Mental Health Organization
Since 2007
Shant Manas service to the Rural Prople started on 24th November 2007 in Madurai, India.
SHANT MANAS
A COMMUNITY MENTAL HEALTH SERVICE IN RURAL SOUTH INDIA
OPERATIONAL POLICY
Context
Shant Manas is a mental health development organisation serving rural communities in South India. It is a non profit making, non government organisation offering a free and accessible mental health support service for ADULTS suffering from mental disorders and associated conditions in the community.
Being essentially a ‘home assessment and treatment service’ Shant Manas will retain its primary focus on the early detection, treatment and recovery of mental health affected people in their own homes. It will offer support to carers and families as well. It will aim to promote positive mental health amongst local people through partnership with rural communities and will work towards promoting sustainability of its mental health support programmes within the existing resources and infrastructure of the communities it serves.
Shant Manas will concentrate its work initially in designated rural areas of Madurai and Kanchipuram districts of Tamilnadu and RangaReddy and Nalgonda districts of Andhra Pradesh. As its work develops Shant Manas will seek to widen its area of operation.
Who the service is for?
Most people treated by Shant Manas ‘community mental health teams’ will have time limited mental health disorders /difficulties. These people, with treatment and supported recovery, over a period of a few weeks to months, will no longer be in need of its services, as their conditions improve.
They will include people with anxiety and stress related disorders, obsessive-compulsive and panic disorders, various forms of depressive disorders, adjustment disorders, acute and transient psychotic or histrionic episodes, mental health problems in pregnancy and child birth, acute drug induced psychoses and confusional states in the elderly.
A significant minority, however, will remain with Shant Manas community mental health teams for ongoing treatment and follow up care for variably extended periods of time depending on their clinical needs. They will include people needing continued specialist care for severe and enduring mental disorders, such as schizophrenia, paranoid disorders, recurrent depression and bipolar disorder.
Long term disorders of lesser severity characterised by poor treatment adherence, eg; missing appointments or being prone to disengagement or discontinuing medication, would be offered an assertive follow up to improve concordance with treatment and consequently quality of life and to prevent relapses.
Any mental disorder where there is significant risk of self harm or harm to others would be offered assessment and intervention as appropriate. Psychiatric rehabilitation of affected people will be given prominence in collaboration with resources in the local community to return them to their previous level of optimal independent and social functioning.
Shant Manas will consider engagement with disorders of personality and addiction problems where these can be shown to benefit from continued contact and support.
Who the service is NOT for?
Shant Manas, at present, is NOT in a position to offer assessments and/or delivery of care to the following :
- Learning disability (mental retardation/handicap/intellectually challenged)
- Other disorders of children
- Epilepsy and other related neurological disorders
- It is also NOT a service geared for the needs of the very elderly in the community
However, Shant Manas teams might be able to help with onward referrals, transportation needs (eg for hospital appointment), and general service user advocacy for such people.
Shant Manas will offer support to families / carers who might be distressed by the burden of care, as appropriate. The Shant Manas Commitment Good health does not just mean a healthy body or physical fitness. It is also about a healthy mind that is able to think clearly, solves problems, enjoys good relationships with others, that feels spiritually at ease and brings
happiness to others in the family and in the community.
Shant Manas is a non discriminatory service, embracing the principle of empowerment and respect for the individual and applying the same standards of care and conduct regardless of a person’s ethnicity, religion, economic, social, gender or disability background, whilst being sensitive to the different needs of different individuals. The organisation holds a deep commitment to the values of a readily acceptable and accessible service to those affected by mental illness and distress, their families and the communities in which they live.
It recognises the importance of carers, family, relatives and friends in their contribution towards recovery. Shant Manas aims to carry out its functions in a non stigmatising way and its approach will be based on a framework that values, acknowledges, and works from an Indian tradition and experience. We will work in cooperation and close partnership with available local resources.
The essential theme of holistically enabling and empowering are central conceptual pillars of Shant Manas upon which all else rests and encompasses. This means that not only does the community provide services to itself, its locality, but in turn
people, when they can, return those skills and understanding back to the community. It will strive to maintain a positive, proactive approach to its work, ensuring a high standard of practice in which staff will continue to update and refresh their skills and refine their practice.
Objectives
To provide free, and accessible, services to help detect, treat, and /or prevent mental health disorders and difficulties in rural communities and offer support to affected persons and their families, without any discrimination of social, religious, economic, linguistic or gender status.
To work proactively, to treat and support service users with severe mental health difficulties within their own home, family and community.
To promote and/or assist in the mental health rehabilitation of affected persons and help ease the burden of care on their families and community.
