|Gujarat Mental Healthcare Policy|
|Thursday, 18 August 2011 16:27|
Health is a state of complete physical, mental, and social well-being of an individual. Mental health thus is an integral part of health care system. The government of Gujarat has taken a number of initiatives to strengthen the health system. Through a network of primary, secondary and tertiary care institutions, the state meets growing healthcare needs of large segment of population. NGOs and private sector also play significant role in provision and financing of health care.
Primary health care system is not yet adequately geared to address mental health problems. Through the National Mental Health Programme and state level initiatives, the DoHFW has initiated a number of steps to strengthen the mental health care system in the state. Inadequate institutional for training and education in Gujarat have rendered various interventions in this sector ineffective. Iner alia there is a need for strategic and focused emphasis on mental health programme to enhance effectiveness of programme interventions. The recent developments in this field also suggest having more strategic and focused approach to address the emerging issues. Some of these provide
The inclusion of mental aspects of health was reflected, for the first time, in the Ninth Five-Year Plan when a separate scheme for ‘Strengthening of Mental Health Services’ was included. The Tenth Five-Year Plan envisages continuation of this emphasis; in particular, it aims to ‘integrate mental health with rural health care and provide special care for mental disorders of all types by scientific surveillance and identification’.
The approach and strategy in the area of mental health, takes into consideration the guidelines contained in the National Health Policy (NHP)–2002. Specifically focusing on mental health, the NHP under Para 2.13.1 states that mental health disorders are actually much more prevalent than is apparent on the surface. While such disorders do not contribute significantly to mortality, they have a serious bearing on the quality of life of the affected persons and their families. Sometimes, based on religious faith, mental disorders are treated as spiritual affliction. This has led to the establishment of informal mental institutions as an adjunct to religious institutions where reliance is placed on faith cure. Acute/chronic mental disorders may require hospitalisation and treatment under trained supervision. Mental health institutions are woefully deficient in physical infrastructure and trained manpower. NHP-2002 will address itself to these deficiencies in the public health sector. ”
The NHP recommends setting up of a network of decentralized mental health services for ameliorating the more common categories of disorders (section 184.108.40.206). The programme outline for such a disease would involve the diagnosis of common disorders, and the prescription of common therapeutic drugs, by general duty medical staff.” In regard to mental health institutions the NHP further envisages for in-door treatment of patients and proposes the upgrading of the physical infrastructure of such institutions at Central Government expenses so as to secure the human rights of this vulnerable segment of society (section 220.127.116.11).
Mental illness burden
Private expenditures account for about 90 per cent of total spending on mental health. The financial burden on the population due to mental disorders is very high, even though only a small percentage of the people in need of mental health services receive appropriate care. The public health delivery system in Gujarat needs considerable support and strengthening to address the mental health needs of the population. An important measure would be to integrate the private sector into the overall mental health policy of the state to ensure access and quality care at affordable costs. Mental health service delivery at present is structured more towards treatment and care of severe mental disorders (SMDs) whereas the need is to develop a delivery structure which also focuses on common mental disorders (CMDs).
Some of the specific challenges faced by mental health sector include:
This policy provides a framework for evolving and implementing strategies to develop MH sector in Gujarat in the context of these challenges. Many of the emerging strategic responses require sustained and long-term efforts. Given the fact that the institutional environment for MH is weak, considerable effort is required in creating learning experiences which will contribute to developing an improved and effective structure to programmes and interventions in this sector.
The treatment of mentally ill persons is governed by the Mental Health Act, 1987 which repealed the Indian Lunacy Act of 1912. The act came into force from 1st April 1993. The state government notified, in May 1993, the Additional Director, Medical Services, as the licensing authority under the Mental Health Act, 1987. State Mental Health Rules have been notified by the Central government in December 1990. The State Mental Health Authority has been set up.
Gujarat was the first state in the country having a Mental Health advisor to advise the State in all matters relating to mental health. It was at the initiative of the state government that District Psychiatry units for out-door patients were set up in eight District centers in 1980-81. 3.3 A pilot project for providing mental health services at the district level was in operation in the district of Sabarkantha before a district general psychiatric unit was set up in 1999-2000 in Navsari with the assistance of Central government.
