ERAWADI FIRE, Mental Health Awareness day on 6th august

   It was an eventful week with Erawady tragedy. One day two Indian express reporters Ms. Sreelatha Menon and Ms.Sanchitha sharma wanted to talk to me about PWDEA act 1995 and The National trust act 1998 as they are going to interview  Ms.Menaka Gandhi who was heading the Social justice Ministry which handles these two acts.They have already interviewed the Union Health Minister Shri CP Thakur who was sympathetic to the cause of mentally ill and also inclusion of disabled due to Mental illness in the National trust act. They not only talked to me at length but also saw the condition of my daughter and was convinced about the inclusion of psychosocial disabled in the National trust act 1998 when they found out that my daughter has been receiving treatment from AIIMS,NIMHANS, and CGHS Delhi and various other private Psychiatrists ,Psychologists,God men  for the last 15 years by the year  2001. Their interview of Ms.Menaka Gandhi should be an eyeopener for all as I find no change in the attitude of the Ministry of Social Justice even today. The link to that interview is below.
  Ms.Menaka Gandhi's Op ed in Indian express 2001
  The best coverage about that incident came in the Frontline magazine of that time with a good background material.The link is below
   Erawady/Frontline article
  I want to post the Supreme court order of Feb 2002 issued in a nutshell on that case(No W.P.(C) NO 334 OF 2001)in which it took suo moto action.
  1. District wise survey of all registered and unregistered bodies purporting to offer mental health care. Licence to be granted or refused depending on whether minimum prescribed standards are fulfilled or not. Process of survey and license must be completed within 2 months of the order and comprehensive compliance report within 3 months. Further the compliance report must state that no mentally challenged person is chained in any part of the state. 2.The Chief Secy. shall be the nodal agency to coordinate implementation of MHA, The Persons with Disabilities Act 1995, National Trust for Welfare of Persons with Autism, Cerebral Palsy, Mental Retardation and Multiple Disabilities Act 1999. 3.The Union of India shall file an affidavit within one month of the Policy of Central Govt. towards setting up at least one Central Govt. run mental hospital in each state and U.T. and State Govt. if not even one State run exists, to give a definite time schedule for establishment of the same. 4.Govt. shall undertake comprehensive awareness campaign with special rural focus to educate people as to provisions of law relating to mental health. 5. Every State shall file an affidavit stating whether State MHA exists and details thereof.
  It again issued another order on 12th April 2002.The contents in nut shell are
  1.Every State shall undertake a Comprehensive Need Assessment Survey of estimated availability of Mental Health Resource Personnel, Type of Mental Health Delivery System in both public and private sector, coupled with an estimate of Mental Health Services that would be required for the population of the state and incidence of mental illness.


2. The Chief Secy shall state whether any minimum standards have been prescribed for licensing of Mental Health Institutions, whether these institutions private or run by the state meet such minimum / prescribed standards as on date of passing the order and steps taken for compliance.

3. How many unregistered bodies offer mental health care exist in the state and whether any of them comply with minimum standards and steps to close down the same. Whether any mentally challenged person is found chained. The Need Assessment Survey shall be submitted by 1st. July to Health Secy and filed in court by 15th. July.

4. Union of India is directed to frame a policy and initiate steps for establishment of at least one Central Govt. run Mental Hospital. Also the UOI was asked to examine the feasibility of formulating uniform rules regarding standard of services in both public and private sector. It also asked UOI to constitute a committee to give recommendations on care of abandoned mentally challenged persons. It also asked UOI to frame norms for NGO's to ensure that the services run by them are supervised by qualified / trained persons.

5. State Govts. are also directed to frame policy and initiate steps for establishment of at least one State run Mental Health Hospital. Pertinently, it calls for establishment of an exclusive full fledged hospital and does not include a psychiatric ward in medical college or Govt. run hospital.

6.Legal Aid: S.C directed that two members of the Legal Aid Board of each state be appointed to make monthly visits to such institutions to enquire whether further treatment is required and assist in discharge.

