Presentation1 (2)

1. PRESENTER:- SIMERPREET KAUR M.Sc. (N) 1 ST Yr. NATIONAL MENTAL HEALTH PROGRAMME

2. INTRODUCTION: Health is defined as a state of complete physical, mental and social wellbeing and merely absence of disease or infirmity(WHO). Mental health therefore forms an essential part of total health and as such forms an integral part of the national health policy. Mental health is one of the essential components of patient care, this aspect was neglected earlier.

3. The government of India realizing that mental health is an integral component of the total health so formulated the- National Mental Health Programme.   National Mental Health Program was launched in 1982 in order to create awareness of mental illness and for improving the magnitude of mental illness improving the availability of infrastructure and trained manpower in India.  

4. EVOLUTION OF NMHP: The government of India felt the necessity of evolving a plan of action aimed at development of the National Mental Health Programmed . For this, an expert group was formed in 1980 , which met a number of times and discussed the issue with many important people concerned with mental health in India as well as with the Director, Division of Mental Health, WHO, Geneva . Finally , in February 1981, a small drafting committee met in Lucknow and prepared the first draft of NMHP. The final draft was submitted to the Central Council of health . Its meeting held on 18-20 August 1982, for its adoption as the National Mental Health Programme for India. In this way NMHP came into existence

5. Objectives: To ensure the availability and accessibility of minimum mental health care for all in the future , particularly to the most vulnerable and underprivileged sections of the population. To encourage the application of mental health knowledge in general health care and in social development . To promote community participation in the mental health service development and to stimulate efforts towards self-help in the community.

6. Aims: Three aims are specified in the NMHP in planning mental health services for the country: 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 to improve quality of life.      

7. STRATEGIES FOR ACTION: Two strategies, complementary to each other were planned for immediate action: Centre to periphery strategy : Establishment and strengthening of psychiatric units in all district hospitals, with OPD clinics and mobile teams reaching the population for mental health services. Periphery to centre strategy: Training of an increasing number of different categories of health personnel in basic mental health skills, with primary emphasis towards the poor and the underprivileged, directly benefiting about 200million people.

8. TARGETS: Adoption of the plan by each state of India. Formation of National Mental Health advisory body as Focal point. A national coordination group will be formed comprising representatives of all state senior health administrators and professionals from psychiatry, education, social welfare and related professions. Formation of curriculum of health personnel of different levels. Organization of mental health training programs for primary health care personnel at the state levels.

9. Provision of programming officers for mental health at state level. Provision of psychiatrist at district level . Enhancing mental health training in under graduate medical education. Development of linkage with other developmental programs like Integrated Child Development Services Scheme (ICDS). Improvement of mental hospitals and psychiatric teaching units.  

10. APPROCHES TO NATIONAL MENTAL HEALTH PROGRAMME: To achieve the objectives the following approaches were formed :   Diffusion of mental health skills : Instead of centralizing mental health skills and expertise in an urbanized community it should reach periphery (i.e. the primary health care structure at the community level like PHC, Sub-centres and Village level workers). Mental health care must start at the grass root level . 2 . APPROPRIATE APPOINTMENT OF TASKS IN MENTAL HEALTH CARE: The tasks to be performed at each level (village workers, sub centre, PHC, district hospital, regional hospital) will be specified and a referral system set up so that the total system works in an integrated fashion.

11. 3 . Equitable and balanced territorial distribution of resources : Every effort will be made to introduce or strengthen mental health first in those regions which are at present deprived of it or where it is seriously deficient. 4.Integration of basic mental health care into general health services : This will facilitate in dealing with patients without gross psychiatric disturbances. It will enable the health worker to identify psychosocial problems. Psychiatric mental health worker will be able to identify and relate psychosocial factors contributing to ill health.

12. 5. LINKAGE TO COMMUNITY DEVELOPMENT: Involvement of state, district and block leadership in the implementation of the mental health program to ensure community involvement in preventive efforts directed at psychosocial problems like alcohol, drug abuse, behaviour of childhood and adolescence, delinquency and other avoidable problems . 6.MENTAL HEALTH CARE: The mental health care service was to include three components namely treatment, rehabilitation and prevention.

13. Treatment sub program multiple levels were planned : those regions which are at present deprived of it or where it is seriously deficient. Treatment sub program Multiple levels were planned:   Village and sub centre level : Multi-purpose workers(MPW) and health supervisors, under the supervision of medical officer(MO), to be trained for: Management of psychiatric emergencies. Administration and supervision of maintenance , treatment of chronic psychiatric disorders. Diagnosis and management of grandmal epilepsy, especially in children. Liaison with local school teacher and parents regarding mental retardation and behavior problems in children. Counselling in problem related to alcohol and drug abuse.