A major landmark in the implementation of the mental health programme has come from the guidelines of the Supreme Court in the Sheela Barse case and the publication of a report on ‘Quality Assurance in Mental Health’ by the National Institute of Mental Health and Allied Sciences (NIMHANS) at the instance of the National Human Rights Commission (NHRC).
The government infrastructure in the mental health sector comprises four hospitals for mental health at Ahmedabad (317 beds), Vadodara (300), Jamnagar (50) and Bhuj (16). These hospitals provide psychiatric care, especially in long-term care of the mentally ill. Psychiatry departments of (government) teaching hospitals at Ahmedabad, Vadodara, Jamnagar, Surat, Rajkot and Bhavnagar provide additional 157 psychiatric beds. Psychiatric beds are also available in the teaching colleges run by municipal corporations at Ahmedabad and Surat; and at private medical colleges at Karamsad and Surendranagar.
At the district level, the government health delivery system consists of honorary psychiatrists who visit district hospitals 2-3 days in a week, with a mental health worker who maintains records. Currently, such services are available in six of the twenty five districts: Bharuch, Panchmahals, Sabarkantha, Junagadh, Mehsana and Banaskantha.
A more comprehensive programme (Centrally sponsored National MH Programme), including activities for sensitization and training of medical and paramedical staff at the primary health centres and community health centres has been initiated in Navsari district from 1999.
There are only a handful of clinical psychologists – only two in the government sector both located in the medical colleges. Five posts of clinical psychologists – four for hospitals for mental health; and one for Navsari District Hospital – have been sanctioned but are vacant for want of suitably qualified candidates. Paramedical staff (psychiatric nurses and occupational therapists) too is less than a handful in the state. There are about 60 psychiatric hospitals / nursing homes in the private sector. There are about 150 psychiatrists in private practice in the state.
Very few civil society organisations are involved in mental health. There are a variety of organisations offering counselling services as a part of their other activities. Many of them have a team of volunteers working under the guidance of qualified MH professionals.
Guiding principles for policy development
The guiding principles for drafting the MH policy have been as follows:
Challenges for the Gujarat MH sector
Analysis of the existing situation in Gujarat indicates that a variety of promising initiatives in the field of MH are already taking place, both in rural and urban settings, by government, non-government and private practitioners. These initiatives cover all levels of service provision as well as prevention and promotion activities. Even though these activities are small scale and uncoordinated, they provide valuable insights for future developments. Looking at the mental health sector in Gujarat, there are a number of priorities for improving the system of MH service delivery. These are described below.
Matching of service demand and delivery It is estimated that there are 2.8 million adults with common and severe mental disorders at any point of time in Gujarat. Each year about 11000 new cases of schizophrenia are added to the mental illness burden. The population burden of all severe mental disorders is more than four times the number of persons affected by schizophrenia. Co-morbidity with physical disorders is common. The recent events of natural disaster and communal violence in Gujarat have significantly contributed to the number of reported cases of depression, trauma and anxiety.
Taking into account the current burden of mental illness in the state, there is an urgent need to augment services. At present the services are provided in a limited number of settings and focus mainly on in-patient and out-patient care. Promotion, prevention and rehabilitation are hardly covered. Table 1 provides a mapping of MH services in various settings (public, private, NGOs etc.). The MH sector not only needs to urgently improve and expand the existing facilities, but also develop new modalities of service delivery to adequately serve the demand among those needing service.
Human Resource Development
The MH sector requires a major effort in capacity building. Current services are insufficient to cope with the growing demand. Motivational levels, both in private and public sector, are too low. Human resources need to be strengthened in three ways: quantity, quality and organisation structure. The numbers of MH professionals will need to increase. This will be for all types of professionals:
MH component in other related courses (MBBS, nursing courses, educational courses, child development courses) needs to be strengthened.
The increase of professionals in the MH services leads to increased availability of services and an increased opportunity to introduce the multidisciplinary approach.
