Every story has a past and the story of mental health is no different. It took us some hundred-odd years to move from the Lunacy Act of 1912 to the Mental Health Act of 1987 and then to Mental Healthcare Act of 2017. But in these 100 years, mental health has been badly ignored and relegated to an insignificant appendage. Mental healthcare gives a gloomy and dark picture. The real picture of mental hospitals, psychiatric wards, and mental retardation homes is a tale of neglect, abuse, victimisation, violation of rights, depravity, and the dark and denied part of ourselves which we want to do away with. Progress has been made, the chained patients are now drugged with obedience, but the abandoned women, children, are still witnessing the hell. The taboos around mental illness and the unsaid fear of a mentally ill, lead one to either negate, deny or ridicule a person who suffers from mental illness. A visit to a mental hospital should be a must for people to understand the dark underbelly of civil society.
Our performance today hasn’t improved. According to WHO (2020), the mental health workforce in India is not up to the mark and there is a huge shortage of psychiatrists and psychologists in the country as compared to the number of people suffering from mental health issues in India. WHO states that in India, (per 100,000 population) there are psychiatrists (0.3), nurses (0.12), psychologists (0.07), and social workers (0.07), while the required number is anything above three psychiatrists and psychologists per 100,000 population. WHO also estimates that about 7.5 percent of Indians suffer from some kind of mental disorder and has also predicted that by the end of 2020 and 2021, almost 20 percent of India will suffer from some kind of mental illness. According to the numbers, 56 million Indians suffer from depression and another 38 million Indians suffer from anxiety disorders. India also accounts for 36.6 percent of suicides globally, and that suicide has surpassed maternal mortality as the leading cause of death among women and teenage girls aged between 15 and 19 years. Further according to WHO, the burden of mental health problems is of the tune of 2,443 disability-adjusted life years (DALYs), per 100,000 population and years lived with disability (YLDs), and the age-adjusted suicide rate per 100,000 population is 21.1. WHO also estimates that, in India, the economic loss, due to mental health conditions between 2012 and 2030, is $1.03 trillion.
In simple words, this data depicts certain concerns and the first concern is the demand of mental health professionals that far exceeds the supply and the gap is humungous. Second, mental health problems are almost becoming a pandemic. Third, mental health problems lead to poor quality of life and are debilitating, and it also hinders performance and causes economic loss to the nation.
What exactly does mental illness and health mean? When one talks about mental health, we presume we are talking of all those people going to the psychiatric wards and hospitals totally crippled with their suffering and not able to function normally, and we are right. But this is not the whole picture, mental health also includes many children, adolescents, adults, and old people who are able to carry on their daily routines, hold a job, go to school, but are having difficulty coping with the problems of everyday living and thereby their quality of life and happiness is affected. Mental health also includes coping strategies, lifestyle measures that we take for a healthy and happy life. Mental health encompasses both health and illness. It includes those we call mentally ill and all those who are going about their daily life with visibly obvious issues of coping and adjustment. And mental health includes all the population irrespective of age and gender because we all need training in managing effectively our emotions, thoughts, and behavior to better our lives and those of others around us.
Determinants of mental health include individual attributes such as the ability to manage one’s thoughts, emotions, behaviors, and interactions with others. In addition, social, cultural, economic, political, and environmental factors have a role to play as do the specific psychological and personality and genetic factors. And mental health affects all of us equally, be it children, adolescents, adults, elders, and even animals. Positive mental health is a need for all life forms. It is the basis of happiness and also the reason for living.
It is ironic that we take care of our physical body and right from our birth, we are taught how to eat, what to eat, how to dress, how to look, how much to weigh, and many other things through socialisation, but all our life what troubles us are our emotions, thoughts and consequent behaviour. When it comes to a person’s physical health, people are so conscious and aware these days—they also have access to a lot more things to maintain their health, they know everything about superfoods, the latest diet trends or workouts, but when it comes to mental health, the awareness just isn’t there. So many people aren’t even aware that they may be suffering from some form of mental health issue. So many people aren’t even aware that happiness is the result of a healthy mind.
