Health is defined as a state of complete physical, mental and social well being and not merely absence of disease or infirmity. With this concept of health, it becomes very clear that mental and social well - being is an integral part of health and cannot be divested from physical health.

Traditionally, psychiatry has maintained considerable distance from other medical specialties.

For a long time, psychiatric care was available only in mental hospitals, which were far removed from other hospitals and even cities. One accompaniment of the de-institutionalization of psychiatry was its acceptance in general hospital settings. The next logical step in the same direction was integration of psychiatry in the primary health care. This integration aimed at the application of psychiatric knowledge by the medical and paramedical personnel of the primary health care settings to provide at least basic mental health care.

It has been noticed that most of the medical facilities are concentrated in the big cities and the primary health centers suffer from an acute shortage of doctors and other medical facilities. In this backdrop the brunt of the treatment has to be borne by the paramedical professionals who takes care of health of the majority population in the village.

The capability of the paramedical professionals and health care workers in the delivery of health care at the Primary level has been proved beyond doubt. While the doctor still remains the leader of the team, suitably trained workers can take responsibility for a considerable proportion of the work. The involvement of health workers in the delivery of the mental health care has been relatively recent development. Several experimental models have demonstrated that health workers, after a brief training, can acquire basic skills for basic mental health care.

Applying the broad principles of primary care in the context of mental health, the following issues need emphasis.

1. Equitable distribution - Health care services should be accessible to all section of the society, with special attention to the vulnerable and needy. Mental health services are distributed so unequally, especially in the developing countries, that there is urgent need for their equitable distribution. This cannot be achieved without providing mental health care as a part of the primary health care level.

2. Preventive approach - It may be conceptualized as primary (general and specific measures to prevent illnesses and to promote health), secondary (early detection and prompt treatment) and tertiary (reduction of disability and optimum rehabilitation). Mental health care can contribute towards all these components. It has been estimated that 50 % of neurological and mental illnesses are preventable by existing knowledge.

3. Multisectorial efforts - Health cannot be attained and maintained by the health sector alone. Participation of other sectors like education, public works, housing, social welfare and law is essential. In the case of mental health, these sectors are of paramount importance as they can play a vital role in the prevent ional and promotional activities.

4. Community participation - Involvement of individuals, families and communities is desirable for a successful rural health care program. This is even more true for mental health care program because family and community play important roles in causation, detection and continued care of the mentally sick.

EPIDEMIOLOGY OF PSYCHIATRIC ILLNESS

The prevalence and pattern of psychiatric illness has been studied in some developed countries for last few decades. Initial studies from U.K. ,where general practitioner system has long been in existence, revealed that about 10 to 15 % of the registered patients in the practice area and about 8 to 30 % patients consulting the doctors were suffering primarily from a psychiatric illness. In another landmark study , the same group of workers showed that the total psychiatric morbidity in a general practice sample of more than 14000 individuals was almost 140 per thousand. Out of which,102 per thousand were assigned a formal psychiatric diagnosis. Women are almost twice as likely to have a psychiatric diagnosis as men. A majority of these case is diagnosed as neurosis, psychosis was diagnosed in 5.8 and alcohol and drug addiction in 2 per thousand individuals. In another study , Goldberg and Blackwell found that conspicuous psychiatric morbidity among general practice patients was about 20%. It was further been estimated that the general practice consultation for identified psychiatric disorders out number psychiatric outpatient attendance by 10:1, and psychiatric admissions by 100:1.

In a study from Bangladesh , 40% of the patients were found to have mental morbidity. Studies from Kenya and Sri Lanka also report 15 to 30% patients as having psychiatric morbidity.

The prevalence studies in India have shown that at any given time, 1-2 % of the population suffers from psychiatric disorders which require urgent attention. Moreover, it is also estimated that 15 to 20 % of the general population of any health facility requires psychiatric help. Mentally retarded individuals constitute nearly 3 % of the population. Neki has reported that 27% of the out patients need psychiatric help, while Murthy has reported that 36% of the general practice patients require psychiatric treatment. Integration of the mental health care with the general health care has been advocated by W.H.O.

