MENTAL HEALTH ISSUES OF INDIA - University of Kansas … Presenta… · · 2016-04-12Inadequate...
Transcript of MENTAL HEALTH ISSUES OF INDIA - University of Kansas … Presenta… · · 2016-04-12Inadequate...
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MENTAL HEALTH ISSUES OF INDIA
Christian Medical College Vellore, India
29 February to 15 March 2016
Justin Williams KU School of Nursing
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OBJECTIVES
➤ Examine community health interventions established by Christian Medical College (CMC), Vellore
➤ Experience Psychiatric Nursing and observe evidence based practices for treatment of mental health diagnoses
➤ Build relationships with health care professionals at CMC
➤ Assimilate in the culture of India while gaining competence of culture to better understand culturally exclusive interventions
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BACKGROUND INFORMATION
➤ Population of India: 1.241 billion (2011)
➤ India constitutes 2.4% of the total land area in the world while being occupied by 16.87% of the population
➤ India has the highest rate of suicide at a mortality rate of 21.1 per 100,000 people (World Health Organization, 2014)
➤ Indian culture relies heavily upon their family structures to provide for needs of women, children, and ill
➤ This is true for mental health treatment as well, families provide much of the care for patients with mental health diagnoses (Avasthi, 2010)
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BACKGROUND INFORMATION (CONT.)
➤ Spirituality very important in India
➤ Majority are Hindu (81%)
➤ Followed by Muslims (13%), Christians (>3%), Sikh (2%), Buddhists (>1%), and Jains (>1%) (CultureGrams, 2014)
➤ Income levels vary
➤ Vellore (Southern India) - lower and middle class
➤ Delhi (Northern India) - middle to upper class
➤ Much of healthcare provided by government programs in partnership with NGOs, NO OVERLAP OF SERVICES
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CHRISTIAN MEDICAL COLLEGE, VELLORE
➤ Private Hospital
➤ Works well with government healthcare services, partners
➤ Started in 1900 by Ida Scudder, an American Missionary
➤ Three Knocks…
➤ Efforts in advancing women through medicine and nursing
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➤ Outpatient Clinic
➤ Can see up to 200-400 patients per day
➤ 2 adult, 1 children/adolescent, and 1 autism team
➤ Inpatient wards
➤ Three wards, income dependent
➤ Acute care room
➤ All provide patient and family housing; floor mat to bed
➤ No patient identifiers, reduce stigma
DEPARTMENT OF PSYCHIATRY
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MENTAL HEALTH ISSUES IN INDIA
➤ Depression, Schizophrenia, Bipolar, Obsessive-Compulsive behaviors, emotional and marital problems (adjustment disorder)
➤ Addiction (primarily alcohol)
➤ Suicide seen primarily with addiction and adjustment disorders
➤ Lack of proper treatment due to lack of access to resources
➤ Transportation
➤ Financial burden
➤ Families do the best they can based on their level of understanding
➤ Conflict of medicine versus homeopathy (D. Kattula, Personal Communication, 2016)
➤ Additionally conflicts arise with insistence of no overlap of services between NGOs and government programs
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Alcohol Prevalence
Inadequate Care Culture Conflict
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SYSTEM INTERVENTIONS
➤ Mental Health Bill of 2013 (Pending)
➤ Decriminalizes suicide
➤ Ensures rights of those with mental illness
➤ Right to care (provided or funded by government)
➤ Right to legal counsel
➤ Greater oversight of mental health facilities
➤ Additional training for law enforcement
➤ Mental Health Act, 1987 (Current)
➤ Terminology changes
➤ Oversight begins of mental health institutions
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COMMUNITY INTERVENTIONS
! Destigmatizing mental health disorders in society
! Moving away from belief that mental health issues stem from supernatural causes while respecting culture
! Social and biological understanding of mental health is growing, however many still believe there is a supernatural aspect to mental health disorders (Saravanan et al., 2008)
! Reporting suicides as cause of death rather than natural causes. Vellore rates higher: 95 per 100,000; due to accurate reporting from community(Manoranjitham et al., 2010).
! Greater awareness of human rights violations
! Chaining loved ones
! Erwadi mental asylum tragedy
! Basic needs must be met first
! Water, Sanitation, Social Justice
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INTERVENTIONS IN PRACTICE AT CMC (INDIVIDUAL LEVEL)
➤ Removing stigma ➤ No patient identifiers
➤ No gowns
➤ No restrictions placed on movement
➤ Family integration into psychiatric care ➤ Family living space provided for all inpatient wards ➤ Family expected to provide personal care and food for patients
➤ Inclusion in psychotherapy sessions, history/interview, discussion of care plan
➤ Removing barriers
➤ Home visits ➤ Reduced cost for medications and services provided, decided by practitioner
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INPATIENT WARD
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Occupational Therapy - Home Visits - Therapeutic Environment
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CONCLUSIONS
➤ CMC is an example of inpatient mental health services that works.
➤ While the United States moved away from inpatient facilities due to abuses; CMC is an example of how inpatient treatment can work even long term.
➤ Family integration into care of mental health patients is paramount and is working at CMC (D. Kattula, Personal Communication, 2016).
➤ Data collection is something CMC would like to improve to provide evidence of their model of care
➤ Case studies are proving the model works though
➤ India is culturally accepting of this less private approach (Would this work in the United States? After destigmatization?)
➤ Conflicts arise due to varies beliefs and system issues within India
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MOST PROFOUND
CLINICAL EXPERIENCE
2 Deaths first day & 1 Suicide attempt by pesticide
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MOST PROFOUND CULTURAL EXPERIENCE
Cultural Assimilation
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REFERENCES
Avasthi, A. (2010). Preserve and strengthen family to promote mental health. Indian journal of psychiatry, 52(2), 113.
Christian Medical College. (2009). Psychiatry - Mental health centre. Retrieved from http://www.cmch-vellore.edu/PatPsychiatry/tabid/287/Default.aspx
CultureGrams. (2014). India. Provo, Utah: ProQuest.
Manoranjitham, S. D., Rajkumar, A. P., Thangadurai, P., Prasad, J., Jayakaran, R., & Jacob, K. S. (2010). Risk factors for suicide in rural south India. The British Journal of Psychiatry, 196(1), 26-30.
Saravanan, B., Jacob, K. S., Deepak, M. G., Prince, M., David, A. S., & Bhugra, D. (2008). Perceptions about psychosis and psychiatric services: a qualitative study from Vellore, India. Social Psychiatry and Psychiatric Epidemiology, 43(3), 231-238.
World Health Organization. (2014, September 4). First WHO report on suicide prevention [Press release]. Retrieved from http://www.who.int/mediacentre/news/releases/2014/suicide-prevention-report/en/