We are literate as far as our body is concerned, but emotionally, mentally, and spiritually we are illiterate. We have been taught how to manage and beautify our body, but no one has taught us how to handle and deal with our thoughts and emotions. Nobody has taught us how to have a beautiful and peaceful mind. Happiness is a by-product of our mental state, it is contemplating that we rank 139 out of 149 countries as per the happiness index ranking. The biggest myth that people believe is that thoughts, emotions, and personality are all innate and unchangeable, whereas the truth is that they are not inborn and permanent, but through training and practice one can have control over them.
Our personality, attitudes, and other psychological aspects are all skills that can be acquired. This needs to start right from childhood. The other myth is that the mind, emotions, and thoughts have no role in maintaining body health. All physiological diseases have a psychological origin. Psychosomatic diseases are the direct result of stress, that is psychological factors affecting the body. Some examples are heart attack, asthma, and many more which are fatal and can cause death. If something is psychosomatic, it does not mean it is not life-threatening.
What then is the answer to all of that? How does one move forward? How does one ensure that all programs are structured for the rural and urban population? How does one bring about change and how does one effectively reach out to all those that require counseling by mental health professionals? How do we train and produce more mental health professionals? How does one educate, train and empower people emotionally, mentally so that they can improve the quality of their life? How does one create awareness and increase the acceptability of the mentally ill, differently-abled, or challenged to make them socially inclusive and friendly?
What we propose in a nutshell is a three-pronged approach to mental health literacy:
1) Create awareness and build acceptance about mental health, mental illness, psychological wellness, and well-being by building inclusive classrooms, workplaces and make diversity a way of life for the urban as well as rural population.
2) To provide counselling and mental health services to people who are also contextualised and customised.
3) Capacity buildingand scaling through training and skilling, we can increase the number of mental health workers so that mental health services can be made available to the entire society.
We can build a mentally literate society through the following endeavours:
Psychological Counselling and Psychotherapy: Talking is therapeutic and cathartic if we provide a safe space for people to talk without any fear of being judged, ridiculed, or admonished about right and wrong in complete confidentiality and secrecy. It can be both individual and group counseling and therapy.
The counselling should be contextual and accompanied by Western techniques, and it should be culture-specific too. It should be in various areas: Mental Health Counselling; Relationship and Family Counselling; Guidance and Career Counselling; Rehabilitation Counselling; Educational Counselling; Substance Abuse Counselling and Sports Counselling
Psychological/Psychometric Assessment and Testing: A wide range of scientific, standardized tests, measures, and psychological instruments can be used to measure and test various aspects of one’s behaviour, personality, attitude, mental status, aptitude, career interests, career skills, relationships, adjustment, leadership skills, emotional intelligence, social intelligence, etc.
Child and Adolescent Care: Life skills training, employability training, psychological assessment to know themselves, and positive psychology training can be given to enable and empower them with the skills, knowledge, and techniques needed to live a fulfilling and productive life.
Research, Assessment, and Development: An intellectual foundation is necessary and research is the answer. One needs to specifically focus on Indic systems and solutions where at least in psychology not much has been done. The psychological counseling and therapy and everything else that is followed is very western knowledge-centric and that is one of the reasons why psychology, unlike the west, has not made itself an indispensable part of the mind space of the individual, community, and society. By working and doing innovative, contextual, culture-specific, and applied research in this realm, we can hope to find answers to making mental health an indispensable part of everyone’s life.
Life Skills Training/Behavioural Skills Training/PersonalityEnhancement Training: We have not learned nor been ever taught how to manage our emotions and thoughts to lead a healthy life. Through training in emotional intelligence, social intelligence, spiritual intelligence, and more we seek to empower individuals- children, youth, adults, and elders to live with dignity, respect, and self-reliance while helping others to do the same. With the help of positive psychology, mindfulness, we can improve the quality of life, increase the happiness and wellbeing index of the person, and then eventually the nation.
