Across the Borders A comparative study of Mental Health Care in Saint John, and in DehraDun. Contents 1. Introduction 1 Part One 2. Health Care Canada 4 3. The current Mental Health Care ‘System’ in New Brunswick 5 4. Mental Health Saint John 8 5. Historical development/foundations of Mental Health Care in Saint John 16 6. Centracare 17 7. Centracare changes its form 24 8. The history of the Mental Health Department Saint John 29 9. Current situation of Mental Health Care in Saint John 30 Part Two 10. Mental Health Care in DehraDun 34 11. The Official Position 34 12. Non-Governmental Health Care 37 13. Raphael: Ryder Cheshire International Centre 38 14. Karuna Vihar 48 15. Psychiatrists and General Physicians 54 16. Alternative Mental Health Approaches 57 17. The Ayurvedic System 60 18. An Analysis 62 19. In Conclusion 64 Page 1 Madness, insanity, mental disability, mental divergence, irrationality, possessions, cuckoo, nuts, mentally disturbed, lost, mystics, extremely godly, wizards, witches, ‘pagal’ are the phrases that different localities in the world have used to provide dissimilar names for similar phenomenon. These names, vastly divergent in their conceived meanings, are based upon the cultural and historical beliefs that dominate the mindset of the people living in the areas. Even within a particular social order people prescribe to divergent belief systems. This divergence within a society is also found to exist within the field of mental health. Due to these various, and conflicting belief systems, a mental condition of a particular individual can be looked upon in many different ways. Under the conditions where mental anomalies are viewed in a very heterogeneous manner, the predominant condition that is diagnosed often has more to do with the dominant belief system existent within the particular society of the time rather then the accuracy of the prognosis. This essay looks at the Mental Health Care being provided within two social milieus: Saint John in Canada, and DehraDun in India. My attempt is to ascertain the similarities and differences that exist within these two cities regarding the area of mental health. My original intention in choosing these areas was because of the obvious difference in the manner in which health care is practiced within the two localities. My research was based upon looking linearly at the Mental Health Care delivery model of Saint John as an integrative approach whereas the model in DehraDun corresponded more to an institutional approach. However as I progressed through this research I discovered my original assumptions to be highly simplistic and thus limiting. One could postulate that the mental health care practices prevalent in Saint John are more directed towards the integrated approach to Mental Health Care; thus mental health Page 2 care in Saint John can be seen as corresponding to a ‘System‘. This analogy is easy to come about because one sees quite clearly a predominant direction in which mental health care finds itself positioned in Saint John. However in DehraDun, due to the sheer divergence of mental health care practices and underlying strong beliefs that propel them forward, it is incorrect to add the word ‘System’ to these practices. If one were to however find some kind of structure that underlies this area of study in DehraDun, it would have to correspond to one that is extremely open-ended and in western terms Post-Modernist in its inclination. Through my research I confirm that mental health practices are influenced by cultural and historical factors, and inversely history and culture are influenced by Mental Health Care practices. In DehraDun, my microcosm for Mental Health Care practices in India, due to the sheer diversity and size of the population, and the divergent social, political, religious, and economic factors, I believe it is impossible for a uniform Mental Health Care System to emerge that can incorporate all facets of thought existent within the society. Thus in DehraDun there exist many avenues for providing divergent explanations for similar phenomenon. Whereas in Saint John, due to the relative homogeneity and smaller size of the population, wealthier infrastructure, and stronger and more efficient Government, there has developed a dominant Mental Health Care System that is upheld by a majority of the local population. When I started this research paper I began by looking at the delivery model of the Mental Health Department in Saint John as my epicenter from where I planned to research Mental Health Practices in Saint John. Similarly I looked upon Raphael International in DehraDun as the epicenter of my research of Mental Health Practices in Page 3 DehraDun. In order to gather a detailed understanding of where mental health care stands in both areas I conducted a detailed and in depth research of the history behind the current status of Mental Health Care in both places. This research of the historical foundations of current Mental