Mixed-methods research, 2015
Appendix 3: Research Summary
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Appendix 4: Recommendations
On the 11th of May 2016, an expert group of key Kashmiri stakeholders joined for a round table conference to formulate recommendations deemed necessary to effectively respond to the mental health situation as outlined in the 2015 Kashmir Mental Health Survey.
The group consisted of:
Dr. Kaisar Ahmed, Principal, Government Medical College, Srinagar
Dr. Maqbool Dar, Head of Department, Institute of Mental Health and Neurosciences (IMHANS), Srinagar
Dr. G. A. Wani, State Nodal Officer, National Mental Health Programme, Srinagar
Dr. Mushtaq Margoob, Senior Psychiatrist, Srinagar
Dr. Arshad Hussain, Associate Professor, IMHANS, Srinagar
Dr. Muzaffar Khan, In-charge of Drug De-addiction center, PCR, Srinagar
Dr. Showkat Shah, Head of Department, Department of Psychology, University of Kashmir
Dr. Saima, Professor, Department of Social Work, University of Kashmir
The following are the outcomes of this consultative process which were agreed upon and endorsed by all members of the expert group:
Recommendations for state policy makers Strengthen mental health human resource:
That, within the State Program Implementation Plan (PIP), the State should:
Augment and create more posts at the Institute of Mental Health and Neurosciences (IMHANS), to cater for the added specialist responsibilities in health facilities at all levels of health care (e.g. in the areas of De-addiction, Child Psychiatry, Geriatric mental health, Disabilities and overall training of manpower)
Augment and create more faculty posts at IMHANS to address the above responsibility of education
Create posts of Consultant Psychiatrists and para-mental health staff such as Clinical psychologists, Psychiatric Social Workers, Psychiatric nurses, Counselors etc. at hospitals in sub-district levels
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- At policy level, sensitize and advocate for the formulation of appropriate criteria for job selection and creation of appropriate posts according to the specialization required. In addition, there should be a review of the existing job selection criteria for mental health recruitment and other disability-related activities.
- Designate medical officers for specific posting to the 10-bedded units within the District Mental Health Program
- Establish incentives for personnel working in mental health, especially in rural areas
Establish Training:
That the State should:
- Create a policy on the training of existing manpower within the health field (e.g. DMHP Psychologists, National Rural Health Mission-based counsellors, medical officers, in various programs) with short-term courses in Mental Health to strengthen competencies relevant to their posts within the system
- Create a highly motivated force and sensitize community personnel (e.g. Community Health Workers (CHWs), Accredited Social Health Activists (ASHAs), Anganwadi workers, Imams and faith healers, teachers, preachers, etc.), through training and empowerment, in increasing awareness of mental health issues, including preventive measures to address substance use.
Education:
That the State should:
- Integrate mental health into the undergraduate medical education curriculum (M.B.B.S.), with a mandatory examination to reinforce importance in general health.
Management of mentally ill patients, including the homeless mentally ill:
That the State should:
- Ensure that mentally ill patients are treated with dignity and devoid of exploitation.
- Develop a CRISIS team and a dedicated HELPLINE for Rescue and Rehabilitation, providing mental health services including facilities such
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as transport, shelter etc. for all mentally ill patients, including homeless mentally ill.
- Initiate innovative models, within a legal approach, to cater for those without caretakers.
Management of mentally ill in inaccessible areas:
That the State should:
- Ensure access to mental health in inaccessible rural areas (especially those cut out for more than six months during the winter period) through audio-visual technology e.g. tele-psychiatry
- Augment training of existing manpower, in rural areas, to identify and manage all mental health issues during periods of inaccessibility (especially in the winter period)
Substance abuse and de-addiction:
That the State should:
- Instruct the Registration authority to formulate guidelines, in consultation with IMHANS, for the setting up of De-addiction centres - Work towards rehabilitative measures, including vocational skills
training, for those who recover from drug addiction
- In addition to detoxification at the de-addiction centre, emphasize the establishment of a primordial preventive model, to address substance use (excessive use of tobacco, alcohol, drugs - cannabis etc.), including the involvement of community personnel
- Move to control Substance use by ensuring implementation of legal measures to restrict availability of such substances
- Move the Education System (schools, universities etc.) to incorporate information regarding substance use within the school curriculum and to educate children, especially youth, on the disadvantages of using such substances, through popular media such as movies dealing with ill effects of substance use and through alternative activities such as sports
- Limit the availability and use of Organophosphate chemicals, in the pretext of suicide prevention
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Intersectoral collaboration:
That the State should:
- Augment mental health work within existing systems of inter-sectorial collaboration (e.g. training of Physical Education teachers in creating awareness regarding de-addiction, child abuse, domestic violence etc.) - Make it mandatory for all schools to have a counsellor and a special
needs’ teacher as part of the School Mental Health Program.
- Under the mandate of Department of School Education, make it mandatory for existing teachers in the Sarva Shiksha Abhiyan, selected as teachers for special needs’ children, to function as per their guidelines and job profile with an appropriate monitoring and accountability mechanism; and augment liaison with DMHP to sensitize teachers on the need for mental health needs just as they are alert on issues such as personal hygiene.
Communication:
That the State should:
- Ensure that Program and policy implementation should be a community driven process with a bottom-up approach, with the involvement of mental health professionals and other stakeholders at community level.
- Establish sensitization of bureaucracy and the political system towards mental health.
Future of national mental health programme:
That the State should:
- Ensure that only Psychiatrists hold the position of State Nodal Officer NMHP, with complete independency and autonomy in the supervision of the District Mental Health Plan.
Recommendations for collaborative departments / implementers Bridging of gap between field and the delivery of mental health care:
That the relevant actors should:
- Create links at Community level with ASHAs in screening for Mental Health disorders (with training and incentive)
- Reorient the department personnel towards the field of mental health with the involvement of Anganwadi workers to identify and address
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mental health issues in the community, with a referral system to mental health professionals
- Ensure academic placement in appropriate posts/ positions: Placement of Psychiatrists, Clinical Psychologists, Psychiatric Social Workers, Counsellors, CHWs etc. incorporated within the Mental Health system appropriately
- Ensure that all counsellors engaged in other programs undergo Basic Mental Health training to augment delivery of their primary role well, in addition to early identification and referral of mental health cases - Ensure proactive and continuous specialized patient-focused training
and support for personnel recruited within the DMHP with a continuous link with multiple programs for supervision and performance based evaluation and appropriate action
- Establish Gender specific community clinics for women at tertiary level, with increased sensitivity towards females
- Establish Mobile mental health teams for Acute Mental Health Crisis Management
Awareness of ill effects substance use That Education institutions should:
- Be proactive in the innovative implementation of the School Mental Health Program, with the help of other mental health professionals and engage in screening movies and documentaries dealing with social issues, including that of substance abuse.
- Ensure the non-availability of such substances within the education campuses.
Collaboration with civil society:
- That a formal link should be established among all allied institutions, the District Mental Health Plan and Non-Governmental Organisations working in the field of community Mental Health in Kashmir
Establishment of working group:
- That an inclusive working group, starting with all those present during the RTC, meets regularly to follow up with the recommendations proposed.
Recommendations for future research in the field of mental health
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- That researchers, in the field of mental health, focus future research on:
- A more detailed research analysis in the area of substance use - An Epidemiological research on vulnerable populations such as
children and the geriatric age group
- Research study on suicide, based on data available on suicide attempts - An evaluative gap-analysis and review to explore whether gaps have
been filled in the measures taken at community level (after a year of implementation of appropriate measures).
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