NIMHANS brings new protocol for child abuse cases

26-Jul-2014

Luna Dewan

BANGALORE : As alleged child sexual abuse cases are being reported from all across the country, it has been learnt that a proper procedure to handle such cases has been missing. In order to address this rising need, Bangalore-based National Institute of Mental Health and Neurosciences (NIMHANS) has come up with a protocol-based and comprehensive child centric approach to handle child sexual abuse (CSA) cases.

Over the past years, the Department of Child and Adolescent Psychiatry at NIMHANS has received several children with CSA issues. When they come for help after visiting to the Child Welfare Committee, police station, the hospital, by then, the child would have already been subjected to questioning on multiple occasions and therefore to re-traumatization. There are many areas which have to be systematically addressed – the child’s reaction to the abuse, ensuring the child’s immediate safety, medical and mental health needs of the child, the concerns of the family including social stigma.

As per the protocol prepared by the Department of Child and Adolescent Psychiatry at NIMHANS, they have specific ones for the families, for the schools, for the police and for the media. Following the Protection of Children from Sexual Offences Act 2013 (POCSO) mandates, families can seek for emergency medical services (EMS) within 24 hours of filing the FIR. EMS are provided by state Registered Medical Practitioners (RMP) in government hospitals and only in absence of such an agency the child will be referred to other sectors. Where the Special Juvenile Police Units (SJPU) work in collaboration with government hospitals, the detailed inquiry can be completed in one sitting.

Once the medical examination is over, the Department of Child and Adolescent Psychiatry, NIMHANS can offer combined therapeutic and forensic interviewing to assist both the healing of the child and the necessary justice processes. According to the protocol, in children with symptoms, they work through trauma by encouraging expression of feelings regarding the abuse, validating experiences, and teaching personal safety. In very young children, this is done through art and play work. The support given by the parent helps in facilitating better healing of the victimized child.

At the school level, preventive workshops, personal safety workshop, life skills education can help as preventive strategies. However, when an incident takes place the system should have a clear protocol for response. Unless the school has a trained counselor or CSA expert, it should not attempt to interrogate the child. This needs to be done by trained experts. Furthermore, preparation needs to be made to receive the child back to the school in natural and non-stigmatizing ways so that the child re-integrates comfortably.

Police forms an important part of the process. In the immediate aftermath of trauma, when there is non -availability of a trained person within the police forces for sensitive interviewing of the child, they need to refer to an expert where forensic interview protocols are followed in the context of healing interventions. Police need to be cognizant that interview processes involving children cannot be hastened as it can exacerbate the trauma and be detrimental to the child’s well-being. Meanwhile, the media must protect the identity and privacy of the child without heightening their trauma by repeated and sometimes intrusive queries.

http://www.dnaindia.com/bangalore/report-nimhans-brings-new-protocol-for-child-abuse-cases-2005466

In search of a revolutionary road

16-Feb-2013

K. S. JACOB

Psychiatric diagnoses continue to lack the predictive power required of hard science. A new framework is needed to understand mental health, distress and disease

 

The American Psychiatric Association (APA) will release the fifth edition of its Diagnostic and Statistical Manual (DSM-5) in May 2013. DSM-5 has been years in the making. The process included planning sessions, international research conferences, review of literature, a series of monographs, secondary analysis of data and field trials involving hundreds of scientists and clinicians, drawn from many countries and disciplines, and feedback from the public. Many interest groups — neurologists, psychologists, insurance and pharmaceutical industries, legal and forensic fraternity, military veterans and anti-psychiatry groups — have been watching the process and outcome closely as the DSM has a wide impact. The Indian Psychiatric Society also submitted its views to the APA.

International standard

The DSM-5 has pursued the basic framework adopted by its forerunners, DSM-III and its successors DSM III R, IV and IV TR. DSM III, with its atheoretical approach, objective diagnostic criteria and specific exclusions, was revolutionary at the time of its introduction in 1980. Its focus on standardised diagnosis and on improving inter-rater reliability had a major impact on psychiatric practice and research. It soon became the international standard.

