PRESENTER:-

SIMERPREET KAUR

NATIONAL MENTAL HEALTH PROGRAMME

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.

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.

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

OBJECTIVES:

1. 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.

2. To encourage the application of mental health

knowledge in general health care and in social

development.

3. To promote community participation in the mental

health service development and to stimulate efforts

towards self-help in the community.

AIMS:

Three aims are specified in the NMHP in planning

mental health services for the country:

1.Prevention and treatment of mental and

neurological disorders and their associated

disabilities.

2.Use of mental health technology to improve

general health services.

3.Application of mental health principles to

improve quality of life.

STRATEGIES FOR ACTION:

Two strategies, complementary to each other were planned

for immediate action:

1. 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.

2. 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.

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.

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.

APPROCHES TO NATIONAL MENTAL

HEALTH PROGRAMME:

To achieve the objectives the following approaches were formed:

1. 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.

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.

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.

A. 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:

i. 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.

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 30-50 psychiatric beds.

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.

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.

7.TRAIN PARENTS AND HEALTH CARE PROVIDERS IN

THE MANAGEMENT OF MENTALLY RETARDED

CHILDREN:

COMPONENTS:

1) 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.

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.

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.

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.

FIVE YEAR PLANS: -

1. 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.

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.

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.

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.

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.

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.

ROLE OF MHN IN PRIMARY 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.

•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.

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.

ROLE OF MHN IN SECONDARY PREVENTION

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.

ROLE OF MHN IN TERTIARY PREVENTION

Accomplished by preventing complications of the mental

illness & promoting achievement of each individual’s

maximum level of functioning through Regular follow up,

Diversion therapy, Recreation therapy, Community Mental

Health Facilities, Day-Evening Treatment/ Partial

Hospitalization Programs, Community Residential

Facilities, Support Groups.

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.

THANK YOU