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Mental Health Services in Rural India: Challenges and Prospects


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Mental health services in India are neglected area which needs immediate attention from the government, policymakers, and civil society or- ganizations. Despite, National Mental Health Pro- gramme since 1982 and National Rural Health Mission, there has been a very little effort so far to provide mental health services in rural areas. With increase in population, changing life-style, unemployment, lack of social support and increasing insecurity, it is predicted that there would be a substantial increase in the number of people suffering from mental illness in rural areas. Considering the mental health needs of the rural community and the treatment gap, the paper is an attempt to remind and advocate for rural mental health services and suggest a model to reduce the treatment gap.
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Vol.3, No.12, 757-761 (2011)
opyright © 2011 SciRes. Openly accessible at
Mental health services in rural India: challenges and
Anant Kumar
Department of Rural Management, Xavier Institute of Social Service, Dr. Camil Bulcke Path, Ranchi, India;
Received 18 August 2011; revised 11 October 2011; accepted 10 November 2011.
Mental health services in India are neglected
area which needs immediate attention from the
government, policymakers, and civil society or-
ganizations. Despite, National Mental Health Pro-
gramme since 1982 and National Rural Health
Mission, there has been a very little effort so far
to provide mental health services in rural areas.
With increase in population, changing life-style,
unemployment, lack of social support and in-
creasing insecurity, it is predicted that there
would be a substantial increase in the number
of people suffering from mental illness in rural
areas. Considering the mental health needs of
the rural community and the treatment gap, the
paper is an attempt to remind and advocate for
rural mental health services and suggest a
model to reduce the treatment gap.
Keywords: Mental Health; Policy; Rural; India;
Services; Treatment Gap; NMHP; DMHP; NRHM
Health is “a state of complete physical, social, and
mental well being and not merely the absence of disease
or infirmity” [1,2]. Nevertheless, our health system is
pre-occupied with curative health care services and dis-
ease prevention, with little attention on social and mental
well being. Among these, mental health and well being
is the most neglected one [3,4], particularly in rural areas
[5,6]. Silence on mental health services in rural India [7]
in the National Rural Health Mission (NRHM) [8] is a
serious matter of concern. The omission of mental health
in the NRHM mission document becomes even more
serious in the backdrop of the uneven performance of the
National Mental Health Program (NMHP, 1982) [9-11]
and District Mental Health Programme (DMHP) [12]
which is operational in only 125 districts out of 626 dis-
tricts of India. With various flaws and implementation
constraints in the NMHP and DMHP [13,14], there has
been a very little effort so far to improve the rural mental
health services.
Mental illness constitutes nearly one sixth of all
health-related disorders [15]. With the population in-
crease, changing values, life-style, frequent disruptions
in income, crop failure [16], natural calamity (drought
and flood), economic crisis [17], unemployment, lack of
social support and increasing insecurity, it is fearfully
expected that there would be a substantial increase [18,
19] in the number of people suffering from mental ill-
ness in rural areas. Among priority non-communicable
diseases in India, mental illness constitutes 26 percent
share in the burden of disease and available data suggest
that there would be a sharp increase in this in coming
years [20-22]. Projections suggest that the health burden
due to mental disorders will increase to 15% of DALY
by 2020 [23]. The study by the National Commission on
Macroeconomics and Health (NCMH) shows that at
least 6.5% of the Indian population has some form of
serious mental disorders, with no discernible rural–urban
differences [24]. Epidemiological studies done in last
two decades shows that the prevalence of mental disor-
ders range from 18 to 207 per 1000 population with the
median 65.4 per 1000 at any given time. Most of these
patients live in rural areas, far away from any modern
mental health facilities [25]. The overall individual bur-
den for rural areas cannot be estimated with the available
studies. Nevertheless, considering the fact that 72.2 per-
cent of population lives in rural areas, with only about
25 percent of the health infrastructure, medical man-
power and other health resources, it may be surmised
that the number of people affected with any mental and
behavioural disorder would be higher in rural areas [26].
Despite NRHM initiatives and improvements, general
health services in rural areas are not adequate and are
struggling with infrastructural, human resources and
A. Kumar / Health 3 (2011) 757-761
Copyright © 2011 SciRes. Openly accessible at
other problems. Only 31.9 percent of all government
hospital beds are available in rural areas as compared to
68.1 percent for the urban population. At the national
level the current bed-population ratio for Government
hospital beds for urban areas (1.1 beds/1000 population)
is almost five times the ratio in rural areas (0.2 beds/
1000 population) [27-29]. There is a shortfall of 8% of
doctors in Primary Health Centres (PHC), 65% of spe-
cialist at Community Health Centres (CHC), 55.3% of
male health workers, and 12.6% of female health work-
ers [30].
