Community Outreach report:(Jan.-March 2007 )
Carom competition:
The carom competition was held on 2nd of January 2007. Manav, Samaritans and Kshitij clients were participated in the carom competition.
Sponsered by:
Sameer Jaisani – Prizes for the Carom Championship
Sports Meet:
The Sports Meet was held on 9th January 2007.There were 70 participants attended the programme. Manav, Samaritans and The Family Welfare Agency were invited for the programme. Various track and One Minute game had taken place in the Sports Meet.
Donors List
Donation in kind:
1) Ramson Dsouza – Cadbury India Ltd.
2) Akhila Maheshwari – Certificates and gifts
3) Sanjay Gupta – Parachute Coconut Oil Bottles
4) Daljit Kaur Suri – Lunch
Donation in Cash:
1) Ms. Sujata Khemka 1000/-
2) Mr. D. M. Rathod 1000/-
3) Mr. Sunil Shinde 1500/-
Total 3500/-
National Seminar
Kshitij Mental Health Centre had organized a two day seminar for the professionals, students-social workers, Clinical psychologist, Counselors, clients, Caretakers in collaboration with Sir Dorabji Tata Trust, the Bombay Psychiatry Society and the Centre for Health and Mental Health of the Tata Institute of Social Sciences on Rehabilitation in Mental Health. The seminar was held on the 29th and 30th of January, 2007 at the Tata Institute of Social Sciences, Deonar.
Schedule:
Day 1
|
Sr. No. |
Time
|
Programme
|
Facilitator/ Speaker |
|
1. |
10:00am 10:30am |
Welcome & Introductions |
Ms. Katy Gandevia, Chairperson of Centre for Health and Mental Health, TISS |
|
2. |
10:30am 11:00am |
Inauguration of the seminar Address by Chief Guest |
Dr. Vimla Nadkarni Dean, School of Social Work, TISS |
|
3. |
11:15am 11:45am |
Tea Break |
|
|
4. |
12:00pm 12:30pm |
Theme of the Seminar, Keynote address |
Dr. R. Thara, Director, SCARF |
|
|
12:30pm- 01:00pm |
Current trends in rehabilitation of the mentally ill |
Dr. Vimla Nadkarni, Dean for School of SW, TISS Dr. Asha Banu, Faculty, CHMH, TISS |
|
5. |
01:00pm-02:00pm |
Lunch |
|
|
6. |
02:00pm 02:45pm |
Medical intervention Importance in treatment of mental illnesses |
Dr. Nilesh Shah, HOD Dept. of Psychiatry, LTMG Hospital |
|
7. |
02:45pm- 03:30pm |
*E. C. T. s Myths and misconceptions *Hospitalization Is it necessary? |
Dr. Y. Matcheswalla, President BPS |
|
8. |
03:30pm-03:45pm |
Tea Break |
|
|
9. |
03:45pm 04:30pm |
Deinstitutionalization- Relevance in Rehabilitation |
Dr. Nimesh Desai, IBHAAS, N. Delhi |
|
10. |
04:30pm 05:00pm |
Discussion |
Dr. Vani Kulhali(moderator) |
Day II
|
|
10:00am 11:00am |
Psychosocial Rehabilitation What is it and its need? |
Dr. K. Sundaram, Director Richmond Fellowship, Bangalore |
|
|
11:00am 11:30am |
Tea Break |
|
|
|
11:30am 12:00noon |
Importance of Day Care Centres & Half way Homes for recovering mentally ill |
Ms. Freny Mahindra, Director, Samritans |
|
|
12:00noon 12:30pm |
Family Support Groups |
Ms. Katy Gandevia |
|
|
12:30pm 01:30pm |
Panel Presentation on roles of each in the rehabilitation process, followed by a discussion (psychiatrist, psychiatric social worker, caregiver, mental health activist) |
Dr. Harish Shetty, Ms. Binifer Jescia, Mr.Arun Bhagwat, Ms. Gitika Talwar,Dr.Vani Kulhali (moderator) |
|
|
01:30pm 02:30pm |
Lunch |
|
|
|
02:30pm 03:00pm |
Legal literacy in MH for professionals and Caregivers |
Ms. Maharukh Adenwalla |
|
|
03:00pm 03:45pm |
Role of media |
Mr. Mahesh Bhatt |
|
|
03:45pm 04:45pm |
Open discussion and summarization |
Dr. Vani Kulhali |
|
11. |
04:45pm 05:00pm |
Vote of thanks |
Ms. Priya Deo |
Expenditure:
The Total expenditure was amount 70,043.10/-
Donation raised :
Dr. Matcheswalla gave 25,000/- cheque for the National Seminar.
