💥Mains Ready By December. Smash Mains & Smash PYQ Admissions Open
Talk to Mentor

Civilsdaily

Login

Subject: Health

  • Outpatient Opioid Assisted Treatment Centres

    The state government in Punjab is banking on Outpatient Opioid Assisted Treatment Centres (OOAT) to curb the drug menace in the state.

    What are the OOAT Centres?

    • The move to set up OOAT centres in Punjab began in October 2017.
    • The centres administer de-addiction medicine, a combination of buprenorphine and naloxone, to the opioid-dependent people registering there.
    • Administered in the form of a pill, the treatment is primarily for addicts of opioid drugs, including heroin, poppy husk and opium.
    • There are such private and state-run centres in Punjab.

    Why is the Punjab government planning?

    • Punjab is planning to open OOAT linked extension centres and clinics in rural areas to broaden the outreach of this treatment.
    • The idea is that patients get medicine nearer their place of residence.
    • It will also reduce pressure on existing OOAT centres which cater to patients from far-off places.

    Administering medicine at OOAT Centres

    The patients are broadly put into three categories or phases.

    • In the induction phase, the newly-registered patients are administered medicine at the OOAT centres for a week or two to manage withdrawal symptoms in the presence of the doctor and counselor.
    • In the second, stabilization, phase, which extends between two to four months.
    • The patient is put on watch for taking any opioid-based “super-imposed” illicit drug and accordingly maximum tolerated dose is administered to nullify the kick of the “super-imposed” drug.
    • In the third, maintenance, phase, the patient is given take-home medicine and it continues for a year and a half before an assessment is done to see whether the medicine can be tapered off.

    Why is Punjab banking so much on OOAT therapy?

    There are two major approaches to wean away opioid-dependent persons.

    • One is the abstinence approach and another alternate medication approach.
    • There are more chances of relapse in an abstinence-based approach as compared to alternate medication for de-addiction.
    • In the abstinence approach, it would have taken years to rehabilitate patients by admitting them to facilities and there would have been increased chances of relapse.
    • On the other hand, the alternate medication approach has been acknowledged as better in various scientific studies worldwide.

    UPSC 2022 countdown has begun! Get your personal guidance plan now! (Click here)

  • The nutrition-hygiene link

    Context

    A recent UNICEF report stated that nearly 12 lakh children could die in low-income countries in the next six months due to a decrease in routine health services and an increase in wasting. Nearly three lakh such children would be from India.

    Problem of nutrition in India and factors responsible for it

    • The National Family Health Survey (NFHS 5) indicates that since the onset of the pandemic, acute undernourishment in children below the age of five has worsened.
    • According to the latest data, 37.9 per cent of children under five are stunted, and 20.8 per cent are wasted — a form of malnutrition in which children are too thin for their height.
    • Comparison with other countries: This is much higher than in other developing countries where, on average, 25 per cent of children suffer from stunting and 8.9 per cent are wasted.
    • Factors: Inadequate dietary intake is the most direct cause of undernutrition.
    • Several other factors also affect nutritional outcomes, such as contaminated drinking water, poor sanitation, and unhygienic living conditions.
    • According to the World Health Organisation, 50 per cent of all mal- and under-nutrition can be traced to diarrhoea and intestinal worm infections.
    • Nutrition and water, sanitation, and hygiene (WASH) are intricately linked, and changes in one tend, directly or indirectly, to affect the other.
    • Poor hygiene and sanitation in developing countries lead to a sub-clinical condition called “environmental enteropathy” in children.
    • Environmental enteropathy is a disorder of the intestine which prevents the proper absorption of nutrients, rendering them effectively useless.
    • Childhood diarrhoea is a major public health problem in low- and middle-income countries, leading to high mortality in children under five.
    • According to NFHS 4, approximately 9 percent of children under five years of age in India experience diarrhoeal disease.

    Way forward

    • Investment in WASH: The link between WASH and nutrition suggests that greater attention to, and investments in, WASH are a sure-shot way of bolstering the country’s nutritional status.
    • Addressing nutrition sanitation problems together: Both WASH and nutrition must be addressed together through a lens of holistic, sustainable community engagement to enable long-term impact.
    • One of the first instances of the link between WASH and nutrition appeared in the Convention on the Rights of the Child in 1989, which urges states to ensure “adequate nutritious foods and clean drinking water” to combat disease and malnutrition.
    • Safe drinking water, proper sanitation, and hygiene can significantly reduce diarrhoeal and nutritional deaths.
    • Multistructural approach: What we require is a coordinated, multisectoral approach among the health, water, sanitation, and hygiene bodies, not to mention strong community engagement.
    • WHO has estimated that access to proper water, hygiene, and sanitation can prevent the deaths of at least 8,60,000 children a year caused by undernutrition.