The epidemiological situation and available health
service system shows that providing mental health ser-
vices in rural areas is a challenging task, which needs
infrastructural, architectural, and programmatic correc-
tion in the existing National Mental Health programme
and District Mental Health programme. Lack of trained
human resource for mental health care and treatment is
another challenge [31], considering few institutions avai-
lable for mental health professional training. Besides
these, major challenge is lack of political commitment
and realization that mental health is an important aspect
of our health system which has far reaching implication
for the development of the country.
Considering the limited or no service availability; the
treatment gap is huge in rural areas. According to one
estimate, even if all 3000 psychiatrists available in the
country are involved in face to face patient contact and
treatment for 8 hours a day, five days a week, and see a
single patient for a total of 15 - 30 minutes over a 12
month period, they would altogether provide care for
about 10% - 20% of the total burden of serious mental
disorders. Surprisingly, it is almost similar to the esti-
mated ‘treatment gap’ of ninety percent.
Barriers in seeking help in rural area are many. Major
barriers in seeking help are unavailability of mental
health services, low literacy, socio-cultural barriers, tra-
ditional and religious beliefs, and stigma [32] and
discrimination associated with mental illness. Unavaila-
bility of mental health services and lack of resources,
particularly in terms of human resources, financial cons-
traints, and infrastructure are one of major barriers
which makes access to mental health services in rural
areas more difficult. The services available in urban
areas are far and costly; and difficult to utilize and
access due to various reasons. Lack of awareness and
recognition of CMD (common mental diseases) with
prevailing stigma and discrimination is an important
issue and barrier which is closely associated with low
literacy in rural areas.
Other barriers are low political will of Central and
state governments and unclear plan of action and policy.
Another barrier is resistance to decentralization [33], and
resistance by mental health professionals and workers,
whose interests are served by large hospitals. Above all,
major barrier is difficulties in integrating mental health
in Primary Health Care. Primary health care workers are
overburdened with lack of supervision and specialist
support. Other barrier is that medical students and psy-
chiatric residents are often trained only in mental hospital
settings with inadequate training of general health work-
force and lack of infrastructure for supervision in the
Another important barrier is mental health leadership
of the country which often lacks public health skills.
Those who are in leadership positions are psychiatrists,
trained in clinical management, without formal Public
health training. Besides, the major barrier and challenge
is resistance by psychiatrists to accept others as leaders.
The people in rural areas are unable to access the ser-
vices of the qualified doctors and other mental health
professionals, where just 0.2 psychiatrists, 0.05 psychi-
atric nurses, 0.03 psychologists per 100,000 people (see
Table 1), and 0.26 mental health beds per 10,000 popu-
lations, 0.2 in mental hospital and 0.05 in general hospi-
tals (see Table 2) [34] are available for the whole coun-
Table 1. Professional per 100,000 populations.
2001* 2005**
Number of psychiatrists 0.4 0.2
Number of neurosurgeons 0.06 0.06
Number of psychiatric nurses 0.04 0.05
Number of neurologists 0.05 0.05
Number of psychologists 0.02 0.03
Number of social workers 0.02 0.03
Source: *Atlas, Country Profile, 2001. World Health Organization. **Mental
Health Atlas, 2005. World Health Organization.
Table 2. Psychiatric beds per 10,000 populations.
2001* 2005**
Total psychiatric beds 0.26 0.26
Psychiatric beds in mental hospitals 0.2 0.2
Psychiatric beds in general hospitals 0.05 0.05
Psychiatric beds in other settings 0.01 0.01
Source: *Atlas, Country Profile, 2001. World Health Organization. **Mental
Health Atlas, 2005. World Health Organization.
A. Kumar / Health 3 (2011) 757-761
Copyright © 2011 SciRes. accessible at
try. Interestingly, the number of availability of psychia-
trist has gone down during 2001 and 2005. To make the
resources equitable, India needs about 140,000 psychia-
trists whereas we have about 3000 psychiatrists and 75%
of them are working in urban areas where less than 28%
of the population lives. The government expenditure on
mental health is another concern where it spends just
0.83 percent of its total health budget on mental health
NGOs and civil society groups are involved in pro-
viding mental health service delivery and community
mental health and have done commendable job [36].
