Making Mental Health a Priority - Tele MANAS

 

Sathiyakala. K1, Danasu. R2

1Nursing Tutor, College of Nursing, AIIMS, Patna.

2Professor cum Principal, College of Nursing, AIIMS, Mangalagiri.

*Corresponding Author Email: sathiyakala.v@gmail.com

 

ABSTRACT:

Worldwide COVID-19 pandemic had led to a prolonged stressful condition and bring about more psychological and social effects in the community. This condition is commonly seen in each group and more commonly it has affected in children, older peoples and even the health workers who are exposed and likely to bring about the condition of stress, anxiety, uneasiness and depression. These prolonged psychosocial issues may result in mental health problems and long-term consequence on the mental functioning and coping capacities of family members.1 India has a huge burden due to mental health problems, with one in every seventh person estimated to be suffering from a clinically diagnosable mental disorder. Taking into account the impact of the Covid-19 pandemic on the psychological and emotional health of citizens, the Union government has announced a ‘National Tele Mental Health Programme’ in 2022.  With the aim to setup the T-MANAS (Tele-Mental Health Assistance and Networking Across States) initiative as a 24 x 7 facility in all states and Union territories. Its vision is to provide immediate mental health interventions for people in mental distress, particularly those in remote and under served areas of the country.

 

KEYWORDS: Tele MANAS, Mental Health, Pandemic, Counselling, Counsellor.

 

 


INTRODUCTION:

Worldwide COVID-19 pandemic had led to a prolonged stressful condition and bring about more psychological and social effects in the community. This condition is commonly seen in each group and more commonly it has affected in children, older peoples and even the health workers who are exposed and likely to bring about the condition of stress, anxiety, uneasiness and depression. These prolonged psychosocial issues may result in mental health problems and long-term consequence on the mental functioning and coping capacities of family members.1

 

Status of Mental Health in India Mental health has today become a much talked about subject. The prominence it has gained in the last few months stands strongly supported given the statistics of mental health related problems in our country.

 

According to an ANI report, the importance of estimates of mental health related problems place their prevalence rates at 5 percent of the population, which amounts to roughly 50 million individuals in our country. Mental health contributes to 11.6 percent of the global burden of disease and the fact is that only 14.52 percent of those afflicted receive treatment which approximates to 7.26 million. Despite this there is a 300 percent shortage of experts in India2

 

Fear, worry, and stress are normal responses to perceived or real threats, and at times when we are faced with uncertainty or the unknown. So, it is normal and understandable that people are experiencing fear in the context of the COVID-19 pandemic. Every age group is processing the events in a different way.3

 

Globally, an estimated 264 million people suffer from depression, one of the leading causes of disability, with many of these people also suffering from symptoms of anxiety. A recent WHO-led study estimates that depression and anxiety disorders cost the global economy US$ 1 trillion each year in lost productivity. Unemployment is a well-recognized risk factor for mental health problems, while returning to, or getting work is protective. A negative working environment may lead to physical and mental health problems, harmful use of substances or alcohol, absenteeism and lost productivity. Workplaces that promote mental health and support people with mental disorders are more likely to reduce absenteeism, increase productivity and benefit from associated economic gains.4

 

The study findings concluded that there is a significant impact of Covid-19 on Mental Health of Employees. Employees faced mild to severe symptoms of depression, anxiety and distress due to prolonged working hours, change in work dynamics, isolation etc. The impact was majorly seen on employees working in healthcare sector. The impact of Mental Health of employees also affected the work culture in organizations to some extent. There was a seen a shift in work culture dynamics due to work from home and virtual mode of communication during Covid-19 pandemic.5

 

The studyresults reveal that the highest percentage 62% of the female adolescents have good mental health whereas the 32% have moderate and 1% have below average mental health.6

 

The review study conceptualizes the pandemic spread of COVID-19 and reviews its effect in the workplace as companies reorganize and establish new patterns of operations in response the COVID-19 virus and to ensure precautionary measure against further spread of the disease.7

 

The study findings reveals that, severity levels of depression and anxiety, stressors related to the pandemic, and barriers students experienced in handling the pandemic-related stress have increased due to many factors such as social isolation, own health and the health of loved ones, financial difficulties, suicidal thoughts, depressive thoughts, class workload, changes in living environment, eating patterns and sleeping habits.8