    Conclusion

    At the end of the day, all sides are working towards a common goal: A safe and healthy population and the hope that the 75th year of Independence becomes a watershed moment in India’s journey.

    UPSC 2022 countdown has begun! Get your personal guidance plan now! (Click here)

  • Why India needs an NHS-like healthcare model

    Context

    Even after the pandemic, the Indian government continues to budget less than 1 per cent of GDP for healthcare, one of the lowest in the world.

    About NHS

    • Every year, Britain’s legendary health network National Health Service (NHS) cures 15 million patients with chronic ailments, at a fraction of the cost spent by the US.
    • The NHS funded by direct taxes is also the fifth largest employer in the world, after McDonalds and Walmart.
    • One of every 20 British workers is employed as a doctor, nurse, catering and technical personnel.

    Public healthcare in India

    • Even after the pandemic, the Indian government continues to budget less than 1 per cent of GDP for healthcare, one of the lowest in the world.
    • In contrast, China invests around 3 per cent, Britain 7 per cent and the United States 17 per cent of GDP.
    • So, 62 per cent of health expenses in India are paid for by patients themselves
    • This is one of the main reasons for families falling into poverty especially during the pandemic.
    • In India, hospitals are beleaguered with absentee staff.
    • As per a Niti Aayog database, in the worst state of Bihar in 2017-18, positions for 60 per cent of midwives, 50 per cent of staff nurses, 34 per cent of medical officers and 60 per cent of specialist doctors were vacant.
    • Those on the job, despite being handsomely paid, are chronically overworked.

    Conclusion

    In the 21st century, not much has improved in India’s public hospitals. Still, in India doctors are often equated with gods. What India needs in NHS like healthcare model.

    UPSC 2022 countdown has begun! Get your personal guidance plan now! (Click here)

  • PM announces Rice Fortification Plan

    PM in his I-day speech has announced the fortification of rice distributed under various government schemes, including the Public Distribution System (PDS) and mid-day meals in schools, by 2024.

    What is Fortification?

    • FSSAI defines fortification as “deliberately increasing the content of essential micronutrients in a food so as to improve the nutritional quality of food and to provide public health benefit with minimal risk to health”.

    What is Fortified Rice?

    • Rice can be fortified by adding a micronutrient powder to the rice that adheres to the grains or spraying the surface of ordinary rice grains with a vitamin and mineral mix to form a protective coating.
    • Rice can also be extruded and shaped into partially precooked grain-like structures resembling rice grains, which can then be blended with natural polished rice.
    • Rice kernels can be fortified with several micronutrients, such as iron, folic acid, and other B-complex vitamins, vitamin A and zinc.
    • These fortified kernels are then mixed with normal rice in a 1:100 ratio, and distributed for consumption.

    Note: Biofortification is the process by which the nutritional quality of food crops is improved through agronomic practices, conventional plant breeding, or modern biotechnology. It differs from conventional fortification in that Biofortification aims to increase nutrient levels in crops during plant growth rather than through manual means during the processing of the crops.

    What is the plan announced by the PM?

    • Malnutrition and lack of essential nutrients in poor women and poor children pose major obstacles in their development.
    • In view of this, it has been decided that the government will fortify the rice given to the poor under its various schemes.
    • Be it the rice available at ration shops or the rice provided to children in their mid-day meals, the rice available through every scheme will be fortified by the year 2024.

    Why such a move?

    • The announcement is significant as the country has high levels of malnutrition among women and children.
    • According to the Food Ministry, every second woman in the country is anemic and every third child is stunted.
    • India ranks 94 out of 107 countries and is in the ‘serious hunger’ category on the Global Hunger Index (GHI).
    • Fortification of rice is a cost-effective and complementary strategy to increase vitamin and mineral content in diets.
    • According to the Food Ministry, seven countries have mandated rice fortification – the USA, Panama, Costa Rica, Nicaragua, Papua New Guinea, Philippines, and the Solomon Islands.