Many of them have set up day care centres, half-way
homes, long-stay homes, counselling centres, suicide
prevention centres, school mental health programmes,
disaster mental health care, and community based pro-
grammes for the mentally ill. Nevertheless, most of their
services are “extension clinics” concentrated in urban
areas with little attention on rural areas. Some of NGOs
who are doing commendable jobs are Medico-Pastoral
Association, Bangalore; Paripurnata, Kolkata; SCARF
and The Banyan, Chennai; Richmond Fellowship Soci-
ety (Bangalore, Lucknow, and Delhi); Cadabams, Ban-
galore; and Ashadeep in Guwahati. Interestingly most of
these efforts are concentrated in Southern states and in
urban areas. Nav Bharat Jagriti Kendra (NBJK), Hazari-
bagh is one of few organizations working in rural areas
in partnership with 23 NGOs in 14 districts of Bihar and
Jharkhand [37]. Some of other organisations working on
mental health in rural areas are Shant Manas Trust in
Madurai [38], and the Richmond Fellowship Society in
Bangalore [39].
Though various NGOs are doing commendable job in
their areas, their geographical and service reach is very
limited and dependent on donor support. Secondly, their
initiatives have been isolated to pockets with limited
funds and have not been supported by the government,
both at the Centre and state level [40]. Thirdly, the con-
tinuance and the quality of services is a serious concern
where the staffs lack professional training and skills.
Fourthly, we have failed to recognize, learn from their
experiences and extend these efforts in rural areas. It
emerges that these NGOs can supplement in providing
mental health services but they cannot be an alternative
to provide mental health care services in rural areas con-
sidering the need and treatment gap.
Proposed decentralization and synchronization of Na-
tional Mental Health Programme (under 11th Five Year
Plan, 2007-2012) with National Rural Health Mission is
a good opportunity and has a wider prospect [41]. We
can hope that this will ensure Primary Health Centre
(PHC) based mental health services to the rural popula-
tion. Involving and training village level Accredited So-
cial Health Activists (ASHA) is another opportunity.
Adding a module on community mental health and train-
ing ASHAs will definitely help in early detection, treat-
ment, and rehabilitation of patients in the community in
the rural areas. Presently, most of the rural people ap-
proach traditional healers (religious saints, tantriks (black
magicians), unregistered medical practitioners, and quacks)
for treating mental health problems. Considering peo-
ple’s faith in them and lack of trained professional,
training these traditional healers could help in alleviating
mental illness in rural areas. Developing short-term spe-
cial curriculum based training for medical officers is
another prospect which will help in providing clinical
services at block level.
Presently, the Government of India is providing men-
tal health services in 125 districts through District Men-
tal Health Programme under NMHP. There is need to
integrate NMHP and DMHP with NRHM Programme to
provide mental health care, services and support to each
and every individual in rural areas.
The Table 3 suggests a model to provide mental health
services in rural areas. Some of the suggestions through
Table 3. Model of mental health care and service in rural areas.
Institution Personnel Level Role
Mental Health Institution Specialist institutional care and services State level Treatment of severe mental health disorders
District Health Society Civil surgeon District level Planning, implementation, and service delivery
Community Health Centre Psychiatrist On one lakh population Treatment for common mental health disorder
Primary Health Centre Medical officer in charge Block (on 30,000 population) Counselling/identification/ referral
Community Care ASHA Village/Community Care, support, education, acceptance, and in
addressing stigma and discrimination
Self Care/Family Care Family/Community members Family Care
A. Kumar / Health 3 (2011) 757-761
Copyright © 2011 SciRes. Openly accessible at
which mental health care and services can be strength-
ened in rural areas are increasing the availability of re-
sources, improving equity in their distribution, and en-
hancing efficiency in their utilization. Besides, there is
also a need to emphasize the role of specialists in filling
the treatment gap. Building capacity of other health
workers, particularly ASHA under the NRHM pro-
gramme may help in demand generation as well as re-
ferral. Following suggestions or strategies in combina-
tion can be used for strengthening the rural mental health
care services:
1) Convergence of National Mental Health Programme/
District Mental Health Programme under National Rural
Health Mission Programme and using existing PHCs and
sub centres to provide mental health services;
2) Capacity building of Rural/registered Medical Prac-
titioners/Primary Health care doctors/ASHA workers/
teachers/Aanganwadi workers on tailor made modules;
3) Advocacy through community, social and other
bodies and involvement of religious leaders, teachers,
local community leaders with key stakeholders;
4) Targeted awareness programme using available ru-
ral media;
5) Provisioning social security to the mentally ill pa-
tients; and
6) Training for caregivers and relatives.
