Mental illnesses are health challenges that can affect the way we think about ourselves, relate to others, and interact with the world around us. They affect our thoughts, feelings, and behaviors. Mental health services in India are neglected area which needs immediate attention from the government, policymakers, and civil society organizations. To address the problem, we have project proposal for intervention to support the persons, family members and the community people with a set of activities like diagnosis, treatment, counselling, medication and care; family and community awareness and capacity building; linkage with government health and rehabilitation facilities to access sustained facilities as far as possible.
Executive Summary:
In India, Jharkhand has become an independent state as the 28th state of India on 15th November 2000, carved out from Bihar state. It is located in the eastern part of India. The state consists of 24 districts divided into 4 commissionaires, predominantly inhabited by different tribal communities and different small ethnic groups. It is one of the poverty stricken state under Indian Territory for which the people are lived in starvation, poor health, low literacy and soon.
Among the health problems, mental health illness is a big problem in the state especially in rural areas due to various reasons like poverty, lack of awareness, lack of treatment facilities, apathy of the family members, lack of community support and so one.
Our organization as a development organization has been implementing several programs for the development of the rural population since its inception. During implementation of various programs we have found a large number of mental illness persons in the villages. Then we have decided to address the problem. Based on our organization information survey and secondary data available we have found large number populations about 379 persons are mentally ill in 20 villages which is under our development intervention area.
To address the above mentioned problems we have been prepared a proposal for intervention to support the persons, family members and the community people with a set of activities like (i) Diagnosis, treatment, counseling, medication and care; (ii) Family and community awareness and capacity building; (iii) Linkage with Govt. Health and Rehabilitation facilities to access sustained facilities as far as possible. This is in brief here. The detail of the proposal stated below for further reference.
State profile:
Jharkhand has become an independent state as the 28th state of India on 15th November 2000, carved out from Bihar state. It is located in the eastern part of India. The state consist of 24 districts divided into 4 commissionaires, predominantly inhabited by different tribal communities and different small ethnic groups, having a total population of around 3.3 crores as per 2011 census. Jharkhand is a state of tribes and dalits. By definition tribe is a social group the members of which live in a common territory, have a common dialect, uniform social organization and cultural homogeneity. Tribal economy largely depends on three natural resources i.e. land, water and forest. Our country and state has advanced in different fields but its fruits have not yet percolated to the targeted people in the stated due to lack of Irrigation, credit, marketing, transport and extension education facility, but despite of these acute problems in agriculture practices they are continuing traditional farming as they are deprived from alternate sources of livelihood. The worst affected are primitive tribal groups which historically are late entrants to settled cultivation on land on hilly slopes with very low fertility. Another group that is severely affected is the scheduled castes and obvious backward casts who are primarily agricultural workers with very little land. These people are compelled to live in the dire situation of abject poverty, superstition, malnutrition, poor health condition and low quality of life due to above mentioned reasons. Literacy rate in Jharkhand has seen upward trend and is 66.41 percent as per 2011 population census. Of that, male literacy stands at 76.84 percent while female literacy is at 52.04 percent. So, low literacy rate is one of the causes of underdevelopment of the state.
District Profile:
Dhanbad district is one of the twenty-four districts of Jharkhand state in India. Dhanbad is the administrative headquarters of this district. The District has extraordinary importance because of its mobilization of local resource bases. The dominant industry of the district is based on coal, which has attracted a concentration of numerous other industries. The high-grade metallurgical coal of the Jharia coalfield within the district feeds most of the existing steel plants of the country.
The rich varieties of by-products of coal from these coal plants have provided necessary raw materials for the developments of chemical industries in the country as well. Other industries are ceramic, iron and steel, engineering and other ancillary industries. The Damodar is the most important river of the Chotanagpur plateau. It rises in Palamu and flows eastward between the plateaus of Ranchi and Hazaribag. It is joined by the Bokaro, the Konar and the Barakar rivers. The Damodar enters Dhanbad district at its confluence with the Jamuria, a stream which marks the western boundary of Dhanbad with Hazaribagh District. The Maithon dam is located on this river about 13 km off its confluence with the Damodar. Dhanbad has a large mix of different cultures and people. There are a significant percentage of people who are Bengalis, Biharis and locals. There are also significant Gujarati, Punjabi, Tamil, Malayali, Telugu, Marwari communities who have been living in Dhanbad for a long time and mostly engaged with business. Therefore, Dhanbad can be called a cultural melting pot. This diversity is also mirrored in the fact that there are a large number of languages spoken in Dhanbad.
