Behavior
related problems account for 34% of all disability (World Bank1993) and include
problems such as violence, malnutrition, tuberculosis, diarrhea disease, sexual
transmitted diseases, motor vehicle accidents and other unintentional injuries.
Substance abuse can directly lead to a range of physical, psychological and
social problems as well as indirectly contribute to disability.
Alcohol
and tobacco abuse together account for the most important causes of preventable
deaths and disability in the world. It is important to distinguish between
alcohol on the one hand and hard drugs and tobacco on the other hand. If
consumed within limits and with common sense, alcohol does no damage to the
health; on the other hand tobacco and hard drugs are dangerous irrespective of
the amounts in which they are used. Thus the prevention of alcohol abuse may
focus on strategies to educate people about “sensible ”drinking. On the
other hand, strategies for combating tobacco or hard drug abuse should focus on
complete on complete abstinence.
How
to Identify Persons with Drug Dependence:
1)
Loss of interest in daily
Routine Activities
2)
Loss of appetite and body
weight.
3)
Unsteady gait.
4)
Unclear Vision
5)
Slurring of Speech
6)
Nausea, Vomiting and Body
pain
7)
Drowsiness
8)
Acute Anxiety, Depression
9)
Changing mood and Temper
10)
Emotional Detachment
11)
Impaired Memory and Concentration
Responsible
Factors For Drug Dependency And Alcohol
1)
Unemployment
Living away
from home.
2)
Migration to cities
Relaxed parental control
3)
Alienation from family.
Early exposure to drugs
4)
Leaving school early
Broken homes
5)
Large urban environment
Areas
where delinquency is common.
Approaches
to Prevention of Drug Dependency:
Approaches
to prevention of drug dependence should have realistic aims. Eradication of drug
problem in a short time is likely to lead to policies that are unrealistic and
self-discrediting. Changes in culture attitudes and alteration in relevant
aspects of the environment can be brought about only slowly.
Legal
Approach:
The
legal control on the distribution of drugs when effectively applied has been and
remains an important approach in the prevention of drug abuse. Controls may be
designed to impose partial restriction or to make a drug completely unavailable.
Legislation restricting of prohibiting advertisements that directly or
indirectly promote use of tobacco and alcohol has been increasingly common in
recent years. The antismoking measures are suggested:
1)
Prohibition of the sale of tobacco products to minors.
2)
Prohibition of smoking in public places
3)
Restriction on the sale of cigarettes from automatic vending machines
4)
Prohibition of smoking in schools and other places frequented by young
people.
5)
Prohibitions of cigarette advertising at times and in places and ways
calculated to ensure its maximum impact on youth.
6)
Establishment of mandatory public health education on health
consequences of smoking.
Educational
Approach:
Educational
approaches to the prevention of drug use and drug related problems have been
used widely and its result is also good. The educational programs for school
children and public information campaigns on electronic media and other ways of
media. The message should be clear and unambiguous to the intended audience and
come from credible source of information. The message should also provide
specific advice rather than general and as far as possible the information
should be new to the communities and should be capable of provoking discussion
or action. To be effective, such approaches should be regarded as a part of
integrated plan of action involving other strategies. We can also be convincing
the school children by this way:
Smoking
and Drinking before the age of 18 is crime
Ø
Advertisement that show beautiful and
athletic people smoking and drinking are selling a lie.In fact,
those who smoke or drink are much sicker than others look much worse.
Ø
You can have fun and party without drugs
or alcohol. Having a good time means enjoying
friendship and activities without the need to take any substances.
Ø
If you know someone who is smoking or
drinking be a friend and suggest to them they
should stop.
Ø
You will use up all your money on alcohol
or tobacco; imagine what you could do with that
money if you stopped.
Ø
Why do you need a drug to be yourself?
Stop and you will really be yourself.
