national mental health program
TRANSCRIPT
NATIONAL MENTAL HEALTH
PROGRAM
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LIVING WITH SCHIZOPHRENIA
MENTAL HEALTH
“Mental health is defined as a state of well-being
in which every individual realizes his or her own
potential, can cope with the normal stresses of
life, can work productively and fruitfully, and is
able to make a contribution to her or his
community”.-WHO
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MENTAL ILLNESS
“A mental illness is a medical condition that
disrupts a person's thinking, feeling, mood, ability
to relate to others and daily functioning. Mental
illnesses are medical conditions that often result
in a diminished capacity for coping with the
ordinary demands of life”.- National Alliance on
Mental Illness(NAMI)
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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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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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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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FACT 2:-MENTAL AND SUBSTANCE USE
DISORDERS ARE THE LEADING CAUSE OF
DISABILITY WORLDWIDE
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FACT 3:-ABOUT 800 000 PEOPLE COMMIT
SUICIDE EVERY YEAR
Suicide is the second
leading cause of death
in 15-29-year-olds
There are indications that for each adult who died
of suicide there may have been more than 20
others attempting suicide. 75% of suicides occur in
low- and middle-income countries. Mental
disorders and harmful use of alcohol contribute to
many suicides around the world.
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FACT 4:-WAR AND DISASTERS HAVE A LARGE
IMPACT ON MENTAL HEALTH AND
PSYCHOSOCIAL WELL-BEING
Rates of mental disorder tend to double after
emergencies.
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FACT 5:- MENTAL DISORDERS ARE IMPORTANT
RISK FACTORS FOR OTHER DISEASES, AS WELL
AS UNINTENTIONAL AND INTENTIONAL 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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FACT 6:- STIGMA AND DISCRIMINATION
AGAINST PATIENTS AND FAMILIES PREVENT
PEOPLE FROM SEEKING MENTAL HEALTH CARE
This stigma can lead to abuse, rejection and
isolation and exclude people from health care or
support.
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FACT 7:- HUMAN RIGHTS VIOLATIONS OF
PEOPLE WITH MENTAL AND PSYCHOSOCIAL
DISABILITY ARE ROUTINELY REPORTED IN MOST
COUNTRIES
These include physical restraint, seclusion and
denial of basic needs and privacy.
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FACT 8:-GLOBALLY, THERE IS HUGE INEQUITY
IN THE DISTRIBUTION OF SKILLED HUMAN
RESOURCES FOR MENTAL HEALTH
Shortages of psychiatrists, psychiatric nurses,
psychologists and social workers are among the
main barriers to providing treatment
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FACT 9:-THERE ARE 5 KEY BARRIERS TO INCREASING
MENTAL HEALTH SERVICES AVAILABILITY
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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FACT 10:-FINANCIAL RESOURCES TO INCREASE
SERVICES ARE RELATIVELY 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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GENESIS AND EVOLUTION OF THE NATIONAL
MENTAL HEALTH PROGRAMME FOR INDIA
1970 community surveys of mental disorders
carried out in different parts of the country had
shown that all types of mental disorders were
widely prevalent in India.
gross neglect of mental disorders in developing
countries
stigma, misconceptions,
inadequate budgets for health care including mental
health
acute shortage of trained mental health personnel
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5 IMPORTANT FACTORS LEADED TO NMHP FOR INDIA
1. “The organization of mental health services in
developing countries” – a set of recommendations
by an expert committee of the World Health
Organization.
Basic mental health care should be integrated
with general health services and be provided by
non-specialized health workers, at all levels.
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carry out one or more pilot programmes to test
the practicability of including basic mental
health care in an already established programme
of health care in a defined rural or urban
population.
training programmes, including simple manuals
of instructions for training of health workers
should be devised and evaluated”
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2. Starting of a specially designated “Community
Mental Health Unit” at the National Institute of
Mental Health and Neuro Sciences (NIMHANS),
Bangalore – 1975
Mental health needs assessment and situation
analysis in over 200 villages in Bangalore rural
district covering a population of about 100,000
were carried out by the community mental health
unit of NIMHANS.