14. ii. Primary health centre (PHC ) : Medical officer aided by health supervisors , to be trained for: Supervision of MPW’s performance Elementary diagnosis Treatment of functional psychosis Treatment of uncomplicated cases of psychiatric disorders associated with physical diseases . Management of uncomplicated psychosocial problems. Epidemiological surveillance of mental morbidity . III. District hospital : 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 3 0-50 psychiatric beds .

15. IV. Mental hospitals and training psychiatric units: the major activities of these higher centre’s of psychiatric care include: Help in case of difficult cases. Teaching. Specialized facilities like occupational therapy units, psycho therapy, and counselling and behaviour therapy.   B. Rehabilitation sub program : The components of this sub-program include maintenance treatment of epileptics and psychotics at the community levels and development of rehabilitation centre’s at both the district level and the higher referral centres.

16. C.Prevention sub program : The prevention component is to be community based, with the initial focus on prevention and control of alcohol related problems. Later, problems like addictions, juvenile delinquency and acute adjustments problems like suicidal attempts are to be addressed.   D. MENTAL HEALTH TRAINING: Mental health training plays a vital role in creating awareness about mental health for reducing stigma about mental illness and this training help us to explore more ideas and issues related to mental health among health professionals such as nurses, nursing students.

17.   7.Train parents and health care providers in the management of mentally retarded children : Components: workshops : Workshops were organized to sensitize and motivate health care professional to implement NMHP as considering the local priorities and resources.   2)MENTAL HEALTH TRAINING: To provide first level of care, training programmes for Para professional and professionals will be conducted. Involvement of community leaders, volunteers, focus groups in mental health training programmes is essential. 3 )MENTAL RETARDATION: Counselling of parents, referring the cases, utilizing welfare agencies in rehabilitation of services.

18. 4 )RESEARCH: Evaluate research programmes will be conducted to determine the outcome of service deliveries and different levels of functioning and on outcome of training programmes. After in depth situation analysis and extensive consultations with state authorities. The NMHP underwent radical restructuring to have a balance between various components of mental health care delivery system, and clearly specified budget allocations .

19. DISTRICT MENTAL HEALTH PROGRAM (DMHP):- The Central Government launched the District Mental Health Program (DMHP) as a 100% centrally sponsored scheme for first five years, at the national level in 1996-97 during the 9th five year plan as pilot project in 4 districts under NMHP and was expanded to 27 districts of the country by the end of 9th Five year plan period.

20. Objective:- 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.

21. FIVE YEAR PLANS: - Tenth Five Year Plan (2002-2007) The NMHP was re-strategized in the year 2003 (in X Five Year Plan) with the following components: DMHP was extended to 100 districts across the country. Infrastructure support has to be provided psychiatry departments in the hospitals and strengthening of medical college hospitals. Modernization of mental health hospitals to reduce chronicity of mental disorders. Usage of outreach services, promoting care of chronically ill. At their doorsteps by ensuring qualitative mental health services . Ensure effective coordination in all areas of activity. Sponsoring community based research projects. Innovation Information Education Communication strategies will be generated through multidisciplinary collaboration.

22. 2. Eleventh Five Year Plan (2007-2012) . DMHP will be extended to another 200 districts. Reinforcement of upgrading psychiatry departments with adequate infrastructural facilities. Construction of modern building with good infrastructure. Provision of adequate man power for all psychiatry units. Research training programmes have to be organized for qualitative and quantitative improvements. IEC training programmes has to be conducted by involving mass media at central level and regional level to reduce stigma attached to mental illness and increase awareness regarding mental health, available treatment and mental health care facilities.

23. 3. Twelfth Five Year Plan (2012-2017) DMHP will be extended to remaining 193 districts. 20 mental hospitals will be taken up for reconstruction. Non-viable mental hospitals will be closed or merged with general hospital. Long term community based Research Projects will be initiated. IEC activities will be planned to cover all sections of population.

24. REVISED NATIONAL MENTAL HEALTH PROGRAMME (2003) The main characteristics of revised Mental Health Program are:- Redesigning the District Mental Health Program Strengthening the medical colleges with the view to develop manpower to deliver quality mental health care improvement of psychiatric care facilities at secondary level and to promote the development of general hospitals psychiatric units to reduce the need of large mental hospitals. Modernization of existing mental hospitals to transform them from custodial care centres to tertiary care centres which provide holistic developmental care to mentally ill patients.

