Mental health service in unequal world

This invited talk was delivered on the occasion of world mental health day. This session covered the power wheel, Maslow concept of needs, vulnerable community and their mental health status, and the session ended with a positive note of successful stories of community mental health care.

1. Dr. Rajeev Kumar MSW (TISS, Mumbai), M.Phil., (CIP, Ranchi), Ph.D. (IIT Kharagpur) E-mail: [email protected] Delivering mental health services in an unequal world

2. An unequal world We live in a world, divided into multiple strata: caste creed nationality, race, gender, political ideology and many more. These strata are unequal in terms of resources, rights, and many other privileges . And this is the bone of all contentions. There is struggle either to survive or to gain power 10/12/2021 ©Dr.Rajeev Kumar 2021 2

3. Adapted from Sylvia Duckworth's wheel of power The root of an unequal world: Needs and struggles 10/12/2021 ©Dr.Rajeev Kumar 2021 3

4. Unequality of health in an unequal world 10/12/2021 ©Dr.Rajeev Kumar 2021 4

5. Mental health and privilege status Mental health is an inevitable component of over-all health and well-being, and no component of health exist in isolation, and so as mental health. Regarding mental health care and treatment, there is a huge gap between “haves and have not” (privileged and under privileged communities). I don’t mean to say, people of affluent classes don’t suffer from mental health issues. They have their own needs, conflicts, and issues. But in this session, our main focus on highlighting mental health issues of underprivileged communities. 10/12/2021 ©Dr.Rajeev Kumar 2021 5

6. Mental health in broader perspective BPSS model (Sulmasy, 2002) 10/12/2021 ©Dr.Rajeev Kumar 2021 6

7. Underprivileged communities and vulnerability to poor mental health 10/12/2021 ©Dr.Rajeev Kumar 2021 7

8. BPSS model and vulnerable communities Vulnerable communities and mental health issues Responsible factors Farmers suicide Economic system Victims of terrorism affected areas Political unrest Mental health of refuges International political dispute Mental health of hidden population Public policy Victims of natural disasters Natural factors Migration and mental health Economic system 10/12/2021 ©Dr.Rajeev Kumar 2021 8

9. Farmers suicide: A neglected mental health issue Bomble & Lhungdim (2020) conducted a study in farmers’ suicide prone area of Vidharbha (Maharashtra) and found majority of farmers were having symptoms of mental distress, anxiety, depression, somatic symptoms, and insomnia. The reasons for their mental distress are low repay capability, high debt, monsoon failure, drought, lack of better price, and exploitation by middlemen ( Chetna , 2016) 10/12/2021 ©Dr.Rajeev Kumar 2021 9

10. Farmers’ suicide in India 10/12/2021 ©Dr.Rajeev Kumar 2021 10

11. Further on farmers suicide 10/12/2021 ©Dr.Rajeev Kumar 2021 11

12. Relation between poverty and mental illness 10/12/2021 ©Dr.Rajeev Kumar 2021 12

13. Political unrest and mental health Ni et al. (2020) political unrest such as riot, insurgency, terrorism pose reveres impact on mental health. Especially females and people of lower socioeconomic status are vulnerable to the poor mental health. Comer et al. (2016) studied that youths who are exposed to terror attacks and media content of terrorism often suffer from PTSD symptoms. 10/12/2021 ©Dr.Rajeev Kumar 2021 13

14. Kashmir terror scenario and mental health issues (Dar & Deb, 2020) The day to day situation in Kashmir : curfew, strike, search operation, crackdown are uncongenial to the people of Kashmir. A common people of Kashmir have fear psychosis because of volatile situation. Especially women are raped and widowed. Many of them suffer constant anxiety and depressive symptoms. And available mental health services are negligible. 10/12/2021 ©Dr.Rajeev Kumar 2021 14

15. Mental health of Kashmiri women ( Wani et al. 2016) 45% of people in Kashmir show symptoms of poor mental health. A study conducted between widowed and half widowed women (whose husbands are disappeared and not confirmed dead). Because of uncertainty, half widowed women exhibit poorer mental than clearly declared widowed women. 10/12/2021 ©Dr.Rajeev Kumar 2021 15

16. Vulnerable youths of Northeast states of India (Kumar et al., 2017 ) a sizeable number of y ouths in northeast states (Manipur, Mizoram, and Nagaland) whose boundary shares with Myanmar indulged in drug abuse and HIV infection. They show poor mental health symptoms. Because of cross-border human-trafficking and drugs. Commercial sex workers and drugs are easily available and young people fall in trap of drug abuse and unsafe sex 10/12/2021 ©Dr.Rajeev Kumar 2021 16

17. Inside Maqboolpura - The Village Of Widows And Orphans 10/12/2021 ©Dr.Rajeev Kumar 2021 17

18. Homeless population vulnerable to drug abuse 10/12/2021 ©Dr.Rajeev Kumar 2021 18

19. Migration and mental health 10/12/2021 ©Dr.Rajeev Kumar 2021 19

20. Mass exodus of migrant workers during lockdown-1 10/12/2021 ©Dr.Rajeev Kumar 2021 20

21. Migration and repercussion on health and mental health Most of HIV/AIDS infected people are either migrant workers and long distance truck drivers. Most of them are less educated. Because of poor awareness, they indulge in unsafe sex in their local sex network and get infected (Kumar et al., 2017). Most of the HIV infected people consume alcohol more often (Kumar et al., 2020). Anxiety , depression, and suicidal tendencies are the common symptoms among people infected with HIV (Kumar et al., 2021 ). 10/12/2021 ©Dr.Rajeev Kumar 2021 21

