Parity of esteem: A global COVID-19 vaccination approach for people with mental illnesses, based on facts from 34 countries; recommendations and solutions.

Background: The coronavirus disease (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has detrimental effects on physical and mental health. Patients with severe mental illness are at higher risk of contracting the virus due to social determinants of health. Vulnerable populations include the elderly, people with pre-existing conditions, and those exposed to SARS-CoV-2. Unfortunately, only a few countries have updated vaccination strategies to prioritize patients with mental illnesses. Therefore, we aimed to explore whether individuals with mental disorders are prioritized in vaccine allocation strategies in different world regions. They are often neglected in policymaking but are highly vulnerable to the threatening complications of COVID-19. Methods: A questionnaire was developed to record details regarding COVID-19 vaccination and prioritizations for groups of persons with non-communicable diseases (NCDs), mental disorders, and substance use disorders (SUDs). NCDs were defined according to the WHO as chronic diseases that are the result of a combination of genetic, physiological, environmental, and behavioral factors such as cardiovascular diseases, cancer, respiratory diseases, and diabetes. Results: Most countries surveyed (80%) reported healthcare delivery via a nationalized health service. It was found that 82% of the countries had set up advisory groups, but only 26% included a mental health professional. Most frequently, malignancy (68%) was prioritized followed by diabetes type 2 (62%) and type 1 (59%). Only nine countries (26%) prioritized mental health conditions. Conclusion: The spread of the coronavirus has exposed both the strengths and flaws of our healthcare systems. The most vulnerable groups suffered the most and were hit first and faced most challenges. These findings raise awareness that patients with mental illnesses have been overlooked in immunization campaigns. The range of their mortality, morbidity, and quality of life could have widened due to this delay.

Perinatal depression among teenage mothers in a tertiary care teaching hospital of Nepal: A cross-sectional study.

The teenage pregnancy has serious adverse effect on physical and mental health of mothers and infants. This cross-sectional study was aimed to assess proportion of perinatal depression and well-being of teenage mothers in Nepal. Perinatal women were evaluated using Mental Health Continuum Short Form, and Edinburgh Postnatal Depression Scale. Of 239 perinatal women, 12 (5%) were teenage with a mean age of 18.17 ± 0.93 years. 33.3% (n = 4) of teenage mothers had depressive symptoms, and 25% (n = 3) had moderate/languishing mental health. A high proportion of depression and poor mental health suggests that screening and supportive care should be provided for teenage mothers.

Cutoff for Benchmark Disability Using World Health Organization Disability Assessment Schedule 2.0: A Community-Based Cross-Sectional Study from Rural South India.

Background: India uses the Indian Disability Evaluation and Assessment Scale (IDEAS) for quantifying disability due to mental illness. The cutoff score for benchmark disability is 7. India has adopted International Classification of Functioning and Health (ICF) and thereby is a signatory to use World Health Organization Disability Assessment Schedule (WHODAS). Cutoff for benchmark disability in WHODAS in a community-based sample is lacking. Methods: The study was conducted in Jagaluru Taluk, Davanagere District, Karnataka. It is a part of an ongoing research funded by Indian Council of Medical Research. Frequency, percentages, mean, standard deviations, mode, median, Receiver Operating Characteristic Curve were used in analyzing the data. Results: The study included 184 persons with severe mental illness with mean age of 47 and average duration of illness (DOI) of 11 years. They had mild disability (5.99) in IDEAS. The corresponding cutoff score in WHODAS, as compared to IDEAS, when the influence of DOI is removed was 24. Conclusions: A shift from IDEAS to WHODAS is feasible. With the undue influence of DOI removed, both hospital and community-based samples show the score of 24 as cutoff.

Current prevalence and determinants of generalized anxiety disorder from a nationally representative, population-based survey of India.

