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DIMAPUR — Even as the world observes World Mental Health Day on the theme “Mental Health at Work,” Nagaland finds itself grappling with rudimentary mental health infrastructure and a severe shortage of skilled professionals, despite a growing need for mental health services.
According to the information provided by the Department of Health and Family Welfare, the state’s only dedicated facility, the State Mental Health Institute Kohima (SMHIK), provides essential services like out and in-patient departments, and emergency services. It also trains future healthcare professionals, offering academic classes to nursing students and internship opportunities for psychology and social work students.
However, the District Mental Health Programme (DMHP), launched in 2016, struggles with limited reach. While the programme exists in five districts—Dimapur, Kohima, Longleng, Phek, and Mokokchung—its effectiveness is hampered by a lack of awareness and accessibility issues in other districts.
Severe shortage of professionals
The WHO recommends at least three practicing psychiatrists per lakh population. Unfortunately, Nagaland falls drastically short of this benchmark with less than ten psychiatrists for a population nearing 20 lakh (as per 2011 Census), which is even lesser than India’s inadequate average of 0.75 psychiatrists per lakh population, as per the 2015-16 National Mental Health Survey.
This shortage is acutely felt within the DMHP, as the Dimapur branch urgently needs a Clinical Psychologist and has been operating without one since July 2024, according to Dr. Temsuyanger, Psychiatrist at the Dimapur DMHP.
He said that from 2016 to September 2024, the DMHP registered 3,645 patients, with drug dependence, depression, and alcohol dependence being the most common conditions.
Notably, between August 2022-2023, a total of 819 new patients were registered, while there were 856 follow-up visits. This increased to 886 new patients and 824 follow-up visits between September 2023 and August 2024, indicating an upward trend.
The psychiatrist also revealed that DHMP has a psychiatrist, a psychiatric nurse, a social worker, and a community nurse and support staff.
Meanwhile, at the Mokokchung DMHP, Akumjungla, a psychiatric nurse, shared that the centre has been functioning without a psychiatrist since 2022. “It is very difficult for us to run without Psychiatrist”, she said, adding that the centre heavily relies on tele-consultations with Dr. Temsuyanger.
Adding to their woes, the Mokokchung DMHP faces frequent medicine shortages. With limited supplies and a growing patient load, patients are often forced to buy from private pharmacies at higher rates.
The centre has a clinical psychologist, a psychiatric social worker, a community nurse, a computer assistant and a ward attendant including herself, and since its launch, it has registered 1013 patients with at least 40 to 70 follow up visits in a month, she said.
The status of the DHMPs in the other two districts could not be ascertained as the helpline numbers provided in the Health department’s portal could not be reached.
Infrastructural needs
Beyond the shortage of trained professionals, the existing mental health infrastructure is severely also inadequate.
Dr. Temsuyanger told Eastern Mirror that the Dimapur DMHP, housed in an old, eight-bed facility, has a leaky ceiling making operations during the monsoon season a challenge. The centre also faces floods during this season and space constraints hamper their ability to run the drug de-addiction unit effectively, with no dedicated recreation room for inpatients and no waiting area for those visiting the OPD.
The Mokokchung DMHP faces its own set of challenges, as Akumjungla pointed out that the OPD operates from a separate building, making it physically isolated. This, she said, contributes to a lack of awareness about the centre’s services, even as the patient load continues to increase. To bridge this gap, the centre in collaboration with schools, churches and organisations, organises mental health awareness campaigns, she added.
Role of NGOs
Meanwhile, non-governmental organisations like the Gracious Life Foundation, founded by Lisali Humtsoe -- a member of the recently formed State Mental Health Authority -- are striving to fill the gaps in mental health services.
Humtsoe said that the foundation is the only NGO in the state that offers both prevention and intervention homes for people suffering from mental health issues.
Noting the status of the DMHPs in the state, she expressed hope that the SMHA would soon come up with policies and guidelines to improve the mental wellbeing of the people in the state.
“We are lagging behind in fighting the problem”, she said, adding that the foundation, in its two years of existence, is already struggling to find funding.
At present, Humtsoe who has been in the profession for over nine years, said that the foundation aims to reach the grassroots across the state, but due to the lack of resources, its work is limited within Dimapur and Chümoukedima districts.
Collaboration and awareness
Furthermore, Humtsoe stressed the importance of collaboration between NGOs and the government to effectively address mental health needs in Nagaland.
“NGOs and government, if we collaborate, we can fill in the gaps,” she maintained.
She went on to state that the foundation has trained over 130 psychology students from within and outside the state. “Since we are short of professional workers, we try to train as many as we can,” she continued, adding that they have also trained over 60 Accredited Social Health Activists (ASHAs) from Dimapur and Chümoukedima.
Identifying the lack of awareness as one of the reasons why people do not seek help, Dr. Tensuyanger suggested introducing a chapter on mental health in the school curriculum. This will ensure that children grow up with an understanding of the issue and gradually enable the eradication of mental health problems.
For short term awareness, the psychiatrist opined that people should first understand the issue as a “collective problem” and NGOs, churches and village councils should be equally pro-active in facing the problem.
The psychiatrist, who has over 26 years of experience, also suggested that all stakeholders must organise awareness campaigns and invite professionals to address the issue.
Noting the growing number of people fighting with mental health issues, he opined that a government-run rehabilitation centre would be of great help.