National Mental health

programme
Aparna M Ajay,
Asst.professor,
SUBHARATHI NURSING
COLLEGE.

It is estimated that 6-7 % of

population suffers from mental disorders.
The World Bank report (1993) revealed
that the Disability Adjusted Life Year
(DALY) loss due to neuro-psychiatric
disorder is much higher than diarrhea,
malaria,
worm
infestations
and
tuberculosis if taken individually.

Together these disorders

account for 12% of the global burden
of disease (GBD) and an analysis of
trends indicates this will increase to
15% by 2020 (World Health Report,
2001).

One in four families is

likely to have at least one member
with a behavioral or mental disorder
(WHO 2001). These families not only
provide physical and emotional
support, but also bear the negative
impact of stigma and discrimination.

Most of them (>90%) remain

un-treated. Poor awareness about
symptoms of mental illness, myths &
stigma related to it, lack of
knowledge
on
the
treatment
availability & potential benefits of
seeking treatment are important
causes for the high treatment gap.

objectives
The Government of India has
launched the National Mental Health
Programme (NMHP) in 1982, with the
following objectives:
1. To ensure the availability and
accessibility of minimum mental
healthcare for all in the foreseeable
future, particularly to the most
vulnerable

 2.To encourage the application of

mental health knowledge in general
healthcare and in social development;
and
3. To promote community participation
in
the
mental
health
service
development and to stimulate efforts
towards self-help in the community

DISTRICT MENTAL HEALTH

PROGRAMME
The District Mental Health Program
(DMHP) was launched under NMHP in
the year 1996 (in IX Five Year Plan).
The DMHP was based on Bellary
Model with the following
components:

 1. Early detection & treatment.

2. Training: imparting short term training to
general physicians for diagnosis and
treatment of common mental illnesses with
limited number of drugs under guidance of
specialist. The Health workers are being
trained in identifying mentally ill persons.
3. IEC: Public awareness generation.
4. Monitoring: the purpose is for simple
Record Keeping.

 Starting with 4 districts in 1996, the

program was expanded to 27
districts by the end of the IX plan.
The NMHP was re-strategized in the
year 2003 (in X Five Year Plan) with
the following components:

 1. Extension of DMHP to 100 districts

2. Up gradation of Psychiatry wings
of Government Medical Colleges/
General Hospitals
3. Modernization of State Mental
hospitals
4. IEC
5. Monitoring & Evaluation

 the NMHP has the following

components/schemes:
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

STATUS OF MENTAL HEALTH

SERVICES

It have been rendered by a

few mental health institutions like
Central institute of psychiatric at
Ranchi and National Institute of
Mental
health
and
neuro
science,Bangalore and in some
states and central government
hospitals.

Need of mental health

programme

Severe mental disorders that

include
schizophrenia,
bipolar
disorder, organic psychosis and
major depression affect nearly 20 per
1000 population.

1. District Mental Health Programme (DMHP)

Presently the DMHP is being

implemented in 123 districts of the
country. The DMHP envisages a
community based approach to the
problem, which includes:
Training of mental health team at
identified nodal institutions.

 Increase awareness & reduce

stigma related to Mental Health
problems.
Provide service for early detection
& treatment of mental illness in the
community (OPD/ Indoor & follow
up).

 Provide valuable data & experience

at the level of community at the
state & center for future planning &
improvement in service & research.

The Government of India

that DMHP should be revised and
consolidated assistance on new
pattern with added components of
Life skills education & counselling in
schools, College counselling services,
Work place stress management and
suicide prevention services should be
provided.

 These components are in addition to

the existing components of clinical
services, training of general health
care functionaries, and IEC activities
in DMHP.

 The team of workers at the district

under the program consists of a
Psychiatrist, a Clinical Psychologist, a
Psychiatric
Social
worker,
a
Psychiatry/Community
Nurse,
a
Program Manager, a Program/Case
Registry Assistant and a Record
Keeper.

2. Modernization of State Run Mental Hospitals

Most of the state run

mental hospitals in the country were
established long ago and are now in
dilapidated state. The infrastructure of
these hospitals stands on custodial care
pattern. The assistance under this
scheme is provided for modernization of
state run mental hospitals from custodial
care to comprehensive management.

As per the existing scheme to

modernize the existing state-run mental
hospitals, a one-time grant with a ceiling
of Rs.3.00 crores per hospital is provided.
The grant covers activities such as
construction/repair of existing building(s),
purchase of cots and equipments,
provision of infrastructure such as watertanks and toilet facilities etc

 .
It does not cover recurring
expenses
towards
running
the
mental hospitals and cost towards
drugs and consumables. This is the
grant for modernization of the
mental hospitals only and any
increase in the number of beds in the
hospital is not permitted.

Up gradation of Psychiatric Wings of

Medical Colleges/General Hospitals

Every medical college should ideally

have a Department of Psychiatry
with minimum of three faculty
members and inpatient facilities of
about 30 beds as per the norms laid
down by the Medical Council of India.

 Out of the existing medical colleges

in the country, approximately 1/3rd
of them do not have adequate
psychiatric services.

