According to the World health organisation (WHO), health refers to physical, social, spiritual as well as mental health and not only the simple absence of disease or infirmity (Murthy, 2014). There have been evident problems of mental health and behavioural health problems which has formed an integral part of the world wide health problems. There is an enormous burden of illness in terms of psychiatric and behavioural disorders. According to the reports given by WHO, there is a probable chance of the overall DALYs burden for neuropsychiatric disorders to be projected to elevate to 15% by the end of the year 2020 (Srivastava, Chatterjee & Bhat, 2016). While the focus is shifted to India, it can be seen that the services and resources available for addressing properly the mental and behavioural disorders, there is a lack of the available resources and which are even disproportionately low when compared to the burden of illness that is prevalent in India. However with the changing model of healthcare in India, the council of health of India that started the strategies for research in mental health (Mendenhall et al., 2014).
India in recent times has been thriving to provide importance to the health of people and asp to highlight the need for a physically and mentally healthy society. Mental health research in India has undertaken both clinical and population based settings, however often there are differences in the priorities which are believed to be complementary to each other (Barry et al., 2013). When viewed from a public health perspective, the pattern that is prevalent in terms of mental illness along with its determinants and characteristics is examined. In addition to this, care related issues such as the aspects of service delivery along with system issues have also been assessed. Some of the recent studies have shown that there have been emergence of new problems related to mental illness because of the common problems like alcohol and drug abuse, depression, suicidal behaviours and several others (Shidhaye & Kermode, 2013). Therefore there is a need to achieve high standards in terms of the quality of care in addition to the elevated outcomes which are based on the principles of care that is universal as well as equity which is quite essential so that there is strengthening of the health systems and this is made responsive for changing health priorities as well as the concerns.
The mental disorders are responsible for providing a significant load of morbidity and disability and often there is increasing mortality due to this. According to the Global Burden of Disease report, it has been seen that the mental disorders accounts for 13% of total DALYs lost for Years Lived with Disability (YLD) (Fazel et al., 2014). In the Indian context, approximately a 100 million persons in India immediately require systematic care which needs to be based on the obtained however they are a few decades old and is also has serious limitations in the methodological. There is a need of preparedness in addition to responsiveness along with the health systems capacity in order to address these probable challenges which have not been understood well even till date (Semrau et al., 2015). Although the reviews done previously in addition to the evaluations have been addressed in an independent way along with its components. Therefore combining all these issues together have contributed to the slowed the growth of mental health services, in addition to the limitation of the expansion of the services in ways that are both quantitative and qualitative in nature.
Goal: The goal of this project is to determine and evaluate the prevalence of severe mental morbidity in Indian along with the development of the strategies for the development of awareness programs for mental health in India.
The specific objectives of the study will include:
The target group for this study are the population in and around the health care centres of the selected states of Bangalore, Punjab, Kolkata and Baroda that have been identified near the primary health care centres. The main focus will be on the rural population which will constitute the major target group. The indicator for this target population will be people suffering from the severe mental disorder such as psychosis; bipolar affective disorder; moderate severe depression and mainly who are using the available services from the health facilities (Patel et al., 2013).
The project activities will be involving the provision of comprehensive, integrated and responsive mental health and social care services in community-based settings, the strategy implementation for promotion and prevention in mental health, and finally strengthening of the information systems, evidence and research for mental health.
An essential part of the study will be the intervention that will carried out by the primary health care personnel accompanied by their training in order to identify and manage of severe mental illness and epilepsy. In addition to this, there will be an evaluation of the carried out intervention through the implementation of a final field survey. The study areas that will be selected will be identified keeping in mind that all of the centres will be around then primary health centres, which would cover approximately 40,000 population at each of the centre (Murthy, 2017). After the selection of the centres will be done, there will be a conduction of the in-service training related to mental illness for the health workers and primary health care doctors, however their routines tasks and activities will not be disturbed.
There will be development of training programs along with the establishment of separate manuals for the instructions regarding handling of the mental health issues which will be provided to the mental health workers and the PHC doctors. Additionally the program will also take into consideration the multipurpose workers. The training involving the PHC doctors will include 15 sessions which will include 2 hours in each session. There would be some kind of flexibility permitted in order to suit the local situation. It will be taken into consideration that the training for the health worker was carried out in the local vernacular language. There were another 11 sessions consisting of two hours and in each there would be lectures along with discussions. There would also be examples of the cases along with original demonstration of cases. The demonstration of the pre and post training assessments that will lead to the knowledge gain of the doctors and health workers at all the four centres will be satisfactory (Patel et al., 2015).
