National mental health program

National mental health program

1. NATIONAL MENTAL HEALTH
PROGRAM

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LIVING WITH SCHIZOPHRENIA

3. MENTAL HEALTH
“Mentalhealthisdefinedasastateofwell-being
inwhicheveryindividualrealizeshisorherown
potential,cancopewiththenormalstressesof
life,canworkproductivelyandfruitfully,andis
abletomakeacontributiontoherorhis
community”.-WHO
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4. MENTAL ILLNESS
“Amentalillnessisamedicalconditionthat
disruptsaperson'sthinking,feeling,mood,ability
torelatetoothersanddailyfunctioning.Mental
illnessesaremedicalconditionsthatoftenresult
inadiminishedcapacityforcopingwiththe
ordinarydemandsoflife”.-NationalAllianceon
MentalIllness(NAMI)
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5. INTERNATIONAL CLASSIFICATION OF
MENTAL DISORDER:
F00-F09Organic, including symptomatic, mental
disorders
F10-F19Mental and behavioural disorders due to
psychoactive substance use
F20-F29Schizophrenia, schizotypal and
delusional disorders
F30-F39Mood [affective] disorders
F40-F48Neurotic, stress-related and somatoform
disorders
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6. F50-F59Behavioural syndromes associated with
physiological disturbances and physical factors
F60-F69Disorders of adult personality and
behaviour
F70-F79Mental retardation
F80-F89Disorders of psychological development
F90-F98Behavioural and emotional disorders with
onset usually occurring in childhood and
adolescence
F99Unspecified mental disorder
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7. 10 FACTS ON MENTAL HEALTH
Fact 1:-Around 20% of the world's children
and adolescents have mental disorders or
problems.
About half of mental
disorders begin
before the age of 14.
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8. FACT2:-MENTALANDSUBSTANCE USE
DISORDERS ARETHELEADINGCAUSEOF
DISABILITYWORLDWIDE
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9. FACT3:-ABOUT800 000 PEOPLECOMMIT
SUICIDEEVERYYEAR
Suicideisthesecond
leadingcauseofdeath
in15-29-year-olds
Thereareindicationsthatforeachadultwhodied
ofsuicidetheremayhavebeenmorethan20
othersattemptingsuicide.75%ofsuicidesoccurin
low-andmiddle-income countries.Mental
disordersandharmfuluseofalcoholcontributeto
manysuicidesaroundtheworld.
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10. FACT4:-WARANDDISASTERSHAVEALARGE
IMPACTONMENTALHEALTHAND
PSYCHOSOCIAL WELL-BEING
Rates of mental disorder tend to double after
emergencies.
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11. FACT5:-MENTALDISORDERS AREIMPORTANT
RISKFACTORSFOROTHERDISEASES, ASWELL
ASUNINTENTIONAL ANDINTENTIONAL INJURY
Mental disorders increase the risk of getting
ill from other diseases such as HIV,
cardiovascular disease, diabetes, and vice-
versa.
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12. FACT6:-STIGMAANDDISCRIMINATION
AGAINSTPATIENTSANDFAMILIESPREVENT
PEOPLEFROMSEEKINGMENTALHEALTHCARE
This stigma can lead to abuse, rejection and
isolation and exclude people from health care or
support.
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13. FACT7:-HUMANRIGHTSVIOLATIONSOF
PEOPLEWITHMENTALANDPSYCHOSOCIAL
DISABILITYAREROUTINELY REPORTED INMOST
COUNTRIES
These include physical restraint, seclusion and
denial of basic needs and privacy.
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14. FACT8:-GLOBALLY, THEREISHUGEINEQUITY
INTHEDISTRIBUTION OFSKILLEDHUMAN
RESOURCES FORMENTALHEALTH
Shortages of psychiatrists, psychiatric nurses,
psychologists and social workers are among the
main barriers to providing treatment
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15. FACT9:-THEREARE5 KEYBARRIERSTOINCREASING