The absence of laboratory tests to diagnose mental disorders forced psychiatry to focus on clinical presentations for this purpose. The lack of pathognomonic symptoms required the discipline to rely on identifying collections of symptoms to define clinical syndromes. Psychiatric classifications include medical conditions (e.g. delirium, dementia and psychiatric manifestations of medical diseases), severe mental disorders (schizophrenia, bipolar disorders, psychotic depression, and stupor) and stress-related conditions (e.g. depression, anxiety and adjustment disorders).

The DSM laid out objective criteria for diagnosis. It offered differential diagnosis in order to distinguish similar conditions. It allowed psychiatrists working around the globe to read from the same page. It facilitated collaboration and comparison. It improved communication, standardised research, increased, and improved the evidence base. A unified language also helped mental health activism.

Despite major advances and significant progress, the DSM has many critics. Most detractors are free with their criticism, without providing comprehensive solutions to the complex issues facing people with mental illness. Defining mental illness is no simple task. A single definition to partition health, illness and disease has proved to be extraordinarily difficult. The diversity of and heterogeneity within these conditions are major challenges. Typically, patients emphasise distress and suffering, while psychiatrists diagnose and treat “diseases.” Mental disorders include both disease and illness. Nevertheless, diagnostic criteria for psychiatric disorders did not bridge the classical disease-illness divide between physicians’ perspectives and patients’ subjective experience of sickness. In fact, the DSM resulted in language, concepts and frameworks, which contrasted starkly with those held by patients, impeding understanding of the illness experience and diminishing the role of patient narratives. In addition, DSM could not overcome the fact that different etiology and pathology can result in similar clinical presentations, and that a particular cause can produce diverse clinical manifestations. Research and specialist interests also increased manifold the number of diagnostic categories.

Little regard for context

The difficulty in separating disease from distress is a major challenge. The DSM system emphasised symptom counts to identify psychiatric categories, with little regard for the context (e.g. psychosocial stress, personality, and coping). This strategy improves reliability of diagnosis for non-psychotic conditions associated with psychosocial adversity, but also includes people with normal responses to such difficulties. Psychiatry tends to reify diagnosis, making abstract concepts concrete. Psychiatric practice transmutes clinical syndromes (collection of symptoms) into diseases.

The DSM III also suppressed etiological debates about mental disorders and placed them on the back burner. The biomedical model, which undergirds the approach, became dominant, annihilating psychological, behavioural and social conceptualisations. However, the APA argued that reliable diagnoses would result in the recognition of underlying neurobiological substrates and facilitate etiological research; it would lead to the development of new and more effective treatments.

However, the frequent revisions of the DSM, with minor changes often based on limited evidence, also prompted debates on the motivation of the APA. The numerous minor and major disagreements with World Health Organisation’s International Classification of Diseases (ICD) -10 diagnostic categories supported the argument that most changes were arbitrary as there was no agreement among international experts. The DSM had to contend with many charges including medicalising normal reactions, lowering diagnostic thresholds to create spurious “epidemics,” creating new categories without evidence, using medication responses to define categories and playing into the hands of the pharmaceutical industry.

Challenges to diagnosis

Defenders of the DSM argue that its primary purpose is to enable psychiatrists to reliably identify individuals who seek clinical attention, and to facilitate communication among clinicians and researchers. The field of psychiatry has to grapple with the current state of knowledge with its inherent limitations. The lack of laboratory diagnosis, poor understanding of genetic basis and psychological vulnerability, and the need to provide categorical diagnosis for phenomena which lie along a spectrum (e.g. depression, anxiety, cognitive impairment and substance misuse) are difficult challenges.

