Dignity in Mental Health

World Mental Health Day (October 10)  and  World Mental  Health Week (09 October  - 15 October 2016)

*Dr Smita N. Deshpande

The ideal concept of health encompasses physical, mental, social and spiritual health. Physical health without enjoying full mental health, leads to loss of social and spiritual health as well. India has a large population of people affected with mental disorders. At least twenty people per every thousand are thought to be afflicted with major mental illnesses which significantly affect health, productivity and social integration not only of the people themselves but also of their families- since stigma against mental illness is rampant. Childhood mental disorders are another untended chunk. Children with mental retardation, autism, and learning disorders often remain undetected. Suicide is another huge problem although the causes of suicide are multifactorial.

Trained mental health personnel are too few to attend to these problems. The District Mental Health Programme (under National Mental Health Programme), now integrated into the National Rural Health Mission, aims to plug this gap to some extent but the issues relating to manpower and financial shortages are yet to addressed. Contrarily, there is a paucity of jobs in this sector which leads to large scale brain drain.

Nevertheless the Government of India was always aware of the importance of mental health as part of overall health issues. India’s National Mental Health Programme is ambitious in its reach and scope.

World Mental Health Day

Encouraging positive mental health, and not just treat mental illness, has been the aim of the World Federation for Mental Health (WFMH) since its inception. The WFMH spearheaded the idea of World Mental Health Day on October 10 every year and was formed at the instance of the first Director-General of the World Health Organization (WHO), Dr. George Brock Chisholm, a Canadian psychiatrist. The driving principle of the WFMH is to ‘promote among all peoples and nations the highest possible level of mental health in its broadest biological, medical, educational, and social aspects’ as cited at their website:  http://wfmh.com.  Today through its activities such as World Mental Health Day and Week, the WFMH continues its drive to improve awareness and remove prejudice about mental disorders. India has been a voting delegate of the WFMH since its inception.

The first World Mental Health Day was observed in 1992, as a tool to draw attention to the need for mental health education, awareness and advocacy. Messages for World Mental Health Day indicate the work that still needs to be done for integrating the mentally ill into society. Messages such as ‘Dignity in mental health’ (WMHD 2015) emphasized ensuring the dignity and rights of the mentally ill. The theme for 2014 was “Living with schizophrenia”. Schizophrenia is a serious mental illness which causes significant disability, and frequently leads to stigma, discrimination and deprivation of rights.

In many countries including India, this Day and Week are observed by organising activities centred around focussing on the need for early detection, treatment, inclusion and empowerment of the mentally ill. Since mental illness deeply affects family members as well, they are also contribute in advocacy.

Mental health organizations, professionals, teaching institutions, advocates and mental health personnel undertake several activities to generate awareness about the issues relating to mental health. This year’s World Mental Health Day message is Dignity in Mental Health: Psychological and Mental Health First Aid for All.

All of us have to face traumatic situations, and many have to face crises - for instance sudden loss of a loved one, failure, sexual or other abuse, rape or accident. Immigration has led to widespread, traumatic displacement of people all over the world. India itself faces a large influx of legal and illegal immigrants displaced due to difficult life circumstances. Many Indians who went abroad for livelihoods are being sent back to an uncertain future.

Anyone facing a crisis event is vulnerable to great emotional disturbance leading to anxiety, depression, increased risk of substance abuse, increased need for care and support, social impairment and psychological distress. People facing such trauma need several different kinds of help from different sectors- police, primary health care, even teachers in schools, neighbours, and social workers in case of child or woman abuse.

In stressful situations, the first priority is of course protecting life and limb through effective first aid. But usually this needs to be supplemented with psychological or psychosocial first aid to ensure early and optimum recovery. What does such first aid comprise of?

Psychological first aid emphasizes support and practical assistance, listening without forcing the person to speak. Assessing the immediate needs and concerns of the person, appropriate social and community based help needs to be provided. Such empathetic listening and caring comes naturally to many people but others feel uncomfortable while still others may turn away or react negatively. Hence training in psychological first aid, without going into the history of antecedent events, needs to be provided immediately. Psychological first aid must have a large social and ‘reality’ based component as well- for instance ensuring safety, food and security, locating lost relatives, calling upon existing social supports for the person and so on.

The World Health Organization developed a one day training manual for psychological first aid which is widely used. In disasters, it needs to be the first response after saving life. Subsequently it should be supplemented with structured community support, care of the vulnerable population such as those at extremes of age, the disabled and mentally ill. For those with more severe issues, trained mental health care will be necessary.

Psychological first aid should be an essential component of training of disaster health workers, and of those who are often called upon in crises such as the police, firemen, or emergency health care workers. This could prevent escalation of healthcare needs and improve outcome for both survivors and workers in crisis situations.

Let us hope that this year’s World Mental Health Day succeeds in bringing this important training to the fore.