Through the pandemic and its impacts, the situation has worsened. Compromised education, lockdown effects on elders, adverse impact on interpersonal relationships, effects on job security and economic fallouts have compounded the mental health situation in the state, as much as across India which has just 0.75 psychiatrists per 1 lakh population against the required 3 per 1 lakh population. This is well below the 6 per-1 lakh population in some developed countries.

Moreover, pre-pandemic figures indicate a mere 0.37% of Karnataka’s budget health expenditure was allocated to mental health. Here too, only 74.4% of the funds allocated to District Mental Health Programme (DMHP) were utilised. There are districts which have exhibited public-private initiatives in an effort to consolidate mental health management programmes. But more inclusive steps involving stakeholders’ are needed.

The Indian Constitution and the Supreme Court point to rights of individuals to mental health. But the reality is far from that.

THE ON-GROUND STATUS
There is a severe scarcity of psychiatrists in the twin districts of Chitradurga and Davanagere. Except two psychiatrists and two counsellors who are working on contract basis, there is no regular recruitment.
In Davanagere, the district has one psychiatrist and one counsellor at District Government Hospital. Along with this, there is a district mental health programme officer at Davanagere, who is recruited on a contract basis and every year his or her appointment is renewed as he or her is recruited under the National Health Mission programme.

The number of patients in private and general hospitals varies from 100 each day to 3000 each month.
In Chitradurga, except a district level mental health programme officer and a counsellor, there are no specialised sanctioned posts at taluk and public health centre (PHC) level. Every month there are about 1,500-2000 cases that are screened at the district hospital.

The Madikeri District Hospital has just one counsellor and a psychiatrist appointed to handle mental illness cases. “There are no appointments of counsellors at PHCs. The team from the district hospital conducts surveillance frequently and visits the taluk and rural health centers for consultation,” says District Health Officer Dr Venkatesh.

The number of private counselling centers is less than a handful. Residents rely on hospitals and clinics in Mysuru or Mangaluru to address mental health issues. Online support is also sought by many. There are no psychiatrists or counsellors appointed in the government taluk hospitals and PHCs in Belagavi. Only one psychiatrist works at the District Hospital.

Senior psychiatrist Dr Bheemsen Takkalaki says, “Mental health problems are huge as per the recent National Mental Health Survey by NIMHANS. The government has brought improvements by appointing psychiatrists in district hospitals but a lot more needs to be done. Awareness needs to be created among people — especially in rural areas — that there are reasons for mental health problems. There are wrong beliefs among people that mental illness is caused by black magic, and about side effects of medicines for mental disorders.”

Despite the introduction of the National Mental Health Programme (NMHP) , public health services for mental patients in Dakshina Kannada have not improved. Except for a ward in Wenlock District Hospital, there are no government facilities in the district for mentally ill patients. A clinical psychiatrist with five decades of experience in the field says incidents of families abandoning persons with mental illness is on the rise.

In most cases, affected men reach the beggars rehabilitation home in Pachanady, while women find their way to facilities run by NGOs and missionaries. “Taking care of mentally-ill patients is difficult. But it is the responsibility of families. If they are treated with love and care, they will improve,” says Prof Hilda Rayappa, a social activist.

UDUPI SETS A PPP EXAMPLE
Udupi has better facilities for mental health treatment due to public-private partnership. Psychiatrists from Kasturba Hospital, Manipal and Dr AV Baliga Memorial Hospital, Doddanagudde, have been roped in to conduct screening camps and counselling sessions across Udupi district. Sources say private doctors under this PPP method offer free consultations and issue appropriate medicines.
Psychiatrists from Kasturba Hospital and Dr AV Baliga Memorial Hospital visit various places in the neighbouring regions each month for consultation and treatment.

This ensures psychiatrists are available in all PHCs, CHCs in the district at least once a month.
Parivartana Psycho-Social Rehabilitation Centre in Kota conducts a free screening camp for mental health issues on the first Wednesday of every month. Periodic one-week training is given to doctors at PHCs and CHCs. Even nurses, ASHAs are trained in the district to identify and refer to the mental health issues among the people in the community at the grass root level. Minor issues are managed at the PHC level by doctors trained in counselling skills, while patients with severe mental illness are referred to the district hospital.

