Mental Health Services

Mental Health Services

The attitude towards mental illness and the treatment of mentally ill have undergone considerable changes through the years. Mentally ill were often beaten, starved, burned and tortured in order to make the body unsuitable place for demons. Gradually man began the quest for scientific knowledge and truth.

The methods of treating mental illness have changed dramatically in the past century. The organization of mental health services demands a wide variety of interventions, regarding from public awareness, early identification, treatment for illness, family education, long term care, rehabilitation, and ensure human rights of the ill persons. Mental health services are delivered through mental hospitals at central, state and district levels.

Community

Community is a group of people with common value, belief, attitude, characteristics, location and interest.

Importance of Community Mental Health

·  It will promote mental health of families

·  It will help the family members to know the social, cultural and situational aspect of care

·  It will educate the family members regarding identification of stressor and coping mechanisms to deal problems.

·  To remove stigma from community people

·  To remove the misconception about mental illness

1.  Mental Health Services available in the Community

Partial Hospitalization

Partial hospitalization is an innovative alternative to hospitalizations. Individuals can attend structured programmes throughout the day and return to home in the evenings. The advantage or partial hospitalization is of lesser separation from families.

Group Homes

These homes may belong to a hospital or rented by 15 to 20 mentally ill recovering patients.

Foster Homes

It is a home in which a patient recovering from a mental disorder is placed in a voluntary family by a social agency for family care is paid by the agency. Patient gets home like environment.

Sheltered Workshop

It is a work oriented rehabilitation facilities with a controlled working environment to fulfill individuals vocational goals.

Quarter Way Homes

This is the place usually located within the hospital campus itself, but not having regular services of a hospital. There may not be a routine rounds, nurses, and most of the activities carried out by patients themselves.

Half Way Home:

A half way home is a transitory residential centre for mentally ill patient who no longer need the full services of a hospital.

Objective: to ensure a smooth transition from hospital to the family

·  YWCA half way home for mentally ill in Chennai

·  Dr. BOAZ’S rehabilitation centre in Chennai

·  Delhi psychosocial rehabilitation society

Day Care Services:

Patients discharged from the hospital and who are residents, services in the form of day care program in the occupational therapy and rehabilitation centre. It helps them to undergo different vocational training programs and thus helps them in their future job-placement.

The following arethe variousvocational training provided

·  printing and book binding

·  tailoring and readymade garments ,

·  handloom carpentry

·  Candle unit, bamboo baskets sericulture,

·  pottery, bakers craft work

·  gardening , mat-weaving

·  Leather work etc.

Day Care Services In India

·  NIMHANS in Bengaluru

·  SCARF in Chennai

·  SANJIVINI in new Delhi

Self Help Groups

Self-help groups or mutual help are voluntary associations of people who share a common desire to overcome mental illness composed of people who are trying to cope with a specific problem. The group helps the members to become socialize. Ex. AA (Alcohol Anonymous)

Suicide Prevention Centers

The incidence of committed suicide are increasing day by day. These suicide prevention centres help in decreasing the incidence of suicide. Some of them are:

·  SNEHA in Chennai

·  SAHARA IN Mumbai

·  SANJIVINI AND SUMAITRI IN New Delhi

Mental Health Services at Various Levels in India

2.  National Mental Health Programme

To create more awareness on mental health among rural people, National mental health programme was started in 1982.

Slogan of National Mental Health Programme: Reaching The Unreached

Aims of National Mental Health Programme

Prevention and treatment of mental and Neurological disorders and associated disabilities

·  Use of Mental Health technologies to improve general health services

·  Application of mental health principles in total national development to improve quality of life

Objectives of National Mental Health Programme

Funtions of NMHP

Mental Hospitals

·  Very chronic and disturbed patient who cannot be looked after in the community, to be certified and admitted in mental hospitals.

Medical Colleges

·  Will take the responsibility of training of general practioners and the medical offices in the primary health centres. They will function as research centres.

District and Taluk Hospitals

·  Will have the department of psychiatry and psychiatrist.

·  They will supervise the medical officers and general practioners in the PHC

Community health workers attached to PHC will identify the patients who suffer from psychiatric disorders and refereeing the patient to the PHC for treatment

Components of NMHP

3. District Mental Health Program (DMHP)

The District Mental Health Program (DMHP) was launched under National Mental Health Program in the year 1996. Presently the District Mental Health Program (DMHP) is being implemented in 123 districts.

THE MAIN OBJECTIVE IS: To provide community mental health services and mental health services with general health services through decentralization of treatment based on primary health care services.

Components of District Mental Health Program (DMHP)

·  Training programs for all health workers in mental health team

·  Public education to increase awareness

·  Outpatient services and indoor services for early identification and treatment

·  Providing valuable data to state for planning, implementing and research.

4. Prevention of Mental Illness

The concept of mental health has got great response in dealing with clients of mental disorders. Community health movement has been considered as revolution in the field of psychiatry. Caplan discussed 3 levels of prevention in “public health model” in includes:

·  Primary prevention

·  Secondary prevention and

·  Tertiary prevention

Primary Prevention

Secondary Prevention

Secondary prevention aims at lowering the intensity and severity of the illness, early diagnosis and early prompt treatment

Tertiary Prevention

Tertiary prevention aims at lowering the disability and relapse, increasing self-esteem and rehabilitation

Specific Problems in Mental Hospitals

·  Escape from mental hospital

·  Death

·  Pregnancy

·  Unknown patient

·  Mentally ill offender (mentally ill criminals)

Human Rights of Mentally Ill

Psychiatry patients currently have the following rights;

·  Right to communicate with people outside the hospital through, telephone, and personal visits.

·  Right to keep clothing and personal effects with them in the hospitals.

·  Right to religious freedom

·  Right to be employed if possible.

·  Right to manage and dispose of property

·  Right to execute wills.

·  Right to make purchases

·  Right to education.

·  Right to independent psychiatric examination.

·  Right to privacy

·  Right to informed consent/Right to treatment.

·  Right to refuse treatment.

Some important milestones in Psychiatry

·  1773 – First mental hospital in Williamsburg, Virginia, US.

·  1783 – Benjamin Rush wrote first textbook on psychiatry

·  1793 – Philippe Pinel removed the chains from mentally ill was the first revolution in Psychiatry

·  1882 – First psychiatric nurse MS Linda Richards from U.S

·  1908 – Clifford Beers an ex patient of a mental hospital wrote the book. “A mind that found itself “based on his bitter experiences in the hospital,

·  1912 – Eugen Bleuler, a Swiss psychiatrist coined the term “schizophrenia”.

·  1912 – Indian Lunacy Act was passed

·  1920 – The term Lunatic Asylum was changed to “Mental Hospital “

·  1927 – Insulin shock treatment was introduced for schizophrenia

·  1938 – Electro Convulsive therapy was introduced for treatment of psychosis

·  1947 – Indian psychiatric society was formed

·  1949 – Lithium therapy was introduced for treatment of mania

·  1952 – Chlorpromazine was introduced – revolution in psychopharmacology

·  1963 – Community health centres act was passed

·  1987 – The Indian Mental Health act was passed.