Merely increasing the number of MH professionals will not improve the services. Quality standards also need attention:
These quantity and quality improvements need a large effort in training and onthe- job support programmes. This training capacity is to be strengthened and to a certain extent newly to be developed. In Gujarat there is a need for an organisation specifically focusing on MH capacity development.
Service providers in the communities
This first contact is varied in approach: it can be a conventional medical doctor, an ISM- practitioner or a less qualified healer, like religious healers. There is desirability of liaison with traditional healers in order to reduce harmful practices, encourage referral when appropriate, and enhance community support to people with mental illness. From a policy perspective, directions will need to be formulated how to involve these various types of service providers into the MH sector. The policy will also encourage more professional regulation amongst traditional healers, so that charlatans are extruded from their system.
Care giver involvement
The creation of organisations of care givers would result in having valuable discussion partners for service providers and administrators. They would also be effective partners for community based NGOs and advocacy groups. In this way, institutional linkages with care givers would be established. From the side of the MH professionals attention is needed to create an attitude to actively involve care givers in the treatment process, to assist them in organising care givers to support each other and to promote contacts with advocacy groups.
Financial resources/government budget/private spending: Allocations to the MH sector are less than one per cent of the total health sector budget. Most of these funds are being spent on hospital and institutional services which cater specially to severe mental illnesses. Also, most of these funds are just sufficient for meeting salary expenditures and not much is available for other programme components. Lower budget allocation limits the availability of services within the government system. Under these circumstances people in need of services depend on the private sector. About 90 per cent of total expenditure in the MH sector is out-of-pocket expenses. Financial protection mechanisms are not available to the populations in general.
The cost of seeking services is high. This is because the treatment is long term in nature. Because of limited availability of MH facilities, patients and their relatives have to travel long distances and transportation is one significant component of the total costs. The policy observes that with the focus on community based approaches financing of services need to be addressed as the risk of financial burden shifts and increases on communities. More decentralisation of public sector programmes, effective involvement of NGOs, and public-private partnerships are broad strategic directions to take care of these problems in this area.
Mental health is a topic with medical, social and economical aspects. Therefore it is not restricted to the Department of Health and Family Welfare. Other departments involved would be:
These other departments have programmes which involve mental health related areas. Coordination mechanisms need to be established to streamline policies and programmes. At the operational level, linkages are needed between MH professionals and other services who are in contact with people with mental disorders, like judiciary, police and various NGOs.
Focus on prevention and MH promotion
For effective MH promotion, indigenous coping mechanisms will form an important basis for programme development. For policy and programme development it is essential to involve citizens and MH service consumers in finding out the most suitable mechanisms for health promotion and stigma reduction.
7.2 Table 2 proposes how the MH Policy proposes to structure the sector in terms of provision of services in various settings. Table 2 provides the desired mapping of service providers. The starting point for service delivery improvement will be the patient’s help seeking behaviour, which implies a strong community focus. This community focus will be the core of the government’s policy towards MH sector improvements. The policy goal is formulated as:
Table 2 proposes how the MH Policy proposes to structure the sector in terms of provision of services in various settings. Table 2 provides the desired mapping of service providers. The starting point for service delivery improvement will be the patient’s help seeking behaviour, which implies a strong community focus. This community focus will be the core of the government’s policy towards MH sector improvements. The policy goal is formulated as:
Develop effective, efficient and adequate provision and mechanisms for community based mental health including promotion, prevention, treatment and rehabilitation, supported by a network of primary, secondary and tertiary services in public and private sectors.
Important indicators for achieving policy goal are described as follows:
Community based mental health approaches will have two focus points: delivery of services and care giver support. Services will focus on alternative ways of care, treatment and prevention like rehabilitation, multidisciplinary work and capacity building. Care giver support focuses on topics like providing information, advocacy and mutual support counselling the care giver, training, economic support, help lines etc. As the result of improved community based MH services, it is expected that prevalence and incidence of mental illnesses will decrease.