Simple methods of identification and
management of persons with mentally illness,
mental retardation and epilepsy in the rural
community by primary care personnel were
developed.
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Pilot training programmes in basic mental health
care for primary health care (PHC) personnel were
conducted in various primary health centres such
as Anekal, Malur and Solur in Bangalore, rural,
Kolar and Tumkur districts in Karnataka state.
Simple mental health educational materials which
could be used by multipurpose health workers in
rural areas were also developed.
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A variety of methods for evaluating the training in
mental health provided to PHC personnel were
developed and tested.
Based on the pilot experiences from its rural
mental health centre, the community mental
health unit at NIMHANS developed a strategy for
taking mental health care to the rural areas
through the existing primary health care network.
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3. World Health Organization (WHO) Multi-country
project: “Strategies for extending mental health
services into the community” (1976-1981)
The propose model of integrating mental health
with general health services and providing basic
mental health care by trained health workers and
doctors as an integral part of primary health care
received substantial support from a multi-country
collaborative project initiated by the WHO and
carried out in 7 geographically defined areas in 7
developing countries, Brazil, Colombia, Egypt,
India, Philippines, Senegal and Sudan.
The department of psychiatry at the post
graduate institute of medical education and
research in Chandigarh was the center in India
and the model was developed in the Raipur Rani
block in Haryana state.
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4. The “Declaration of Alma Ata”- to achieve
“Health for All by 2000” by universal provision of
primary health care (1978)
According to the Alma-Ata declaration, primary
health care is "essential health care based on
practical, scientifically sound and socially
acceptable methods and technology made
universally accessible to individuals and
families in the community through their full
participation and at a cost that the community
and the country can afford to maintain at every
stage of their development in the spirit of self-
determination"
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5. Indian Council of Medical Research –
Department of Science and Technology (ICMR-
DST) Collaborative project on ‘Severe Mental
Morbidity’
During the late 1970s and the early 1980s,ICMR
and DST of Govt. of India funded a 4 centre
collaborative study to evaluate the feasibility of
training PHC staff to provide mental health care
as part of their routine work.
At the end of one year period about 20% of the
actual cases were identified and managed by the
PHC personnel under the overall supervision of
the centre staff.
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In1982, the above factors contributed into small
measure to the drafting of the NMHP. The draft of
the NMHP, written by an expert drafting
committee which consisted of some of the leading,
senior psychiatrists in India.
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The objectives of NMHP were: (a) to ensure the
availability and accessibility of minimum mental
healthcare for all in the foreseeable future,
particularly to the most vulnerable and
underprivileged sections of the population
(b) to encourage the application of mental health
knowledge in general healthcare and in social
development
(c) to promote community participation in the
mental health service development and to
stimulate efforts towards self-help in the
community
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WHAT HAPPENED AFTER NMHP 1982?
No budgetary estimates or provisions were made
for the implementation of the programme
There was lack of clarity regarding who should
fund the programme – the federal government of
India or the state governments who perpetually
had inadequate funds for health care.
Great doubts were expressed about the feasibility
of implementing the programme in larger
populations
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The need for planning the implementation of the
programme at a district level was highlighted.
Five specific periods from 1982
1) 1982-1990 – Development of the pilot district
mental health programme at Bellary district in
Karnataka
2) From the late eighties to 1996 – Training of
trainers and sensitization workshops
Primary health centre workers can be trained
and supervised to identify and manage certain
types of mental disorders and epilepsy along with
their routine work at the primary health centres.
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Most mental health professionals were
disinterested in public health aspects of mental
health. The country office of the WHO supported a
programme of training mental health professionals
to become trainers of primary care staff and
programme mangers of NMHP. Funding was also
made available for holding nation wide
sensitization programmes for senior health
administrators.
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A national workshop organized by NIMHANS, in
collaboration with Ministry of Health and Family
Welfare, Govt. of India involving the health
departments all the states and union territories in
February 1996, strongly recommended that National
Mental Health Programme should be activated by
sanction of adequate funds from Central Government
(Plan funds). The workshop further recommended
that District Mental Health Programmes should be
implemented in each state/union territory and the
“Bellary programme” as developed by NIMHANS
could serve as a prototype.
