National mental health program unit 15 of mental health nursing

National mental health program

3. LEARNING OBJECTIVES
At the end of the class, students will be able to
•List out the Aims, Objectives, Strategies and
approaches of NMHP
•Explain the activities of NMHP
•Describe the National Health Authority, Policy and
Revised NMHP

4. CONTENT- OVERVIEW
•Introduction
•Aims of NMHP
•Objectives
•Strategies
•Approaches
•Mental Health Care
•Activities
•Revised National Mental Health Program

5. INTRODUCTION
The Government of India has launched the
National Mental Health Programme (NMHP) in 1982,
keeping in view the heavy burden of mental illness in
the community, and the absolute inadequacy of mental
health care infrastructure in the country to deal with it.

6. AIMS
1.To provide mental health care to the total
population within the available resources.
2.Prevention and treatment of mental and
neurological disorders and their associated
disabilities.

7. Contd.,
3.Use of mental health technology to improve
general health services.
4.Application of mental health principles in total
National development to improve quality of life.

8. OBJECTIVES
1.To ensure availability and accessibility of
minimum mental health care for all in the
foreseeable future, particularly to the most
vulnerable and underprivileged sections of
population.
2.To encourage application of mental health
knowledge in general health care and in social
development.

9. Contd.,
3. To promote community participation in the mental
health service development and to stimulate efforts
towards self-help in the community.

10. STRATEGIES
1.CENTRE
TO PERIPHERY

11. Contd..
1. Centre to periphery strategy
oPsychiatric units in all hospitals
oOutpatient clinics
oMobile teams
2. Periphery to centre strategy
oTraining of different categories of health personnel.

12. APPROACHES
1. Diffusion of Mental Health skills to the periphery of
the Health care service system.
2. Appropriate appointment of tasks in Mental Health
care.
3. Equitable and balanced territorial distribution of
resources

13. Contd.,
4.Integration of Basic Mental Health care into General
Health Services.
5.Linkage to community development.
6. Mental Health care.
7.Mental Health Training
8.Mental Retardation & Drug Dependence.

14. MENTAL HEALTH CARE: THREE
COMPONENTS OR SUB-PROGRAMMES

15. 1.TREATMENT SUB-PROGRAMME
A. Village and sub Centre level:
Multipurpose workers & Health supervisors,
under the supervision of Medical Officer , to be
trained for:
 Management of psychiatric emergencies
Administration & supervision of maintenance
treatment for chronic psychiatric treatment.

16. Contd.,
Diagnosis and management of grandmal epilepsy,
especially in children.
Liaison with local school teachers & parents
regarding mental retardation and behavior
problems in children.
Counseling in problems related to alcohol and drug
abuse.

17. Contd.,
B. Primary Health Centre (PHC):
The Medical Officer, aided by the Health
supervisor, to be trained for
 Supervision of the Multipurpose worker’s
performance.
Elementary diagnosis
Treatment of functional psychosis

18. Contd.,
Treatment of uncomplicated cases of psychiatric
disorders associated with physical illness.
Epidemiological surveillance of mental morbidity.

19. Contd.,
C. District Hospital :
At least one psychiatrist to be appointed to each
district hospital as an integral part of the district health
services.
The district hospital should have 30 to 50 psychiatric
beds.

20. Contd.,
The psychiatrist in the district hospital was
envisaged to devote only a part of his time in
clinical area and greater part in training &
supervision of non-specialist health workers.

21. Contd.,
D. Mental Hospitals and Teaching Psychiatric units:
The major activities of these higher centers of
psychiatric care include:
Help in care of ‘difficult cases’
Teaching
Specialized facilities like occupational therapy
units, psychotherapy, counseling & behavior
therapy.

22. Contd….

23. 2. REHABILITATION SUB-PROGRAMME
Components include
Maintenance treatment of epileptics & psychotics at
the community level.
Development of rehabilitation centers at both district
level & higher referral centers.

24. 3.PREVENTION SUB-PROGRAMME
Prevention & Control of alcohol-related problems.
To tackle the following problems later:
Addictions
Juvenile delinquency
Acute adjustment problems
Suicidal attempts

25. ACTIVITIES
Community Mental Health Programme at primary
health care level in state & union territories.
Training of existing primary health personnel
without additional staff.
Development of state level Mental Health
Advisory Committee & identification of state level
programme officer, preferably a psychiatrist.

26. Contd.,
Establishment of regional centers of community
mental health.
Development of a task force for mental hospitals.
Prevention & promotion of Mental Health
Task force for mental health education for
undergraduate medical students.

27. Contd.,
 Voluntary agencies to be involved in mental health
care.
 Priority areas to be identified such as:
Child mental health
Public mental health education
Drug dependence
 Mental health training of atleast one doctor at every
district hospital.

28. Contd.,
 Establishment of a department of psychiatry in all
the medical colleges & strengthening of existing
ones.
 Provision of at least 3 or 4 psychotropic drugs in
adequate quantities at PHC level.

29. REVISED NATIONAL MENTAL HEALTH
PROGRAMME (2003)

30. Revised National Mental Health
Programme (2003)
The programme comprises five closely networked strategic
components with a total outlay of Rs. 19 billion during the 10
th

five year plan.
Redesigning the DMHP, around a modal institution, which
in most instances will be the zonal medical college.
Strengthening the medical colleges.