Other than the district town, the outskirt areas of Dhanbad district is the villages, in remote location the people are engaged in various jobs such as agriculture, daily labour, labours in nearby factories, small business, vending etc. etc. The communities are mixed culture communities. Economically the people are poor, males are the source of income, alcoholic attitude prevailing among the male folk. There is a social harmony in spite of various casts, religion and communities reside in the villages.
The women literacy in the area is very low. The health scenario of the people is bad. The hospitals in blocks and rural areas are low infrastructure, lack of technical human resource, lack of Doctors, lack of required health services due to which the rural people’s health condition is worst one. The sever condition of the women and children. During our project activity implementation in the villages we have found a large number of mental ill patients due to different reasons which need to be address.
Block/Area Profile:
Tundi block is a remote area of the district though attached to the district town. But the people of the area are deprived of number of basic facilities such as health facilities, drinking water, roads, sanitation and so on. The coal and factory dust also a big problem in the area. The greenery of the area severely destroyed. The worst condition of the people has been suffering in mental problem.
Most of the people living in these areas are dependent on agriculture are mainly marginal and small farmers. The average land use for each of these products is 2-3 bighas and sometimes less. Due to irregularities in monsoon the food insecurity is a chronic and rather a permanent feature of their life. Food shortages affect every poor household, especially those engaged in casual agricultural & non-agricultural labour. Level of food shortages varies from a few months when harvest supplies run out to starvation conditions for marginal farmers & landless when both food & employment are in short of supply. The farmers, whatever produced from their existing farming land, can be able to have availability of food for their families, maximum for a period of 3 months to 6 months. This situation forced them migrate to cities and towns to earn money to manage livelihood.
A large number of the rural people in the target area have been suffering in mental health problem. No effective mental health care is available. In rural hospitals there is no Doctor, nurses, psychiatrist for treating mental illness. Mental health illness is a condition for which a person cannot behave in a normal manner. Depression alone is ranked as one of the leading cause for mental illness.
The family members also ignore those patients. The barriers for care is basically stigma, poor economic condition, lack of facilities for care nearby and lack of sympathy of the family members too. This situation needs to be addressed. Identified those persons are to be taken care of. The project has been designed keeping in mind of the above mentioned situation.
Problem Statement:
The prevalence of mental disability was found higher among males than among females. The prevalence rate was higher among the productive groups and among individuals with low socio economic status. Mental disorders are prevalent in people of all regions, countries and societies. They affect men and women at all stages of life. Contrary to popular belief, the poor are more likely to suffer from mental illness.
Mental health services in India are neglected area which needs immediate attention from the government, policymakers, and civil society organizations. Despite, National Mental Health Program since 1982 and National Rural Health Mission, there has been a very little effort so far to provide mental health services in rural areas. With increase in population, changing life-style, unemployment, lack of social support and increasing insecurity, it is predicted that there would be a substantial increase in the number of people suffering from mental illness in rural areas. Considering the mental health needs of the rural community and the treatment gap, there is a need for intervention of external actors/NGOs to address the problem.
Mental health awareness is very low in our country. Every family you will find at least one person suffering from the following mental and emotional issues, problems and diseases, alcohol addiction, smoking addiction, drug addiction, sex addiction, anxiety, depression, insomnia, anger, short temperament, frustration, irritation, stress, tension, low confidence, negative thinking, confusion, monotony and fear. In the present era, mental disability is a major public health problem in the every society. Many of the mental disabilities are correctable if detected early and treated in time.
As per the 1987 Mental Health Act, provides safeguards against stigmatization of patients suffering from mental illness. Community care of the chronic mentally ill has to be arranged for the betterment of all those identified persons. But as an organization we believe that, there is scope for community-based rehabilitation of the mentally ill people at the village level itself.
