ISSN (Print) - 0012-9976 | ISSN (Online) - 2349-8846

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New Tactics, Strategic Failure

Mental Healthcare

The provision of mental healthcare at the primary level in low- and middle-income countries is woefully inadequate today. While the recent emphasis on the link between mental disorders and non-communicable diseases appears to be a tactical advance, it is also an admission of the strategic failure of integrating mental healthcare into primary care.

The Alma Ata Declaration on Universal Healthcare (WHO 1978) was a clarion call for nations to focus on health for all their peoples. The mental health movement also acknowledged the inadequacy of care for people with mental illness living in the community. The World Health Organization (WHO) led the effort to incorporate mental healthcare within primary healthcare in developing countries. This resulted in pilot projects in different parts of the developing world (WHO 1984). Evidence from these endeavours was then employed to establish national mental health policies and programmes in many countries (DGHS 1982).

In India, pilot projects in Raipur Rani (Chandigarh) and Sakalwara (Bengaluru) were scaled-up for the Bellary District Mental Health Programme (Karnataka) in 1988. The district programme then became the blueprint for similar plans rolled out in over 123 districts across the country (Goel 2011). But patchy and variable implementation, lack of human resources, limited budgets, inability to utilise available funding and the failure to integrate mental healthcare into primary care resulted in poor delivery of mental health services in most areas (Sarin and Jain 2013).

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