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Introduction:
According to the World Health Organization (WHO), over a third of people in most countries meet criteria for one or more of the common types of mental disorders at some time in their life. Global health estimate studies (GBD 2010, WHO GHE) reported that a substantial proportion of the world’s disease burden came from mental, neurological and substance use disorders.
Disability-Adjusted Life Year (DALY) for a disease or health condition are calculated as the sum of the Years of Life Lost (YLL) due to premature mortality and the Years Lost due to Disability (YLD). Global disease burden has shifted from communicable to non-communicable diseases (From YLLs to YLDs). Neuropsychiatric conditions account for 28% of YLD making it the leading cause of global YLDs (years lived with disability) and Recent revised estimations revealed this figure closer to 33% (Lancet Psychiatry 2016).
The most important causes of disability due to health-related conditions worldwide include unipolar depression, alcoholism, schizophrenia, bipolar disorder, obsessive compulsive disorder and dementia followed by epilepsy, developmental and behavioral disorders in children and adolescents, self-harm / suicide and other significant emotional or medically unexplained complaints.
Determinants of mental health
The WHO constitution states: "Health is a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity." An important implication of this definition is that mental health is more than just the absence of mental disorders or disabilities. Mental health is a state of well-being in which an individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and is able to make a contribution to his or her community.
A complex interaction of social, psychological and biological factors determines the level of mental health of a person at any point of time (Bio psycho social model). Adverse life events like unemployment, bereavement, loss etc. from social aspect; Personality factors, coping skills, self-esteem, tolerance level etc. from an individual’s psychological aspect; medical, hormonal, substances and genetics from biological aspect precipitate the onset of a psychiatric illness. The treatment plan depends upon whether the occurrence is predominantly biological, psychological or social so as to determine whether medicines or counseling or both to be observed in the course of treatment.
Evidence based practice
Evidence based clinical practice guidelines are strictly being followed in psychiatry to choose appropriate medicines and to determine the duration of treatment for a particular disorder. Existing guidelines recommends an acute phase treatment of up to 12 weeks, continuation phase up to 9 months, and maintenance phase as 2 years for a first episode and 5 years to lifetime for subsequent episodes in mainstream conditions like recurrent depression, Bipolar and schizophrenia. Apart from medicines therapies like cognitive behavioral therapy (CBT), interpersonal therapy (IPT), assertive community treatment (ACT), social skills training (SST) and family focused therapy (FFT) are being widely used in conjunction.
Indian scenario
Although many effective interventions for the treatment of mental disorders are available and awareness about mental disorders has risen, the proportion of those who need mental health care but who do not receive it remains very high. This so-called "treatment gap" is estimated to reach about 76-85% for low- and middle-income countries. An estimated 70 million-plus people living with mental disorders in India and for every 1 million people, there are just 3 psychiatrists, and even fewer psychologists/social workers.
To address these issues the Indian government has launched the National Mental Health Program (NMHP) and The District Mental Health Program (DMHP) and spend above 300 crores until the current (12th ) five year plan. Inclusion of mental health illnesses in non-communicable diseases in the current five-year plan and the New Mental Healthcare Act, 2017 are the new developments to suit the mental healthcare needs.
Appa mental health facility
Background
Among the 32 districts in tamilnadu, Tiruvannamalai ranks 13 in population, closer to Madurai, trichy, vizhuppuram and cuddalore with around 25 lakhs people (2011). But, when comes to mental health facilities, While nearby districts have easy accessibility to mental health care like district mental health centre (DMPH), large number of practicing private psychiatrists and psychiatric settings, tiruvannamalai did not have any fulltime practicing psychiatrist or psychiatric settings by then (10 years back). So, people in need had to travel far towards vellore, Chennai, trichy and pondicherri for treatments. Also despite high prevalence of alcohol related disorders (addiction), there was no single de addiction centre available back then in tiruvannamalai.
Birth
Realizing the shortage of mental health professionals and the mounting need for mental health care in and around tiruvannamalai, APPA MENTAL HEALTH FACILITY was started on oct-10th (world mental health day) as a 15 bedded psychiatric nursing home in the town of tiruvannamalai with a vision to develop frurther in to a holistic mental health care delivery including De-addiction, Rehabilitation, Daycare, Homage / Half way home for the chronic mentally ill and special school for the differently abled children in the long run.
Milestones
Initial years of practice remained highly challenging because of the widespread stigma and prevailing faith healing / quack practices around mental illnesses. But yet,
A consistent holistic approach, starting from a very careful and detailed diagnostic assessment to confirm the presence or absence of any psychiatric illness followed by psycho educating the client and caregivers regarding the nature and course of the presenting illness and available treatment options for them to choose at their free will and following up their progress closely to ensure better compliance towards a better remission/recovery.
A consistent Bio-psycho-social approach, because majority of the chronic psychiatric conditions needs to be addressed rightfully under Bio-psycho-social model for adequate remission/recovery because under every psychiatric condition there is a person behind the illness (Psychological perspective) and his circumstances including other persons and environment (social perspective). Although psychiatrists are experts in both prescribing drugs (biological perspective) and psychosocial interventions, it needs more than two hands to deliver beyond prescriptions and those hands are our mental health professionals. Mental health professionals are clinical (or trained) psychologists, psychiatric (or trained) social workers and mental health (or trained) nurses according to MHCA-2017. Accordingly, a complete mental health facility by standards cannot remain complete without such dedicated mental health professionals.
And a consistently, wide range of intervention programs done by our Hospital team under school mental health, community mental health, social rehabilitation and awareness programs targeting vulnerable groups and community at large over the years has gained a reputation for Appa hospital and its team enabling them to extend their services under de-addiction and rehabilitation centres subsequently .
Current status
We continued caring our clients directly and through telepsychiatry 24/7 without shutting down during the COVID-19 pandemic and currently have established a 60 bedded extended mental health facility under single roof upon our clients’ continual request and their valuable support towards achieving the same.
Our Philosophy
Science is our only religion and spirituality is our only (meta) science. Our success rate with our clients is our testimony. Most of our clients reached us only by word of mouth. Please drop your identities and approach us with open mind to get your questions answered.
Our Signature
“Love and be loved”
Todays Thought
News & Events
29/04/2018
Full Moon Day - Free mental
health awareness camp
at girivalam path
Contact us
Appa Mental Health Facility,
36, Muthuvinayagar kovil street,
Railway station road,
Tiruvannamalai-606601.
Telephone:+91 9444986370
+91 9487712953
+91 9487712952
E-mail: appahospital@gmail.com