Concept Paper on Promotion of Community Mental health in Kanniyakumari District

Submitted to
INTERNATIONAL FEDERATION OF RED CROSS AND RED CRESCENT SOCIETIES IFRC P.O.Box 372 17 chemin des Crets Perit Saconnex Geneva Switzerland

1. INTRODUCTION Community mental health services will lessen social exclusion, says WHO. The World Health Organization (WHO) signaled the urgent need for countries to provide a network of community mental health services at its Global Forum for Community Mental Health (Geneva, 30-31 May 2007). For the first time, WHO invited people living with mental disorders to attend the Forum, sending a message to countries that it is important to give a voice to this excluded group to claim their rights and secure their participation in society. There are nearly 54 million people around the world with severe mental disorders such as schizophrenia and bipolar affective disorder (manic-depressive illness). In addition, 154 million people suffer from depression. People living in developing countries are disproportionately affected. Mental disorders are increasingly prevalent in developing countries, the consequence of persistent poverty-driven conditions, the demographic transition, conflicts in fragile states and natural disasters. At the same time, more than 50% of developing countries do not provide any care for persons with mental disorders in the community. Viable options available to communities to improve the lives of people living with mental disorders and exercise their rights to community-level detection and treatment of mental disorders include: Integrating mental health care within the primary health care system; Rehabilitating long-stay mental hospital patients in the community; Implementing anti-stigma programmes for communities; Initiating population-based effective preventive interventions; and Ensuring full participation and integration of people with mental disorders within the community. Community mental health services (CMHS) vary depending on the country in which the services are provided. 2. NEED FOR THE INTERVENTION 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. The mental health of a community is adjudged by indicators like: rate of suicide, homicide, alcoholism, substance abuse, rape and eve-teasing. In Kanniyakumari district, reports indicate an increasing trend in suicide: Registered Cases of Suicide YEAR 2003 2004 2005 2006 MALE 234 297 321 195 FEMALE 135 121 142 76 TOTAL 349 418 463 271

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(Up to July) Source: District Police Office, Nagercoil. While more men commit suicide, the attempted suicide is high among women. Often men choose crude ways to commit suicide. One should also take into account the un-reporting and under reporting. The below given figures indicate the total sale of liquor in the government outlets in Kanniyakumari district: 1.04.2004 to 31.03.2005 1.04.2005 to 31.03.2006 1.05.2006 to 30.11.2006 ` 2,01,15,55,780 ` 2,51,38,97,445 ` 1,90,68,98,444

(Source: District Manager, TASMAC, Nagercoil.) In 2010, the total sale was ` 499,12,00,000. The Daily Thanthi, a vernacular paper dated July 8, 2011 reports that Kanniyakumari district has 147 wine shops and during the first half of the year, the total sale of liquor was ` 279 crores. During the month of June alone the sale of liquor was ` 48,62,00,000. Analysis of the figures shows that the average sale per day is ` 6,126,049.2, and the per capita expenditure on alcohol per day is ` 3.6, which is very high. Similarly, violence against women and eve teasing are on the alarming increase. TYPE OF CASES 2001 2002 2003 2004 2005 2006 (Upto July) 3 17 94 1 14

Dowry death 5 3 4 1 Cruelty by husband / relative 29 29 50 54 40 Immoral traffic act 314 274 185 147 251 Rape 6 10 11 3 13 Molestation 27 43 22 22 15 (Source: District Police Office, Nagercoil.)

The coastal community is known for alcoholism. The men and male youth are susceptible to alcoholism. Suicide and substance abuse are increasingly affecting the youth. Addiction causes self-defeat, frustration and depression which further raises alcohol and drug dependence. To prevent the youth from these, regular intervention to promote mental health is needed. Kanniyakumari district faces a unique problem of deserted mentally ill or mentally retarded or disoriented aged. People with psychiatric, severe neurotic and serious geriatric problems are deserted in places like Kanniyakumari, Sucidnram and Nagercoil by the tourists and pilgrims from other parts of the state and country. As part of the National Mental Health Programme, in Kanniyakumari District, the Medical Officers, Nurses and Sanitary Inspectors are trained on identification of mental illnesses at the rural area. The PHCs are equipped to deal with minor mental illnesses and the Government hospital at Padmanabhapuram has a separate ward with 10 beds to treat the mentally ill. The psychiatrist attached to the Government hospital also visits the taluk hospitals and provides out patient care to the mentally ill. The government rehabilitation programmes are implemented by the District Disabled Rehabilitation Officer.

