Bringing to light a survivor’s struggles

25-May-2014

Reshma Valliappan (right) was presented the ‘Media for Mental Health’ award for her writing on her tribulations after she was diagnosed with schizophrenia.

CHENNAI : “I have never raped, tortured, or abused anyone, and yet because I am a ‘survivor of psychiatry’, neither the government nor society gives me the rights I deserve,” says Reshma Valliappan.

Around 12 years ago, Reshma was diagnosed with schizophrenia, and now, she has made it her mission in life to educate those around her on what people with mental illness go through in daily life.

On Saturday, in recognition of one of her stories on the tribulations she endured because of the disorder, the Schizophrenia Research Foundation (SCARF) and the Press Institute of India presented her with the first prize at the ‘Media for Mental Health’ award function.

“I wrote this piece as a kind of catharsis when I was in therapy, and I sent it to a friend, who then forwarded it to the Women’s Feature Service and they immediately accepted it,” she told The Hindu .

Indian law states that people with mental illness cannot travel in an aeroplane unless they are sedated, and they need a doctor and therapist to accompany them on public transport. They can’t vote, have no say in their treatment and don’t have the same right to education as others.

Many of these rules are unconstitutional, but nobody is willing to change these archaic rules, says Reshma.

By the time she was 15 years old, Reshma’s life had already started to spiral out of control. Addicted to several recreational drugs, she was living weeks at a time in her car and barely ever came home. It was not till much later that she was referred to a psychiatrist, who diagnosed her with ‘paranoid schizophrenia.’

Though it took her a couple of years to come to terms with it, she later realised that her calling was to reach out to other people with mental illness and help the ‘layman’ understand what it is to have a mental illness, she said.

Now, she has been clean for nearly four years and, in order to raise awareness on mental health issues, she has started the ‘Red Door Project’. (The project can be reached at http://www.reddoor.in or on Facebook through ‘The Red Door Group’ and on tumblr at thereddoorproject.tumblr.com.)

The project, which has over 800 members from around the world, encourages people with mental illness and others to share their experiences.

Three prizes were presented to people from the English media and two to people who wrote in a vernacular medium by cinematographer and filmmaker Rajiv Menon.

According to director, SCARF, Thara Srinivasan, the idea of these awards is to encourage people to write about mental health in the media.

http://www.thehindu.com/news/cities/chennai/bringing-to-light-a-survivors-struggles/article6044731.ece

‘Survivor of Psychiatry’ Bags Media for Mental Health Award

26-May-2014

CHENNAI: Writing about mental health issues can be a challenge. It should be no surprise then that the first place in the Media for Mental Health awards has gone to a writer who has battled schizophrenia herself.

Reshma Valliappan, a survivor of psychiatry, as she calls herself, a co-founder of Mind Ares and a member of various national and international groups for persons with mental health issues came away with the first place in the ‘Media for Mental Health’ awards given by the Schizophrenia Research Foundation and the Press Institute of India.

The award was given in recognition of one of the numerous pieces that Reshma has written about her battle with schizophrenia and what she had to face from society and the State.

“People with mental disorders do not have many of the rights and privileges that the Constitution promises. They cannot even vote,” she said.

This lack of understanding, coupled with the prevailing misconception has made writing about mental health issues that much more difficult. Ask R Thara Srinivasan, Director of Schizophrenia Research Foundation (SCARF), and she says the very same thing. “These misconceptions have percolated to all levels of the social strata and have become widely accepted beliefs. Sometimes, stories in both print and visual media only serve to reinforce these myths,” she said.

But bearing a distinct contrast to those run of the mill articles come those who got their writers these awards recently.

Besides Valliappan, Mini P Thomas (The Week, Bangalore) and Arun M and Sam Paul A (The New Indian Express, Kozhikode), received the award in the English language category, while Geetha Gengiah (Puthiya Thalaimurai) and Reji Joseph (Rastra Deepika) won the award in the regional language category

“There are very few well-researched stories on mental health related issues. Therefore, it’s very important to recognise them,” said Srinivasan.

The awards were given by cinematographer and filmmaker Rajiv Menon. Padma Bhushan awardee and founder of SCARF Sarada Menon was present.

http://www.newindianexpress.com/cities/chennai/Survivor-of-Psychiatry-Bags-Media-for-Mental-Health-Award/2014/05/26/article2245072.ece

Putting patients first

India must enforce strict rules on clinical trials

19-May-2014

Nalinakanthi V

INDIA : This year, on International Clinical Trials day, India has a reason to feel satisfied with the progress made in regulating the use of humans to test drugs. In August last year, the Supreme Court had batted for patient safety, coming down hard on the clinical research industry. But this is just the beginning. A vibrant environment needs to be created wherein adequate safeguards are available for trial patients while promoting novel research.

Though instances of unethical conduct of clinical trials in India dated back to 2005, the issue came under spotlight only in June 2011, after the Economic Offence Wing of Madhya Pradesh submitted its enquiry report. The report brought to light some gruesome facts about the conduct of trials in the state. Thousands of individuals, mostly children, were subjected to drugs and vaccines trials between 2006 and 2010, violating guidelines.