Community
Approach:
The
non-medical use of drugs individually as well as in its mass appearance involves
a complex interaction of drug, man and his/ her environment, including social,
economic and cultural, political, and other elements of varying character and
strength. The rapid changes taking place at the present time in relations
between individuals groups and nations are also reflected in a rapidly changing
pattern of drug abuse. There should be a strong emphasis on action at the
community level to prevent drug abuse. Initiating preventive interventions in
the community brings preventive action to the level of people’s every day
lives and actions and contributes to emphasis on strengthening primary health
care. Action at the community level is also important since communities often
bear the main burden of dealing with the harmful use of drugs and drug related
problems.
A
popular approach to the prevention of drug abuse is provision of alternative
activities, which may help to prevent drug abuse- e.g. teen centers providing
activities attractive to the adolescents who might otherwise drift in to drug
taking subculture. Such activities include the establishment of groups or
organization interested in athletics, sports, music, public policy.
Treatment:
Treatment cannot
take place unless the individual attends for treatment. He must come to terms
with the possibility of a life without drug taking. Unfortunately, drug takers,
as a rule, have little or no motivation to undergo treatment. Alcoholics tend to
deny that their consumption is abnormal; others openly defend their habits. Long
term treatment is only a medical problem, but needs cooperation of psychologist
and social workers. The steps of treatment include;
a.
Identification of drug addicts and their motivation for medication.
b.
A person needs hospital-based treatment in some cases.
c.
Counseling and follow up based on clinic or hospital or home visit.
d.
Rehabilitation.
Rehabilitation:
The
rehabilitation of former drug user regardless of age, is in most of the cases a
long and difficult process. Relapses are very frequent. Success of the treatment
necessities the adoption of the mature and realistic attitude by the local
community and the avoidance of panic, moral condemnation and discrimination.
Facilities for Vocational training and sometimes the provision of sheltered
workshops and community based rehabilitation approaches are useful in
rehabilitation and help to prevent relapse.
Government
Initiatives
Drug
demand reduction activities have been the Ministry of Health and Family Welfare
and the Ministry of Social Justice and Empowerment, Government of India. The
Ministry of Health lays emphasis on treatment, including community-based
treatment, health educational activities, and human resource development through
training of health personnel in substance abuse management throughout the
country. It established 5 treatment centers in 1988. Seventy-two treatment
centers were initiated at medical colleges and district hospitals. Training
curricula for resource staff have been developed by the Ministry of Health and
Family Welfare. In the early
1990’s,
it was estimated that 1000 medical officers had been trained over 32 courses
across 18 institutions (Ray 1998). The feedback from such evaluation however,
has been the inadequate clinical exposure, inadequacy of adequate resource
material, and inadequate exposure to community-based services. The Ministry of
Social Justice and Empowerment funds more than 341 NGOs throughout the country
for counseling, rehabilitation and aftercare. It also supports public awareness
campaigns, media publicity and community-based action in the area.
Gujarat
is the only state at where alcohol sale is totally prohibited and minors cannot
be sold any tobacco items.
Voluntary
Sector initiatives
for Prevention
The
Ministry of Social Justice and Empowerment fund many of the nongovernmental
organizations working in the area of substance abuse. Their brief has been to
carry out rehabilitation and aftercare, awareness building, and prevention. A
few have carried out successful and innovative approaches for demand reduction
and rehabilitation. The many voluntary originations have started counseling
services to addicted people and also their family members and also conducting
community sensitization programs through Wall painting, Picture shows, Puppet
shows and Street platy etc. Many of them have started School Mental Health
Program. The Voluntary Sector could be effective machinery for Alcohol
prevention the society. We
could also bar owners to insist that customers do not drink and drive home, or
teach them ways of politely but firmly refusing to serve alcohol to someone who
is clearly drunk. Adolescence is
the time when many people first try smoking or drinking. This is the most
important time to provide education on how to avoid smoking and prevent drinking
problems. The some messages we can use in school and colleges. The youngsters
believe that smoking cigarette is a fashion and it would make good impression on
others. We can convince the school students in this way.
The
Fact we can’t ignore.