The rural mental health services are neglected area
which needs immediate attention considering the burden
of disease and treatment gap. District Mental Health
Programme needs restructuring and convergence within
the NRHM. The “extension clinic” approach needs to be
replaced with integration of mental health services with
general health services, particularly under NRHM. In-
volving ASHAs under NRHM is an opportunity to pro-
vide mental health services at door steps in rural areas.
Lastly, ensuring bottom up approach and community
ownership are must to achieve universal mental health
services, care and support in rural areas.
I am thankful to Prof R. Srinivasa Murthy, Prof Doncho M. Donev
and Dr. Amit Ranjan Basu for their comments on the paper.
[1] World Health Organization (1948) Preamble to the
Constitution of the World Health Organization as adopted
by the International Health Conference, New York, 19-22
June 1946, signed on 22 July 1947 by the representatives
of 61 States (Official Records of the World Health Or-
ganization, no. 2, p. 100), and entered into force on 7
April 1948.
[2] World Health Organization (2006) Constitution of the
World Health Organization-Basic Documents, 45th
Edition, Supplement.
[3] Kumar, A. (2010) Mental health services in India: A case
study of Jahangirpuri. LAP Lambert Academic Pub-
lishing, Germany.
[4] Kumar, A. (2001) Mental health in a public health per-
spective. The Bihar Times, Bihar.
[5] Thara, R., Padmavati, R. and Srinivasan, T. (2004) Focus
on psychiatry in India. British Journal of Psychiatry, 184,
[6] Meltzer, M. (2008) Mental health care in India: Pre-
scribing the right policy. Pepperdine Policy Review.
[7] Kumar, A. (2005) National rural health mission and
mental health. Health Action, 18.
[8] Ministry of Health and Family Welfare, Government of
India. (2005) National Rural Health Mission (2005-
2012)Mission Document.
[9] Government of India (1982) National Mental Health
Programme for India. Ministry of Health and Family
Welfare, Government of India, New Delhi.
[10] Director General of Health Services (1990) National
Mental Health Programme: A progress report (1982-
1990), New Delhi.
[11] National Mental Health Programme for India. (1982)
Government of India, Nirman Bhavan, New Delhi.
[12] Isaac, M.K. (1988) ‘Bellary District Mental Health Pro-
gramme’, Community Mental Health News, 11 & 12,
ICMR-CAR on Community Mental Health. NIMHANS,
[13] Kumar, A. (2005). District Mental Health Program in
India: A case study. Journal of Health and Development,
1, 24-25.
[14] Wig, N.N. and Murthy, R.S. (2009) Mental health
careneed to expand its reach. The Tribune.
[15] Pathare, S. (2011) Less than 1% of our health budget is
spent on mental health. InfoChange News & Features.
[16] National Commission on Farmers (2006) Serving farm-
ers and saving farmers, fifth and final report. Govern-
ment of India, Ministry of Agriculture, Shastri Bhavan,
New Delhi.
[17] Chatterjee, P. (2009) Economic crisis highlights mental
health issues in India. The Lancet, 373, 1160-1161.
[18] Pathare, S. (2011) Less than 1% of our health budget is
spent on mental health. InfoChange News & Features.
[19] Report of the National Commission on Macroeconomics
and Health (2005) National Commission on Macroeco-
nomics and Health Ministry of Health & Family Welfare
Government of India, New Delhi.
[20] Peters, D., Yazbeck, A., Ramana, G., Sharma, R., Pritch-
ett, L. and Wagstaff. A. (2001) Raising the sights: Better
A. Kumar / Health 3 (2011) 757-761
Copyright © 2011 SciRes. Openly accessible at
health systems for India’s poor. The World Bank, Wash-
ington, DC.
[21] The World Health Report (2001) Mental health: New
understanding, new hope. World Health Organization,
[22] Gururaj, G. and Issac, M.K. (2004) Psychiatric epidemi-
ology in India: Moving beyond numbers. In: Agarwaal,
S.P., Goel, D.S., Salhan, R.N., Ichhpujani, R.L. and
Shrivatsava, S., Eds., Mental HealthAn Indian Per-
spective (1946-2003), Directorate General of Health Ser-
vices, Ministry of Health and Family Welfare, New Delhi,
[23] Murray, C.J.L. and Lopez, A.D. The global burden of
disease. A comprehensive assessment of mortality and
disability from diseases, injuries and risk factors in 1990
and projected to 2020. (GBD Series Vol. I. Harvard
School of Public Health on behalf of the World Health
Organization and the World Bank, Cambridge, Massa-
chusetts, 1996).