Causes of mental illness in rural India:
- Mental illness is the causes of bad parenting;
- Stress is one of the causes of mental illness;
- Depressing is a normal part of ageing process;
- Depression results from a personnel weakness;
- Addiction is one of the causes of mental illness;
- Mental illness due to family discord, separation and divorce;
- Regular alcoholism results such illness;
- Family unrest causes mental illness;
- Anxiety and Fear causes such illness;
Rational:
The mental illness rural persons need treatment and support to overcome the problem. Though mental illness is a highly stigmatized and deeply personal health issue, but our organization is committed to a bottom-up, grassroots family and community led approach to treat those persons so that they can cure completely over a time of period. We believe that this could be possible through involvement of the family members, local communities, health workers, and other stakeholders like Government Hospital and with the help of psychiatrists.
The mental illness can be treated. This means that many people who have a mental illness, and are treated, recover well or even completely through diagnosed and continuous treatment. But as because there are many different factors contributing to the development of each illness, it can take time and very difficult to say that, how, when or to what degree someone in going to be cure.
Target Group / Beneficiaries:
The target group is 3851 families of 20 villages. The occupation of the family members varies from agriculture labour, contract labour, marginal farm family, small business, services in factories and establishments and so on. The people are from all caste and religion through majority are Dalit and Tribals and with poor economic condition. The detail Demography stated below.
What do we mean for diagnosis?
As far as our knowledge is concerned, ‘when someone starts to feel mentally ill, he or she has to be bring to a Specialized Doctor for treatment or other Health professional for diagnosis. After a thorough check up and dialogue with the patient and the family member, a Doctor can make a diagnosis based on a particular pattern of symptoms. Then the Doctor or Specialist can then be made about the best treatment for these symptoms and their underlying causes based on the symptoms of mental illness.
Treatment Methods:
There are several methods of treatment as on toady so far the advancement of medical science is concerned. It normally involved (i) psychological therapy; (ii) medication; (iii) community support.
So the basic rational this project is to provide various supports to the mentally ill persons in the target area so that all they can cure over a time of period. At the same time to create community awareness to support such patients to recover from such illness and lead a normal life.
Objectives:
The primary objective was to operate a community-based mental health program in 20 identified villages wherein there are already 379 mentally distressed persons found as per organization survey and available secondary data. The specific objectives are-
- To assess the prevalence and pattern of mental disability.
- To arrange Doctor at the village level for diagnosis, treatment.
- To facilitate Medication facilities.
- To organize community awareness and capacity building.
- To link with Hospitals at the District and State level involving the family members.
- To link with Rehabilitation Center in dare need for any particular person.
Strategies:
- Health diagnosis and treatment camp
- Community Education & capacity building training
- Capacity building of Community Mental Health Workers
- Community Reintegration
- Cluster approach [The villages has already been divided in 4 clusters (5 villages in each cluster) based on close proximity of the villages.
- Activities:
The activity components would to be-
- Facilitate Doctors visit in clusters for diagnosis and treatment e.g. psychological therapy;
- Medication;
- Community awareness and capacity building
- Linkage with Local/District/State hospital and Rehab centers.
Project Duration:
1 Year
Manpower:
- Project Coordinator cum Counselor – 1
- Field Supervisor – 2
- Accountant – 1 (Part Time)
Implementation Plan:
The organization will take necessary action, as soon as the project will be approved. To contact with Specialist Doctor with team, Community mobilization, Family contact, Finalization of camp dates, Community education/ awareness camps, Link with Govt. Hospitals/Rehab centers, Deployment of staff and other logistic arrangements will be done with an immediate effect.
Monitoring & Evaluation:
The Project Coordinator will be responsible for day to day monitoring of the project. The organization Secretary/Chief Functionary will monitor the center time to time on a weekly basis and as and when required. The supporting agency or its assigned agency will monitor as suits for the best implementation of the project.
Sustainability:
It has been anticipate that, the project will be sustained through linking with the Govt. District/ State level Hospitals and Rehabilitation centers.
Anticipated Outcome:
Diagnosis and treatment of cure of 379 identified mentally persons in the target area.
Created awareness among the family members and the community as a whole to take care of such patients in future.
Deliverables:
Monthly progress Report & Finance report;
Quarterly progress Report & Finance report;
Annual progress Report & Audit report;