    Advantages offered

    • Health: Fortified staple foods will contain natural or near-natural levels of micro-nutrients, which may not necessarily be the case with supplements.
    • Taste: It provides nutrition without any change in the characteristics of food or the course of our meals.
    • Nutrition: If consumed on a regular and frequent basis, fortified foods will maintain body stores of nutrients more efficiently and more effectively than will intermittently supplement.
    • Economy: The overall costs of fortification are extremely low; the price increase is approximately 1 to 2 percent of the total food value.
    • Society: It upholds everyone’s right to have access to safe and nutritious food, consistent with the right to adequate food and the fundamental right of everyone to be free from hunger

    Issues with fortified food

    • Against nature: Fortification and enrichment upset nature’s packaging. Our body does not absorb individual nutrients added to processed foods as efficiently compared to nutrients naturally occurring.
    • Bioavailability: Supplements added to foods are less bioavailable. Bioavailability refers to the proportion of a nutrient your body is able to absorb and use.
    • Immunity issues: They lack immune-boosting substances.
    • Over-nutrition: Fortified foods and supplements can pose specific risks for people who are taking prescription medications, including decreased absorption of other micro-nutrients, treatment failure, and increased mortality risk.

    Adhering to FSSAI standard

    The Food Safety and Standards Authority of India (FSSAI) sets standards for food items in the country.

    • According to FSSAI norms, 1 kg fortified rice will contain iron (28 mg-42.5 mg), folic acid (75-125 microgram), and Vitamin B-12 (0.75-1.25 microgram).
    • In addition, rice may also be fortified with micronutrients, singly or in combination, with zinc(10 mg-15 mg), Vitamin A (500-750 microgram RE), Vitamin B1 (1 mg-1.5 mg), Vitamin B2 (1.25 mg-1.75 mg), Vitamin B3 (12.5 mg-20 mg) and Vitamin B6 (1.5 mg-2.5 mg) per kg.

    UPSC 2022 countdown has begun! Get your personal guidance plan now! (Click here)

    Back2Basics: Public Distribution System (PDS)

    • The PDS is an Indian food Security System established under the Ministry of Consumer Affairs, Food, and Public Distribution.
    • PDS evolved as a system of management of scarcity through the distribution of food grains at affordable prices.
    • PDS is operated under the joint responsibility of the Central and State Governments.
    • The Central Government, through the Food Corporation of India (FCI), has assumed the responsibility for procurement, storage, transportation, and bulk allocation of food grains to the State Governments.
    • The operational responsibilities including allocation within the State, identification of eligible families, issue of Ration Cards and supervision of the functioning of FPSs etc., rest with the State Governments.
    • Under the PDS, presently the commodities namely wheat, rice, sugar, and kerosene are being allocated to the States/UTs for distribution.
    •  Some states/UTs also distribute additional items of mass consumption through PDS outlets such as pulses, edible oils, iodized salt, spices, etc.

    Mid-Day Meal Scheme

    • The Midday Meal Scheme is a school meal program in India designed to better the nutritional standing of school-age children nationwide.
    • It is a wholesome freshly-cooked lunch served to children in government and government-aided schools in India.
    • It supplies free lunches on working days for children in primary and upper primary classes in government, government-aided, local body, and alternate innovative education centers, Madarsa and Maqtabs.
    • The programme has undergone many changes since its launch in 1995.
    • The Midday Meal Scheme is covered by the National Food Security Act, 2013.

    The scheme aims to:

    1. avoid classroom hunger
    2. increase school enrolment
    3. increase school attendance
    4. improve socialization among castes
    5. address malnutrition
    6. empower women through employment

  • Issues related to people with disabilities

    Context

    Twenty years ago on August 6 in Erwadi in Tamil Nadu’s Ramanathapuram, a fire broke out in a thatched shelter, engulfing 43 chained people who had psychosocial disabilities.

    Legal provision for the persons with disabilities

    • India ratified the Convention on the Rights of Persons with Disabilities (CRPD) in 2007.
    • The Rights of Persons with Disabilities Act  was enacted in 2016.
    • The Mental Healthcare Act (MHCA) was enacted in 2017.

    Failure of the states

    • Sates have failed to uphold the human rights of people with disabilities in general and those with psychosocial and intellectual disabilities in particular.
    • Only eight states/UTs — Karnataka, Andhra Pradesh, Uttar Pradesh, Jammu & Kashmir, Maharashtra, Odisha, Kerala, and West Bengal — have framed rules for implementation of MHCA.
    • Unless we implement the law in letter and spirit, the Global Mental Health Movement will remain a mere buzzword and the CRPD-reliant MHCA will remain a law only on paper.

