The call for scaling up of mental health services in South Asia where more than a fifth of humanity live has never been stronger (Isaac, 2011). Providing mental health for all, is a lofty ideal. The reality though may be in bridging the treatment gap for common mental disorders and major mental and neuro-psychiatric disorders that impose a huge burden on society (Thirunavukarasu and A Shyam Sundar, 2011).
From a research standpoint, bridging the treatment gap is also integrally linked to bridging the evidence gap. Research is essential to generate the evidence that can be applied to practice. Most studies are done in high-income countries, and the finding are not directly relevant to our populations that have vastly different ethnographic, demographic and socio-cultural variables.
Thus there is a growing requirement for a cadre of researchers to monitor trends, to assess the health burden and develop novel cost-effective, sustainable and equitable models of care in the region.
South Asia is home to more than a fifth of humanity. Of the 6.8 billion global populations, more than 1.6 billion live in the 8 countries of South Asia. South Asia is the poorest region on the earth after Sub-Saharan Africa. South Asia is also a region of great contrasts. During the past couple of decades, the region has witnessed rapid social and economic change. Mental, neurological and substance use related disorders account for a major share of the burden of diseases in the South Asian countries. This paper describes issues related to mental health in South Asia and traces the historical development of mental health services in the region. The paper also provides an overview of the current situation of mental health services in the region and speculates about what is needed in the future.
Abstract: Recent estimates have demonstrated that mental health problems cause considerable morbidity and burden on individuals and society. Despite this, a large part of the suffering population worldwide does not receive adequate treatment, especially in the less developed nations. The nations belonging to the SAARC conglomeration share the twin problems of increased burden of mental illness and inadequate resources. In this article, we review the current resources available in the region and suggest that the way forward is to actively collaborate in developing and disseminating information; policy and service development; advocacy and research.
Mental and behavioural disorders affect more than 25% of people at some time during their lives. Around 20% of all patients seen by primary health care professionals have one or more mental disorder. People should access mental health services closer to their homes, thus keeping their families together and maintaining their daily activities. Mental health services delivered in primary care minimize stigma and discrimination, and remove the risk of human rights violation. However, common misunderstandings about the nature of mental disorders and their treatment have contributed to the neglect of mental health services. Despite the potential to successfully treat mental disorders, only a small minority of those in need receive such treatment. The common misunderstandings are:...
History of mental health services in Nepal
Hospital-based mental health services
Psychiatric services remained virtually unknown in Nepal till 1961. Unlike other countries where the mental asylum first marked its presence in the care of mentally ill, mental health services started in a general hospital setting in Nepal. The first psychiatric OPD service was started in 1961 at Bir Hospital (General Hospital), Kathmandu, when the first psychiatrist of Nepal returned after completing his DPM from Great Britain. A 5-bedded inpatient unit was established in the same hospital in 1965, which was further strengthened to 12 beds in 1971. In 1972, a 10-bedded neuro-psychiatric unit was established in the Royal Army Hospital, Kathmandu. In 1976, Father Thomas Gaffney started a rehabilitation center for Nepali drug abusers. During 1983-84 a number of non-governmental organizations were started in the field of mental retardation and drug abuse....
Historical background
The concept of mental illness is an ancient one found in Ayurvedic medicine that prevailed in Sri Lanka and India over 2000 years. Organic and supernatural causes were considered as aetiological factors of mental illnesses and the treatment methods were based on those causative factors (Neki, 1973).
After the British colonized Sri Lanka in 1796, they recognized the need for a modern western system of approach for mental illness and in 1839 Governor Mackenzie introduced an ordinance to establish lunatic asylums. The mentally ill patients were housed in a leprosy asylum in Hendala during this period. A building of a separate asylum in Borella close to the city of Colombo was started in 1846 (Wambeek, 1866) and patients from Hendala Leprosy asylum was transferred to Lunatic asylum Borella in 1847. As this hospital was overcrowded, soon many mentally ill people were imprisoned in jails throughout the island. The asylum provided protection and occupational therapy as the main mode of treatment.
The Borella asylum became increasingly overcrowded over the years and was an extremely unhealthy environment for the habitation of the mentally ill. Even though the need existed for a long period, addition of new accommodation or building a new asylum were delayed due to many barriers under the British colonial administration. After much debate steps were taken to build a new asylum in Cinnamon Gardens Colombo. The new asylum which was opened in 1884 became overcrowded within a period of one year (Carpenter, 1988)....
Abstract: Factors causing delay in initiation of appropriate treatment at the first instance vary from region to region depending upon socio-cultural profile, education, attitude of family/society towards mental illness, perceptions, myths, beliefs, stigma attached with psychiatric disorder, availability/accessibility of psychiatric services & previous experience of receiving psychiatric help. There is also a significant role of care providers in deciding the pathways to psychiatric care. Studies regarding help seeking behaviour and attitude toward mental illnesses and services which primarily determine the pathway of care have been carried out mainly in developed nations.
The authors discuss their view that awareness modifies the cultural myths regarding psychiatric disorders. Comparing two studies regarding help seeking behaviour, one done recently and another carried out three decades back at Lucknow, the authors conclude that even though India, like many other developing nations has made considerable progress with regard to mental health care provision, the faith healers are still the first care provider for the majority of psychiatric patients. This pathway then leads to local medical practitioner, general physician and then may be a psychiatrist. There are however, instances where care seekers might revert back to faith healers or may simultaneously be seeking help from modern as well as traditional methods of therapy.
Hence, active learning from the experiences of people requiring treatment for the first time is necessary to assist service providers to purposefully plan for more effective gate-ways or path ways to mental health services...
Abstract:
Objective: To assess knowledge, attitude and competency among mental health care
professionals working in primary care.
Method: Fifty mental health care workers in groups of two participated in the study. Both
groups received training for 5 days. Structured pre-test and post-test questionnaires were used as assessment instruments.
Results: On the pre-test, the mental health workers scored 65%. On the post-test after receiving
five days primary mental health care training, they scored 74%.
Conclusion: It was concluded that health personnel in or linked to primary health care facilities
when trained, can better recognize, assess and manage mental disorders (General practitioners,
Paramedical staff and Lady Health workers) and refer if necessary..
