Outcomes from the Sakalawara Experience
The community health care work done in the Sakalawara unit provided valuable evidence of the success of the model adopted. The strategy adopted for the management of patients consisted of prescribing a few selected drugs, giving free supply of drugs for 2- 4 weeks, counseling, making patients come for follow-up at Sakalawara unit, sending of medicines to patient through other people, making home visits in case patient did not turn up, and encouraging early rehabilitation.
CRC and others studied the management of 51 schizophrenics, 30 acute psychotics, 27 MDPs (manic depressive psychosis) and 268 epileptics in the community with minimum number of drugs. Most of the schizophrenics and epileptics had been ill for more than two years. Disability in the group was severe and most of them were a burden to their families. But once they were started on medication, all of them showed marked improvement and their disability was considerably reduced. The study of patient outcomes over three and half years showed that detection and management of mental diseases could be effectively done in the community and hospitalization was rarely required.
The main aim of the Community Psychiatry Unit was to extend mental health services into the community (meaning rural, under-served areas) by integrating mental health services with the existing system of primary health care. To make this possible, primary health care staff had to be trained in basic mental health care. Simple manuals of instructions and short-term training programs for medical officers and multipurpose workers of PHCs were developed by the team. CRC edited the manual for health workers and contributed a few chapters. He designed simple case records to be maintained by PHC staff. Pilot training programs were carried out and evaluated at Primary Health Centres at Malur and Anekal (Karnataka) between 1978 to 1980.
In 1982 regular residential training programs for medical officers and health workers in PHCs were started at the centre at Sakalawara. The health workers’ training period was 6 days and that for the medical officers was 12 days. The training was evaluated by pre and post-training assessments.
CRC was part of the team which developed ‘Manual of Mental Health for Multipurpose Workers’ and ‘Manual of Mental Health for Medical Officers’. They were printed in 1985 by NIMHANS and are being used across India and abroad to train medical and non-medical workers in mental health care.