Even the mentally ill were not spared. Many such patients were subjected to trials for various drugs including the ones used to treat premature ejaculation. This was driven by perverse, profiteering motive pursued by a few clinical research organisations (CROs) that amassed millions of dollars at the expense of innocent patients. “The entire research community has been blamed for the mistakes of isolated people,” says Suneela Thatte, President of Indian Society of Clinical Research (ISCR).

A welcome ruling

After series of unsuccessful debates in various forums including the Vidhan Sabha, a writ petition was filed in the Supreme Court in January 2012 by the NGO Swasthya Adhikar Manch and others. In October 2013, the court ordered halting of all the 157 clinical trials approved between January and August 2013. It sought a detailed report from the apex and technical committees, assessing the risk versus benefit for patients, before allowing trials in these 157 drugs. The court also expressed concern over the non-existence of a strong framework to ensure safety of these patients.

This is a very positive move. Some changes have since been effected to the existing regulations such as mandating a video recording of the patient consent, registration of ethical committees and formulation of compensation for trial subjects who suffer adverse reaction, to name a few. But this will not suffice. Ensuring effective implementation of the set regulations is the most critical aspect.

Ensuring strict adherence to regulations will not only ensure protection of patients’ right but will also benefit the CROs who have been doing legitimate business. “We have always wanted robust regulatory framework governing clinical trials in India,” agrees Thatte.

The SC order is conducive to patients, but it has also made the clinical trial industry aware of its responsibilities towards patients. Today, on the occasion of International clinical trials day, the industry body ISCR plans to distribute a special patient handbook, which will serve as a guide for those who intend to participate in clinical trials. It is also conducting patient awareness programmes.

Safety and innovation

The industry’s efforts now seem to be directed towards re-building the confidence among the patient community, while also sending the signal to the government that they are willing to adopt the best practises in clinical trials.

As a developing country, India needs to encourage investment in innovative research. Hence, it is important to strike a balance between safety of trial subjects and the country’s healthcare needs, without compromising one for the other. “Patient is a very important stakeholder. Unless they come out and participate in trials, no innovative medicine will be available to patients” adds Thatte.

http://www.thehindubusinessline.com/opinion/putting-patients-first/article6026059.ece

Attacker shows clear sign of mental ailment: JJ dean

14-May-2014

Mateen Hafeez & Sumitra Deb Roy

MUMBAI: The 42-year-old patient, who attacked three others in Bombay Hospital on Monday, was kept sedated in the psychiatry ward of JJ Hospital. Hospital insiders also said he was restrained to the bed, but authorities denied this.

Dean Dr TP Lahane said doctors have found clear symptoms of mental ailment. Whether or not that could have led him to attack cancer patient Lilabihari Thakur (65) is difficult to say, said JJ doctors. Thakur died in the attack.

“In two days, we will carry out a CT Scan and MRI to see if he has brain lesions,” said Lahane. He added that the patient has a history of mental illness. JJ staffers also said he had refused to eat and was being fed through a tube.

Lahane said knowing his condition, it was perhaps erroneous to keep him in a general ward. The patient’s family has told JJ doctors that he was admitted to Masina Hospital’s psychiatry facility 5-6 years ago.

Bombay Hospital doctors, however, said they were completely unaware of any mental ailment history the patient may have had. They had treated the patient twice for brain TB in a span of one year.

Psychiatrist Dr Harish Shetty lashed out at the consultants. “Non-psychiatric doctors are condescending to mental health issues. Patients should always be evaluated for mental health problems,” he said.

Meanwhile, the Azad Maidan police said two ward boys had overpowered the accused but let go of him as he tried to bite them. “Fearing an infection, they left him on the bed,” said the officer.

Krishna Prakash, additional CP, said on Sunday, the accused was seen banging his head against the wall. “A nurse had informed his wife about this,” he said.

“On Monday, he had an argument with his brother-in-law and kicked him 3-4 times. Later, he also kicked a woman sweeper before attacking the patients,” said a police officer.

http://timesofindia.indiatimes.com/city/mumbai/Attacker-shows-clear-sign-of-mental-ailment-JJ-dean/articleshow/35078688.cms?

‘Hosps should not shun psychiatric patients’

14-May-2014

MUMBAI: Even before the HIV-TB patient with a history of mental illness attacked fellow patients in Bombay Hospital, killing one on Monday, it has been a practice in most city hospitals to not admit patients with serious psychiatric illness. Psychiatrists now fear hospitals will be doubly wary of accepting psychiatric patients needing emergency care for ailments such as diabetes, heart care, etc.

“Most hospitals only offer OPD service for psychiatric patients. They never apply for the licence needed to admit serious psychiatric patients,” said psychiatrist Dr Yusuf Matcheswalla, who operates the biggest psychiatry facility in a hospital with 110 beds (the handful of other institutions in Mumbai with this licence operate as nursing homes).