This policy document provides policy directions which would lead to an improved mental health situation in the state. Resource constraints – financial and human – necessitate choices and the government envisages implementing various interventions in phased manner. One of the foremost and important task is to augment the supply of human resources in this sector and secondly, improving access or new modalities of service delivery. Development of any intervention in this sector has to focus on these issues. At the same time the following criteria will guide the implementation process:
Through this policy the government will address the following areas to strengthen the mental healthcare sector in Gujarat
These areas are elaborated below. Together they form the framework for action for the years to come. The details and strategic action plan is elaborated in Appendix 1. The implementation arrangements for this framework are presented in the next section.
Service Provision: The delivery of MH services will need substantial improvement. Priority strategies are:
For the public sector
For the Private sector
For the role of care givers
Institutional development and finance: Strengthening the institutional environment of the MH sector is a long term effort. Priority strategies are:
Towards institutional mechanisms
For human resource development
For MH research
Organisational linkages: Coordination and cooperation among key players in the MH sector is crucial for effective improvements. Priority strategies are:
For integration of MH in general health
For coordination with other departments
Boundary Conditions: There are a number of interfaces with other areas which lie outside of the control of the MH sector itself. Still these need to be addressed in order to achieve the policy goal. Priority strategies are:
For the interface with law
For ethical practices
Based on these policy directions a detailed strategic action plan has been provided in Appendix 1.
The priority directions formulated in the previous section provide numerous opportunities for developing pilot projects within the broad policy goal and the conditions for sustainable sector development. Separate monitoring and evaluation research will provide information as to efficiency and effectiveness of the projects.
In order to make informed decisions on place and type of services, a condition would be to develop a documentation system on topics like patient flows, patient backgrounds, service quality and outputs, and community needs. This documentation will need to be established within the next three years.
With reliable and quality data on projects and documentation, annual policy discussions will be held. Results of these discussions will lead to possible policy adjustments and to decisions on wider scale implementation and the regulatory framework.
Organisation and management: In order to facilitate innovations in the MH Sector, the government is in the process of establishing an organisation which will stimulate, fund, and guide innovation projects in the sector. This organisation - the Gujarat Foundation for Mental Health and Allied Sciences – is registered as a not-for-profit company. The mission of this Foundation is formulated as follows:
The Gujarat Foundation for Mental Health and Allied Sciences aims at managing and facilitating the process of developing and designing appropriate interventions and advocating policies and laws in mental health sector which ensure availability and accessibility of mental health services especially to most vulnerable and under-privileged sections of the population with gender focus. This will be done by strengthening of capabilities and capacities in mental health services by facilitating, promoting and stimulating effective partnerships with civil society. The Foundation also aims at promoting the use of ethical mental health knowledge and best practices in the general health care and integrating psycho-social development efforts for the purpose of improving the well being of people.
The main tasks of the MH Foundation will be:
Until the MH Foundation is operational, the government has requested IIM-A to carry out the Foundation’s task as the managing agent of pilot projects.
Role of the government in sector development
Development of regulations: The government will set up mechanisms to:
Setting up a public information base: Information for the public is very scanty in the health sector in general and in the MH sector in particular. Various stakeholders, including care givers, do not have adequate information about the provision of services and what they are expected to do when they are faced with a problem. Moreover, the consumer will need information on where to go when in need. The government will set up an information data base on service providers so that patients and care givers acquire the necessary information timely.
Facilitate decentralization: The government has a number of implementation responsibilities in MH, especially in the Mental Hospitals, the Teaching Hospitals and the Psychiatric Wards of the General Hospitals. In the past few years initiatives have been taken to work towards more autonomy for health organisations, leading to increased efficiency and staff motivation. The government will seek ways to continue with providing increased autonomy. The government will also take action in facilitating decentralised management of schemes sponsored by the federal government.
Inter-sectoral coordination: There are a number of institutions which are directly or indirectly involved in the delivery of MH services. Many of the activities carried out by these institutions, both inside and outside the health sector, have a mental health component. The government will, in the coming years, set up a mechanism for coordination between MH services from various government agencies. In order to carry out this stewardship role, and to facilitate policy implementation, the government will take actions to create a separate Directorate for Mental Health under the Additional Director of MH.