MENTALHEALTHSERVICESAVAILABILITY
The absence of mental health from the public
health agenda and the implications for funding
The current organization of mental health
services
Lack of integration within primary care
Inadequate human resources for mental health
Lack of public mental health leadership.
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16. FACT10:-FINANCIALRESOURCES TOINCREASE
SERVICESARERELATIVELY MODEST
Governments, donors and groups representing
mental health service users and their families need
to work together to increase mental health services,
especially in low-and middle-income countries.
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17. GENESISANDEVOLUTION OFTHENATIONAL
MENTALHEALTHPROGRAMME FORINDIA
1970community surveysofmentaldisorders
carriedoutindifferentpartsofthecountryhad
shownthatalltypesofmentaldisorderswere
widelyprevalentinIndia.
grossneglectofmentaldisordersindeveloping
countries
stigma,misconceptions,
inadequatebudgetsforhealthcareincludingmental
health
acuteshortageoftrainedmentalhealthpersonnel
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18. 5 IMPORTANT FACTORS LEADED TONMHPFORINDIA
1.“Theorganizationofmentalhealthservicesin
developingcountries”–asetofrecommendations
byanexpertcommitteeoftheWorldHealth
Organization.
Basicmentalhealthcareshouldbeintegrated
withgeneralhealthservicesandbeprovidedby
non-specializedhealthworkers,atalllevels.
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19. carryoutoneormorepilotprogrammes totest
thepracticabilityofincludingbasicmental
healthcareinanalreadyestablishedprogramme
ofhealthcareinadefinedruralorurban
population.
trainingprogrammes,includingsimplemanuals
ofinstructionsfortrainingofhealthworkers
shouldbedevisedandevaluated”
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20. 2.Startingofaspeciallydesignated“Community
MentalHealthUnit”attheNationalInstituteof
MentalHealthandNeuroSciences(NIMHANS),
Bangalore–1975
Mentalhealthneedsassessmentandsituation
analysisinover200villagesinBangalorerural
districtcoveringapopulationofabout100,000
werecarriedoutbythecommunitymentalhealth
unitofNIMHANS.
Simple methods of identification and
management ofpersonswithmentallyillness,
mentalretardationandepilepsyintherural
community byprimarycarepersonnelwere
developed.
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21. Pilottrainingprogrammes inbasicmentalhealth
careforprimaryhealthcare(PHC)personnelwere
conductedinvariousprimaryhealthcentressuch
asAnekal,MalurandSolurinBangalore,rural,
KolarandTumkurdistrictsinKarnatakastate.
Simplementalhealtheducationalmaterialswhich
couldbeusedbymultipurposehealthworkersin
ruralareaswerealsodeveloped.
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22. Avarietyofmethodsforevaluatingthetrainingin
mentalhealthprovidedtoPHCpersonnelwere
developedandtested.
Basedonthepilotexperiencesfromitsrural
mentalhealthcentre,thecommunity mental
healthunitatNIMHANS developedastrategyfor
takingmentalhealthcaretotheruralareas
throughtheexistingprimaryhealthcarenetwork.
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23. .
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3.WorldHealthOrganization(WHO)Multi-country
project:“Strategiesforextendingmentalhealth
servicesintothecommunity”(1976-1981)
Theproposemodelofintegratingmentalhealth
withgeneralhealthservicesandprovidingbasic
mentalhealthcarebytrainedhealthworkersand
doctorsasanintegralpartofprimaryhealthcare
receivedsubstantialsupportfromamulti-country
collaborativeprojectinitiatedbytheWHOand
carriedoutin7geographicallydefinedareasin7
developingcountries,Brazil,Colombia,Egypt,
India,Philippines,SenegalandSudan.