[24] National Commission on Macroeconomics and Health
Background Papers—Burden of Disease in India (New
Delhi, India). (2005) Ministry of Health & Family Wel-
fare, New Delhi.
[25] National Mental Health Programme (2010) National
Institute of Health and Family Welfare.
[26] Gururaj, G., Girish, N. and Isaac, M.K. (2005) Mental,
neurological and substance abuse disorders: Strategies to-
wards a systems approach. National Commission on Ma-
croeconomics and Health Background Papers—Burden
of Disease in India (New Delhi, India). Ministry of Health
& Family Welfare, New Delhi.
[27] Yadav, K., Jarhyan, P., Gupta, V. and Pandav, C.S. (2009)
Revitalizing rural health care delivery: Can rural health
practitioners be the answer? Indian Journal of Commu-
nity Medicine, 34, 3-5.
[28] Ministry of Health and Family Welfare, Government of
India. Chapter I: Overview of the National Health Sys-
tem. In: Report: Task Force on Medical Education for the
National Rural Health Mission.
[29] Ministry of Health and Family Welfare, Government of
India (2007) Bulletin on rural health statistics.
[30] Ministry of Health and Family Welfare, Government of
India (2007) Bulletin on rural health statistics.
[31] WHO-AIMS Report on Mental Health System in Uttark-
hand, India. (2006) WHO and Ministry of Health, De-
hradun, Uttarkhand, India.
[32] Raguram, R., Weiss, M.G., Channabasavanna, S.M. and
Devins, G.M. (1996) Stigma, depression, and somatiza-
tion in South India. American Journal of Psychiatry, 153,
[33] Saraceno, B., Van, O.M., Batniji, R., et al. (2007) Barri-
ers to improvement of mental health services in low-in-
come and middle-income countries. Lancet, 370, 1164-
1174. doi:10.1016/S0140-6736(07)61263-X
[34] WHO (2005) Mental health atlas. World Health Organi-
sation, Geneva.
[35] WHO (2001) Atlas: Country profiles on mental health
resources. World Health Organisation, Geneva.
[36] Thara, R. and Patel, V. (2010) Role of non-governmental
organizations in mental health in India. Indian Journal of
Psychiatry, 52, 389-395.
[37] Nav Bharat Jagriti Kendra (2010) Community Mental
Health Programme.
[38] Shant Manas Trust (2010).
[39] The Richmond Fellowship Society (India) (2010).
[40] Patel, V. and Thara, R. (2003) Meeting mental health
needs in developing countries. NGO innovations in India,
Sage (India), New Delhi.
[41] Mental Health Programme (2010) Source: National
Portal Content Management Team, Reviewed on: 07-07-
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... Despite the economic progress made by India, it has been seen that about 80 percent of those who need mental healthcare are outside the purview of treatment. Community healthcare services in India are scarce, and mental health service providers are unevenly distributed (Kumar, 2011;Thara & Patel, 2010). The problem of service delivery is compounded by negative attitudes and lack of knowledge among the population, which prevents the timely seeking of help. ...
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... Technology skills training of community people may be an acceptable solution to avoid digital exclusion . Publicly mobilizing community resources and engaging non-profit institutions for such training and support have been extensively efficient in providing MH care via digital technology in rural areas of LMICS, including Bhutan and Nepal (Kumar, 2011;Thara and Padmavati, 2013). Our findings also infer that misinformation and stigmas spread by social media can negatively impact MH and healthcare-seeking behavior among service users. ...
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... The historical emphasis on physical health has downgraded the perceived importance of mental health (Gururaj et al., 2016). This is especially prevalent in rural India which suffers further deprivation because of the inequitable concentration of mental health services in urban areas (Kumar, 2011). Consequently, the concept of mental health is still in its infancy among the rural population. ...
