Future of Mental Health- Prof.Murthy

I delivered the following oration- FUTURE OF MENTAL HEALTH with theme of ‘ Mental Health is too important to be limited to Professionals’ on September 16, 2018.

Professor Narendra Nath (October 1, 1930-July 12,2018) is my teacher and mentor.
He is an eminent international psychiatrist and pioneered community mental health in India and other developing countries.
Oration was at the Postgraduate Institute of Medical Education and Research(PGIMER), Chandigarh.
I also completed my post-graduation at PGIMER(1972-1975) and was a faculty member(1975-1981).

The power-point of the presentation and the audio of the oration are included in the blog.-Please visit AUDIO section of the blog1_ORATION-Sept 16 2018 to hear the oration.
I will upload the video of the oration in the coming days.

Future of mental health
Care of persons identified as suffering from mental disorders, over the course of human history, has been an evolving process. The processes to recognise who are suffering from mental illness and where and how they should be cared for and what will be their position in the society after recovery has been influenced by social, economic and political factors of the time.

There was a time, earlier to the 17 century, where even the organised church had an official document, ‘malleus maleficorum’ , authorising identifying and punishing the persons, who will be diagnosed as mentally ill today. In the 19th century, Dorethea Linde Dix, pioneered building ‘asylums’ as it was felt homes are the wrong places for the ill to be in. Clifford veers, author of ‘A Mind that found itself’(1908) brought home the horrors of mental hospitals and started the ‘mental hygiene’ movement. The advent of psychoanalysis enlarged the canvas of mental health to include nearly every one both in terms of the need and the people who could address the needs. The world wars followed by the welfare movements in Europe, along with the discovery of the pharmacological agents to influence ‘behaviour’ led to massive ‘deinstitutionalisation’ . This process has brought us to current situation of recognising the human rights of the persons with mental disorders. A remarkable change from viewing ill persons as bad, to mad, sad and ; like anybody in the community’. Al, of these changes were associated with many changes in the places of care and place of ill persons in the society.

Prof.Wig was a person ahead of his time. More than three decades back he expressed the then radical view,
“Mental health is too important to be limited to mental health professionals”.
This vision of mental health implies that, (i)mental health is a subject of interest to all people, all aspects of society, (ii)wide range of interventions are needed for mental health of the society, and (iii) all people in the society could be part of the mental health movement.

This vision of Prof.Wig, is relevant to the world mental health and of special interest for mental health in India in the current times. The subject of my oration will be examine the applicability of this visionary viewpoint in the current context and present some thought for future of mental health.

The current challenges of mental health in India are:
• ‘Unmet need’ mental health care continues to be high, over 80%;
• Societal changes in India, like the increasing urbanisation, break up of the joint family, both working parents, aspirational youngsters and the impact of the mass media have been well recognised to have mental health implications.
• Issues like farmers suicide, substance abuse, domestic violence, are discussed in the public domain, but often in economic/legal terms and not in terms of the mental health dimensions.
• Enhanced recognition of wide range of systems of health care (Ayurveda, yoga, naturopathy, homeopathy, etc) presents both an opportunity and a challenge, in providing the community with evidence based mental health care.
• There is inadequate leadership of the mental health professionals in the social issues, though the recent position of IPS with regards to Section 377 is a welcome one.

For mental health to be a PEOPLE movement rather than being limited to professionals, there is need to examine evidence in seven areas.

1. Evidence for mental health relevanceto society beyond clinically diagnosable mental disorders;
2. Evidence from the biological(brain) basis of mental disorders and mental health issues;
3. Evidence of the social factors for mental disorders and mental health issues;
4. Evidence of mental health interventions, beyond ‘medical’ interventions;
5. Evidence for ‘non-professionals’ to be part of mental health movement;
6. Evidence of societal interventions for mental health of all people; and
7. Feasibility of applying this vision and mission in the current world.

The scientific evidence for each of these statements arising from the vision of Prof.Wig would be critically presented.

The second part will focus on what does this vision Prof.Wig will mean for the immediate future of mental health of the world and India in particular.

I would like to see the following in the coming decades:
1. Mental health should receive higher position in the hierarchy of needs of individuals, families, communities and the Government.
2. Mental health care will be seen beyond clinical conditions and will include promotion of mental health and prevention of mental disorders;
3. Most of the mental health care will occur at the level of individuals, families, in the community and not in ‘institutions’;
4. There will be greater efforts at empowering individuals, families and communities towards ‘self-care’ for mental health;
5. There will be recognition and response to mental health implications of developmental processes;
6. There will be leadership of mental health professionals to work with the sectors beyond health, like education, welfare, labour, law and justice, environment and human rights;
7. There will be increased multi-disciplinary and multi-dimensional initiatives for understanding all aspects of mental health .

Prof. Wig was an Institution and his thinking was far ahead of thinking of his contemporaries. His view “Mental health is too important to be limited to mental health professionals”is appropriate to our times.We all will do well to follow his broader approach to mental health. This will be the best tribute and celebration of his life, by each one of us.

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