Stigma and mental illness

   The stigma attached to mental illness is one of the main obstacles to better mental health care and better quality of life of people who have illness and their families.

That stigma exists and that it is pernicious is gradually being accepted (Link et al., 1992)

Mental health workers and others who should be concerned with stigma attribute their inaction against it to various reasons


1. too busy to give this a higher priority


2. ignorance


3. nihilism – stigma cannot be changed by individuals


The WHO multi-centre study in four developing countries studied community attitudes using seven case vignettes in Columbia, India, Philippines and Sudan. This study found that the community differentiated the different disorders in terms of severity tolerability manageability and desirability as neighbours (Wig et al 1980). The respondents placed greater emphasis on external behaviour rather than internal symptoms experienced by the individual.



Indian public and mental health professionals are more tolerant than in developed countries in their approach to and acceptance of patients and their families (Sathiavathy et al., 1971, Verghese and Beig, 1974).


Factors contributing to greater tolerance and support are

• Rural agrarian nature of society.


• Strong family system with filial affiliation


• Models for explaining the cause of illness that are external (eg: spirits) and are shared by community members


• Reversibility of behaviour including symptoms.


Lack of awareness regarding various aspects of mental health even amongst educated urban youth, lack of awareness about available treatment options and pervasive defeatism lead to tendency to maintain social distance from the mentally ill (Prabhu et al 1984)

INDIAN INITIATIVE

According to WHO estimates mental health needs of Indian population is served by fewer than 4000 psychiatrists (many of these are in private practice). Today there is one mental health worker (Psychiatrist, Clinical Psychologist or Nurse) for every 250,000 people.

On February 6th, 2004, Dr.Abdul Kalam, President of India helped launch an anti stigma effort in India – this included collaboration between SCARF and the WPA Global programme.

A number of activities to publicize anti- stigma and educational initiatives were taken up. Networking with multiple social groups and collaborative efforts are still continuing. The goal is to create an educational network built upon mutual trust and community service. This initiative is well supported by the media also.


Kerala is blessed with an educated population, strong family ties and high density of population. Wide readership of print media, high penetration by electronic media, presence of many community service organizations, good collaboration between mental health professionals in private and govt. sector, presence of District Mental Health Programmes in five districts are factors favoring success of a state-wide anti stigma initiative.



This is a priority issue and I exhort all mental health professionals to actively think about how each one of us can contribute towards this end.

DISTRICT MENTAL HEALTH PROGRAMME, IDUKKI



The District Mental Health Programme in Idukki is about to start its field activities in Idukki. The Nodal Centre of the programme is functioning at Medical College, Kottayam.



The team comprising of Psychiatrist, Psychiatric Social Worker and Nurse have been appointed. Dr.Cleetus, Sri. Niju Abraham and Smt. Lissy Jacob have joined for the above mentioned posts. (in respective order). The Idukki District office of District Mental Health Programme, Idukki has started functioning in the District T.B Centre, Painav from 1st April 2007 on wards.



Training programme in mental health have been started for General Medical Officers in Idukki district. The first batch of Medical Officers was given 5 day training from 15th to 19th May 2007.


Ten out reach clinics have been identified in consultation with District Medical Officer of Health, Idukki.



Further details regarding the programme can be had from Dr. Ashok kumar, Nodal Officer, District Mental Health Programme, Idukki (Phone No. 94476 33846)



DISTRICT MENTAL HEALTH PROGRAMME, KANNUR



The District Mental Health Programme in Kannur has started conducting clinics in 20 peripheral Govt. Hospitals in the district.



The Nodal Centre of the programme is functioning at Department of Psychiatry, Medical College, Kozhikode. The field centre in Kannur district will shortly start functioning at the District Hospital, Kannur.


The field staff comprising of Psychiatrist, Psychiatric Social Worker and Nurse have been appointed. Dr.Rajagopal, Sri. Aneesh Thomas and Staff Nurse are conducting the clinics on a daily basis.



The conveyance facility is provided by the DMOH, Kannur.



