Rationale of the Course
Mental health is an integral and essential component of health. The World Health Organization (WHO) constitution states: “Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity.” WHO defines mental health as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to her or his community.
Mental health problems are also one of the most important contributors to the global burden of disease and disability. The Global Burden of Disease world over due to mental health concerns is greater than that expected by tuberculosis, cancer or heart disease. In the year 2000, mental and neurological conditions accounted for 12.3% of disability-adjusted years lost globally and 31% of all years lived with disability at all ages and in both sexes. Of the top 10 health conditions contributing to disability adjusted life years, four are mental disorders. Mental and behavioral disorders affect more than 25% of people at any given point of time. Over 450 million people worldwide are affected by mental, neurological or behavioral problems at any given point of time. In India, about 20 to 30 million people appear to be in need of mental health care. A meta-analysis of 13 epidemiological studies concluded that the prevalence estimate of mental health problems is 58.2 per 1,000 populations. The study indicated that mental disorders were higher in urban areas, among women, in the age group of 35–44 years and in the lower socio-economic strata. The study concluded that in India nearly 1.5 million people suffer from severe mental disorders and 5.7 million suffer from various psychiatric disorders requiring immediate attention. Mental and neurological disorders include schizophrenia, substance abuse, epilepsy, or other disorders affecting the nervous system. Over 8, 00, 000 people commit suicide every year, due to mental disorders.
“The Mental Health Atlas 2011” released by the WHO has cautioned the globe that low-income countries only have 0.05 psychiatrists and 0.42 nurses per 1,00,000 people, compared to 170 times more psychiatrists in high-income countries (80,000+ psychiatrists for 840 million people in Europe) and 70 times more nurses. In India, we have only 3,500+ psychiatrists, 1,000+ psychiatric social workers, 1,000+ clinical psychologists and 900+ psychiatric nurses. The WHO atlas also points to the uneven distribution of the investments in mental health: majority of low- and middle-income countries allocate less than 2% of their health budget to mental health. Moreover, 80% of the mental health budget in developing countries is spent on mental hospitals that serve only 7% of patients. The National Mental Health Programme (NMHP) of India was launched in 1982 to provide minimum mental health care to maximum through integration of mental health services within the existing health care system. In 2001, the NMHP was re-launched as part of the Tenth Five-Year Plan (2002–2007) and the budgetary allocation was increased more than seven-fold.
Mental health is determined by socioeconomic, biological and environmental factors. Cost-effective public health and inter sectoral strategies and interventions exist to promote, protect and restore mental health. Mental health and well-being are fundamental to our collective and individual ability as humans to think, emote, interact with each other, earn a living and enjoy life. On this basis, the promotion, protection and restoration of mental health can be regarded as a vital concern of individuals, communities and societies throughout the world. Multiple social, psychological, and biological factors determine the level of mental health of a person at any point of time. For example, persistent socio-economic pressures are recognized risks to mental health for individuals and communities. The clearest evidence is associated with indicators of poverty, including low levels of education. Poor mental health is also associated with rapid social change, stressful work conditions, gender discrimination, social exclusion, unhealthy lifestyle, risks of violence, physical ill-health and human rights violations. There are also specific psychological and personality factors that make people vulnerable to mental disorders. Lastly, there are some biological causes of mental disorders including genetic factors which contribute to imbalances in chemicals in the brain.