24. Thedepartment ofpsychiatryatthepost
graduateinstituteofmedicaleducationand
researchinChandigarhwasthecenterinIndia
andthemodelwasdevelopedintheRaipurRani
blockinHaryanastate.
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25. 4.The“DeclarationofAlmaAta”-toachieve
“HealthforAllby2000”byuniversalprovisionof
primaryhealthcare(1978)
AccordingtotheAlma-Atadeclaration,primary
healthcareis"essentialhealthcarebasedon
practical,scientificallysoundandsocially
acceptablemethods andtechnologymade
universallyaccessibletoindividualsand
familiesinthecommunity throughtheirfull
participationandatacostthatthecommunity
andthecountrycanaffordtomaintainatevery
stageoftheirdevelopmentinthespiritofself-
determination"
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26. 5.IndianCouncilofMedicalResearch –
Department ofScienceandTechnology(ICMR-
DST)Collaborativeprojecton‘SevereMental
Morbidity’
Duringthelate1970sandtheearly1980s,ICMR
andDSTofGovt.ofIndiafundeda4centre
collaborativestudytoevaluatethefeasibilityof
trainingPHCstafftoprovidementalhealthcare
aspartoftheirroutinework.
Attheendofoneyearperiodabout20%ofthe
actualcaseswereidentifiedandmanagedbythe
PHCpersonnelundertheoverallsupervisionof
thecentrestaff.
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27. In1982,theabovefactorscontributedintosmall
measuretothedraftingoftheNMHP.Thedraftof
theNMHP, writtenbyanexpertdrafting
committeewhichconsistedofsomeoftheleading,
seniorpsychiatristsinIndia.
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28. TheobjectivesofNMHPwere:(a)toensurethe
availabilityandaccessibilityofminimummental
healthcareforallintheforeseeablefuture,
particularlytothemostvulnerableand
underprivilegedsectionsofthepopulation
(b)toencouragetheapplicationofmentalhealth
knowledgeingeneralhealthcareandinsocial
development
(c)topromotecommunityparticipationinthe
mentalhealthservicedevelopment andto
stimulateeffortstowardsself-helpinthe
community
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29. WHATHAPPENED AFTERNMHP 1982?
Nobudgetaryestimatesorprovisionsweremade
fortheimplementationoftheprogramme
Therewaslackofclarityregardingwhoshould
fundtheprogramme –thefederalgovernmentof
Indiaorthestategovernmentswhoperpetually
hadinadequatefundsforhealthcare.
Greatdoubtswereexpressedaboutthefeasibility
ofimplementing theprogramme inlarger
populations
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30. Theneedforplanningtheimplementationofthe
programmeatadistrictlevelwashighlighted.
Fivespecificperiodsfrom1982
1)1982-1990–Developmentofthepilotdistrict
mentalhealthprogramme atBellarydistrictin
Karnataka
2)Fromthelateeightiesto1996–Trainingof
trainersandsensitizationworkshops
Primaryhealthcentreworkerscanbetrained
andsupervisedtoidentifyandmanagecertain
typesofmentaldisordersandepilepsyalongwith
theirroutineworkattheprimaryhealthcentres.
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30
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31. Most mental health professionals were
disinterestedinpublichealthaspectsofmental
health.ThecountryofficeoftheWHOsupporteda
programmeoftrainingmentalhealthprofessionals
tobecometrainersofprimarycarestaffand
programme mangersofNMHP.Fundingwasalso
made availableforholding nationwide
sensitizationprogrammes forseniorhealth
administrators.
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32. AnationalworkshoporganizedbyNIMHANS, in
collaborationwithMinistryofHealthandFamily
Welfare,Govt.ofIndiainvolvingthehealth
departmentsallthestatesandunionterritoriesin
February1996,stronglyrecommended thatNational
MentalHealthProgramme shouldbeactivatedby
sanctionofadequatefundsfromCentralGovernment
(Planfunds).Theworkshopfurtherrecommended
thatDistrictMentalHealthProgrammes shouldbe
implementedineachstate/unionterritoryandthe
“Bellaryprogramme”asdevelopedbyNIMHANS
couldserveasaprototype.
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33. Theemphasisshouldbeininvolvingthefamilies
inlookingafterthementallyillandspecial
emphasisshouldbegiventopoor,weakerand
underprivilegedsectionsofthesociety.The
workshopalsosuggestedvariousrequirements
andcomponents suchashuman resources,
equipments,bedsetcforsuchaDistrictMental
HealthProgramme.
TheMinistryofHealthandFamilyWelfare,Govt.of
IndiaformulatedDistrictMentalHealthProgramme
(underNationalMentalHealthProgramme)asa
fullycentrallyfunded5yearpilotscheme
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34. 3)1996-97to2002(IXFiveYearPlan)–Wider
implementation oftheDistrictMentalHealth
Programme
TheDistrictMentalHealthProgramme was
launchedduring1996-97infourdistricts–one
districteachinAndhra Pradesh,Assam,
RajasthanandTamilNadu
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35. Theobjectiveswere,
i)Toprovidesustainablementalhealthservices
tothecommunityandtointegratetheseservices
withotherservices
ii)Earlydetectionandtreatmentofpatients
withinthecommunityitself
iii)Toseethatpatientsandtheirrelativesdonot
havetotravellongdistancestogotohospitalsor
nursinghomesincities
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36. iv)Totakepressureoffmentalhospitals
v)Toreducethestigmaattachedtowardsmental
illnessthroughchangeofattitudeandpublic
education
vi)Totreatandrehabilitatementallyillpatients
dischargedfromthementalhospitalwithinthe
community.
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36
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37. IXplanperiodwasalsofacilitatedbyavarietyof
otherfactorssuchas:
