Perspectives of Community Nurses on Treatment Engagement of Persons with Severe Mental Illnesses (PwSMI): A Qualitative Study from South India.

Background: There is increasing evidence of the need for treatment engagement between Persons with Severe Mental Illnesses (PwSMIs) and Mental Health Professionals (MHPs). This therapeutic process involves collaborative work between patients and MHPs, which improves the condition. Community nurses are uniquely positioned to facilitate this process as they act as the focal point of interaction between patients and the health system. Methods: This qualitative study explored the community nurses' experiences in treatment engagement with PwSMI through eight group interviews of 35 community nurses from District Mental Health Programs (DMHPs) across Karnataka (South India) from February 2020 to March 2020. The audio recordings of the interviews were transcribed and coded to arrive at themes and subthemes. Results: The major themes identified were factors influencing treatment engagement, strategies to tackle treatment nonengagement, and challenges in dealing with nonengagement. The reasons for nonengagement were lack of insight and lack of knowledge of sociocultural, logistic, and treatment-related factors. The DMHP teams contacted patients through phone calls, home visits, and liaisons with health workers and intervened with them through education and depot injections. The major challenges were difficulty conducting home visits, distances, the unavailability of medications, and the need for adequate infrastructure and human resources. Conclusion: Community nurses address a few factors of nonengagement, such as insight, sociocultural factors, and treatment-related factors. Addressing the systemic challenges and adequate training of nurses in intervening in the dropped-out PwSMIs would help to reduce the treatment gap.

Admission of persons with disabilities into nursing and midwifery courses: Progress made by the Indian Nursing Council.

India's Persons with Disabilities Act, 1995 (PWD Act, 1995) mandated a minimum enrollment reservation of 3% for persons with disability (PwDs) across all educational courses supported by government funding. Following this, the Indian Nursing Council (INC) issued regulations limiting such an enrollment quota to PwDs with lower limb locomotor disability ranging between 40%-50%. The Medical Council of India (MCI) also restricted admissions under the PwD category to PwDs with a lower limb locomotor disability to comply with the Act. The Rights of Persons with Disabilities (RPwD) Act, 2016, which replaced the PwD Act, 1995, raised the minimum reservation to 5% for all government-funded institutions of higher education and extended this reservation to PwDs under 21 different clinical conditions, rather than the seven conditions included under the PwD Act, 1995. Following the enactment of the RPwD Act, 2016, the MCI issued regulations that allowed PwDs with locomotor disability and those with a few other types of disabilities in the range of 40%-80%, to pursue graduate and postgraduate medical courses, while the INC has not made any changes. This article addresses the complexities of inclusion of PwDs in the healthcare workforce, offers suggestions for inclusive measures; and compares the INC admission regulation released in 2019 to the MCI 2019 admission guidelines for graduate and postgraduate medical courses.

Uttarakhand Disaster 2013: A Report on Psychosocial Adversities Experienced by Children and Adolescents.

OBJECTIVE: To report the psychosocial adversities faced by children and adolescents in the Uttarkashi, district of Uttarakhand, experienced immediately after the Himalayan Tsunami in June 2013. Also to discuss issues pertinent to the disaster management including the needs of the disaster affected areas and future challenges. METHODS: This is a cross sectional observational report from the community assessment and interventions that were carried out as part of the disaster relief work by National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore within 1 mo of the disaster. Assessments and interventions were done by a team consisting of psychiatry resident, clinical psychologist, psychiatric social worker and a nurse. All diagnosis were made using International Classification of Diseases 10 (ICD 10) and the data was analysed using descriptive statistics and chi-square tests. RESULTS: A total of 300 children were screened; the mean age of the sample was 11.5 y and 65(32.5%) were boys. Two hundred (66.7%) children/adolescents reported one or the other psychosocial adversities attributable to the disaster. Psychological distress was present in 54/300 (18%) of the individuals. Loss of shelter and loss of playing space were the social issues having a statistically significant association with psychological distress signals such as feelings of anxiety, helplessness, insecurity, grief and uncertainty. Stress induced diagnosable psychiatric disorder was not present in any child or adolescent, however stress related psychiatric symptoms were present in around 13%. CONCLUSIONS: Himalayan tsunami of Uttarakhand in 2013 was associated with considerable psychosocial adversities among the resident children and adolescents. As children are a vulnerable population, a public health approach towards assessment and management of the psychosocial adversities in this population is urgently required at the state and national levels.

Psychiatric and medical disorders in the after math of the uttarakhand disaster: assessment, approach, and future challenges.

PURPOSE: To present the descriptive data on the frequency of medical and psychiatric morbidity and also to discuss various pertinent issues relevant to the disaster management, the future challenges and psychosocial needs of the 2013 floods in Uttarakhand, India. MATERIALS AND METHODS: Observation was undertaken by the disaster management team of National Institute of Mental Health and Neurosciences in the worst affected four districts of Uttarakhand. Qualified psychiatrists diagnosed the patients using the International Classification of Diseases-10 criteria. Data were collected by direct observation, interview of the survivors, group sessions, individual key-informant interview, individual session, and group interventions. RESULTS: Patients with physical health problems formed the majority of treatment seekers (39.6%) in this report. Only about 2% had disaster induced psychiatric diagnoses. As was expected, minor mental disorders in the form of depressive disorders and anxiety disorders formed majority of the psychiatric morbidity. Substance use disorders appear to be very highly prevalent in the community; however, we were not able to assess the morbidity systematically. CONCLUSIONS: The mental health infrastructure and manpower is abysmally inadequate. There is an urgent need to implement the National Mental Health Program to increase the mental health infrastructure and services in the four major disaster-affected districts.