Need for micro-finance self-help groups among women family caregivers of persons with mental disability in rural India

PurposeMicro-finance self-help groups empower caregivers to indulge in productive activities based on the local availability of resources to reduce their financial burden. The purpose of this paper is to assess the need for and feasibility of initiating micro-finance groups for the caregivers of persons with mental disability in a rural socio-economically backward community of Karnataka, India.Design/methodology/approachThe design of the study was a cross-sectional survey, with mixed methodology design out of the eight localities where the Mental Health Public Health Centres (PHC) were running successfully in Konandur area, Thirthahalli Taluk, Karnataka, one PHC was selected using simple Random Sampling Design and a 5 kms radius from Konandur town was selected as the area of the survey (190 households). During door-to-door survey, if the family indicated that a particular member is mentally unwell, the GHQ-5 and Symptoms and Others checklist were administered on him/her and the women caregiver was interviewed using qualitative needs assessment schedule and Perceived Social Support Scale.FindingsTen persons/households with mental illness (5.26 per cent) were identified in the community. Themes of financial needs, capacity of the caregiver, community resources, need for the microfinance self-help groups, informational needs, social support, burn out, and stigma elicited in the interview were depicted in the form of a conceptual framework to understand the inter-connectedness between the various themes.Research limitations/implicationsThis study is the first initiative in the field of micro-finance self-help groups for the persons with mental illness and families. The design of the study was a cross-sectional survey, which is found globally to be the most suited in conducting prevalence studies, as it provides accurate results for future studies as well as it is the first step to obtain accurate baseline values to later plan a prospective follow up study. The study used mixed methodology design. Though the sample size was small, the information collected from the participants in qualitative and quantitative method was triangulated and conceptual frameworks were developed. As this study is one of the first of its kind in the country, the results of this study from the stated sample can be considered as an important pilot for future longitudinal and cross-sectional studies to be planned in the community.Originality/valueThere is hardly any scientific literature which talks about the need for Micro-finance self-help groups for Persons with Disability, especially with person with mental disability. In order to initiate any Micro-finance SHG activities, it is essential to first undertake the need for and feasibility of initiating such micro-finance group activities in any given area. This study will be an important milestone in initiating any self-help group activity for caregivers of persons with mental disability, as it would help us understand the financial needs of the community, based on which a draft proposal to initiate micro-finance self-help group activities can be drawn up

Development and validation of clinical schedule for primary care psychiatric nursing (CSP-N) for primary care nurses

Introduction: As per the World Health Organization's mental health report for 2022, nearly a billion people have mental health issues, and 82% of them are in low and middle-income countries where mental health services are largely absent. For the successful integration of mental health into primary health care, proper training and education of primary care professionals are mandatory. Primary care nurses are in an excellent position to screen, identify, dual collaboration for treatment planning/referral, and follow-up of persons with mental illness (PMI), but they often lack the confidence and competence to tackle mental health problems. The study aimed to develop and validate the clinical schedule for primary care psychiatric nursing (CSP-N). Materials and Methods: It is conducted in two phases: the development and validation phases. An extensive literature search has been conducted, and the ten themes derived from the two-focused group discussions and three-direct one-to-one interviews and input from mental health experts were used to design the CSP-N. The CSP-N was checked for content validity by a panel of 17 experts using the item-level content validity index (I-CVI) and the scale-level content validity index (S-CVI). Results: The draft version 1 of the CSP-N showed high content validity for individual items (I-CVI range: 0.82 to 1.00) and high overall content validity (S-CVI = 0.95), and suggestions from the experts were incorporated. The CSP-N was developed in four modules. The single-measure two-way mixed absolute agreement ICC value was calculated (for 32 subjects) for the reliability test, and the ICC value was 0.97 with a 95% CI (0.94, 0.99). Conclusions: Using an iterative approach, the development and validation of the CSP-N demonstrated high I-CVI and S-CVI for screening and identification, dual collaboration for the treatment plan, referral, and follow-up of a person with mental illness by the nurses in the community

Conceptual framework of psychiatric care in India: moving from community psychiatry to public psychiatry