i)Furtherrecommendations andresolutionsby
the(CentralCouncilofHealthandFamily
Welfare)CCHFW.
ii)Thepublicationofaninfluentialreportbythe
NationalHuman RightsCommission ofIndia
(NHRC) on“Qualityassuranceinmental
health”29
iii)Thewidemediapublicity,publicoutcryand
interventionbytheSupremeCourtofIndia
followingtheErwaditragedywherein26
chainedmentallyillpersonswereaccidentally
killedinafireaccidentthattookplacein
ErwadiDargahinRamanathapuram districtof
TamilNadustateinAugust2001.
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38. 4) 2002 to 2007 -X Five Year Plan period
NMHP implementation through a series of
meetings with mental health professionals involved
in DMHP and various other stake holders .
DMHP to 100 more districts
strengthen facilities and services at secondary and
tertiary levels of mental health care provision to
support the growing DMHP
The Planning Commission of India approved a
budget of 190 crores during the X Five Year Plan
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39. Thefivestrategiesadoptedwere
i)ExpandtheDMHPto100districts
ii)Upgradeandstrengthenthedepartmentsof
psychiatrytoimprovetreatmentandtraining
facilities.Bettermentalhealthcarefacilitiesat
generalhospitalandmedicalcollegehospital
settingswasexpectedtobringdowntheloadon
mentalhospitals
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40. iii)Modernizeandtransformmentalhospitalsto
improvepatientcareandreduce/preventlong
stay
iv)Strongeremphasisandfundingforactivities
providingmentalhealthIECactivitiesto
communities
v)Supportresearchandtraining
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41. 5)2007onwards…
Dealingwiththeacuteshortageoftrainedhuman
resources.
ApprovedRupees408croresinXIPlanisfor
settingup10CentresofExcellenceinthefieldof
MentalHealth,centreswillfocusontraining
psychiatrists,clinicalpsychologists,psychiatric
socialworkersandpsychiatricnurses
33Government medicalcollegeswouldalsobe
supportedforstartingpostgraduatecoursesor
increasingtheintakecapacityforpostgraduate
traininginmentalhealth.
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42. NATIONALMENTALHEALTHPROGRAMME
(NMHP)-1982
Objectives:-
1.Toensuretheavailabilityandaccessibilityof
minimum mentalhealthcareforallinthe
foreseeablefuture,particularlytothemost
vulnerableandunderprivilegedsectionsofthe
population;
2.Toencouragetheapplicationofmentalhealth
knowledgeingeneralhealthcareandinsocial
development
3.Topromotecommunityparticipationinthe
mentalhealthservicedevelopment andto
stimulateeffortstowardsself-helpinthe
community.
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42
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43. AIMS:-
Preventionandtreatmentofmentaland
neurologicaldisordersandtheirassociated
disabilities.
Useofmentalhealthtechnologytoimprove
generalhealthservices.
Applicationofmentalhealthprinciplesin
totalnationaldevelopment toimprove
qualityoflife.
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44. STRATEGIES :-
Integratingmentalhealthwithprimary
healthcarethroughtheNMHP.
Provisionoftertiarycareinstitutionsfor
treatmentofmentaldisorders.
Eradicatingstigmatizationofmentallyill
patientsandprotectingtheirrightsthrough
regulatoryinstitutionsliketheCentral
MentalHealthAuthorityandStateMental
HealthAuthority
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45. MENTALHEALTHCARE
1.The mental morbidity requires priority in
health care delivery and treatment
2.Primary Health care at Village and Sub
center level
3.At the primary Health center level
4.District hospital level
5.Mental hospitals & teaching psychiatric
units
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46. 1.Thementalmorbidityrequirespriorityin
healthcaredeliveryandtreatment
Moderntreatmentofschizophrenia,dementia
andencephalopathiesreducedisabilitytoa
greatextent.
Properrecognitionandtreatmentisvery
importanttoreducethemorbidityinthe
community
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47. 2.PrimaryHealthcareatVillageandSubcenter
level
Multi-purposeworkersandhealthsupervisor
trainedtodealwith
managementofpsychiatricemergencies
maintanence oftreatmentadvisedfromthe
highercentre
management ofgrandmalepilepsythroughthe
utilizationofappropriatemedicineunderthe
guidanceofamedicaldoctorandschoolteacher
management ofchildrenwithmentalretardation
andbehaviorproblems
counsellingofpatientssufferingfromalcohol
anddrugusedisorders.
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48. 3. At the primary Health center level
Medical officers will to be trained to provide
the following services:-
Supervision of MPW and health supervisors
Producing mental diagnosis with help of flow
charts and neurologic examination.
Treatment of mental disorders that can be
managed at PHC
Epidemiological surveillance of mental morbidity
along with planning and implementation of
program for the same
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49. 4. District hospital level
It was recognized that there should be at least one
psychiatrist attached to every district hospital as
an integral part of district health services.
The district hospital should have 30 -50 psychiatric
beds. Three should be provision of admission and
treatment of all kinds of mental disorders, ECT and
further referral services.
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49
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50. 5. Mental hospitals & teaching psychiatric units
Major activities of these higher centers of