    Violations of rights in private asylums

    • Private asylums survive because of their close proximity to faith-based healing centres.
    • Because mental health conditions carry a high stigma, caregivers flock to these faith-based facilities in the hopes of finding a cure.
    • Private players take advantage of their vulnerabilities, forcing such persons with psychosocial issues to be grouped together and chained in these shelters.
    • Chaining in any way or form is outlawed under Section 95 of the MHCA.

    Way forward

    • Human right approach: We must work to ensure that the human rights approach to disability is integrated into mental health systems, education, law, and bureaucracy.
    • We move away from pathologisation, segregation, and a charity-based approach.

    Conclusion

    Implementation of rights of the persons with disability needs implementation in letter and spirit and human rights based approach.

  • [pib] SATYAM Programme

    The Ministry of Science & Technology (MoST) is implementing the Science and Technology of Yoga and Meditation (SATYAM) Programme to explore the effect of yoga and meditation as add on therapy to fight COVID-19.

    SATYAM Programme

    • The MoST is implementing SATYAM Programme since the year 2015-16 to promote scientific research in the field of yoga and meditation in order to understand its role in human wellbeing.
    • Its main objective is encouraging scientists, clinicians and experienced practitioners of yoga and meditation, with a proven track record, to submit concept notes.

    Themes covered:

    • Investigations on the effect of Yoga and Meditation on physical and mental health and well being.
    • Investigations on the effect of Yoga and Meditation on the body, brain, and mind in terms of basic processes and mechanisms.

    Focus on COVID

    It shall focus on three dimensions of COVID related illness:

    • Mental Stress
    • Respiratory
    • Immune system

  • Organ Transplantation in India

    The Government of India is implementing National Organ Transplant Programme (NOTP) to promote organ donation and transplantation across all States/Union Territories (UTs).

    National Organ Transplant Programme (NOTP)

    • In 2019, the GoI implemented the NOTP for promoting deceased organ donation.
    • Organ donation in India is regulated by the Transplantation of Human Organs and Tissues Act, 1994.

    Types of Organ Donations

    • The law allows both deceased and living donors to donate their organs.
    • It also identifies brain death as a form of death.
    • Living donors must be over 18 years of age and are limited to donating only to their immediate blood relatives or, in some special cases, out of affection and attachment towards the recipient.

    (1) Deceased donors:

    • They may donate six life-saving organs: kidneys, liver, heart, lungs, pancreas, and intestine.
    • Uterus transplant is also performed, but it is not regarded as a life-saving organ.
    • Organs and tissues from a person declared legally dead can be donated after consent from the family has been obtained.
    • Brainstem death is also recognized as a form of death in India, as in many other countries.
    • After a natural cardiac death, organs that can be donated are cornea, bone, skin, and blood vessels, whereas after brainstem death about 37 different organs and tissues can be donated, including the above six life-saving organs

    (2) Living donors:

    They are permitted to donate the following:

    • one of their kidneys
    • portion of pancreas
    • part of the liver

    Features of the NOTP

    • Under the NOTP a National Level Tissue Bank (Biomaterial Centre) for storing tissues has been established at National Organ and Tissue Transplant Organization (NOTTO), New Delhi.
    • Further, under the NOTP, a provision has also been made for providing financial support to the States for setting up of Bio- material centre.
    • As of now a Regional Bio-material centre has been established at Regional Organ and Tissue Transplant Organization (ROTTO), Chennai, Tamil Nadu.

    More moves for facilitation:  Green Corridors

    • Studies have suggested that the chances of transplantation being successful are enhanced by reducing the time delay between harvest and transplant of the organ.
    • Therefore, the transportation of the organ is a critical factor. For this purpose, “green corridors” have been created in many parts of India.
    • A “green corridor” refers to a route that is cleared out for an ambulance carrying the harvested organs to ensure its delivery at the destination in the shortest time possible.

    About NOTTO

    National Organ and Tissue Transplant Organization (NOTTO) is a national level organization set up under the Directorate General of Health Services, Ministry of Health and Family Welfare.