Sun Pharmaceutical Company gave 4944/- donation for seminar.
Ms. Ganatra Sarla gave 5000/-donation
Donation Box: 5159/-
Sale of goods in National Seminar: 720/-
Sensitization talk and Poster exhibition
Sensitization talk and Poster exhibition were held at different places are as follows:
Tata Institute of Social Sciences, Deonar: 29th and 30th January 2007
N.M.Joshi School: 15th February 2007
Sitaram Municipal School No. 1, Lower Parel on 24th February 2007
N.M.Joshi Police Station, Lower Parel on 27th Feb.07
Sitaram Municipal School No.2, Lower Parel, 6th March 2007
Sitaram Municipal School No. 1-held on 10th March 2007
Beggars Home , Chembur on 5th March 2007
We got Rs.700/- honorarium.
Rangoli Competition:
On the occasion of International Womens Day we organized a Rangoli Competition which was held on 5th of March 2007 for the B.D.D.Chawl Women.
Inner wheel Member gave cash prizes to the winners.
Sponsored by:
Inner wheel Club of Mumbai Downtown
Railway Worker Women:
Monthly programme were held in the month of 23rd Feb.07 and 8th March 07.
Donation raised: 150/-
Picnic:
The Family Welfare Agency had organized the picnic .
Our day care clients had picnic on 3rd and 4th February 2007 at Saphale Kelwa beach. It was overnight picnic.
Jan Mansik Arogya Abhiyan (JMAA)
Introduction:
Jan Mansik Arogya Abhiyan (JMAA) is a human rights based movement in the area of Mental Health. It is platform to raise collective voce of resistance to end the brutality , oppression and discrimination against psychiatric patient. It is forum for individual for organizations and alliances to come together to struggle for the restoration of the self-determination, autonomy, liberty, respect, dignity and the right to care of persons with psychosocial; disability.
The JMAA meeting was held on 9th March 2007. JMAA member were discussed about the Charters of Demands.
2nd National Health Assembly was held at Bhopal 23rd March07 to 25th March 07
We went as a JMAA member to present our Charter of Demand in the seminar
This seminar was held on 23rd to 25th March 2007 had attended. We put forward the charter of Demands as JSA member , Maharashtra.
Charter of demands are as follows:
Charter of Demands mental Health
Preamble
The Right to Mental Health is linked fundamentally to the right to health. Yet, mental health also needs separate attention. The well being of people includes both physical as well as mental health. We cannot separate the two except in an artificial manner. Wherever there is a health problem, there would often be a mental health program (e.g. malnutrition, anaemia). The reverse is also true (e.g. depression).
Mental health however has received very little attention in programs, policy or in advocacy. Mental health has sometimes been put up as a special category of health. However, this area needs to be also seen as an independent area for advocacy and political action. There are differences between the health sector and the mental health sector.
Stigma against people who have been diagnosed with a mental illness is not usually found among health patients. People who have been diagnosed also run the high risk of becoming deprived of all their constitutional and citizenship rights (e.g. right to vote, right to hold political office, form associations, contract, etc.) All civil, political and social, economic rights are also taken away (e.g. right to free movement, right to consent, right to marry, etc.) These consequences are not there for health patients. Further, there are problems about how a mental health diagnosis is made: There are no conclusive tests for such diagnosis, unlike in the health system. This results in a lot of subjectivity when someone is diagnosed mentally ill. Social exclusion is a major consequence of the diagnosis. While recognizing mental health as having linkages with health, mental health also brings in a lot of issues which cannot be seen in terms of health.
