Bridging the gap
NHM Cochin in collaboration with MEHAC FOUNDATION have come together to train primary health care workers regarding mental health
KOCHI: Sheela is a frequent visitor to the urban health center. Every Friday, which is her day off from work, she patiently waits in queue to meet the doctor who is the only person who listens to her list of aches and pains, sleep and other problems. Sometimes the doctor too gets busy and Sheela has to go back with just a prescription of multivitamins, some analgesics and sometimes a sleeping tablet or two. The PHC doctor is sympathetic to her but she confesses that she has not been helping much. ‘I think she has depression. She will not go and see a psychiatrist and I really don’t know how to help her. We really don’t learn much of psychiatry in our MBBS curriculum and though I know the names of a few drugs, I am not confident enough to prescribe them or give her the kind of support she needs. I am afraid I may say the wrong thing. So I end up prescribing multivitamins which I know are useless for her but at least she goes home happy for the day and they won’t harm her. ‘
Most general physicians have similar tales to narrate of recalcitrant patients. Research shows that at least 25 percent of people attending a general medicine OP have clear cut psychiatric diagnosis while at least 40 per cent of those suffering from a chronic physical illness have co-morbid psychiatric diagnosis. Most of them do not get diagnosed and those who do may still remain untreated because of the huge knowledge and competence gap that exists among medical professionals about psychiatry. The National health mission (NHM) and District mental health programme do a good job of reaching out to psychiatric patients but most of the time, only those patients with chronic and severe mental illness who are already on medication. The answer to this conundrum would be to equip primary health care doctors, nurses and other workers with basic knowledge of some common mental health conditions, their diagnosis and treatment. It was with this objective in mind that NHM Cochin, in collaboration with MEHAC FOUNDATION-an NGO working for mental health since 2008 have come together with a unique project to train the primary health care workers at all levels from ASHA (Accredited social Health Activists), JPHN (Junior Public Health nurse) to Doctors and nurses in all PHCs. Primary health care workers get an opportunity to be trained in mental health. The training is done by psychiatrists, psychologist and social workers of MEHAC .
So far, 500 people including 23 primary health doctors, 27 staff nurses, 57 junior public health nurses, 57 palliative care nurses and around 300 ASHA volunteers have been trained using the in-house training module of MEHAC. Around 90 more community workers will be trained soon. Instead of the usual didactic classroom lecture style, the module is taken in small groups and is activity-based so that the salient points are driven home. The project is sponsored by BFIL, a Hyderabad-based company as part of their CSR initiative.
Dr Bindu Menon -Consultant Psychiatrist , Mehac Foundation