 

Positive Attitude and Self Esteem are crucial to mental and social well-being. They influences aspirations, personal goals and interaction with others. This paper stresses the importance of positive attitude and self-esteem as a protective factor and a non-specific risk factor in physical and mental health. Evidence are presented illustrating that positive attitude and self-esteem can lead to better health and social behavior, and that poor self-esteem is associated with a broad range of mental disorders and social problems, both internalizing problems (e.g. depression, suicidal tendencies, eating disorders and anxiety) and externalizing problems (e.g. violence and substance abuse). The researcher discuss the dynamics of positive attitude and self esteem in these relations. Focusing on positive attitude and self esteem are considered a core element of mental health promotion and a fruitful basis for a broad-spectrum approach.9

 

The Most Common Causes for depression among teenagers are anxiety caused by stress at work, relationships, financial problems or other sources, depression, physical illness that prevents an individual from leaving the home and boredom and feeling like there is nothing else to do.10

 

India comprises around 18% of the global population and significantly contributes to the global burden of mental disorders. In 2019, mental disorders were the second leading cause of years lived with disability (YLDs), and self-harm and violence were the tenth leading cause of death. Evidence suggests that suicide deaths increased by 40% from 1990 to 2016 making it the third leading cause of death in several Indian states. Recent national level studies have highlighted that 15% of the adult population in India have mental health issues requiring intervention and a wide treatment gap of 70-92% exists for a range of mental disorders.11With one in seven Indians suffering from mental health issues, (India State-Level Disease Burden Initiative Mental Disorders Collaborators, 2020,) it is of urgent importance that more robust mental health infrastructure be put in place. Launching a digital platform dedicated to psychiatric concerns would require considerable governmental commitment to attract, develop, and keep a sufficient pool of human resources for high quality services.12

 

The Government of India’s (GoI) recent mental health initiatives include the National Mental Health Policy, 2014, that envisages the provision of universal access to mental health care and the National Mental Health Policy, 2017, that recognises mental health as one of the policy thrust areas. The new Mental Healthcare Act, 2017, enshrines access to mental health as a statutory right and an entitlement, including its provision through primary healthcare.11,13


The Government of India launched the National Mental Health Programme (NMHP) in 1982, in response to the heavy burden of mental illness and critical need of mental health care infrastructure in the community.11,13

 

Development of Tele MANAS services:

The District Mental Health Program (DMHP) was appended to the NMHP in 1996 to overcome the shortcomings of the programme and transitioned the districts into administrative and implementation units for NMHP. The DMHP envisages extending mental health services through the existing healthcare infrastructure and human resources at the community level. With regard to Mental Health services, providing in-person healthcare is challenging, particularly given the large geographical distances and limited resources. Therefore, the Government of India has implemented the use of telemedicine through eSanjeevani in the Ayushman Bharat Health and Wellness Centres (AB-HWCs) that saves the cost and effort, especially of rural patients, as they need not travel long distances for obtaining consultation and treatment.11,13

 

Mainstreaming telemedicine in the Indian health system has minimized inequity and barriers to access. The large number of daily consultations on eSanjeevani are a testament to this fact. Advocating the use of digital tools for improving the efficiency and outcome of the healthcare system, particularly in the domain of mental health care, the National Tele Mental Health Programme, Tele Mental Health Assistance and Networking Across States (Tele MANAS) was announced in the Union Budget 2022. The apex institutions (NIMHANS, IIIT-B, NHSRC), regional co-ordinatingcentres and mentoring institutions will be working closely with the states/UTs in all these activities by providing support for technical issues, collaborative consultations, capacity building, implementation, service provision, linkages, monitoring and evaluation, research, innovations etc.11,13

 

Aim and Objectives:

To provide universal access to equitable, accessible, affordable and quality mental health care through 24X7 tele-mental health services as a digital component of the National Mental Health Programme (NMHP) across all Indian States and UTs with assured linkages.

·       To exponentially scale up the reach of mental health services to anybody who reaches out, across India, any time, by setting up a 24x7 tele-mental health facility in each of the States and IJTs of the country

·       To implement a full-fledged mental health-service network that, in addition to counselling, provides integrated medical and psychosocial interventions including video consultations with mental health specialists, e-prescriptions, follow-up services and linkages to in-person services.

