Call for Collective Action
By Muzamil Wagay
MENTAL ILLNESS has turned out to be a next major global health challenge, making it a matter of urgent concern considering the enormous distress and burden with subsequent after effects of the COVID-19 pandemic we are witnessing. Poverty, conflicts and other humanitarian crises are closely related to mental illness and, in some cases, they lead to suicide, one of the most common causes of preventable death among teenagers and young adults. And we are not alien to these things here in Kashmir. The burden of crisis induced as a result of the political quagmire we are in ―we have been facing the burnt since long and its ill effects are quite evident. In the absence of appropriate mental health facilities for children and adolescents, the state of mental health in Kashmir has deteriorated. Children have been left powerless and unhappy as a result of the perceived danger and relentless abuse, which has halted their successful coping mechanisms and resulted in a rise in various psychological problems. Talking about the service delivery, we are way behind, more precisely behind the borderline of adequate minimum of the developed world.
Despite a multi-fold increase in mental symptoms of mental ill-health, not much attention is being paid to expand and modernize the present mental health infrastructure. In the past two decades, the only psychiatric hospital in the valley has seen a massive rise in the inflow of patients and is in no way adequate to meet the needs and demands of ever-increasing mental health cases. There is an immediate need, under such circumstances, for mental health services at all fronts and levels – be it micro or macro. The promising District Mental Health Program (DMHP) under the National Mental Health Programme (NMHP) is still in its infancy in the region and so far, no significant progress has been made regarding its implementation. Given the high magnitude of the mental health issues, lack of both pharmacological as well as non pharmacological interventions, and inadequate community-based intervention, there is an urgent need to address this serious problem. Our approach to address mental health concerns is yet to evolve beyond the conventional segregated model of psychiatric care in a setting meant exclusively for such problems. There is, in no way, a mechanism in place in the mainstream health care setting that incorporates a mental health service delivery.
Approaches and Intervention in settings
Mental health research has emerged predominantly from a health-based discourse, but has been influenced by an increasing awareness of the multiple and complex biological, psychological and social factors that shape mental illnesses (WHO). The dominant mental health care models have proven inadequate to overcome the dynamic complexities of mental illness, which accounts for nearly one-third of all adult disability worldwide. Apart from the concerns about the efficacy and safety of conventional treatments, we have been witnessing disparities in mental health service delivery to different socioeconomic classes and the lack of integration of mental health services into primary care and other medical subspecialties. It is a known fact that individuals with mental health problems often have a wide range of needs that may be social and psychological implying those requiring the services have to access not just to doctors and nurses, but to psychologists, social workers, occupational therapists and other therapists.
Designing Alternate Models of Care
We have not yet seen any significant outcome in terms of mental health care as the overriding effects of illness are ever increasing with each passing day. We have learned that quite recently when COVID hit and with how lonely we got when the lockdown was in place. The burden somehow increased and there was no mindfulness to unlock happiness within and outside. That’s where we felt that how much health, relationships, interests, mattered. The work had to be kept all aside and we just sought ways to get on the routine. The championed care models began to lose essence and we could realise that there should be in place a basic human model of care- models capable of more adequately addressing mental illness in primary care settings, taking into account complex medical, psychological, social, and cultural factors. These circumstances call for radical change in the paradigm and practices of mental health care, including improving standards of clinician training, developing new research methods, and re-envisioning current models of mental health care delivery.