He said psychiatric patients manage to get entry into big hospitals only when there is a flare-up of other ailments not relating to their mental state. “More violent crimes are committed by normal people than psychiatric patients,” said psychiatrist Dr Harish Shetty. Dr Anjali Chabbria said the Bombay Hospital attacker could have suffered an electrolyte imbalance, triggering violence. “People shouldn’t stigmatize those with mental illnesses,” she added.

Could Monday’s attack have been averted? Dr Matcheswalla, acting head of JJ Hospital’s psychiatry department, believes so. “The patient has a history of mental illness, which should have been spotted,” he added.

Jaslok Hospital for instance, has a psychological counsellor visiting patients prone to depression. “If the counsellor feels the patient needs help, s/he is referred to the psychiatrist,” said hospital CEO Dr Taran Gianchandani. tnn

http://timesofindia.indiatimes.com/city/mumbai/Hosps-should-not-shun-psychiatric-patients/articleshow/35078710.cms?

Schizophrenic Woman Jumps from Floor 5 of Hospital, Saved

14-May-2014

CHENNAI : A 40-year-old schizophrenic woman undergoing treatment at the Government Stanley Hospital, who jumped off the fifth floor of a building in the hospital, had a close call after she landed on the cushions arranged by Fire Service personnel on Tuesday.

The woman, identified as Hemavathy, reached the 5th floor of the 10-storeyed building around 3:30 am on Tuesday and threatened to commit suicide. As efforts by the police personnel at the hospital outpost to persuade her failed, Fire and Rescue Services personnel were called in.

A team of firefighters who arrived at the spot struck a conversation with Hemavathy, during which the woman agreed to have some water to drink. “But she was very adamant and warned that nobody should come near her. We had to throw a water bottle that landed near her. She drank the water,” said V K Sampath Kumar, the leading fireman of Washermenpet Fire Station.

Two firefighters then reached the fifth floor and started persuading Hemavathy to come down. “Even as we were standing on the fifth floor, she threatened to jump if we moved towards her. We asked her why she wanted to commit suicide, but she could not give clear replies and there was no coherence in her talk,” said Sub-Inspector Tamilselvan.

As another hour of vain attempts passed, a fireman and a police official tried to get hold of her. Upon realising that she was being cornered, Hemavathy suddenly leapt from the building. “Fortunately, a fireman got hold of her saree and for some distance she rolled slowly by holding on to the saree. Then, she lost grip and fell on the cushions arranged on the floor,” said Sampath.

The firefighters had made the precautions even as they were talking to Hemavathy.

Doctors said Hemavathy did not suffer any injury in the fall and was under treatment at the hospital. She had been admitted on Saturday by staff of an orphanage at Red Hills where she had been staying for the past few years. “She is suffering from schizophrenia and has suicidal tendencies. She also has the tendency of inflicting injuries on herself. In fact, she was admitted for treatment for an injury she herself caused on her scalp,” said a doctor.

http://www.newindianexpress.com/cities/chennai/Schizophrenic-Woman-Jumps-from-Floor-5-of-Hospital-Saved/2014/05/14/article2223532.ece

Woman escapes with injuries after jump from 5th floor at hospital

14-May-2014

CHENNAI: A 50-year-old woman jumped off a spiral staircase on the fifth floor of the Government Stanley Medical College and Hospital in the wee hours of Tuesday but escaped with minor injuries after firemen managed to prepare a ‘bed’ of mattresses on the ground.

Police said Hemavathy, a resident of Red Hills, had been admitted to the hospital on May 5 for a head injury. The woman, who is said to be suffering from schizophrenia, had herself caused the injury to her head and had appeared depressed since then, they added. She had injured herself in the past too.

Around 3.30am on Tuesday, a patient noticed her missing and informed the nurses on night duty. They tried to go near her but stayed away after she threatened to leap to the ground. The nurses then informed the fire and rescue services personnel, some of whom climbed the fifth floor to convince her.

Other members of the rescue services team arranged thick mattresses on the floor to form a ‘bed’. On the fifth floor, one of the firemen trying to convince her to get down, got hold of her saree but she jumped off.

The incident created panic among onlookers but doctors said Hemavathy suffered almost no injury in the fall and was continuing treatment. She had been admitted by officials of an orphanage at Red Hills where she had been staying for the last few years.

http://timesofindia.indiatimes.com/city/chennai/Woman-escapes-with-injuries-after-jump-from-5th-floor-at-hospital/articleshow/35079112.cms?

Surge in mental health patients in India’s Jammu and Kashmir

12 May 2014

Murali Krishnan

SRINAGAR : India’s health experts are reporting a surge in the number of people seeking treatment for mental health issues in the state of Jammu and Kashmir.

Years of separatist-related violence in the region have taken a toll on residents, with many people suffering from mental health disorders as a result.

On any given day, hundreds of people line up at the dilapidated Rainawari Psychiatric Hospital in Kashmir’s summer capital, Srinagar.

It is one of the few facilities in the region that offers treatment for mental health disorders.