Health Care practices illustrates the manner in which current practices parallel the dominant beliefs of the localities. Through this research I have found that some DehraDun Mental Health care practices concur with the approach and practice of Mental Health Care in Saint John; whereas other Mental Health Care practices in DehraDun are clearly reminiscent of practices that were in existence in Saint John in the past. However it is important to know that whereas one can look upon Mental Health Care practices in a developmental/evolutionary manner in Saint John, it will be a folly to look upon Mental Health Care practices in DehraDun in a similar fashion. The reason for this is that in India, Time is not looked upon in a progressive manner like it is in the West: Time in India is generally believed to be cyclical. Therefore in India one finds within the Mental Health Care field a unique mixture of old and new Mental Health Practices. Incorporated in this paper are philosophical positions and current trends that are central to the delivery of Mental Health Care in Canada and India. In order to support my findings I used literature by noted authors such as Michel Foucault, Sudhir Kakar, Erving Goffman, Thomas Szasz, and Michael Perlin. I have also incorporated information that I obtained from various pamphlets, brochures, and government periodicals. The Internet has been used extensively throughout this research to keep in touch with my contacts and also to tap into various online Mental Health Care discussions. Through this research I interviewed people who are Page 4 directly or indirectly involved with the delivery of Mental Health Care services. Due to the number and length of the interviews I have not been able to use them in their complete form. Instead this paper has incorporated parts of them at areas where I deem relevant. This paper will describe, in fiscal terms, the Government of Canada’s involvement with Health Care in Canada. This is followed by a picture of the present state of Mental Health Care Delivery in New Brunswick, which is followed by an in depth analysis of this picture. Health Care Canada One of the top priorities of the Government of Canada is Health Care. Canada has a very strong Federally funded Health Care Delivery System, and a large percentage of the Federal Budget is allotted towards maintaining, and upgrading this Health Care Delivery System. In 2003 from Canada’s Gross Domestic Product of $958.7 billion , $120 billion was spent on providing Health Care for Canada’s population of approximately 32.5 million people (Canadian Budget). According to the World Health Report of the World Health Organization, the Canadian Government spends around 7% of its National Gross Domestic Product on providing its citizens with quality Health Care. In Canada the total private funding for Health Care amounts to only 29.2% of all the health costs through the country, and the rest of the costs for Health care are provided for by the Government’s Health Care Plan. The Provincial and Territorial Governments in Canada also give priority to Health Care. The Government of New Brunswick, for example, in 2004 allotted 28% of its budget towards Health Care costs. This figure amounts to $1.609 billion from which $56.4 million (3.04%) has been allotted to the Mental Health Department for its effective functioning. (Canadian Budget) Page 5 THE CURRENT Mental Health Care ‘system’ IN New Brunswick. The Government of New Brunswick’s Department of Mental Health Services Division primarily works to provide central leadership and accountability for the effective, efficient and equitable delivery of all forms of Mental Health Services to the Province of New Brunswick. From time to time this division assesses the mental health needs of New Brunswick’s population. Based upon their assessments and in conjunction with the Provincial Mental Health Policy, the Mental Health Act, and the Mental Health Services Act they allocate financial and human resources whilst monitoring their usage. Involved in their work is the direct management of thirteen Community Mental Health Centers that are situated around New Brunswick. Also they negotiate the effective delivery and purchase of service contracts with Hospital Corporations for in-patient services (Psychiatric units and Hospitals) through out the Province. The Structure of New Brunswick’s Provincial Mental Health Care The Assistant Deputy Minister of Health and Wellness, who is a member of the Department’s senior management team, heads the Mental Health Division. This senior management team helps deliver Mental Health Care Services through out the Province of New Brunswick. The management team works on providing services through the following four distinct operational sectors: y Community Mental Health Center’s y Psychiatric Units y Psychiatric Hospitals y Non-Profit Organizations and consumer and family groups with a primary mandate Page 6 of serving people with Mental Health issues.