·       To extend services to vulnerable groups of the population and difficult to reach populations11,13

 

Organizational Structure:

In addition to the steering committees, the Apex Nodal Institute for mentoring and monitoring of Tele MANAS will be NIMHANS. Five regional coordinating centers: NIMHANS, Bengaluru; LGBRIMH, Tezpur; CIP, Ranchi; IHBAS, Delhi; and PGIMER, Chandigarh will assist NIMHANS in co-ordination with the 23 mentoring Institutions and 51 State/UT cells

 

 

The Government of India (GoI) in its Union Budget 2022, announced the National Tele Mental Health Programme of India, Tele Mental Health Assistance and Networking Across States (Tele MANAS) and entrusted the Ministry of Health and Family Welfare (MoHFW) to guide its overall implementation.

 

Consequently, the MoHFW formed a National Technical Advisory Group (NTAG) and three technical advisory sub-committees (Mental Health Service Delivery, Information Technology Architecture and Health Systems) to achieve specific goals and objectives of Tele MANAS.11,13

 

Functions of National Technical Advisory Group (NTAG):

·       Steer the development of the programme, strategy, scope, and activities related to tele mental health Programme at the national level.

·       Review the deliverables and Identify the future priorities, opportunities, and challenges and to suggest appropriate action.

·       Provide advice to the apex nodal center regarding its tele mental health Programmeactivities.Periodically review the emerging evidence in the area and provide course corrections.

·       Review activities and decisions of the technical advisory sub-committees and Advise on process and outcome research indicators.11,13

 

Organizing system:

·       Tele MANAS will be organized as a two-tier system. Tier 1 will comprise the State Tele MANAS cells, which includes trained counsellors and mental health specialists. Tier 2 will comprise specialists at District Mental Health Programme (DMHP)/Medical College resources for physical consultation and/or eSanjeevani for audio visual consultation.

 

Tele MANAS Calling Mechanism:

·       The public can access the Tele MANAS helpline by dialing tollfree number or short code. This call will be an IVRS based audio calling only, with a timely auto-call back approach. Through the automated callback service, the caller will first be attended to by a trained counsellor.

·       Based on the level of care required, the counsellor will either provide the care needed within their capabilities or refer the caller for specialist care.

·       If the caller requires specialized care, the call will be handled by a mental health specialist (clinical psychologist, psychiatric social worker, psychiatric nurse, or a psychiatrist). This level of service will contain both audio as well as video-based options.

·       In case the caller requires urgent in-person intervention/complex evaluations and management, they will be referred to the nearest in-person service for physical consultation and/or an audio-visual consultation with a specialist will be arranged through eSanjeevani. These centers will range from Health and Wellness Centre (HWCs) to tertiary care centers as part of the DMHP.11,13

 

Tele-mental health services implantation at the national level, care must be taken to adapt these services to the local cultural context of different regions (e.g., operation capabilities in the local language and delivering interventions in a culturally sensitive way). There is a need to incorporate helpful indigenous treatment modalities such as yoga or mediation along with the delivery of psychoeducation about the bio-psycho-social model of mental health in a culturally sensitive manner. Moreover, it is not clear if and how the provision to provide appropriate psychotropic medications would be made available to people seeking care through tele-mental helplines under the NTMHP. Further, a significant proportion of the population in India has poor digital literacy and lack access to smartphones or quality internet connection, and are also often at greater risk of experiencing poor mental health and mental disorders.14

Tele-mental health services needs to be planned to promote equitable access to these services; for example, having a text messaging line to seek immediate intervention or schedule a call-back/appointment from the tele-mental health center based on initial basic information provided in the text message. There is significant stigma attached to mental health, and people often do not seek or are hesitant in seeking treatment due to the fear of this. Thus, assuring the patient of privacy and health-related data security is of critical importance in ensuring successful adoption of tele-mental health services by people. There is a need to have training programs to sensitize mental health professionals about the technological, legal, ethical, and clinical aspects related to the tele-mental health practice. In addition, there is a need to develop quality control mechanisms and systems for regular monitoring and evaluation of tele-mental health service delivery as well as assessment of mental health-related outcomes among its beneficiaries.14