To offset the rush, the Indian government recently opened another counselling centre at the Shri Maharaja Hari Singh (SMHS) Hospital, which is equally populated.

Majid Shafi, a doctor at SMHS, listens to young patients scarred by the region’s conflict.

Dr Shafi says most patients suffer from depression, chronic post-traumatic stress disorder, drug addiction and suicidal tendencies in numbers that are shockingly high.

“The prevailing situation over the last two decades is contributing to psychiatric disorders,” he said.

“In the early 90’s, we had about 2,000 patients visit us in our psychiatric diseases hospital.

“Currently we are having more than 100,000 visitors per year. The patients that we see are just the tip of the iceberg.”

Mental health ailments have emerged as one of the most pressing public health concerns in Kashmir.

One of Kashmir Valley’s leading psychiatrists, Arshad Hussain, says mental health issues in the region are coming to the fore as awareness of psychiatric help grows.

“When we had a huge mental morbidity particularly post-traumatic stress, all of them did not come to psychiatrists,” he said.

“Much of that mental health morbidity went to faith-healing and spiritual places in Kashmir.

“But now psychiatry and shrinks have become a reality in Kashmir and I see mental health issues increasing with time rather than decreasing.”

Shutdowns and frequent curfews in the Valley have also affected locals psychologically.

Doctors say the true story of those suffering from trauma or anxiety-related disorders is hard to understand.

Difficult to access

Remote villages have been bearing the brunt of regional violence for years on end, and many who live in the rural outback have little access to counselling.

Abdul Bhatt, 64, a labourer from the rural hinterland of Tangmarg takes a 40 kilometre journey to meet with doctors at the psychiatric hospital.

For over eight years, Mr Bhatt has been diagnosed with psychotic depression and is on a cocktail of drugs for anxiety, emotional liability, and recurring nightmares.

“I am tired and can’t keep coming here. It is difficult to get a bus and that is why I want more medicines to last me much longer,” he said.

Although the number of doctors and psychiatrists working across the state has increased, Shazia, a medical student says it is still far from adequate to address pressing mental health issues.

“Obviously, I do get unhappy about it … there are so many people,” she said.

“We are all doctors but apart from the physical work we do, this is a huge emotional burden.”

Najeeb Wani from the rural district of Anantnag, about 60 kilometres from Srinagar, says the situation will only improve when the violence stops.

“All of us know what is happening in Kashmir for more than two decades and these things will happen,” he said.

“Things will only become better if normalcy returns. But killings happen regularly here and only Allah is with us.”

With no end to the separatist conflict in sight, the mental health of many more in Jammu and Kashmir is likely to be affected in the months and years to come.

http://www.abc.net.au/news/2014-05-12/an-surge-in-mental-health-patients-in-india27s-jammu-and-kashm/5448254

TB patient goes on the rampage, kills one, injures three in Bombay Hospital

13-May-2014

Somita Pal & Little Yadav

MUMBAI : A 42-year-old HIV positive patient suffering from TB of the brain went on the rampage at Bombay Hospital on Monday, killing a 65-year-old lung cancer patient and injuring two others. The Agripada resident was admitted on May 8 after he tested positive for HIV. He was also suffering from a psychiatric problem, but the hospital denied the charge.

In an unprovoked attack around 6.30am, the patient started hitting Lilabihari Govardhan Thakur, 65, who was sleeping on the adjacent bed, with a saline rod till he started bleeding. He also injured two other patients – Praful Parmar, 70, and Janardhan Arte, 66 – and a ward boy. “There were 30 patients in the ward on the third floor when the incident took place. The medical staff swung into action with a rope and sedative injection to restrain the patient. He was brought under control by four ward boys and five nurses after 15 minutes,” said a doctor with Bombay Hospital. The police later arrested the patient and booked him for murder.

Thakur was shifted to the ICU, but he passed away four hours later. “He had a severe skull fracture. We tried reviving him, but he succumbed to his injuries. His body has been sent to JJ Hospital for post-mortem,” said Bombay Hospital spokesperson Dr Sagar Sakle.

Sources said the attacker suffered from psychiatric problems and had homicidal tendencies. Before he was admitted to Bombay Hospital, he underwent treatment at Mazgaon’s Masina Hospital. JJ Hospital dean Dr Tatyarao Lahane also confirmed to dna that the patient had a history of mental illness and was treated for the same a few years ago. But Dr Sakle said: “The patient had no psychiatric problem and that was the reason he was not referred to a psychiatric.”

Neurologist Dr Nirmal Surya of Bombay Hospital who was treating the patient told dna: “He was not under any medication. He had TB of the brain a year-and-a-half ago, but he stopped taking medicines midway. An MRI scan detected swelling in his brain, but he showed no signs of violence or aggression in the last four days.”

The patient was kept in the ward till he was arrested. He was later shifted to JJ Hospital where he is kept under observation in the psychiatry ward. The doctor treating him at JJ told dna that he suffers from chronic psychiatric ailment. “He was on anti-psychotic medicines which he had stopped taking,” he said.