 This is a scheme for strengthening of

the psychiatric wings of government
medical
colleges/hospitals
which
provides for a one-time grant of
Rs.50 lakhs for up gradation of
infrastructure and equipment as per
the existing norms.

 The aim of the scheme is to

strengthen the training facilities for
Under-Graduates & Post-Graduates
at Psychiatry wings of government
medical colleges/hospitals.

 The grant covers construction of new

ward, repair of existing ward,
procurement of items like cots, tables
and equipments for psychiatric use
such as modified ECTs.

A. Centers of Excellence
(Scheme A)
Under Scheme-A, at least 11 Centres
of Excellence in mental health were
to be established in the IXth plan
period by upgrading existing mental
health institutions/hospitals.

 A grant of up to Rs.30 crores is

available for each centre. The
support includes capital work
(academic block, library, hostel, lab,
supportive departments, lecture
theatres etc.), equipments and
furnishing, support for faculty
induction and retention for the plan
period.

 The commitment to take over the

entire funding of the scheme after
the 11th five year plan period from
the state government is required.
The proposal of the State
Governments for these centers must
include definite plan with timelines
for initiating/ increasing PG courses
in Psychiatry, Clinical Psychology,
PSW and Psychiatric Nursing.

Setting Up/ Strengthening PG Training

Departments of Mental Health Specialities
(Scheme B)

To provide further impetus to

manpower development in Mental
Health,
Government
Medical
Colleges/ Hospitals are supported to
start PG courses in Mental Health or
to increase the intake capacity for PG
training in Mental Health.

The support involves capital

work for establishing/improving mental
health departments (Psychiatry, Clinical
Psychology, Psychiatric Social Work, and
Psychiatric Nursing), equipments, tools and
basic infrastructure, support for engaging
required/deficient
faculty
for
starting/enhancing the PG courses. The
support of up to Rs. 51 lacs to Rs. 1 crore
per PG department is available.

5. IEC Activities

NMHP has dedicated funds for IEC

activities for the purpose of increasing
awareness and removal of stigma for
mental illness. The funds are allocated
at central and state levels for IEC
activities. An amount of Rs. one crore
is allocated for the purpose of IEC
activities at central level.

4. Manpower Development Scheme

In order to improve the training

infrastructure in mental health,
Government of India has approved
the Manpower Development
Components of NMHP for XIth Five
Year Plan. It has two schemes which
are as follows:

Treatment of mental disorder based

on
Integration of mental health with primary
health care through the National Mental
Health Programme.
Provision of teritiary care institution for
treatment of mental disorders
Eradicating stigmatization patients of
mentally ill patients and protecting their
rights through regulatory institution like
central Mental Authority and State Mental
Health Authority.

MENTAL HEALTH
PROGRAMME
In 1982,the national health
programme was launched to mitigate
the hardships of mentally ill
patients.
To ensure availability and
accessibility of minimum mental
health care for all in the near
foreseeable future, particularly to
most vulnerable sections of the
population.

 To encourage mental health

knowledge and skills in general
health care and social development.
To promote community participation
in mental health service
development and to stimulate self
help in the community.

 A model of health care at the level

of district was evolved and field
tested in the Bellary district of
Karnataka
by NIMHANS between
1986 and 1995.

 The programme DMH envisages a

community based approach to deal
with mental health problems in the
country.

Interventions
Training of mental health team at the
identified nodal institutes with in the
states.
Increase awareness about mental
health problems.
Provide services for early detection
and treatment of mental illness in
community itself with both OPD and
indoor treatment and follow up of
discharge cases.

 Provide valuable data and experience

at the level of community in the
states and centre for future planning,
improvement in service and
research.

Funds are provided by the

government of India to the state
government and the nodal institutes
to meet the expenditure on staff
,equipments,vehicles,medicines,stati
onery, contingencies, training, IEC
activities etc.

Cont..d

The training to the trainers

at the state level is being provided
regularly by the National Institute of
Mental Health and Neurosciences,
Bangalore under the National Mental
Health Programme.

Teritiary care hospitals

Well known in public sector
National institute of Mental health
and Neuroscience {NIMHANS}
Central institute for psychiatry
{CIP}
The Institute of Human Behavior
and Allied Sciences,IHBAS DELHI.

 The main problems in the field are

Inadequate
number
of
trained
psychatrists.
The medical care in these hospitals
are custodial in nature and this
needs to be changed to a more
therapeutic approach.
The government of India along with
NIMHANS have developed booklet on
minimum standards of care in mental

Barriers to implementation of the

programme.
Shortage of trained manpower in the
fields of mental health.
Social stigma and lack of knowledge
of
psychiatric patients and their
families.
Negative
attitude
of
general
practitioners,
primary
care
physicians and other specialist.

 NGOs/Voluntary organization do not

find this field attractive
Inadequate staff and infrastructure of
mental hospitals and psychiatric of
medical colleges.
Uneven
distribution
of
spare
resources limiting the availability of
mental health care to those living in
urban areas.

Cont..d
Inadequate funding for mental health
,which remains a relatively low
priority area.