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INDIA

SUPPORT TO PEOPLE WITH

Project Activities / Outcomes

1. Development, in local languages, of a manual for family intervention.

2. Training of the local workers to both raise awareness about mental health problems and their appropriate identification, management and referral, and implement actual inte rventions. 3. Immediate care to some 1500 families, in terms of brief psychoeducational intervention sessions, whose content covers basic information about the diseases and basic training in daily living, problem-solving and skills, and of pharmacological trea tment to patients. The opening of day centres for people with mental disorders is a central aspect of this care model. 4. Contacts with relevant NGOs in order to get them mobilized and actively involved in the project, particularly for awareness-raising events and information dissemination about mental health problems and their manage ment. Particular attention is given to the establishment of creating /strengthening of existing NGOs of relatives and friends of people with mental disorders.

Background however, indications pointing to the fact that the outcome of this disorder is strongly influenced by social factors, of which the family appears to be a key Schizophrenia is a severe mental element. disorder which accounts for much suffering of those affected and their The state of mental health families, in addition to a cost to society estimated as 1.1% of the total burden of disease (in terms of DALYs – In India, for a population of nearly one disability adjusted life-years) and 2.8% billion people, there are an estimated of the total YLDs (years lived with four million people with schizophrenia, disability). with different degrees of impact on some 25 million family members. The ultimate goals of the treatment of people with schizophrenia is the India has a national mental health productive reintegration into programme, which was formulated in 1982 and adopted as the mental health mainstream society. There is enough th evidence that care of persons with policy. More recently, the 10 Five- schizophrenia can be provided at Year Plan of India for the Years 2002– community level through: 2007 emphasized some strategies for the National Mental Health (i) medications to relieve Programme as saying “…..and to shift symptoms and prevent relapse; the focus from the present custodial (ii) and model to a community-based approach psychosocial interventions to help with extension of basic mental health patients and families cope with the care through outreach facilities.” illness and its complications, and also The objectives of the national mental to prevent relapses; and health programme are: (iii) rehabilitation that helps i) to ensure availability and patients reintegrate the community and accessibility of minimum mental regain educational or occupational health care for all in the foreseeable functioning. future, particularly to the most The goals of psychosocial vulnerable and under-privileged rehabilitation for people with sections of the population; schizophrenia encompass a variety of ii) to encourage application of mental measures that go from improving health knowledge in general health and social support care and in social development; and networking, to . iii) to promote community Central to this is consumer participation in mental health service empowerment and the reduction of development and to stimulate efforts stigma and discrimination, through towards self help in the community. improvement of both public opinion and pertinent legislation. The respect The approaches adopted by the for human rights is a presiding programme are: principle to this strategy. i) integration of basic mental health The incidence of schizophrenia is care into general mental health care largely similar in developed and services; developing countries; there are, ii) training of primary health care problem of stigma against mental personnel in the aspects of mental disorders. health care; There is a total of 0.25 psychiatric beds iii) provision of adequate per 10,000 population and 0.4 neuropsychiatric drugs in peripheral psychiatrists per 100,000 population. health care institutions; Yet, there are no more than 40 iv) support and supervision of trained psychiatric hospitals, some 26,000 primary health care personnel; psychiatric beds in total and some v) establishment of a psychiatric unit at 4000 psychiatrists in the whole the district level; and country; in other words, approximately one psychiatrist per 1000 persons with vi) encouraging community schizophrenia. participation. This clearly indicates: The proportion of health budget to GDP is 5.2%. The country spends (a) the importance of developing 0.83% of the total health budget on innovative programmes to help these 1 people and their families in their daily mental health (WHO, 2001) . confrontation with schizophrenia, and

(b) that these programmes must be Mental health services strongly anchored in the community and also be strongly family-based and family-oriented. Mental health care is a part of the primary health care system. Mental With the financial support of health care in primary care is available Associazione Cittadinanzza and in certain designated project areas but Caritas, WHO has launched a project not all over the country. Community of support to people with care facilities for patients with mental schizophrenia with the ultimate goal of disorders are available in some emphasizing the empowerment of designated districts. In addition, families. various non-governmental organizations provide different types of services. The District Mental Health Programme which is being operated in 22 districts in the country attempts to take mental health care to the rural and underprivileged sections of the society. There are about 40 mental hospitals operating in India with a varying amount of bed strength. They still have a large proportion of long-stay patients. Funding is poor and staffing inadequate. All this adds to the Example of information leaflet in local language (hindi).

