Reaching the unreached

Proactive case finding for severe mental illness in a rural area in the Indian Punjab: findings and lessons

People with severe mental illnesses may experience barriers in accessing community mental health services. We used the key informant method to detect people with untreated severe mental illness in seven villages in the Indian state of Punjab. The key informant was a local community leader. We were able to contact 11 patients who were identified as suffering from severe mental illness by the key informants. On assessment, eight of them had intellectual disability and three had psychotic and affective illness. We discuss the barriers and opportunities for providing mental health services in the community.

Extent and determinants of burden of care in Indian families: a comparison between obsessive-compulsive disorder and schizophrenia

BACKGROUND

Limited data is available for family burden in anxiety disorders such as obsessive-compulsive disorder (OCD), particularly from the developing world where families are the primary source of support for patients.

AIM

To compare family burden in patients with OCD and schizophrenia in an Indian setting and to examine the influence of caregivers' demographics, patients' illness severity and disability on family burden.

METHOD

This comparative cross-sectional study assessed family burden in key relatives of patients with OCD (n = 50) and schizophrenia (n = 30) respectively.

RESULTS

Indian families experience significant degrees of burden in the care of their relatives with OCD and schizophrenia. Key relatives' demographic characteristics did not influence burden severity. Illness severity and patients' disability had a direct positive relationship with perceived family burden.

CONCLUSION

Indian families of patients with OCD experience burden comparable to that of families of patients with schizophrenia. There is a need to develop local needs-based support programmes for families of patients with psychiatric disorders in India.

Caregiver burden in anxiety disorders

PURPOSE OF REVIEW

Family burden research has primarily focused on severe mental disorders. Despite the high prevalence and chronic disabling nature of anxiety disorders, family burden has been relatively neglected in our understanding of their impact on caregivers. The paper reviews the available evidence on caregivers' burden in different anxiety disorders.

FINDINGS

Obsessive-compulsive disorder and posttraumatic stress disorder are the only anxiety disorders that have been studied in this regard, while there is a significant lack of data about other anxiety disorders. Caregiver burden in obsessive-compulsive disorder is equivalent to that of severe mental disorders like schizophrenia and affective disorders. Spouses/partners and children experience a significant degree of burden in looking after their relatives with posttraumatic stress disorder.

SUMMARY

Available limited data indicates an adverse impact on families looking after their relatives with anxiety disorders such as obsessive-compulsive disorder and posttraumatic stress disorder. There is an urgent need for further research to increase our understanding of family burden and, accordingly, to support families involved in the care of patients with anxiety disorders. The impact of caregiver burden on disease and recovery in anxiety disorders also needs to be addressed in future research.

The International Consortium on Mental Health Policy and Services: objectives, design and project implementation

The concept of the burden of disease, introduced and estimated for a broad range of diseases in the World Bank report of 1993 illustrated that mental and neurological disorders not only entail a higher burden than cancer, but are responsible, in developed and developing countries, for more than 15% of the total burden of all diseases. As a consequence, over the past decade, mental disorders have ranked increasingly highly on the international agenda for health. However, the fact that mental health and nervous system disorders are now high on the international health agenda is by no means a guarantee that the fate of patients suffering from these disorders in developing countries will improve. In most developing countries the treatment gap for mental and neurological disorders is still unacceptably high. To address this problem, an international network of collaborating institutions in low-income countries has been set up. The establishment and the achievements of this network--the International Consortium on Mental Health Policy and Services--are reported. Sixteen institutions in developing countries collaborate (supported by a small number of scientific resource centres in industrialized nations) in projects on applied mental health systems research. Over a two-year period, the network produced the key elements of a national mental health policy; provided tools and methods for assessing a country's current mental health status (context, needs and demands, programmes, services and care and outcomes); established a global network of expertise, i.e., institutions and experts, for use by countries wishing to reform their mental health policy, services and care; and generated guidelines and examples for upgrading mental health policy with due regard to the existing mental health delivery system and demographic, cultural and economic factors.