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Mental Health: an Indian Perspective, 1946–2003 Agarwal Et Al

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Mental Health: an Indian Perspective, 1946–2003 Agarwal Et Al Mental Health An Indian Perspective 1946–2003 Mental Health An Indian Perspective 1946–2003 EDITOR S. P. Agarwal Director General of Health Services Ministry of Health and Family Welfare Government of India, New Delhi. ASSOCIATE EDITORS D. S. Goel R. L. Ichhpujani Senior Advisor - Psychiatry (Retd) Deputy Director General Armed Forces Medical Services Directorate General of Health Services National Consultant (Mental Health) Ministry of Health and Family Welfare Directorate General of Health Services Government of India Ministry of Health and Family Welfare New Delhi New Delhi R. N. Salhan S. Shrivastava Medical Superintendent Chief Medical Officer Safdarjung Hospital Directorate General of Health Services New Delhi Ministry of Health and Family Welfare Government of India, New Delhi Directorate General of Health Services Ministry of Health and Family Welfare New Delhi Mental Health: An Indian Perspective, 1946–2003 Agarwal et al. Directorate General of Health Services / Ministry of Health and Family Welfare Nirman Bhawan, Maulana Azad Road, New Delhi-110 011 ELSEVIER A division of ELSEVIER Reed Elsevier India Private Limited Copyright © 2004 Directorate General of Health Services, Ministry of Health & Family Welfare All rights reserved. No part of this publication may be reproduced, stored in a retrieval system, or transmitted in any form or by any means, electronic, mechanical, photocopying, recording or otherwise, without the prior permission of the copyright holder. ISBN 81-8147-195-4 (PB) ISBN 81-8147-502-X (HB) Published for Directorate General of Health Services/Ministry of Health & Family Welfare. This is not a priced publication. It is intended for free circulation amongst libraries, policy makers and health professionals. The views expressed in this publication are the Authors’ own and do not reflect, directly or otherwise, Government policy in any manner. Elsevier, a division of Reed Elsevier India Private Limited 17 A/1, Main Ring Road, Lajpat Nagar-IV New Delhi-110 024. Printed at Replika Press Pvt. Ltd. Preface ental disorders have profound implications on the health and well-being not only of individuals but also of families and entire communities. The resultant emotional distress Maffects the ability to cope with stress as well as productivity. Other negative implications include alcohol and substance abuse, delinquent behaviour and impaired quality of life. Inappropriate risk-taking behaviour patterns contribute to major public health problems such as HIV/AIDS and road accidents. In this context, the projected rise in the proportion of the global burden of disease attributable to mental/neurological disorders and substance abuse from 11.5% in 1998 to 15.5% by the year 2020 is a cause for concern. Increasing suicide/attempted suicide rates, comprising 1.6% of the global burden in 1998, add yet another disturbing dimension to this somber scenario. What causes even greater worry is the high incidence of suicide in Kerala, the most literate state in the country with a high quality of life rating. This highlights the complexity of the problem. The need for renewed vigour in the provision of community-based mental healthcare services is thus self-evident. India was perhaps the first country in the world, and certainly the first among developing countries to recognise the need to integrate mental health services with general health services at the primary care level. The National Mental Health Programme (NMHP), launched in 1982, aimed at the treatment of mental disorders within the community, using the existing primary health centre and community health centre staff who were given special training for this purpose. Unfortunately, however, the subsequent progress in the implementation of this programme was not satisfactory. In May 2001, several months before the tragedy at Erwady, a small town in the Ramanathapuram district of Tamil Nadu, where 26 mental patients who had been kept chained in a religious asylum were burnt to death, drew national attention to the plight of the mentally ill, a small group was constituted in the Directorate General of Health Services to analyse the causes of this under-performance and to suggest corrective measures. In order to generate baseline data in respect of mental health laws and services, detailed questionnaires were sent to all state governments, but the response was poor. Later, consequent upon the directions issued by the Hon’ble Supreme Court in CWP 334 of 2001, the same format was used to collect the required information. In the meanwhile the NMHP underwent a complete review and reorientation. From a one-dimensional programme, virtually synonymous with the district mental