Resource mobilisation and allocation
DoHFW also need to focus on reorienting existing budget expenditures and reallocating some of these resources for effectiveness of programmes. For example, if 1 in 3 adults in primary care are suffering from CMDs and they are being treated albeit not explicitly for mental illnesses, then one-thirds of primary care resources spent on adults in PHC setting are already in mental health care. It is now a case of reorienting these service providers by sensitising, training and supervision. Finally, cost effectiveness of interventions will add to availability of resources.
Strengthening the ethics of care
The formulation and enforcement of ethical guidelines is crucial for quality of care in mental health services.
Towards formulating an appropriate environment for ethical practices, the government will initiate steps in collaboration with mental health professionals to define and implement minimum standards and best practices guidelines. For developing these guidelines the following would be included:
In order to ensure that ethical practices are followed, the government will strengthen the mechanisms and functional linkages with the regulatory system. One of the areas the regulations can focus on is promoting mechanisms for institutional ethics. The government will initiate steps to set up an institutional review board which can look into the standards, ethics and other humanitarian aspects of mental health and laws related to mental health. The professional bodies have an important role to play in strengthening these mechanisms.
Providing information on best practices is another critical factor in strengthening the quality of services. IEC strategies in the MH sector will address this. Consumer associations play important role in disseminating the information and these bodies will be strengthened. The government will also strengthen the mechanism to develop professional codes and start the process of formulating patient bill of rights. Implementation and strengthening of various mechanisms promoting ethical practices would require research and consultation to finalise the proposed strategies.
The broad action plan would be as follows:
Addressing stigma and ignorance
The government will strengthen the PHC/CHC services to handle routine mental illness cases. For this purpose the government will develop community based approaches and this will be done in collaboration with the NGOs and private sector. In the initial phase, interventions would focus on strengthening counseling services and developing mechanisms which help in identification of risk cases. Over a period of time these facilities will be equipped to handle psychiatric emergencies through appropriate referral. Decentralisation of MH services will be vigorously pursued.
Various health facilities which provide MH services need to develop out-reach services and collaborate with other out-reach services already being provided under other health sector programmes. This would also facilitate integration of mental healthcare services in general health. The facilities immediately to start these outreach programmes are the hospitals for mental health, psychiatry wards of teaching hospitals, and district hospitals. All district hospitals will be equipped to provide mental healthcare services. Human resources are a major constraint in developing effective service delivery. In the short run, DoHFW will issue appropriate guidelines which would enable these facilities to hire mental health professionals on a contract basis.
Granting autonomy to hospitals for mental health (HMH) would improve both effectiveness and efficiency of services. Other facilities such as psychiatry departments of teaching hospitals should also be provided adequate autonomy which gives them flexibility to hire personnel. National mental health programme (NMPH) is an important step towards developing and implementing community based approaches. However, the performance of this programme has also suffered because of inadequate autonomy and the way the programme has been structured. The programme has also suffered because of poor monitoring and lack of programme guidelines. DoHFW will review the NMHP structure and develop appropriate monitoring systems.
The government will focus on and develop appropriate interventions which ensure that caregivers can assume their roles effectively. These will include psychoeducation about the illness, strengthening coping skills and family counselling and support. They will be provided more information on case handling. A programme focusing on providing awareness and training in coping skills needs will be developed. Appropriate financial support mechanisms will be developed to provide support.