The most ardent supporters of the DSM acknowledge its imperfections but argue that it reflects our current understanding and state of the science. They contend that DSM-5 is not an attempt to define normal and that being normal is not the same as not having a DSM-5 diagnosis. They argue that having a psychiatric diagnosis is not the same as being insane or crazy, stigmatising labels, which do not apply to the vast majority of people with a DSM diagnosis. They suggest that prescribing medication for any condition in preference to time and labour-intensive psychological interventions is dependent on many factors, including the economic realities of medical practice, and does not necessarily imply medicalising normality.

Pressure from user groups

The use of a single set of criteria, useful to psychiatrists working in specialist settings, in other locations (e.g. definitions for legal use and for reimbursement, in primary care and across cultures) is not without problems. There was also pressure from patient and user groups, as any changes to the DSM-IV categories in the new revision would have affected their claims for disability support and health insurance. Consequently, there were demands to enlarge and to reduce the diagnostic net from different quarters.

A close examination of the DSM-5 suggests the maintenance of status quo. Psychiatric diagnoses and theories, with their technical language, operational criteria, elaborate classificatory systems and empirical data continue to lack the predictive power required of hard science. Its diagnostic systems and models do not explain many aspects of mental health and illness. Human cognition, emotion and behaviour are complex, interconnected and under a variety of influences (e.g. genetics and biology, psychological, social and cultural forces), whose effects cannot be teased out under controlled experimental conditions.

Nevertheless, psychiatric treatments help millions of people lead productive lives. The DSM process and consultation was elaborate and transparent, seeking opinions and evidence from people with diverse backgrounds. Despite its shortcomings, it does reflect the current state of the science. Psychiatry, at this moment in time, has been compared to biology before Darwin and astronomy before Copernicus.

Thomas Kuhn in his book The Structure of Scientific Revolutions described three stages: (i) normal science (routine scientific work) within existing paradigms and a dedication to solving puzzles, (ii) serious anomalies produced by research, which leads to a crisis, and finally (iii) resolution of the crisis by the creation of a new paradigm. Psychiatry today, with its attempt at solving the clinical puzzles and its many anomalies, is awaiting a paradigm shift, which will not only clarify these complex issues but will also provide for a new framework, insight and understanding. Psychiatric research, despite its current attempts at testable conjectures and refutations, is still within a paradigm that seems inadequate for the complexity of the task. Psychiatry awaits its new dawn.

 

(Professor K.S. Jacob is on the faculty of the Christian Medical College, Vellore. The views expressed are personal)

http://www.thehindu.com/opinion/lead/in-search-of-a-revolutionary-road/article4419552.ece

 

 

 

 

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The secret illness

5-Jan-2013

DIVYA SREEDHARAN

Awareness of pre- and post-partum depression is crucial to ensure the safety and health of both new moms and their babies.

M lives in Hyderabad. After her delivery, she underwent the traditional 40-day confinement. Being restricted to a room with just the baby affected her. She began to feel suicidal; thoughts of harming both her baby and herself filled her head.

S is from Delhi. After she had her baby, she experienced severe crying bouts. Doctors at a premier mental health insitute diagnosed her as having Obssessive Compulsive Disorder (OCD). But treatment did not help. She lost interest in her baby her family and herself.

Neither M or S or their families understood what was happening to them, post-delivery; that they were actually experiencing some form of post-partum depression (PPD).

“M somehow got hold of my number. She called me to say she had a very bad feeling towards her baby,” recalls Dr. Archana Nirula, a Delhi-based gynaecologist and the India coordinator for Postpartum Support International (PSI), a voluntary group that supports new moms and creates awareness on post-partum disorders.

M’s husband was in the U.S. at the time. Dr. Nirula contacted him and with his help, convinced M’s in-laws to let her, literally, step out of the confinement room. The in-laws were told they had to help her care for the newborn.

“S is my cousin’s wife,” says Dr. Nirula. “I told my cousin to immediately hire help to care for the baby; that he must take S out often, spend time with her. I impressed upon him that he too must share the responsibility of looking after the baby,” she explains.