The psychiatric care across western countries has evolved from mental hospitals to community psychiatry as a by-product of deinstitutionalisation. The psychiatric care in India traditionally followed the homecare then shifted to mental asylums, then to various forms of community care such as co-community care within mental hospitals, camps, rural mental health clinics, District Mental Health Programmes (DMHPs), and general hospital units/ private clinics. With these evolutions, the psychiatric care in India can be divided into mental hospital psychiatry and community psychiatry. This division hinders the growth of many other sub-specialties of psychiatry such as primary care psychiatry, disaster psychiatry, public psychiatry, etc. The authors propose to abandon the concept of community psychiatry and classifying psychiatric care into two broader divisions: clinical psychiatry and public psychiatry. Clinical psychiatry is divided into hierarchy-based primary, secondary, tertiary, and quaternary care psychiatry. In contrast, public psychiatry is to be divided into non-hierarchy-based community/ local level (micro), district level (meso), state/ country (macro), and global level (mega). The proposed public psychiatry cannot function in isolation or standalone field. It shall begin to synchronise with an Indianised Jacob’s concept of public health to achieve its targets. The divisions proposed above should be kept in mind for framing the future policies on psychiatric care in India

Barriers to Disclosure of Intimate Partner Violence among Female Patients Availing Services at Tertiary Care Psychiatric Hospitals: A Qualitative Study

Background: Intimate partner violence (IPV)/domestic violence is one of the significant public health problems, but little is known about the barriers to disclosure in tertiary care psychiatric settings. Methodology: One hundred women seeking inpatient or outpatient services at a tertiary care psychiatric setting were recruited for study using purposive sampling. A semi-structured interview was administered to collect the information from women with mental illness experiencing IPV to know about their help-seeking behaviors, reasons for disclosure/nondisclosure of IPV, perceived feelings experienced after reporting IPV, and help received from the mental health professionals (MHPs) following the disclosure of violence. Results: The data revealed that at the patient level, majority of the women chose to conceal their abuse from the mental health-care professionals, fearing retaliation from their partners if they get to know about the disclosure of violence. At the professional level, lack of privacy was another important barrier for nondisclosure where women reported that MHPs discussed the abuse in the presence of their violent partners. Conclusion: The findings of the study brought out the need for mandatory screening of violence and designing tailor-made multicomponent interventions for mental health care professionals at psychiatric setting in India

Karnataka state telemedicine project: Utilization pattern, current, and future challenges

Background: The Telemedicine Network Project in the state of Karnataka was introduced in the year 2001. This is a value added service from the health department of the government of Karnataka. There is no data on its utilization pattern or its future challenges. This study was conducted from a nodal center in order to understand the above two issues. Materials and Methods: We used a 51-item survey questionnaire that captured data on infrastructure, technical aspects, and connectivity parameters, tele-consultations including emergency services, human resources, and coordination aspects both at the client as well as the nodal centers. Results: Services are operational in 25 district hospitals across the state for the past 3.3 (2.1) years. Space was ear-marked across all the client centers. Back-up power supply was present only in 10 (40%) of the client centers. Quality of satellite connection was acceptable in 18 (72%) centers. Approximately, 3.0 (1.8) phone calls had to be made to the nodal centers to obtain one appointment. Monthly maximum and minimum cases done over the past 2 year period were reported as 58.2 (66.2) and 13.5 (16.2) respectively. Each consultation lasted for 26.1 (13.9) min. Tele-consultation advices from nodal centers were carried out completely in only 9 (36%) centers. Only in 13 (52%) client centers, did doctors keep up with appointment regularly. All technicians reported that the training they received was inadequate. 16 (64%) technicians were asked to do works that were not pertaining to telemedicine. 19 (76%) technicians had frequently felt insecurities about their jobs. Conclusions: The telemedicine service has been largely under-utilized and has failed to deliver the promise in Karnataka state. At present, the obstacles reflect both inherent limitations in the technology and also improper use of human resources. Successful implementation of the given recommendations may in the long run help optimal utilization and reach all end-users