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Aim: To assess the health-care needs of the patients with severe mental disorders. Materials and Methods: Patients with the diagnosis of a severe mental disorder (schizophrenia and related psychotic disorders, bipolar disorder, recurrent depressive disorder, major depressive disorder and obsessive compulsive disorder) were assessed using Camberwell Assessment of Need-Research version (CAN-R) Scale and indigenously designed Supplementary Needs Assessment Scale (SNAS). Results: The study included 1494 patients recruited from 15 centers. The most common diagnostic group was that of affective disorders (55.3%), followed by psychotic disorders (37.6%). The mean number of total needs as perceived by the patients was 7.6 on the CAN-R. About two-third of the needs as assessed on CAN-R were met, and one-third were unmet. On CAN-R, main domains of needs as reported by patients were those of money, welfare benefits, transport, information about the illness and treatment, relief of psychological distress, company, household skills and intimate relationships. On SNAS, the mean number of total needs as perceived by the patients was 7.6 of which 4.1 were met needs. The most common domains of needs as assessed on SNAS were those of financial help, medical reimbursement, psychoeducation, free treatment, certification of mental illness, flexible work/job timings, addressing the caregiver stress and legal aid. Conclusion: About two-third of the needs, of the patients with severe mental disorders are met as assessed using CAN-R. However, higher percentages of unmet needs are identified on SNAS. In view of the commonly reported needs, a change in the orientation of services offered to people with mental disorders is very much called for. At the government level, desired policies must be formulated to support the patients with mental disorders.

The perfect balance of mind, body and soul is considered as complete health in Ayurveda. Ayurveda has its own identity as most ancient and traditional System of Medicine in India. Even Ayurveda emphasizes its treatment modalities into three parts viz. Satwawajay Chikitsa, Yuktivyapashray and Daivyapashray Chikitsa. Sattvavajaya therapy mentioned in Charakasamhita and it used as new concept of psychotherapy in Ayurveda. The effectiveness of "traditional mental health promoting practices" was identified as health regimens (swasthvrtt), correct behavior (sadvrtt), and yoga. Sattvavajaya as psychotherapy, is the mental restraint, or a "mind control" as referred by Caraka, is achieved through "spiritual knowledge, philosophy, fortitude, remembrance and concentration. Ayurvedic psychotherapy would play a dual role: First, as a revival of authentic medical culture, the exercise of a practice with an assumed primordial dimension, and second as a discovery of authentic subjectivity, the revelation of a self with an assumed interior depth. When we integrate the contemporary art of psychotherapy with the ancient science of Ayurveda, it becomes a powerful combination that is called Psycho Veda. The integration of Psycho and Veda is motivated by the complete integration of the immense but fairly contemporary view of the mind, emotions and psyche and how this performs in our lives. Integrating Psychotherapy and Vedic principles teaches us how to rediscover critical knowledge and awareness of the natural forces and rhythms that compliment and strengthen our human experience, through the understanding of the psyche and what our inner experiences are and also involving practical daily activities with thorough attention to our total environment to bring about radical changes in our mental outlook and in physical health.

Context: Lack of literature on psychological aspects of survivors of farmers' suicides is hurdle in devising effective helping strategies for rising number of survivors across the country. Aims and Objectives: To assess the psychological distress and its correlates in survivors of farmers' suicides. Settings and Design: Case–control study design was used in Wardha District of Vidarbha region in the central India. Materials and Methods: A predesigned and pretested semistructured questionnaire was used to assess sociodemographic variables. Self-Reporting Questionnaire-20 was used to evaluate psychological distress in 98 survivors of farmers' suicides and 98 age, sex, and occupation-matched controls. Statistical Analysis: Significance of differences between case and control groups were assessed using Chi-square test or Fisher's two-tailed exact test for class variables. For continuous variables, Student's t-test was used P < 0.05 was considered significant. Results: Significantly higher proportion of survivors had psychological distress than controls. Female survivors, spouse and parents of suicide victims had a high risk of distress. Psychological distress was commonly expressed by depressive and somatic symptoms. Conclusions: Survivors of farmers' suicides are suffering from significant psychological distress.

