Dr Anindya Das AIIMS Rishikesh Disclaimer Open as read only file when asked for password Learning objectives Role of extramedical measures in influencing health gains in general Social determinants of health SDH ID: 614835
Download Presentation The PPT/PDF document "Public Mental Health" is the property of its rightful owner. Permission is granted to download and print the materials on this web site for personal, non-commercial use only, and to display it on your personal computer provided you do not modify the materials and that you retain all copyright notices contained in the materials. By downloading content from our website, you accept the terms of this agreement.
Slide1
Public Mental Health
Dr. Anindya DasAIIMS Rishikesh
Disclaimer: Open as read only file when asked for passwordSlide2
Learning objectives
Role of extra-medical measures in influencing health gains in generalSocial determinants of health (SDH)Definitions of health and mental healthBurden of disease study and mental healthSDH and mental healthMental health services in IndiaPrevention in Mental HealthSlide3
Public Health
≈ 70%↓mortality Ann decline rate: .22/1000
.04/1000
`40%
Ref:
McKinlay
JB,
McKinlay
SM. The questionable contribution of medical measures to the decline of mortality in the
US in
the
20
th
century
. Milbank Memorial Fund Quarterly Health & Society.
1977;55:405-28
.
(90% of
↓ prior to 1950)Slide4
Ref:
McKinlay JB, McKinlay SM. The questionable contribution of medical measures to the decline of mortality in the United States in the twentieth century. Milbank Memorial Fund Quarterly Health & Society. 1977;55:405-28.Public HealthSlide5
Social determinants of Health
Health equitySocial stratificationLife course perspectiveIssue of globalizationSlide6
defining Health
Critiques: “state” vs dynamic interacn. btwn individuals’ potentials, life’s demands & social/environmental determinants“complete”… unrealistic (e.g. chronic disease) “….mental /social/emotionl./spiritual/cultural wellbeing” ?? spiritual doubt, aging, poverty, crime can be medically treated?Slide7
Mental Health
Cultural relativism“MH is a state of well-being …[to] realizes [one’s] own potential, …[to] cope with the normal stresses of life, …work productively & fruitfully, & …contribution to …[one’s] community”Subjective wellbeingPerceived self-efficacyAutonomyCompetenceIntergenerational dependenceSelf-actualizing of ones potentialSlide8
Burden:
DALYDALY: Years of life lost due to premature mortality (YLL) in the population + the years lost due to disability (YLD) for incident caseYLL= number of deaths at each age á X standard life expectancy at age áYLD= prevalence of different disease/injury sequel X disability weight for that sequel World Health Report, 2010Slide9
2010 mean ranks among health conditions that cause disability, global estimate, all age groups
Available at:
http://vizhub.healthdata.org/irank/arrow.phpSlide10
Prevalence of major mental disorders: India
DisordersPrevalence rate / 1000 populationMood, stress related & anxiety disorders12.3 - 20.7Disorders of childhood
16.5
Psychoactive substance use
6.9
Personality disorders
2-10
Development Disorders
4.2 (1.4 - 25.3)
Psychotic disorders
2.7
Organic disorders (dementia, delirium)
0.4
Ref: Reddy &
Chandrashekhar
1998,
Murali
2001, Anita 2003, NCMH 2005,
Saha
2005Slide11
All mental disorders: 13% global burden of disease
Leading cause of death 15-45 yrs.: suicideInverse care law treatment gap serious mental disorders HICs: 35.5-50.3% LMICs: 76.3-85.4% (Ref: World Mental Health Survey, 2004) Slide12
Inequality and
Mental Illness12r = 0.73 Income inequality & proportion of adults mentally ill in the prior 12mts. in rich countriesSource: Prickett & Wilkinson. Inequality: an underacknowledged source of mental illness and distress. BJP; 2010Slide13
Unemployment & suicide
136mts. time advanced non-leniar relationship of suicide to unemploymenthigher effects for lower baseline unemployment ratesRR of suicide X unemployment was
↑by
20–30% in all world regions
Source:
Nordt
et al.
Modelling suicide
& unemployment
: A longitudinal analysis covering 63 countries,
2000-11.
The Lancet
Psychiatry
;
2015Slide14
Source
: Rubio-Codina et al, London: Mimeo Institute for Fiscal Studies, 2013.14SDH and Mental Health (MH)Slide15
Interrelationship of mental & physical disorders
Premature mortality in mental disorders (in developed nations die ≥10 years younger than general pop.) (other than from suicide/ substance use disorders)Adverse health behaviour: also patterned by SDHIatrogenic effects of psychotropic useDiscrimination in general health services: availability & use?? Additional explanationsStudy of Nordic mental health system & deinstitutionalization (Ref: Wahlbeck et al, Outcomes of Nordic mental health systems: life expectancy of patients with mental disorders. BJP; 2011)Slide16
Mental health services
Evolution of the community mental health program in IndiaDe-institutionalization movementNational Mental Health Program, 1982 Mental Health Act, 1987→ 1993 Erwadi fire incident, 2001 NHRC commissioned study of mental hospitalsMental Health Care Bill/Act (2017)Global Mental Health for LMIC/Scale up strategiesSlide17
Prevention
Mothers: pregnancy & perinatal periodParenting skill, child-parent interaction, early stimulationGrowth monitoring &nutrition of children: cognitive capacityChildren & adolescentsschool based programs for building resilience, life skills trainingSuicide prevention: access to meansAlcohol policiesSocial DeterminantsSlide18
Thanks
Bibliography:Oxford Textbook of Public HealthNew Oxford Textbook of Psychiatry