Mental Health Needs in Manipur

By Prof K B Kumar *

Manipur literally means a jewel-land. Buffeted by lush, picturesque hills and valleys, Manipur should have been idyllic. 60% of literacy rates, a large women work force, basically hard working nature, occupational multiplicity, ability to adapt to a new situation fast, a prosperous society - no beggars on the street, no servants in homes, no starvation etc. Manipur should have been the most progressive State and sought after tourist's destination of the country.

But in the last four decades, the glamour of this culturally rich State has fallen in the web of violence. Whatever may be the reasons behind the evolution of the movement this bleeding portion of the Nation has kept the entire people of the country disturbed. Common citizens who want a normal and peaceful life are fed up with the no-win situation.

Deployment of security forces in the State to handle the situation caused lot of stress and strain to common citizens and different forms of violence have disrupted the socio-economic development of the people. Economic hardship and compounding unemployment problem have led youths to drug trafficking, arm trading etc. for easy money. Such mayhem has caused psychological trauma to the public.

Psychological effect

The strife-torn Manipur today is under siege, reeling under the fallout of nearly four decades of insurgency. All houses have tall iron gates—to keep out miscreants. Fear of coming out is all-pervasive. Corruption, unemployment, poverty, poor social infrastructure and the absence of even minimal civic services mark life in Manipur. The damage is psychological as well as physical. For the sake of fighting for freedom, cadres live a very insecure life. Keeping on offensive and defensive modes preoccupy their minds.

Majority of these cadres live in deep jungles where normal communication and life is snapped. Once they are separated from their loved and dear ones, they too face mental stresses and it affects their behaviour. Frustration, threat and conflict are expressed in the form of sexual and physical abuse, alcohol and drug abuse, indulgence in indiscriminate harm against oneself and others etc. Most social scientists have emphasized a causal relationship between mental illness and terrorism. Several lines of evidence suggest intolerance, violence, social crime, communal tension etc. negatively impacts the lives of people particularly with mental illness and society as a whole. Another important factor is that individuals who live in a stressful, unpredictable environment with little family or community support may be at increased risk for violent behaviour.

The risk for violent behavior is related to, among other factors, low socio-economic status, social stress, social isolation, poor self-esteem and personality problems. The importance of conducting a survey on the prevalence of mental illness in the region to effectively bridge the gap between infrastructural needs, manpower resources and existing conditions and rehabilitation of those traumatized is often talked about.

But a difficult geographical terrain and inaccessibility of places makes reaching across to the common man has made this task an arduous. Studies have indicated Manipur is one of the States with the highest prevalence of HIV and epidemic is increasing among the general population primarily through heterosexual sex and injecting drug use. Most injecting drug users (IDUs) are men, an estimated 40% are married, and death rates have been high in the last five years.

Due to HIV-related deaths there are increasing numbers of IDU widows, many of whom are HIV infected, and experiencing poor health, social isolation, discrimination and poverty. All these factors compromise their mental health. Mental health care in the North East region particularly insurgency affected regions like Manipur needs considerable improvement. Acute shortage of trained human resources in this region and inaccessibility of certain areas make the task of extending both hospital-based and community-based services a difficult, but not impossible proposition.

The social psychologists emphasize on the three key determinants of community and individual mental health viz. social inclusion, freedom from discrimination and violence, and access to economic resources. All these three elements are utterly lacking in this part of the country. Mental health promotion in this region therefore should address improving the social, physical and economic environments that influence mental health.

In addition, actions to promote mental health can be designed to foster protective factors in individuals such as coping capacity and resilience; increase connections between individuals and communities; create opportunities for income generation and employment; assist in community mobilization; and address stigma and discrimination.

Innovative approach to development that highlights local community strengths (relationships and assets), achievements and visions, rather than the more conventional focus on community problems, deficiencies and needs should be considered and implement in all activities. This approach assists communities to design and apply their own strategies to promote positive and sustainable change. This kind of "Appreciative Inquiry" approach moves through four phases; Discovery, Dreaming, Designing and Delivery/Destiny.

Information about the health issue and local attributes and successes are used by the community to create a vision of what they can achieve if their strengths are mobilized. The community develops and applies strategies to address the health problem. Such structured and facilitated participatory action on strengths-based approach will improve mental health and reduce likelihood in developing disorders. All these objectives need enormous trained human resources that are sensitive to prevailing psychosocial and geopolitical environment. Unfortunately facility for augmenting human resource development unlike at parts of the country is limited in NE regions.

The Department of Clinical Psychology

The Department of Clinical Psychology at RIMS, Imphal is the only one of its kind in the whole of North Eastern region responsible for offering training in clinical psychology and producing professional Clinical Psychologists for the entire 7 States. Beginning made in year 2003 the department has already contributed more than 50 professional clinical psychologists to NE region.

Though started off with usual bureaucratic hiccups and facing constant threat of closure due to fund crunch, the department of clinical psychology in less than a decade's time has grown to be one of the premier training and service institutes in the country. The two-year M.Phil Clinical Psychology training course conducted at this department (affiliated to Manipur University and recognized by the Rehabilitation Council of India—A Statutory body under Ministry Social Justice and Empowerment, New Delhi) is generic, covering all types of patient & setting and a wide range of assessment & treatment techniques.

The contributions of the department in the last 6 – 7 years in improving the efficiency of psychiatric and psychosocial services in the region are significant. The theoretical orientation is mostly cognitive-behavioural, but the department is also open to other perspectives. Multidisciplinary approach guides students in their clinical work.

The faculty members over time has developed more effective psychological intervention strategies appropriate for people of this region by combining eastern and western approaches. With excellent faculty supervision, students offer individual, couple, family, and group counselling, testing and assessment, and other services to residents of this region.

Being located in a general hospital the department has links with other health care departments like neurology, neurosurgery, paediatrics, medicine, and other specialized departments of the hospital and caters to psychological issues associated with physical diseases, thereby epitomizing primary health care delivery in this region. The department is closely linked with the department of psychiatry in all its role/activities.

The faculty members of psychiatry department lend their expertise, supervise certain aspects of clinical training, facilitate data collection of the trainees' research work and support with infrastructural requirements. Thus, both of these departments work in collaborative manner to promote mental health service in this region. The departmental orientation, curriculum, research activities and clinical placements reflect its emerging new identity.

Recently, the department also has been recognized as centre for enrolling scholars for Doctoral Degree (Ph.D). With the mission to provide excellent hands-on training for future clinical psychologists who will provide outstanding professional service to their clients and demonstrate special expertise when working with clients affected by social tension, trauma and abuse, there is no doubt that growth and development of the Department of Clinical Psychology, under able guidance of Prof. Akshayakumar Singh, have significant implications for the effectiveness of mental health service delivery in the country particularly NE States.