Capacity Building through Counselling Skills Learning Programme: In a scenario where the number of people suffering from mental illness far exceeds the number of mental professionals available how does one scale up so that one can reach villages too along with the cities. The way out is capacity building of primary healthcare workers, teachers, and community members. Teachers are the first people who can be the torch bearers in ensuring mental health becomes a household term. School is where discrimination and abuse of differently-abled people begin. Students are beaten, ridiculed especially children with learning disabilities because of lack of knowledge. Training teachers in counseling skills, psychological first aid, and crisis intervention will not only help in easing the pain of the children, youth, adults, and elders who are facing the challenges but will also help in building inclusive classrooms and communities and accepting diversity. Internships and mentoring can be other modes of capacity building.
Community Focused Projects, and Volunteering: What mental health needs is social action research and interventions based on the primary research to make long-lasting and deliverable changes and build an inclusive, diverse community, and a society that makes psychological wellness, happiness, quality of life, and mental health literacy as the benchmark for a progressive society.
Dr Chavi Bhargava Sharma is a psychologist with more than 29 years of expertise in the area. She is also an educational entrepreneur who is involved in academics and research.
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OVERWEIGHT CHILDREN CAN REDUCE CARDIOVASCULAR RISK BY FOLLOWING HEALTHY DIET
Statistically overweight children who follow a healthy eating pattern significantly improve their weight and reduce a variety of cardiovascular disease risks suggests the findings of a Cleveland Clinic-led research team.
The study, which was published in the Journal of Clinical Pediatrics, paired parents and children together throughout the trial. According to the Center for Disease Control and Prevention, obesity now affects 1 in 5 children and adolescents in the United States. Children who are obese are more likely to have high blood pressure and high cholesterol which are risk factors for cardiovascular disease. Adult obesity is associated with an increased risk of several serious health conditions including heart disease, type 2 diabetes, and cancer.
For one year, researchers studied changing cardiovascular disease risk markers associated with three healthy eating patterns in 96 children between the ages of 9 and 18 years old with a body mass index (BMI) greater than 95 percent. BMI is calculated by dividing a person’s weight in kilograms by the square of height in meters, but for children and teens, BMI is age and sex-specific and is often referred to as BMI-for-age.
The three healthy eating patterns studied were the American Heart Association Diet, Mediterranean Diet, and Plant-based diet. All three emphasised whole foods, fruits and vegetables and limited added salt, red meat and processed foods. Parent and child pairs attended weekly educational sessions for four weeks which covered suggested foods to eat and avoid how to read package labels, proper portion sizes and shopping tips.
Fasting blood tests were used to access biomarkers of cardiovascular risk. All three diets were associated with improvements in weight, systolic and diastolic blood pressure, total cholesterol, and low-density lipoprotein.
“This study helps show the importance of starting healthy eating patterns as young as possible. We know that cardiovascular disease begins in childhood, and children’s eating patterns are easier to mold than adolescents and adults,” said lead author Michael Macknin, M.D., Professor Emeritus of Pediatrics of Cleveland Clinic Lerner College of Medicine.
The American Academy of Pediatrics Committee on Nutrition recommends that healthy children age 2 and older follow a diet low in fat (30 percent of calories from fat). These are the same recommendations for healthy adults. In the study, dietary compliance rates averaged 65 percent in week 4 and 55 percent in week 52 suggesting small improvements in diets can still be very beneficial.
“Because the process of heart disease begins in childhood, prevention should begin there as well,” said W.H. Wilson Tang, M.D., study author and research director in the section of heart failure and cardiac transplantation medicine in the Sydell and Arnold Miller Family Heart, Vascular and Thoracic Institute at Cleveland Clinic.
“A large majority of heart disease is due to modifiable or controllable risk factors, so it’s important for children to understand that they are in large part responsible for their health,” added Tang.