Counselling, along with medication and family support, helped. Both women are now healthy, active mothers. Their babies are growing well.

Baby Ahuti in Mumbai was not so lucky. The three-month-old infant’s death was plastered across newspapers and television channels in October 2012. The police arrested her mother Dharmishtha Joshi on charges of battering the infant. The mother allegedly beat her “because she would not stop crying”, reported the police. Later it emerged that Ahuti’s twin sister had died just 12 days after birth.

Was Dharmishtha Joshi suffering from post-partum psychosis (a result of untreated and prolonged PPD)? What role did the babies’ father, Kalpesh Joshi, play in this tragedy? “There are many such horror stories across India,” says Dr. Nirula.

If a new mother is feeling detached from her baby or unable to nurse or care for the infant, she finds it impossible to admit that she needs help. If she is herself not aware of these changes, then her family must seek help, stresses Dr. Nirula. “In India, families, whether educated or uneducated, consider this condition a stigma; a shame. Even the treating medical fraternity link it to a psychiatric problem rather than a PPD (which is what happened to S),” she points out.

Nora Kropp, a mother of two, a professional midwife and Bangalore-based founding member of the Bangalore Birth Network (BBN) concurs. “We have idealised the state of motherhood to such an extent that a mother is not supposed to feel anything negative,” she observes.

Yet, there is enough research, done in India and across the world, to show that post-partum disorders can harm if left untreated or undiagnosed. A 2002 report in the Journal of Nervous and Mental Disease said women with severe postpartum psychiatric disorders admitted to an Indian psychiatric hospital reported infanticidal ideas and behaviour. A 2004 research paper in World Psychiatry also suggests that, in India, the new mother is at a greater risk of developing severe post-partum disorders if, she is poor, has experienced antenatal depression, is in a bad marital relationship, subject to domestic violence, and has given birth to a female baby.

In the West, there are support groups such as www.postpartumprogress.com and active networks such as PSI. There is nothing of the sort in India though birthing communities such as Birth India and BBN do deal with post-partum care. Dr. Nirula says that panic calls come to her cell phone or Delhi clinic. She stresses that gynaecologists/obstetricians and birth networks across India must set up networks and counselling for post partum disorders.

If women like M and S receive the help and support they need, babies like Ahuti will not die.

PPD vs. the Baby Blues

PPD is not the Baby Blues. The blues manifests as weepiness, vulnerability, forgetfulness, and stress after the babies are born. The blues should be over around two weeks after delivery. If it continues, even if the symptoms are mild, it is called PPD.

PPD is one of six post-partum mood disorders and is the most common. The primary cause is thought to be the huge hormonal drop in the mothers’ body after the baby is delivered. This hormone shift then affects the neurotransmitters (brain chemicals).

If the new mom is experiencing loss of appetite, difficulty sleeping at night when the baby sleeps, hopelessness, poor concentration, anxiety, anger, deep sadness, low self esteem, overwhelming energy or lack of energy, she or her family must get help right away.

Source: Dr. Shoshana Bennett, post-partum expert based in the U.S.

Helplines

Dr. Archana Nirula PSI Coordinator, India +91-9810192690 or +91-11-41634773/41634774. Email: sunrayclinic@gmail.com

The National Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore has a perinatal psychiatry clinic: 080-2699 5554

Bangalore Birth Network—http://www.bangalorebirth.org/bangalorebirth@gmail.com http://health.groups.yahoo.com/group/bangalorebirthnetwork/

Go to http://www.birthindia.org/ and click on the ‘Services Directory’ to contact midwives, birthing and lactation specialists in Bangalore, Delhi, Mumbai, Kochi, Goa, Gujarat, Kerala, Hyderabad, Pune and Chennai. They help new moms get in touch with counsellors for PPD

 

 

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Set aside 50 lakh a year to prevent suicides, IITs told

M Ramya

18-Nov-2012

The survey revealed that over the last two years 12 students committed suicide and 18 others attempted it.