In order to strengthen their involvement, Department of Health and Family Welfare in collaboration with the Social Justice and Empowerment will consider developing and designing a spectrum of services to reduce the burden on the family as well as disability in the patient. The Department of Health and Family Welfare will set-up inter-sectoral coordination mechanism to develop appropriate interventions. Interventions in this sector should focus on promoting setting up crisis intervention centres, 24-hour helpline and short-term shelters as well as DoHFW can consider developing and designing a spectrum of services for reduction of disability such as day care centres, sheltered workshops, half-way homes, and long term residential facilities. Increasing budget allocation to MH sector · State government to allocate more resources to the MH sector at PHC/CHC and district levels · Develop plan for raising resources from GoI under NMHP · Explore and develop resources mobilisation from various sources Strengthen the efficiency of existing allocations · Examine the existing allocations and reprioritise the allocations · Allocate resources for sensitisation and reorientation at various levels to improve efficiency of existing allocations Strategising design and development of interventions · Developing cost effective interventions · Presentation to various donors. Welldesigned interventions should interest donors and the private sector.
There are various other areas of concern, which need to be addressed to strengthen the role of family caregivers. One of which is being to have a legal regime which recognises the disabilities, induced by mental illness. And consequently provide proactive support to mainstream the concerns of both the caregiver and the person with mental illness. In 1995 the mental illness was recognised as a disability in the Persons with Disability Act. This inclusion did not yield major benefits as till recently mental illness was not considered a measurable disability like blindness or other disabilities. However, in case of mental illnesses WHO as well as the Indian Psychiatric Society have set standards for disability measurement. The initiative such as the International Disability Exchanges and Studies (IDEAS) should help us addressing the concerns with respect to persons with mental disorder. There is need to balance the hardship induced by constant re-evaluations with the fear of extending services to the undeserved. Family caregivers have also been asking for the explicit inclusion of mental illness in the National Trust Act so that state support may be available for their wards after them. Currently only mental illness, which coexists with other disabilities, stands included as multiple disability. The government will initiate steps towards implementing these measures. 15.5 From a rehabilitation angle other advocacy issues which merit attention are: work opportunities, self-employment and reservations in government jobs, sheltered workshops and occupational therapy. A major role can be played by various offices such as the Disability Commissioner's Office, the Social Justice and Empowerment Department and the Department of Health and Family Welfare etc. As suggested the Department of Health and Family Welfare will constitute an inter-sectoral committee to look into these coordination issues.
Strategies towards private sector
The government has an important role in ensuring that the private sector grows with the public goal in mind. This can be done through public-private partnerships. For ensuring effective partnerships, the Department of Health and Family Welfare will develop an appropriate incentive system; ensure there is mutual trust across agencies and develop appropriate institutional mechanisms which bring various stakeholders together. One of the prerequisites for these partnerships will be developing an effective regulation and accreditation system. Licensing is an important way to regulate the private sector. The objective is to ensure basic minimum quality of services and reduce variation in quality and costs.
The other prerequisite for a healthy development of private sector involvement is emphasising continuing professional education. In order to ensure this, the government will strengthen institutions responsible for education programmes.
Given the wide diversity of providers, there has to be strategic planning framework which ensures that services are not duplicated across different settings. The government will develop strategic planning framework so that duplication of services are minimised.
There is need to develop a plan to integrate traditional healers with the main stream. The government will develop appropriate guidelines so as to ensure that their roles and responsibilities are limited to providing and maintaining village MH information, help CMDs through counselling and refer SMDs through referral pathways. They will be encouraged to provide adequate cooperation in detection of risk cases. It is important that for effective planning they are registered. Registration system will be put in place for this purpose.
Human resources and capacity strengthening at various levels
Training facilities do not exist and significantly limit the availability of trained manpower for immediate future. At the same time, initiatives such as district level MH programmes remain less effective in the absence of performance based monitoring mechanisms. The government will take appropriate steps to strengthen the training and education of mental health professionals at all levels. This would start with recognised programmes of mental health professionals in clinical psychology and nursing. At graduate level, psychiatry modules will be strengthened. Post-graduate education in psychiatry will be reoriented to make multidisciplinary work more relevant.
Hospitals of MH can become nodal agencies for developing training material and imparting training programmes. Human resource systems will be made performance oriented so that there is no training loss and there is adequate monitoring at implementation levels. This will be done by developing an appropriate health information system which includes data on utilisation of MH services. In order to promote the effective use of multidisciplinary approaches, an appropriate working environment will be created where MH professionals can use each other’s expertise.
