Scarf of warmth

Chennai-based SCARF has drawn up a pragmatic programme to identify the mentally ill quickly.

A report. Dr. Saraceno addressing the gathering at SCARF.The Anna Nagar-based Schizophrenia Research Foundation (SCARF) has taken an initiative to launch the Urban Mental Health programme on or before October 10. SCARF is one of the four recognised by the Geneva-based World Health Organisation (WHO) as collaborating centres for mental health in India.

All the speakers at the inauguration of the SCARF's new programmes recently highlighted how important it was to decentralise the system so that the mentally ill could be identified quickly.

Dr. B. Saraceno, Director, Department of Mental Health and Substance Abuse, WHO, said that there were institutions which excelled in research but not in the commitment to take the results to the community, there were others, which reached out efficiently to the mentally ill but lacked the rigorous discipline to do research, and there were only a few centres, which blended the best of both. SCARF, Dr. Saraceno said, ``continues its social commitment and maintains a high standard of scientific exploration''. He said that even though a cost- effective system of treatment existed, only 20 per cent of schizophrenia patients in urban areas actually got treatment.

Dr. R. Thara, director, SCARF said that the need to reach out to the mentally ill was important because in most cases the sick remained unidentified. She also said that faith healing was not restricted to villages. Nearly 20-30 per cent of mentally ill people visiting religious centres for miracle cures were from the educated, urban sections of society, she said.

Given the crippling shortage of psychiatrists, teaching institutions as well as mental hospital beds, it was impossible to hospitalise all the mentally ill. As some mental illnesses crippled their victims progressively over time, it was important to identify the incidence before the victims became difficult to manage, if not unmanageable as in many instances of schizophrenia.

One way would be to train public health centre (PHC)-level general physicians to identify the mentally ill. The other - adopted by SCARF - would be to reach out to the non-Government organisations (NGOs), which provide basic health care. These NGOs could offer basic health care services, identify and provide medication to the mentally ill, and refer only the difficult cases to the mental institutions in the State.

With some support from the pharmaceutical companies, the programme could be sustained initially, Dr. Thara said, till the system evolved to maintain the momentum.

One of the hurdles in sustaining mental health care is the cost of drugs. A mentally ill person often requires a cocktail of drugs costing at least Rs.500 a month - a sum not many families can afford. So either the drugs should be available cheap or they should be subsidised by the Government.

As pharmaceutical companies are run for profit and not charity, the drugs are unlikely to be marketed at a low price. The only feasible option therefore would be to subsidise the drugs. The belief that for sustenance of an NGO, innovation was critical, as Dr. Thara claimed, seemed to defy reason unless financial support to an NGO was dependent on the novelty of projects. If so, it would imply that philanthropists hated to support an NGO's on- going meaningful programmes. Facts show otherwise.

A programme that identifies and takes care of the pitfalls during its efficient run for years makes the best use of every rupee the NGO gets. SO the need to devise novel schemes for survival hardly seems convincing.

Dr. Bertolote, team coordinator, Department of Mental Health and Substance Abuse, WHO, offered to be the godfather of the FACES (Family Care Empowerment Support) programme.

He clarified later that being a godfather meant that the project would get relevant information inputs from other parts of the world. He would also help in networking people and agencies, and provide technical support. What matters is the assurance that the WHO would be there to help in case of need.

One of the aims of the FACES programme is to reach out to families and communities with audiovisual inputs to sensitise them about the plight and the needs of the mentally ill.

Given the track record of the SCARF for the last 17 years, one feels almost certain that it would try its best to keep its promise. So the mentally ill in urban areas are likely to be identified sooner than they have been so far.

That's a reassurance many families will welcome after silently bearing the brunt and the burden of living with the mentally ill, whom they unwillingly hide from the community as long as possible.

GOUTAM GHOSH

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