Mental health experts have given the thumbs down to the BMC’s plan to exploit Aarey colony for commercial use. In a city where more than three people take their lives daily, open spaces and greenery are a critical necessity that the government cannot deny its citizens, they say.

Child specialists are on the same page and feel open spaces play a unique role in developing a child’s social, emotional and cognitive skills. “It is proven that any child who spends more than two hours on a gadget does not perform very well in school. But, as doctors when we advise parents to take their children to the outdoors, the reply often is where to take them? So we need to look at creating more greenery and not hacking them,” said paediatrician Dr Deepak Urga, who consults at Lilavati Hospital in Bandra.

http://timesofindia.indiatimes.com/city/mumbai/Open-spaces-critical-for-mental-well-being-Experts/articleshow/46304945.cms

A new international study led by the University of Melbourne and Deakin University has stated that as with a range of medical conditions, psychiatry and public health should now recognise and embrace diet and nutrition as key determinants of mental health.

Lead author, Dr Jerome Sarris said that while the determinants of mental health were complex, the emerging and compelling evidence for nutrition as a key factor in the high prevalence and incidence of mental disorders suggested that nutrition was as important to psychiatry as it is to cardiology, endocrinology and gastroenterology.

In the last few years, significant links have been established between nutritional quality and mental health. Scientifically rigorous studies have made important contributions to our understanding of the role of nutrition in mental health, he added.

Findings of the review revealed that in addition to dietary improvement, evidence now supports the contention that nutrient-based prescription has the potential to assist in the management of mental disorders at the individual and population level.

Studies show that many of these nutrients have a clear link to brain health, including omega-3s, B vitamins (particularly folate and B12), choline, iron, zinc, magnesium, S-adenosyl methionine (SAMe), vitamin D, and amino acids.

…

The study is published in The Lancet Psychiatry

http://zeenews.india.com/news/health/healthy-eating/better-diet-and-nutrition-critical-in-maintaining-mental-health_1538836.html

Two state-of-the-art public hospitals in New Delhi are barely operational years after they officially opened – not for lack of funding but because officials did not spend the millions of dollars allocated to treat heart and kidney patients.

The empty hospitals in the heart of the Indian capital are emblematic of the paralysis gripping a public health system that is responsible for some of the world’s worst health indicators. Many of the country’s 1.2 billion people have a choice between expensive private care, or no care at all.

Prime Minister Narendra Modi faces many challenges to his stated goal of providing universal public health coverage, but one of the most daunting is ending the logjams that mean officials consistently fail to use their budgets.

At the 300-bed Janakpuri Super Speciality Hospital, gleaming marble-floored corridors disappear into dark wings, thick chains locking the doors to most of the five-storey building. Wards lie empty, without beds. It officially opened in 2008.

In another part of the city of 16 million people, the Rajiv Gandhi Super Speciality Hospital sits in a landscaped 13-acre complex. It started outpatient services in 2003 but more than a decade later only six beds – of the 650 the hospital was built for – receive overnight patients.

The hospitals were allocated $48 million in the current financial year but still lack basic equipment and, crucially, doctors. They will only spend a fraction of the amount by year-end: under 20 percent in the case of Janakpuri hospital.

A Reuters investigation found no evidence that corruption was responsible for the situation. Instead, officials and health experts blamed a tortuous procurement process, political wrangling and bureaucratic incompetence.

Janakpuri hospital Director M.M. Mehndiratta said he waited 15 months for approval to hire more doctors, with the request travelling to Delhi’s top health officials before getting stuck for months in the administrative and finance departments.

…

India’s health system will need to add 3.6 million hospital beds, 3 million doctors and 6 million nurses over the next 20 years to meet the needs of the growing population, consultants PwC India estimate.

“We buy an X-ray machine, but there is no X-ray operator,” Health Minister J.P. Nadda said while discussing general health funding with reporters last month. “Money is not the major factor, it is (the lack of) optimal utilisation.”