Work-place environment is an important determinant of performance and in need of increased attention. The government will take steps to update the basic infrastructure.
Human resource policies would give adequate emphasis to interventions which help increase research capacities in the mental healthcare sector. The staff will be encouraged and given adequate support to develop collaborative national and international programme
Strengthening role of NGOs
The capacity strengthening of NGOs in the area of mental health is very critical to promote the role of NGOs in this sector. The government will facilitate developing structured training programmes which include training on counselling skills and referral pathways for NGOs. The experience of pilots elsewhere will be used to develop knowledge base on implementing community based interventions. These capacity strengthening programmes for NGOs will also include: (a) visit to these places which would help these institutions to develop insight into community based interventions and (b) addressing various legal-ethical issues.
The routine components of MH will form part of the PHC/CHC delivery system. The referral pathways need to be strengthened to make these efforts more effective. The government will also consider and develop strategies to integrate mental health in other systems of medicines by involving ISM practitioners to increase service provision at village and taluka level. Developing this intervention will need training of ISM practitioners and other community level staff in areas of counselling, identification, and referral. Currently DoHFW has a School Health Education programme. Psychological aspects of health need to be integrated with this programme. Other programmes where the MH components can be included are RCH and STD/HIV/AIDS. DoHFW will develop appropriate institutional mechanisms which ensure integrating mental health aspects in various programmes. Strategies to integrate mental health in other programmes would also ensure provision of mental healthcare services catering to vulnerable groups. For example, the Department of Women and Child Welfare has programmes such as family counselling centres and ICDS (integrated child development scheme). By adding mental healthcare components in these programmes, the overall gains can be significant. Similarly, the Department of Social Justice and Empowerment has programmes on de-addiction and child welfare activities. In the same way the Department of Education can include components of positive mental health at school education level. Strengthening of counselling services at school level is an important means for early detection and prevention. There are many unknowns in this area and the government proposes to initiate pilots to gain understanding and experience and develop initiatives which can be up-scaled later.
An important instrument in this process is the "UN Principles for Protection of Persons with Mental Illness and the Improvement of Mental Health Care". Implementing these in the local context would involve mooting amendments to existing legislations; constructing new legislations such as a Right to Rehabilitation Act; and challenging existing laws and practices through class action and public interest petitions. The legal framework will help us in this direction.
It has been experienced that lack of research and documentation in mental health law has been a block in examining the local context. It is necessary to document the various legislative and adjudicative efforts in Gujarat, encompassing comparative legal studies, and research on state relevant rules, notifications, case records, and schemes. There is also a need to form a coalition or network of partners that will deliberate upon local needs in the mental health law, amendments to rules, utilisation and adjudication. The government will encourage increasing the interaction of legal players, disability administrators, NGOs, patient groups, carer groups, consumer adjudicators and activists. Appropriate forums would be created for this purpose. Such interactions will assist in placing mental health law reform on the agenda of diverse groups. Against the context of low awareness in the area of mental health law, the government will suggest developing pilots to prepare training curricula for various stakeholders including police and the judiciary. Going by the present motivation of legal actors, building local training capacities in this area would be an important future agenda of this policy.
Given the complexity of the MH sector and the action plan which needs to be developed based on various strategic directions as outlined above, the Mental Healthcare Office of the Department of Health and Family Welfare, Government of Gujarat will need considerable strengthening. This will be necessary in order to ensure: (a) promotion of public private partnerships and formalising mechanisms for these partnerships, (b) developing regulatory structures and capacities, (c) strengthening the role of professional bodies, (d) information and IEC, and (e) intraand inter-sector coordination.
Developing and organising the mental health platform, where the participants/organisations can discuss and advise on mental health policy and strategic issues, can strengthen the sector improvement efforts. The sector also needs to introduce measures which stimulate the formation and strengthening of self-help groups, support groups, and advocacy groups. The Mental Healthcare Office of the Department of Health and Family Welfare can play pivotal role in this process.
Stimulate MH Research
|Last Updated on Tuesday, 10 January 2012 16:26|
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