Training programme in mental health for Medical Officers in Kannur district has been started. The first batch of 19 Medical Officers were given a-three day training. The DMHP Kannur also conducted a one day training programme for all the Supervisory field staff of Kannur district. 58 people took part in the training.



Essential psychotropic drugs have been procured from CPC listed firms for supply through the out reach clinics.


The attendance at the clinics is encouraging according to Dr.Harish.M.T.



Further details regarding the programme can be had from Dr. Harish.M.T, Nodal Officer, District Mental Health Programme, Kannur (Phone No. 98472 80957)



DMHP-Wynad



In view of the high rate of farmers suicide reported in the district, Government of India Sanctioned DMHP for Wynad District in 2006=07.First installment for the programmeis released. Institute of Metal Health and Neurosciences,Kozhikkod is the nodal centre and the Director of the Institute is the nodal officer of the programme.Steps are being takentoimplement theprogramme.



District Mental Health Programme-Thrissur.



The D.M.H.P Thrissur started functioning from August 2000. Today the programme has completed six years of activities and service.


As on date, more than 8000 patients in and around Thrissur are registered with the programme.



The follow up rates are not encouraging over the past 8 to 10 months. This can be attributed to lack of funds, lack of availability of medicines and doubts regarding continuity of the programme. In April 2007 only 1012 patients came for follow up.



However, from February 2007 onwards the D.M.H.P has been able to ensure availability of drugs to the patients. Medicines were bought by the respective panchayat’s and municipalities where the out reach clinics are located from their maintenance grant funds.



The programme has received a further installment of funds from the Central Government (approx. Rs. 6.9 Lakhs) in April 2007. This will be sufficient to continue the activities of the programme till the end of 2007.



Consequent to the reception of funds, D.M.H.P Thrissur has initiated quite a few new activities to improve patient care, rehabilitation, community participation, integration with health service and mental health promotion



Patient care



The clinic timings and schedule of clinics have been redone to ensure ease of operation, participation of the local medical officer and to decrease waiting period of the patients. Case records of all the clients are also being updated. Computerization of clinical data is also planned.

Community based activities



From April 2007 onwards more time is set apart for field based activities like home visits, community resource mobilization, and liaison with local institutions. Self help groups of clients and family members have been started in two centres.

Training

To improve follow up rates, case identification and community participation in care and support, D.M.H.P Thrissur has started training all the field staff in Thrissur district. So far six such half day training sessions over the past 45 days. Field staff and their supervisors are trained to improve early identification of mental illnesses, communication with patients and families and to ensure community participation. Nearly 280 JPHN’s, JHI’s and health supervisors have undergone training so far. The results and feedback are encouraging.



Manomithra



A new campaign has been started to re energize the D.M.H.P Thrissur through participation of the field health workers. The campaign will award the best mental health leader in every Block Panchayat as “Manomithra” every month during the monthly DMO conference based on their activities in the previous month. Such achievements will be given publicity and recognition in the monthly newsletter of D.M.H.P and the monthly reports sent to KSMHA.



Newsletter



A monthly newsletter containing ready-reckoner information for medical officers and field health staff will be brought out from June 2007 onwards. The bi-lingual newsletter will also address the needs of clients and family members.

DMHP-Thiruvananthaputam

The programme started functiong in 1999 and term of the programme is over by 2004.The programme is now continuing with thehelpof the State Government. Mental Health Centre,Thiruvananthapuramis the nodal centre. The Programme is taking care of 9……..patients registered with it



GOVERNMENT MENTAL HEALTH CENTRE THRISSUR

HISTORY


Mental hospital Trichur was opened in the year 1889 by His Highness Maharaja of Cochin as a single block with 15 cells for males and females. Additional blocks were built gradually and female section was separated. The management of this hospital was taken over by the Govt. of Kerala in 1956. Pavilion wards for females and males were constructed in 1969. In the year 1984 the hospital was renamed as Govt. Mental Health Centre Trichur as recommended in the Estimate committee report. Six psychiatric units (4 under Kerala Health Services and 2 for Medical College Thrissur were created in1984. Permission to visit the inmates was granted to their relatives and friends from 1984 onwards. Better provisions in the diet schedule as recommended by Krishnamoorthy Commission were implemented the year 1984. Family ward for females (where the relatives stay with the patients and look after them) was introduced in 1987 and for males in 1989.


