Mental health care in Karnataka: Moving beyond the Bellary model of District Mental Health Program

Parthasarathy, R.; Channaveerachari, Naveen Kumar; Manjunatha, Narayana; Sadh, Kamaldeep; Kalaivanan, Rakesh Chander; Gowda, Guru S; Basvaraju, Vinay; Harihara, Shashidhara Nagabhushana; Rao, Girish N; Math, Suresh Bada; Thirthalli, Jagadisha

doi:10.4103/psychiatry.indianjpsychiatry_345_19

Cited by 4 publications

(5 citation statements)

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“…As a method of overcoming the above shortcomings (and with the view to scale up), the district was thought to be a better administrative and implementation unit of the mental health programme 4 . A pilot for this model was started and successfully completed in Bellari district of Karnataka [conducted by the National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru] based again on the foundations of learnings from Raipur Rani and Sakalawara experience (vide supra), but with one major difference.…”

Section: Resultsmentioning

confidence: 99%

“…( ii ) The Karnataka narrative: The developments in Karnataka’s DMHP are notable as it has moved beyond the Bellary model in all aspects including clinical services (evidenced by the increase in the footfalls to clinics), capacity building and research activities with several innovations and this has potential positive influence other States as well 4 . Other significant highlights include extending specialised mental healthcare to the taluk/block level and, in some cases, to community health centres and primary healthcare centres, the Manochaitanya Programme, and embracing innovative technologies for meaningful capacity building (Karnataka Tele-mentoring and Monitoring Programme) 35 , 36 .…”

Section: Resultsmentioning

confidence: 99%

“…It aimed to take mental healthcare to the masses and resonated with the global call of health for all by the year 2000. Its operational arm, the District Mental Health Programme (DMHP), emerging out of the Bellari model, was implemented as a centrally sponsored programme since 1996 4 . Beginning with 27 districts, a decade of expansion resulted in the country having 127 districts under DMHP during the 10 th Five-Year Plan.…”

Section: Introductionmentioning

confidence: 99%

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Mental Health Programme in India: Has the tide really turned?

Kumar,

Gangadhar,

Sadh

et al. 2023

Indian J Med Res

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Mental disorders in India form a major public health concern and the efforts to tackle these dates back to four decades, by way of the National Mental Health Programme (NMHP) and its operational arm, the District Mental Health Programme (DMHP). Although the progress of NMHP (and DMHP) was relatively slower till recently, the last 4-5 years have seen rapid strides with several initiatives, including ( i ) expansion of DMHPs to 90 per cent of the total districts of the country, ( ii ) the National Mental Health Policy and ( iii ) strengthening the Mental Health Legislation by way of providing explicit provisions for rights of persons with mental illnesses. Among others, factors responsible for this accelerated growth include the easily accessible digital technology as well as judicial activism. Federal and State cooperation is another notable feature of this expansion. In this review, the authors summarize the available information on the evolution of implementation and research aspects related to India’s NMHP over the years and provide a case for the positive turn of events witnessed in the recent years. However, the authors caution that these are still baby steps and much more remains to be done.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Mental Health Programme in India: Has the tide really turned?

Kumar,

Gangadhar,

Sadh

et al. 2023

Indian J Med Res

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“…[ 27 ] Consistent efforts at the primary level have shown its ability to cater to the majority. [ 28 ] Strengthening primary care to include mental health and utilizing community health workers to provide mental health care is the way forward to reduce the treatment gap. [ 29 ]…”