CHENNAI: All central government funded technical institutions (CFTIs) in the country, including the IITs, IIMs and NITs, have been advised to set aside Rs 50 lakh a year to provide counselling services and conduct activities to ensure the mental health of their students.
A task force, constituted by the ministry of human resource development to study the increasing occurrences of suicides among students enrolled at the IITs and other such campuses in the country, made the recommendation to Union human resources development minister Pallam Raju and minister of state Shashi Tharoor earlier this week.

The task force, headed by professor M Anandakrishnan, designed a questionnaire for the CFTIs to assess the existing mental health needs, understand the magnitude of the problem and ascertain the resources. Of the 86 CFTIs asked to fill the questionnaire, only 26 responded. Of this, more than half do not have a full time counsellor and only 10 have scope for students to self-declare mental health problems.

Pallam Raju suggested that the counselling services could be made a component in the accreditation process and that special weightage be given to the provision.

The task force has suggested that the government set up an empowered committee on the lines of the Raghavan committee on ragging “as it cannot be assumed that they will be followed by all CFTIs with the same degree of rigour and seriousness”.

The survey revealed that over the last two years 12 students committed suicide and 18 others attempted it. As many as 872 students have been referred for counselling in these institutions. Relationship issues, personal problems, mental stress and family problems were reported as reasons for the suicides.

http://timesofindia.indiatimes.com/india/Set-aside-50-lakh-a-year-to-prevent-suicides-IITs-told/articleshow/17261769.cms?

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One killed in attack by mentally challenged

July 12, 2012

ANDHRA PRADESH : A man died, while two others sustained injuries in an attack by a mentally deranged man at Ukkunagaram on Wednesday.

M. Appa Rao (55) was approaching the flyover bridge near BC gate, when the accused hit him with a rod on the head. The victim later succumbed to his injuries. Some time later, two other men alighted an autorickshaw near the bridge and were walking on the road when the accused attacked them. Two other men, who were walking behind, tried to intervene but fled on realising the danger and informed the CISF personnel who took the accused into custody.

http://www.thehindu.com/todays-paper/tp-national/tp-andhrapradesh/article3630252.ece

Duo shows mental illness no bar to achieving success

Jul 09, 2012

Luna Dewan

Bengaluru : The correct medical intervention, counselling, and above all, whole-hearted support from the family, can help mentally ill or disabled persons from living a productive and happy life. Arun and Kiran Kumar (names changed to protect identity) who have been visiting the Department of Psychiatric and Neuro Rehabilitation Centre (DPNRC) at NIMHANS for the past couple of years are testimony to this fact. Arun is now employed as an attendant at the hospital and Kiran has got through an interview at the Akshay Patra Foundation, Vasantapura, and will be starting work in a few days.

“For the past 20-22 years, our only concern has been how to get our son to be normal”, said 71-year-old Rajamanikkam, Arun’s father. Arun, now 35, seemed to change when he was in 10th standard. He used to fall ill often, be angry, remain aloof, and instead of going to school, would go somewhere else. “We kept a close watch on Arun, but his condition worsened. He had to discontinue his education. We checked out various hospitals and doctors. He was suffering from both mental retardation and mental illness, according to the doctors. We were in Delhi then. After my retirement in 2006, we settled down in Bengaluru and started his treatment at NIMHANS,” Mr Rajamanikkam said.

“We used to get him to the rehabilitation centre every day where he was counselled and met similar patients. He used to work at the Centre’s training unit for about four or five years. He now travels alone, does shopping and his daily chores on his own, and for the past six months he is working at the hospital as an attendant. He comes back home, reads newspapers and plays chess. We are so relieved now seeing our son’s progress,” says an elated Mr Rajamanikkam.

Kiran Kumar, 31, is another example of how mental retardation and illness is no bar for achieving greater heights. For the past couple of years he has been attending the rehabilitation centre. His mental retardation was complicated by his habit of smoking and drinking. Since he did well at the rehabilitation centre, the special employment exchange sent him for an interview with the Akshay Patra Foundation. Kiran got through and will be starting work there in another few days.