The hospitals premises have an area of about 14 acres and at present there are 16 wards including a KHRWS pay wards. Initially the sanctioned bed strength was 240 and the present sanctioned bed strength is 361. The daily census on an average is 380.


Demographic particulars


Name of the hospital : Govt. Mental Health Centre, Thrissur


Location : west fort, Thrissur -680004


Year of established : 1889


Total area : 14 acres (approximate)


Administrative control : Govt of Kerala


Catchment area : Five Districts in Kerala


Thrissur Ernakulam Palakkad, Idukki and Malappuram


Authorized bed strength : 361


Average daily bed occupancy :



Services provided

Free services are provided in the following areas:


1. Out patient services


a. Psychiatric out patient services


b. General Outpatient services to non psychiatric patients


2. Casualty and emergency services


3. Inpatient services


4. Rehabilitation services.


5. Recreation facilities


6. Mental Health Education programmes


7. Continuing education programme for medical and paramedical staff of the Health services

Out patient services


The average daily attendance in the Psychiatry out patient department is 60 and 5 to 7 patients will be admitted to the wards. Patients reaching here for out patient treatment are provided the required medicines from the OP pharmacy. The drugs required till the next review date will be supplied. The OP Pharmacy will functions till 5 PM on all days except Sundays(on Sundays pharmacy will be open till 1 PM. IN addition to the psychiatry Out patient department a general out patient department is functioning in this hospital Hear the doctor examines patients with physical illness and required medicines will be supplied will be pharmacy.

Casualty and emergency services


Casualty is functioning round the clock .The construction of a building for the behaviour intensive care unit is nearing completion. When this unit starts functioning, the management of acutely disturbed patients would become easier.


In patient services


The average daily admission is 6. The admissions are mainly under two categories – Voluntary boarder and under judicial orders. Patients will be admitted to the wards from 8 AM to 8 PM. Patients brought after 8 PM are initially kept and managed in the observation room attached to the psychiatry OP. They will be admitted to the wards in the next morning. Ward pharmacy system is functioning in all wards. A power laundry unit is functioning in this hospital for handling linen. Police Personnel are posted as guards for criminal inpatients. Separate wards are provided for patients admitted under court orders.



Recreation facilities


There are facilities for playing football and shuttle badminton. Carom boards and chess boards are available in the wards. Most of the wards have TV sets with cable connection in some of them. Recovered patients are permitted to go to the library and reading room where they can read news papers, periodicals and story books. TV with cable connection is also provided in the library. There is gymnasium and equipments for body building exercise. There is an open air stadium where cultural and entertainment programme are usually conducted by the Nursing students. Talented patients also participate in this programme. Hospital day is regularly celebrated the last week of December every year. In this celebration the hospital staffs as well as patient participate. This is conducted under the auspices of the Society for Occupation Therapy and Rehabilitation.



Rehabilitation Services


A society for occupation therapy and rehabilitation has been working in this hospital since 1989. The society is registered under charitable societies act. This quasi government society undertakes the following rehabilitation services for the inmates of this hospital.


1. Cultivation of Tapioca cap Plantain Elephant yam, Turmeric.


2. Piggery unit functioning in this institution helps a disposal of waste food and vegetable parts


2. Goat farming


3. Horticultural nursery


4. Stationary shops run by a recovered patient.


5. Candle making.


6. Soap making


7. Book binding Unit



A book binding unit is functioning in this centre and many recovered patients come to the centre and make note books and covers. Many of the note books required in the wards are produced in this unit


A rehabilitation ward for the recovered patients has recently started functioning. This ward houses a library and a reading room. The books and other reading materials available in the library was donated by the Library council
Newer developments:


The Infrastructure facilities of this centre are expanding utilizing the special central assistance granted for development. The following wards are going to the commissioned shortly.


1. The Behaviour Intensive care unit


2. Forensic ward


3. Sick ward


4. De-addiction ward


The hospital functioning is closely monitored by the monitoring committee appointed by the Honourable High court of Kerala.