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 Table of Contents  
LETTER TO EDITOR
Year : 2018  |  Volume : 34  |  Issue : 2  |  Page : 187-188

Mental health in tribes: A case report


1 Department of Psychiatric Social Work, Institute of Mental Health and Neurosciences, Kozhikode, Kerala, India
2 Department of Psychiatry, Institute of Mental Health and Neurosciences, Kozhikode, Kerala, India

Date of Web Publication29-Jun-2018

Correspondence Address:
Dr. Anvar Sadath
Institute of Mental Health and Neurosciences, Government Medical College Campus, Kozhikode - 673 008, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijsp.ijsp_56_17

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How to cite this article:
Sadath A, Uthaman SP, Shibu Kumar T M. Mental health in tribes: A case report. Indian J Soc Psychiatry 2018;34:187-8

How to cite this URL:
Sadath A, Uthaman SP, Shibu Kumar T M. Mental health in tribes: A case report. Indian J Soc Psychiatry [serial online] 2018 [cited 2019 Dec 13];34:187-8. Available from: http://www.indjsp.org/text.asp?2018/34/2/187/235663



Sir,

Tribes are the aboriginal inhabitants of our country, who depend on natural resources for their survival and have cultural patterns congenial to their physical and social environments. Scheduled tribe population accounts for 8.2% of the total population of the country. Scheduled tribe population in Kerala is 364,189, out of which half are in Wayanad district. They constitute 18.5% of the total population in Wayanad.[1] Tribals are the most deprived and marginalized social category in India, and there is little and scattered information on the actual burden and pattern of illnesses they suffer from.[2] Little is empirically known about the mental health status of tribal communities in Wayanad. We report a case of a tribal woman with severe mental illness who was recently brought to our community mental health clinic at Kalpetta, Wayanad.

Consent to publish this case was obtained from the patient's father.

Ms. Ramani (real name masked) is a 26-year-old single female who belongs to “Paniya tribe” and lives at Kalpetta, Wayanad. She was brought to us a few months ago, with 7 years' history of talking to self, decreased self-care and poor personal hygiene, social withdrawal, and occupational dysfunction. On evaluation, she was diagnosed with schizophrenia. In the past, she was treated with antipsychotic medication from a private psychiatric hospital at Wayanad but soon discontinued due to financial difficulties. In between, she was also taken to multiple faith healers. Her father reported to have spent a huge amount of money toward expenses of faith healing.

Ms. Ramani is youngest in the family, and she has three sisters and one brother. She lives with her 79-year-old father and an elder sister in a hut at a tribal village in Kalpetta. Two sisters and the brother are married, and they currently live with their family of procreation. She lost her mother 3 years back who, according to information from patient's father, died due to severe anemia. The elder sister with whom she lives is a known case of chronic psychosis. Nevertheless, functionally, the sister is better than the index patient. This sister is the caregiver for Ramani, while father is at work and away from home. Ms. Ramani's elder brother who lives with his family also suffers from a severe mental illness.

The financial needs are being met through the meager income generated by father through his occasional coolie work and old-age pension. Apart from this, Ms. Ramani receives a meager amount as disability pension. No other sources of income or financial support are available to the family. The father had borrowed huge amount from moneylenders for patient's treatment, and now he is struggling to pay that back. During our home visit, the patient's sister revealed that they cook only once in 2 days and have food only once a day. Shockingly, they are not eating much food other than rice for many years. Our consultant psychiatrist confirmed a diagnosis of anemia in the patient. We also observed that the patient lives in an unhygienic condition at home and her personal care is being neglected. Later, our teams' liaison and coordination work with tribal promoter, tribal officer, and health inspector helped facilitate patient's admission to a rehabilitation home and also ensured ongoing psychiatric treatment and follow-ups.

