An Analysis of the Mental Health Challenges in the State of Kerala, India

Presented to: Dr Manoj Mohanan and Dr Joanna (Asia) Maselko6th April 2011

SUSAN CHENDuke University

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Morbidity rate for Kerala is double the national average. Inadequacy of past epidemiological and community based

surveys in India. Kerala suicide rate is 2.5 times the national average.

Suicide Rate per 100,000:

Less than 10

10-20

20-30

30+

National Average: 10.9 per 100,000

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Youth

Elderly

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Mental Health

Centers*

Medical

Colleges*

General / District / Taluk

Hospitals*DMHP Clinics*

Primary Care Centers

Community Health CentersAnganwad

i

ASHA

Private / Cooperative

Centers*

Private / Cooperative

Hospitals*Pri

va

teP

ub

lic

*Provide some level of psychiatry, social services, counseling and psychiatric drugs.

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Community Workers Community Centers Hospitals / Colleges

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State Government of Kerala -Minister for Health And Social Welfare

Kerala State Mental Health Authority

District Panchayaths District Panchayaths

Block Panchayaths (Community Health Centres and Taluk

Hospitals)

Block Panchayaths (Community Health Centres and Taluk

Hospitals)

Village Panchayaths (Primary Care Centers)Village Panchayaths

(Primary Care Centers)

KRISIS /

SPACE

NGOs

DMHPDMHP HMIS

RSBY/

CHIS

KMSC

Aswasa Kiranam Scheme

Aswasa Kiranam Scheme

School Health

Program

Anganwadi / ASHA

IMHANS

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Stigma Mitigation Programs

Life Skills Training

Stepped Care

Cognitive Behavioral Therapy

Task Shifting

Department of Health – KSMHA Research

1. Prevalence of Mental Illness

2. Contextual Environment

3. Mental Health Care

System

4. Mental Health Care

Professionals

6. Local Mental Health

Initiatives

7. Global Mental Health Initiatives

Mental Health Centers

Medical Colleges

General / District / Taluk Hospitals

DMHP Clinics

Primary Care Centers

Community Health Centers

Anganwadi

ASHA

Private / Cooperative Centers

Private / Cooperative

Hospitals

5. Mental Health Governance

Structure

1. Establish statewide governance structure.

2. Undertake rigorous population studies.

3. Launch statewide community awareness and life-skills campaign.

4. Increase the number of local psychiatric resources and enhance mental health education programs.

5. Implement a stepped care model.

6. Enhance support to family care givers.

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Maximize effectiveness of prevention, identification, diagnosis and treatment interventions targeting mental illness.

Maximize public access to mental health services. Minimize costs to the public and State of Kerala

associated with improving mental health services. Minimize time required to improve mental health

services.

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• Reports to Kerala Health Minister.• Sets Kerala mental health policies and regulations.• Coordinates and monitors initiatives.• KMHSA enforces regulations.

• Quarterly meeting between Medical Colleges, Mental Health and District Hospitals.

• Reports to State Level Coordinator.

• Leverages social media and mobile technology to highlight public concerns and promote accountability.

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Drive Research Based Public Policies

Drive Research Based Public Policies

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Mental Health

Centers*

Medical

Colleges*

General / District / Taluk

Hospitals*Primary Care

Centers*

Community Health

Centers*

Anganwadi

ASHA

Private / Cooperative

Centers*

Private / Cooperative

Hospitals*

*Provide some level of psychiatry, social services, counseling and psychiatric drugs.

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Pri

va

teP

ub

lic

Community Centers Hospitals / CollegesCommunity Workers

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State Level Coordinator & KSMHA

ResearchResearch

1. Establish Statewide Governance Structure

3. Community Awareness and Life-

Skills Campaign

4. Enhance Available Medical Resources

2. Undertake State-wide Population

Studies

5. Implement Stepped Care

Model

6. Support Family Care

Mental Health Centers

Medical Colleges

General / District / Taluk Hospitals

Primary Care Centers

Community Health Centers

Anganwadi

ASHA

Private / Cooperative Centers

Private / Cooperative

Hospitals

Public Focus GroupPublic Focus Group Mental Health Advisory Committee

Mental Health Advisory Committee

2012 2013 2014

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Implementation OutlineImplementation OutlinePart (a)Part (a)

2012 2013 2014

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Implementation OutlineImplementation OutlinePart (b)Part (b)

2012 2013 2014

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Population Studies

Community Awareness

Enhance Medical Resources

Stepped Care

Family Care

Statewide Governance

Implementation OutlineImplementation OutlineAggregateAggregate

Expand

Resources

Enhance CapabilitiesTechnology Investment

Research Grants

Anganwadi ASHANon-MH

Prof.Teachers

1. Establish Statewide Governance Structure

X X

2. Undertake Statewide Population Studies

X

3. Launch Community Awareness and Life Skills Campaign

X X X

4. Enhance Available Medical Resources

X X X X

5. Implement Stepped Care Model

X X X X X

6. Support Family Care X

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Aggregate AnalysisAggregate AnalysisAction StepsAction Steps

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(Rupees)Projections of Benefits

Productivity Per Capita Saved (Half Impact) 1,658,335,815

Estimate of Available Funds

Allopathy Un-utilized budget (Based on 2007/08) 273,500,000

2011-12 Kerala Budget Extract

School Health Program 1,000,000

ASHA Allowance 111,500,000

DMHP 2,000,000

PHC & CHC 9,000,000

Hospitals 40,000,000

Aggregate AnalysisAggregate AnalysisCost and Benefit AnalysisCost and Benefit Analysis

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