Primary Urban Health Care Unit and Community Movement

The mental health services in the country are far from developed, and not easily accessible. The minuscule mental health budget often concentrates on building of services in expensive psychiatric hospital set-ups rather than primary or community care, or close to where people live. These services often, only concentrate on the more severe mental health conditions, while common mental health conditions like panic attacks, anxiety, stress, and depression which are more likely to be experienced by anyone at any given point of time are largely
ignored.

It is in this context that Iswar Sankalpa launched a pilot project – the Urban Mental Health Programme (UMHP) – Project Sambandhan – in partnership with the Kolkata Municipal Corporation (KMC) in wards 78 and 82.

This project aims to evolve a holistic care pathway for the socio-economically disadvantaged population in the slums in both these wards – by integrating mental health services with physical health care services in the primary health care setting. By reaching out to those having some mental health conditions – the project aspires to promote early detection and minimise stigma as well. Hence, UMHP focuses on the preventive aspects of mental illness and health – and thus leads to quicker intervention.

UMHP has a dualistic goal

  1. To integrate mental health services with general health services offered at the ward health units of the two wards under the KMC and in the process train and create non-psychiatric workers in the field of mental health. This will help in establishing a faster identification, intervention and treatment process.
  2. To evolve a community movement towards positive mental health. This is an inclusive idea of mental well-being and not simply the absence of mental health conditions. This will help target the knowledge, attitude and practices of the community and bring change.

Our vision is that these wards will serve as models which the KMC can adapt in their other wards, heralding a new Calcutta – the city of joy where madness is no longer misunderstood, shunned and discarded off, but embraced and provided intervention, treatment and support.

PHILOSOPHY

The Urban Mental Health Programme (UMHP) works in two wards (78 and 82) of the Kolkata Municipal Corporation and is a clinic based intervention model. It is simultaneously working on creating a positive movement towards mental health care in the surrounding community. These wards have a concentrated slum population and the majority of the families belong to the low income or below-poverty line groups.

The Target Group:

The philosophy behind starting a programme like UMHP in such a low-income group community encompasses understanding the dynamics of living in an urban slum.

In a research paper released by the United Nations – Understanding Slums, Case studies for the Global Report on Human Settlements 2003, it was estimated that about one

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third of the population of Kolkata lives in slums, of which over 40% of Kolkata’s slum residents have been slum dwellers for two generations or longer, and more than half originate from the Kolkata hinterland.

Space crunch, big families, and poor sanitation coupled with the majority being engaged in the informal sector with average monthly earnings between 500 and 1700 rupees; some three-quarters of the Kolkata slum population are below the poverty line. These pre-existing conditions contribute to the high illiteracy of this population which consequently leads to very limited options for raising the standard of living, and thus creating a vicious cycle of poverty, unemployment and illiteracy.

This scenario further intensifies the poor knowledge and information disseminated amongst these communities and leads to a low level of health awareness amongst our target population, regarding general health care, and an even lower awareness on mental health care.

Services in West Bengal:

The current scenario of mental health care being accessed in West Bengal can be understood through the Performance of Mental Hospitals 2002-03 to 2006-07;

Activity 2006-07 2005-06 2004-05 2003-04 2002-03
1) OPD attendance of persons with mental health conditions (Mental Hospitals, Medical Colleges, District Hospitals, NGOs, Nursing Homes 632528  576874 496912 367005 381669
2) Indoor admission of persons with mental health conditions (Mental Hospitals only) 1516  1245 1032 712 862

According to World Health Organisation (WHO) estimates, the worldwide prevalence of mental health conditions is, approximately –

  • 1% major mental illness,
  • 4-5% minor mental illness,
  • 3-5% substance dependence and
  • 3% mental retardation,

This implies that about 10-12% of a given population at any given time has a mental health condition. Given that West Bengal’s population is about 80 million, the absolute number of persons with a mental health condition is 8 million but the number of persons accessing OPD care in 2006 was less than 7 lakhs. Further, an estimated 5% of persons with major mental health conditions need inpatient care and this number is estimated to be 32,000 – the admissions in the same year was less than 2000. The above estimates leave no room for doubt, the overwhelming need for extending mental health service delivery in the state.

The UMHP model of delivering mental health care facilities has been devised taking this background into account. These ward health units serve as the primary urban health care centres in Kolkata. They are both more localized