The National Mental Health Program primarily visualized ensuring availability and accessibility of minimum mental health care for all, particularly to the most vulnerable and underprivileged sections of population.[3] To some extent, the district mental health program (DMHP) improvised the accessibility of mental health treatment in rural areas through its community-based approaches. However, to a large extent, mental health services remain inaccessible for tribal population who live in remote places. The availability of mental health services in Wayanad is largely limited to DMHP in the district. Even in these DMHP service points, the number of tribal patients seeking mental health services is extremely less. Adding to this, massive treatment dropout is also observed among tribal people who are started on treatment from DMHP.

The case we depicted here is an epitome that illustrates the physical and mental health status of the tribal population in Wayanad. Ms. Ramani's family is one among many tribal families who strive for survival along with disability. They are the most underprivileged social groups, who are marginalized in socioeconomic aspects of life, resulting in poor physical and mental health. We discussed elsewhere the concept of identity-mediated psychosocial disability among socially excluded individuals and groups.[4] The mere identity of being tribal or member of a socioeconomically backward group is perceived as stigmatizing and results in an incapacity for accessing their rights.[4] This family could not ensure regular and continuous treatment for the sick family members due to poverty, poor social support, myths and misconceptions, internalized stigma, and the difficulties in accessing public psychiatric facilities. The combination of social problems such as poverty, illiteracy, and harsh living environment makes it more difficult for the marginalized group to access health care.[4] Evidently, the tribes have been suffering from disproportionate level of communicable and noncommunicable disorders.[2]

Despite remarkable progress in mental health in the nation, there are marginalized populations such as tribals who live in poverty and suffer inequality in health and mental health. In countries such as India, the social determinants of health such as education, living standards, environment, access, equity, and others contribute significantly to both causation and recovery.[5] Poverty, low living standards, and related factors are implicated in the increased occurrence.[5]

To improve the mental health of tribes, we make a few recommendations. First, the tribes are special social groups having their own customs, traditional values, beliefs, and traditional healing systems. Many of them do not seek modern treatment for health and mental health problems. Hence, education and awareness regarding mental health issues and modern treatment need to be provided to this population. Second, the DMHP services improved the overall mental health-care delivery system in the districts, but such services are not covering tribal dominant areas sufficiently. The tribes living in interior places have to travel long distance to access these services. Thus, the services need to be provided at accessible distance to improve the mental health service utilization. Allocating more mobile mental health teams in the tribal dominant area would be an option to address these issues. Finally, proper liaison and coordination with key people such as tribal promoters, accredited social health activists, community health workers, and doctors and nurses in primary health centers and community health centers are essential for improving the mental health of the tribal population. It is highly recommended to have more community participation, increased support for community health workers, and coordination with other stakeholders for ensuring effective tribal mental health in India.

Acknowledgment

We thank Ms. Anitha, MPhil PSW trainee, Institute of Mental Health and Neurosciences, Kozhikode, for her active support and work with this case.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form, the legal guardian has given his consent for images and other clinical information to be reported in the journal. The guardian understands that names and initials will not be published and due efforts will be made to conceal patient identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Census of India 2011: Provisional Population Totals-India Data Sheet. Office of the Registrar General Census Commissioner, India. Delhi: Indian Census Bureau; 2011.  Back to cited text no. 1
    
2.
Jain Y, Kataria R, Patil S, Kadam S, Kataria A, Jain R, et al. Burden & pattern of illnesses among the tribal communities in central India: A report from a community health programme. Indian J Med Res 2015;141:663-72.  Back to cited text no. 2
[PUBMED]  [Full text]  
3.
National Mental Health Programme for India. Directorate General of Health Services (DGHS). New Delhi: Ministry of Health and Family Welfare, Government of India; 1982.  Back to cited text no. 3
    
4.
Jose JP, Cherayi S, Sadath A. Conceptualizing psychosocial disability in social exclusion: A preliminary discourse. Contemp Voice Dalit 2016;8:1-13.  Back to cited text no. 4
    
5.
Lund C, Breen A, Flisher AJ, Kakuma R, Corrigall J, Joska JA, et al. Poverty and common mental disorders in low and middle income countries: A systematic review. Soc Sci Med 2010;71:517-28.  Back to cited text no. 5
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