Byline: P. Behere, M. Bhise "Indian Agrarian Crisis: Farmer, the most endangered species" Despite the popular image of farming as a peaceful and healthy way of life, agriculture has the highest rates of mortality in any industry.[sup] [1] Suicide among farmers is now a universal phenomenon. Studies across the globe have identified farming as one of the most dangerous industries. Farming environments are characterized by a broad and changeable range of physical, biological and chemical hazards that are similar across all cultures. Thus, it is important to view the issue of farmers' suicide from a global perspective. Context of Farming Although farming practices, production systems and type of farms are diverse, there are commonalities across the farms, which are important to health. Most farms continue to be family-owned and operated business and are exposed to the volatility of commodity markets, the variability of weather patterns and the influence of respective government regulations. Farmers are thus exposed to a high rate of stress. Physical stressors and hazards of the farm environment are compounded by regulatory framework and economic dynamics of managing farm business. These operate in the context of declining trends of trade for agricultural produce, volatile commodity markets, limited availability of off-farm employment, growing cost of machinery and production and loss of farm or livelihood due to crop failures.[sup] [2] Economic concerns and government bureaucracy have been consistently identified as a major cause of stress and a contributor to suicide. There is no customary or mandatory retirement age for farmers all over the world and many tend to work beyond the customary retirement age, placing the younger generation in a dependant relationship with their parents for much longer than is typical. This can lead to tension between the two generations on the farm. Recently, we have witnessed such cases in India: The son becoming alcoholic following the father having retired from active government service and taking a dominating and leading role in farming. Roles between work, home and family are often blurred, with farming operating as an occupation and way of life for many farmers. Research had shown a relationship between monetary and family problems with suicide. British farmers were more concerned about family problems[sup] [3] while indebtedness and monetary concerns were reported to be the major reason for suicide among Indian farmers.[sup] [4],[5] Farmers' Suicides in Different Cultures Studies in India, Sri Lanka, USA, Canada, England and Australia have identified farming as one of the most dangerous industries associated with a high suicide rate than in general population. In India, farmers' suicides had been reported from various states, viz. Punjab, Maharashtra, Andhra Pradesh, Kerala and various other states with varied cultural practices and farming patterns. A study in the Vidarbha region of Maharashtra had associated indebtedness (87%) and deterioration in the economic status (74%) as major risk factors for suicide.[sup] [6] This study has revealed that age-adjusted suicide mortality rate for male farmers had trebled from 17 in 1995 to 53 in 2004. An independent study by the author in the region concluded that farmers committing suicide were in their 40s, who were living with family and most were married. Among modes of suicide, poisoning was the most prevalent, followed by hanging and jumping from a height.[sup] [7] In England and Wales, in contrast, fire arms were the method most frequently used by male farmers, followed by hanging and carbon monoxide poisoning. Farmers who commit suicide tend to use methods to which they have easy access because of their occupation. In India, due to the easy availability of pesticide and lack of education and efforts on the part of the system to train farmers in safe use of it, pesticide consumption is the most common method of committing suicide. …