The complainant, nurse Alina Anthony, told the police, that the hospital staff forced him to a chair and restrained him from moving after the violence erupted. Senior inspector Narendra Singh of the Azad Maidan police station said initially, a case of attempt to murder and voluntarily causing hurt with use of sharp weapon was registered against the accused. “However, after the cancer patient passed away, a case of murder was also registered,” he said.

The deceased, Thakur, was a resident of Pratiksha Nagar in Sion. “My father was shifted to the general ward from the ICU on April 30. His bed was next to that of the accused. My mother had gone down to buy medicines when my father was attacked,” said Pankaj, Thakur’s son. Eyewitnesses said the accused unscrewed the rod of the IV drip and first attacked Pankaj’s father with the rod thrice before making the others his target.

Psychiatrists said such incidents should not deter private hospitals from admitting patients with mental illnesses. Noted psychiatrist Dr Harish Shetty said: “Private hospitals should start a ward dedicated to mental illness. This incident could have been avoided if Bombay Hospital had such a ward.” He said most doctors were not familiar with mental illnesses. “Some years ago, a patient committed suicide in a private hospital and since then, its management stopped admitting patients with mental illnesses. The awareness about mental illness is very low even in the medical fraternity,” he said.

http://www.dnaindia.com/mumbai/report-tb-patient-goes-on-the-rampage-kills-one-injures-three-in-bombay-hospital-1987698

Suspected schizophrenic attacker of cancer patient in JJ psychiatry ward

Sumitra Deb Roy & Malathy Iyer

MUMBAI: The 42-year-old patient who attacked others in Bombay Hospital is likely to undergo intensive psychiatric treatment on a priority basis at the state-run JJ Hospital because doctors there claimed he had a history of mental illness.

“We found out that he was under treatment for schizophrenia until six years ago. He has been suffering from seizures as well for the last two years,” said Dr T P Lahane, the dean of the JJ Group of Hospitals.

The patient, who cannot be named because of his HIV-positive status, also suffers from diabetes, tuberculosis and has impaired kidney function.

The JJ team will determine whether his impaired mental status led to his violent spree that ended in the death of a cancer patient. “He is in the psychiatry ward, and we are carrying out diagnostic tests to determine all his health problems. We will then start his complete treatment,” added Dr Lahane. The JJ doctors are also trying to establish if he has lesions in his brain.

It appears the attacker has been under treatment of various doctors over the last few years. He was in a private hospital in Byculla, but left 10 days ago because his “headaches refused to cease”.

“He was treated for brain tuberculosis last year, but didn’t follow up until a few days back,” said Dr Sagar Sakhle, Bombay Hospital spokesperson. This time around, he was admitted under neurologist Dr Nirmal Surya. The hospital did not seem to be aware of his mental illness.

“We were still in the process of investigating his various illnesses,” said Dr Surya. On Sunday morning, he underwent a procedure to collect cerebrospinal fluid for further investigations. “He was most cooperative with our technicians at that time,” he added.

After the early morning mayhem on Monday, the doctors learnt that the attacker’s ‘headaches’ were so severe he would bang his head against the bedstead. Dr Surya said it’s possible his HIV condition was so advanced that he had developed HIV encephalopathy, a bunch of neurological disorders. Medical textbooks say that HIV encephalopathy begins with intellectual decline and forgetfulness and degenerates into progressive decline in memory, and psychosis.

http://timesofindia.indiatimes.com/city/mumbai/Suspected-schizophrenic-attacker-of-cancer-patient-in-JJ-psychiatry-ward/articleshow/35031990.cms?

Negligence shown to mental illness and its patients responsible

Sudhir Shetty

MUMBAI : The Bombay Hospital incident, in which an HIV+ patient suffering from brain TB killed another patient and injured two, is a sharp reminder of the negligence shown to mental illness and its patients, especially if they are suffering from chronic ailments, even by the medical fraternity.

Dr Yusuf Matcheswalla, a psychiatrist attached with Masina hospital, said: “The problem with treatment of chronic ailments is that specialists are so busy trying to diagnose the patient with respect to their area of expertise (ie a chest physician focussing on TB) that they forget s/he can also have mental illness and be on the verge of a nervous breakdown. Abroad, chronic patients are mandatorily referred to a psychiatrist.”

A similar incident happened in Sewri TB hospital on February 12, when a 40-year-old multi-drug-resistant TB (MDR-TB) patient attacked a ward boy and other patients with knife. This was followed by a teenaged TB patient ending his life.

An ailment like tuberculosis often ends up isolating the patient socially, say doctors. The absence of support from friends and relatives, coupled with physiological and mental side effects of the disease, has made it a thumb rule for doctors to advice psychiatric counselling for these patients.

Dr Jaising Phadtare, professor of pulmonary disease and intensivist at Grant Medical College, admits to the need for robust counselling for patients, especially during the first three months of treatment, for MDR-TB.

“The doctor has to counsel the patient and make him/her understand the basics of medicine and its effects. For instance, the doctor must explain the need to take a particular drug at a certain time…” said Phadtare. “Helping build the patient’s confidence in the initial three months of treatment can go a long way for the next couple of years of treatment.”