psychiatric care include:
a. Help in care of ‘difficult’ cases.
b. Teaching.
c. Specialized facilities like, occupational therapy
units, psychotherapy, counseling & behavioral
therapy.
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50
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51. COMPONENTS OF NMHP
1. District Mental Health Programme(DMHP)
2. Manpower Development Schemes -Centers Of
Excellence And Setting Up/ Strengthening PG
Training Departments of Mental Health Specialities
3. Modernization Of State Run Mental Hospitals
4. Up gradation of Psychiatric Wings of Medical
Colleges/General Hospitals
5. IEC
6. Training & Research
7. Monitoring & Evaluation
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52. DISTRICTMENTALHEALTHPROGRAMME
(DMHP)
launched under NMHP in the year 1996 in IX
Five Year Plan
The DMHP was based on ……………….model
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53. COMPONENTS
1.Earlydetection&treatment.
2.Training:impartingshorttermtrainingto
generalphysiciansfordiagnosisandtreatmentof
commonmentalillnesseswithlimitednumberof
drugsunderguidanceofspecialist.TheHealth
workersarebeingtrainedinidentifyingmentallyill
persons.
3.IEC:Publicawarenessgeneration.
4.Monitoring:thepurposeisforsimpleRecord
Keeping.
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54. Starting with ………… districts in 1996
was expanded to 27 districts by the end of
the IX plan.
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55. TheDMHPenvisagesacommunitybasedapproach
totheproblem,whichincludes:
Trainingofmentalhealthteamatidentified
nodalinstitutions.
Increaseawareness&reducestigmarelatedto
MentalHealthproblems.
Provideserviceforearlydetection&treatment
ofmentalillnessinthecommunity(OPD/Indoor&
followup).
Providevaluabledata&experienceatthelevel
ofcommunity atthestate&centerforfuture
planning&improvementinservice&research.
.
55
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56. Conductedanevaluationin2008
AddedLifeskillseducation&counsellingin
schools
Collegecounsellingservices
Workplacestressmanagement
Suicidepreventionservices.
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57. THETEAMINCLUDING INDMHP……
Psychiatrist
Clinical Psychologist
Psychiatric Social worker
Psychiatry/Community Nurse
Program Manager
Program/Case Registry Assistant
Record Keeper.
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58. PRINCIPLES, GOALS& OBJECTIVES OFTHE
DMHP INTHEXII THPLAN
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59. PRINCIPLES
i) A life course perspective with attention to the
unique needs of children, adolescents and adults.
ii) A recovery perspective, through provision of
services across the continuum of care and
empowerment of persons with mental illness and
their care-givers.
iii) An equity perspective through specific attention
to vulnerable groups and to ensure geographical
access to mental health services
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60. iv)Anevidencebasedperspectivebyfollowing
establishedguidelinesandexperiences on
treatmentsanddeliverymodels.
v)Ahealthsystemsperspectivewithclearly
definedrolesandresponsibilitiesforeachsector
fromcommunitytodistricthospitalandincluding
acascadingmodelofcapacitybuildingand
supervision.
vi)Arightsbasedperspectivetoensurerightsof
personswithmentalillnessareprotectedand
respectedbymentalhealthservices.
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61. GOAL
Improve health and social outcomes related to
mental illness .
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62. OBJECTIVES
TheprimaryobjectiveoftheDistrictMental
HealthProgramme istoreducedistress,disability
andprematuremortalityrelatedtomentalillness
andenhancerecoveryfrommentalillnessby
ensuringtheavailabilityofandaccessibilityto
mentalhealthcareforallintheXIIthPlanperiod,
particularly the most vulnerable and
underprivilegedsectionsofthepopulation.
.
62
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63. OtherobjectivesoftheDMHPare:
a)Toreducethestigmaattachedtowardsmental
illness.
b)Topromotecommunity participationinthe
mentalhealthservicedevelopment andto
stimulateeffortstowards self-helpinthe
community.
c)Toincreaseaccesstopreventiveservicestothe
populationatrisk,inparticular,addressingthe
riskofsuicideandattemptedsuicide.
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64. d)Toinformthepersonwithmentalillness,their
caregivers,professionalsandotherstakeholders
oftherightsofpersonswithmentalillnessand
ensurethatrightsarerespectedduringthe
provisionofcareandservices.
e)Tobroadbasementalhealthintootherrelated
programs suchasRCH,SSA,workplace
interventionandsimilar.
f)Toensureamotivatingandempoweringwork
placeforstaffbyallowinganopportunityto
improvetheirskillsandrecognitionoftheirwork.
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64
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65. g)Togenerateknowledgeandevidencerelatedto
thedeliveryofmentalhealthcareandservices;
h)Toimprovetheinfrastructureformentalhealth
servicedelivery.
i)Toestablishgovernance,administrativeand
accountabilitymechanisms torealizetheabove
objectives.
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65
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66. MONITORING OF THE DMHPMinister of H&FW
DGHS
Central monitoring agency for DMHP
(Joint director of mental health, a secretariat with staff including coordinator,
project assistant, data entry operator/ statistician, clerk)

