Volume 5 Issue 12 December 2015
Consultation Liaison Psychiatry Focus: ‘Community medicine’
Community health service, initially concerned with communicable diseases, has taken holistic path involving personal services of mental health. However, community psychiatry is in formation and needs collaborative efforts to provide comprehensive interventions engrossing multifactorial causation of psychiatric disorders arising out of multiple stressors and risk factors from the individual, the family and the community. In the era of demographic transition, the family and social support system is increasingly being affected by unplanned urbanization, drug use, and changing family issues. Community Psychiatry in India is in a developing phase of decreased reliance on hospitalization, and attempts integration of everyday life of chronic patients into the mainstream. Yet, it is painful to accept that in our medical education system psychiatric disorders are ‘neglected diseases’; that the psychiatric problems are positive diagnosis and can be explained by classical pathophysiology as all other somatic diseases and curable to a great extent, is ignored. Along with common citizens, health care providers of all approaches and all levels (other than directly related to psychiatric care) have gross misconceptions regarding pathogenesis of psychiatric disorders and their management.
To manage above issues in a good move the Bellary model of District Mental Health Programme (DMHP) has been adopted by the Government of India under the National Mental Health Programme with the primary aim of making mental health care accessible to all by setting up psychiatric services in peripheral areas, training primary health care personnel and involving the community in promotion of mental health care. DMHP was started with four districts in 1996, and the programme covered 123 districts in the 11th Five year Plan.
Further we need multipronged approach involving experts from Community Medicine, Psychiatry, Family Medicine, Sociology etc. and involvement of Not-for-profit organizations for integration of health care and health education to develop a network of comprehensive Primary Mental Health Care involving social determinants, and different levels of mental health provision in differential settings. We need futuristic attitude in all pervasive integrated planning for mental health through network of facilities and human resources to reach last man on road even at the remotest corner with a sustainable referral system and technical leadership center. All these can see the light of the day from the positive political will and close collaboration to take challenges of community level mental health agenda in the Sustainable Development Goals.
Dr. Ranabir Pal Professor and Head, Department of Community Medicine Andaman & Nicobar Islands Institute of Medical Sciences (ANIIMS), Port Blair Email id: ranabirmon@yahoomail.co.in