 

Tele-mental health services should supplement the existing traditional mental health care system (NMHP/DMHP) with digital technology-delivered interventions complementing the in-person care received by the person experiencing mental health problems15

 

The study highlighted the challenges and opportunities for improving access to mental health services in India. It emphasizes the need to combat stigma, enhance awareness, and address barriers that prevent individuals from seeking and utilizing mental health services effectively. Collaborative efforts involving healthcare providers, policymakers, community organizations, and the general public are crucial for creating a supportive environment that promotes mental well-being and encourages individuals to access available services, including TeleMANAS12

 

CONCLUSION:

Since its launch on 4th November, 2022, the various telemanascentre has received more than 1,00,000 calls as people with mental illness from various states and UTs are seeking professional help.

 

These numbers convey the enormous demand and needs but also show that TELE Manas is acceptable to people and they are initiating contact with mental health providers. The current step is expected to ensure cost-and-time-effective and comprehensive services for the poorly served population of the region and strengthening mental health services in our country

 

REFERENCES:

1.      Bindu Nair, Jaya Mathew. Mental health and psychosocial wellbeing during Covid-19. International Journal of Nursing Education and Research. 2021; 9(4):488-0

2.      Nishant Kumar. The Mental Healthcare Act, 2017: A Radical Step towards Sound Mental Health in India. Research J. Humanities and Social Sciences. 2017; 8(3): 306-310.

3.      VishwanathBiradar, PreranaDalvi. Impact of COVID19 on Child Health: Parents Perspective. Int. J. Nur. Edu. and Research. 2020; 8(4): 463-467

4.      Lalitha. R. Mental Health in Work Place. Asian J. Nursing Education and Research. 2020; 10(3): 384-387.

5.      RajeshwariNarendran, MehvashBaluch. A Literature Review on effects of Covid-19 on Mental Health of Employees and its impact on Organizational Work Culture. Asian Journal of Management. 2023; 14(2): 133-6

6.      Nagesh V A, David A Kola. A Study to determine the Impact of Social networking Sites on Mental Health of female Adolescents in Smpu College, Dharwad. Int. J. Nur. Edu. and Research. 2018; 6(2): 210-213

7.      Sheila Menon, Vidya Bhagat. A Review Study on the impact of COVID-19 on Mental Health in the workplace and on working people. Research Journal of Pharmacy and Technology. 2021; 14(12): 6725-1.

8.      U.S. MahadevaRao, Thant Zin, Suganya M, Jivaneswaran A/L Kanasan, Afnan Anaqi Bin Afriezul, SitiHajarAmirah Binti Roslan, Nur Syakirah Bt Che Seman, Maizun Binti Mohamad Ali Khan. Impact of Covid-19 on Mental Health among Medical Students. Research Journal of Pharmacy and Technology. 2023; 16(2):809-0.

9.      Digpal Singh Chundawat. Positive Attitude and Self- Esteem: Key to Mental Health. Asian J. Nursing Education and Research. 2018; 8(4): 555-558.

10.   Senthil Thirusangu. Cyber Disorders on Adolescence Depression and Suicide Mental Health Concern for the new Millennium. Int. J. of Advances in Nur. Management. 2019; 7(3):281-284.

11.   https://main.mohfw. gov.in/, https://telemanas.mohfw.gov.in

https://nhm.gov.in/

12.   Ashrajdeep Singh Assessment of Effective Uptake of Tele manas Service in India EPRA International Journal of Multidisciplinary Research.  2023; 9(7): 20-26

13.   https://telemanas.mohfw.gov.in/assets/img/AboutUs/flowchart.png

14.   Singh S, Sagar R. Tele mental health helplines during the COVID-19 pandemic: Do we need guidelines? Asian J Psychiatr. 2022; 67: 102916.  

15.   Rajesh sagar et al National Tele-Mental Health Program in India: A step towards mental health care for all? Indian J Psychiatry. 2022; 64(2): 117–119.

 

 

 

 

Received on 08.08.2023         Modified on 13.11.2023

Accepted on 16.01.2024      ©AandV Publications All right reserved

Asian J. Nursing Education and Research. 2024; 14(1):73-76.

DOI: 10.52711/2349-2996.2024.00015