INDIA’S COVID-19 VACCINATION COVERAGE EXCEEDS 81.85 CRORE
With the administration of 96,46,778 vaccine doses in the last 24 hours, India’s Covid-19 vaccination coverage exceeded 81.85 crores (81,85,13,827) as per provisional reports till 7 am on Tuesday, informed the Ministry of Health and Family Welfare.
The ministry said that this has been achieved through 80,35,135 sessions. As per the data, as many as 1,03,69,386 healthcare workers have been inoculated with the first dose of the Covid vaccine while 87,50,107 have been inoculated with both doses. The number of frontline workers vaccinated stands at 1,83,46,016 (first dose) and 1,45,66,593 (two doses).
According to the health ministry, 33,12,97,757 vaccine doses were administered as the first dose and 6,26,66,347 vaccine doses were given as the second dose in the age group 18-44 years.
Also, in the age group of 45-59 years, 15,20,67,152 people have received the first dose and 7,00,70,609 have received the second dose whereas 9,74,87,849 vaccine doses were administered as first dose and 5,28,92,011 vaccine doses given as the second dose to the people over 60 years. Meanwhile, India reported 26,115 new Covid-19 cases in the last 24 hours.
Sustained and collaborative efforts by the Centre and the states, UTs continue the trend of less than 50,000 daily new cases that are being reported for 86 consecutive days now.
“The recovery of 34,469 patients in the last 24 hours has increased the cumulative tally of recovered patients (since the beginning of the pandemic) to 3,27,49,574,” the ministry said.
The active caseload is presently 3,09,575 which constitutes 0.92 percent of the country’s total positive cases while the recovery rate stands at 97.75 percent. The testing capacity across the country continues to be expanded. The last 24 hours saw a total of 14,13,951 tests being conducted. India has so far conducted over 55.50 crores (55,50,35,717) cumulative tests. The weekly positivity rate at 2.08 percent remains less than 3 percent for the last 88 days now. The daily positivity rate was reported to be 1.85 percent. The daily Positivity rate has remained below 3 percent for the last 22 days and below 5 percent for 105 consecutive days now.
‘Robotic lab’ at AIIMS has capacity to conduct 2 lakh tests in a day
Amidst the prevalence of the Covid-19 pandemic, the country’s renowned hospital, All India Institute of Medical Sciences (AIIMS) here has prepared a ‘robotic lab’ that has the capacity to conduct more than two lakh general tests in a single day.
AIIMS “robotic smart lab” has the capacity to conduct two lakhs tests in a single day. This hi-tech lab was started last year in July and inaugurated by Former Union Health Minister Dr Harsh Vardhan. Union Health Minister Mansukh Mandaviya on Monday also visited this lab and spent more than 20 minutes to see the working of this robotic lab which is fully IT and digitally enabled. Currently, this lab is conducting 3,000-4,000 tests per day but it has a capacity to conduct 8,000 tests per hour and two lakh tests in a single day.
“As of now, we are conducting 3,000-4,000 sample testings in a single day via this lab. The capacity is almost 8,000 tests per hour and 2 lakh tests in a day,” said Dr Tushar Sehgal, Assistant professor, Department of Medicine at AIIMS, Delhi.
This AIIMS smart lab is providing high-quality diagnostics and reduced time in producing lab reports here. The lab is doing more than 70- 270 advanced tests and some of them are free of cost for the patients, the official said.
Elaborating further, Dr Sehgal told ANI, “The testing involves a few stages. It primarily involves three main stages i.e. pre-analytical, analytical and post-analytical stage.” “We have three different types of sample testing methods as well. Haematology, Coagulation, Chemistry are the methods,” he added. AIIMS Hi-tech robotic lab is also providing some free-of-cost tests like the D-Dimer test that costs around Rs 1,000 in private labs. “There are some tests which we do free of cost. Our vision is to provide most of the tests free of cost like LFT, CBC, D-Dimer test etc.”