State monitoring agency
(Joint director of mental health,Secretary of the state mental health
authority,project coordinator with a medical background)
(meet DMHP once in 3 month,visit each DMHP and meet MO in 6 months)

District level-district program officer
(Visit each taluk monthly, Meets the medical officer in each taluk monthly)
.
66
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67. BARRIERS IN IMPLEMENTATION OF
DMHP
.
67
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68. 1. ADMINISTRATIVEBARRIERS
Somecentersdidnotsubmittheutilization
certificateandthatcontributedforthedelay.
ReleaseofthefundwasproblemforDMHP
Notgiventheclearguidelinesforoperatefund.
Lackofcoordinationbetweentheworkers
resultsindelayintrainingprogram,operation
ofaccounts,purchaseofdrugsandstationary
fortheprogram.
.
68
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69. 2. LACKOFMANPOWER RESOURCES
Nonavailabilityofstafflikepsychiatrist,
psychologistandsocialworker.
Lackoftimeandinterestofthepsychiatristfor
theprogram.
Lackofcommitmentoncontinuationofservice
isamajorbarriertorecruitpersonnel.
.
69
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70. 3. MOTIVATIONBARRIERS
Poor pay scale
Untimely staff transfer
Unfilled vacancies in PHC lead to transfer of work
to the rest
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70
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71. 4.GENERALISSUES
Doctorsareoftenpoorleadersandthis
underminestheirroleastheheadofprimary
careteam.
Afrequentinterpersonalproblembetweenthe
doctorandtheparamedicalstaffbreaksdown
communication andthisseriouslyhampers
efficiency.
Doctorsspendlottimeincurativeand
outpatientwork.Privatepracticeofdoctors
reducestheiravailabilityforhospitalwork.
.
71
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72. 2.MODERNIZATION OFSTATERUN
MENTALHOSPITALS
a one-time grant Rs.3.00 crores per hospital is
provided.
For construction/repair of existing building,
purchase of cots and equipment's
provision of infrastructure such as water-
tanks and toilet facilities
not cover recurring expenses towards running
the mental hospitals and cost towards drugs
and consumables, increasing bed strength etc.
.
72
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73. 3. UPGRADATION OFPSYCHIATRICWINGS
OFMEDICALCOLLEGES/GENERAL
HOSPITALS
Everymedicalcollegeshouldideallyhavea
Department ofPsychiatrywithminimum of
threefacultymembersandinpatientfacilitiesof
about30bedsasperthenormslaiddownbythe
MedicalCouncilofIndia.
one-timegrantofRs.50lakhsforupgradationof
infrastructureandequipmentaspertheexisting
normsforGovt.MCH/hospitals.
.
73
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74. Theaimoftheschemeistostrengthenthe
trainingfacilitiesforUnder-Graduates&Post-
GraduatesatPsychiatrywingsofgovernment
medicalcolleges/hospitals.
Thegrantcoversconstructionofnewward,
repairofexistingward,procurementofitemslike
cots,tablesandequipment'sforpsychiatricuse
suchasmodifiedECTs.
.
74
.

