District Mental Health Programme (DMHP)

District Mental Health Programme (DMHP) in Uttar Pradesh: A Review.
District Mental Health Programme (DMHP) is part of National Mental Health Programme, India.

1. District Mental Health Programme in Uttar Pradesh: A Review By: Syed Sajid Husain Kazmi M.Phil. Clinical Psychology Dept. of Clinical Psychology, AIBAS, Amity University, Lucknow

2. Introduction Mental health is defined as a state of well-being in which every individual realizes his or her own potential, can cope with the normal stresses of life, can work productively and fruitfully and is able to make a contribution to his/her community. (WHO-2014) The lifetime prevalence rates of mental disorders in adults range from 12.2 to 48.6% and 12‑month prevalence rates range from 8.4 to 29.1%. (WHO-2016) National Mental Health Survey, 2015-16 (India): Common mental disorders (CMDs), including depression, anxiety disorders and substance use disorders are affecting nearly 10% . National Mental Health Survey, 2015-16 (U.P.): 6.1% prevalence rate.

3. The Government of India launched the National Mental Health Programme (NMHP) in 1982, keeping in view the heavy burden of mental illness in the community and the inadequacy of mental health care infrastructure in the country to deal with it. 3 main components of NMHP - Treatment of Mentally ill Rehabilitation Prevention and promotion of positive mental health. National Mental Health Programme

4. Limitations of NMHP: Under NMHP, the unit of service delivery was Primary Health Centres and Community Health Centres. Hence, the extent of service delivery was limited. The program had some inherent conceptual flaws in the form of: no budgetary estimation or provision for the programme, lack of clarity regarding who should fund the programme – the central government of India or the state governments, which perpetually had inadequate funds for healthcare. ( Rasheed , 2015)

5. Inception of District Mental Health Program: To overcome the limitations of NMHP and to scale it up, it was perceived that the district should be the administrative and implementation unit of the program. The National Institute of Mental Health and Neurosciences (NIMHANS) undertook a pilot project (1985–1990) at the Bellary District of Karnataka to assess the feasibility of DMHP and demonstrated that it was feasible to deliver basic mental healthcare services at the district, taluk and at PHCs by trained PHC staffs under the supervision/support of a district mental health team. The success of the Bellary project paved the way for DMHP, which was subsequently launched in 27 districts in 1996 with the initial budget of 280 million INR.

6. Objectives of DMHP: To provide sustainable basic mental health services to the community and to integrate these services with other health services. Early detection and treatment of patients within the community itself. To reduce the stigma of mental illness through public awareness. To treat and rehabilitate mental patients within the community.

7. Evolution of DMHP: 10 th Five Year Plan ( 2002–07) 11 th Five Year Plan ( 2007–12) Budget extended to 1390 million INR Program officer (a psychiatrist) & family welfare officer in each district. • Essential drugs at PHCs and District Hospitals. • Training programs for Medical Officers. • ( Scheme‑A ) : Strengthening of infrastructure with the establishment of 11 Centers of Excellence & upgradation of Mental Institutions/ Hospitals. ( Scheme‑B ) : Setting u p/ strengthening of 30 units each of Psychiatry, Clinical Psychology, Social Work & Psychiatric N ursing . Program extended to 110 districts, with upgradation of psychiatric wings of 71 medical colleges/general hospitals and modernization of 23 mental hospitals.

8. DMHP in 12th Five Year Plan: Mental Health Policy Group (MHPG) was appointed by the MoHFW in 2012 to prepare a draft of DMHP for 12th Five Year Plan (2012–17) Objectives were: To reduce distress, disability and premature mortality related to mental illness. To enhance recovery from mental illness by ensuring the availability of and accessibility to mental health care for all, particularly the most vulnerable and underprivileged sections of the population.

9. Method: Documents and websites of Ministry of Health and Family Welfare ( MoHFW ), Director General of Health Services (DGHS, U.P.) and other government agencies were visited to obtain relevant documents on NMHP/ DMHP such as the document of regional workshops for NMHP (2011–2012), policy draft document for the 12th Five Year Plan (2012), and parliamentary committee and NITI Aayog report on the on going program.

10. Results: Status of DMHP in U.P. Implemented in all 75 districts of U.P. Trained Mental Health Professionals hired in each district. District Programme Officer Psychiatrist Clinical psychologist Psychiatric Nurse Psychiatric Social Worker

11. Scheme A Scheme B Upgradation of Psychiatric Wings of Medical Colleges: MLN Medical College, KGMU, GSVM, MLB Medical College Jhansi, LLRM Medical College Meerut, S.N. Medical College Agra, IMS BHU . Modernisation of State Run Mental Hospital: Mental Hospital Bareily , IMHH Agra, Mental Hospital Varanasi Centre of Excellence: Institute of Mental Health & Hospital, Agra KGMU for strengthening the Psychiatry, Clinical Psychology, Psychiatric Social work, Psychiatric Nursing departments. For Building, Recruitment, Books and Journals, Equipments and tools etc. Total Fund utilised: Rs 37,58,59,428

12. DMHP in U.P. 3 rooms allotted at District Hospitals for DMHP. Role of Mental Health Professionals (Psychiatrist and Clinical Psychologist): 3 day OPD at District Hospital. 2 Day OPD at selected CHCs and PHCs. 1 day Awareness Campaign/programme at school/colleges in coordination with Clinical Psychologist, Psychiatric Social Workers and other team members.

13. DMHP- New Components: School Mental Health Services: Life Skills Education in Schools, Counseling Services. College Counselling Services: Through trained teachers and counsellors. Work Place Stress Management. Suicide Prevention Services- Counseling Center at District level, Sensitization Workshops, IEC, Collaboration with various departments. Dua se Dawa Tak Mann Kaksh

14. Conclusion: DMHP has completed more than three decades, the lessons learned from the past can bring about a lot of insights about the future course of action. For example leadership at all the levels of governance/administration, financial and human resources have been important determinants for the outcome of the program, so are community and stakeholders’ participation, standardization of training for community mental health professionals, IEC activities, the involvement of NGOs and private sectors.

15. Limitations Government websites are not updated at regular intervals. Not much information/data is available in public domain.

16. Reference: Roy, S., & Rasheed , N. (2015). The national mental health programme of India.  Int J Curr Med Appl Sci ,  7 , 7-15. https://www.nhp.gov.in/national-mental-health-programme_pg http://dghs.gov.in/content/1350_3_NationalMentalHealthProgramme.aspx http://www.dgmhup.gov.in/EN/MentalHealth World Health Organization, editor. Mental Health Atlas 2005 Rev ed. Geneva: World Health Organization; 2005.