Events of CHP
Patna, March 9. National Conference on “Partnership to Scale up Mental Healthcare in Bihar” was organized today by the Centre for Health Policy at Asian Development Research Institute (ADRI) in collaboration with Department of Health Government of Bihar, Department of Social Welfare Government of Bihar, State Human Rights Commission and Bihar State Legal Services Authority.
Mr. Mangal Pandey, Health Minister, Govt. of Bihar in his inaugural address emphasized that the Bihar state need to develop its own health policy in order to move in right direction for future healthcare priority, such health policy must also be inclusive of mental health needs. He clearly stated that as discussed earlier, he will rely on suggestions of CHP, ADRI for developing such policy. The Health Minister also highlighted the needs to have healthy ‘Manas’ (Human resources) and healthy ‘Mind’ (mental health) for future development of the state. Dr. P.P. Ghosh, Director, CHP-ADRI in his welcome address also highlighted the urgent need for accelerating mental health interventions by the government and judiciary. Justice Samrendra Pratap Singh highlighted the legal aid work being done by the Bihar State legal services authority.
In the first Technical session, Prof. Suresh Bada Math, Professor of Psychiatry, NIMHANS, Bangalore spoke on innovative solutions for implementation of Mental Healthcare Act 2017. He highlighted that there is no need for conducting a new study to estimate the prevalence of mental illness as the National Mental Health Survey conducted by NIMHANS already provides a high prevalence of mental illness in the country, which is currently estimated to be around 10%. He further highlighted the need to utilize technological innovations for improving mental healthcare. This session was chaired by Dr. N. K. Sinha, State Programme Officer for Mental Health, State Health Society, Bihar.
In the second session ‘Methods to strengthen the National Mental Health’ Programme was discussed. Prof. Rajesh Kumar, Head of Psychiatry Department at IGIMS, Patna explained some of these methods for immediate implementation by the concerned authority. The Chair of the session Dr. Karuna Kumari, IAS, Additional Executive Director, State Health Society, Government of Bihar, said the state government will focus on mental health needs of the adolescent population.
In the third session, Dr. Soumitra Pathare Director of Centre for Mental Health Law and Policy at ILS Pune presented the work of a project called “Atmiyata”. This project aims at community mobilization through training self-help groups to connect person with a mental disorder to existing mental healthcare services and providing support and coping skills to their families. In the fourth session, Dr. K.V. Kishore Kumar Director of the Banyan and the Banyan Academy of Leadership in Mental Health highlighted the urgent need for the establishment of aftercare services (rehabilitation and reintegration) for persons with a mental health condition. He urged the chair for the session, Dr. Shivaji Kumar, Commissioner, State Disability Commission, Bihar emphasized to focus on integration of Social welfare institution with Public health institution to address mental health needs of people.
Ms. Apurva Shristi, Legal Specialist at CHP, ADRI proposed vote of thanks and re-iterated commitment of CHP to work in this area.
CONCEPT NOTE:
The Mental Healthcare Act (2017) has ushered in new hope for changing the mental healthcare scenario in India. Thislaw aims to ensure mental healthcare delivery at the community level, with due respect to the rights of the mentally ill and the needs of their families. It provides a right’s-based approach to accessing mental healthcare treatment & psychotropic drugs at government run hospitals and primary healthcare facilities. Under the Act, each state is required to lay down new institutional machinery for the overall supervision of mental health initiatives by the state, and specifically to regulate all mental health facilities and professionals. The urgent need for the implementation of this law in Bihar arises from a high national mental morbidity rate and the massive socio-economic impact of these conditions, as estimated by the National Mental Health Survey (NMHS), conducted in the year 2015-16, across 12 Indian states.
As per the NMHS estimates, nearly fifteen percentof the total Indian population is in need of active interventions for mental healthcare across the entire population (adolescent, adult and the elderly) andincludes all genders (male, female and transgender). The impact of Mental Neurological and Substance-use (MNS) disorders has far reaching consequences in all domains of life (social, work and family) for both the afflicted and their caregivers, including their ability to conduct even basic daily activities. If both direct and indirect costs of mental healthcare are taken into account for the affected population, the economic burden is huge.
Mental illnessdisproportionately affects individuals belonging to lower socio-economic status. Epidemiological studies conducted in Indiashow a cyclic relationship between mental illness and poverty, where mental illness can lead to poverty, and at the same time, individuals belonging to a lower socio-economic status, are at a higher risk of mental illness. The stigma of a mental health disability can further perpetuate this cycle and lead to broad scale discrimination at home and in schools, the work place, public situations and even in hospitals and clinics.
The Mental Health Policy (2014) specifically recognizes certain categories of individuals who are more vulnerable to mental illness and calls for specific interventions for these populations. These groups includeindividuals with physical or mental disabilities, the homeless, juveniles in conflict with law, commercial sex workers, orphansand the elderly population. They often require long term mental health interventions, including rehabilitation and reintegration services. Since social welfare institutions and custodial institutions cater to these vulnerable groups, provisions for screening of mental illness, as well as provisions to ensure mental healthcare for its target population, is essential.
In Bihar, ignorance about mental illness, the stigma and discrimination attached with mental illness, limited mental health treatment services and providers, absence of aftercare services and the presence of informal providers,pose as major barriers serving the mentally ill. To address these barriers, a systems perspective for mental healthcare provides a broader framework that allows better integration of the already available services and improves the uptake of care for those with MNS disorders. The essential components of Bihar’s Public Mental Health System (PMHS)includethe Health Department and Social Welfare Department which has a strategic role in promotion and delivery of mental healthcare to the public; the State Human Rights Commission which has the authority to monitor and evaluate all state mental health institutions in order to protect the human rights of the mentally ill; and the State Legal Services Authority that plays a crucial role in creating legal awareness of mental health concerns and that renders legal services to mentally ill persons, free of cost.
There is an essential need for a multidimensional approach to strengthen the PMHS across all departments, including implementing the mental health laws, improving ongoing mental health programs, and integrating and coordinating the activities of various stakeholders. Mental health literacy initiatives promote awareness, acceptance and options for care through informed decision-making by the policy maker, service provider and service consumer.With education and support, mentally ill individuals and their caregivers can become their own best advocates for services and interventions to meet the needs of the affected persons. Their participation in planning, implementation and monitoring of these services, can lead to effective and sustainable solutions.
With rising concern among the policy makers and rising awareness among the general population of Bihar, early recognition and access to treatment will follow, as will the adoption of preventive measures. The beginning is a dialogue on innovative solutions for mental healthcare in Bihar between the different stakeholders of the PMHS. Toward this end, the Centre for Health Policy is hosting a one-day conference at the Asian Development Research Institute on March 9, 2019. This effort has been taken up, in collaboration with Department of Health, Government of Bihar, Department of Social Welfare, Government of Bihar, State Human Rights Commission and the Bihar State Legal Services Authority.
To R.S.V.P. Contact : ajit.ceppf@adriindiaadmin.org
Report on National Conference on Partnership to Scale up Innovative Solutions for Mental Healthcare in Bihar