75. 4. MANPOWER DEVELOPMENT SCHEME
To improve the training infrastructure in mental
health
two schemes
A. Centers of Excellence (Scheme A)
B. Setting Up/ Strengthening PG Training
Departments of Mental Health Specialities(Scheme B)
.
75
.

76. 5. IEC ACTIVITIES
Aimisincreasingawarenessandremovalof
stigmaformentalillness
Rs.1croreisallocatedforthepurposeofIEC
activities
.
76
.

77. APPRAISAL OFTHEEXISTINGSITUATION
.
77
.

78. 1.ISTHEMAINAPPROACH OFTHENMHP
NAMELY INTEGRATION OFMENTAL HEALTH WITH
PRIMARY CARE STILLTHERIGHT APPROACH?
.
78
.

79. WHO and many expert committees’ recommendations
have repeatedly emphasized the soundness of the
approach to integrate mental health with primary
health care as a major relevant strategy for mental
health care delivery in developing countries.
An extensive and authoritative review of the situation
of mental health care across the globe in 2007 -the
Lancet Global Mental Health series, unequivocally
recommends that “….. mental health should be
recognized as an integral component of primary and
secondary general health care, particularly in
low and middle income countries”
.
.
.

80. 2. HOWEFFECTIVE ISTHE
IMPLEMENTATION OFNMHP?
.
80
.

81. i) absence of full time programme officer for
NMHP in many states
ii) inadequacies in the training for PHC personnel
iii) inadequate record maintenance
iv) non-availability of basic information about
patients undergoing treatment at various centres
(regularity of treatment, outcome of treatment,
drop-out rates etc)
.
81
.

82. v)difficultiesinrecruitmentandretentionof
mentalhealthprofessionalsintheDMHP
vi)non-involvementofthenon-governmental
organizations(NGO)andtheprivatesector
vii)inadequatementalhealtheducationaland
communityawarenessactivities
viii)absenceofprogramme outcomeindicators
andmonitoring
ix)inadequatetechnicalsupportfrommental
healthexperts.
.
82
.

83. 3. ISTHEREANYEVIDENCE FORTHE
EFFECTIVENESS OFPRIMARY CAREMENTAL
HEALTH?
.
83
.

84. The most convincing evidence forthe
effectivenessoftheDMHP comesfromNorth
Kerala.Duringthepastfewyears,theDMHPis
beingimplemented inthefivedistrictsof
Kozhikode,Kannur,Malappuram,Kasargodand
Wayanadundertheoverallco-ordinationofthe
InstituteofMentalHealthandNeuroSciences
(IMHANS),Kozhikode,Kerala–aninstitution
selectedbytheMinistryofHealthandFamily
Welfare,GovernmentofIndiaforelevationasa
CentreofExcellenceinmentalhealthduringthe
current11
th
FiveYearPlan.
.
84
.

85. Personsrequiringinpatienttreatmentforsevere
mentaldisordersfromalltheabovedistrictsare
generallyadmittedtothementalhospitallocated
inKozhikode.Theannualnumberofadmissionsin
Kozhikodementalhospitalin2005was2622.The
totalannualadmissionsinthehospitalsteadily
camedownto1836in2009.Similarly,thetotal
annual outpatientfollow-upsofdischarged
patientstoocamedownfrom31802in2005to24610
in2009,whilethetotalannualnumberofnew
outpatientregistrationswentupfrom2243in2005
to2944in2009
.
85
.

86. 4. HASTHEREBEENANYINDEPENDENT
EVALUATION OFTHEDMHP?
.
86
.

87. OneofthemajorcriticismsoftheNMHP and
particularlyitsDMHPcomponentwasthatitwas
notindependentlyevaluatedbeforeitslargerscale
expansionduring10
th
and11
th
Plans.
Independentevaluationwascommissionedbythe
MOHFand wascarriedouttheIndianCouncilof
MarketingResearch(ICMR),during2008-2009.The
termsofreferencefortheevaluationincluded,
besidesobjectiveandcriticalassessmentofthe
DMHP, providing recommendations and
suggestionsforimprovements inimplementation
andfutureexpansionoftheprogramme.

.
87
.

88. 20 districtswere selected for the evaluation
Recommended…….
“It was observed that implementation of DMHP
has resulted in availability of basic mental health
services at district / sub-district level. As such it is
recommended to expand this programmeto other
districts of the country”
.
88
.

89. Itwasobservedthat
irregularflowoffundshadaffectedthe
implementation
Thereweresignificantdelaysininitiationofthe
programmeevenafterthereleaseof
Shortageoftrainedandmotivatedmentalhealth
professionals
difficultiesinretainingrecruitedstaffwere
problemsinmanystates.
Lowutilizationoffunds,meantfortrainingand
IECactivitieswasnoticedinmanydistricts.
.
89
.