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Data compiled by Reuters in collaboration with the Public Health Foundation of India shows the under-utilisation is a national problem. Even though India revised down its federal health budget mid-year in all but one year since 2005, the country only once managed to spend all the funds.

…

A senior health official in New Delhi blamed delays such as those plaguing Rajiv Gandhi and Janakpuri hospitals on the incompetence of government employees and a “lethargic and slow” process of selecting vendors. Fearing corruption charges, officials work in an environment of “procurement phobia”.

“We need clearances from about 10 agencies before laying even a brick,” said the official, who asked not to be named.

…

Since the Delhi government began building the Rajiv Gandhi and Janakpuri hospitals in 1998, dozens of private hospitals have sprung up to meet the city’s growing medical needs.

Industry body ASSOCHAM estimated in 2013 that India’s private hospital sector would grow at 20 percent annually and become a $125 billion market by 2017.

The private sector now accounts for 80 percent of India’s healthcare delivery market.

Apollo Hospitals Enterprise Ltd., India’s largest listed hospital chain by revenue, classifies inadequate public spending as one of its growth drivers.

http://in.reuters.com/article/2015/02/12/india-healthcare-hospitals-idINKBN0LF2G220150212

Following the birth of her third child, Delhi-based entrepreneur Smita* found herself feeling “disconnected and depressed”, often for days at a stretch. “Much later I was told it was severe post-partum depression but at the time it wasn’t properly diagnosed,” she told IPS.

“My marriage was in trouble and after my symptoms showed no signs of going away, my husband was keen on a divorce, which I was resisting.”

After a therapy session, Smita was diagnosed as bi-polar

…

One day after she suffered a particularly severe panic attack, Smita found 10 policemen outside her door. “I was taken to a prominent mental hospital in Delhi where doctors sedated me without examination. When I surfaced after a week I found that my wallet and phone had been taken away.”

All pleas to speak to her husband and parents went unheeded.

It was the beginning of a nightmare that lasted nearly two months, much of it spent in solitary confinement. “The nurses were unkind and cruel.
…
“There were women there who told me they had been abused and molested by the staff.”

Not all the women languishing in these institutions even qualified as having mental health problems; some had simply been put there because they were having affairs, or were embroiled in property disputes with their families.

Days after she was discharged her husband filed for a divorce on the grounds that Smita was mentally unstable.

“I realised then that my husband was building up his case so he would get custody of the kids.”

Isolated and afraid, Smita did not find the strength or support to fight back. Her husband won full custody and left India with the children soon after. “My doctor says I am fine and I am not on any medication but I still carry the stigma. I have no access to my kids and I no longer trust my parents,” she told IPS.

Smita’s story points to the extent of violence women face inside mental health institutions in India. The scale was highlighted in a recent Human Rights Watch (HRW) report, ‘Treated Worse than Animals’, which said women often face systematic abuse that includes detention, neglect and violence.

Ratnaboli Ray, who has been active in the field of mental health rights in the state of West Bengal for nearly 20 years, says on average one in three women are admitted into such institutions for no reason at all. Ray is the founder of Anjali, a group that is active in three mental institutions in the state.

“Under the law all you need is a psychiatrist who is willing to certify someone as mentally ill for the person to be institutionalised,” Ray told IPS. “Many families use this as a ploy to deprive women of money, property or family life. Once they are inside those walls they become citizen-less, they lose their rights.“

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“One can’t help but notice the stark contrast between the male and female wards,” points out Vaishnavi Jaikumar, founder of The Banyan, an NGO that offers support services to the mentally ill in Chennai, capital of the south Indian state of Tamil Nadu.

“You will find wives and mothers coming to visit male patients with food and fresh sets of clothes, while the women’s wards are empty.” Experts also say discharge rates are much lower when it comes to women.

The indifference towards patients is evident not just in institutions, but also at the policy level, with mental health occupying a low rung on the ladder of India’s public health system.

According to a WHO report the government spends just 0.06 percent of its health budget on mental health. Health ministry figures claim that six to seven percent of Indians suffer from psychosocial disabilities, but there is just one psychiatrist for every 343,000 people.

