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W.H.O and Mental Health
By Dr Shantibala
Health by the year 2000 AD has been the goal of WHO and we are
apparently aware of it. However mere absence of illness is not
health. To be healthy a person must be physically, mentally,
socially and spiritually healthy. The fact that the mental
component has all along been woefully neglected needs to be
highlighted.
In the year 2001 the World Health Organization did a special
focusing on mental health activities, the theme being 'Mental
Health - stop exclusion, dare to care'. It is indeed not a step
but a leap in the direction of mental health. Mental disorder has
no discrimination - age, sex, caste, creed, color, society or
country. It will be not hard to imagine the impact of mental
disorders in terms of psychological, social and economic
well being.
One out of every four people who seek treatment for any illness is
troubled by mental disorder that are not correctly diagnosed and
subjected to exclusion both in medical profession and the
community in not being treated. The figure of mental disorders and
the problems related to use of alcohol and drugs and other
psychotropic substances can be as high as 400 millions in the
world. Depressive disorders, schizophrenia, Alzheimer's disease,
alcohol and drug dependence, epilepsy and mental retardation being
the representative worldwide, WHO on the World Health Day (7th
April, 2001) highlighted the key concepts of 'Care' and
'Exclusion'.
The above-mentioned six disorders also reflect the gap between
available means of health care and their application for mental
disorders. The WHO's global strategies are for improving
population coverage, reaching out to the unreached and quality
psychiatric care throughout the world more so in the developing
countries. The concern is to increase awareness of mental illness
among the general public at large, the health professionals and
policy makers at about the relative significance of mental
disorders in contributing to the "global burden of disease".
The WHO, the World Bank and the Harvard University jointly developed
the measure for the burden known as the "Disability Adjusted Life
Year" (DALY) which measures the overall burden of a disease by
combining the years of potential life lost due to premature death
from the disease (mortality factor) and the years of productive
life lost due to the disability (morbidity factors) produced by
the conditions. The reality now is that the psychiatric disorders
are amongst the most important contributors to the global burden
of disease (1990). Depressive disorders, Schizophrenia, Mental
retardation, Epilepsy and Alzheimer's disease and substance
dependence accounts for 5 of the 10 leading cause of disability, which indicate the importance deserved to be addressed.
According to the World Health report, the total burden of disease mental
disorders (9.7%) rank almost as high as cardiovascular disease
(10.5%). The seriousness of the long underestimated impact of
mental problems has become clearer now and the projection of
global DALY by the year 2020 is even greater where an increase of
15% (Mental disorders) is expected. In Global disease burden, next
to Ischaemic heart disease, major depressive disorder could be the
second leading cause. According to Ustam (1999) the study of
global burden of disease has become an eye opener and mind opener
for public health.
Majority of needy population particularly those in rural areas,
small towns and slums of big cities are unable to get modern
psychiatric care who seeks public health psychiatric services
which are badly organized, under-staffed and poorly funded due to
inadequate share of government support. The rich, the well-to-do
middle class and the elite are no doubt catered by private sector
psychiatry, which have progressive services.
The relevance of social setting and cultural needs of our country
to psychiatry is important and the Asian countries are at a
disadvantage as the present day psychiatry is primarily European
oriented.
In India the philosophical methods of Gita, Upanishads and Puranas
will be a more appropriate methods of psychological treatment. The
solid Indian family support system can give better protection and
emotional support for chronically and mentally ill patients rather
than the mechanical support in the developed countries. The mental
problems cannot entirely depend on the modern science and
technology but on a blend of Indian mind, family structure and
functioning, culture and social context, which is indeed a precious
natural resource in the care of mentally ill.
The reluctance of people to seek psychiatric treatment is basically the effects of social isolation and exclusion resulting from Stigma, Prejudice and
Discrimination of mental illness and the existing outdated nature of many a mental institution in our country. Acceptance, respect and compassion can encourage people to come forward for seeking psychiatric treatment so that the afflicted can be helped
to lead a more productive life.
Appreciating the WHO's initiative in the World Health Day 2001,
7th April - "Mental Health - Stop Exclusion Dare to Care" we must
all respond positively. Let us not allow mental illness to stop
our lives and goals but help bring awareness to sensitize the
whole of the community and the medical profession. Only a
collective effort can realize the initiative of the W.H.O. It is
never too late towards a positive change.
(Courtesy: The Imphal Free Press)
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