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There are four rehabilitation homes run by the NGOs. How ever they are inadequate given the enormousness of the problem. How ever there is no community based comprehensive attempt to promote community mental health. The level of awareness of the public with regard to mental illness, mental retardation and issues related to mental health is very low. There are many superstitions related to mental health and illness which need to be addressed. A better understanding of the illness will help their relatives to seek appropriate intervention. It is also necessary to educate the family and the community that mentally ill can be cured and helped to lead a normal life. The triple needs that need to be addressed are: Promotion of mental health Prevention of mental illness and Identification and referral of the mentally ill This project aims at addressing these issues through a net work of community based NGOs. 3. TARGET AREA AND PEOPLE The project is to be implemented in Kanniyakumari District. Kanniyakumari District is situated on the southern most tip of Indian sub continent and one of the smallest districts of Tamil Nadu with nearly 1,684 Sq.k.m. and a population of 18,63,174 (Census 2011). Kanniyakumari district has: 1 District Panchayt (11 Wards) 9 Panchayat Unions (113 wards) 4 Municipalities (117 wards) 56 Town panchayats (912 wards) and 97 Village Panchayats (996 wards)

The territorial feature of this district consists of sylvan scenes, attractive hillocks, gorgeous tourists spots, salubrious weather and eye pleasing coasts. Though this district has all the potentials, there was not appreciable growth due to the complexities and contradictions. The high prevalence of suicide, alcoholism, dowry deaths, eve teasing and communal disturbances speak for lack of mental health and suggests for concrete intervention to promote community mental health. 4. OBJECTIVES

1. To promote awareness on mental health and mental illness through various

community based interventions.

2. To prepare a cadre of peer educators, community leaders and volunteers to improve

the psychosocial competence of the community and facilitate early identification of mental illnesses and refer them 3. To provide counseling and psychological intervention to the neurotic patients

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4. To provide referral services to the psychotic patients

5. As a strategic means to promote a network of NGOs to undertake follow up activities

and advocacy. 5. INTERVENTION MODEL CHANGE AGENT Peer Educators MENTAL STATUS Mental Wellbeing Community Mental Health Workers Psychiatric Social Workers Psychiatrist M.H. Knowledge Attitude and Behaviour Psycho social Problems Mental Disorder PROPOSED INTERVENTION Psycho social Competence Mental Health Education Psycho social Interventions Professional Treatment

COMMUNITY

6. STRATEGIES PROPOSED

Strategy for implementation will be through a

network of NGOs. RUCODE India, KODI Trust and Resource Centre will be the implementing partners.

Each partner will cover three blocks each and

thus the entire district will be covered.

Pro-Vision will be the co-ordinating partner. Page | 4

7. ACTIVITIES TO BE CARRIED OUT NO 1. TARGET Students 2. Peer educators 3. Social deviants 4. Neurotic patients 5. Psychotic patients ACTIVITIES Individual counseling Group work Motivation programme Carrier guidance Personality development Leadership qualities Communication skills Problem solving techniques Individual counseling Group therapy Motivation programme Trainings Promotion of Community Support system Individual Counseling Support for Families Strengthening Community Involvement Treatment Referral Early Diagnosis Treatment Treatment adherence Support for Families Strengthening Community Involvement Rehabilitation Referral Orientation to the directors Training to the co-ordinators Training to the community health workers EXPECTED OUTCOME Nearly 75 % of the students will be motivated to concentrate in studies and develop a future vision for themselves. At least 900 peer educators will be developed and they will be in a position to motivate their colleagues.

Persons with deviant behaviours will be identified and motivated to join the mainstream of life.

The neurotic patients will be assisted with psychological intervention and greater involvement of the community

With appropriate treatment nearly half of the patients will become normal and another half will become manageable

6. Promotion of a network of NGOs

A network of 4 NGOs with three implementing and one lead partner will work for the promotion of community mental health and they will have a team of trained mental health workers

8. DURATION The project is to be implemented initially for a period of three years. 9. EXPECTED OUTCOME

Implementation of this project would result in increased mental health of the people district of Kanniyakumari which it is expected to contribute for the overall development of the district of Kanniyakumari.

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10. CONCLUSION Keeping in mind the relevance of the project and the expected impact it is likely to create in the mental health of the people of Kanniyakumari District, Pro-Vision is confident that the donors will come forward to support this noble cause. On receiving a positive response, a detailed proposal with the financial requirements will be submitted to the donors.

To Take Forward: Dr. S. Johnson Raj, MSW, MA, M.Phil, Ph.D. Chief Executive, Pro-Vision sjohnsonraj@gmail.com provision.ngl@gmail.com provision.ngl@rediffmail.com

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