Oct 12, 2015
Madhya Pradesh has taken a step ahead to prioritise mental health as a public health issue, write Shalini Ahuja and Rahul Shidhaye.
New Delhi: We know what to deliver to people with mental health conditions as there is ample “evidence” pointing towards effectiveness of drugs and psychosocial interventions in reducing the misery associated with these conditions.
Sad as it may sound, the irony is that very few of the individuals with mental health conditions receive treatment. Be it stigma within individuals and professionals, inadequacy in the number of psychiatrists, public health researchers, psychologists, nurses, social health workers or incapacity of the system to understand the needs of the community, the fact remains that the ones who need care the most don’t receive it.
Mental health conditions are classified into common mental illnesses (such as depression and anxiety), severe mental illnesses (such as schizophrenia and bipolar disorder), substance use disorders (such as alcohol use disorder) and childhood mental health disorders. Incidence and gravity of mental health conditions is on a rise in India. In 2010 within mental health conditions almost two third (64%) of the disease burden was contributed by depressive disorders and substance abuse disorders.
What is the central government doing to combat this issue?
The draft Mental Health Care Bill which preserves mental health as a right is tabled in the parliament and is awaited to be passed. India also has a National Mental Health Programme running since 1982. This programme decentralizes treatment from specialized mental hospital based care to primary health care. Despite having a NMHP India has never had a mental health policy unlike other countries such as Nepal, Nigeria, Uganda and South Africa.
The Minister of Health and Family Welfare, Government of India in October 2014 launched India’s first ever mental health policy. This policy shows a vision to work on elements such as advocacy, promotion, prevention, treatment and rehabilitation of people suffering from mental illnesses. Integrating mental health with general services, protecting rights of a person with mental illness, putting priority to safety and quality of treatment are all addressed in the policy which is also in line with the core values accepted internationally.
What are the new initiatives in Madhya Pradesh?
Madhya Pradesh has taken a step ahead to prioritise mental health as a public health issue. Department of Health Services, Government of Madhya Pradesh, in association with PRIME and EMERALD projects (Public Health Foundation of India-Sangath Collaboration) conducted workshops in early this year to develop a consensus and come up with a Mental Health Action Plan 365.
This mental health plan 365 outlines the specific actions, concerned departments, timeframes and support required to achieve the goals and objectives set out in the national mental health policy. Representatives from the state government, local bodies, civil society, service users, care givers of individuals with mental health conditions, health care providers, medical colleges, academic and research institutions, schools and colleges, private sector and media were involved in developing this plan for the state. Wide range of issues varying the from status of school mental health programme, mental health service provision in government hospitals to rights of people living in shelter homes were discussed during the course of planning.
The plan goes beyond implementing the district mental health programme, it envisages provision of procurement of antipsychotics within the essential drug list of community and primary health centres, ensuring dissemination of training material to all the health providers providing mental health care in the state, ensures data flow on mental health conditions within the routine information systems and coming up with innovative ways in generating awareness within community and health workforce.
The action plan for the state also addresses the needs of vulnerable people living with mental illnesses. Sensitizing police and the judicial system, providing mental health services in homeless shelters and in prisons are few of the initiatives indicated in the plan. The growing suicide burden is planned to be addressed by initiating discussion on a suicide prevention programme, life skills programme and a mental health helpline. While the plan is getting approved by the state, capacity building initiatives of training medical officers on mental health have begun.
It is mooted that interplay within departments working for mental health at higher levels and convergence amongst departments at the community level shall help in putting the plan into action.
To enhance coverage and improve the quality of mental health services, mental health action plan 365 for Madhya Pradesh offers a robust policy framework. It is likely that the MP model for implementing mental health integrating with general health service shall also be adapted by other states in the near future.
Rahul Shidhaye works as a Research Scientist with Public Health Foundation of India. Shalini Ahuja is a Research Fellow, Public Health Foundation of India.