Madurai district of Tamil Nadu has the distinction of providing highest quality mental health care services, says an evaluation of the District Mental Health Programme (DMHP). The outstanding performance is primarily attributed to regular inflow and availability of medicines at health centres.
While satisfaction with the quality of services is an average of 7.3 on a scale of up to 10, Madurai attained a score of 9.6. Other districts that are rated higher than the average are Raigarh and Buldana in Maharashtra, Tinsukia and Nagaon in Assam, Navsari in Gujarat, and Delhi.
The DMHP is being implemented in 123 districts across the country with the aim of creating awareness about mental health, its early detection and treatment and removing the stigma associated with it.
Evaluation for future expansion was done by the ICMR, a division of Planman Consulting (India) Pvt. Ltd. It visited 20 districts where the DMHP was being implemented and five non-DMHP districts. The results showed that the expenditure on training and IEC components that require a lot of ground work, coordination and network in the community, is below par in most of the districts.
The results also showed that only one-third of the districts utilised the funds made available under the programme, while the remaining used only 37-47 per cent of the money owing to administrative delay, difficulty in recruiting and retaining qualified mental health professionals.
Regarding availability of drugs, it said that only 25 per cent of the districts reported that there was regular inflow. “This is because of lack of dedicated drug procuring mechanism for the DMHP and financial authority to the nodal centre, though 80 per cent of the beneficiaries across the districts indicated having received at least some medicines from the health centre.”
About 61 per cent of the beneficiaries accessed the district hospitals at their first point of contact. The percentage of patients accessing community health centres was 12.7 per cent and primary health centres 11.5 per cent — much lower than the expected levels. Again, 18 per cent of the total respondents confirmed that they were referred to the district level hospitals for treatment. “This stresses need for regular training to all general health care staff, which was limited to only first three years and that too only 15 to 20 per cent of the health staff in the 10th Plan,” the study said.
However, the good news is that 75.7 per cent of the patients reported that they were treated with dignity and respect. With respect to trust and confidence, an impressive 72.8 per cent reported that they had full trust and confidence with the medical personnel who treated them and another 25.3 per cent stated they had trust and confidence to some extent. “One-fourth of the beneficiaries indicated having received counselling services under the DMHP which is good, considering the fact that counselling is a time intensive activity,” the study pointed out.
In the districts having the DMHP, 87 per cent of the community members said they knew about mental illness, which was higher than non-DMHP, where the percentage was 75 per cent. The study described the difference as significant and attributed it to implementation of the programme.
Nearly half of the respondents (48 per cent) reported sadness and depression as the symptoms of mental illness, followed by fear and nervousness (42 per cent), lack of sleep (41.6 per cent) and over-excitement symptoms such as hallucination (36 per cent), fits (45 per cent), pointing to the effectiveness of the programme as compared to the non-DMHP districts. Awareness of illnesses such as psychosis, neurosis and epilepsy were also found to be significantly higher in the DMHP districts.
Importantly, more than half of the respondents from the DMHP districts agreed that proper medication and counselling could help in the treatment, against only 30 per cent in the non-DMHP districts.
The difference in approach of the respondents from the DMHP and non-DMHP districts was clearly evident as far as conservative methods and beliefs are concerned. For example, consulting occult practitioners was suggested by only 47.3 per cent of the respondents from the DMHP districts, against over 70 per cent from the non-DMHP respondents.
