28-APR-2014Josephine d'AllantMore than 450 million people worldwide suffer from
mental disorders, according to the WHO. These illnesses are especially
destructive among the poor, those with chronic health conditions, minority
groups, and communities exposed to conflict and disasters. Because 75 percent
of the mentally ill in the Global South remain untreated, it is crucial to
highlight successful initiatives that address this issue, including in
Bangalore, Cape Town, Accra, Bogotá, and São Paulo.
This past year marks an important turning point in mental healthcare in India.
The landmark Mental Healthcare Bill 2013 has been introduced and is under
review to be passed as law. The new bill "aims to ensure proper medical
treatment is provided to mentally ill patients" and "seeks to regulate the
public and private mental health sectors and establish a mental health system
integrated into all levels of general health care," says an article in the
Indian Express. Gaps in care have usually been filled by NGOs providing
treatment while also increasing public awareness around issues of mental
illness. In Bangalore, the Richmond Fellowship Society focuses on a Therapeutic
Community approach which emphasizes using skill and compassion to enable the
mentally ill to rebuild their lives with dignity. Outreach services include
halfway homes, long-term stays, and public awareness campaigns as well as
development, research and advocacy on related issues. Importantly, the Richmond
Fellowship has also launched a training program for care providers to improve
services on the ground. The Fellowship runs Asia's only M.S. degree in
psychosocial rehabilitation and counseling, "to address the paucity of trained
manpower" in the field.
In South Africa, many factors including disease, poverty, abuse, violence, and
changing social structures contribute to the high occurrence of mental health
issues. Within such harsh conditions, one notable project is Cape Town's Sultan
Bahu Drug Rehab Centre, which has achieved the highest drug addiction recovery
rate (87 percent) and retention rate (83 percent) in the entire province. Its
three drug rehab centers also form some of the only internationally accredited
facilities of their kind on the continent. The success of the facility, in
part, lies in attending to both the complex needs of the individual based on
'cognitive behavioral' therapy constructs, as well as, to the affected families
at all stages of the rehab process, and in appropriateness to context, culture,
and religion. Thus, within a generally poor community, the services are made
physically and financially accessible; and both the two primary religious
affiliations of the area, Christian and Muslim, are accommodated. Practitioners
at the Centre are also enrolled for post-graduate studies in addictions care,
which is a first in South Africa.
The issue of mental health stigmatization in Accra is of great concern to
individuals, families, civil society groups, and many religious bodies. These
concerns affect the resources and quality of life of the mentally challenged.
The stigma associated with mental health issues causes relatives to abandon
their family member in state institutions in order to limit the negative
perceptions others may have towards them. In the absence of government action,
the mental health advocacy group For All Africa (FAAF) is pushing to change
societal perceptions of persons with mental disorders through education. FAAF's
work includes a variety of different approaches aimed at changing the major
structural and attitudinal barriers to achieving positive mental health
outcomes in Accra. In addition, it encourages policy makers to improve services
and treatment of the mentally ill.
In Bogotá, 68 percent of homeless use bazuco (similar to crack), and 80 percent
of them use it on a daily basis. Lack of access to treatment and prevention
aggravates the situation, as the homeless often get treated only in emergency
rooms during acute crises. In order to tackle these problems the Secretaría de
Salud de Bogotá has launched a program to create 130 new hospital beds,
distributed in four health centers around the city. These beds are specifically
targeted to treat mental health and drug abuse patients, especially the
homeless. This program seeks to better treat and prevent mental health
problems, while at the same time improving the overcrowding in the emergency
rooms. The homeless are often difficult to convince to seek treatment, so it
will be necessary to monitor whether they use the new facilities.
In Brazil, the government ensures that mental health is understood as a
fundamental part of overall well-being, and therefore promotes diagnosis and
treatment in coordination with other health services, never in isolation. To
address cases of severe mental illnesses, the government has put into place
Psycho-Social Attention Centers, known as CAPS (Centros de Atenção
Psicossocial). These aim to replace the traditional psychiatric hospitals used
to isolate patients with more human interventions focused on care, support, and
social interaction. The CAPS conduct proper diagnosis and offer free care and
support services to people with different levels of mental illness. Each center
has a specialized team composed of psychiatrists, nurses, psychologists,
occupational therapists, and social monitors. Currently, São Paulo has several
CAPS operating throughout the city, including 20 CAPS for adults and 20
additional CAPS focusing specifically on treating alcohol and drug abuse. Some
of the centers are focused on the youth to avoid committing children to
institutions that would isolate them from their families and communities. These
centers work to promote social integration and family involvement in the
children's treatment.
http://www.huffingtonpost.com/josephine-dallant/mentally-ill-and-poor-wha_b_5215401.html
[Tags poverty, mental health, Global South, India, mentally ill, recovery,
interventions,]
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