Byline: Prakash. Behere, T. Sathyanarayana Rao, Akshata. Mulmule Life, as they say, is a gift from god and can be given only by him. Hence, taking away life and that too one's own, has always been forbidden. Suicide has, since times immemorial, been a topic of constant controversy and unending debate. Religion, monarchy, and colonialism all condemned and prohibited suicide. Suicide is defined as death caused by self-directed injurious behavior with any intent to die as a result of the behavior. Suicide attempt, on the other hand, is a nonfatal self-directed potentially injurious behavior with any intent to die as a result of the behavior. A suicide attempt may or may not result in injury. [sup][1] The people who committed or attempted suicide have always been the subjects of wrath of the religion bound societies in the past. Following this religious trail, lawmakers in the past, served punishments to both the bodies of the victims and the survivors of a suicide attempt. Sometimes even the surviving family members were punished for their act. But liberalization and education with the help of progress in understanding the underlying causes of suicide, has led to a change in this stance worldwide. Gravity of Problem There has been an alarming increase in suicide rates in recent years. There were 127,151 cases of suicide noted in the National Crime Records Bureau in 2009 which have increased to 134,799 in 2013. Suicide rate that is, the incidence of suicide per one lakh population, has increased from 10.9 in 2009 to 11.4 in 2010. Family problems and illness were the two major reasons for suicides, together accounting for 46% of all suicides. Drug abuse/addiction (3.3%), love affairs (3.2%), bankruptcy or sudden change in economic status (2.0%), poverty (1.9%), and dowry dispute (1.6%) were the other causes of suicides. [sup][2] Religion and Suicide Almost all the religions condemn and prohibit suicide with each having an elaborate description of the punishments incurred by the offenders in their respective hells. Hinduism believes in the individual turning into a ghost and wandering between the mortals and the heavenly till the time of their actual death as per fate, whereas Islam mentions the fate of the person who commits suicide, remains to repeat the same act by which he committed suicide till eternity in the fire of hell. Some religions, like the Jews, have discrimination against those who commit suicide in the form of separate burial away from the normal deaths and limited mourning rights to the kings. The Indian Law on Suicide and its Past The Indian penal code drafted in 1860 on the recommendations of first law commission of India established in 1834 under the Charter Act of 1833 under the chairmanship of Thomas Babington Macaulay came into force in British-ruled India in 1862. [sup][3],[4] It has substantially survived for over 150 years without major amendments in several jurisdictions. But there has been a need to rethink and amend several of its sections as per the prevailing societal beliefs from time to time. The recent amendment of the section 377 is one such example. As per the Indian penal code, 1860, chapter XVI of offences affecting the human body and of offences affecting life, section 309 deals with Attempt to commit suicide. It states that "whoever attempts to commit suicide and does any act toward the commission of such offence, shall be punished with simple imprisonment for a term which may extend to 1-year." [sup][5] This law has remained untouched and not amended for the past 155 years since it came into force, thus warranting a relook and repeal as per today's scientific understanding of the subject and societal attitude. Evolving Consensus Over the Years - World View Destigmatization of the act of suicide started with the pioneering work of Durkheim. His theory that external pressures or societal stressors, can contribute to suicidal behavior, increased awareness about suicide and helped to begin destigmatization. …

In this chapter, the relation between religion and mental health and vice versa has been described. From primitive times different religions have different beliefs and systems of worshipping. Every religion with their belief system has implications on mental health and illness. We described how Hindu system of beliefs and rituals may have an effect in causation of various mental illnesses. It is also described how religion can help an individual to sustain one's life in various domains. The relationship between different religion and symptomatology is described. The impact and outcome of religion on mental health have been highlighted.

Byline: P. Behere, T. Sathyanarayana Rao, Akshata. Mulmule Introduction Manu Smruti described about women values in ancient time - " Yatr naaryastu pujayante ramante tatr devtaa ," that is Gods abound where women are honored, this was the ancestral enchanting in the land of Bharatvarsha (India) where gory heinous crimes against women and specially children are on rise these days. [sup][1] It is said that sexual abuse is the most common and threatening behavior calculated to induce fear in all women, it means men have chosen to maintain control over women. Rape is the fastest growing crime in the country. [sup][2] Rape occurs in India every twenty minutes. [sup][3] Ministry of Women and Child Development concluded that 53.22% of children reported having faced sexual abuse of which 21.90% faced severe form. [sup][4] Sexual abuse in children refers to sexual behavior between a child and an adult or between two children when one of them is significantly older or uses coercion. More than 70% of abusers are immediate family members and close acquaintance. [sup][5] There is hence a need to focus the enquiry on children. The perpetrator and the victim may be same sex or opposite sex. The sexual behaviors include touching breast, buttocks and genitals, whether the victim is dressed or undressed; exhibitionism; fellatio; cunnilingus and penetration of the vagina or anus with sexual organs or object. Sexual abuse may involve behavior over an extended time or a single incident. In addition to the form, inappropriate sexual touching, sexual abuse also refers to sexual exploitation of children for instance, conduct or activities related to pornography depicting minors promoting or trafficking in prostitution of minors. [sup][6] It is not just a phenomenon by itself but also has very serious and long lasting impact as psychological disturbances. Thus, ranges from anxiety to sexual dysfunction or post-traumatic stress disorder that follow sexual abuse. Research so far has concentrated on sexual crimes against women in the reproductive age. There is increasing incidences of sexual abuse in children today. This area is very sensitive. We should be receptive for early identifications and prevention of such incidences in girls in the community. How Big is the Problem? Child abuse in one or another form has existed in almost all societies throughout the history however, recognition of child abuse as a social problem is of recent origin. The research on child sexual abuse (CSA) in India has not received much attention this due to low reporting of victims . Nearly, 53% of children faced some amount of sexual abuse; among them 52.94% were boys and 47.06% girls. The significant finding was that contrary to the general perception, the overall percentage of boys was much higher than that of girls. Across the country, every second child is being subjected to one or other forms of sexual abuse and every fifth child is facing severe forms of sexual abuse. [sup][4] A total of 33,098 cases of sexual crime against children were reported in country in 2011 as compared to 26,694 in 2010 it means increase by 24%. Number of cases under procuration of minor girls increased from 679 (2010) to 862 in 2011, i.e., increase by 27%. A total of 7,112 cases of child rape were reported in country during 2011 as compared to 5,484 in 2010, increase by 29.7%. Sexual abuse is highest in Madhya Pradesh (1,262) followed by Uttar Pradesh (1,088) and Maharashtra (818). [sup][7] In 2011, more than 24 thousand cases were reported - about 70 a day. New figures released by the Delhi Police reveals that a woman is raped every 18 h or molested every 14 h. [sup][8] There are 80,000 pending rape cases in India and nearly 1,000 rape cases are pending in Delhi courts. [sup][9] Off late, we have seen some cases of CSA in Wardha district which is again a very traumatic event. The cases are yet to start in court. …