•
2/3 of patient’s earning spent on alcohol
•
40% of alcoholic patients contribute no money to family
•
Heavy loans
•
Absenteeism, sickness, unemployment
•
Loss of productivity
•
Cost of treatment
•
Costs of material damage
•
Cost of monitoring
•
Cost of treatment
•
Emotional distress to families.
References
:
1.
Where there is no Psychiatrist by Dr. Vikram Patel
2.
A Model Project of NIMHANS on Drug and Alcohol
3.
Prevention and Social
Medicines by Perk and Perk
But
we cannot deny that healthy body needs healthy mind. A person with healthy mind
should be able to think clearly, should be able to solve various problems faced
in life and should enjoy good relation with every one and should feel
spiritually at ease and bring happiness to others in the community. This is
called healthy man. We always say that mind and body are separated; in reality
they are like two side of the coin. We cannot think they are not dependent on
each other. Just as physical body can fall ill, so too can the mind. This is
called mental illness. Mental illness is not a personal failure. It does not
happen only to other people. We people could not openly speak about cancer few
years ago and at present we feel shame to share information about the HIV/ADIS
patients. The barriers are gradually broken down. The people with mental illness
are at same position and excluded.
Mental
illness includes broad range of problems. For most people mental illness thought
of as an illness associated with severe behavioral disturbances such as
violence, agitation and sexually inappropriate. The entire family is suffered
along with these people. The burden of mental illness is increased day by day,
450 million people are suffering from mental illness in the world, and every
year 20,000 people are added in “SCHIZOPHRENIA”
in Gujarat. It is estimated that depression is second ranked disabling diseases
in 2020. The Mental Health Act, 1987 enables to provide good and effective
treatment to the “Persons With Mental
Illness” in the country; even these stigmatized people are restricted to
avail treatment at some extent. These hospitals are stigmatized as “Ganda
Ni Hospital”.
The need is aroused that recognition should be given; special programs and
policies should be framed for the mental illness. The most controversial
question is “Persons With Disability
Act, 95” included mental illness as disability, on other side it seems as
illness. The question is if it is considered as illness at that time the
treatment comes. The disability never is curable. If it is curable, it cannot be
called disability. So could we say Mental Illness is a Disability?
We need to understand the term of disability. The term of disability is
explained in following way.
If
a person is unable to perform an activity, which he is otherwise expected to
perform because of his illness that is termed as disability.
We need to understand the term of disability in very elaborative way.
Unfavorable
Condition: Conditions that functions as a medium for diseases, accidents or
environmental agents.
Cause:
A
disease, Accidents or Environmental agents.
Impairment:
Any loss or abnormality of psychological, physiological or anatomical
structure or function, which may result from a disease, accident, or other
genetic or environmental agents.
Disability:
Any restriction or lack of ability to perform an activity to
perform an activity in the manner or within the range considered normal for a
human being.
Handicap:
A disadvantage for a given individual that limits or prevents the fulfillment
of a role that is normal (depending on age, sex, and social and cultural
factors) for that individual.
How
can be said mental illness as a Disability?
Unfavorable
Condition: Loss of the job, financial constraint, anxiety about the family
members
Cause:
Chemical disturbances in brain
Impairment:
Impairment
in mental functioning and social relationship.
Disability:
Inability in doing self-care activities, maintaining social relationship
enable to perform his/ her social roles.
Handicap:
A
man feels neglected, disrespected, socially isolated and considers himself an
economic burden of his family.
The
psychiatric disorders do not cause any physical disabilities, but they
restricted the person from doing many activities, which he is otherwise
supposed. The mental illness is not fully curable but it is controllable. The
Disability in psychiatric illness can be dynamic. It can depend on the
person’s phase of illness, the treatment status and social support he/she has.
Mainly the psychiatric disability is called social disability because a person
has to perform certain social roles in the society.
1. Self
care : A person with mental illness may not look after his own self care. He
may not maintain good hygiene, even he is not bother about his
appearance.
2. Interpersonal
Relationship: Mentally ill person is not able to develop new relationship or
maintain healthy existing relationships with others even not with his family
members. His way of relating with people may be distorted and deficient.
