Mental Health in India

Transcription

1 Mental Health in India The work of Tata Trusts spanning three decades Tasneem Raja Lead Mental Health, Tata Trusts All photographs have been used with consent

2 Tata Trusts A brief introduction

3 3

4 Mental Health in India An Overview

5 The overall weighted prevalence for any mental morbidity was 13.7% lifetime and 10.6% current An estimated 150 million persons are in need of mental health interventions 5 National Mental Health Survey of India

6 Amongst the population that sought care, the median duration for seeking care from the time of the onset of symptoms varied from 2.5 months for depressive disorder to 12 months for epilepsy. In majority of the cases, a government facility was the commonest source of care. The median amount spent for care and treatment varied between disorders: alcohol use disorder: ` 2250; schizophrenia and other psychotic disorders: ` 1000; depressive disorder: 1500; neurosis; ` 1500; epilepsy: ` National Mental Health Survey of India

7 Spectrum of existing services What exists today! 43 mental hospitals- inequitably distributed Plethora of unregulated services by private sector Informal services Psychiatrists- Largely urban and private sector A handful of psycho social services- private or NGO based Government district mental health program- barely functional Untrained general physicians Informal care providers Community groups Pop- psychology Family 7

8 Our Work in Mental Health Tata Trusts work in mental health is spread over the country spanning several decades

9 Health Portfolio: Goal To create a Swasth Bharat : Ensuring the provision of Equitable, Affordable, High Quality and Sustainable Health Care, made Universally Accessible.

10 Tata Trusts- Spectrum of experience (Direct implementation & Partnerships) Community based care Care of homeless with MI Institutional reform Public Engagement Research & Development Preventive and promotive care Identification Systemic reform Awareness and attitude change Publications/ print media Curative care Care group interventions Anti-stigma interventions Tele-psychiatry Economic integration Illness management Rehab & reintegration into family Rehab & integration into community Long stay care Capacity building of staff Individual care packages Reintegration into community Government and public health system engagement Private service providers Religious bodies Law enforcement Process documentation Films Case studies Research publications in peer reviewed journals 10

11 Community based care An Overview

12 Creating community awareness through relevant modalities Photo, The ANT, Asam, Jan Man Swasthya Program 12

13 Integrating mental health services into primary Care FRCH Pune, Jan Man Swasthya Program 13

14 14 Tele-Psychiatry; care in the community Photo from SCARF

15 Technology with vibrant community engagement Connecting remote rural areas to services Identifying and initiating patients to care Linking them to public health care in the longterm 15

16 Community engagement in vulnerability mapping, service planning and delivery Staged process of linking psychiatric hospitals, general tertiary care psychiatric services to community outreach points Building community processes to sustain linkages 16 Jan Man Swasthya Program; In partnership with Parivartan, Ashadeep, ANT, RKHMS, FRCH, JCM

17 An example of a community engagement framework Categories/ Groups Domain Form of engagement Mode of engagement Frequency Output Outcome Capacity building input SMD Epilepsy Support groups Formation of support groups at partner sites Weekly meetings- to start with intense facilitation will be required A regular and well established group User network/ Peer leaders An understanding of how groups are formed, formation of networks and development of advocacy agenda Patient CMD Loosely formed groups Education, intervention sessions Once a week A group engagement Regular and systematic group engagement The various tools that can be used such as yoga, s tress management, movie discussion etc Especially SMD and epilepsy Development of peer workers/ leaders Individual/ specific group Regular engagement through a structured process Peers taking program responsibility Moving from being recipients of services to descision makers Structured curriculum for peer workers Jan Man Swasthya Program; In partnership with Parivartan, Ashadeep, ANT, RKHMS, FRCH, JCM 17 17

18 Interventions for highly vulnerable groups Homelessness

19 The journey of recovery from mental illness and homelessness requires multi faceted interventions Photo from The Banyan 19

20 The street clinics of Kolkata- Ishwar Sankalp Treating homeless people with illness on the street through a robust local community engagement program- linked to government and private providers for medication, acute illness management The next step is to link the work to the proposed reform of the psychiatric hospital in the city Photo credits@ jayati saha 20

21 Supported living in the community Photo, Ishwar Sankalp, Kolkatta 21

22 Peer support and camaraderie; the building blocks of recovery Home Again Program of The Banyan 22

23 Employment A range of options

24 A Homeless man with mental illnessreintegrated through employment at a street tea stall Ishwar Sankalp Kolkata 24

25 The INCENSE program Brought together a range of stakeholderspeople with SMD, caregivers, communities, business managers, production engineers and entrepreneurs 25

26 Employment & sheltered living for men, Ashadeep Assam 26

27 Restoring individuals and families to familiar occupations Fishing, The INCENSE program Tezpur in Assam 27

28 Restoring individuals and families to familiar occupations Weaving 28 The INCENSE program Tezpur in Assam

29 Employment opportunities for long stay clients in a psychiatric hospital The INCENSE program Pune 29

30 Institutional reform Behind closed doors

31 Institutional reform with a Government mandate 31

32 The Intervention design Structural Reform Hygiene & sanitation Land development for agriculture OPD structural change Recovery ward Transit ward Engagement Family ward Process Reform Automation OPD process optimization Acute care wards Day care center Legal aid cell Ward reform PWD process Peer % care giver SHGs Citizenship Employment Recovery plan Discharge planning & follow up Capacity Building Human rights & mental health SMD & recovery centric care Independent living skills Alternatives to restraint & isolation Technical skills Soft skills Pillars of reform The core reform committee The Ward Champions Master Trainers 32

33 Recovery centric care for the long stay cohort The INCENSE program- Pune 33

34 T h a n k Yo u