Mental health to take centre stage

THIRUVANANTHAPURAM: With one in eight people in the state’s population having mental ailments requiring psychiatric intervention, the state mental health authority has launched a massive screening exercise at the grassroots level for early detection of common mental disorders. Ashwash Clinics have been set up in 170 family health centres which were earlier known as Primary Health Centres (PHCs). Of the 2500 cases screened at these centres during the last three months, nearly 400 were detected with minor to major mental ailments. “Doctors at the family health clinics see patients using diagnostic criteria known as PH Q 9 questionnaire. The WHO approved questionnaire objectifies and assesses degree of depression severity,” said Dr Kiran, Director State Mental Health Programme.

Those detected with psychiatric problems are examined by a multi-disciplinary team led by a psychiatrist and comprising a psychologist and social worker which visits Aswash centres on a designated day every month. Apart from treatment, those with positive signs of mental disorder are also subjected to counselling. As people with mild depression symptoms like loss of appetite, lack of energy and sleeplessness are examined by general physicians at the family health centres, they need help from psychiatrists and psychologists subsequently. Experts say the local level screening is significant from Kerala’s point of view as the state has significantly high rate of lifestyle diseases including diabetes, blood pressure and cardiac ailments. Such patients are more prone to depression which can also aggravate their health condition. As a doctor put it; “A person who had a heart attack could get another one if he is severely depressed.” “It’s a good initiative as the clinics facilitate the treatment of stigmatised mental disorders along with other common health issues in a public health setup. Moreover it will also help prevent people from going to quacks and those claiming to provide magic remedies,” said Kochi-based psychiatrist C.J. John.

According to him, depression was the most untreated and under treated mental health issue. If untreated, nearly 15 per cent people might develop suicidal tendencies at a later stage. In that sense, the initiative at the level of the family health centre is quite significant. Moreover, it would be easier for women to seek treatment for depression at the family health centres. Female depression is the most under-reported as women suffer silently within the four walls of their homes.
Experts say though the number of people seeking treatment for depression has increased in the state over the years, there is still a large section which is outside the system. Initiatives like Ashwash are encouraging people to seek medical support at an early stage which is heartening. “I think the biggest takeaway of Ashwash centres is that it has taken the first line of treatment of mental disorders to the periphery level. Till now, psychiatric treatment including first line, was available only in speciality centres or private clinics. Getting treatment at a speciality care centre is difficult for a majority of the people,” said Dr Anish N R K, psychiatrist,  Mental Health Centre Peroorkada.

The most common mental disorder in the state is depression while those above the age of 40 years were more prone to common mental disorders. However, higher education, employment and better income were protective factors. The biggest problem in psychiatric treatment is the huge dropout rate of patients. There are many factors behind this problem; reluctance to seek treatment and continue regular treatment. In case of mild depression, a patient might require regular medicines for six months to one year. “Many patients who feel better within a week are tempted to stop the medication or come under social pressure to discontinue. In case of schizophrenia, the treatment duration could go up to two years. There could be three to four therapeutic stages,” said Dr Kiran. Doctors say depression especially psychotic depression is hundred per cent curable and to a great extent preventable. Hence people should not hesitate to get such conditions treated promptly. A recent survey conducted by the Kerala State Mental Health Authority and National Health Mission in five districts revealed  that 1 in every eight persons (12.43 per cent) had mental illness requiring psychiatric intervention.

Many in the field say that depressive disorders and other mental health issues are widely prevalent and cannot be managed by psychiatrists alone. Most cases of depression can be managed by non-specialist health care providers like primary care doctors and other medical specialists. Hence there is need for investing in training of non-specialist health care providers. The government has plans to expand the screening progamme further by extending Ashwash clinics to 200 more family health centres across the state. However, experts say along with screening, the government should also come up with a concrete policy on threatening mental disorders. A State Depression Control Programme is needed at the earliest if the government is serious about achieving the UN Programme on Sustainable Development Goals which seeks to control depression and bring down the suicide rate from 24.9 per lakh population to 16/lakh by 2030.