There are several mental health private practitioners in the district. Dr Ravindra Munoli, Associate Professor, Department of Psychiatry, KMC, Manipal says substance abuse cases are common of late. There has been an increase in cases pertaining to anxiety and depression and attention deficit hyperactivity disorder (ADHD). ‘‘They come for treatment quite early due to awareness’’ he says.  

STATE GEARING UP
The concept of Mano Chetana clinics at PHCs was started in 2019 and MoUs were signed with Nimhans for assistance and case references.  Randeep D, Commissioner, Health Department, says Mano Chetana clinics are held every Tuesday at PHCs, where trained doctors counsel those seeking help and prescribe medicines.

Since some psychiatric medicines are costly, and fearing this, those seeking help do not approach doctors. Randeep says e-consultation platforms have been created, wherein assistance from experts in Nimhans is being taken. As a pilot, the centres for brain health are being set up in Chikkaballapur, Jayanagar (in Bengaluru) and Kolar.

On whether doctors in PHCs are adequately qualified to prescribe medicines and explain the situation to patients, Dr Rajini P, Deputy Director Public Instructions (Mental Health), Karnataka health department, says doctors are MBBS and trained. “You do not need a psychiatrist for common psychological problems. Mostly, a person just needs someone to talk to. If you do not treat a patient at the PHC, then the burden on institutes like NIMHANS increases. With this being the aim, the NMHP was launched. Karnataka is the first state to have an integrated mental health centre.”

She says counselling and observation are done over two weeks, after which if the person is not improving then signs of biological problems become visible and Mano Chetana centres help.
Dr KV Trilokchandra, Special Commissioner, Health, Bruhat Bengaluru Mahanagara Palike (BBMP), says the brain health initiative was taken up by NIMHANS to identify people with mental health needs.

Doctors in the PHCs have been sensitised to identify those needing help when they come for health issues. A protocol on how to handle patients has also been laid out. There are many psychosomatic and hypochondriasis cases. So far one batch of doctors in Bengaluru, in the south zone, has been trained by NIMHANS to address such cases. The training is now being extended to other zones and PHCs.

THE SHIVAMOGGA EXAMPLE FOR IMPROVEMENT
Shivamogga has had more number of psychiatrists over the past several decades. Late Dr Ashok Pai was instrumental in setting up Karnataka State Mental Health Task Force in 2013. As per that, two programmes — Manochaitanya and Manasadhara — were implemented. The district has 22 psychiatrists, including six in government hospitals and four in Shivamogga Institute of Medical Sciences. District Health and Family Welfare Officer Dr Rajesh Suragihalli says, “Every Tuesday is termed ‘Super Tuesday’ when two government psychiatrists visit two taluk headquarters every week to provide medical help for both neurotic and psychotic disorders.”  The district has 20 counsellors and social workers who visit schools, colleges, workplaces like garments and other such places where more number of women work to listen to their problems and extend counselling services. The counsellors have been regularly visiting the Central jail, juvenile homes, industries and factories, says the DHO. All PHC medical officers have been imparted training for initial medical diagnosis and to provide medical help for neurotic problems.Shivamogga has made significant contributions in mental health from early 1980s. Because of a robust set-up, Shivamogga gets cases from lesser equipped neighbouring districts of Chikkamagaluru, Davanagere, Haveri, Ballari, Chitradurga, and Dharwad.

New Delhi: The Election Commission has asked the rival factions of the Shiv Sena, led by Uddhav Thackeray and Eknath Shinde, to submit documents by August 8 in support of their claims on the election symbol of the political outfit.

Election Commission sources said the two sides have been asked to submit documents, including letters of support from the legislative and organisational wings of the party and the written statements of the rival factions.

They said the requirement were made in line with the Paragraph 15 of the Election Symbols (Reservation and Allotment) Order, 1968.