    1. National Human Organ and Tissue Removal and Storage Network
    2. National Biomaterial Centre (National Tissue Bank)

    [I] National Human Organ and Tissue Removal and Storage Network

    • This has been mandated as per the Transplantation of Human Organs (Amendment) Act 2011.
    • The network will be established initially for Delhi and gradually expanded to include other States and Regions of the country.
    • Thus, this division of the NOTTO is the nodal networking agency for Delhi and shall network for Procurement Allocation and Distribution of Organs and Tissues in Delhi.
    • It functions as apex centre for All India activities of coordination and networking for procurement and distribution of Organs and Tissues and registry of Organs and Tissues Donation and Transplantation in the country.

    [II] National Biomaterial Centre (National Tissue Bank)

    • The Transplantation of Human Organs (Amendment) Act 2011 has included the component of tissue donation and registration of tissue Banks.
    • It becomes imperative under the changed circumstances to establish National level Tissue Bank to fulfill the demands of tissue transplantation including activities for procurement, storage and fulfil distribution of biomaterials.
    • The main thrust & objective of establishing the centre is to fill up the gap between ‘Demand’ and ‘Supply’ as well as ‘Quality Assurance’ in the availability of various tissues.

    The centre will take care of the following Tissue allografts:

    1. Bone and bone products
    2. Skin graft
    3. Cornea
    4. Heart valves and vessels

  • A cardinal omission in the COVID-19 package

    Context

    On July 8, 2021, the Union government announced the “India COVID-19 Emergency Response and Health Systems Preparedness Package: Phase II”. But it lacks provision for the medical workforce.

    Objectives of the package

    • The stated purpose of the package is to boost health infrastructure and prepare for a possible third wave of COVID-19.
    • There is plan to increase COVID-19 beds, improve the oxygen availability and supply, create buffer stocks of essential medicines; purchase equipment and strengthen paediatric beds.

    What is lacking in the package?

    • Workforce shortage: The package barely has any attention on improving the availability of health human resources.
    • As reported in rural health statistics and the national health profile there are vacancies for staff in government health facilities, which range from 30% to 80% depending upon the sub-group of medical officers, specialist doctors to nurses, laboratory technicians, pharmacists and radiographers, amongst others.
    • Interstate variation: In addition, there are wide inter-State variations, with States that have poor health indicators with the highest vacancies.

    Way forward

    • Package for filling the existing vacancies: The COVID-19 package II needs to be urgently supplemented by another plan and a similar financial package (with shared Union and State government funding) to fill the existing vacancies of health staff at all levels. 
    • An objective approach to assess the mid-term health human resource needs could be the Indian Public Health Standards (IPHS).
    • IPHS prescribes the human resources and infrastructure needed to make various types of government health facilities functional.
    • The pandemic should be used as an opportunity to prepare India’s health system for the future.
    • Scrutiny of the progress on policy decision: The progress on key policy decisions, for the last few years, to strengthen India’s health system, including those in India’s national health policy of 2017, need to be objectively scrutinised.
    • These two sets of policy decisions should be reviewed and progress monitored, through a meeting of the Central Council of Health and Family Welfare, of which the Health Ministers of the States are members.

    Conclusion

    India’s health system will not benefit from ad hoc and a patchwork of one or other small packages. It essentially needs some transformational changes.

  • How China eliminated malaria and the road ahead for India

    Recently, El Salvador and China were declared malaria-free by the WHO.

    What is Malaria?

    • Malaria is a disease caused by a parasite called plasmodium vivax, p. filarium.
    • The parasite is spread to humans through the bites of infected mosquitoes.
    • People who have malaria usually feel very sick with a high fever and shaking chills.
    • While the disease is uncommon in temperate climates, malaria is still common in tropical and subtropical countries.

    How many countries have successfully eliminated malaria?

    • Since 1900, 127 countries have registered malaria elimination. This is definitely not an easy task.
    • It needs proper planning and a strategic action plan based on the local situations.
    • All these countries followed the existing tools and strategies to achieve the malaria elimination goal.
    • The main focus was on surveillance.
    How did China eliminate malaria?
    • China followed some specific strategies, namely strong surveillance following the ‘1-3-7’system: malaria diagnosis within 1 day, 3 days for case investigation and by day 7 for public health responses.
    • Molecular Malaria Surveillance for drug resistance and genome-based approaches to distinguish between indigenous and imported cases was conducted.
    • All borders to the neighboring countries were thoroughly screened to prevent the entry of unwanted malaria into the country.

    What is the current scenario of malaria in India?

