Mental health problems generally exist on a significant scale in remote rural areas, but these get very little recognition, let alone proper care. Firstly there is an overall shortage of psychiatrists in our country, and then most of them are heavily concentrated in big cities. The chances of people in remote rural areas getting the services of psychiatrists are really low.
However, Jan Swasthya Sahyog (JSS), a widely appreciated health initiative in Chhattisgarh, is striving to tackle mental health problems in a better way within some existing constraints in its work in Kota and Lormi blocks in Bilaspur district.
The situation of mental health in the information received so far in the course of work done by JSS is quite serious. Several cases of suicides and attempted suicides have been reported. These steps are taken in a situation of sudden, temporary bursts of anger and depression. The victim actually doesn’t want to die, and says so when able to make a coherent statement, and such suicides could be avoided by better preparations to deal with such cases and take action in the form of counselling etc. One additional problem is that poison in the form of pesticides and related chemicals is easily available in most households, and there is easy access to it. It is truly a tragic situation when soon after the catastrophic happening the victim of self-inflicted harm regrets his/her action and says that he/she wants to live. But by then it may be too late. Even if the victim survives, he/she may suffer other serious health consequences. What will be really helpful will be to recognise the likely symptoms which indicate high possibility of such self-destructive behaviour so that timely preventive action can be taken.
Senior health activist of JSS Ben Ratnakar says, “The more serious situations arise in the context of patients who exhibit violent behaviour tendencies. The proportion of males is higher among such patients. It is very difficult to bring them from remote villages to hospitals, let alone complete the treatment. Often family members wish that they go away on their own. If they wander away from the village it is considered a relief. If a woman is in such a stage an effort is made to send her to her parents’ home. But sometimes she may also be left at an isolated place. Women who are depressed and remain quiet also suffer. Sometimes the husband marries a second time and they get further isolated. Liquor addiction is also responsible for many mental health problems in their villages.
Recognising the seriousness of mental health problems the JSS has taken up the treatment of several mental health patients. It is hoped that the rural communities starting with the basic unit of family can be involved much more closely in the better care of mental health patients in the near future.
By using video conferencing it has been possible to use the expertise of renowned psychiatric Dr. Prashant Gogia in the treatment of many patients of these villages. Dr. Gogia says that this technology can be very useful to reach out to patients in remote villages but this also has its limitations. Particularly for carrying out counselling this technology has limitations as face to face contact is better, but still some progress can be made particularly if the patient is situated in more comfortable conditions at the time of counselling.
Health activists have to learn to be responsive towards this and only then they can involve the communities in mental health issues.
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Bharat Dogra
The writer is a Delhi-based freelance journalist who writes on social concerns.[/column]