7. Rights: Patients and their guardians shall be explained their rights by a team of 2 members of the Legal Aid and a Judicial officer. Also formation of a Board of Visitors (Sec 37 -inspection of hospital). Besides the stated membership of the board in Sec 37, additionally, The Additional District Judge/ CJM and or President of the Bar Association of that area AND State Disability Commissioner or his or her nominee.

8. A scheme for rehabilitation process like a quarter way home be envisaged.

  The UOI had been directed by the S.C. to file an affidavit on four issues viz. Frame policy and initiate steps to form one mental hospital in each state, examine feasibility of formulating uniform rules for private and public sector and frame norms for NGO's, constitute committee to look into issues of care of abandoned mentally ill and collate information of all states regarding Need Assessment Survey.


   UOI has filed affidavit stating 1. Establishing New Mental Health Hospitals : The S.C. may consider reviewing it's directions for establishing mental health hospitals in each state by the Central Govt as such a step will run counter to the current scientific thinking among mental health professionals the world over, including India (UNCRPD is a direct result of this thinking). 2. Uniform rules for public and private sector mental health institutions and norms for NGO's working in the field of mental health. The affidavit concedes that the Rules are equally applicable to the Govt. and non Govt. sectors. In order to formulate norms for NGO, govt is setting up an expert group to examine and submit it's report within a period of six months of it's constitution. 3. Care of mentally ill persons who have no immediate relatives: A committee has already been set up and the recommendations are being examined and will be placed before the S.C. in due course. 4. Conclusions on Need Assessment Survey reports Distribution of mental health services between and within states is uneven, there is major shortage of trained manpower in all categories, deficiencies in infrastructure clinical and rehabilitative services. It has suggested three corrective ways a) Reduce and minimize hospitalization to a max of 30 days, involve families in patient care b) Prolonged hospitalization is counter productive c) community based care is a cost effective option. It also suggests that in service health personnel be trained in short term training programs at reputed institutions.
  I asked Col Goel (rtd)who was Mental health Advisor in the Union Health Ministry at the time of Erawady about this affidavit and i quote him below.
   Date: Monday, 26 July, 2010, 5:18 AM


""Dear Capt Jahanan,



Thanks. The counter affidavit referred to by you had been filed on behalf of the Union of India and you may direct your queries/concerns to the nodal Ministry, the Ministry of Health & FW. I imagine the Hon'ble Supreme Court must have taken into considerations all affidavits and other material filed by the IPS, IAPP and other stake-holders while arriving at its decision, assuming that the final judgement of the Hon'ble Court in this matter has been handed down. I had relinquished my assignment in Nirman Bhawan in Oct 2005, and have been away from the country since. It will be, therefore, inappropriate on my part to comment on the points raised by you mainly, it appears, on the basis of Dr Nagpal's letter written almost 8 years ago, in Nov 2002. I would, however, like to point out that you appear to have equated the Hon'ble Supreme Court's interim direction regarding "...the Policy of Central Govt. towards setting up atleast one Central Govt. run mental hospital in each state and U.T. and State Govt. if not even one State run exists,..." with 'NIMHANS type institution in every state capital'.