Agreeing with Phadtare, Dr Nagsen Ramraje, head of chest medicine department at Sir JJ Group of Hospitals, said the prolonged course of treatment makes the patient anxious. “The anxiety is coupled with social stigma and insecurity about the future. Also, side effects of the drugs precipitate depression,” said Ramraje.

Doctors also feel that a few things in the TB control programme need to be changed. A second-line drug, cyclocerine, is known to induce psychosis and, hence, doctors say an alternative tericox, which has fewer side effects, must be included in the programme.

http://www.dnaindia.com/mumbai/report-negligence-shown-to-mental-illness-and-its-patients-responsible-1987674

Married Working Women Most Pressurised: Study

10-MAY-2014

BHUBANESWAR : The pressure of managing home and job is taking a heavy toll on the mental health of married working women, particularly those in a nuclear family.

However, only a minuscule number of them is reporting for treatment or seeking relief measures largely due to lack of awareness or fear of social stigma.

Almost one third of married working women in the Capital could have poor mental health but only around 10 per cent of them have sought any kind of health services, a study by Department of Community Medicine, Kalinga Institute of Medical Sciences (KIMS) has revealed.

Taking around 240 married women from educated background, mostly graduates and post-graduates who worked in different positions in both Government and private organisations, researchers Dr Anshuman Panigrahi, Dr Aditya Prasad Padhy and Dr Madhulita Panigrahi found 32.9 per cent of the respondents beset with some degree of psychological condition.

The problems manifested as mental fatigue, stress, anxiety and frustration. Some had even progressed to depression and displayed anger, phobia and other social and emotional distress. But most did not seek health services even though they are available across Government and private hospitals.

It was observed that younger women had poorer mental health than their older counterparts, which could be due to the pressures of handling additional responsibilities. The study identified three major predictors of poor mental health outcome among the women. Those with favourable attitude of colleagues at workplace were 4.5 times more likely to have normal health than those facing unfavourable or indifferent attitude.

The likelihood of normal mental health rose by four times when women were sharing problems with husbands against those who did not.

Further, women who perform exercise, yoga or meditate at least twice a week were seven times less vulnerable to mental health problems than those who did not.

The status of women has undergone rapid change due to multiple factors as urbanisation, increased level of education, awareness and assertion of rights and influence of media. More and more women are taking up employment so that they could supplement family income and be independent. But at the same time they have to discharge their responsibilities as home-maker. The double pressure is having an impact on the growing creed of working women while the number of nuclear families is accentuating the problem due to withdrawal of the support system.

The study emphasises on making workplaces more conducive and favourable for women. At family level, the spouses should more often share their problems which will ultimately result in finding solutions. Community-based orientation programmes on mental health should be organised and working women should be encouraged to incorporate exercise, yoga and meditation in their daily routine.

The study ‘Mental health status among working women residing in Bhubaneswar, India: a psychological survey’ has been published in Biomed Research International.

STUDY LINK : http://dx.doi.org/10.1155/2014/979827

http://www.newindianexpress.com/states/odisha/Married-Working-Women-Most-Pressurised-Study/2014/05/12/article2220261.ece

Attention-based family therapy

12-May-2014

Farida Raj

Parenting is tough. If the family needs therapy don’t hesitate to take help.

I had an invite from Seva Counselling Centre, to attend a lecture on Attachment Based Family Therapy (ABFT) by Dr. Pravin Israel, clinical psychologist and senior researcher at the Akershus University Hospital in Norway, with roots from Hyderabad. As a teacher and Counsellor, I had practiced Solution Focused Brief Therapy (SFBT) but ABFT – I had no idea!

According to Dr. Pravin, in India, relatively little importance seems to be given to the mental health problems of young people. Young people seldom seek help or come to mental health clinics.

Though parenting is fundamental to the survival and success of the human race, yet little scientific information is available about parenting. There exists a strong attachment between parent and child and when that bond is strained or ruptured, it leads to various mental health problems, among others, depression, self-injury and suicide in adolescents.

The quality of interpersonal relationships in family can precipitate or aggravate the above mentioned problems in adolescents, he says. ABFT explores the relationship between parent and the adolescent. It aims to repair interpersonal ruptures and rebuilds emotionally protective, secure-based, parent-child relationships.

The primary assumption of ABFT is that high family conflict, harsh criticism, physical or emotional neglect or abuse, can rupture attachment bonds. Ruptured attachments and a negative home environment may inhibit young people from developing the internal and interpersonal coping skills needed to safeguard against stress leading to depression.

According to Dr. Pravin, the adolescent phase is a complex one with needs, interests and desires that are strong and complicated. The adolescent tends to experience opposing desires and to waver between needs for support and independence, selfishness and selflessness, traditional values and a desire for individuality. Because of ambivalence in his views and judgments, it is often difficult for him to take a standpoint in close relationships. Such experiences create feelings of inadequacy and in turn, feelings of insecurity that overwhelms the adolescent.