22. From the studies we discussed, we can come up with a conclusion, how the vulnerable communities fall in trap of high risk behavior which affect their mental health, and form such vicious cycle. 10/12/2021 ©Dr.Rajeev Kumar 2021 22

23. A ray of hope: Some success story of community mental health programme in India 10/12/2021 ©Dr.Rajeev Kumar 2021 23

24. Before we embark on community mental health, we need to break these vicious cycles, which are our barriers. 10/12/2021 ©Dr.Rajeev Kumar 2021 24

25. Dava-Dua Project in Gujrat Dava-Dua project in Gujarat is an example of a combination of “magical-religious ailment” and “modern psychiatric interventions” for the treatment of mental illness. The project provides psychiatric treatment for those who are visiting a Mira Datar Dargah of Unava (one of the Taluka of Sabakantha District) for a cure, making psychiatric services not only accessible but also advocating fair treatment of psychiatric patients by sensitizing and training faith healers . (Pandya et al., 2019) 10/12/2021 ©Dr.Rajeev Kumar 2021 25

26. Mobile technology-based programs Systematic Medical Appraisal, Referral and Treatment (SMART) mental health project in Andhra Pradesh The George Institute for Global Health's SMART Mental Health program—a digital mental health application for screening, management, referral and treatment of depression, stress and suicidal risk in rural patients through primary health center in Andhra Pradesh revealed positive treatment outcomes https://www.georgeinstitute.org.in/projects/smart-mental-health-cluster-randomized-controlled-trial 10/12/2021 ©Dr.Rajeev Kumar 2021 26

27. NIMHANS ECHO model Tele-psychiatry and mobile telepsychiatry for reaching out to vulnerable communities for the early detection and treatment of psychosis is an effective approach to reduce treatment gaps . Tele-mentoring based on NIMHANS ECHO model for consultation, training, and education is effective not only for building the capacity of mental health professionals but also conducting regular review meetings with district mental health programme staff. 10/12/2021 ©Dr.Rajeev Kumar 2021 27

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29. R eferences Bomble , P., & Lhungdim , H. (2020). Mental health status of Farmers in Maharashtra, India: A study from farmer suicide prone area of Vidarbha region .  Clinical epidemiology and global health ,  8 (3), 684-688. Brenes , G. A., Danhauer , S. C., Lyles, M. F., Hogan, P. E., & Miller, M. E. (2015). Barriers to mental health treatment in rural older adults.  The American Journal of Geriatric Psychiatry ,  23 (11), 1172-1178. Chethana , B. (2016). Determinants of Farmers’ Suicide in India-A State Level Analysis.  Research Journal of Humanities and Social Sciences ,  7 (3), 193-197. Comer, J. S., Bry , L. J., Poznanski , B., & Golik , A. M. (2016). Children’s mental health in the context of terrorist attacks, ongoing threats, and possibilities of future terrorism.  Current psychiatry reports ,  18 (9), 1-8. Dar, A. A., & Deb, S. (2020). The volatile situation in Kashmir and its impact on the mental health of common people. In  Upholding Justice  (pp. 152-168). Routledge India. Housen , T., Ara , S., Shah, A., Shah, S., Lenglet , A., & Pintaldi , G. (2019). Dua Ti Dawa Ti : understanding psychological distress in the ten districts of the Kashmir Valley and community mental health service needs.  Conflict and health ,  13 (1), 1-11. Kumar, R., Suar, D., & Singh, S. K. (2017). Regional differences, socio-demographics, and hidden population of HIV/AIDS in India. AIDS Care , 29 (2), 204–208. https://doi.org/10.1080/09540121.2016.1211605 Kumar, R., Suar, D., & Singh, S.K. (2021). Biopsychosocial-spiritual model: Predictors of medication adherence, coping, and resilience in HIV/AIDS. Journal of Health and Religion (first revision submitted). Springer Nature Publication. Kumar, R., Suar, D., Singh, S. K., & Bhattacharya, S. D. (2020). Why do AIDS Sufferers on Antiretroviral Therapy Die Early?—Evidence from Jharkhand in India. In  Race, Ethnicity, Gender and Other Social Characteristics as Factors in Health and Health Care Disparities . Emerald Publishing Limited. pp. 199-216.  https://doi.org/10.1108/S0275-495920200000038015 Ni, M. Y., Kim, Y., McDowell, I., Wong, S., Qiu , H., Wong, I. O., ... & Leung, G. M. (2020). Mental health during and after protests, riots and revolutions: a systematic review.  Australian & New Zealand Journal of Psychiatry ,  54 (3), 232-243. Pandya, A., Shah, K., Chauhan, A., & Saha , S. (2020). Innovative mental health initiatives in India: A scope for strengthening primary healthcare services.  Journal of family medicine and primary care ,  9 (2), 502 Wani , M. A., Mir, M. S., Sankar , R., Khan, Z. Z., & Rakshantha , P. (2016). Impact of prolonged deprivation on mental health of widows and half-widows in Kashmir Valley.  Mental Health: A Journey from illness to wellness , 211-220 . https://www.ruralhealthinfo.org/toolkits/mental-health/1/barriers https://www.indiatimes.com/news/india/the-story-of-maqboolpura-the-village-of-widows-and-orphans-punjabdrugcrisis-256499.html 10/12/2021 ©Dr.Rajeev Kumar 2021 29

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