“In the evening I also attend bhajans near my house, and play cricket. I am good at finding bus routes. Whenever my mother wants to go somewhere, I accompany and guide her,” laughs Kiran. Dr Nirmala B.P., associate professor and psychiatric social worker at DPNRC, NIMHANS says: “We are trying to train our patients so that they become competent with normal people. We get in touch with as many NGOs as we can so that once these patients are fine they can be recruited for jobs and they can lead a normal life.” Apart from the medication and training at the centre, the support of the family is important. Arun’s father is always at the forefront and never misses a parent-doctor meeting at the hospital, says Dr Jagadisha, professor in the Department of Psychiatry, NIMHANS.

http://www.asianage.com/bengaluru/duo-shows-mental-illness-no-bar-achieving-success-235

Priest with Alzheimer’s wanders off, found in Lower Parel 10 hrs later

3-July-2012

 

A 74-year-old Alzheimer’s patient, who wandered off from his Bandra home on Saturday, was found and reunited with his family hours later, thanks to an alert police patrol.

 

MUMBAI : Fr Sabino D’silva, a retired priest who is cared for at the Clergy Home, Bandra Bandstand, ventured out alone at 11.20 am and was found ambling about a street in Lower Parel around 9.30 pm.

 

He later told cops that he had travelled to Mahalaxmi by train and then walked to Lower Parel. Though he could not recall other events of the day, the 74-year-old’s family and caregivers at the Clergy Home are relieved that he is back.

 

Before being diagnosed Alzheimer’s (a brain disease that causes gradual loss of memory, speech and movement), D’silva was a priest in a Vakola church. He was moved to the Clergy Home a month ago. On Saturday, he left the place when the watchman was not manning the gates.

 

Footage of CCTV cameras installed at the building shows him dressed in a shirt and half pants, and carrying a black bag. Onlookers saw D’silva hiring an auto moments after exiting the premises.

 

“He was carrying around very little cash, so we assumed that he would be in or around Bandra,” said a priest at the home. “After his whereabouts could not be determined, we made announcements in the chapel and even put up posters.”

 

D’silva’s family showed his picture at a nearby restaurant, but in vain. Finally, a missing person’s complaint was filed at the Bandra police station.

 

“The CCTV footage only showed D’silva leaving the building. It didn’t reveal his direction,” said Investigating Officer SM Kole, who relayed news about the former priest’s disappearance and his description to the police control room.

 

Hours later, at 9.30 pm, a patrol team of the NM Joshi Marg police spotted him roaming aimlessly in Lower Parel. Not sure if he was the man described by Kole, they took him to the police station.

 

D’silva told cops that he got off a train at Mahalaxmi. “He, however, could not recall where he lived or who his family members were,” said Sub-Inspector Shaileshkumar Ningadali.

 

A constable found a book in D’silva’s black bag, which helped establish that he was a former priest. Cops then set about contacting various churches in the city. Finally, they got in touch with the Clergy Home and his family.

 

Mirror contacted his family members, but they refused to comment.

 

No country for the mentally ill

Jul 8, 2012

 

Ambika Pandit

 

NEW DELHI : After a year under the care of strangers, Rekha, 40, is on the way to recovering her mental moorings, but her family has drifted beyond reach. A few days ago, an email from her US-based brother made it clear that they were unwilling to take her home. Where does Rekha go now?

 

It’s a question facing many mentally ill people in the city. Smriti Vaid from St Stephen’s Hospital – the state-appointed mother NGO on homeless – says cases of mentally ill patients being abandoned on streets to fend for themselves are on the rise.

 

“Rekha was found on August 16 last year. She was treated at the Institute of Human Behavior & Allied Sciences. After she started showing signs of recovery the big question was to find a space for her, as there is no government facility for such patients to stay in and recover till the time they can be re-integrated with society,” Vaid said.