Byline: Prakash. Behere, T. Sathyanarayana Rao, Kiran. Verma "Marriage consists of the rules and regulation which define the rights, duties and privileges of the husband and wife." – Georgea Lundberg Marriage is a social union or legal contract between a male and a female having intimate interpersonal relationships. It has been the greatest and most important of all social institutions in the human society. People marry for many reasons such as legal, social, libidinal, emotional, economic, spiritual, and religious. These might include arranged marriages, family obligations, legal establishment of a nuclear family unit, legal protection of children, and public declaration of commitment. The relationship between marriage and mental illness is very complicated and this issue commonly arises in psychotic illnesses. Psychosis is usually diagnosed at late adolescent and early adulthood. Being a disease of the age at which decision of marriage is taken, the question of whether to marry or not and whether marriage will lead to improvement or deterioration in psychoses is equally faced by patients, their family members, and treating psychiatrists. Mental disorders and problems in marriage are closely linked though there is a controversy about the sequence. Peculiarities of Marriage in India In India, marriage is a social institution of extreme importance. It is much more than a variety of close personal affiliation uniting two partners and is based on the following foundations... [sup][1] most often it is not a free personal choice but is an arranged relation between two families; the maturity of the partner is not an essential requirement for marriage, and marriage encompasses a heterosexual relationship. In Indian marriage, the husband is considered the head and principle earner of the family; sexual fidelity and monogamy of both husband and wife are represented as marital ideals. Society exerts great pressure on both sexes to marry; mostly people marry without thinking about their personal choice of getting or not getting married. In the presence of mental illness, if marriage is done under pressure, it may lead to deterioration of mental condition. Situation of Mentally Ill Females In India, marriages are usually arranged by parents and are influenced by number of factors such as astrological compatibility, caste regulation, geographic proximity, and expectations of dowry. Female psychotic patients have multifold psycho-socio-economic problems than males because in an Indian setting, male dominates and he is the deciding person for selection of partner. Female patient undergoes tremendous stress in getting married, and if she is having pre-existing mental illness, then the situation worsens. Almost all females face many of the following problems in getting married and sustaining married life. Firstly, at the time of proposal, when a girl is shown to the male partner, it is a stress due to the uncertainty of fixing up of marriage. Secondly, the question of dowry hampers and causes stress. Thirdly, after marriage, she has to leave her parents' house where she has spent 18-20 years of her life. Fourthly, she goes to a new house where she has to cope up with new family members of different temperaments. Fifthly, if she is on drugs for maintenance of improvement from psychoses, she has to face difficulties such as her in-laws may ask for the reason of taking drugs and she may stop taking because of impending risk of questioning and may lead to relapse. Sixthly, she has to undergo first sexual experience which may be traumatic to her. Seventhly comes pregnancy, which itself is a stress (wanted or unwanted). Eighthly, she undergoes the stress of having a male or female baby because male babies are socially much more accepted and preferred over female babies. And finally, child birth. Because of the above-mentioned stressors, female psychotic patients may have more episodes of exacerbation of symptoms or relapse of psychotic illness. …

Incidence of farmers ending their lives in Vidarbha region had hit epidemic proportions recently. We adopted the psychological autopsy approach to offer some insight into the reason why these individuals resorted to such a drastic step. Suicide in farmers is public health problem and we suggested some immediate and serious interventions to prevent suicide.