    • As per the Global Malaria Report 2020 by the World Health Organization (WHO) India shared 2% of the total global malaria cases in 2019.
    • India has a great history of malaria control.
    • The highest incidence of malaria occurred in the 1950s, with an estimated 75 million cases with 0.8 million deaths per year.
    • The launch of National Malaria Control Programme in 1953 and the National Malaria Eradication Programme in 1958 made it possible to bring down malaria cases to 100,000 with no reported deaths by 1961.
    • This is a great achievement been made so far.

    Unexpected resurgence

    • But from a nearing stage of elimination, malaria resurged to approximately 6.4 million cases in 1976.
    • Since then, confirmed cases have decreased to 1.6 million cases, approximately 1100 deaths in 2009 to less than 0.4 million cases and below 80 deaths in 2019.
    • India accounted for 88% of malaria cases and 86% of all malaria deaths in the WHO South-East Asia Region in 2019.
    • It is the only country outside Africa among the world’s 11 `high burden to high impact’ countries.

    Road ahead for India

    Collaboration:

    • India is a signatory to National Framework for Malaria Elimination (NFME) 2016-2030 aiming for malaria elimination by 2030.
    • This framework has been outlined with a vision to eliminate the disease from the country which would contribute to improved health with quality of life and poverty alleviation.
    • China collaborated with Harvard University and the Massachusetts Institute of Technology, USA for Molecular Malaria Surveillance.
    • In India, there are very dedicated expert scientists who can take up such assignments.

    Diagnosis:

    • India stands at a very crucial stage. The present challenge is the detection of asymptomatic cases in most endemic areas.
    • Molecular Malaria Surveillance must be used to find out the drug-resistant variants and genetic-relatedness studies to find out the imported or indigenous cases.
    • The surveillance must be strengthened and using smart digital surveillance devices would be an important step. Real-time and organic surveillance is needed even in remote areas.

    Monitoring:

    • The results of each malaria case can be registered in a central dashboard at the National Vector Borne Disease Control Programme, as it is done for COVID-19 cases by Indian Council of Medical Research.
    • All intervention activities must strictly be monitored.
    • Vector biology, site of an actual vector mosquito bite, host shifting behaviour, feeding time, feeding behaviour and insecticide resistance studies need to be carried out to support the elimination efforts.

  • Mental health care in India

    Context

    Recently, a High Court suggested that homeless persons with health conditions be branded with a permanent tattoo, when vaccinated against COVID-19.

    Issue

    • In many countries, persons with severe mental health conditions live in shackles in their homes, in overcrowded hospitals, and even in prison.
    • On the other hand, many persons with mental health issues live and even die alone on the streets.
    • Three losses dominate the mental health systems narrative: dignity, agency and personhood.
    • Issues with the laws: Far-sighted changes in policy and laws have often not taken root and many laws fail to meet international human rights standards.
    • Many also do not account for cultural, social and political contexts resulting in moral rhetoric that doesn’t change the scenario of inadequate care.
    • There is also the social legacy of the asylum, and of psychiatry and mental illness itself, that guides our imagination in how care is organised.

    Way forward: A responsive care system

    • We must understand mental health conditions for what they are and for how they are associated with disadvantage.
    • These situations are linked, but not always so, therefore, not all distress can be medicalised.
    • Adopt WHO guidelines: Follow the Guidance on Community Mental Health Services recently launched by the World Health Organization.
    • The Guidance, which includes three models from India, addresses the issue from ‘the same side’ as the mental health service user and focuses on the co-production of knowledge and on good practices.
    • Drawn from 22 countries, these models balance care and support with rights and participation.
    • Open dialogue: The practice of open dialogue, a therapeutic practice that originated in Finland, runs through many programmes in the Guidance.
    • This approach trains the therapist in de-escalation of distress and breaks power differentials that allow for free expression.
    • Increase investment: With emphasis on social care components such as work force participation, pensions and housing, increased investments in health and social care seem imperative.
    • Network of services: For those homeless and who opt not to enter mental health establishments, we can provide a network of services ranging from soup kitchens at vantage points to mobile mental health and social care clinics.
    • Small emergency care and recovery centres for those who need crisis support instead of larger hospitals, and long-term inclusive living options in an environment that values diversity and celebrates social mixing, will reframe the archaic narrative of how mental health care is to be provided.

    Conclusion

    Persons with mental health conditions need a responsive care system that inspires hope and participation without which their lives are empty. We should endeavour to provide them with such a responsive care system.