 

When Rekha, an economics graduate from Nagpur, was found inside a tin shed in Karkardooma, she was living a beggar’s life. She now stays at north Delhi’s Kabir Basti shelter run by the voluntary organization Sudinalaya – the only such facility for mentally ill women. But with her family having abandoned her, recovery alone is no longer good news.

 

Shelters for mentally ill not before next year

 

Forty-year-old Rekha was found in a tin shed in Karkardooma a year ago. Though the mentally ill woman is on the road to recovery at a shelter home, her family has abandoned her.

 

“Attempts to trace Rekha’s family led to an address in Nagpur, and finally her brother called from the US to ask about her condition. Rekha’s hopes rose after speaking to him, but finally all he sent8% was an email stating that he and his family had tried hard to support Rekha through her illness but she was unable to adjust with them, and now he was unwilling to take up her responsibility,” said Smriti Vaid from St Stephen’s Hospital, an NGO.

 

“While the government has no facility of its own, it does not even attempt to support institutions that are trying to provide care,” said Sreerupa Mitra Chaudhury from Sudinalaya.

 

In another case on June 27, the St Stephen’s rescue team found a seemingly disturbed woman walking on the road near Tis Hazari Metro station. “Dressed in t-shirt and jeans, Meena had sore feet that suggested that she have been on the road a long time,” said Sonu, a rescue team member. The 35-year-old’s family was traced to Yamuna Vihar in northeast Delhi and it turned out that she had been missing since June 25. Her mother said they had complained to cops a day later.

 

Although Meena’s family was relieved to have her back, her mother worries about her disappearing again. “I want her to be admitted to some institution so that she can be monitored during treatment. At home, often it is not possible to predict her mood. At times, she refuses to take medicine.” Meena’s husband died around six years ago and she has a 13-year-old daughter and a 10-year-old son.

 

Dr Amod Kumar from St Stephen’s said Meena’s case also highlights the need for care homes. Meanwhile, the Delhi government is now trying to get its plan to build five halfway homes for such patients off the ground.

 

Only after NGOs approached the Delhi high court a few years ago citing absence of facilities for the growing number of mentally ill people on the streets and drug addicts in need of long-term support did the state swing into action to set up these homes. A plan to build facilities in Dwarka, Narela and Rohini was thus conceptualized by the department of social %welfare.

 

The proposal for these homes was recently cleared by the Expenditure Finance Committee, and the department of social welfare is preparing to award the work of construction to the public works department. However, the homes are unlikely to be ready till late next year, sources said.

 

(Names of the women have been changed)

 

http://sp.m.timesofindia.com/PDATOI/articleshow/14738764.cms

“Empower ‘108’ Ambulance to pick up wandering mentally ill”

  17-June-2012

Volunteers submit plea to Health Minister

VELLORE : President of Udhavum Ullangal-Vellore Era. Chandrasekaran, professor and Head of the Department of Psychiatry, Christian Medical College, Vellore, Anna Tharyan and consultant psychiatrist, Vellore, S. Zubaida Sultana, have made a plea to Health Minister V.S. Vijay to empower 108 Ambulance Service to pick up wandering mentally ill persons as soon as they get alerts and admit them to the nearest hospital.

The petitioners pointed out that the number of mentally ill persons wandering in the streets is increasing day by day, posing great risk not only to their lives but also others. Usually, it is difficult to predict the behaviour of such wandering persons. On June 4, a mentally ill person had set fire to a house, resulting in the death of two persons in Ranipet. A mentally ill person set himself afire in Ambur about two months ago. There are many instances of such persons, especially women who faced all sorts of abuse and ill-treatment from the community around them.

The 108 Ambulance Service in Tamil Nadu had been of great help to the general public. But this service does not meet the requirement of the mentally ill persons, the petitioners said.

