Community Intervention Programmes at Karnataka
a) The Thirthahalli (CoInPsyD) program
The community intervention program in Thirthahalli taluk, Shivamogga district (Community Intervention Psychotic Disorders, CoInPsyD) was started in June 2005 with research grants under the National Mental Health Program awarded to Dr. B N Gangadhar, Professor of Psychiatry, NIMHANS.
Since then, our team from NIMHANS and Dr. U Arunachala, a private psychiatrist practicing in Thirthahalli has been examining clinically relevant research questions among this representative, community-dwelling schizophrenia patients: these include, studies on course and outcome, disability, age at onset, metabolic syndrome, work functioning, family burden, substance use and tardive dyskinesia.
Needless to mention that, in addition to studying this cohort scientifically, the team has as well been providing regular clinical services to these underserved patients. Nearly 2/3rds of these patients were out-of-treatment and our team has provided services to them virtually at their doorsteps – while most receive follow up care in their nearest primary health centres, a substantial proportion of patients is seen in their houses. Where there is no government supply of medications, the team has provided medications such as olanzapine, clozapine etc., free of cost.
Though our research is focused on schizophrenia patients, for every patient with schizophrenia, the team has provided clinical services to four or five patients with various other disorders such as bipolar disorder, recurrent depressive disorders, alcohol use disorders, dysthymia, anxiety disorders, mental retardation, specific learning disabilities, etc., and neurological disorders like epilepsy, migraine, etc. Enhancing the community’s awareness about mental illnesses was an expected byproduct of our efforts. We have written newspaper articles on psychiatric disorders. Other community service activities that our team has engaged in Thirthahalli are to conduct a ‘disability’ camp and conducting interaction programs with community leaders in Thirthahalli focusing on the burden and disability caused by severe mental disorders and the role that communities could play in reducing these disabilities. During the camp, disability certificates were issued to 230 persons with mental retardation. A significant academic activity that the team accomplished was the state-level Continuing Medical Education (CME) program for psychiatry post-graduate students in Kavishaila of Thirthahalli Taluk in December 2010.
Additionally, to commemorate a decade of this work, in December 2015, a national conference was held in Thirthahalli, titled “Deliberations on Care Delivery (DECADE) for Mental Illnesses in Rural Communities”. Following topics were discussed: (a) 10 years experience of treating patients with severe mental disorders in their own communities (b) Challenges in reaching psychiatric care to patients: reflections on the National Mental Health Program (c) Role of Community Health Workers and how to harness them? (d) Challenging Neuropsychiatric cases in rural practice (e) managing alcohol use disorders at Primary Health Care Centers and (f) Relevance of Mental Health Care Bill 2013, on community treatment. Experts from all over the country actively participated in the deliberations.
For this work, our team has got excellent support from the department of health and family welfare and the taluk hospital of Thirthahalli. We have been able to manage funds from various sources to continue our service-cum-research activities thus far (i.e., from the National Mental Health Program’s research funds and grants from NIMHANS, including the team’s funds from pharmaceutical company supported clinical trials). These funds are used for the following purposes: travel, lodging and boarding for the research staff, salary support for the research staff, medication and in-patient admission costs for patients and other contingencies till date, 400 patients with schizophrenia have been identified. They are being treated and followed-up (around 12,000 follow-up visits). The number of patients with other disorders that the team has treated till now is about 4000 (totally 22,000 follow-ups till date). We have trained around 60 health workers in Thirthahalli taluk. We have also been bearing the occasional inpatient admission charges for patients. Needless to say, this program has benefited patients and families immensely in terms of the easy access to psychiatric care and clinical benefits. From clinical, epidemiological and public health research points of view, this cohort is a unique one in the country, wherein the entire patient population of the taluk is accessible in their natural living environment. Consequently, the data that gets generated will not only be clinically meaningful, but also will have important public health and policy level implications.
b) The Turuvekere (TURUVECARE) Program
This community intervention program (Treating the Untreated Psychosis in Rural Community: Variation in the experience of care, TURUVECARE) at Turuvekere taluk, Tumakuru district was started in December 2009. Like in Thirthahalli, our team aimed to identify and treat all patients with schizophrenia in the taluk in addition to the research questions. Initial funds came from the American Psychiatric Association as an award to Dr Naveen Kumar, one of our team members. The award was provided with the specific objective of studying metabolic complications of antipsychotic medications among patients with schizophrenia. After this, two more research grants were obtained, one from the
Government of Karnataka (Dr Jagadisha Thirthalli, to study the variation in experiences of caring patients with psychosis) and the other from the Department of Biotechnology, Government of India (Dr Jagadisha Thirthahalli for studying parental consanguinity in patients with schizophrenia and comparing with that of the general population). Another important academic achievement from Turuvekere is related to post-graduate theses. Three MD dissertations and one PhD dissertation have come out from this program. In addition, one PhD thesis is ongoing from these cohorts. These theses form unique contributions to the area and have yielded interesting findings. Experience related to service delivery is identical to that of Thirthahalli. Till date, 260 patients with schizophrenia are identified, treated and are being followed-up (total of 3500 follow follow-ups till date). The total number of patients with other psychiatric disorders is 2500 (total 6000 follow-ups till date). As in the case of Thirthahalli, the team has treated four to five patients with other psychiatric disorders for every patient with schizophrenia. In addition, we have liaised with the local Lion’s club of Turuvekere in conducting periodic health camps. The number of psychiatric patients who have been treated in these camps amounts to 3500. The team has issued around 500 disability certificates to patients with psychiatric disability. The team has trained 50 doctors, 50 nurses, 54 health workers and 300 ASHA workers. They all have been trained in the identification/treatment/referral of persons with psychiatric disorders. Even here, our team is getting excellent support from the taluk health administration.
In a recent development, we have partnered with Chitta Sanjeevini Charitable Trust, an NGO supported by the Infosys Foundation and Lions Club International in Thirthahalli and Turuvekere to provide psychiatric medications, which are not available through the government sources. With this, we have been able to provide medications that not only treat the illness, but also improve their productivity and quality of life.
Most recently, alumnus of NIMHANS, friends and well-wishers have been voluntarily donating funds to keep both these programs running. Finally, a three-years research project has been sanctioned to Dr Naveen Kumar by the Department of Science and Technology, Govt. of India. The aim of this project is to examine the relevance of ‘social-cognition’ deficits with regards to functioning of persons with schizophrenia in these two taluks.
In the process of all these, we have gained awareness of the ways in which the health system and the community interacts at the grass-root level. Continuing these two endeavors would have immense benefits to all the stakeholders including patients, their families and local health administration. Needless to say, we could gain insights into a number of research questions with a lot of public health importance.
Summary of the activities from these two community intervention programs
Schizophrenia patients identified
Number of follow-ups for schizophrenia patients (Approximate)
Number of other patients identified and followed up (Approximate)
Numbers of disability certificates issued
Papers presented in conferences
Number of awards/prizes won
1 completed; 1 ongoing
1 MSW thesis, 2 MPhil (PSW) thesis
Number of Health Professionals including ASHAs trained
800 (including doctors, nurses, health workers and ASHA workers
Continued Medical Education Programs held (December 2010)
1 in Kavishaila of Thirthahalli Taluk, for psychiatry postgraduate students of Karnataka
National Conference on Community Psychiatry (December 2015)
1 in Thirthahalli, titled “Deliberations on Care Delivery (DECADE) for Mental Illnesses in Rural Communities”
Number of trained stake holders in the community
300 (such as anganwadi workers, traditional faith healers, community leaders etc.)
Newspaper articles on these two programs and about severe mental disorders
Interactive programs with community leaders
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