Mental health is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, and work productively and fruitfully. The concept of mental health has been discussed in the ancient Ayurvedic treatise on childhood diseases, disabilities in Sri Lankan medical chronicles and literature, Jathaka’s stories dealing with the life of Buddha and also well attested in the sermons of the Prophet Muhammed. There are principles for integrating mental health into primary health, several myths, scientifically proven successful ventures due to intervention carried out for babies who were at high risk. There are well founded preventive strategies for mental illnesses and the role of communities in rehabilitations. A number of justifications are presented in support of integrating mental health into primary care, the tasks that lie ahead of primary care services and benefits of well-organized programs of primary health care.
There are several myths about mental health and mental retardation that need to be addressed and the masses need to be educated so that the myths do not become realities, like perceptions are taken as facts.
The common myths are as follows:
- Mental Retardation(MR) is a hereditary problem.
- Bad deeds in previous life of parents cause MR.
- MR is caused by pregnant and lactating women not following restrictions on food.
- MR is infectious.
- Brain operations can cure MR.
- Marriage can cure MR.
- Children with MR become completely normal when they grow up to be adults.
- MR adults have sexual control and pose a danger to others.
- In fact, adults with MR are sexually more inhibited than their normal counterparts. On the contrary many such people are victims of sexual abuse.
- MR children are incapable of learning anything and so everything has to be done for them.
- MR children should not be made to cry for any reason or should not be disciplined in any fashion.
Items on facts
There is no known medicine, herbal preparation or substance to ‘cure’ MR! In fact, there are no specific diagnostic tests to confirm causal association of the various mental illnesses, leaving less scope for confirmatory cure. Presently prescribed medicine mostly reduces the symptoms and gives temporary relief provided the patient complies with the treatment. It is also imperative that the multiple causes like biological, psychological, environmental factors too are addressed.
Importance of early intervention
Following is a very important study conducted in Hyderabad itself which compares the outcome of early intervention and no intervention. “One good example of early intervention for at-risk babies is the UNICEF-funded project conducted by the Andhra Pradesh Association for the Welfare of Mentally Retarded, in Hyderabad, India. All babies born in a large hospital were screened for risk factors for delayed development, such as very low birth weight, birth asphyxia, birth trauma, persistent jaundice, convulsions and congenital anomalies. Intervention was carried out for 410 babies who were at high risk. Most of them belonged to low socioeconomic class. Intervention was conducted at home, utilizing the “home visitor” model, along the lines of the Portage Project. During their weekly visits, the trained home visitors educated the family members in child health care, provided support and guidance, taught them the skills of early stimulation, and helped them to access medical services. The results at the end of three years were very positive. Only 6.8% had persistent developmental delay, compared to 12% in a group of children in whom intervention was not carried out for a variety of reasons.”
Primary prevention strategies
Primary prevention refers to a set of approaches that reduce or eliminate of the risk of MR in the community. Knowledge of causes of MR can help to reduce number of cases by at least 25% by practicing primary prevention. There are many methods of primary prevention of mental illnesses:
- Improving the nutritional status of the community as a whole.
- The girl child needs special attention, as it could affect the offspring of these children in future.
- Universal iodization of salt to prevent Iodine Deficiency Disorders.
- Administration of folic acid tablets to reduce the occurrence of neural tube defects.
- Nutritional supplementation during pregnancy, focussing on intake of calories and iron.
- Assure that the child is completely immunized.
- Avoiding early pregnancy before the age of 21 yrs and over 40 years, to minimize the risk of Downs Syndrome.
- Spacing between pregnancies to help the mother to nutritionally replenish herself before the next pregnancy.
- Avoiding exposure to harmful chemicals and substances including alcohol, nicotine and cocaine during pregnancy, especially early pregnancy. Failed abortions are caused by chemicals often administered by quacks, using harmful medicines. All pregnant women should inform their doctors about their pregnancy status;
- Health education about healthy practices during pregnancy and child-rearing.
- Measures to reduce lead and environmental pollutants that can impair brain development.
Communities can play a very important role in the rehabilitation of those affected by mental or physical disorders. There is an urgent need to establish and strengthen community based rehabilitation programs with the following objectives:
- to increase the awareness of the community and to sensitize it to issues and bring about a positive attitudinal change;
- to facilitate bringing patients and their families into the mainstream;
- to mobilize community resources and enhance community participation in building the required services;
- to establish accessible, available and affordable services for the majority of people within the community itself;
- to ensure that these people and their families have a say in how the services are run, and
- to promote ownership of the programs by the community itself so that they continue even without external aid or support
Justification for integrating mental health into primary health
It is high time that mental health program becomes an integral part of primary health care (PHC) centers throughout the country. The present status of the PHCs leaves a lot to be desired to even approach meeting the minimal needs of majority of India’s population who are primarily living in rural areas. The severe shortage of competent medical doctors, allied health professionals, infrastructure and ready availability of essential medicines as well as even basic diagnostic equipment could make the availability of mental health professionals a luxury. In spite of this pathetic situation presented above, there are several good reasons for integrating mental health into primary health as given below.
- The burden of mental health is great.
- Mental and physical health problems are interwoven
- The treatment gap for mental disorders is great.
- Access for primary health care of mental health is enhanced.
- Primary care for mental health promotes respect for human rights.
- Primary care for mental health is affordable and cost effective.
- Primary care for mental health generates good health outcomes.
The tasks ahead
Following are the basic essentials for providing mental health services in the PHCs.
Early identification of mental disorders.
- Treatment of common mental disorders.
- Management of stable psychiatric patients
- Referral to higher level when required.
- Mental health promotion and prevention
Benefits of well-organized PHCs
The need of the nation in health care in general and mental health in particular is to have access to competent care which is affordable as well as acceptable. Early treatment and primary prevention methods like creating awareness and sensitizing both the providers and beneficiaries need to become reality instead of promises and plans gathering dust in the offices of the bureaucrats awaiting release of funds to fulfill the lofty pronouncements and the pressing needs of the millions to lead mentally healthy lives.
The Honorable Prime Minister of India proclaimed that “ache din ayengay” in his election speeches. The masses are anxiously waiting for those days with the hope that where there is a will, there is a way. Let us hope that the promised “ache din” will arrive soon for one and all to lead a mentally healthy life.
“The roots of mental illness” SCIENCE WATCH, AMERICAN PSYCHOLOGICAL ASSOCIATION
Primary Care: Clinics in Office Practice Volume 34, Issue 3, September 2007, Pages 571–592,Mental Health
MOHFW, GOI, Five Years (2009-2014) Achievements and New Initiatives
MOHFW, GOI, National Mental Health Program.