"Psychosocial care should be a component of overall health care"

K SEKAR, assistant professor, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, talks to NEELAM SINGH about psychosocial distress among survivors of the Latur and Osmanabad earthquake ten years since the tragedy, and the role of the community in providing mental health care

Published: Monday 15 March 2004

What are the main findings of the psychosocial assessment of the Marathwada earthquake survivors?
One out of every three persons suffers from psychological distress. 65 per cent have been impaired by functional limitations. Such disability reduces a victim's functionality by one-third. So each such patient has lost 12,000 working days in the ten years since the tragedy; monetarily such people have lost at least Rs 12 lakh each -- even if we keep their earnings to a conservative Rs 100 per day. It's a huge cost to a family. Women and aged were found to have higher levels of psychological morbidity. Even ten years after the quake, people complain of anxiety and palpitations.

To what extent can the community care model help?
Community has the potential to take care of 60-70 per cent patients. Another 20 per cent will require intervention of primary health workers or school or anganwadi personnel. Only 5-10 per cent cases need referring to mental hospitals. Rehabilitation of the mentally challenged cannot happen in a few years; it is a lifelong process. We have to start institutionalising psychosocial care mechanisms in the community.

Was the role of community in providing psychosocial care always recognised?
Such a role was first recognised during the Orissa super-cyclone of 1999. Community level workers were provided training and a person with a medical background was given three months training at National Institute of Medical Health and Neurosurgery (nimhans), Bangalore. On evaluating the Orissa programme about eight months back, we found that persons who were provided psychosocial care showed less psychological distress, their ability to function had increased and their quality of life improved. But when we studied cases where only physical rehabilitation was provided, psychological distress was much higher. That proved for the first time that community could provide mental health care when empowered to do so.

What is the state of psychosocial care in India?
It is still at an incipient stage. Till 1993, patients were only treated for symptoms. Today psychosocial care has made some progress, but we still have to recognise that at every stage there has to be an assessment of the needs of patients and a strategy for care devised accordingly.

When did nimhans get involved with psychosocial care for disaster-affected people?
nimhans has been involved in psychosocial and disaster care from 1981, when about 70 children from 54 families died due to the Venus circus fire accident. When our organisation reached out to these families, it had a bigger disaster waiting: most of them had not reconciled to the death of their child. Then the Bhopal gas tragedy happened and since there was no psychiatrist in entire Bhopal, nimhans trained local primary health centre doctors in mental health care.

What is being done in terms of pre-disaster preparedness in psychosocial care?
We have not been able to take up that issue at all. We are now working on psychological first aid -- both in Orissa and Gujarat; this endeavour is just a couple of months old. So far we have only discussed a few possible reactions to a disaster.

Is there adequate recognition of psychosocial care needs of people at the policy level?
Though there is some recognition of mental health issues at policy levels, they are not spelt out clearly. Psychosocial care should be a component of overall health care.

How long will it take for disaster management policy to incorporate principles of psychosocial care?
When an earthquake struck in Bhuj, Gujarat, there was an immediate call from the government as well as civil society for this kind of care. That was a major step. The process to draw guidelines is still on. I won't put a very specific timeframe for this, we are into the process, it will take its own course and we have to move along.

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