Regards,
D S Goel

  ERAWADY HAPPENED IN 2001.SUPREME COURT OF INDIA WHICH NORMALLY FUNCTIONS AS THE DISABILITY MINISTRY FOR ORDINARY CITIZENS LIKE US  HAS PASSED ITS ORDERS DURING 2002.
   BUT STILL THE DISABLED DUE TO MENTAL ILLNESS ARE TO BE INCLUDED IN THE NATIONAL TRUST ACT 1998.NEITHER REHABILITATION COUNCIL TRAIN ANY REHABILITATION PROFESSIONALS TO LOOK AFTER DISABLED DUE TO MENTAL ILLNESS.
OF COURSE A HOSPITAL LIKE NIMHANS OR AIIMS IN EVERY STATE IS A DISTANT DREAM AS THE PRIVATE SECTOR HOSPITALS HAVE STIFLED UNION HEALTH MINISTRY IN SPITE OF INCREASE IN THE MENTAL HEALTH BUDGET WHICH IS NORMALLY SPENT ON SEMINARS FOR VISITING PROFESSIONALS OR FOR INDIAN PROFESSIONALS ATTENDING SEMINARS IN FOREIGN COUNTRIES.DISTRICT MENTAL HEALTH PROGRAMME DOES NOT COVER ALL DISTRICTS and UNCRPD IS CITED FOR HOME BASED TREATMENT.UNCRPD IN FACT DOES NOT AFFECT THE WEALTHY WHO KEEP THEIR WARD IN POSH PRIVATE SECTOR HOSPITALS INDEFINITELY OR TAKE THEM TO SWITZERLAND
  MENTAL HEALTH BUDGET IS RUPEES 987 CRORES FOR A POPULATION OF 1OO CRORE PEOPLE WHILE THE SAME UNION OF INDIA SPENDS RUPEES 40,000 CRORES FOR COMMONWEALTH GAMES AND OUR BILLIONARE MUKESH AMBANI SPENDS HIS OWN MONEY OF RUPEES 3000 CRORES FOR HIS PERSONAL HOME.ANOTHER BILLIONAIRE SPENDS 1000 CRORES IN HIS F1 SPORTS PURSUIT.
   Union of India has NOT even bothered to consult family or user representatives before filing its affidavit while it has consulted 3000 member Indian Psychiatric society.So as THE 10th anniversary of 6th august approaches i implore users and carers of India to ponder deeply ABOUT ERAWADI on National Mental health Awareness day.

A Mother should know Child development issues

Subject: Article on developmental issues in children

Main Point: Knowledge for mother about a child's development and
early detection & management of any dev delay.

Category of Topic: Mentally-Challenged

Message: WHAT EVERY MOTHER SHOULD KNOW


Was my baby healthy at birth?"Dear Mom, you brought me into this new land, don't you want to know how
I'm feeling?" this is what the newborn baby seems to be saying
imploringly.

Sure, the new mother should be abreast of her baby's condition:

* What's his birth weight?
* Is he premature?
* Did he cry after birth?
* Is he feeding properly?
* Is he sick?
* Does he have any abnormality?
* Does he need any special treatment?

During the baby's stay in the hospital it is preferred that the mother
be constantly involved in the baby care. This early mother-child bonding
is the 1st step of early intervention to support normal development.



Is my child developing normally?
This is a question that comes to every mother's mind as she fondly
cradles her baby. But unfortunately, very few have a clear concept of
the developmental milestones and we professionals fail to provide the
required information to them.

In an attempt to make up for this shortfall, I put forth here a simple
list of achievements of your little master, for you mothers to go
through:


At three months of age, most babies:


* turn their heads toward bright colors and lights
* move both eyes in the same direction together
* respond to their mother's voice
* make cooing sounds
* bring their hands together
* wiggle and kick with arms and legs
* lift head when on stomach
* become quiet in response to sound, especially to speech
* smile


At six months of age, most babies:


* follow moving objects with their eyes
* turn toward the source of normal sound
* reach for objects and pick them up
* switch toys from one hand to the other
* play with their toes
* recognize familiar faces
* imitate speech sounds
* respond to soft sounds, especially talking
* roll over


At 12 months of age, most babies:


* get to a sitting position
* pull to a standing position
* stand briefly without support
* crawl
* imitate adults using a cup or telephone
* play peek-a-boo and pat-a-cake
* retrieves a hidden toy
* wave bye-bye
* put objects in a container
* say at least one word
* make "ma-ma" or "da-da" sounds


At 18 months of age, most children:


* like to push and pull objects
* say at least six words
* follow simple directions ("Bring the ball")
* pull off shoes, socks and mittens
* can point to a picture that you name in a book
* feed themselves
* make marks on paper with crayons
* walk without help
* point, make sounds, or try to use words to ask for things
* say "no," shake their head, or push away things they don't want


