NIMHANS to evolve inexpensive, practical model for mental health care in rural areas

"Mad Basha". This was how the villagers of Anekal taluk in Karnataka referred to Basha Khan, an agricultural labourer, who for years wandered around wide-eyed, pulling his hair, carrying rubbish in his pocket, beating his wife frequently and abusing people. But today Basha is sane, thanks to a team of psychiatrists who diagnosed his ailment as a common case of psychosis and put him on drugs for six months.Basha is one of the lucky few to receive timely medical care. There are an estimated six million mentally ill people in rural India. They have little hope of cure. Many have been deserted by their kith and kin. Some have been taken to traditional healers like the village mantravadis (witch doctors) to exorcise the spirits.Only a few have ever visited a mental hospital because the stigma and superstitions attached to mental illness have led people to believe that it is incurable. Moreover, the 37 mental hospitals in the country are all located in cities. These are either too far away or too costly for them to visit. As a result, the majority of the patients become chronically ill until death claims them.Unique Project: Providing sophisticated mental care for India's burgeoning rural population would not only be expensive but would be impossible for another few decades. But a unique experiment is now on at the Community Psychiatry Department of the prestigious National Institute of Mental Health and Neuro-sciences (NIMHANS), Bangalore, to evolve a relatively inexpensive and practical model for introducing mental health care in rural areas.Taken up in 1976, the initial results have been "highly encouraging" and next month a full-fledged mental health programme for Karnataka is to be launched that may well be the forerunner for such programmes all over the country.Professor Ravi Kapoor, Head of the Community Psychiatry Department and the brain behind the project, said: "We are developing a model for mental health care that would make use of the already available channels of health care in India without incurring additional expenditure."Health care in rural areas is administered by the Primary Health Centres (PHCS), manned by a qualified doctor and several multi-purpose health workers. In the model being developed by Professor Kapoor's team, the PHC staff would be trained to treat basic mental illnesses such as psychosis and epilepsy. Treating a psychotic: Hope at lastThis way no special staff needs to be added. Complicated cases would be referred to the district psychiatric teams of medical college units and patients needing prolonged treatment would be admitted to state mental hospitals.To find out whether the PHC staff could be taught to treat mental illness, the team evolved its own training programme. A manual was prepared and a two-day programme was held in a PHC. The team was surprised to note that the questions asked by the trainees went far beyond expectations. However, it was found that teaching aids like flow charts used by the World Health Organisation (WHO) did not serve any purpose as the trainees aimlessly flipped pages during classes.Said Kapoor: "We then evolved a system which had minimum lecturing, a lot of story telling and visits to field areas to study real patients." A three-month training programme was then started as the final test to find out whether the PHC staff could absorb the knowledge and use it. A one-and-a-half year evaluation of the training programme showed that the staff could easily detect and manage cases of mental illness.Survey: To find out the extent of mental illness in rural areas a service programme was started in Anekal taluk in Bangalore district. A hundred and twenty villages were chosen and some shocking facts had emerged from the 76,000 people surveyed in the past four years.Almost all the psychotic and epileptic patients had become chronically ill after initial unsuccessful attempts by traditional healers, NIMHANS and other agencies. All psychotics had been ill for more than two years and one-third of them had been ill for more than 10 years.The majority of the epileptics were ill for more than three years. As many as 86 per cent of the cases were disabled. Significantly, almost all of them had consulted traditional healers and a majority of the patients did not go to a hospital in spite of NIMHANS being hardly 20 km away. Poverty and ignorance were the main reasons.But even more important was the fact that two-thirds of the mentally ill people treated by the team accepted die treatment programme and a majority of them had improved considerably. Many of them, like Basha, had stopped being a burden on their families and could lead normal lives. Interesting, too, was the fact that almost 84 per cent of the; cases could be treated at home.The follow-up rate, which is vital for mental treatment, was about 75 per cent, almost 15 per cent higher than that of NIMHANS. The myth about the cost of treatment too shattered. On an average only Rs 50 a year was spent on each psychotic patient and only Rs 20 on epileptics.Asserts Kapoor: "After these pilot studies, we are extremely confident that the training programmes work and our rural mental health scheme could be launched." As a forerunner, a model training centre has been set up on an 11 acre plot of land in a tiny village called Sakalwara, 18 km from Bangalore. With the help of funds from the Karnataka Government, the centre has an out-patient department, in-patient facilities for 20, quarters for the trainees and staff and therapeutic facilities suitable for patients coming from rural areas. The centre is nearing completion and the team now plans to launch the first official training programme for PHC doctors and multipurpose workers.It would be an intensive three-week course and, after completion, evaluation studies and further programmes would be taken up. This would be the first step towards implementation of their model for rural mental health care.Meanwhile, the Indian Council for Medical Research has started in January last an independent evaluation programme of the technique used by Dr Kapoor's team in Bangalore, Patiala, Calcutta and Baroda to find out whether the scheme could be implemented all over the country and the costs involved. Backed by WHO, the Post-Graduate Mental Institute in Chandigarh has taken up a time-bound project to study whether the PHC staff could be trained to handle mental illnesses.The fact that the entire model rests on the efficiency of the PHCS is a risk as the general opinion is pretty poor about them. But Kapoor frankly admits, "We have no choice really. The country does not have the resources at the moment to set up a separate mental health care delivery system. Even if the existing health care system works at 50 per cent efficiency, that is enough for us."Published By: AtMigration Published On: Feb 22, 2014 13:21 IST--- ENDS ---

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NIMHANS to evolve inexpensive, practical model for mental health care in rural areas

There are an estimated six million mentally ill people in rural India. They have little hope of cure. Many have been deserted by their kith and kin. Some have been taken to traditional healers like the village mantravadis(witch doctors) to exorcise the spirits.

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