Mental Health as a basic human right of all:
WHO defines mental health as, the capacity of the individual, group and the environment to interact with one another in ways that promote subjective well being, the optimal development and the use of mental abilities (cognitive, affective and relational), the achievement of individual and collective goals consistent with justice and the attainment and preservation of conditions of fundamental equality. This definition is all encompassing, putting mental health at the basis of all social, political and economic dimensions of life. The definition also highlights the fact that social justice and mental health are related. Mental health is linked to social power and powerlessness, marginalization, discrimination, socio-economic vulnerability.
The Alma Ata declaration of health for all was also promised in the mental health field, through the National mental health program, 1982. This program has been largely unrealized in most parts of the country. We place a demand for a much higher level of political commitment from local and national governments to focus on the Right to Mental Health of people.
To fulfill the state obligations on the Right to Mental Health, we demand:
§ Protection of basic survival including shelter, water, food, good quality health and mental health care
§ Equal opportunities for all sections of society to find satisfying livelihoods
§ Opportunities where there is scope to develop on peoples potentials, aspirations and achievements
§ An equitable social, economic and political environment for all sections of society by which they can experience a sense of well being
§ A violence free society
§ In situations of violence and conflict, a higher political will to bring immediate justice and restoration of peace to people
§ Good governance which upholds human rights and is inclusive in the process
§ Policies and laws that promote peoples mental health and are consonant with the human rights framework
§ Integration of mental health in other policies and programs related to poverty alleviation, health, disability, social welfare, housing, employment etc.
§ Special recognition of the needs, protections and rights of people labeled with a mental illness
Demands for quality mental health care:
§ Greater budgetary provisions for mental health at the state, municipal and Zilla Parishad level
§ Increase in the number of officials working on mental health within the State Health Department to ensure greater ongoing commitment to formulation, implementation and supervision of mental health policies
§ A comprehensive national and state level mental health policy using an inclusive process of all stakeholders in the sector
§ Community based mental health care should be developed as against institutional models of mental health care:
· Immediate Review and evaluation of the National and District Mental Health Program, which was proposed as a community mental health program.
· Government should develop a good database on mental health and distress in the population based on expressed and experienced needs of people and local variations of populations. Community care programs should be tailormade for each community rather than being mere drug portals
· Identify good community models practiced by NGOs and individuals and document for purposes of up scaling; create funds for supporting the same
§ Develop robust community mental health programs for substance abuse, domestic violence, suicide and depression
§ Communities and the end users of mental health care should be involved in planning and review of services and programs and policy
§ Government should create multiple facilities for care, such as rehabilitation facilities, shelters, day care, and other respite facilities
§ Government should initiate promotional and prevention programs at the community level, such as starting counselling facilities
§ Create policies where the advocacy work of users and carers can be supported and encouraged
§ Good quality psychosocial intervention and prevention programs in all services related to children and adolescents, including school mental health programs, child and adolescent guidance services, etc.
§ Psychosocial interventions, promotional and preventive mental health services in collaboration with womens health and other empowerment programs
§ Holistic mental health care which includes non drug approaches addressing overall well being and not just at symptom reduction
§ Encourage the use of alternative practices in mental health (yoga, meditations, various kinds of therapies, etc.) through supportive policy
§ Rational, affordable, accessible and equitable mental health care
§ Rational drug treatment at all levels of mental health care
§ Violence free and consent based management of patients in critical care must be provided for (e.g. strategies for least restrictive environments, minimizing admission on involuntary basis, etc.)
