Managing Mental Health Sector in Gujarat: An Overview of Strategic Priorities

Abstract

Mental health disorders are actually much more prevalent than is apparent on the surface. Health sector, in general, and mental health sector, in particular, faces a number of challenges which include: shortage of trained mental health professionals inadequate training capacity absence of multidisciplinary approach nearly non-existent linkages between the community and hospital-based care weak institutional framework. Many of these problems flow from meagre financial resources, both governmental and non-governmental. This paper is based on several studies relating to socio-economic determinants of mental disorders; mental health delivery systems in the public, private, and the voluntary sector; the cost of mental health services; framework for financing mental health sector; issues relating to human resource development; management issues in the mental health sector; gender and mental health; role of ethics in mental health; issues relating to destigmatization of mental health; and interface of law and mental health in the context of Gujarat. It provides a broad canvas of strategies which need to be pursued to address issues facing this sector. The strategies discussed here should form part of the mental health programme of the government. Of late, there is a growing recognition of the fact that something needs to be done in this sector. The inclusion of mental aspects of health was reflected, for the first time, in the Ninth Five-Year Plan when a separate scheme for ‘Strengthening of Mental Health Services’ was included. The Tenth Five-Year Plan envisages continuation of this emphasis; in particular, it aims to ‘integrate mental health with rural health care and provide special care for mental disorders of all types by scientific surveillance and identification.’ Enhancement of mental health requires improved provision of preventive, curative, and rehabilitative services. Given the resource availability and social dimensions of the problem, appropriate community-based and cost-effective interventions need to be developed. Besides, there are also many ethical and legal concerns that need to be taken into account. A large number of cases of mental disorder currently go untreated as competent professional help is not available easily. This would need augmentation of capacities and competencies of large number of professionals and health workers working in the government, NGOs, and the private organizations. This paper suggests a series of priorities in laying out 12 strategic directions and a comprehensive set of short-term implementation modalities for the immediate two to three years. The strategic directions are: resource mobilization and allocation strengthening of ethics of care addressing of stigma strengthening of public mental health system strengthening of role of caregivers promotion of private sector human resources and capacity strengthening at various levels strengthening of the role of NGOs integration of mental health with other fields strengthening of the interface with law strengthening of the institutional mechanisms stimulation of mental health research.