1 World Health Organization (2001). Atlas: Country profiles on mental health resources. Geneva, WHO.

Project description In order to do that, a manual for family intervention has been developed, translated into local languages and This project has two main lines of used to train health workers who see action: people with schizophrenia. (a) support for families, basically The training of those local health through interventions such as workers covered both awareness- psychoeducational programmes, and raising about mental health problems social and emotional support, and and their appropriate identification, (b) development / strengthening of management and referral techniques, associations of families affected by as well as the actual implementation of schizophrenia. those interventions. The strategic approach involves A variety of conscientization establishing mental health extension programmes and student mental health services in the community, particularly orientation programmes were initiated in some which never had this kind of to propagate the existence of mental services. It builds up on already health services available at their existing resources in the community, doorsteps besides making them like buildings and eventual conscious that there exist various types community health workers of Primary of mental health problems in varying Health Care Centres. severity in children and adults and that these can be managed with appropriate In practical terms, the Project initiates interventions if given at the onset of community-based and outreach mental the illness. health programmes in areas wherein these services have not yet reached or Training and orientation programmes are not accessible in terms of the costs are imparted to the village health involved in consulting mental health workers and teachers of the schools in professionals and the expenditure for the community, trainees, . Besides these, outreach students posted from both programmes give other benefits by undergraduate and postgraduate reducing stigma and spreading the colleges. They are given a detailed message that these illnesses can be orientation on psychosocial kept under control, if appropriate rehabilitation by the project’s teams. professional help is given in time. These efforts of treating the mentally ill within the society makes the The teams visit the villages and slum reintegration of such persons back to areas near Delhi, especially local the mainstream of society easier, since schools, grocery shops, local they are not separated from the society physicians and the clinics run by them, at any given time of the treatment. The STD booths and distribute leaflets on modern concept of Community-Based mental illness. In addition, they request Rehabilitation is the order of the day in the shop owners and the school the treatment of the mentally ill. Given authorities to distribute the copies of the support of adequate resources, these to the children at schools and the appropriate NGOs can augment these public who visit the shops. They services in the existing clinics and advise them to refer or send people further initiate such clinics in several who suffer from any of the mentioned new places. problems to the newly opened clinics for free treatment and counselling. These efforts have started showing dedicated staff who make regular gradual results, as there is an increase periodic visits to the identified centres. in the number of clients attending these After the initial screening by members new clinics. of the Team, a psychiatrist further reviews the patient in detail to confirm Those who require further in-patient the diagnosis before further care or any other general medical care professional assistance is given along are referred to the nearest General with free medication. The patients are Hospital Psychiatric Unit of reviewed periodically and kept on a Government Hospital . This co- maintenance dosage. Those who ordination helps the actively require inpatient care are referred to symptomatic clients obtain the in- the nearby General Hospital patient care until they stabilize Psychiatric Units (GHPUs) and once medically and later can be followed up discharged from the GHPUs the team in the community by the local mental follows them up in the community and health team. Those with problems of continues to provide counselling and co-morbid and medication free of cost. alcoholism are referred to de-addiction centres for detoxification. Contacts are also established and maintained with relevant NGOs in So far, approximately 1500 families order to get them mobilized and have benefited from these activities, in actively involved in the project, terms of brief psychoeducational particularly for awareness-raising intervention sessions. The scope of events and information dissemination these interventions covers basic about mental health problems and their information about the diseases and management. basic training in daily living, problem- solving and communication skills, and A particular attention is given to the pharmacological treatment to patients. establishment of new /strengthening of existing NGOs of relatives and friends To all of those in need, appropriate of people with mental disorders. psychiatric and other medication is provided free of charge, as is the case Regular family support groups are with all other interventions. organized with family members/carers of people suffering from mental health Hand in hand with the care model is problems with the purpose to psycho- the opening of day centres for people educate and to strengthen the services with mental disorders, with active offered by this society for the needy. outreach programmes both in rural Family therapy sessions are being areas in South India and in different taken for the patients’ families, slum areas. especially wherever family pathology The project’s teams are in a position to exists, as usual. bring about a substantial change in people’s attitude by way of multiple activities aimed at conscientization about the mental illness and the treatment available. This has resulted in gradual attraction of the clients with mental health problems towards the clinics running in different suburban and rural areas in both Central and South India. The team consists of a