Many adolescents strive towards goals and achievement levels that are un-realistic in view of their actual endowments and acquired abilities; they repeatedly fail and experience deep disappointment and even despair. Sometimes, parents pressure the adolescents and young adults into striving towards goals they lack the ability to achieve. This is often accompanied by feelings of inadequacy tinted with depression.

During adolescence conflicts arise from a variety of causes – quarrelling parents, nagging and teasing by a family member, being misunderstood by a friend or rejected by the peer group cause internal stress. When conflict and stress increase, it may lead to mental disturbances.

Adjusting aspirations to abilities and skills is essential in avoiding situations of severe conflict and in promoting personality integration. ABFT steps in to help adolescents and their parents address relationship issues and thereafter turn to solve other conflicts that may be bothering the adolescent.

According to attachment theory, individuals who have a safe and sound sense of security, have higher self esteem, are able to adapt to situations, have problem solving skills and ability for direct communication – the essential skills needed for autonomy and individuation. In contrast individuals with insecure attachments most likely engage in maladaptive strategies and social isolation.

Dr. Pravin talked about a case where Tina, a fifteen year old was clinically depressed. She harboured tremendous resentment against her mother. The mother, a single working parent, would send her to the grandparents during summer holidays. Unfortunately, there the poor child was sexually harassed by a friend of the family. The mother had no clue and was perplexed about Tina’s hostility towards her.

An ABFT therapist was able to help both mother and the daughter. An individually oriented therapist may not have uncovered and helped them resolve this painful experience that was causing distress and damage.

There is scarcity of family therapy treatments that are specific to adolescents. ABFT is a new model designed for treating depressed and suicidal adolescents. It was developed by Professor Guy Diamond and his team in Philadelphia, USA.

The model is approved by relevant authorities in USA as an empirically validated model. It focuses on family relationships rather than addressing symptoms separately. Here, the adolescent talks about what caused the rupture while the parent listens with respect and helps them to tell their story.

The ABFT therapist focuses on resolving past or current impasses in the attachment relationship. Both the parent and the adolescent take mutual responsibility for change thus rebuilding trust and reshaping relationships.

Listening to Dr. Pravin’s brilliantly presented lecture, I could see that almost everyone present in the auditorium became introspective. May be thinking of their adolescent days and ruptured attachments!!

The premise of this article is that repairing attachments problems can promote better self-regulatory capacities in adolescents which in turn can lead to a decrease in depression and suicidal behaviour.

http://www.thehindu.com/features/metroplus/attentionbased-family-therapy/article5996204.ece

Not Enough Nurses in ICU, Says Expert

12 May 2014

U. Tejonmayam

CHENNAI : Mental illness could be a major cause of concern by 2020 but there has been no effort to increase the syllabus on mental health for medical professionals, according to former director of Medical Education Dr V Kanagasabai.

Paying tribute to nurses during an event held at Madras Medical Mission to celebrate International Nurses’ Day, here on Saturday, Kanagasabai, who is also the former dean of Madras Medical College, said that he had recommended increasing the syllabus on mental health since there was no such subject at the undergraduate level.

“There is only a small section of the syllabus on mental health since the 1980s,” he said. Accoring to a study in World Psychiatry Journal, 75 per cent of people with mental disorders had been sick for more than a year without treatment. The journal states that a vast chunk of work in mental illness is done by primary care practitioners, especially in rural India.

Dr Kanagasabai says that nurses are better equipped as they have courses on mental health.

He said the average life span has gone up to 67 and it may rise further. But the biggest challenge is the quality of life.

He highlighted the shortage of nurses in intensive care units, where there should be at least four nurses for one patient. But we have one nurse for one patient, he said.

He said the role of nurses had changed in India. They play multiple roles, he said. Earlier Dr K Jacob, secretary of Madras Medical Mission, while delivering presidential address, said that they were a force for change.

“In the modern medical profession, they are the backbone of the healthcare system,” he said.

‘Brothers’ get a Raw Deal in Women’s Bastion

It is no longer news that women are breaking into another male bastion. But the same can’t be said about men breaking into the female bastion. Nursing has been traditionally a woman-dominated profession. But there are men too, who join the profession for the same reason as women — to care for the sick and the injured.

History tells us that globally, men were primarily caregivers during wartime when they took efforts to save the lives of fellow soldiers. It was perhaps not until Florence Nightingale was allowed in the battlefield where she tended to wounded soldiers. Today, however, while a few male nurses are employed in private hospitals, those in the State-run hospitals are restricted primarily to mental health hospitals, hospitals and dispensaries in government offices, departments and tutoring.

“We are qualified and trained in all branches including obstetrics and gynaecology. Males were mainly recruited to handle patients in mental hospitals, inmates in prisons, courts, prison wards in hospitals and be a part of the medical team for VIPs. Of course, we are also utilised in places where they need physical efforts like lifting a patient,” says Shankar Shanmugam, a teacher in the Chengelpet Government Medical College.

