Mental health care for all: let’s make it a reality

Mental health care for all: let’s make it a reality
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arifmaghribi@yahoo.com

World Mental Health day is observed on October 10 every year. This year’s theme is “Mental health care for all: let’s make it a reality”. In order to make mental health services available to all, we have to remove the stigma attached with it due to myths.

Young or old mostly hesitate to visit a counselor or psychiatrist even in 2021, young boys and girls do not visit them as somebody might see them and how will they get married in future and old think they will be labeled as so called “ mad “.

While fact remains, the majority of people who need help have depression, anxiety, or PTSD [ Post traumatic stress disorder] . We should treat mental health disorders just like hypothyroidism, diabetes or hypertension, in fact if patients comply with advice of counselors and psychiatrists as compared to diabetes they will need medicine for some time while in diabetes, hypertension it is for life time. In order to remove stigma and make people aware, I am giving a simple classification of psychiatric disorders and even if you are not a doctor, you will understand it.

Classification of psychiatric disorders.

Neurotic= When contact of an individual with reality is not broken like Anxiety, OCD, PTSD, Conversion disorders.

Psychotic=When contact of an individual with reality is broken like Schizophrenia, Schizotypal disorder.

Lot of literature is available on depression, anxiety, and PTSD, but today let us simplify psychotic disorders usually present only in two to three percent of the general population. But let us talk of depression first in simple words and then Schizophrenia.

According to International Classification of diseases (ICD), depression can be mild, moderate and severe.

MAJOR SYMPTOMS.

Depressed mood.

Loss of interest & enjoyment.

Reduced energy leading to increased fatigue and less active life. Somatic depression is common in Kashmir. These patients take a lot of painkillers and vitamins without any improvement.

MINOR SYMPTOMS:

Reduced concentration and attention

Reduced self-esteem and self-confidence

Ideas of guilt and unworthiness

Pessimistic view of future

Disturbed sleep

Disturbed appetite

For diagnosis, a duration of two weeks is required.

Now let us do some mathematics.

MILD DEPRESSION = Two MAJOR SYMPTOMS and 2 OF MINOR. 2+2=4

MODERATE= 2 FROM MAJOR AND 4 FROM MINOR SYMPTOMS. 2+4=6

SEVERE= 3 FROM MAJOR AND MORE THAN 5 FROM MINOR SYMPTOMS. 3+5=8.

Now let us talk of Schizophrenia

Major symptoms of Schizophrenia or most psychotic disorders, remember their prevalence in any population is low.

Delusions: They are fixed false beliefs far beyond credibility that may be bizarre [for example ‘my right eye is a computer that controls the world' or non bizarre [detectives of my city are after me] and these remain unmodified despite clear evidence to the contrary. Patients believe that they were born to spread a particular religion or cult; they also wrongly think other persons can hear silent thoughts of patient.Some patients believe that their wife/husband is not faithful without any sort of evidence or believe family members or neighbours’ want to poison them.

HALLUCINATIONS: Even if a patient's family and patient are in a single room, patients usually complain of hearing strange voices or seeing strange things when others do not hear or see it. Most common are auditory (voices) which the patient perceives as coming from outside the patient's head. Many times in cases of untreated patients these voices ask the patient to walk on water and many die of accidental suicides. In visual hallucinations patients can see angels, fairies, or ghosts.

Other symptoms include

Loosening of associations: Patients' ideas are disconnected, jump from topic to unconnected topic and their speech is incoherent.

Over inclusiveness: Patients continually may disrupt the flow of their thoughts by including irrelevant information. Neologisms: Patients coin new words which may have symbolic meaning for them.

Blocking: Speech is halted (often in mid sentence) and then picked up a moments or minutes later, usually at another place. These patients have a short attention span. Echolalia= Patients repeat words or phrases in musical or singing fashion without an apparent effort to communicate.

To be considered schizophrenic it is of utmost importance to visit a psychiatrist near you, only he can diagnose the disorder, also the following criteria is important.

Have at least 6 months of sufficiently deteriorated occupational, interpersonal and self-supportive functioning, have been actively psychotic in a characteristic fashion during at least part of that period and must not be able to account for the symptoms by the presence of a schizoaffective or major mood disorder, autism or an organic condition.

It’s very important to mention here contrary to popular belief such patients usually are not violent towards doctors, although due to lack of insight some of them will not visit any doctor or counselor stating that they are healthy and do not need to visit any health care provider.

It’s pertinent to say use of cannabis and genetic factors play a significant role in development of Schizophrenia.

Treatment

Medical treatment: Do not stop or start treatment without doctor’s advice.

Family counseling and gradual rehabilitation of patients in the workplace ensures great results.

As can be seen most patients do not have these symptoms and have depression or anxiety, they need to seek help. And remember to visit any government hospital near you for treatment as they have trained as well as qualified counselors or psychiatrists.

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