§ Guidelines and good practice standards must be set for mental health treatments including:
· 1. We demand that users and carers be given information about available treatment options which will result in them, choosing the mode of treatment. They also need to be given information about diagnosis, prescriptions, treatment and side effects of psychotropic drugs
· 2. Standardized, comprehensive and multi axial assessment
· 3. Quality time from the service provider, privacy, confidentiality, non hierarchical and non abusive forms of care and dignified treatment
§ Need based mental health care and not one model for all. Women, children, adolescents, vulnerable groups such as street children, women in sex work, people in conflict situations, individuals affected by natural or human made disasters require services that are tailored according to their needs.
§ Budgetary and program provisions/arrangements to ensure continuity of care
§ Programs and services should be developed not just at curative level but at preventive and promotive level
§ There should be ongoing mental health training for government functionaries with the objective of introducing a mental health perspective across officials of different departments.
§ There should be increase in mental health training facilities in medical, social work and psychology training programs. To ensure training with regard to psychosocial management of mental distress.
§ Mental health training should be incorporated in medical syllabi and refresher courses for medical professionals of all specializations to incorporate a mental health component in their practices.
§ There must be a social and technical audit of mental healthcare systems
§ As mental health care is linked to justice, legal aid services must form an integral part of the mental health care system at all levels
§ How mental health care is to be organized across institutions (beggars homes, state homes for women, remand homes for children, prisons and other custodial homes) must be addressed in a human rights sensitive manner. Laws must be created which are people friendly to address this issue.
§ The special needs of homeless mentally ill persons must be addressed in a sensitive and human rights preserving manner.
§ We demand that our consent should be sought in medical and non medical research related to mental health
Special demands with respect to Disability:
§ Mental illness is the seventh category in the Persons with Disabilities Act. However, even the few benefits available to persons with disabilities are not made available to persons diagnosed with a mental illness. We demand that
· The state must promote and support research and actions on psychiatric disability
· The Persons With Disabilities Act should be implemented for persons diagnosed with a mental illness also
· Representation of psychiatric disability through recognized civil society bodies in State level committees
· Better co-ordination between the Mental Health and the Disability Departments and functionaries, from policies to implementation
· Programs for disabilities (psychosocial rehabilitation, self employment, protection of employment, etc.) should be made available to psychiatric disability
· Benefits for persons and families with disabilities should be made available and the procedures simplified
· Institutions must provide disability certificates and also facilitate the process of securing disability benefits based on the same.
· The existing laws and rules (Mental Health Act) creates many barriers and contradictions in setting up rehabilitation facilities for psychiatric disability. These must be removed.
· We demand a genuine inclusion in all national as well as state level laws, policies and programs related to disability
Special Demands with respect to Institutional care:
§ Various judicial pronouncements from the Supreme Court and the state High Court (e.g. Mahajan Committee Recommendations) should be strictly followed. The recommendations of the NHRC in the Quality Assurance Report should be implemented.
§ Currently there is an exclusive reliance on biochemical modes of treatment. The mental health care provided should be more holistic. There should be effective management debilitating side effects.
§ Patient service provider ratio is extremely poor, which needs improvement. (For example in one of the state mental hospital, the ratio is 3 psychiatrists and 6 social workers to the population of about 1900 clients).Recruitment of staff for vacant posts. Posts of clinical psychologists have lapsed due to non recruitment. Readvertising for the same
§ Patient attendant ratio is extremely poor at the moment. It almost amounts to 1:80. This needs to improve.
§ Judicious use of ECT following the international guidelines. Some mental hospitals and government and municipal hospitals still practice direct, unmodified ECT. This should be banned.
§ Effective strategies to reduce huge number of long stay patients. More community linkages to be developed.
§ Solitary confinement cells should be abolished. Crisis intervention units must be created which are more humane and based on clinical objectives. Staffs who are working in these units must be skilled in clinical work.
§ Programs to create mental health awareness and reduce stigma associated with mental health
§ Continuity of medicines supply needs to be ensured. Quality of medicines needs to be taken into account.