At two years of age, most children:


* use two-to-three-word sentences
* say about 50 words
* recognize familiar pictures
* kick a ball forward
* feed themselves with a spoon
* demand a lot of your attention
* turn two or three pages together
* like to imitate their parent
* identify hair, eyes, ears, and nose by pointing
* build a tower of four blocks
* show affection


At three years of age, most children:


* throw a ball overhand
* ride a tricycle
* put on their shoes
* open the door
* turn one page at a time
* play with other children for a few minutes
* repeat common rhymes
* use three-to-five-word sentences
* name at least one color correctly



Of all these, 4 achievements must be noted:

* Social smile by 2 months
* Head holding by 4 months
* Sitting alone by 8 months
* Standing alone by 12 months





What is developmental delay?

A developmental delay is any significant lag in a child's physical,
cognitive, behavioral, emotional, or social development, in comparison
with the normal.

A baby's rate of development is determined partly before birth,
primarily as a result of genetic make-up and partly due to various
physical insults during and just after delivery. Normal development is
again quite flexible, occurring over a range of time. Definite deviation
beyond that range in any sector of development is developmental delay.
When a child consistently reaches developmental milestones much later
than other children, a professional consultation is usually warranted.
Few babies develop at a uniform rate; most develop quickly in some areas
and slower in others. Some babies reach most or all developmental
milestones slightly later than "average." As long as a child's
development falls within the broad range that is considered normal,
reaching one or more milestones late is generally not a cause for
concern.

Several developmental areas are of interest: gross motor skills (e.g.,
crawling, walking), fine motor skills (e.g., grasping and manipulating
objects), receptive (understanding) and expressive (speaking) language,
self-help (e.g., feeding, dressing), and social and play skills. While
it is important to consider each of these areas, some are more important
predictors of developmental difficulties than others.

Gross motor skills tend to be of particular importance to parents. They
are readily observable and easy to compare from one child to the next.
The timing of concrete achievements such as first steps is usually easy
for any parent to pinpoint. But a particular achievement such as early
walking bears little relationship to later intelligence. Communication
and social skills are generally more important in understanding a
child's developmental progress.

During the first half of the first year, baby's communication skills are
largely nonverbal. Smiling, making eye contact and turning in the
direction of a familiar voice, are all signs that baby is connecting
with and relating to his social environment. Later in the first year,
babbling begins and words may start to appear. In most cases, baby's
vocabulary will continue to grow by leaps and bounds as he moves through
the second year. Again, however, it is the ability to use language to
communicate and relate to the social world that is most important. A
child who has a limited speaking vocabulary late into the second year,
but is able to communicate needs through gestures, point to named
objects in books, and follow simple directions, is most likely not
exhibiting significant developmental delay.

The nature of a child's play also provides important information about
intellectual development. Very young children tend to play alongside,
rather than with, other children. Early play consists largely of using
body and senses to interact with the environment. During the toddler
years there is a move toward pretend play and increasingly interactive
play with other children. Flexibility and creativity become more evident
as a child begins to engage in symbolic play (e.g., using a block to
represent a car) and role-playing (e.g., "I'll be the mommy and you be
the baby"). Steady progression toward more social and complex play
suggests that development in this area is on track.

Some red flag warning signs that a child's development may not be on
track include:

Infants (0-2 years):

* Little interest in surroundings and caregivers
* Absence or minimal eye-contact or smiling
* Lack of responsiveness to sound
* Absence of babbling by end of first year
* Failure to walk by 15 months of age
* Failure to use hands to manipulate and explore objects.

Toddlers (2-3 years):

* Little interest in other children
* Limited use of words or gestures to communicate needs
* Repetitive non-communicative or parrot-like speech
* Very repetitive, non-purposeful play (e.g., focuses only on
parts of objects such a wheels, knobs; obsessively turns pages of book
without attending to or recognizing content).