However, men face discrimination just like women do in a male-dominated profession. “While there are patients comfortable with male nurses, there were instances when patients preferred women. It could be difficult for a male nurse in the beginning of his career,” said Aaron, who specialises in critical care at Apollo Hospitals.

Nevertheless, the industry will be poised for a plethora of opportunities for male nurses if the it takes efforts to strictly adhere to the optimal patient-nurse ratio.

http://www.newindianexpress.com/cities/chennai/Brothers-get-a-Raw-Deal-in-Womens-Bastion/2014/05/12/article2219944.ece

http://www.newindianexpress.com/cities/chennai/Not-Enough-Nurses-in-ICU-Says-Expert/2014/05/12/article2219237.ece

Prisoner murder bare s jail worms No. 3 o n list of ‘lunatic’ inmates

7-May-2014

KINSUK BASU

KOLKATA : Bengal has the third highest number of “lunatic prisoners” in the country but more than half its prisons don’t have a jail doctor to treat even regular inmates, leave aside those with serious mental ailments.

Prison directorate sources said out of 58 jails, only 21 have doctors. The rest has pharmacists doubling up as doctors during emergencies.

Even those that boast a physician on their payroll don’t have the necessary expertise to deal with inmates like Nizamuddin, the mentally unstable prisoner at Presidency Jail who allegedly killed fellow convict Happy Singh alias Harpreet, 37, on Monday morning, prison directorate officials admitted.

The last published report of the National Crime Records Bureau in 2012 states that Bengal has 417 inmates who are mentally ill — third after Odisha and Andhra Pradesh.

The murder of Happy has exposed successive governments’ lethargy towards addressing serious prison issues such as treatment of criminals like Nizamuddin who need regular monitoring under trained eyes.

“Barring a few, including Presidency, Alipore and Dum Dum, there are no observation wards in most of the jails where such inmates may be kept and treated,” said a senior official of the prison directorate.

“Even the efficacy of drugs administered to patients is questionable, though over Rs 10 crore is spent annually on procuring medicines for jails. Medicines find a way out of the jails.”

Preliminary inquiry reveals Nizamuddin was under psychiatric treatment since November 27, 2011, and has since been under medication. On May 2, he was admitted to the jail hospital for treatment of complications.

Next day, he was referred to the Bangur Institute of Psychiatry. On May 4, jail doctor N. Chatterjee discharged him, apparently satisfied that he was responding to medication. Insiders said the mental ward could only house 20 patients.

The very next morning, he killed Happy.

Experts asked two questions after the incident. Was Nizamuddin receiving the right treatment for his mental ailments? Did he undergo regular medical check-ups?

“There is no concept of monitoring mentally ill inmates. Since we don’t have special cells for such prisoners, they are left to stay with other inmates, some of whom are hardened criminals,” admitted an official of Presidency Jail.

Of the 306 mentally ill inmates lodged in Bengal’s jails, 103 men are convicts who would remain in prison for a considerable period of time. There are 199 undertrial prisoners suffering from various mental illnesses. Like Nizamuddin, all of them stay with regular inmates across all the jails and seldom undergo any medical follow-up.

“There should be an observation ward for such patients or criminals. A round of medication should be followed up by regular checks. They should be kept under close observation,” said senior psychiatrist Ranadip Ghosh Roy who once worked with Dum Dum Central Jail. “If such patients are teased by other inmates, they develop complications such as mood swings and psychopathic personality disorder. Hence, regular monitoring is a must.”

Experts dealing with prisoners’ mental health said inmates “bullied” by seniors either lapse into bouts of depression or develop aggression. Since both conditions can lead to suicides or extreme behaviour, it is necessary to have a separate observation or mental ward. Besides, it is mandatory under the mental health act of 1987 to provide treatment by specialist doctors to these patients.

Most jails in Bengal don’t have any observation ward or specialists like psychiatrists.

“We seek help from experts only in special cases. There are no psychiatrists on our rolls,” Haider Aziz Safwi, the minister in-charge of prisons and correctional homes, told Metro. “There is shortage of doctors as well. The sub divisional jails need doctors. We are trying to hire some on contract.”

Contempt plea

Calcutta High Court on Tuesday gave an advocate liberty to move a contempt petition against the state for its failure to provide security to inmates of correctional homes across the state.

The division bench of Chief Justice A.K. Mishra and Justice Joymalya Bagchi told advocate Tapas Bhanja: “You can file a contempt case if you wish.”

Advocate Bhanja on Tuesday moved the division bench with a copy of the day’s The Telegraph and said: “See, my lords, an inmate of Presidency jail has been killed by another inmate. This court had passed an order on June 13 last year asking the state to provide adequate security to the inmates. This order has not been carried put properly.”

“Why should not contempt proceedings be drawn against the state authorities for failing to obey the court’s directive?” he asked.

The division bench replied: “If you wish, you can file a contempt case.”

On June 13 last year, the division bench had issued guidelines for better jail facilities.

http://www.telegraphindia.com/1140507/jsp/calcutta/story_18315931.jsp