90. FUTUREOFNMHP
.
90
.

91. Tomakementalhealthcaremoreaccessibleto
thosewhomostrequirethem,theserviceswill
havetobestrengthenedatthesub-centre,PHC
andCHClevels.
NMHPiscurrentlyafullycentrallyfundedPlan
programme.Toensurecontinuityofthe
programme beyondthe11
th
FiveYearPlan,the
financialresponsibilityfortheprogramme will
havetobegraduallyshiftedtothestate
governmentsandmentalhealthserviceswillhave
tobeintegratedintheStateandDistrict
ImplementationPlan.
.
91
.

92. ThecommunityparticipationandICEcomponents
ofNMHPneedstrengthening.
Appropriatenon-pharmacological interventions
willhavetobeintroducedintotheprogrammeand
thePHCstafftrainedadequately.
ThecommunityparticipationandICEcomponents
ofNMHPneedstrengthening.
Thereisanurgentneedtoenhancethecapacityin
thecountrytotrainmentalhealthprofessionals.
.
92
.

93. Oneoftheproposalsforbetterimplementationof
NMHPisitsintegrationwiththeNationalRural
HealthMission(NRHM)
Ithelpstooptimaluseofexistinginfrastructureat
variouslevelsofhealthcaredeliverysystemand
sustenanceofDMHP beyondtheexpiryofthe
periodofcentralassistancebyitsintegrationin
thedistricthealthsystem.
.
93
.

94. AnintegratedIECunderNRHM,involvementof
NRHM infrastructurefortrainingrelatedto
mentalhealthatthedistrictlevel,useofNRHM
machineryforprocurementofdrugstobeusedin
DMHPandbuildingofcrediblereferralchainsfor
appropriatemanagement ofcasesdetectedat
lowerlevelsofthehealthcaredeliverysystemare
alladditionaladvantagesofintegrationofDMHP
withNRHM.
.
94
.

95. JOURNAL PRESENTATION
Title:-Impactevaluationofthecommunity
mentalhealthprogramathabra
Aims:Theprimaryaimofthefollowingstudyis
toassesstheimpactoftheCMHPonthelocal
populationandsecondaryaimistoevaluatethat
whatextenttheCMHPhavebeenabletoprepare
themtotakeresponsibilityoftheCMHPasa
whole.
.
95
.

96. MaterialsandMethods:Usingsystematicrandom
samplingmethod1486respondentswereselected
anddatacollectusingaquestionnaire.In-depth
interviews,focusgroupdiscussions,participant's
observationandsecondarydatasourceswerealso
used.Inferencesdrownbasedonabovealldata
sources.
.
96
.

97. ResultsandConclusion:Two-thirdofthe
studiedpopulationandmoresointhe
targetareaexpressedthatthecommunity
cantakeresponsibilityofrunningtheir
ownCMHPs.Though,thelargerpopulation
ofthemisstillnotacquaintedwiththe
activitiesoftheCMHP, theprogram
deservessupporttosustain.
.
97
.

98. THEORY APPLICATION
HEALTHBELIEFMODEL
.
98
.

99. CONCLUSION
 TheWorldBankreport(1993)revealedthatthe
DisabilityAdjustedLifeYear(DALY)lossdueto
neuro-psychiatricdisorderismuchhigherthan
diarrhea, malaria, worm infestationsand
tuberculosisiftakenindividually.Accordingtothe
estimatesDALYslossduetomentaldisordersare
expectedtorepresent15%oftheglobalburdenof
diseasesby2020.SoNMHP helptodevelopa
infrastructureformentalhealthservicedeliveryin
allaspects.
.
99
.

100. .
100
.
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1. Director General of Health Services (DGHS): National Mental Health
Programme for India. New Delhi, Ministry of Health and Family
Welfare; 1982
2. Gururaj G., Isaac M.K. Psychiatric epidemiology in India: moving
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3. World Health Organization. Organization of mental health services in
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4. World Health Organization. The declaration of Alma Ata. Geneva:
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5. World Health Organisation. World Health Report 2001-Mental
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6. World Health Organization. Integrating mental health into primary
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101. 8. Sridhar,R.B.(2011). Textbook for community health nursing.2nd
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12.http://mohfw.nic.in/,Mnistry of health and family welfare
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.
101
.

102. THANKYOU
.
102
.