Earlier this week, the Shinde faction of the Shiv Sena had written to the Commission seeking allocation of the party’s ‘bow and arrow’ election symbol to it, citing the recognition granted to them in the Lok Sabha and the Maharashtra Assembly.

The Shiv Sena split last month when more than two-thirds of the party’s MLAs withdrew their support from the Maharashtra government led by Uddhav Thackeray, throwing their lot with Shinde.

Shinde was sworn in as Maharashtra Chief Minister on June 30 with support of the BJP.

On Tuesday last, at least 12 of the 18 Shiv Sena members in the Lok Sabha expressed no confidence’ in floor leader Vinayak Raut and declared Rahul Shewale as their floor leader.

Lok Sabha Speaker recognised Shewale as the leader the same day.

To ensure that neither faction is deprived of information, the poll panel has also directed exchange of documents submitted by the two groups over the past two days.

This is the initial step, checking may come much later, explained a former EC official.

The claim over the symbol assumes significance as the Supreme Court had on Wednesday directed the Maharashtra State Election Commission to notify elections to local bodies within two weeks.

Elections are due in several civic bodies in Maharashtra, including the Brihanmumbai Municipal Corporation (BMC), which would indicate which Sena faction gets the popular support.

Earlier, the Uddhav Thackeray faction of the Shiv Sena had written to the EC, requesting it to hear its views before making any decision on representations for claims over the party name and its poll symbol.

New Delhi: A woman was allegedly raped by two railway employees in a room at the New Delhi station, the national transporter said on Saturday. Four railway employees, including two who stood guard outside the room, have been arrested.

All the four accused work in the electrical department, the Railways said.

The woman, who was found on platform 8-9 on Friday, narrated her ordeal to officials and they informed the Railway Protection Force (RPF), it said.

The woman told the officials that she has been separated from her husband for the last one year and is engaged in a court case for divorce. Around two years back, she came in contact with a man through a common friend. The man told her that he is a railway employee and can arrange a job for her too, it said.

Both of them continued talking on the phone. On July 21, the accused invited her to his house for a party to celebrate his son’s birthday and for buying a new house, according to the Railways.

He picked up the woman from Kirti Nagar metro station around 10.30 pm and brought her to platform 8-9 at the railway station. He asked her to sit in a hut for electrical maintenance staff, the national transporter said.

Later, the man came to the hut along with his friend and bolted it from inside. The two sexually assaulted the woman one after another. Two accomplices of the accused facilitated the assault by guarding the room from outside, it said.

All the four accused have been arrested. They were produced before a local court, which sent them to judicial custody, the Railways said.

Colombo: More than 1,000 valuable artefacts, including items of vintage and antique value have reportedly gone missing from Sri Lanka’s Presidential Palace and Prime Minister’s official residence at Temple Trees here after irate anti-government protesters occupied these premises earlier this month, police said on Saturday.

On July 9, anti-government protesters occupied the residences of former President Gotabaya Rajapaksa and former Prime Minister Ranil Wickremesinghe after storming into their premises and setting fire to one of the buildings protesting the government’s handling of the unprecedented economic crisis.

Based on initial investigations at least 1,000 items of value, including rare artefacts have gone missing from the Presidential Palace as well as the Prime Minister’s official residence, web portal Colombo Page quoted police sources as saying.

Special investigation teams have been formed to begin an investigation, it said.

What is compounding the agony for the investigative officers is that the Sri Lankan Department of Archaeology does not have a detailed record of the antiques and different artefacts at the Presidential Palace, even though it has been gazetted as a place of archaeological importance, the report said.

A senior official of the Department of Archaeology told Sunday Lankadeepa newspaper that it would be difficult to get specific and clear information about the exact number of antiques that have gone missing, even though police estimate that it could be well over 1,000.

Newly-elected President Ranil Wickremesinghe said he respects the rights of the protesters to peacefully undertake their demonstrations, but he asserted that he will not allow another government building like the Presidential Palace or the Prime Minister’s private residence to be occupied.

Wickremesinghe said he has authorised Sri Lanka’s armed forces and the police to take whatever action is necessary to stop people from storming public facilities and obstructing Parliament.