§ Conditions at the hospitals need to be more hygienic and life friendly.
§ Self grooming is an important aspect of personal well being. Institutions should pay greater attention to this. Residents should be provided soap, oil, and other toiletries required. Hospitals should provide mirrors. (If glass mirrors are a problem, plastic mirrors can be provided). All the residents should be provided with undergarments. Women should be provided with sanitary napkins. Hospital must ensure adequate supply of the same. Residents should be allowed to take a bath and should be provided washed clothes every day. Clothes worn by residents must be comfortable and appealing to the people wearing them. Clients should be provided with individual storage space to keep their belongings. There should be some private space for prayer, reading, etc.
§ Almost all of these old institutions possess acres of land which are unutilized. This needs to be used for vegetation and gardening.
§ Wards need to be better ventilated and better lit and clean. Some of the infrastructure is old and need repairs. More comfortable bedding for sleeping should be provided as the current bed patient ratio is poor.
§ Dining facilities need to be improved
§ Intercom facilities between wards and doctors/ nurses station as the wards are at a distance from each other.
§ Greater emphasis on and activities for play, reading, recreation and leisure activities
§ Presence of a diagnosis does not automatically make a person incapable of taking decisions about his / her life. Currently many decision such as, which treatment to carry out, whether, regarding adoption of the child if the mother is labeled with a diagnosis of mental illness are taken by relatives and most of the time by hospital authorities. We demand that there should be standardized ways of assessing capacity to decide before such decisions are made on behalf of the client.
§ Better linkages with community NGOs, civil societies and other resources for eliciting community participation in mental health care.
§ Greater financial and material resources and re-allocation of current human resources for strengthening occupational therapy activities and also developing effective marketing strategies
§ Increased range of occupational activities those match and enhance residents experience, interest and skills and that facilitate their reintegration in the society.
§ Patients should not be used as manual labour. If their work is said to be therapeutic, objectives should be set for the therapy and work should be limited by those objectives. General maintenance of the institution cannot be considered as therapy.
§ Effective and sensitive Information Education Comunication strategies
§ Increased efforts and effective strategies to involve families as active partners in mental health care.
§ Privacy in visitors rooms, space for families to visit and stay, more community friendly ward spaces, as in other public hospitals
§ Increased participation of residents in planning vocational activities, daily activities, food and any other decision which concerns them. Overall there should be a spirit of voluntarism. The system must work towards upholding confidentiality, autonomy and dignity of patients.
§ User fees( daily charges of RS 22, certification charges, medical investigation charges, charges for medicines during the leave of Absence etc) need to be reduced if possible eliminated
§ Aftercare plans for those patients who have been discharged. Also facilities like day care centre within the hospital.
§ Initiate support groups for recovered clients and also for carers
§ The workings of the state mental health authority must be more transparent and open to review by civil society
§ The Legal Services Authorities Act should be implemented in the case of institutionalized patients. All patients should have a free access to legal representation and legal aid.
Assertion of civil, political and economic rights of people labeled with the diagnosis of mental illness:
§ Entitlements across sectors such as education, employment, housing, social security, etc
§ Demand socio economic security with respect to housing, insurance and property
§ Non discrimination in educational settings
§ A violence free life and right to bodily integrity. We demand safe environments.
§ We demand that we should have a right to vote, contest elections, hold public offices and be a member of statutory bodies
§ We demand freedom to move freely.
§ We demand poverty alleviation, employment programs, free vocational and skills training programs, equal wages.
§ Demand a right to have a family, to love, to marry, to have children.
§ We demand an environment in which positive identity construction is possible for people labeled with the diagnosis of mental illness.
§ Demand dignity and autonomy
§ Demand legal aid and free and easy access to grievance redressal
§ Participation in formation and review of rules and programs related to mental health
§ We want to be recognized equal before the law
§ We demand necessary assistance as enshrined in the United Nations Disability Convention.
Email – kshitij.mhc@vsnl.net