Section: Discussionmentioning

confidence: 99%

Schizophrenia spectrum disorders in India: A population-based study

Hegde,

Nirisha,

Basavarajappa

et al. 2023

Indian Journal of Psychiatry

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Introduction: Schizophrenia spectrum disorders represent a significant global health concern, contributing significantly to the global burden of disease. The National Mental Health Survey (NMHS) of India, conducted between 2015 and 2016, investigated the prevalence and epidemiological correlates of schizophrenia spectrum disorders in India. Materials and Methods: The NMHS conducted a population-based cross-sectional study in 12 Indian states from 2015 to 2016, encompassing 34,802 adults. The overall study design of the NMHS was a multistage, stratified, random cluster sampling technique, incorporating random selection based on probability proportion to size at each stage. The Mini-International Neuropsychiatric Interview 6.0 was used for psychiatric diagnoses, disability was assessed using Sheehan's disability scale, and the illness-related socioeconomic impact was assessed using a questionnaire based on the World Health Organization Disability Assessment Schedule 2.0. Firth penalized logistic regression was employed to understand the correlates of current schizophrenia spectrum disorder. Results: The study found a lifetime prevalence of schizophrenia spectrum disorders at 1.41%, with a current prevalence of 0.42%. A substantial treatment gap of 72% existed for current cases, rising to 83.3% in urban non-metro areas. The penalized logistic regression revealed that the age group category of 30–49 years, unemployed status, and lower education level had higher odds of association with schizophrenia spectrum disorders. Conclusion: The primary finding of this study is a lifetime prevalence of 1.41%, a current prevalence of 0.42%, and a substantial treatment gap of 72%. Addressing this treatment gap and holistic intervention is crucial for reducing the socioeconomic impact of this disorder. Strengthening the National Mental Health Program and implementing community-based rehabilitation are essential first steps in this direction.

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“…The National Mental Health programme, was launched in 1982 to address the inadequate mental health infrastructure (Wig & Murthy, 2015) This was followed by a District Mental Health Programme in 1996 to facilitate each state to develop mental health interventions at the primary care level (Parthasarathy et al, 2021). Yet the budget allocation across these programmes is still surprisingly low, given the predicted economic loss due to mental health issues between 2012 and 2030 of more than USD 1 trillion (Sharan et al, 2017).…”

Section: Mental Healthmentioning

confidence: 99%

Co-creating Mental Health services that prevent a descent into Homelessness

Rajan

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Homelessness is a global issue exacerbated by poverty, forced migration, rapid urbanization, and lack of affordable housing. In India, around 1.8 million people were homeless in the 2011 Census, with many forced to sleep on the streets or in unofficial settlements. The link between homelessness, poverty, and mental illness is complex and uncertain. The increased risk of mental illness from poverty creates a greater risk of homelessness, with approximately 25% of homeless people experiencing serious mental health issues in India. The Poverty, Mental Illness & Homelessness (PMIH) nexus is particularly relevant in India due to its large homeless population, high resource inequalities, and high prevalence of mental illness. This thesis aims to understand the factors influencing homelessness in the population attending the clinic and find ways to leverage them in improving services. It focusses on the experiential knowledge of diverse stakeholders, including primarily women with severe mental illness, and identify pathways otherwise left unseen. By addressing the research gap and focusing on the experiences of women with severe mental illness, the Banyan better solutions may be found to address the complexities of poverty, mental illness, and homelessness in India. The interactive research approach and mixed methods are used to address the persistent problem of PMIH in outpatient clinics. The study focuses on understanding factors of homelessness among people with mental illness and the service needs and usage of those accessing outpatient facilities. It finds that 32.65% of women with mental illness accessing outpatient clinics reported experiencing homelessness, with low educational attainment and relational disruptions being associated with higher odds. Eliminating gender-based differences in education could be a crucial policy and practice direction to reduce homelessness risks among women with mental illness. The study examines the lived experiences of women with mental health issues in Tamil Nadu who have been treated by The Banyan. Six themes related to protective factors against homelessness were identified: resilience emerging from trauma, treatment adherence, responsibility and purpose, family and relationships, spirituality, and employment and living space. 95% felt they were not at risk of becoming homeless, indicating hopefulness about future prospects. However, the majority struggled in terms of quality of life, highlighting the complex relationship between resilience and challenges. In part 2, the study discusses the service needs of clients during the Covid-19 pandemic situation, emphasizing the need for expanding mental health interventions to include individuals with psychosocial disabilities. Social work practitioners play a crucial role in crisis intervention, providing clinical services and coordinating interdepartmental liasoning work. Key recommendations include involving trained community-level workers, involving non-government organizations, creating a single window system for all social protection measures, including mental illness as an eligibility category in disability social protection schemes, and continuing useful mechanisms implemented during the pandemic in the post-pandemic world. In conclusion, this thesis emphasizes the integration of information and reflexive practice in preventing homelessness among vulnerable individuals, emphasizing the importance of social entitlement policies, greater flexibility in support and institutionalization of practices, and exploring the experiences of men and their narratives.

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Mental health care in Karnataka: Moving beyond the Bellary model of District Mental Health Program

Cited by 4 publications

References 4 publications

Mental Health Programme in India: Has the tide really turned?

Mental Health Programme in India: Has the tide really turned?

Schizophrenia spectrum disorders in India: A population-based study

Co-creating Mental Health services that prevent a descent into Homelessness

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