NATIONAL MENTAL HEALTH PROGRAMME

IS IT DOING ENOUGH TO ABOLISH THE STIGMA OF MENTAL ILLNESS IN OUR COMMUNITY?

India is one of the countries which launched mental health programme as early as 1982,keeping in view the heavy burden of mental illness in the community and the absolute inadequacy of mental health care infrastructure in the country to deal with it. My article is about NMHP,Is it doing enough to abolish the stigma of mental illness in our community? The Aims and objectives of the programme include To provide proper mental health care to all, particularly to the most vulnerable and underprivileged group of population. Integration of mental health with primary health care through NMHP. Eradicating stigmatization of mentally ill patients and protecting their rights through regulatory institutions like the central mental health authority and state mental health authority. Many people would not be aware of the accident which took place in August 2001 exactly 18 years after implementation of NMHP.

This happened in our own nation INDIA ,that too in our very prosperous Tamilnadu in a small place called Erwadi of Ramanathpuram district where in 28 mentally ill patients were accidentally killed in a fire accident that took place in Erwadi dargah.This happened in a mental asylum where,the inmates were tied with chains and kept in semi illuminated,ill ventilated small rooms and there was no sufficient toilet facilities and the food provided to the inmates were not nutritious and inadequate in quantity.Both the sexes were kept in the same room. According to the report presented by Mr. N.Ramadas single member commission of inquiry under commissions of inquiry act 1952, the occurrence took place in the early morning at about 5.00 a.m.Therefore by that early hours, nobody would have had access to that area. Police registered the case and took up investigation and examined villagers nearby and ultimately concluded that the cause of fire was only an accidental one caused by fall of burning chimney on the thatch of the shed .25 persons out of 43 were charred to death on spot and 3 were dead the next day at Government hospital, Ramanathapuram.The reason for the death of 25 mentally ill patients was that they were fettered with chains and tied in poles during burning so they could not escape. The rest of the patients were escaped, as they were not chained. During that time the caretakers of the said home concentrated in rescuing their personal belongings without taking steps to rescue the chained mental patients by breaking their chains. The entire shed was gutted in few minutes. They were not only kept in chains, but also tied in poles. Therefore they could not be rescued. The people in the adjacent home assert that they at first ignored the cries and calls of the patients because they usually shout at nights. When addresses of the deceased individuals were checked to hand over the dead bodies.Many were found bogus and false. This is the rate of stigmatization of these poor souls. The fundamental human rights enshrined in Article 21 of the constitution includes the RIGHT TO LIVE WITH HUMAN DIGNITY and right to health. Supreme Court has ruled that maintenance and improvement of public health is one of the obligations that flow from article 21 of the constitution. The mentally ill have the Fundamental human right to receive quality mental health care and basic human living conditions. The mentally ill persons deserve the

privileges enjoyed by any other human being. Society, of course for its protection should not place such persons under care of restrain for their own sake or for the sake of society at large. Duty is cast on the community to preserve, protect and promote their interest. Environment facilities are to be provided. Right to be treated humanely and live a life of dignity is imposed. It is not charity but mandatory. All persons with mental ill or who are being treated as such persons shall be treated with humanity respect for the inherent dignity of the human. It forbids the discrimination on grounds of mental illness. It guarantees to every mentally ill person civil, political, economic, social status or membership of a cultural or political values or religious group. Mentally ill patients are entitled to appropriate treatment, rehabilitation and a right to community and family life. The attitude of society towards persons afflicted with mental illness must be changed considerately and it should be realized that no stigma should be attached to such illness as it is curable, particularly when diagnosed at an early stage. Thus the mentally ill persons are to be treated like any other sick persons and the environment around them should be made as normal as possible. ARE MENTALLY ILL PATIENTS CONSIDERED HUMAN? If yes, what about our duty in preserving their rights? Werent they stigmatized in 2001, after 18 years of implementation of national mental health programme.So,What has gone wrong? It is clear from the above incident that NMHP failed to attain one of its most important goals Eradicating stigmatization of mentally ill patients and protecting their rights I think this is the time to think over the reasons for the failure of NMHP. The main reason for the failure of NMHP is Poor commitment of the government, psychiatrists and community at a large and more emphasis is made on curative services and preventive measures are largely ignored. The complete lack of training to manage common psychiatric conditions seen in general medical settings is a major flaw in the

curriculum of India. The inability to recognize common psychiatric symptoms by primary care physicians and nurses often ends up in dismissal of the patients complaints as unimportant or management using benzodiazepines and vitamins. Psychiatrists usually prefer the safety of concerned institutions rather than moving into community. They favour referrals and consultations to transfer expertise to primary care professionals. Basic medical and nursing education needs to be skill based to produce competent practioners.The current specialty based medical education has become a knowledge based information transmission system. The role of Mass media in educating people about mental health awareness is nowhere when compared to TB dots and Anti HIV campaigns. The wide media publicity and public outcry is needed to bring awareness on mental health. An advertising campaign must be set up to destigmatise mental illnesses. Five radio spots and five TV spots in 12 languages are running (said to be running!!!)At present at a cost of 6.83 crores.This must be improvised.

World mental health day is celebrated on October 10th of every year. The day promotes open discussion of mental disorders, and investments in prevention, promotion and treatment services. This year the theme for the day is Depression: A Global Crisis. Depression affects more than 350 million people of all ages, in all communities, and is a significant contributor to the global burden of disease. Although there are known effective treatments for depression, access to treatment is a problem in most countries and in some countries fewer than 10% of those who need it receive such treatment. By 2020, depression is expected to be the second largest illness in the world and NMHP is an awesome plan to prevent it. The success lies in our hands to participate and make this plan A DREAM COME TRUE