Year : 2021  |  Volume : 63  |  Issue : 3  |  Page : 212--214

Mental health care in Karnataka: Moving beyond the Bellary model of District Mental Health Program


Rajani Parthasarathy1, Naveen Kumar Channaveerachari2, Narayana Manjunatha2, Kamaldeep Sadh2, Rakesh Chander Kalaivanan2, Guru S Gowda2, Vinay Basvaraju2, Shashidhara Nagabhushana Harihara2, Girish N Rao2, Suresh Bada Math2, Jagadisha Thirthalli3,  
1 Mental Health, Government of Karnataka, Bengaluru, Karnataka, India
2 Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
3 Department of Epidemiology, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India

Correspondence Address:
Naveen Kumar Channaveerachari
Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka
India




How to cite this article:
Parthasarathy R, Channaveerachari NK, Manjunatha N, Sadh K, Kalaivanan RC, Gowda GS, Basvaraju V, Harihara SN, Rao GN, Math SB, Thirthalli J. Mental health care in Karnataka: Moving beyond the Bellary model of District Mental Health Program.Indian J Psychiatry 2021;63:212-214


How to cite this URL:
Parthasarathy R, Channaveerachari NK, Manjunatha N, Sadh K, Kalaivanan RC, Gowda GS, Basvaraju V, Harihara SN, Rao GN, Math SB, Thirthalli J. Mental health care in Karnataka: Moving beyond the Bellary model of District Mental Health Program. Indian J Psychiatry [serial online] 2021 [cited 2021 Jul 30 ];63:212-214
Available from: https://www.indianjpsychiatry.org/text.asp?2021/63/3/212/318719


Full Text



Karnataka state has taken many strides forward with regard to the District Mental Health Program (DMHP) and is one of the few states to have dedicated DMHP psychiatrists as team leaders in all the districts. Moreover, some of the recent developments have moved beyond the Bellary model and augur well for the nation. This article attempts to provide a summary of such developments in the state and discusses the future directions.

 Core Services



DMHP in Karnataka offers (a) clinical services, including the outreach services (on a rotation basis), covering the primary health centers (PHCs), community health centers, and taluk hospitals; (b) training of all the medical officers and other health professionals such as nurses and pharmacists of the district; (c) information, education, and communication (IEC) activities – posters, wall paintings in PHCs, IEC activities for schools, colleges, police personnel, judicial departments, elected representatives, faith healers, bus branding, radio talks, etc., In addition, sensitization of Anganwadi workers, accredited social health activists, auxiliary nurse midwives, police/prison staff, agriculture department/horticulture department/primary land development bank staff, village rehabilitation workers, staff of noncommunicable disease/revised National Tuberculosis Control Program, etc.; and (d) targeted interventions are being focused on life skills education and counseling in schools, college counseling services, workplace stress management, and suicide prevention services. These initiatives have led to a phenomenal increase in patient footfalls to clinics [Figure 1] and >100,000 stakeholders are trained in various aspects of mental health (in the past 3 years).{Figure 1}

 Seamless Medication Availability



The procurement has been streamlined. The state-level purchase is done by the Karnataka Drugs and Logistics Society, based on the indents collated from each of the districts, and then, sent to their respective district warehouses. Individual indenters (taluk hospitals, community health centers, and primary health centers) then need to procure them from the district warehouses. The amount spent for the purpose has gone up drastically to INR 3 crores (30 million rupees) in the past financial year (2017–2018). However, further streamlining is possible in the sense that the delays can be further curtailed.