Pre-schoolers (3-5 years):

* Speech that is very difficult to understand
* Little or no pretend or imaginary play
* Little interest in social interaction
* Difficulties with balance, running
* Difficulty using crayons or scissors, manipulating small
objects.

What are the different developmental disabilities (NDD)?

At least 8 percent of all children from birth to six years have
developmental problems and delays in one or more areas of development.
Some have global delays, which means they lag in all developmental
areas.

Common neuro developmental disabilities (NDD) include:

· Cerebral Palsy

· Mental Retardation

· Speech and language disorders

· Attention Deficit Hyperkinetic Disorder (ADHD)

· Autism

· Learning disabilities

· Visual and hearing defects



Where do I go to?

Consult your Pediatrician immediately.

Remember to get an Eye and Hearing test done.

You will be referred to a Child Developmental Clinic for Early
Intervention Therapy through a team approach.



What is done for Early Intervention?

Early intervention starts right from the baby's stay at the NICU. The
environment is rendered developmentally supportive through the
following:

· Optimizing lights in the Nursery & mimicking diurnal variation

· Reduce noise to minimum

· Use of soft music

· Club painful procedures & interventions

· Non nutritive sucking

· Tactile stimulation through soft stroking and caressing.

· Kangaroo mother care



Later, early intervention is continued through the provision of :

· Stimulation in all sectors of development

· Stimulate the child through the normal developmental channel
and help him to achieve the next milestone every time.

· Passive exercises to prevent stiffness

· Parents are encouraged to constantly provide appropriate
stimulation.

· Counsel the parents. Assess the parenting skills and provide
necessary education.



What can I expect?

Early Intervention is neither a single dose therapy nor a magic
medicine. We do not expect miracles that the child will be absolutely
normal, coming 1st in class or winning an obstacle race. But we help him
to win his own obstacle race.

Through EIP the child gradually achieves the best of his potentiality.
He is taught to perform to the best of his ability to survive
independently in society. His strong points are brought into focus,
through which his life is made purposeful.

And again, in some, much is achieved beyond expectation, bordering on a
miracle!

The take home message is "Be patient and sincere, you will be rewarded."

Name: Dr.Nandita Chatterjee

Organisation: Nanritam

Location: Kolkata

Brain health is health of the body

As one grows old , one thinks of the health of the brian and how one can avoid the dreaded alkhazemier and how one can keep one's faculty functioning.
Some useful tips have come which can help in brain health and corresponsingly general health also.
1.Get plenty of sleep. This is the most important step as brain regenerates itself during this period. It is also the first sign of mentalillness when the person is sufferring from sleeplessness.
2. Brain healthy diet. This must contain Fish, sea food, folic acid and all those food which contain Omega 3 fatty acids, anti/oxidants etc. Leafy vegetables,fruits and food rich in carbohydrates also must form part of your diet.
3. Stay mentally active. A game of bridge a day keeps the alkazhmier away is a saying worth following. But you can have your brain ticking by playing chess, crossword puzzles, suduko etc.
4.Physical exercise is a must. Anything which strengthens your heart helps your brain also
5. Stay social by using carer groups, ORKUT, email, and all those social functions like marriages,parties etc.
6.Learn to manage stress from the beginning in your school,college, workplace,marriage etc.One has to understand that stress is part of life and also part of progress. But one must know how to manage it. confiding in peer groups is also a stress buster.
7. Brain is protected by skull and one must protect it from injury by using helmets, driving carefully and all one can do using ones commonsence.
8.Avoid the standard drill of smoking, alcohol,drugs.
9. One cannot fight ones heridity and ones genes. But one must not fear it. Both my parents sufferred from diabeties and my mother never allowed three of us going near sweets. But i think it is my fathers relaxed attitude to discease which helped all of us in the long run. Uric acid and gout has got up with me but it can be faught by diet alone. Brain disceases also follows this same pattern.
10. controll all addictions. i am unable to control this addiction to internet surfing for the last 2 years. But i think i can manage if i realy want to .