Public Mental Health: An Evolving Imperative

By Desai, Nimesh | Indian Journal of Psychiatry, July-September 2006 | Go to article overview

Public Mental Health: An Evolving Imperative


Desai, Nimesh, Indian Journal of Psychiatry


Byline: Nimesh. Desai

The development of community mental health from clinical psychiatry has often been described as a process independent of the larger process of the development of the field of community health,[1],[2] and as if the movement towards the community was specific to psychiatry or mental health. The contributing factors and determinants of this movement have generally been identified as (i) institutional care being expensive and/or harmful in terms of 'institutionalization' syndrome, (ii) inadequacy of human resource or qualified professionals, (iii) and that the general health workers and paraprofessionals can be trained to deliver these services in their own settings for majority of patients. The fact that the movement occurred significantly as a part of the larger movement of community medicine or community health is also often overlooked. The Bhore Committee Report of 1946, which laid the foundation for the community health movement in India, not only combined the 'top down' and the 'bottom up' approaches but also included substantive emphasis on issues of mental health, albeit within the limitations of that period, much before some of the noted western movements of community mental health.[3]

The 'top down' approach of building three apex institutions, viz. All India Institute of Medical Sciences (AIIMS), New Delhi; All India Institute of Hygiene and Public Health, Kolkata and All India Institute of Mental Health, Bangalore (later to become NIMHANS), along with the 'bottom up' approach of providing primary health care, and 'community orientation to medical services and medical education', also recognized psychiatry and mental health as integral parts. It is a different matter that the entire movement of the preventive and social medicine, including the development of the academic departments, have had a mixed impact, but the larger movement of community medicine or community health, as many progressive academic departments christened themselves later, has had significant impact in different spheres. The major guiding principle and the strategy had been of 'reaching the unreached' with a sense of paternalism if not charity, and was also governed by the socialist ideology in the socio-political atmosphere of the post-Independence period in India, as in many developing countries after the second world war. Psychiatry followed medicine in this approach, without realizing the need for a different and larger conceptual framework for mental health. Indeed, the field of community medicine had in the meanwhile, evolved to the larger concept of health, beyond the medical model, and recognized the need for working across sectors. The community psychiatry initiatives in the 1960s and 1970s culminated in the National Mental Health Programme (NMHP) in India, one of the earliest in the world with inadequate emphasis on the conceptual issues of community mental health. Some merits and benefits of these programmes as well as the experiences in implementation have been discussed.[4],[5] The limited success of the NMHP, and the community mental health movement has to be recognized and accepted.

Although the community-oriented health models have significant improvements over the clinical models, their limita-tions are often not appreciated. Some important limitations are: (i) the paternalistic, charitable strategy of reaching the unreached, (ii) carrying the clinics to the community with no emphasis on prevention or promotion, (iii) being limited to treatment, (iv) limited scope in target conditions and interventions identified, and most importantly, (v) continued use of the dyadic paradigm borrowed from the medical and clinical models, of one 'patient' and one 'provider'. On the other hand, the public health, and as such the public mental health models have the advantages of (i) being larger on scope beyond treatment, including prevention of promotion, (ii) being intersectoral and cutting across sectors that impact health, (iii) population paradigm, focusing on millions and not individuals, (iv) policy leading to programmes, (v) expertise of basic sciences of epidemiology and biostatistics, (vi) inclusion of applied sciences such as health economics, and (vii) inputs from public participation through advocacy and activism. …

The rest of this article is only available to active members of Questia

Sign up now for a free, 1-day trial and receive full access to:

  • Questia's entire collection
  • Automatic bibliography creation
  • More helpful research tools like notes, citations, and highlights
  • A full archive of books and articles related to this one
  • Ad-free environment

Already a member? Log in now.

Notes for this article

Add a new note
If you are trying to select text to create highlights or citations, remember that you must now click or tap on the first word, and then click or tap on the last word.
One moment ...
Default project is now your active project.
Project items

Items saved from this article

This article has been saved
Highlights (0)
Some of your highlights are legacy items.

Highlights saved before July 30, 2012 will not be displayed on their respective source pages.

You can easily re-create the highlights by opening the book page or article, selecting the text, and clicking “Highlight.”

Citations (0)
Some of your citations are legacy items.

Any citation created before July 30, 2012 will labeled as a “Cited page.” New citations will be saved as cited passages, pages or articles.

We also added the ability to view new citations from your projects or the book or article where you created them.

Notes (0)
Bookmarks (0)

You have no saved items from this article

Project items include:
  • Saved book/article
  • Highlights
  • Quotes/citations
  • Notes
  • Bookmarks
Notes
Cite this article

Cited article

Style
Citations are available only to our active members.
Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

(Einhorn, 1992, p. 25)

(Einhorn 25)

1

1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

Cited article

Public Mental Health: An Evolving Imperative
Settings

Settings

Typeface
Text size Smaller Larger Reset View mode
Search within

Search within this article

Look up

Look up a word

  • Dictionary
  • Thesaurus
Please submit a word or phrase above.
Print this page

Print this page

Why can't I print more than one page at a time?

Help
Full screen

matching results for page

    Questia reader help

    How to highlight and cite specific passages

    1. Click or tap the first word you want to select.
    2. Click or tap the last word you want to select, and you’ll see everything in between get selected.
    3. You’ll then get a menu of options like creating a highlight or a citation from that passage of text.

    OK, got it!

    Cited passage

    Style
    Citations are available only to our active members.
    Sign up now to cite pages or passages in MLA, APA and Chicago citation styles.

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn, 1992, p. 25).

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences." (Einhorn 25)

    "Portraying himself as an honest, ordinary person helped Lincoln identify with his audiences."1

    1. Lois J. Einhorn, Abraham Lincoln, the Orator: Penetrating the Lincoln Legend (Westport, CT: Greenwood Press, 1992), 25, http://www.questia.com/read/27419298.

    Cited passage

    Thanks for trying Questia!

    Please continue trying out our research tools, but please note, full functionality is available only to our active members.

    Your work will be lost once you leave this Web page.

    For full access in an ad-free environment, sign up now for a FREE, 1-day trial.

    Already a member? Log in now.