pradesh were refusing the vaccine for their children, doubting its effectiveness and some suspecting rumours that the vaccine caused impotence (6).

4.  UNICEF set up social mobilisation networks to specifically target these social groups and dispel myths about the vaccine (6, 7).

5. Other public awareness methods, such as the famous Indian film star Amitabh Bachchan lending his image to the polio eradication efforts as a UNICEF Goodwill Ambassador certainly helped (8).

6. Over time, the concerted effort of international health organisations, the Indian government, the millions of dollars and vaccine doses donated to the effort, and uncountable numbers of volunteers have led to the zero cases of polio in India today

A superficial comparison with Mental Health program. 

Key strategy

Comparing status in NMHP

1. Collaboration

The WHO was instrumental in setting up NMHP in most developing countries. They also support salaries of some key persons in the ministry of health related to mental health, which now is required to be taken up by the ministry itself.

2. Generating data

No concerted effort has been make until recently. Some efforts both at national level  and also at our state level (Kerala) seems to present (though it appears things have not been well thought through)

3. Targeting

Little thought for targeting the vulnerable is present. There is no concerted plan for rehabilitation (may be Madhurai, DMHPs in northern kerala districts has done something on it). No plan for homeless mentally ill. Outreach services focuses only on pharmachotherapy of patients who can come to the periphery centre.

4. Social mobilisation

Nearly absent and not part of the written strategy of the program. NGO participation present in TN. In Kerala they work independently and provide long stay facilities for homeless mentally ill. Coverage of disability benefits very poor.

5. Concerted effort

No intersectoral coordination between dept of medical education, dept of health, Social welfare dept, education dept, NGOs, and the dominant private sector.

6. Public awareness

Some achievements in this sphere in terms of conducting programs through functional DMHPs.

7.. Volunteers

No plans yet for volunteer involvement.

My inference is that  targeting services for the most vulnerable of the mentally ill, and  social mobilisation are the key elements lacking. Some achievements has been made in conducting Public awareness programs though their impact needs to be accessed.
Reference:  1. Kobayashi, L. (2014). India is polio free. Public health perspectives. PLOS Blogs [web log]. Retrieved Jan, 2014,  from  http://blogs.plos.org/publichealth/2014/01/16/india-polio-free/
18.02.2014
On a similar note another post from the lancetblog on whether India will be able to repeat the success of polio for the HIV program. http://globalhealth.thelancet.com/2014/02/17/can-polio-free-india-lead-hiv-free-india