Exploring psychiatric patient restraints: Balancing safety, ethics, and patient rights in mental healthcare.

Restraint, often linked with limiting an individual's freedom of movement, has become a focal point of extensive discussion and evaluation within the realm of mental healthcare. Striking a delicate balance between ensuring individual safety and minimizing reliance on restraint methods poses a significant challenge. In mental health inpatient settings, the prevalent forms of restraint encompass physical, chemical, environmental, and psychological methods. Paradoxically, the consequences of employing restraint can be severe, ranging from injuries and cognitive decline to sedation and, in extreme cases, fatalities. This paper seeks to offer a nuanced exploration of the landscape surrounding psychiatric patient restraints, considering both global perspectives and specific insights from the Indian context. The guidelines outlined in India's Mental Healthcare Act of 2017, which governs the use of restraint on individuals suffering with mental illnesses, are also examined in detail.

District-level differences in the distribution of mental and substance use disorders in Assam.

Background: The lifetime prevalence of mental morbidity in Assam is estimated at 8% (NMHS 2015-16). Understanding the distribution patterns of different types of mental disorders among persons with mental morbidity in different districts would facilitate evidence-driven district mental health programming in Assam. Given the varied socio-geopolitical situation across districts in Assam, significant variations in the distribution of mental disorders are expected. Aims: To assess interdistrict differentials in common mental disorders (CMDs), severe mental disorders (SMDs), socioeconomic impact, healthcare utilization, and mental disability across three districts sampled in NMHS in Assam. Materials and Methods: This cross-sectional study used stratified random cluster sampling to identify and study eligible adult participants in Dibrugarh, Barpeta, and Cachar districts. Standardized scales and validated questionnaires were used to assess mental morbidity, disability, socioeconomic impact, and healthcare utilization. The distribution of different mental disorders among persons with mental disorders and their interdistrict differentials were tested using the Chi-square test of significance. Results: Among persons with mental morbidity, the most common disorder was CMDs (79%). The proportional distribution of CMDs among persons with mental morbidity was significantly higher in the Dibrugarh district (79%), whereas the distribution of SMDs was higher in the Cachar district (55%). The distribution of alcohol use disorder was the highest in the Dibrugarh district (71.6%). Significant differences in disability and healthcare utilization were observed between the districts. Conclusions: NMHS 2015-16 Assam indicates significant differentials in the distribution of CMDs and SMDs, healthcare utilization, and associated disability between the three districts. The differentials necessitate further research to understand socio-ethnocultural, religious, geopolitical, and other factors influencing the distribution. These differences need to be accounted for during the implementation of mental health programs in the state.

Health care delivery model in epilepsy to reduce treatment gap: World Health Organization study from a rural tribal population of India.

PURPOSE: To design and develop an effective health care delivery model in epilepsy to reduce the treatment gap in a rural tribal community in India. METHOD: This study was conducted in tribal dominated Namkum Block (114,068 population) of Ranchi, Ranchi District, Jharkhand state, India and carried out as four-staged program-first stage consisted of separate training programs (to 6 volunteer health workers, traditional practitioners of community including 267 faith healers and qualified practitioners), second stage consisted of awareness campaign programs, third stage consisted of diagnosis, treatment delivery and follow-up in once a month camps with free medication and final stage consisted of continued follow-up after the end of study by local practitioners. RESULTS: Health volunteers identified 787 probable cases in the community, 453 attended the camps, and 318 were diagnosed and treated for epilepsy in the camp. Treatment gap was 95% on the initial assessment. 213 epileptic patients enrolled in the study completed 12 months treatment and more than 75% were seizure free at the end of the study. Eighty percent of patients' care-givers and their family members were satisfied with the care provided. At the end of study, local medical practitioners continued to do the follow-up of study participants to ensure continuity of care although results of further follow-up are not included in the present study. CONCLUSION: A four-staged program in epilepsy treatment delivery model was successful. Voluntary health workers from the community can be effectively trained to identify cases and persuade them to seek treatment. The delivery model should include intensive health awareness campaign, training of doctors and other health care providers, free supply of AEDs (Antiepileptic drugs), continuous follow-up for compliance and side-effects of the drug and tactful dealing with indigenous practitioners and faith healers without antagonising them.