Mental health literacy (MHL) is important for the prevention, early identification and treatment of mental health problems. However, its benefits have not been fully realised in rural India, which homes the majority of India's population. The current study assessed the level of well-being among rural residents and evaluated the effectiveness of a new digital intervention designed to improve MHL and well-being of rural residents. The four week intervention involved participants spending 20-25 minutes to engage with educational materials daily. The content of each week centred around a particular theme: mental health awareness, mental health disorders, lessons from positive psychology and self-help happiness strategies. Participants completed pre-test quantitative measures of well-being (happiness, life satisfaction and quality of life) and provided qualitative responses revealing their MHL level. In the post-test, participants completed the well-being measures again, elaborated their experience of the intervention and its utility during pandemic. Quantitative assessment of baseline well-being measures indicated moderate level of happiness, life satisfaction and quality of life. Qualitative responses revealed that despite having basic understanding of mental health, participants lacked knowledge that is crucial for timely detection and help seeking for mental illness. A significant improvement in happiness, life satisfaction and quality of life was observed after the intervention. Participants positively evaluated the benefits of the intervention in the backdrop of pandemic and displayed willingness to engage in similar future initiatives. The intervention appears promising in enhancing MHL and well-being among rural residents.
... Because our intervention is designed to be portable, freely accessible, and brief, it can also overcome barriers to traditional face-to-face treatment. This is critically important in India, given that many are unable to access treatment, often due to issues like cost, accessibility, and resources [7,25,26]. ...
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Although 20% of the world’s suicides occur in India, suicide prevention efforts in India are lagging (Vijayakumar et al., 2021). Identification of risk factors for suicide in India, as well as the development of accessible interventions to treat these risk factors, could help reduce suicide in India. Interoceptive dysfunction—or an inability to recognize internal sensations in the body—has emerged as a robust correlate of suicidality among studies conducted in the United States. Additionally, a mindfulness-informed intervention designed to reduce interoceptive dysfunction, and thereby suicidality, has yielded promising initial effects in pilot testing (Smith et al., 2021). The current studies sought to replicate these findings in an Indian context. Study 1 (n = 276) found that specific aspects of interoceptive dysfunction were related to current, past, and future likelihood of suicidal ideation. Study 2 (n = 40) was a small, uncontrolled pre-post online pilot of the intervention, Reconnecting to Internal Sensations and Experiences (RISE). The intervention was rated as highly acceptable and demonstrated good retention. Additionally, the intervention was associated with improvements in certain aspects of interoceptive dysfunction and reductions in suicidal ideation and eating pathology. These preliminary results suggest further testing of the intervention among Indian samples is warranted.
... The need of the hour is to ensure a grassroots approach; community ownership is vitally important to achieve universal mental health services, care and support in rural areas. [5] In this issue, we have two papers focusing on two vital areas of mental health. The first paper by Surti et al. demonstrates how homoeopathic teaching institutions can team up with NGOs and plan and implement mental health services; the study describes one such project undertaken at an old age home. ...
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... The management of the mental symptoms during menopause is conventionally with antidepressants, anti-anxiety drugs which may have side effects, Testosterone patch therapy is administrated for sexual illness where as yoga and relaxation therapy are given for physical symptoms in menopausal women [5] . menopause, such as physical changes, psychological changes, etc [6] . ...
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To evaluate the effect of Step aerobic exercises and music therapy on mental health in menopausal women. Menopausal women of selected areas of Belagavi city were screened in a door to door survey using Menopause Quality Of Life (MENQOL) questionnaire. 69 menopausal women who fulfilled the inclusion criteria were divided randomly into 3 groups Group A was administrated Music therapy, for Group B Step Aerobic Exercises was given and Group C was administrated combination of Music therapy and step aerobic exercises. All three groups showed significant changes from pre and post intervention. The p-value for Group A versus Group B between pre-test and post-test was 0.001*.For Group A versus Group C was 0.001* and for Group B versus Group C between pre-test and post-test was 0.906 which was not significant. Step aerobics, music therapy and a combination of both were equally effective in improving the mental health status of post-menopausal women. Any one or combination of them can be used to help improve quality of life in these women.
... First, there is a paucity of skilled human resources serving diagnostic services to a population of over 1.2 billion such as developmental practitioners, psychiatrists, neurologists, and psychologists (Kumar, 2011). When available, these specialists work in urban areas inaccessible to the large rural population. ...