 The Collaboration with the Karnataka State Wakf Board



The WAKF board of Karnataka runs a “Darga” in south interior Karnataka. Thousands of persons with mental illnesses do come over here for religious cure. On a day of every week, the attendance crosses 10,000 footfalls. Recently, the authorities have agreed to come up with an allopathic PHC inside the campus of the Darga. The idea is to have integrated and comprehensive care for patients without hurting their religious sentiments. Although such collaborative initiatives are spread across the country, this one is occurring at a larger scale with involvement of governmental agencies [Table 1].{Table 1}

 Research Initiatives



Although excellent evidence-based studies have come out in community settings, actual involvement of government machinery in these kinds of initiatives is few and far. Their involvement is imperative for the evidence to become pragmatic and generalizable. Of course, by doing so, the methodological rigor compromises a bit. NIMHANS and Government of Karnataka have been collaborating for such service-driven research initiatives for over a decade and a half. Community-based interventions are going on in three taluks – Thirthahalli, Turuvekere, and Jagaluru, wherein cohorts of severe mental disorders are being cared for. In addition, several research questions (of public health significance) are being answered.[6],[7] Exciting new initiatives are also underway: examining the magnitude of reduction of treatment gap by these community interventions, impact of care at doorsteps (CAD) services from the DMHP machinery, impact of technology-based mentoring program for DMHP staff, evaluation of the impact of tele-OCT, etc.

 Discussion and Future Directions



All the above-mentioned activities in Karnataka take it beyond the Bellary model of DMHP. For example, the Memorandum of understanding (MOU) between NIMHANS and the state gives the flexibility and easy maneuverability for active collaboration. Odisha is another state which has taken this path of MOU. This collaborative activity can be expanded pan India as there are several Centers of Excellence spread throughout India. Another aspect of the Karnataka story is collaborative research activity. As described above, many activities going on across the state have the potential to inform public health policies. Karnataka has also been able to counter long-standing and well-known criticisms of DMHP/NMHP: for example, issues related to human resources, availability of medications, funding, mentoring and monitoring, and sustenance, etc., at least to an extent. Of course, the state needs to do much more for mental health care. For example, compliance with Mental Health Care Act-2017; handling unequal distribution of mental health human resources; rigorous involvement of local administration to tackle micro-level issues; refining DMHP to suit special populations such as geriatric, children, and adolescents; and perinatal and upscaling urban DMHP, in areas such as Bengaluru Metropolitan City. Another area for improvement is that the DMHP evaluation strategies should move beyond head counting and consider meaningful patient-related outcomes, including cost-effective analysis. Digital technology should further be exploited. The upcoming Karnataka Mental Healthcare Management System is a step in the right direction.[8] Finally, the DMHP should involve health and wellness centers to cater to the mental health needs, particularly for follow-up services, case detection, providing basic counseling, stress management, advocating lifestyle changes, relapse prevention strategies, and other preventive and promotive strategies.

References

1Manjunatha N, Kumar CN, Chander KR, Sadh K, Gowda GS, Vinay B, et al. Taluk Mental Health Program: The new kid on the block? Indian J Psychiatry 2019;61:635-9.
2Manjunatha N, Kumar CN, Math SB, Thirthalli J. Designing and implementing an innovative digitally driven primary care psychiatry program in India. Indian J Psychiatry 2018;60:236-44.
3Pahuja E, Santhosh KT, Fareeduzzafar, Manjunatha N, Kumar CK, Gupta R, et al. An impact of digitally-driven Primary Care Psychiatry Pr. Indian J Psychiatry 2020;62 Suppl 1:S17.
4Manjunatha N, Singh G. Manochaitanya: Integrating mental health into primary health care. Lancet 2016;387:647-8.
5Manjunatha N, Singh G, Chaturvedi SK. Manochaitanya programme for better utilization of primary health centres. Indian J Med Res 2017;145:163-5.
6Agarwal PP, Manjunatha N, Parthasarathy R, Kumar CN, Kelkar R, Math SB, et al. A performance audit of first 30 months of Manochaitanya programme at secondary care level of Karnataka, India. Indian J Community Med 2019;44:222-4.
7Kumar CN, Thirthalli J, Suresha KK, Arunachala U, Gangadhar BN. Alcohol use disorders in patients with schizophrenia: Comparative study with general population controls. Addict Behav 2015;45:22-5.
8Karnataka Mental Health and Management System to be launched in March-The Hindu. Available from: https://www.thehindu.com/news/cities/bangalore/karnataka-mental-health-and-management-system-to-be-launched-in-march/article30689819.ece. [Last acessed on 2020 May 17].