“Don’t obstruct the parliamentarians and the parliament from carrying out their duty,” he said this week.

In a pre-dawn raid on Friday, Sri Lankan security forces attacked a site of anti-government protesters at Galle Face, where several government offices are located, injuring at least nine persons.

Rudraprayag: An 18-year-old unmarried woman died of excessive bleeding on Saturday at a district hospital here, while the body of the baby she delivered was found in the toilet of the medical facility, officials said.

At a press conference, chief medical superintendent of the district hospital Rajiv Singh said the woman was admitted to for treatment of low hemoglobin levels and the hospital was not informed about her pregnancy.

The woman died of excessive bleeding on her hospital bed at 3 am the body of her baby was found in the toilet at 5 am, Chief Medical Officer of Rudraprayag B K Shukla told PTI.

A departmental inquiry has been ordered into the incident, the Shukla said.

Neeraj Chopra

Eugene: Olympic champion Neeraj Chopra scripted yet another history as he became only the second Indian and first male track and field athlete to win a medal in the World Championships by clinching silver in the javelin throw final here.

The 24-year-old Chopra, who had come into the showpiece as a hot medal favourite, produced a best throw of 88.13m to finish second.

The legendary long jumper Anju Booby George was the first Indian to win a medal — bronze — in the World Championships in the 2003 edition in Paris.

Chopra began with a foul throw and had 82.39m and 86.37m to be at fourth after three rounds. He got his rhythm back with a big fourth round throw of 88.13m, his fourth career-best effort, to jump to second place, which he held on to till the end. His fifth and sixth throws were fouls.

Defending champion Anderson Peters of Grenada won gold with a best throw of 90.54m while Olympic silver winner Jakub Vadlejch of Czech Republic took the bronze with 88.09m.

Chopra had topped the Group A qualification round and qualified for the final at second place behind Peters by sending his spear to 88.39m for his third career-best throw. Peters had topped Group B with an effort of 89.91m.

The other Indian in the fray, Rohit Yadav finished at 10th with a best throw of 78.72m. Rohit had finished 11th overall in the qualification round with a best throw of 80.42m.

The 21-year-old Indian had recorded a season’s and personal best of 82.54m while winning a silver at the National Inter-State Championships last month.

Chopra had won Indian athletics’ maiden gold in the Tokyo Olympics last year. He is only the second Indian to have won an individual gold in the Olympics, after shooter Abhinav Bindra, who clinched the yellow metal in 2008 Beijing Games.

Neeraj Chopra

Eugene: Olympic champion Neeraj Chopra scripted yet another history as he became only the second Indian and first male track and field athlete to win a medal in the World Championships by clinching silver in the javelin throw final here.

The 24-year-old Chopra, who had come into the showpiece as a hot medal favourite, produced a best throw of 88.13m to finish second.

The legendary long jumper Anju Booby George was the first Indian to win a medal — bronze — in the World Championships in the 2003 edition in Paris.

Chopra began with a foul throw and had 82.39m and 86.37m to be at fourth after three rounds. He got his rhythm back with a big fourth round throw of 88.13m, his fourth career-best effort, to jump to second place, which he held on to till the end. His fifth and sixth throws were fouls.

Defending champion Anderson Peters of Grenada won gold with a best throw of 90.54m while Olympic silver winner Jakub Vadlejch of Czech Republic took the bronze with 88.09m.

Chopra had topped the Group A qualification round and qualified for the final at second place behind Peters by sending his spear to 88.39m for his third career-best throw. Peters had topped Group B with an effort of 89.91m.

The other Indian in the fray, Rohit Yadav finished at 10th with a best throw of 78.72m. Rohit had finished 11th overall in the qualification round with a best throw of 80.42m.

The 21-year-old Indian had recorded a season’s and personal best of 82.54m while winning a silver at the National Inter-State Championships last month.

Chopra had won Indian athletics’ maiden gold in the Tokyo Olympics last year. He is only the second Indian to have won an individual gold in the Olympics, after shooter Abhinav Bindra, who clinched the yellow metal in 2008 Beijing Games.