INTEGRATION OF MENTAL ILLNESS INTO COMMUNITY
BASED REHABILITATION PROGRAMMES

DISCUSSION LED BY:
Mohan Isaac, Department of Psychiatry, NIMHANS,
Bangalore - 560 029, India.
Ph: 6642121

Psychiatric disorders as a cause of disability are grossly underestimated all over the world, just as they are in India. In recent years however, there has been a significant growth in all aspects of psychiatric care in the community, through a growth in operations of the private sector and the NGOs. During this phase there has also been a growth in training facilities for personnel to be employed in mental health services outside the mental health sector. These sectors, such as social welfare, education and so on, have recently become more interested in mental health services.

Pilot projects in community mental health services were started in India by 1975. They have subsequently been integrated into the primary health care system. A specialised programme called National Mental Health Programme was also initiated in 1982. Community based mental health rehabilitation services however, did not expand fast enough, because of many difficulties. Firstly, the stigma of mental illness prevented these persons from coming forward to seek help. Because of the same reason, they did not organise themselves into self-help groups to demand for services. At the policy level, mental illness was only recently classified along with other disabilities by the Government of India, making it difficult to access resources, and as a result the established CBR programmes did not include these people in their programmes. Thus, at present, the only programmes that exist for mentally ill persons in the community are limited to identification of cases and medical treatment. Yet, there are not even enough places to train personnel, if they are needed by CBR programmes to rehabilitate mentally ill persons in their projects.

In the current situation, the primary need is to sensitise the multi-disability CBR programmes regarding the potential of community based mental health services. This process reduces the stigma for the decision makers in CBR, and gives mental health rehabilitation strategies equal priority with other disabilities. It results in initiation of programmes that are realistic and need based, and that are likely to give rise to tangible benefits. Similarly, availability of information regarding the limits of such services, and the levels of success that they can achieve, will bring forth better operational plans that are more cost-effective.

There are also some special qualities of the Indian population, that require consideration before planning an operation of community based mental health rehabilitation services. They are the rural nature of the Indian population, their relative lack of geographical mobility, the role of extended families, the availability of community resources and the need to stress vocational aspects in rehabilitation. There are other aspects like the relative paucity of pilot projects in this area, the difficulty of replication of projects managed by highly motivated individuals, problems of staff burn out, the burden on the family due to the disability, sustainability of the programmes and the scarce availability of resources, that need consideration. Even though community based mental health rehabilitation services are in their infancy in India, they are likely to produce tangible results in the Indian milieu, when they expand further in this country.

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Friday Meeting Transactions
Associate Publication of Asia Pacific Disability Rehabilitation Journal
Vol.1 No.2 1999

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