Convergence and Integrated Approach
Convergence doesn’t mean just more on print and less on ground. There should be a zeal to incorporate and implement it in the settings by orienting people responsible for it. More interprofessional education and training on mental health, both in terms of its genesis and interconnectivity with physical health must be put on priority. This training must be cemented into the early basic training of all health and social care staff as a matter of urgency; that all professional bodies should make such training a requirement of ongoing professional development for their members; that staff across different disciplines should have regular opportunities to exchange expertise and information. “Better integration can help drive positive change. But in the end, this is not only about systems, it’s about people at the helm. It’s about inspiring local leaders, dedicated and energetic staff and individuals who deserve the most integrated, personalised and empowering care and support we can offer.” (National Collaboration for Integrated Care and Support, UK)
Setting of a Multidisciplinary Team
The need to establish community-based alternatives to hospital treatment and to ensure the coordinated health and social care for the severely mentally ill establishes the ‘TEAM’ as a central feature of virtually all forms of modern mental health care. The multidisciplinary team is members of different professionals working together. A team is described as a group of people with complementary skills who are committed to a common purpose, performance goals, and approach, for which they hold themselves mutually accountable. Having a forum that represents various areas of expertise is becoming increasingly important as healthcare specialisation increases and awareness about health and mental health conditions grows. Some of the benefits of multidisciplinary team models include improved clients’ health outcomes and functioning, enhanced quality of life, reduced costs, and utilization of medical services. Modern psychiatric practice calls for effective interprofessional collaboration between psychiatrists, nurses, psychologists, social workers, occupational therapists, speech & language therapists, special educators and other health service professional staff with proper consultation with patients and their significant others. It is essential to obtain the agreement of all professional staff and carers, expected to contribute to a patient’s care programme that they are able to participate as planned.” The trajectory of services would include; viewing patients in a socio-economic context, systematic view of service provision, Team-based services, long-term-longitudinal treatment perspective, and commitment to social justice by addressing the needs of children and adolescents and to provision of services where those in need are located and in a fashion that is acceptable as well as accessible. A key strength of multidisciplinary teams is that the combined expertise of a range of mental health professionals is used to deliver seamless, comprehensive care to the individual. Research supports that multidisciplinary collaboration is the most successful way to offer a comprehensive mental health service to people with mental health issues, particularly those with long-term mental health problems. We cannot oversee the reality of adopting a multi-faceted integrated approach in policy and practice, as the limitations of the intervention models that we have been using, have shadowed our results so far.
Paradigm Shift: Community Mental Health
Based on experience, there is broad international consensus for shifting from a single focus on treatment of psychological symptoms to “contextually appropriate, multi-layer systems of support that build on existing resources” (UNICEF). The community-based intervention approach is the prime model not only for comprehensively understanding the intricacies about the causality of mental health illness but also for paving the way for effective and integrated formulation and implementation mechanisms for mental health services, thereby addressing all the mental health disparities and asymmetries. Community-based intervention contributes to an increase in the relevance and outreach of the public health impact of mental health services. Such intervention also contributes to the reduction of mental distress-related social stigma and is also the strongest intervention in low economic conditions in communities. The approach ensures to create pathways to more effectively restore, strengthen, and mobilize family and community support and systems with the ultimate goal of supporting child and family wellbeing in humanitarian settings.
To achieve intended impact and outcome, the intervention strategies need to be focused by keeping in mind the diverse needs of individuals, diverse groups and communities.
Strengthening natural support systems and capitalising on community’s own knowledge and capacity prove meaningful and sustainable in helping recover and restore well-being of people. This is a more sustaining and effective mechanism to meet new challenges and be hopeful about the future.
The customised approach can be directed to the different contexts by tailoring the processes and adopting a theory of change.
This can be done by recognising the local support systems, bringing in the pool of resources at disposal, supervising the community stakeholders and building capacities of the frontline functionaries and making them a part of the process.
This emphasises more for a strengthened mechanism of multi-layered approach at the policy level and incorporating a range of service delivery protocol through a comprehensive team at place.
Views expressed in the articles are the author’s own responsibility. The content is not intended to be a substitute for professional medical advice, diagnosis, or treatment and is strictly for educational/informative purposes only
- Muzamil Wagay is a Professional Social Worker – Working on Mental Health, Disability Rehabilitation and Development policy. He currently works as Program Coordinator at Child Guidance and Well-being Centre, Institute of Mental health and Neurosciences (IMHANS)- Kashmir
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