2017; Volume 18, No 10, October
Featured Article
Strengthening mental health care – A palliative care model for chronic mental illnesses in Kerala, South India
Throughout the year, IAHPC board members contribute a range of opinion pieces and other thought-provoking articles to the IAHPC Newsletter.
This month, it is the turn of our board member Dr. Chitra Venkateswaran, MD (Psychiatry), Founder and Clinical Director of the Mehac Foundation, a not-for-profit organization that works toward improving the quality of lives of mentally ill people and their families in Kerala, and throughout India, by incorporating the principles of palliative care.
Many mental illnesses can become chronic with some interspersed with episodes of acute symptoms. The long-drawn-out illness trajectory of mental illness highlights the need for a palliative approach. Stability, and most importantly quality of life, is the aim, rather than focusing on cure of the disease. Symptoms and disability are managed optimally. Mental and neurological disorders account for 12.3 of the total disability adjusted life years (DALYs), contributing to 14 percent of the global burden of disease. At least 25 percent of people consulting a general practitioner have a clear-cut psychiatric diagnosis, while at least 40 percent of those suffering from a chronic physical illness have a co-morbid psychiatric diagnosis.
Yet, mental health is still one of the most neglected areas in public health – at all levels – policy, health expenditure, research, and the establishment of new services. This amounts to an enormous burden in India with gross disparity between the number of mentally ill, treatment facilities and trained professionals, resulting in a large 'mental health gap' in the community. Many people end up in the community with severe and persistent mental illness.
In the early nineties, the palliative care movement evolved in North Kerala, India, spearheading a significant step in public health growth. From this movement, a palliative care model for mental health has gradually started to establish itself built on the shared values and vision of palliative care and mental health care. Established in 2008, the Mehac Foundation’s vision is to improve the quality of life for people with chronic mental illness and their families through holistic care with respect for autonomy and choice. The service incorporates palliative care principles with a public health approach that is specific to mental health care, with community participation.
Community participation is a key characteristic of the Mehac Foundation model: Volunteer members of the Mehac team.
Providing support in the community
Mehac has taken a proactive role in the community, with homecare projects as the unique component. This has helped create a space for mental health at grass roots level with public-private-non-governmental organization partnerships working on advocacy and awareness issues and enabling preventive treatment and rehabilitation. The family is considered as the unit of care, supported by a democratic and skilled multidisciplinary team. Since its creation in 2008, the Mehac team, together with partner organizations, has supported almost 3,500 people and their families. Around 1,200 are presently under long-term care with 15 units in the community.
Here’s one example of support. A 35-year-old man with chronic schizophrenia lived with his mother. She was old and needed help to care for her son but no one helped them because of his aggressive and abusive behavior. After one month of regular home care and medication from our team the man’s self-care started improving and he established a rapport with us. On that visit his mother said: “After so many years me and my son slept in mat peacefully at night.”
After five months’ regular follow ups the son became stable, found work as a laborer and, for the first time, was able to give money to his mother.
The characteristic feature of the Mehac service is that it is mostly integrated with palliative care at village level, and it indirectly addresses social factors such as stigma. It is proving to be a feasible model that can be replicated and blends well with the concept that is evolving internationally.
While Mehac has evolved from the palliative care movement there is now, in parallel, increasing discussion and publication of subject matter related to palliative psychiatry.
More abut the author . . .
Alongside her work with the Mehac Foundation, Chitra Venkateswaran is Professor in Psychiatry and Consultant in Psycho-Oncology in the Department of Oncology and Palliative Care, Amrita Institute of Medical Sciences, Kochi, Kerala, India. Read Chitra’s bio here.