That ratio falls even further for psychologists, with just one trained professional for every million people in India.

Furthermore, the country has just 43 state-run mental hospitals, representing a massive deficit for a population of 1.2 billion people. With the District Mental Health Programme (DMHP) present in just 123 of India’s 650 districts, according to HRW, the forecast for those living with mental conditions is bleak.

“Behind that lack of priority is the story of how policymakers themselves stigmatise,” contends Ray. “The government itself thinks [the cause] is not worthy enough to invest money in. Unless mental health is mainstreamed with the public health system it will remain in a ghetto.”

http://www.ipsnews.net/2015/01/dumped-abandoned-abused-women-in-indias-mental-health-institutions/

India’s health care delivery mechanism is defined by shortcomings; the doctor-patient ratio is skewed, over 75 per cent of India’s population has no health insurance, there is a shortage of two million hospital beds compared with the global requirement of 2.5 beds per 1000 people and the spending on health is abysmally low at a little over one per cent of the GDP.

These statistics however, are not the only illustration of the gaps that exist in the system; the inability to utilise the available infrastructure worsens the problem. This was endorsed by the Union Health and Family Welfare Minister J.P. Nadda’s recent admission that “there are health centres where there is an X-ray machine, but nobody who knows how to operate it.”

Extremely high out-of-the-pocket expenses on diagnostics and medicines, poor quality of services in government-run hospitals and lack of human resource to deliver the services have been identified as the major lacunae that the government needs to address with alacrity.

Also counted as failures of the system are insufficient attention to research (including developing newer medicines and vaccines) and preventable nutritional disorders, maternal and child mortality and reduction in the burden of non communicable diseases.

A white paper ‘Aarogya Bharat 2015’, released by NATHEALTH, Healthcare Federation of India this past week shows India requires $3 trillion in cumulative funding and has the potential to generate 15 to 20 million jobs by 2025.

Yet, less than one per cent of delivery providers are accredited and although rural India accounts for about 70 per cent of the population, it has less than one-third of the nation’s hospitals, doctors and beds resulting in huge disparities in the health outcomes.

Under spending on health care and pharma sectors has been flagged thus in the report; compared to the U.S. (8,895 $) and China (322 $), India (58 $) had the lowest per capita health care expenditure in 2012; the per capita spending on pharma products and medical devices in 2013 stood at $15 as against $ 1440 in the U.S. and $90 in China. The doctor-patient ratio too is among the lowest with a mere 0.5 doctors for every 1000 patients in large parts of the country.

India’s GDP spending on health brackets it with lower income countries, the Sub Saharan Africa, Afghanistan, Haiti, Azerbaijan and Georgia says a World Bank report of 2012. A consequence of out patient treatments and direct payments is individuals being pushed below the poverty line.

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Despite 98 per cent of drugs needed for treatment of various disorders manufactured in India, 65 per cent of the population does not have access to essential and life-saving drugs says the WHO 2012 World Medicine Situation Report.

Every State procures medicines for free distribution to patients, but the free medicine model has been slow to pick pace; with Rajasthan, Kerala and Tamil Nadu being the only States that have a better record to show.

As the Centre gets ready to roll out its ambitious Universal Health Assurance Mission (UHAM), there are doubts about how it will ensure quality health care for Indians.

Recently, there was a downsizing of the health budget after the revised estimates for the last quarter showed that States have failed to utilise what was earmarked for spending on healthcare. While the Ministry was quick to defend that none of its flagship programmes would be affected by the cuts, it raised questions on why States have been dragging their feet on executing the spending.

All eyes now rest on the Health Minister’s commitment that the UHAM will not merely be limited to pumping more money into the system, but removing the bottlenecks that choke the health care system.

“There is no dearth of funds, the issue is optimum utilisation of resources and assurance of services,” he said promising to fill the gaps in the health delivery system.

http://www.thehindu.com/news/national/gaps-in-health-delivery-systems/article6822138.ece