VARIOUS INFECTIONS SURGE AMONG CHILDREN AS POST-COVID SYMPTOMS
Respiratory syncytial virus (RSV) is emerging as the latest post-Covid symptom among infants and young children, said a paediatric expert on Tuesday.
According to Dr Dhiren Gupta, a senior paediatric pulmonologist at Sir Ganga Ram Hospital, the early phase of RSV infection in babies and young children is often mild, like a cold. However, in children younger than age three, the illness may move into the lungs and cause coughing and wheezing. In some children, the infection can also turn into severe respiratory disease. Dr Gupta told ANI, “Among 100 cases of post-covid complications, 80 percent patients are suffering from RSV, whereas among RSV cases 80 percent patients are infants.”
The expert also added that if a patient had prolonged fever as a post-Covid symptom, then about 1 percent to 20 percent chances are patient is suffering from Tuberculosis.
“Unfortunately there is no specific treatment for RSV infection and normally takes between seven and 10 days to settle,” said Dr Gupta. The doctor said though the Covid-19 infections have not increased in number, the severity of Covid infection was a little bit more than generally found.
“Also, children who were completely fit and healthy before Covid are suffering from tuberculosis and liver abscess along with RSV and they were not given immunosuppressant such as steroids,” he added.
A pyogenic liver abscess is the development of a pus-filled pocket of fluid within the liver. Pyogenic means producing pus. A liver abscess can develop from several different sources including a blood infection, an abdominal infection or an abdominal injury that was infected.
Completing recommended sleeping hours could lead to smarter snacking choices, says a new study
The findings of a new study suggest that people who miss the recommended seven or more hours of sleep per night might make poorer snacking choices than those who adhere to shut-eye guidelines.
The study abstract has been published in the Journal of the Academy of Nutrition and Dietetics and the research will be presented in a poster session on 18 October at the 2021 Food and Nutrition Conference and Expo. The analysis of data on almost 20,000 American adults showed a link between not meeting sleep recommendations and eating more snack-related carbohydrates, added sugar, fats and caffeine.
It turns out that the favoured non-meal food categories—salty snacks and sweets and non-alcoholic drinks—are the same among adults regardless of sleep habits, but those getting less sleep tend to eat more snack calories in a day overall.
The research also revealed what appears to be a popular American habit not influenced by how much we sleep: snacking at night. “At night, we’re drinking our calories and eating a lot of convenience foods,” said Christopher Taylor, professor of medical dietetics in the School of Health and Rehabilitation Sciences at The Ohio State University and senior author of the study.
“Not only are we not sleeping when we stay up late, but we’re doing all these obesity-related behaviours: lack of physical activity, increased screen time, food choices that we’re consuming as snacks and not as meals. So it creates this bigger impact of meeting or not meeting sleep recommendations,” added Taylor.
The American Academy of Sleep Medicine and Sleep Research Society recommends that adults should sleep seven hours or longer per night on a regular basis to promote optimal health. Getting less sleep than recommended is associated with a higher risk for a number of health problems, including weight gain, and obesity, diabetes, high blood pressure and heart disease.
“We know lack of sleep is linked to obesity from a broader scale, but it’s all these little behaviours that are anchored around how that happens,” said Taylor.
Researchers analysed data from 19,650 US adults between the ages of 20 and 60 who had participated from 2007 to 2018 in the National Health and Nutrition Examination Survey. The survey collected 24-hour dietary recalls from each participan—detailing not just what, but when, all food was consumed—and questions people about their average amount of nightly sleep during the workweek. The Ohio State team divided participants into those who either did or didn’t meet sleep recommendations based on whether they reported sleeping seven or more hours or fewer than seven hours each night. Using US Department of Agriculture databases, the researchers estimated participants’ snack-related nutrient intake and categorized all snacks into food groups. Three snacking time frames were established for the analysis: 2:00-11:59 a.m. for the morning, 12:00-5:59 p.m. for the afternoon, and 6 p.m.-1:59 a.m. for the evening.