Mental health promotion involves actions to create living conditions and environments that support mental health and allow people to adopt and maintain healthy lifestyles. These include a range of actions to increase the chances of more people experiencing better mental health. A climate that respects and protects basic civil, political, socio-economic and cultural rights is fundamental to mental health promotion. Without the security and freedom provided by these rights, it is very difficult to maintain a high level of mental health. Promoting mental health depends largely on inter sectoral strategies. WHO says that specific ways to promote mental health include the following:
- Interventions during early childhood (e.g. home visits for pregnant women, pre-school psycho-social activities, combined nutritional and psycho-social help for disadvantaged)
- Support to children (e.g. skill building, child and adolescent development)
- Socio-economic Empowerment of women (e.g. improving access to education and micro-credit schemes)
- Social support for elders (e.g. befriending initiatives, community and day centres)
- Programmes targeted at vulnerable groups, including minorities, indigenous people, migrants and people affected by conflicts and disasters (e.g. psycho-social interventions after disasters)
- Mental health promotional activities in schools (e.g. supporting ecological changes in schools and child-friendly schools)
- Mental health interventions at work (e.g. stress prevention)
- Housing policies (e.g. housing improvement)
- Violence prevention programmes (e.g. reducing availability of alcohol and access to arms)
- Community development programmes (e.g. integrated rural development)
- Poverty reduction and social protection for the poor
- Anti-discrimination laws and campaigns
- Promotion of the rights, opportunities and care of individuals with mental disorders
Interventions for people with mental illness have showed efficacy, cost-effective, feasible, and affordability. They include:
- treatment of epilepsy with anti epileptic drugs;
- treatment of depression with (generically produced) antidepressant drugs and brief psychotherapy;
- Treatment of psychosis with older anti psychotic drugs plus psycho-social support;
- Taxation of alcoholic beverages and restriction of their availability and marketing.
A range of effective measures also exists for the prevention of suicide, prevention and treatment of mental disorders in children, prevention and treatment of dementia, and treatment of substance-use disorders. The Mental Health Gap Action Programme (mhGAP) has produced evidence based guidelines for non-specialists to enable them in identification and management of mental health priority conditions.
Community mental health is a decentralized pattern of mental health, mental health care, or other services for people with mental illnesses. Community-based care is designed to supplement and decrease the need for more costly inpatient mental health care delivered in hospitals. Community mental health care may be more accessible and responsive to local needs because it is based in a variety of community settings rather than aggregating and isolating patients and patient care in central hospitals. It also follows a strategy of community development that furthers the mental health of all community members through promotion of mental health and prevention of mental disorders. These services provide accessible, affordable, acceptable and quality mental health care in the community for people with psycho social disabilities aiming at their social integration. Community Mental Healthcare is implemented with the active participation of service users, their families and communities together with health, education, social and employment services. It is aimed to improve the quality of life of people with psycho social disabilities through early identification of disorders, access to affordable treatment, improvement of social integration and livelihood security, to reduce the incidence of preventable mental and neurological disorders and their causes, to empower people with psycho social disabilities, facilitate their participation in the development of their communities and emphasize the role of positive mental health for community development.
Community health workers, as per WHO, should be members of the communities where they work, should be selected by the communities, should be answerable to the communities for their activities, should be supported by the health system but not necessarily a part of its organization, and have shorter training than professional workers. Similar to non-communicable diseases, most mental health disorders can be treated or prevented if addressed at the primary care or community level, avoiding higher health-care costs and increased risk of disability and mortality. The role of general practitioners, nurses and community health workers in addressing mental health is pivotal, as is the specific training they require. Both the number of health workers as well as in-service education are to be substantially scaled-up to alleviate the burden of these conditions. In this context, the Diploma in Community Mental Healthcare in a rural environment finds its significance and relevance.
Aim of the Course
- To contribute meaningfully towards people’s wellbeing and wellness, the course will address the growing and complex needs of Community level mental healthcare through a development of trained and certified human resources.
Key Concepts in Community Mental Healthcare
- Championing mental health within a wellness paradigm in the community
- Networking with key community stakeholders, including the local governance institutions, in order to facilitate appropriate welfare measures and engage in relevant advocacy for inclusion in local implementation of mental health related policies and schemes
- Formulating social interventions for alleviation of allied or contributory or precipitating factors of distress so that mental health of people is protected.
- Identification of people with issues in mental health, facilitate pathways to clinical and social care and follow up on progress
- Ability to offer support and guidance services for individuals and groups.
- Improvement in the quality of life towards restoration of mental health among people recovering or recovered from mental illnesses.
- Ability to reflect upon action, formulate new learning and innovate for the context within the community
- Grounded in user focused participatory practice driven by values of democracy, equity and justice
Training of Trainers
In the addition to the above, we deliver the course with partners in order to provide capacity building, sharing our course, and the models of care from The Banyan.