Within three years of the launch of Prerna Prakalp programme that was started to prevent suicides among farmers due to growing agrarian and financial distress, constant vacancies and lack of staff continue to hamper the mental health programme in Maharashtra.
The programme started in 2015 across 14 districts that recorded a high incidence of farmer suicides. Latest data with the Directorate of Health Services (DHS) shows until February 2018, 16,968 farmers have been diagnosed depressed. Of these a significant 58 per cent cases (9,905 farmers) are in Amravati, followed by Latur with 2,101 depression cases.
The programme’s reach, however, remains poor in several districts despite a high incidence of depression. For instance, in Yavatmal only 74 farmers have been found suffering from depression, in Hingoli 66, and in Osmanabad not even a single depression case has been recorded, data from DHS shows.
These are also the districts with a vacant post for psychiatrist. Of 14 districts where Prerna Prakalp programme runs, five – Osmanadabad, Jalna, Hingoli, Yavatmal and Washim – have no psychiatrist. Of 92 posts sanctioned for paramedical staff, doctors and psychiatrists under the programme, 23.9 per cent or 22 posts remain vacant.
“There are other issues. Whenever our health workers detect a depression case, if he is not a farmer, getting treatment for him becomes difficult,” said Yogini Dolke, attached with Srijan NGO.
Dolke added that last month an 18-year-old daughter of a farmer was diagnosed with depression in Zari Jamni taluka of Yavatmal. “But the doctor who visited the village refused to take up a new case. We had to travel 120 km to Yavatmal civil hospital for her counselling,” Dolke said.
In Yavatmal, lack of psychiatrist and paramedical staff has not just hampered the follow-up of farmers already diagnosed as depressed, but even affected new depression cases. “What about depression amongst wives of farmers who commit suicide? They are not being counselled because there isn’t enough staff,” Dolke said.
At least 25.12 lakh farmers have been screened for depression, hypertension, diabetes, heart ailment, stroke and cancer by the state government. In total, 1.11 lakh have been referred to rural, district or sub-district government hospitals after getting diagnosed with any one ailment. There is, however, no data of those who dropped out of follow-up treatment. In Amravati, Rahul Bais, attached with Swarajya Mitra, said that the issue of depression among farmers’ widows remains unaddressed.
“These women not just face personal trauma, but also deal with legal hassles of land ownership and worry about their children’s future. The programme does not capture them entirely,” Bais said. He added that even depressed farmers are not being counselled regularly. State health officials said that since a post for psychiatrist is filled on contractual basis, regular vacancies cannot be prevented. “Every time a psychiatrist resigns, we have to train a new one to replace him. The process takes time,” a DHS official said.
According to Seema Kulkarni, attached with NGO Makaam, there is also need for active involvement of Accredited Social Health Activists (ASHA) to routinely follow up with cases in which farmers or their family are diagnosed as depressed. “The program needs better implementation,” she said.
Maharashtra government now plans to scale up mental health program to 25 districts this year. Each district will have a team of six- a psychiatrist, doctor, and three to four paramedical staff.
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