Statistical analysis showed that almost everyone—95.5 percent—ate at least one snack a day, and over 50 percent of snacking calories among all participants came from two broad categories that included soda and energy drinks and chips, pretzels, cookies and pastries.
Compared to participants who slept seven or more hours a night, those who did not meet sleep recommendations were more likely to eat a morning snack and less likely to eat an afternoon snack and ate higher quantities of snacks with more calories and less nutritional value.
Though there are lots of physiological factors at play in sleep’s relationship to health, Taylor said changing behaviour by avoiding the nightly nosh, in particular, could help adults not only meet the sleep guidelines but also improve their diet.
“Meeting sleep recommendations helps us meet that specific need for sleep-related to our health, but is also tied to not doing the things that can harm health,” said Taylor, a registered dietitian.
“The longer we’re awake, the more opportunities we have to eat. And at night, those calories are coming from snacks and sweets. Every time we make those decisions, we’re introducing calories and items related to increased risk for chronic disease, and we’re not getting whole grains, fruits and vegetables,” added Taylor.
“Even if you’re in bed and trying to fall asleep, at least you’re not in the kitchen eating – so if you can get yourself to bed, that’s a starting point,” noted Taylor.
INFANTS EXPOSED TO DOMESTIC VIOLENCE HAVE POOR COGNITIVE DEVELOPMENT: STUDY
A new study has revealed that infants coming from homes with domestic violence often go on to have poor academic outcomes in school due to neurodevelopmental lags and a higher risk for a variety of health issues, including gastrointestinal distress, trouble eating, and sleeping, as well as stress and illness.
The findings of the study were published in the ‘Maternal and Child Health Journal’. While assessing a pregnant woman with premature labour in 1983, Linda Bullock noticed bruises on the woman. When she asked what happened, the woman told Bullock a refrigerator had fallen on her while cleaning the kitchen.
“Something didn’t seem right, but I didn’t know what to say at the time. I just went on to the next question of the assessment,” said Bullock, now a professor emerita at the University of Missouri Sinclair School of Nursing.
“We stopped her labour and sent her home, but I will bet my last dollar I sent her back to an abusive relationship, and it sparked my interest in helping other nurses assist battered women. What we didn’t know at the time was the impact violence had on the baby,” Bullock added.
Bullock helped implement the Domestic Violence Enhanced Perinatal Home Visits (DOVE) program in rural Missouri, which empowered safety planning and reduced domestic violence for hundreds of abused pregnant women.
After learning from home health visits that many of the abused women had up to nine different romantic partners during and following pregnancy, Bullock conducted a study to examine the impact of multiple father figures on the cognitive development of newborn infants.
After administering neurodevelopmental tests during home visits three, six and 12 months after birth, she was surprised to find the infants of women who had only one male partner who abused them had worse cognitive outcomes compared to infants of women with multiple male partners, only some of whom were abusive.
“The findings highlight the variety of ways the multiple father figures may have been helping the mom support her baby, whether it was providing food, housing, childcare or financial benefits,” Bullock said.
“For the women with only one partner who abused them, the infant’s father, the father may not have provided any physical or financial support or played an active role in the child’s life. It can be difficult for busy, single moms struggling to make ends meet to provide the toys and stimulation their infants need to reach crucial developmental milestones,” Bullock added.
Bullock added that infants coming from homes with domestic violence often go on to have worse academic outcomes in school due to neurodevelopmental lags and a higher risk for a variety of health issues, including gastrointestinal distress, trouble eating and sleeping, as well as stress and illness.
“When nurses are visiting homes to check in on pregnant women and their developing babies, we want them to be trained in recognising the warning signs of potential intimate partner violence,” Bullock said.
“I still think back to 1983 when I sent that lady back home into a terrible situation, and I am passionate about making sure I can help nurses today not make the same mistake I made,” Bullock continued.
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