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The emphasis should be in involving the families
in looking after the mentally ill and special
emphasis should be given to poor, weaker and
underprivileged sections of the society. The
workshop also suggested various requirements
and components such as human resources,
equipments, beds etc for such a District Mental
Health Programme.
The Ministry of Health and Family Welfare, Govt. of
India formulated District Mental Health Programme
(under National Mental Health Programme) as a
fully centrally funded 5 year pilot scheme
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3) 1996-97 to 2002 (IX Five Year Plan) – Wider
implementation of the District Mental Health
Programme
The District Mental Health Programme was
launched during 1996-97 in four districts – one
district each in Andhra Pradesh, Assam,
Rajasthan and Tamil Nadu
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The objectives were,
i) To provide sustainable mental health services
to the community and to integrate these services
with other services
ii) Early detection and treatment of patients
within the community itself
iii) To see that patients and their relatives do not
have to travel long distances to go to hospitals or
nursing homes in cities
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iv) To take pressure off mental hospitals
v) To reduce the stigma attached towards mental
illness through change of attitude and public
education
vi) To treat and rehabilitate mentally ill patients
discharged from the mental hospital within the
community.
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IX plan period was also facilitated by a variety of
other factors such as:
i) Further recommendations and resolutions by
the (Central Council of Health and Family
Welfare) CCHFW.
ii) The publication of an influential report by the
National Human Rights Commission of India
(NHRC) on “Quality assurance in mental
health”29
iii) The wide media publicity, public out cry and
intervention by the Supreme Court of India
following the Erwadi tragedy wherein 26
chained mentally ill persons were accidentally
killed in a fire accident that took place in
Erwadi Dargah in Ramanathapuram district of
Tamil Nadu state in August 2001.
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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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The five strategies adopted were
i) Expand the DMHP to 100 districts
ii) Upgrade and strengthen the departments of
psychiatry to improve treatment and training
facilities. Better mental health care facilities at
general hospital and medical college hospital
settings was expected to bring down the load on
mental hospitals
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iii) Modernize and transform mental hospitals to
improve patient care and reduce / prevent long
stay
iv) Stronger emphasis and funding for activities
providing mental health IEC activities to
communities
v) Support research and training
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5) 2007 onwards…
Dealing with the acute shortage of trained human
resources.
Approved Rupees 408 crores in XI Plan is for
setting up 10 Centres of Excellence in the field of
Mental Health, centres will focus on training
psychiatrists, clinical psychologists, psychiatric
social workers and psychiatric nurses
33 Government medical colleges would also be
supported for starting post graduate courses or
increasing the intake capacity for post graduate
training in mental health.
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NATIONAL MENTAL HEALTH PROGRAMME
(NMHP)-1982
Objectives:-
1. To ensure the availability and accessibility of
minimum mental healthcare for all in the
foreseeable future, particularly to the most
vulnerable and underprivileged sections of the
population;
2. To encourage the application of mental health
knowledge in general healthcare 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.
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AIMS:-
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 in
total national development to improve
quality of life.
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STRATEGIES:-
Integrating mental health with primary
health care through the NMHP.
Provision of tertiary care institutions for
treatment of mental disorders.
Eradicating stigmatization of mentally ill
patients and protecting their rights through
regulatory institutions like the Central
Mental Health Authority and State Mental
Health Authority
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MENTAL HEALTH CARE
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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1. The mental morbidity requires priority in
health care delivery and treatment
Modern treatment of schizophrenia, dementia
and encephalopathies reduce disability to a
great extent.
Proper recognition and treatment is very
important to reduce the morbidity in the
community
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2. Primary Health care at Village and Sub center
level
Multi-purpose workers and health supervisor
trained to deal with
management of psychiatric emergencies
maintanence of treatment advised from the
higher centre
management of grand mal epilepsy through the
utilization of appropriate medicine under the
guidance of a medical doctor and school teacher
management of children with mental retardation
and behavior problems
counselling of patients suffering from alcohol
and drug use disorders.