Introduction: Generalized anxiety disorder (GAD) is one of the common anxiety disorders leading to impairment and burden. However, GAD remains the least studied anxiety disorder. There is a need for nationally representative epidemiological data of GAD to understand the current burden and plan the mental health policies and programs to attain their unmet needs. Hence, this study focuses on epidemiology, socio-demographic correlates, disability, and treatment gap of GAD from India's National Mental Health Survey (NMHS) 2016. Materials and Methods: NMHS 2016 was a nationally representative epidemiological survey of adult respondents from 12 states of India. NMHS is a multi-stage, stratified, random cluster sampling with random selection based on probability proportional to size at each stage. The Mini-International Neuropsychiatric Interview 6.0.0 used to diagnose psychiatric disorders. Sheehan disability scale was used to assess the disability. The current weighted prevalence of GAD was estimated. Association between GAD and socio-demographic factors was done using Firth's penalized logistic regression. The treatment gap and disability in GAD also calculated. Results: The current weighted prevalence of GAD is 0.57%. The male gender and higher education groups have significantly lesser odds with current GAD. Urban metro and the married group have significantly higher odds with current GAD. The most common comorbid psychiatric disorders are depression (15.8%) followed by agoraphobia (9.4%). Among respondents with current GAD in the past 6 months across three domains, around 2/5th has mild and moderate disability, 1/10th has a severe disability, and 1/20th has an extreme disability. The overall treatment gap of current GAD is 75.7%. Conclusion: NMHS 2016 has provided valuable insights into the epidemiology and burden of GAD among the general population. The available findings provide a glimpse of the current scenario in GAD to aid policymakers in targeting interventions.

Bombay Begums-A treasure for social guidance films on determinants of women's mental health.

A woman's health should reach beyond the narrow perspective of maternal and reproductive health and should encompass physical as well as mental health across the life cycle. The focus should be shifted to a broader, social, legal, and economic factors rather than just immersing on lifestyle and individual factors. Recognition of mental health issues among women, education, training, and interventions at various levels would contribute to the improvement of mental health issues among women.

The Legality and Ethical Issues of Certifying Laypersons as Mental Health Counselors in India.

Background: The burden of mental health conditions and consequent disability impacts are felt most in low- and middle-income settings. These settings are constrained by the limited availability of resources to provide even essential aspects of mental health care (MHC). Task shifting and sharing interventions have shown promise in delivering community-based MHC across such low-resource settings. Some counseling tasks such as friendship bench interventions have been successfully shifted to laypersons. However, ethical and legal concerns regarding laypersons' incorporation in MHC delivery systems have not been examined. Purpose: To examine the ethical and legal concerns surrounding the certification of laypersons as community-based mental health counselors. Method: We undertook an academic review of various legislations pertinent to MHC service delivery and the certification of allied health care professionals to inform on acceptable and tenable strategies toward incorporating such a task-shifted intervention. Conclusion: Scaling up the training of human resources to address access problems can be the first step in addressing the MHC access and treatment gaps. The certification of laypersons as community-based mental health counselors, although legally tenuous, can be pioneered by tertiary-level MHC institutions. This certification has sound ethical justification and is a progressive step toward realizing universal mental health coverage.

Ethical and legal issues concerning COVID 19 vaccinations in persons with mental illness in India.

Mental healthcare in India faces severe challenges amid the ongoing pandemic. India runs the largest vaccination drive globally, including booster doses to rapidly vaccinate its population of over a billion. As persons with mental illness are at greater risk of adverse outcomes from COVID 19, they need prioritized access and administration of these vaccines. This manuscript examines the current legislation and identifies how the legal and ethical frameworks can prioritize COVID 19 vaccinations for persons with mental illness in India through a review of the various legislations of India concerning persons with mental illness and judicial judgments concerning the pandemic and vaccination. Subsequently, we discuss ethical and legal challenges associated with vaccination in this vulnerable population and possible solutions. Based on the current review, the authors recommend the guidelines for capacity assessment for vaccination decisions and discuss existing legal frameworks relevant to the vaccination of persons with mental illness.

A camp approach of community psychiatry in India: Past, present, and the future.

Camps are a popular approach to deliver medical care in India. While it is usually a one-off event for physical ailments, it is a long-term affair in Psychiatry. One of the first camps in psychiatry was rolled out as early as in 1967 at Mandar, Ranchi, followed by Raipur Rani (Haryana) in 1976 and at Gunjur, Karnataka in 1977. This camp approach became extremely popular and got expanded across India as they were thought to be synonymous with community-based outreach for mental illnesses. In the past 5 years, however, newer models of community care have emerged, necessitating a relook at this traditional approach. In this paper, the authors trace the origin, utility and future directions of these camps, taking data from community psychiatry camps conducted by the National Institute of Mental Health and Neurosciences, Bengaluru, a premier neuropsychiatric tertiary care institute in India. Data have been collated from the annual reports of the Institute, database from the District Mental health Program, Government of Karnataka, India, and compared with published literature on the same field. While camps remain as one of the important avenues to reach the unreached, there is a need to change the approach of their functioning by incorporating training (primary care providers) aspects and collaborative care. The latter may make the initiative more meaningful and sustainable.