I read the article “Repackaging mental health programmes” (Nov. 4) by Professor K.S. Jacob with special interest. I have worked as a nodal officer of a District Mental Health Programme in Kerala for three years. I agree with most of Prof. Jacob's conclusions. There is a lack of enthusiasm in the psychiatric fraternity in implementing such programmes. The community health worker / public health nurse / health inspector has neither the time nor the motivation to cooperate in promoting mental health. The newly introduced ASHA is also entrusted with maternal and child health immunisation. It would be good if field workers are dedicated specifically to mental health care in districts where the DMHP is operational. The model has worked well in Kerala, although the health workers are volunteers.

District mental health programmes are operational in all five districts of north Kerala, implemented by IMHANS, Kozhikode. Of the five programmes, two receive funds from the Central government as part of DMHP. The other three were started by IMHANS with funding from the State NRHM. All the programmes are running in a fairly successful manner. We have been able to reduce the overcrowding at the government mental hospital.

Dr. M.T. Harish,

Associate Professor of Psychiatry,

Government Medical College,

Kozhikode

Indifference towards the mentally ill is common in our society. Dr. Jacob's call for putting in place a workable, humane and effective programme to achieve the goal of mental health for all should be taken seriously.

At present, a sedative course to subdue the mentally ill or disowning them seems to be the practice. The way many of them wander in public — abandoned, ridiculed and attacked — is pathetic. Prevention and rehabilitation are of paramount importance in dealing with mental health.

S.V. Venugopalan,

Chennai

I agree with Dr. Rajamohan (Letters, Nov. 5) — that most psychiatrists rely on drugs without exploring non-medical therapies that are useful and curative in obsessive compulsive disorders, generalised anxiety disorders and reactive depression. A few of my relatives are being treated for depression with a powerful dose of drugs. I am told that they sleep most of the time. I feel distressed because they are under the illusion that they are receiving treatment.

S. Sampath,

Washington

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