The primary instruments that will be included in the study were Indian Psychiatric Survey Schedule (IPSS) for measuring psychiatric morbidity and the Katz’s Social Adjustment Scale (KAS Behaviour Inventories) for the measurement of the social dysfunctioning in relation to the IPSS. There is a need to modify the instrument according to the Indian setting. A 15-item questionnaire of short lenght will be developed in order to assess attitudes towards mental illness and epilepsy. A short screening proforma will also be developed (Kyu et al., 2016).
During the end of intervention phase, there will be a conduction of a field survey which will be carried out by the research team. This will be done at all the 4 centres which were identified in order to estimate the magnitude of severe mental morbidity prevalence. The survey that will be conducted will be a two-stage survey. At the beginning of the initial stage, the trained research investigators will be involved in administration of a simple 15 questions screening proforma. This will be provided to one adult member of every household in the study. This will be carried out after the collection of certain basic socio-demographic information regarding the concerned household (Thomas et al., 2015). This so called ‘symptom in others’ questionnaire will be responsible for asking them if they happen to know anybody who is suffering or was suffering from one or more of the 15 symptoms that is mentioned either in their families or in their villages. While the conduction of the second stage, there is a conduction of all such nomination of the probable cases which will be assessed in detail using the IPSS. This is based on the symptoms that is recorded by the IPSS, where the patients will be diagnosed (Shidhaye, Gangale & Patel, 2016). The ‘symptoms in others questionnaire’ is basically an important instrument which will be involved in detecting the severe mental morbidity, which are the different forms of psychoses and epilepsy that is the focus of this study.
With the available background on the topic, a study was undertaken to examine the state of mental health services in India in reference to the perspective of public health. This considers the aspects of promotion and prevention of the mental health along with the social and cultural factors related to the services of mental health. As mentioned earlier the primary objective of the study is to review the mental health services in India in addition to analysing the implementation of programs which will try to follow the National Mental Health Programme (NMHP), keeping the national and target area context (Vellakkal et al., 2013).
The study mainly focused on the various secondary sources like the government reports along with the policy papers which are related to mental health and is published by the Ministry of Health and Family Welfare and also the Directorate General of Health Services including the reports from the Planning Commission in addition to the books and the articles that were published in the various Journals. This will be taken into consideration for the literature review so that there is clarity of concepts related to the subjects of mental health. The study will involve collection of both primary and secondary sources which will be used to gather information regarding the services that are rendered. In the initial stages, the information will be gathered from the various studies and the research articles obtained from various sources. The information will also be collected from the field through the administration of interviews and some case studies. This will include the informal interviews with the local people along with the patients and their family members, and service providers like the doctor and social worker (Goel, Subramanyam & Kamath, 2013).
Sampling will be carried out in the rural regions especially in the areas which are near the primary health care facilities. This involves including the states, out of which certain districts were selected. From these districts, some talukas were selected and from this some clusters were selected. Out of these clusters, the households which were nearer to the primary health facilities were selected and then the individuals who were required to be diagnosed. The section procedure is shown as below:
Districts
Talukas
Clusters
Households
Individuals
In order to collect information for the study, the schedule of the structured and the unstructured interview and the techniques of observation were mainly. Apart from this, there will also be collection of secondary data from the various sources in addition to which there will be some cases where there will be conduction of informal unstructured interview which will also be carried out. The conduction of the informal interviews will be done with the patients and also their family members when they will be waiting for their turn at the psychiatric OPD regarding the services and also the facilities that are available and also about their perception of mental health and the need for services. For the purpose of interviewing the service providers it is required for the doctor and social worker to also be interviewed using the same method as mentioned previously.
The data collection schema
The above methodology was chosen for this study in order to assess the prevalence of mental illness in India in an unbiased manner. With the conduction of the interviews, the primary data was obtained for the study.
