Metro-Urban Mental health in developing countries: from origins to outcome: an Indian experience

Amresh Shrivastava: MD,DPM,MRCPsych, Executive Director: Mental Health Resource Foundation, & Prerana Charitable Trust, Mumbai, India. Assistant professor, Department of Psychiatry, University of Western Ontario, London, Ontario, Canada

Address of presenting author E Mail: dr.amresh@gmail.com 467, Sunset Drive, Regional Mental Health care, St.Thomas, Ontario, Canada, N5H 3V9 Phone: 519-631-8510 x 49252, fax 519-631-2512. & 519-641-3833 The life of the mentally ill in large metropolitan areas is presumed to be more Challenging. The impact of urbanization on service utilization and outcome is not clearly known. The present paper discusses results from three different studies highlighting the influence of urban life in Mumbai (third largest city in the world, 18 million) on mental health issues. 1. a ten year follow up study of schizophrenia, 2.effectiveness of newer services for suicide prevention, and 3. Stigma and discrimination. The city has a two-tier system, government funded and private, catering to the needs of every citizen. Awareness is reasonably high leading to high service utilization. Insurance coverage for severe mental illness is a problem. The study revealed high a drop out rate (49%); 60% had a good outcome but 35% were still living with symptoms and disability. There was a long duration of untreated psychosis: mean 3 years and 5 months; a high incidence of any side effect at the end (25%). Most patients and families (79%) felt that stigma exists which causes discrimination particularly in social life and employment opportunities. More than 85% felt that the best way to deal with stigma is to provide early treatment. The media played a key role in awareness of services. Patients utilized the new help line facility. Students in examination crisis were found to be new high-risk group. The main causes for suicide attempts were relationships, financial stress and psychiatric illnesses. Networking and linking of available services was effective, highlighting local needs and the importance of local resources. Comparative studies are required with smaller cities and rural areas to address the specific contribution of the very big city.

Abstract for Symposia in APA: 2009 Life of a mentally ill patient in metros is known to be more challenging. Impact of urbanization on service utilization and outcome is not clearly known. Present study reflects upon the influence a metropolis urban life of Mumbai on various parameters of schizophrenia in studies like: ten years follow up, effectiveness of newer services for suicide prevention & ‘stigma and discrimination ‘. The city has two tire system, government funded and private catering to the needs of every citizen. The awareness is reasonably high leading to high service utilization. Insurance coverage for severe mental illness is a problem. The study revealed high drop out rate (49%); patients with god outcome (60%) but still living with symptoms and disability (35%); High duration of untreated psychosis (mean 3 years 5 month); high incidence of any side effect at the end (25%). Most patients and families (79%) felt that stigma exists which causes discrimination particularly in social life and employment opportunities. More than 85% felt that best way deal with stigma is to provide early treatment. Media played a key role in awareness drive. Patients utilized the new help line facility. Students in crisis of examination results were found to be new high-risk group; main causes for suicide attempts were relationships, financial stress and psychiatric illnesses. Networking and linking available services was effective experiment highlighting local needs & importance of local resources.

Comparative studies are required with smaller cities and rural areas to address the issue of global impact of metro life.