31. Strengthening of central and state mental health
authorities.
Modernization of mental hospitals.
Research and training included.
Contd.,

32. DISTRICT MENTAL HEALTH
PROGRAMME (DMHP)
This programme started as a part of NMHP
implementation. Initially 7 district started this
programme between 1997 to 1998. Gradually,
other districts also started, reaching 25 districts in
22 states of India.

33. AIMS
1.Training programmes of all workers in mental
health team at the identified Nodal institution in
the state.
2.Public education in the mental health to increase
awareness & reduce stigma.

34. 3. For early detection & treatment, the OPD and indoor
services as provided.
4. Providing valuable data and experience at the level
of community to the state and center for future
planning, improvement in service & research.
Contd.,

35. TARGETS
DMHP covers the entire country.
Streamlining/ modernisation of mental hospitals in
order to modify their present custodial role.
Upgrading department of psychiatry in medical
colleges & enhancing the psychiatry content of the
medical curriculum at undergraduates as well as post-
graduate level.

36. Contd.,
Strengthening the central & state Mental Health
Authorities with a permanent secretariat.
Appointment of medical officers at state headquarters
in order to make their monitoring role more effective.
Research and training in the field of community mental
health, substance abuse and child/adolescent
psychiatric clinics.

37. CENTRAL MENTAL HEALTH
AUTHORITY
Constitution of the Authority:
Official members:
a)Secretary or Additional secretary, Ministry of health
and family welfare, Government of India.
b)Joint secretary, Ministry of Health and family welfare
dealing with mental health.

38. Contd.,
c)Additional Director-General of Health services
dealing with mental health.
d)Director, General Institute of psychiatry, Ranchi
e)Director, National Institute of Mental Health and
Neurosciences, Bangalore
f)Medical superintendent, Hospital for Mental
diseases, Shahdara.

39. Non-Official members
a)One social worker
b)Clinical psychologist
c)One Medical psychiatrist-who has special
interest in the field of Mental Health.

40. STATE MENTAL HEALTH AUTHORITY

State Mental Health Authority was formed and
notified on 1-8-1994.
Ex-officio Members:
1.The secretary, Health & Family welfare -
Chairman
2.Deputy secretary, Health and Family welfare
- Member
3.Director of Medical & Rural Health services
- Member

41. NATIONAL MENTAL HEALTH POLICY

42. According to WHO ‘Mental health policies describes the
values, objectives and strategies of the government to
reduce the mental burden and to improve the mental health.
The first draft of national mental health policy was prepared
in late 2001 and came into existence in 2003.

NATIONAL MENTAL HEALTH POLICY

43. •The district mental health programme is redesigned
around a nodal institution ,where most instances will be
the zonal medical colleges.
•Strengthening the medical college psychiatry
departments with a view to develop psychiatric
manpower.
POLICY OBJECTIVES

44. •Streamlining and modernization of mental hospitals
to transform them from the present.
•Strengthening of central and state mental health
authorities in order that they may effectively fulfill
their role of monitoring on going mental health
programme.
Contd.,

45. •Research and training aimed at building up an
extensive database of epidemiological information
relating to mental disorder and their courses.
•Focused information, education and communication
activities with the active collaboration of professional
agencies.

46. •Strengthening of central and state mental health
authorities by facilitating the establishment of
permanent secretaries and networking of state
authorities with national level.
•IEC training and research by sponsoring, relevant
community based research projects and binding up an
extensive data base .

47. Eleventh five year plan(2007-2012)
The DMHP will be extended to another 200 districts while
consolidating same 200 districts covered at the end of 10
th

plan.
Qualitative and quantitative improvement will be introduced
in the areas of research, training and IEC, with more focused
attention on epidemiological catchment area surveys on a
larger scale.
ELEVENTH FIVE YEAR PLAN (2007-2012)

48. 10
th
five year plan (2002-2007)

✸
District mental health program will be extended to
one district attached to each of the 100 medical
colleges in the country.

✸
Strengthening of medical colleges with allocation
of Rs.50 lakhs each to 100 medical colleges.

✸
Streamlining and modernization of mental hospitals
with the aim of reduction in chronicity through
intensive therapeutic intervention.
PRIORITIZE THE GOAL

49. Twelth Five Year Plan (2012-2017)
•The DMHP will be extended to the remaining 193
districts and the gains made in the previous plans will
be consolidated, further up gradation of the
psychiatric department in medical colleges will be
undertaken and 20 mental hospitals will be
contracted.

50. OBJECTIVES:
•To achieve the acceptable standard of good health
amongst the general population in the country.
•To increase the access to the decentralized public
health system.
NATIONAL HEALTH POLICY(NHP)

51. •Specific recommendation with regard to mental
health
•Upgrading infrastructure of institutions at central
government expense so as to secure human rights.
•Envisages a network of decentralized mental health
services.
Contd…

52. •Aims of NMHP
•Objectives
•Strategies
•Approaches
•Mental Health Care
•Activities
•Revised National Mental
Health Program
SUMMARY

53. CONCLUSION