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Autism Spectrum Disorders, hereafter referred to as autism, emerge early and persist throughout life, contributing significantly to global years lived with disability. Typically, an autism diagnosis depends on clinical assessments by highly trained professionals. This high resource demand poses a challenge in resource-limited areas where skilled personnel are scarce and awareness of neurodevelopmental disorder symptoms is low. We have developed and tested a novel app, START, that can be administered by non-specialists to assess several domains of the autistic phenotype (social, sensory, motor functioning) through direct observation and parent report. N=131 children (2-7 years old; 48 autistic, 43 intellectually disabled, and 40 typically developing) from low-resource settings in the Delhi-NCR region, India were assessed using START in home settings by non-specialist health workers. We observed a consistent pattern of differences between typically and atypically developing children in all three domains assessed. The two groups of children with neurodevelopmental disorders manifested lower social preference, higher sensory sensitivity, and lower fine-motor accuracy compared to their typically developing counterparts. Parent-report further distinguished autistic from non-autistic children. Machine-learning analysis combining all START-derived measures demonstrated 78% classification accuracy for the three groups (ASD, ID, TD). Qualitative analysis of the interviews with health workers and families (N= 15) of the participants suggest high acceptability and feasibility of the app. These results provide proof of principle for START, and demonstrate the potential of a scalable, mobile tool for assessing neurodevelopmental disorders in low-resource settings.
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Objective The main objective of this exploratory study was to investigate the overlooked perspectives and beliefs of Accredited Social Health Activists (ASHA workers) regarding a collaborative care mental health intervention (HOPE: H ealthier Op tions through E mpowerment), mental illness and the health of their rural communities. Design Semi-structured, one-on-one, qualitative interviews. Setting Seven primary health centres (PHCs) in rural Karnataka, India. All PHCs had previously completed the HOPE study. Participants 15 ASHA workers, selected via purposive sampling. ASHAs are high school-educated village women trained as community health workers. ASHAs were included if they had previously participated in the HOPE intervention, a collaborative-care randomised controlled trial that aimed to integrate mental healthcare into existing primary care systems in rural Karnataka. Interventions No interventions were introduced. Results ASHA workers mostly had positive interactions with patients, including encouraging them to attend sessions, helping to explain the topics and techniques, and checking on the patients frequently. ASHA workers were able to identify key barriers to treatment and facilitators to treatment. ASHAs claimed that their knowledge about mental illness improved because of the HOPE study, though gaps remained in their understanding of aetiology and treatment. Several expressed interest in receiving additional mental health training. Overall, ASHAs viewed the HOPE study as a necessary and effective intervention, and requested that it expand. Conclusions This paper discusses the perspectives of ASHAs who participated in a novel effort to extend the collaborative care model to their own communities. ASHA workers help maintain relationships with patients that encourage participation, and the efforts of ASHAs often aid in mitigating common barriers to treatment. ASHA workers’ beliefs and knowledge regarding mental illness can be changed, and ASHAs can become effective advocates for patients. Future collaborative care interventions would likely benefit from involving ASHA workers in community outreach efforts.
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The book highlights the Mental Health services in India from public health perspective considering preventive and curative aspects of mental health recognising the socio cultural factors in mental health services. It looks into the various conceptual issues and concerns related to mental health services in India. Author has made an attempt to understand and examine the various issues related to mental health viz., concept and scope of mental health, various dimensions and component of mental health, nature of mental health and illness, perception and cultural issues involved in understanding of mental health, theories, definitions and other issues. It also gives historical perspective of the development of mental health as a discipline and the development of the mental health services in India since colonial period. It investigates and focuses on the mental health services delivery with reference to District Mental Health Programme and National Mental Health Programme in India.
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Background Specialist mental health care is out of reach for most Indians. The World Health Organisation has called for the integration of mental health into primary health care as a key strategy in closing the treatment gap. However, few studies in India have examined medical practitioners’ mental health-related knowledge and attitudes. This study examined these facets of service provision amongst doctors providing primary health care in a rural area of Karnataka is Southern India. Methods A mental health knowledge and attitudes questionnaire was self- administered by participants. The questionnaire consisted of four sections; 1) basic demographics and practice information, 2) training in mental health, 3) knowledge of mental health, and self-perceived competence in providing mental health care, and 4) attitudes towards mental health. Data was analysed quantitatively, primarily using descriptive statistics. Results This study recruited 46 participants. The majority of participants (69.6%) felt competent in providing mental health services to their patients. However, there was a substantial level of endorsement for several statements that reflected negative attitudes. Almost one third of participants (28.0%) had not received any training in providing mental health care. Whilst three-quarters of participants correctly identified depression (76.1%) and psychosis (76.1%) in a vignette, fewer were able to name three common signs and symptoms of depression (50.0%) and psychosis (28.3%). Conclusions Integrating mental health into primary health care requires evidence-based up-skilling programs. Doctors in this study desired such training and would benefit from it, with a focus on both depth of knowledge and uncovering stigmatising attitudes towards people with mental health problems.