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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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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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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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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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DISTRICT MENTAL HEALTH PROGRAMME
(DMHP)
launched under NMHP in the year 1996 in IX
Five Year Plan
The DMHP was based on ……………….model
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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.
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Starting with ………… districts in 1996
was expanded to 27 districts by the end of
the IX plan.
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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.
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Conducted an evaluation in 2008
Added Life skills education & counselling in
schools
College counselling services
Work place stress management
Suicide prevention services.
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THE TEAM INCLUDING IN DMHP……
Psychiatrist
Clinical Psychologist
Psychiatric Social worker
Psychiatry/Community Nurse
Program Manager
Program/Case Registry Assistant
Record Keeper.
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PRINCIPLES, GOALS & OBJECTIVES OF THE
DMHP IN THE XII TH PLAN
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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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iv) An evidence based perspective by following
established guidelines and experiences on
treatments and delivery models.
v) A health systems perspective with clearly
defined roles and responsibilities for each sector
from community to district hospital and including
a cascading model of capacity building and
supervision.
vi) A rights based perspective to ensure rights of
persons with mental illness are protected and
respected by mental health services.
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GOAL
Improve health and social outcomes related to
mental illness .
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OBJECTIVES
The primary objective of the District Mental
Health Programme is to reduce distress, disability
and premature mortality related to mental illness
and enhance recovery from mental illness by
ensuring the availability of and accessibility to
mental health care for all in the XIIth Plan period,
particularly the most vulnerable and
underprivileged sections of the population.
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Other objectives of the DMHP are:
a) To reduce the stigma attached towards mental
illness.
b) To promote community participation in the
mental health service development and to
stimulate efforts towards self-help in the
community.
c) To increase access to preventive services to the
population at risk, in particular, addressing the
risk of suicide and attempted suicide.
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d) To inform the person with mental illness, their
care givers, professionals and other stakeholders
of the rights of persons with mental illness and
ensure that rights are respected during the
provision of care and services.
e) To broad base mental health into other related
programs such as RCH, SSA, work place
intervention and similar.
f) To ensure a motivating and empowering work
place for staff by allowing an opportunity to
improve their skills and recognition of their work.
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g) To generate knowledge and evidence related to
the delivery of mental health care and services;
h) To improve the infrastructure for mental health
service delivery.
i) To establish governance, administrative and
accountability mechanisms to realize the above
objectives.
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MONITORING OF THE DMHP
Minister 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)
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BARRIERS IN IMPLEMENTATION OF
DMHP
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1. ADMINISTRATIVE BARRIERS
Some centers did not submit the utilization
certificate and that contributed for the delay.
Release of the fund was problem for DMHP
Not given the clear guidelines for operate fund.
Lack of coordination between the workers
results in delay in training program, operation
of accounts, purchase of drugs and stationary
for the program.
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2. LACK OF MANPOWER RESOURCES
Non availability of staff like psychiatrist,
psychologist and social worker.
Lack of time and interest of the psychiatrist for
the program.
Lack of commitment on continuation of service
is a major barrier to recruit personnel.
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3. MOTIVATION BARRIERS
Poor pay scale
Untimely staff transfer
Unfilled vacancies in PHC lead to transfer of work
to the rest
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4. GENERAL ISSUES
Doctors are often poor leaders and this
undermines their role as the head of primary
care team.
A frequent interpersonal problem between the
doctor and the paramedical staff breaks down
communication and this seriously hampers
efficiency.
Doctors spend lot time in curative and
outpatient work. Private practice of doctors
reduces their availability for hospital work.
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2. MODERNIZATION OF STATE RUN
MENTAL HOSPITALS
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.
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3. 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.
one-time grant of Rs.50 lakhs for up gradation of
infrastructure and equipment as per the existing
norms for Govt.MCH/hospitals.
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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 equipment's for psychiatric use
such as modified ECTs.