25. Strengthening the central and state mental authorities to make them effective in monitoring mental health care agencies, on going mental health care program and promoting inter sectorial collaboration. Motivating research and training to generate extensive data regarding epidemiological information of mental illness, their course, outcome, therapies needed, burden on family and society . Development of awareness with strengthening information and communication drive by Involving nongovernmental organizations and mass media. Services are focused to special section of high risk population prone for stressful disorders. Social skill training programme , life skill education programmes has to be conducted to focus groups like school children.

26. ROLE OF NURSE in the Implementation of National Mental Health Programme:-   Three primary goals of community health nurse, Promotion of mental health , Prevention of mental illness, Provision of holistic care and support for individuals experiencing mental ill health.  

27. R OLE OF mHN IN P R IMA RY PREVENTION Child care and child-rearing measures include : Antenatal care to mother and educating her regarding the adverse effects of radiations, drugs and prematurity. Essential timely and efficient obstetrical assistance to guard against the ill effects of anorexia, injury at birth. Counseling of the parents of physically and mentally handicapped children. Programmes to enrich child mother relationship by stressing the importance of warm accepting intimate relationship.

28. PROGRAMMES ORIENTED TO THE CHILD IN THE SCHOOL: Early signs of learning difficulties or behavioural abnormalities should be detected, teachers should be taught to identify the early symptoms of abnormal conduct and behaviour in the children and refer cases. FAMILY-CENTERED ACTIVITIES PROGRAMS: Attitudes of mutual trust, love and respect for one, another need to be fostered. Educational services in the field of mental health, like- Parent -teacher associations, Child guidance clinics .

29. Programmes for Families in Crisis like adolescence, death of a new baby , Retirement or menopause, Death of a wage earner in the family. Can be handled at mental hygiene clinics, psychiatric first-aid centres, walk-in-clinics.   Society-centred Preventive Measures Community development ,social administration, Collection and evaluation of epidemiological data. Budgeting these measures require coordinated activities among persons belonging to different norms and disciplines.

30. ROLE OF MHN IN SECONDA RY P R EVENTION Early Diagnosis and Case Finding achieved by educating the public and community leaders , Mahila Mandals , Balwadis etc. in recognizing early symptoms . Early Reference. Screening programmes : Simple questionnaires should be developed and administered. For Early and Effective Treatment.

31. ROLE OF MHN IN TE R TIA RY P R EVENTION Accomplished by preventing complications of the mental illness & promoting achievement of each individual’s maximum level of functioning through R egular follow up, Diversion therapy, R ecreation therapy, Community Mental Health Facilities, Day-Evening Treatment/ Partial Hospitalization Programs, Community R esidential Facilities, Support Groups.  

32. Mental health Authority: A central authority established by the central or state government to regulate, develop, direct and coordinate the Mental Health Services under the central government . Functions of mental health authority: - These authorities also advise the government on Mental Health matters. They supervise the psychiatric hospitals and psychiatric nursing homes and other mental health agencies. These authorities have the jurisdiction to renew or cancel the licenses.

33. Bibliography:- Book references Taneja D.K. Health Policies and Programmes in India. 8 th edition. Delhi: Doctors Publications; 2010. Gulani K.K. Community Health Nursing Principle & Practices. 1 st edition. Delhi: Kumar Publishing House; 2008. Bhatia MS. Essentials of Psychiatry. 5 th edition. New Delhi: CBS Publishers and Distributors; 2000. Neerja KP. Essentials of Mental Health Nursing. 1 st edition. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd; 2008. Sharma Pawan. Essentials of Mental Health Nursing. 1 st edition. Haryana: Jaypee Brothers Medical Publishers (P) Ltd; 2003. Sreevani R. A Guide to Mental Health and Psychiatric Nursing. 3 rd edition. New Delhi: Jaypee Brothers Medical Publishers (P) Ltd; 2010. National Mental Health Programme. Ninth Plan (1997-2002). Planning Commision. Govt. of India, Nirman Bhawan , New Delhi. Online references http://www.nihfw.org/NDC/DocumentationServices/NationalHealthProgramme/NATIONALMENTALHEALTHPROGRAMME.html http://www.yourarticlelibrary.com/india-2/national-mental-health-programme-nmhp-india/11225/

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