The prevalence of the severe mental morbidity will be tabulated as the following:
|
Diagnoses |
Bangalore |
Baroda |
Kolkata |
Punjab |
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|
No of cases |
Rate/1000 |
No of cases |
Rate/1000 |
No of cases |
Rate/1000 |
No of cases |
Rate/1000 |
|
Epilepsy |
|||||||
|
Organic brain syndrome |
|||||||
|
Schizophrenia |
|||||||
|
Mania |
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|
Depressive Psychosis |
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|
Total no of cases and the prevalence rate/1000 |
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|
Population studied |
|
Bangalore |
Baroda |
Kolkata |
Punjab |
Total |
|
|
Population studied |
|||||
|
Total number of patients with severe mental morbidity |
|||||
|
Rates per 1000 population |
|||||
|
No of patients identified and managed by then PHC team during the intervention phase |
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|
Percentage of patients managed by the PHC team |
The primary health care staff will be responsible for the identification and the management of the severely mentally ill individuals and also who are epileptic in their respective catchment areas along with the maintenance of simple case records. Most of the patients will be detected and will be managed by the PHC team and in addition to which they will also be assessed by the research staff.
There will also be a conduction of an altitude survey, which will be conducted before and after the intervention phase that will be able to show that at all the 4 centres where there were overall changes in the attitudes directed in positive direction. After obtaining the overall satisfactory results along with the item wise analysis there is seen to be some crucial items including then sustainability of the local health centre (Srivastava, Chatterjee & Bhat, 2016).
The cost evaluation of the overall study as approximated will include the estimated cost for the training purpose that will be including the case finding and case holding by PHC personnel, along with the cost of monitoring and cost of the final survey. This will also be including the cost of records, along with the drugs, training material and other such incidental expenses. There will also be some expenses on the research staff and cost of travel were the main costs which are required to be taken in to consideration. However in the cost estimation, the usages of the PHC personnel will not be taken into consideration as they are already in employment. The estimated total cost of the program responsible for interventions and training along with the monitoring in addition to the final survey is approximately to be about 1,914.95 Australian Dollar that is one lack of Indian currency which is applicable at each of the centre. The study was carried out in the form of a research project therefore, a major portion of the total costs will be needed to be constituted by the salaries for the research staff. In case of the large-scale replication of the intervention programme along with the costs will be likely to be less.
The existing health care system can be associated with a number of drawbacks and lacunas. The major lacuna identified would comprise of inefficient healthcare infrastructure across various health care organizations (Andrade et al., 2014). Also, societal stigma can be accounted as a major reason which significantly serves as a barrier that reduces the accessibility to health care facilities among common people (Becker & Kleinman, 2013). Mental health is perceived as a ‘curse’ within the society and is often associated with a number of superstitions (WHO, 2014). Mental health patients are often secluded and there is a major lack of education and awareness about the seriousness of mental illness among the people (Murthy, 2014), (Patel et al., 2013). Therefore, it is extremely important to adapt measures and strengthen the health care system by introducing reforms that would help in improving the access to health care facilities among the entire population base.
As has been discussed above, the research study would underpin conducting one-on-one semi-structured interview with health care professionals. This would be done in order to estimate the average number of mental health patients that seek treatment intervention. The study would also help in critically evaluating the factors that serve as major societal barriers that restrict the reporting of the mental health cases. Also, through the interview responses, the findings of the research study would help in adapting measures to strengthen the existing policies and take up intensive awareness campaigns in order to popularise the concept of mental health wellness among the entire population set.
Conclusion
Hence, to conclude it can be said that mental health wellness is perceived as a stigma in most of the developing nations. There are innumerable instances where patients are unable to seek treatment opportunities. The primary reason for the same has been identified as the inaccessibility to health care facilities or the victimization due to societal stigma and other associated superstitions. Further, it should also be mentioned here that the prevalence rate of mental health patients is gradually increasing with every passing day. In context of the emerging seriousness, it can be said that there is an immediate need to introduce reforms in the healthcare system so as to provide quality services that would yield positive patient outcomes. It can be commented here that in order to take steps as to ensure reforms it is pivotal to identify the existing gaps and lacunas within the healthcare system and accordingly initiate reforms. For the successful identification of the gaps within the health care policies the research study would conduct a thorough investigation.
This would be done by conducting a semi-structured interview with the health care professionals so as to develop an idea about the existing barriers that facilitate lack of access to health care opportunities. Also, in order to develop a clear understanding about the existing health care policies and evaluate the gap, a thorough and intensive literature review was conducted to get a clear idea about the effectiveness of the policies in the context of healthcare. It can be thus be expected that conducting awareness campaigns about the seriousness of mental health issues can help in making people aware about the merging seriousness of the issue. Further, incorporating the fundamentals of maintaining mental health as a part of the academic curriculum in schools can also help in spreading awareness with respect to mental health.
References
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