At present, the legal procedure for extending help to a mentally ill person is tedious and time-consuming. It begins with a police First Information Report, a certification by a government doctor, and production of the person before the District Magistrate. The Magistrate has to give an order to admit the person in a government hospital for observation. A report on the condition of the person has to be given to the Magistrate in the next 10 days based on which the latter gives a reception order for the mentally ill person to be admitted to a mental hospital. Usually, non-governmental organisations undertake the task of coordinating with police, court and hospitals to ensure proper care of the mentally ill persons.

During this long procedure, the police have to provide protection to the mentally ill as well as others around them . “Because of this tiresome procedure, usually the police turn a blind eye to the public’s alert regarding the wandering mentally ill persons. Result of this is that the mentally ill persons are left uncared, unsafe and exposed to public ire,” the petitioners said.

They requested the Minister to look into the matter and simplify the norms and procedures for extending help to the mentally ill .

“Our humble suggestion is to empower the 108 Ambulance Service to pick up the wandering mentally ill persons as soon as the alerts about them are received, and admit them to the nearest hospital. The FIR, magistrate’s reception order, doctor’s/psychiatrist’s report, etc., could be effected at the bedside of the mentally ill patients in the hospital as done in road traffic accident cases,” they said.

http://www.thehindu.com/todays-paper/tp-national/tp-tamilnadu/article3538766.ece

‘Apathy, stigma causes such cases’

Jun 17, 2012

 

NEW DELHI: The story of the two sisters who were rescued from their apartment in Rohini on Saturday is not new. There have been two similar incidents reported in Delhi in the past few years. But despite this, there remains a lack of awareness about mental illnesses and social apathy towards such people. Psychiatrists say that there is need for a government-run helpline service to address the issue.

 

In the recent case, the elder sister weighs just 15 kg, has bedsores and her body is infected with maggots. She can’t move her limbs. Her younger sister, too, suffers from a serious psychiatric disorder. Neighbours say the two sisters have been in this condition for nearly two years. But in the last four months, things had deteriorated. Their 65-year old mother says her two daughters never wanted to go to the hospital. Doctors say that in such cases, the role of neighbours becomes even more crucial. “If the neighbours knew about the sisters, they should have informed police. It is a clear case of social apathy. In such cases, neighbours have to play a proactive role,” said Sameer Parikh, director, mental health centre at Fortis Healthcare.

 

Explaining the mental condition of such patients, Dr Nand Kishore, associate professor of psychiatry at AIIMS said, “In such cases, patients first withdraw themselves from any social activity or try to get away from people. They stop taking care of themselves and many die due to starvation or by committing suicide,” he said.

 

Apart from the sisters, doctors say the complete mental evaluation of the elder sister’s 13-year-old son, who used to stay with them, should be done and his rehabilitation should be planned accordingly. “There is a need to assess the mental state of the son as he has been seeing them in this condition for nearly a year. Once the assessment is done, only then can one plan his rehabilitation into the mainstream,” said Dr Sameer Malhotra, head of the department, mental health at Max Healthcare.

 

Doctors say that millions of mentally ill people across the country continue to suffer in similar circumstances due to lack of timely intervention. The government, experts say, needs to set up a helpline where people can call and report about such incidents so that the state government can provide held. “Like we have police helpline number, a helpline should be there for mental illnesses. The government should also rope in RWAs so that such people can be given timely medical assistance,” said Dr Jitender Nagpal, senior consultant psychiatrist, Moolchand Medicity.

 

“People don’t consider mental illness as a disease that can be treated. There is still a stigma attached to mental illness. Anxiety and depression, which are the most common conditions and can be easily treated, are referred to doctors only when the patient’s condition worsens. The attitude of our society towards mentally ill patients needs to change,” said Dr Nagpal.

 

Doctors say millions of mentally ill people across the country continue to suffer due to lack of timely intervention.

 

http://articles.timesofindia.indiatimes.com/2012-06-17/delhi/32281740_1_mentally-ill-people-mental-health-mental-state