health programme, the restrategised NMHP became a comprehensive mental healthcare delivery system, with an outlay of Rs 190 crore (US $ 42 million) for the 10th Five Year Plan. This represents a quantum jump over the 9th Plan allocation of Rs 28 crore (US $ 6 million). Formally launched on 22 Oct 2003, the programme is expected to cover nearly two hundred districts across the country. Medical college departments of psychiatry will be strengthened to improve undergraduate as well as postgraduate training. Mental hospitals are to be modernised and streamlined to provide community oriented tertiary care of a high standard. Destigmatisation of mental illness through information, education and communication activities will be a major thrust area in this national programme. Relevant research to study the demographic and longitudinal profile of mental morbidity is expected to provide the necessary inputs for refining the system and for future planning. The availability of psychotropic drugs at reasonable cost has been ensured by our robust and innovative pharmaceutical industry and we hope to weather the fallout of globalisation and the new trade environment without any major hardships to our people. As we embark on this ambitious journey, it might do well to pause, introspect and take stock. The present book is a sincere attempt in this regard. It aims to provide a platform for a wide spectrum of views on various aspects of the subject, primarily from a public health perspective. The authors have been accorded full freedom in this regard and the views expressed herein do not reflect government policy. In an area as complex as this, there are bound to be differences in opinion. This does not, however, dilute our commitment to the common aim: doing the greatest good to the largest number. I have no doubt that this book will constitute a landmark in the chronicles of mental health in India. Dr S. P. Agarwal M.S. (Surg) M.Ch. (Neuro) Director General of Health Services Government of India New Delhi Contributors A. Gupta Associate Professor Department of Neurosurgery All India Institute of Medical Sciences (AIIMS) New Delhi - 110 029 Ajit Awasthi Additional Professor Department of Psychiatry Postgraduate Institute of Medical Education and Research (PGIMER) Chandigarh - 160 012 Ajita Chakraborty Professor of Psychiatry (Retd) 84, NE Block, New Alipore Kolkata - 700 053 A. K. Agarwal Professor of Psychiatry (Retd) B-104/2, Nirala Nagar Lucknow - 226 020 A. K. Kala President Indian Association of Private Psychiatry 95-A, Model Gram Ludhiana - 141 002 Amita Dhanda Professor and Registrar NALSAR University of Law Justice City, Shameerpet, Hyderabad - 500 014 A. Venkoba Rao Emeritus Professor of Psychiatry Tilak, 506, IV Main Road KK Nagar, Madurai - 625 020 Col. Kirpal Singh Senior Advisor — Psychiatry (Retd) T-38, Rajouri Garden New Delhi - 110 027 Dinesh Bhugra Dean Royal College of Psychiatrists Institute of Psychiatry PO Box 25, HSRD De Crespigny Park London SE5 5AF D. Mohan Professor of Psychiatry (Retd) G-4, Jangpura Extension New Delhi - 110 014 D. Saldhana Professor of Psychiatry Armed Forces Medical College Pune - 411 040 D. S. Goel Senior Advisor — Psychiatry (Retd) Armed Forces Medical Services National Consultant (Mental Health) Directorate General of Health Services Ministry of Health and Family Welfare New Delhi - 110 011 G. G. Prabhu Dean (Retd) Faculty of Mental Health and Neurosciences Bangalore University Orchid Court, 3/1, Church Road, Yadavgiri Mysore - 570 020 G. Gururaj Professor of Epidemiology National Institute of Mental Health and Neuro Sciences (NIMHANS) Bangalore - 560 029 J. K. Trivedi Professor of Psychiatry King George's Medical College Lucknow - 226 020 K. Bhaskaran Chief of Psychiatry (Retd) Geelong Hospital, Victoria, Australia 21, Sampurna, 8, Palace Cross Road, Bangalore - 560 020 Kiran Rao Additional Professor Clinical Psychology National Institute of Mental Health and Neuro Sciences (NIMHANS) Bangalore - 560 029 K. Reddemma Professor Department of Nursing National Institute of Mental Health and Neuro Sciences (NIMHANS) Bangalore - 560 029 K. Srinivasan Professor of Psychiatry St. John's Medical College Bangalore - 560 034 Madhukar Katiyar Professor of Psychiatry King George's Medical College Lucknow - 226 020 M. A. M. Khan Professor of Psychiatry (Retd) 296, Adarsh Nagar Shapurwadi, Hyderabad - 500 063 Mathew Varghese Additional Professor of Psychiatry National Institute of Mental Health and Neuro Sciences (NIMHANS) Bangalore - 560 029 M. Gourie Devi Senior Consultant Neurologist Sir Ganga Ram Hospital, New Delhi - 110 060 M. K. Isaac Professor of Psychiatry National Institute of Mental Health and Neuro Sciences (NIMHANS) Bangalore - 560 029 M. Ranganathan Department of Psychiatry National Institute of Mental Health and Neuro Sciences (NIMHANS) Bangalore - 560 029 M. Sarada Menon
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