National mental health program

An overview of National mental health program in India

1. NATIONAL MENTAL HEALTH PROGRAMME Dr.Sujit Kumar Kar Assistant Professor Dept. of Psychiatry, KGMU, Lko

2. Psychiatry services in community

3. Psychiatry services as priority Theme for the World Health Day 2001: "Mental Health: Stop Exclusion - Dare to Care“ 2017 WHD theme- Depression: Let’s talk

4. Psychiatry services in community

5. Psychiatry services in community

6. Psychiatry services in community

7. Psychiatry services in community India is the first developing country to formulate National mental health program

8. Psychiatry services in community In India, National mental health program was introduced in the year 1982

9. Psychiatry services in community In 1970s, community survey of mental health disorders were carried out in different parts of India

10. Psychiatry services in community Survey of 1970s, suggest all types of mental health problems are prevalent in India

11. Psychiatry services in community Reports from developing countries suggest about gross neglect of mental disorders in developing countries.

12. Psychiatry services in community Reasons of gross neglect of mental disorders 1.Stigma 2. Myths and misconceptions 3.Scarcity of budget 4.Shortage of trained professionals

13. Psychiatry services in community It was suggested that the basic mental health care should be decentralized and integrated with existing general health services

14. Psychiatry services in community Five important factors that contributed to drafting of NMHP in 1980s Recommendations by expert committee of the WHO Starting of community mental health unit at NIMHANS, Banglore in 1975 – Sakalwara project WHO multi-centric project: Strategies for extending mental health service to community (1976-1981) The “Declaration of Alma Ata” – to achieve “Health for all by 2000” by universal provision of primary health care (1978) ICMR-DST collaborative project on “severe mental morbidity” at 4 centers – Banglore , Patiala, Calcutta, Baroda

15. Psychiatry services in community The AIMS of NMHP Prevention and treatment of mental and neurological disorders and their associated disabilities . Use of mental health technology to improve general health services . Application of mental health principles in total national development to improve quality of life.

16. Psychiatry services in community The objectives of NMHP To ensure availability and accessibility of minimum mental health care to all To encourage the application of mental health knowledge in general health care and in social development To promote community participation in mental health service development and to stimulate efforts towards self-help in the community

17. Psychiatry services in community The STRATEGIES to achieve the objectives Integration mental health with primary health care through the NMHP Provision of tertiary care institutions for treatment of mental disorders Eradicating stigmatisation of mentally ill patients and protecting their rights through regulatory institutions like the Central Mental Health Authority, and State Mental health Authority

18. Psychiatry services in community Dilemma related to funding of NMHP 1982.... Who will fund to run the NMHP? Central Govt. Vs State Govt.

19. Pilot DMHP 1982-1990 To see the feasibility of DMHP Bellary district, Karnataka Conducted by NIMHANS, Banglore MOs & Health workers at PHCs in the district were trained in Mental Health Care Six essential drugs were provided (CPZ, Amitryptiline , THP, Inj. Fluphenazine decanoate , Phenobarbitone , Diphenyl hydantoin )

20. DMHP The program was implemented in two phases 1 st phase in 1996-97 in four districts (one each in AP, Assam, Rajastan , TN) 2 nd phase in 1997-2002, extended to districts of other states

21. DMHP 1982: Implementation of NMHP 1996: DMHP added to NMHP 2003: Re- strategization of Program by addition of two schemes M odernization of state mental hospitals Up-gradation of psychiatric wings of medical colleges/ general hospitals 2009: Manpower development scheme become the part of the program

22. Objectives of DMHP To provide sustainable mental health services to the community and integrate it with other services Early diagnosis and treatment within the community To avoid long travel of patients and their caregivers for mental health care To take pressure off mental hospitals To reduce stigma Treatment and rehabilitation of discharged mentally ill patients with in the community

23. DMHP in India (June 2016) I mplemented in 241districts To be expanded to other districts soon

24. DMHP in U.P (Dec. 2017) Currently in 45 districts To be expanded to another 30 districts soon Currently regulated by NHM Mentoring and training center for operating – Dept. of Psychiatry, KGMU, Lko

25. DMHP working structure Manpower (on contractual basis): Psychiatrist, Clinical Psychologist, Psychiatric Nurse, Psychiatric Social Worker, Community Nurse, Monitoring & Evaluation Officer, Case Registry Assistant, Ward Assistant/ Orderly Financial support @ Rs . 83.2 lakhs per DMHP

26. DMHP working structure Controlled by NHM Envisages provision of basic mental health care services at the community level Service provision: provision of mental health out-patient & in-patient mental health services with a 10 bedded inpatient facility.

27. DMHP working structure Out-Reach Component : Satellite clinics: 4 satellite clinics per month at CHCs/ PHCs by DMHP team Targeted Interventions Life skills education & counselling in schools College counselling services Work place stress management Suicide prevention services

28. DMHP working structure Sensitization & training of health personnel: at the district & sub-district levels Awareness camps: for dissemination of awareness regarding mental illnesses and related stigma through involvement of local PRIs, faith healers, teachers, leaders etc

29. DMHP working structure Community participation : Linkages with Self-help groups, family and caregiver groups & NGOs working in the field of mental health Sensitization of enforcement officials regarding legal provisions for effective implementation of Mental Health Act

30. Future of NMHP is based on…. WHO : Mental Health Action Plan 2013-2020 4 major objectives To strengthen effective leadership and governance for mental health To provide comprehensive, integrated and responsive mental health and social care services in community-based settings To implement strategies for promotion and prevention in mental health To strengthen information systems, evidence and research for mental health

31. Summary

32. Questions & Comments

33. Suggested Readings http:// www.nihfw.org/NationalHealthProgramme/NATIONALMENTALHEALTHPROGRAMME.html http:// dghs.gov.in/content/1350_3_NationalMentalHealthProgramme.aspx http:// nrhm.gov.in/images/pdf/programmes/NMHP/District_Level_Activities.pdf http:// apps.who.int/iris/bitstream/10665/178879/1/9789241565011_eng.pdf

34. Thank You