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The paucity of treatment facilities and psychiatrists in the Government sector has widened the treatment gap in mental health. Non-governmental organizations (NGOs) have played a significant role in the last few decades in not only helping bridge this gap, but also by creating low cost replicable models of care. NGOs are active in a wide array of areas such as child mental health, schizophrenia and psychotic conditions, drug and alcohol abuse, dementia etc. Their activities have included treatment, rehabilitation, community care, research, training and capacity building, awareness and lobbying. This chapter outlines the activities of NGOs in India. This is a revised version of the chapter in the book on mental health to be brought out by Government of India.
(from the cover) Mental disorders are among the most common and most disabling health problems worldwide. In most developing countries, however, mental disorders are an area of public health which have been neglected. Voluntary agencies have stepped in to play an important role in developing innovative models of mental health care for under-served populations. However, in many developing countries, such alternative NGO models of mental health care have rarely been documented. This volume fills this gap by describing the work of voluntary agencies in the field of mental health with the explicit objectives of documenting innovative achievements, examining the issues involved, and determining their success and viability in the Indian setting. It brings together 17 NGOs from various regions of the country who, between them, have dealt with a wide range of mental health and allied issues from severe mental disorders, autism, hyperactivity in children, and substance abuse, to trauma and violence, suicide prevention, and Alzheimer's disease in the elderly. This book may be used as supplementary reading for post-graduate courses in social work and clinical psychology, and may be of interest to psychiatrists, social workers, public health organizations, voluntary agencies and public health professionals. (PsycINFO Database Record (c) 2003 APA, all rights reserved)
India’s perspectives on mental health and standards of care have been complicated by developmental factors, resulting in recognition not upheld in practice. India is a country of particular interest due to this disparity between its rhetoric and reality, and looking at the history of mental health and the impact of these factors will help shape recommendations for improving mental health care. Mental health policy efforts and traditions of care continue to fall short of the country’s mental health care needs. Policy recommendations proposed in this paper center on community mental health care, which should and can be expanded by maximizing existing resources in the community. Increased training and education, in addition to research, should also be included in this effort. These recommendations are provided because they are cost-effective, beneficial for health, and take into account country-specific demographics to improve the state of mental health care in India.
The National Mental Health Program (NMHP) for India was the result of efforts to develop noninstitutional models of mental health (MH) care. The NMHP envisages integration of MH care with general health care and welfare activities. Since 1982, training and workshops on the NMHP have been held for MH professionals. The NMHP has been implemented in about 10 state/union territories, and financial support for the program has been included in the 7th 5-yr plan. (PsycINFO Database Record (c) 2012 APA, all rights reserved)
The rural health system of India is plagued by serious resource shortfall and underdevelopment of infrastructure leading to deficient health care for a majority of India. The differences in urban-rural health indicators are a harsh reality even today; infant mortality rate is 62 per thousand live births for rural areas as compared to 39 per thousand live births for urban areas (2007).(1) Only 31.9% of all government hospital beds are available in rural areas as compared to 68.1% for urban population. When we consider the rural-urban distribution of population in India, this difference becomes huge. Based on the current statistics provided by the Government of India, we have calculated that at a national level the current bed-population ratio for Government hospital beds for urban areas (1.1 beds/1000 population) is almost five times the ratio in rural areas (0.2 beds/1000 population).(2,3) Apart from this shortfall in infrastructure, shortfall in trained medical practitioners willing to work in rural areas is also one of the factors responsible for poor health care delivery systems in rural areas. The number of trained medical practitioners in the country is as high as 1.4 million, including 0.7 million graduate allopaths.(4) However, the rural areas are still unable to access the services of the qualified doctors. A total of 74% of the graduate doctors live in urban areas, serving only 28% of the national population, while the rural population remains largely unserved.(4) There's shortfall of 8% doctors in Primary Health Centres (PHC), 65% for specialist at Community Health centres (CHC), 55.3% for health workers (male), 12.6% for health workers (female) (2007).(5) This shortfall in human resources in rural areas is only going to increase in future, more so with corporatization and privatization of health systems. The already dwindling number of doctors in government sector and rural areas would further decrease owing to greater opportunities in private sector both in urban and peri-urban areas, and much higher remunerations.