presidential address
Presidential Address
Address delivered at the ANCIPS 2009 in Agra on 9th January 2009
The Vision
Reaching the unreached
The rural population comprising about 74% is beset with multiple disadvantages. High population growth rate, agrarian form of economy, primitive agricultural practices, illiteracy, ignorance, unemployment, underemployment, caste-based politics, urban rural divide, social iniquity and discrimination account for 22.15% of the population remaining below poverty line. "State of the World Population 2007" report comments on the rapid shift of rural population to the cities by 2008. This ‘pseudo-urbanization’ may lead to shortage of resources in cities leading to ‘urban poverty’. Relationship between poverty and poor mental health has been well studied and stated. The World Health Organization report on mental health states ‘Mental disorders occur in persons of all genders, ages, and backgrounds. No group is immune to mental disorders, but the risk is higher among the poor, homeless, the unemployed, persons with low education’. Poverty, unemployment, poor education, and poor nutrition may pave the way for maladaptive behaviours, depressive illness, and broken families. The vicious cycle of poverty breeding mental dysfunction may culminate in substance use, domestic violence, and antisocial behaviour. The pathological family atmosphere may cast a negative impact on child mental health. 14-16
Ignorance, illiteracy, ‘myth understanding’, poor access to psychiatric services, and fractured community care/ support necessitate the need for mental health literacy, psycho education, proper immunization, improved nutritional care, and better mental health service delivery in rural population. This may be facilitated by IPS in collaboration with NRHM (National Rural Health Mission) and DMHP.
Rehabilitation
Psychiatric rehabilitation facilities do not satisfy even adequate requirements in many states across India. There is a polarization towards South India especially Kerala, Karnataka and Tamil Nadu in the psychosocial rehabilitation map. Training facilities exist at NIMHANS, Richmond Fellowship Society of India at Bangalore, and SCARF at Chennai. Many NGOs are involved in rehabilitation practices especially in substance use disorders, HIV, dementia, and schizophrenia. However, IPS has not done enough in this area except for formulation of IDEAS.
It is quite appropriate and appreciable to have a status report of psychiatric rehabilitation facilities and initiate skill development in psychiatric rehabilitation under the umbrella of IPS.
Research
The research output from India concentrates mainly on epidemiology and service delivery. The database on drug abuse research has been mainly from AIIMS (New Delhi) and NIMHANS (Bangalore). Psychiatric genetic research is another domain, again from New Delhi and Bangalore. Biological psychiatry research initiated from Lucknow has now shifted mainly to Bangalore. The priorities in research on mental health have been outlined elsewhere.17-18 Research publications in international database during the last decade mainly reflect on the studies generated from selected teaching institutions in India- NIMHANS (Bangalore), PGI (Chandigarh), AIIMS (New Delhi), RML hospital (New Delhi), KGMC (Lucknow), IHBAS (New Delhi), CIP (Ranchi). CMC (Vellore) deserves a special mention for its collaboration with Cochrane Database.
There are efforts in conducting and pursuing research in other teaching institutions and private psychiatric centres. But the limiting factors include
- Lack of proper training in research methodology
- Lack of motivation
- Lack of infrastructure
- Lack of skill in writing a research paper
- Lack of funding
A bird's eye view on the Central Budget allocation under the health ministry 19, 20 can reveal why major teaching institutions have been able to churn out research data.
Central Budget Allocation for Training and Research-2008-2009
Centre |
Budget Allocation (in Crores) |
AIIMS |
452 |
PGI |
183 |
JIPMER |
128 |
Lady Hardinge Medical College
& Smt. Sucheta Kripalani Hospital, New Delhi |
99 |
NIMHANS |
68 |
RML |
10.8 |
Others |
10.9 |
It would be worthwhile to look at the budget allocation for research and propose research agenda for mental health. Central Budget Allocation for Research-2008-2009
Centre/Activity |
Budget Allocation (in Crores) |
ICMR |
356 (How much for mental health research?) |
Promotion, Co-ordination and development of basic, applied and clinical research |
50 |
Inter-sectorial Co-ordination in Medical, Biomedical and Health Research |
19 |
Advanced Training in Research in Medicine and Health |
5.5 |
International Co-operation in Medical and Health Research |
10 |
Matters Relating to Epidemics, Natural Calamities and Development of Tools to Prevent Outbreaks |
5 |
Matters Relating to Scientific Societies and Associations, Charitable and Religious Endowments in Medicine and Health Research Areas |
2 |
Other Health Research Schemes |
1 |
Provision for projects/ schemes of North EasternAreas and Sikkim |
40 |
Hospitals and dispensaries have separate allocation for development plans.
However, the state-run institutions depend upon research grants from respective state governments. The allocation for mental health research might be negligible or almost nil partly due to the myopic vision of mental health planners in the ministry or due to “masterly inactivity” of the state psychiatric associations. There is a provision from central ministry for upgrading selected institutions to ‘AIIMS Model’ with an allocation of 490 crore rupees. Hopefully, the barren land for research in mental health may become fertile in the near future, if properly planned and executed.19
IPS should focus on this issue and try to facilitate research in psychiatry.
The possible ways include
- Research methodology training to selected psychiatrists
- Advocacy to reallocate and channelize research grants. A core group should screen the proposals and the advocacy committee of IPS should try to impress the ministry and ICMR (Indian Council of Medical Research) to take appropriate steps. NMHP has 58 crores as its share whereas NRHM having 10786.25 crores as budget allocation encompasses National Drug De-addiction Control Programme (11 crores) and Information Education and communication (171.7 crore). The core group may try to include mental health related programmes under NRHM.
- Orientation in skills in drafting a research paper
- Young researchers group under IPS may have a positive impact
- The international associational networking may render assistance to mental health research in India.
|