To develop innovative and accessible community based support services in partnership with resources in the local community.
To ensure engagement with the individual’s family and/or carers as partners in care.
To build understanding, respect and sharing between Shant Manas and local guardians of health care, such as doctors, vaids, marathoners, and other health practitioners.
To collaborate with government health departments and any relevant non government health or allied organisation towards a holistic approach to mental health care and support of those affected, their families and their community.
To provide support and training for staff and other people caring for, and working with, mental health needs in the catchment areas.
To promote both quantitative and qualitative research into the understanding, treatment and management of mental disorders in the rural Indian community.
To publish, print and circulate booklets, pamphlets dealing with, or bearing upon, mental health issues, as applicable to the work of Shant Manas.
To provide training placements for social workers, nurses, doctors, counsellors, psychologists, students, or any other group deemed appropriate, by conducting and supporting workshops and offering field experience under supervision.
To promote mental health awareness, and coping strategies, through public education, exhibitions, street plays, public meetings or in any other appropriate medium or manner.
To foster a spirit of ‘inclusiveness’ where everybody, associated with the work of Shant Manas, regardless of position and status, feels that their contribution matters and benefits from shared support and open communication.
Shant Manas ‘Care Pathway’
With each new referral or initial contact Shant Manas staff will screen all the information received to ascertain appropriateness of referral and the perceived mental health needs of the individual concerned. Where a referral is found to be inappropriate for Shant Manas, then onward referrals to other appropriate services or agencies, where available, will be made with the consent of the individual.
Each Shant Manas referral that is accepted will be registered in the Shant Manas Register. They will then receive a prompt, and carefully coordinated, comprehensive assessment, conducted at their home, of their mental health needs. This assessment will be carried out by an experienced member of the multidisciplinary team and will identify a range of issues that may contribute to an individual’s mental health difficulties.
The assessment, and its outcome, will be discussed at the multi disciplinary team meeting and a care co-ordinator will be appointed. The care coordinator, in consultation with the team, and through discussion and agreement with the service user, and their carers, designs a ‘care plan’ that will outline the proposed interventions and their stated objectives that are to be achieved by the service user. All planned interventions and care plan will be documented in the case notes.
An assessment of their carers’ needs will form an essential part of the care pathway and their needs will be supported wherever possible. The care coordinator takes a proactive interest in ensuring continuity in the delivery of the agreed care plan and would review progress with the service user at regular intervals.
The care coordinator also organises interventions, reviews and discharge. See below.
Interventions:
Shant Manas will offer family focused interventions, while striving for empowerment, in treating mental disorders and enhancing holistic mental health. In this regard we would engage family members, where appropriate, as partners in care.
To enable this work, the organisation’s Mental Health Outreach Workers (MHOW) will be trained in communication and mental health assessment skills and would have adequate knowledge and experience of working, in a respectful and culturally sensitive manner, in the rural community. Through regular meetings with service users the MHOW will offer informed individual and family counselling as indicated.
They will monitor and evaluate progress in response to medication and other psychosocial interventions as defined in their care plan package. They will also support and assist in the process of the person’s recovery, rehabilitation, and social inclusion.
MHOW’s role, essentially, will be one that is flexible and adaptable to the needs of the individual, their family, and their community. This could also include facilitating support groups, establishing peer groups, promoting mental health awareness in general and, in particular, psycho-education in areas of anxiety and stress management and de-addiction strategies.
MHOW will be supported, and supervised, by a team of committed mental health specialists, including senior psychiatrist, community psychiatrist, community psychiatric nurse, social worker and psychologist. Administrative and secretarial support will also be made available.
The Shant Manas psychiatrist, as part of the team, will also offer appointment for assessment, a treatment plan, and follow up visits all in the person’s home setting. Medication will be provided, free of charge, to those with limited financial means.
It is envisaged that all other professionals involved will also conduct the majority of their assessments and interventions in the community. This would enable the Shant Manas experience to become a ‘fully accessible and totally exclusive home and community based mental health service’ in rural parts of South India where it currently operates.
Reviews and Discharge
Every care plan will be reviewed regularly by the care coordinator and the MDT ( multi disciplinary team) along with the individual and their family/carers. Reviews will be recorded in the case notes and the revised plan of care agreed by all.
Discharge will be a planned process, in agreement with the service user and their carer, within the empowering and enabling philosophy of Shant Manas. Before closure of a case a ‘discharge summary’ would be prepared by the care co-ordinator outlining the treatment, the progress, and the outcome, as well as the service user’s own views and feedback. This discharge summary would be filed in their case notes, a copy of which will also be provided to the individual, for their personal records.
MC & CV Nov 2008