Why Mental Health Training Programs?

In developing country the situation of mental health awareness / treatment and rehabilitation is very grim. The trainees' programs are often more inadequate. In the medical colleges the psychiatric training at the graduate level is highly inadequate. The psychiatry has received very poor representation in the curriculum, with a few lectures and with a two week clinical posting. Moreover, the university examination does not assess the students in psychiatry.The recommendation of the various national and regional workshop for improvement in the psychiatric training for the graduate medical students have still not received due attention by the Medical Council Of India. Very little effort has been made to modernize the syllabus and the training method. Even now, old fashioned syllabi and methods of the teaching are followed. There is a pressing need to restructure and revitalize the syllabus, and to introduce newer methods of teaching.

Goldberg has emphasized that the training program are struck by irrelevance to general practice. The most disheartening part is that nearly 50% of the medical schools do not have psychiatric staff to teach the graduate students who therefore are totally deprived of training in psychiatry.

The role of general practitioner in early detection, drug management , counseling , public education , follow up and rehabilitation has been stressed by Shah.

Why Rural Medical Practitioner The Prime Target?

The rural medical practitioner, on account of his position in the community, commands great respect from the leaders of the community and religion, whose cooperation and goodwill are very vital for the success of community mental health work. On account of intimacy with the client and his family over a long period, he is aware of the coping behaviour during stressful situations. He knows about their cultural, social and economical background, which helps in evaluating the symptoms more realistically and correctly. An enlightened medical practitioners able to allay fears, misbelieve, wrong notions, and educate them for proper consultation and treatment by imparting correct and scientific information. Many notions about the causation of mental illnesses (e.g. evil spirit, planet positions, bad stars) and treatment (drugs, ECT etc.) need to be corrected by proper education which can be best done by the rural medical practitioner. Removal of stigma for mental disorder is the first and most crucial step in launching mental health programs in rural areas, and the role of the medical practitioner is invaluable in this regard.

Aim of Training Program for Medical Practitioners

To develop a holistic and humane approach towards the mentally sick through awareness generation, treatment and educating the non M.B.B.S. medical practitioners in the field of mental health.

Actively involve the family members and near ones to sustain the efficacy and professional services in the treatment process of the mentally sick.Clarify the role of medical practitioners and paramedical health workers in the field of mental health.Networking with existing governmental and non governmental organizations in the local area .Development of standard assessment tools for evaluation and culturally appropriate longitudinal and cross sectional studies using observation of mentally sick subjects in natural setting in the area of developmental processes.

Creation of self help groups among patients and their family members so as to sustain the project and to form a triad of medical practitioners, patient and their family members.

According to available data , mental disorder is equally prevalent in rural areas. The availability of professional and paramedical staff is very low in comparison to other medical specialties and most of them are urban based. Only a few district hospitals of W.B. are having psychiatrists though without proper facilities. In the non governmental sector, there are many organizations working in the field of health but without any services for the mentally sick ones. Hence with such lack of awareness, the mentally ill patients remain either undetected or improperly handled. A few cases of acute mental illnesses are referred to the cities and most of the time the treatment becomes expensive.

NIBS has decided to continue and expand its package of preventive, curative, and promotive services in mental health in rural areas utilizing the existing health care delivery systems.

The objectives of Rural mental health camps are :

> To ensure the availability and accessibility of minimum mental health care for all in the foreseeable future, particularly to the most vulnerable and underprivileged sections of populations.

> To encourage application of mental health knowledge in general health care and in social development.

> To promote community participation in the mental health service development and to stimulate efforts towards self-help in the community.

Should this interests you, please contact us or phone at 033-2246 9662/ 2286 5203. Contact person – Dr. Kedar Ranjan Banerjee, Hony Secretary, NIBS 98300 27976.