3. Family:
Mentally ill person is not able to maintain healthy atmosphere at home as
before. He may be totally withdrawn or hostile towards other family members.
He is also economically dependent on family members and not able to bear
financial responsibility of the family. On other side he makes unnecessary
expenses. He may not be able to fulfill the emotional and sexual need. The
server mentally ill persons may not able to take major decisions and family
also not involving in decision-making.
4. Social:
The mentally ill persons is not able to participate in social activities like
festivals, marriages and occasions. He may avoid them actively. Some times he
may not be aware of the social events happening around him in his village,
state or the country. He will not be involved in any recreational or religious
activities.
5. Occupational:
due to the mental illness, a person may remain absent very frequently. He may
not be able to concentrate in his work for long time. His quality work is also
degraded. Sometimes he may lost the job or loss incurred in business.
Conclusion:
The
PWD Act 1995 has already included mental illness as disability. The Indian
Disability Evaluation and Assessment Scale(IDEAS) have been developed for
disability assessment of persons with mental illness. The Persons with Mental
illness are eligible to avail all the Rights and Social services as per
mentioned in PWD ACT1995. These people are no longer to stand in queue and wait
for turn. The Social Defense Department of Govt. of Gujarat has included Mental
illness in social security benefits in new G.R. recently. The new format
includes mental illness with other disability.
Article written by : Bharat Joshi (Project Coordinator)
References:
-
WHO
Health Report 2004
-
Towards
Comprehensive Community Based Rehabilitation Programs By Geert Vanneste
-
Foundations
and Techniques in Psychiatric Rehabilitation By: T. Murli, B. Sudarsan,
K.P. Shivraman Nair, A.B. Taly
- Fundamentals
of Mental Health Education by Shashi Prabha Sharma
“
Collectives of voluntary associating persons who share a common problem; they
are self –governing, rely on the experimental knowledge of their members as
the group’s source of authority, provide mutual assistance which is at least
emotional support and do not charge fees (Borkman). The other synonym is support
group, mutual help group. The group is in demographic nature and involves self
governance, equal rights within group process, leadership at the pleasure of the
group, free expression of thought and feeling, independence from external rule.
The
self-help group members are key role players in any rehabilitation program. But
the scenario is totally different in mental health. In other rehabilitation
program, the self-help group members might be direct stakeholders or directly
affected. In mental health, the family members or carers are self-help group
members who are stake holders and directly affected. The sickness of any family
member might disturb the routine of every day life. The physically ill people
are deeply involved in getting well and setting back into previous role.
The
situation is totally different in mental health, a person is not ready to accept
he is mentally ill and consequently he denies the treatment. His behavior not
only disturbs his family, the community is also disturbed as well. The carers
are treated with hostility instead of gratitude. The carers have lots of burden
like financial problems, disruption to household and social functioning and
feelings of anguish; guilt is also associated with it. They also face lack of
information about disorder and its medication, lack of resources and treatment
facility. These are very real obstacles to make rehabilitation process smooth.
The carers can get good services and information through self-help group. This
group could be formed in different ways; one group is of people who have
recovered from mental illness and the other could be group of family
members. It is very difficult to form groups of patients who have recovered. The
family members, friend or relatives are survivors could be organized for their
own benefits.
Benefits
that can be derived from participating in support groups are directly related to
the needs of the family members. The active participation in self-help group
activities is more beneficial to the family members to overcome the problems and
to gain more knowledge and information. While, they are working in a group,
their problem solving capacity is also increased, they get practical advice
Suggestions are also provided, they find new
ways to think, to feel and deal with life experiences and their attitude is
totally changed. This also helps family members to decrease negative thoughts,
emotions. The group is involved in many activities at several levels.
The
first and foremost activity of the self help group member is to provide an
emotional support to the family members. This activity of the self help group is
based on the first and immediate need of the family members. The family members
need relief from their emotional disturbance. Once, they join the group the
“WE” feeling is generated. This is one kind of mutual support to family
members, which would be helpful to