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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)
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5. IEC ACTIVITIES
Aim is increasing awareness and removal of
stigma for mental illness
Rs. 1 crore is allocated for the purpose of IEC
activities
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APPRAISAL OF THE EXISTING SITUATION
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1. IS THE MAIN APPROACH OF THE NMHP
NAMELY INTEGRATION OF MENTAL HEALTH WITH
PRIMARY CARE STILL THE RIGHT APPROACH?
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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”.
..
2. HOW EFFECTIVE IS THE
IMPLEMENTATION OF NMHP?
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80
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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)
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v) difficulties in recruitment and retention of
mental health professionals in the DMHP
vi) non-involvement of the non-governmental
organizations (NGO) and the private sector
vii) inadequate mental health educational and
community awareness activities
viii) absence of programme outcome indicators
and monitoring
ix) inadequate technical support from mental
health experts.
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3. IS THERE ANY EVIDENCE FOR THE
EFFECTIVENESS OF PRIMARY CARE MENTAL
HEALTH?
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83
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The most convincing evidence for the
effectiveness of the DMHP comes from North
Kerala. During the past few years, the DMHP is
being implemented in the five districts of
Kozhikode, Kannur, Malappuram, Kasargod and
Wayanad under the overall co-ordination of the
Institute of Mental Health and Neuro Sciences
(IMHANS), Kozhikode, Kerala – an institution
selected by the Ministry of Health and Family
Welfare, Government of India for elevation as a
Centre of Excellence in mental health during the
current 11th Five Year Plan.
.
84
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Persons requiring inpatient treatment for severe
mental disorders from all the above districts are
generally admitted to the mental hospital located
in Kozhikode. The annual number of admissions in
Kozhikode mental hospital in 2005 was 2622. The
total annual admissions in the hospital steadily
came down to 1836 in 2009. Similarly, the total
annual outpatient follow-ups of discharged
patients too came down from 31802 in 2005 to 24610
in 2009, while the total annual number of new
outpatient registrations went up from 2243 in 2005
to 2944 in 2009
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4. HAS THERE BEEN ANY INDEPENDENT
EVALUATION OF THE DMHP?
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86
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One of the major criticisms of the NMHP and
particularly its DMHP component was that it was
not independently evaluated before its larger scale
expansion during 10th and 11th Plans.
Independent evaluation was commissioned by the
MOHFand was carried out the Indian Council of
Marketing Research (ICMR), during 2008-2009. The
terms of reference for the evaluation included,
besides objective and critical assessment of the
DMHP, providing recommendations and
suggestions for improvements in implementation
and future expansion of the programme.
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20 districts were 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 programme to other
districts of the country”
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88
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It was observed that
irregular flow of funds had affected the
implementation
There were significant delays in initiation of the
programme even after the release of
Shortage of trained and motivated mental health
professionals
difficulties in retaining recruited staff were
problems in many states.
Low utilization of funds, meant for training and
IEC activities was noticed in many districts.
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FUTURE OF NMHP
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90
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To make mental health care more accessible to
those who most require them, the services will
have to be strengthened at the sub-centre, PHC
and CHC levels.
NMHP is currently a fully centrally funded Plan
programme. To ensure continuity of the
programme beyond the 11th Five Year Plan, the
financial responsibility for the programme will
have to be gradually shifted to the state
governments and mental health services will have
to be integrated in the State and District
Implementation Plan.
.
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The community participation and ICE components
of NMHP need strengthening.
Appropriate non-pharmacological interventions
will have to be introduced into the programme and
the PHC staff trained adequately.
The community participation and ICE components
of NMHP need strengthening.
There is an urgent need to enhance the capacity in
the country to train mental health professionals.
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92
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One of the proposals for better implementation of
NMHP is its integration with the National Rural
Health Mission (NRHM)
It helps to optimal use of existing infrastructure at
various levels of health care delivery system and
sustenance of DMHP beyond the expiry of the
period of central assistance by its integration in
the district health system.
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93
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An integrated IEC under NRHM, involvement of
NRHM infrastructure for training related to
mental health at the district level, use of NRHM
machinery for procurement of drugs to be used in
DMHP and building of credible referral chains for
appropriate management of cases detected at
lower levels of the health care delivery system are
all additional advantages of integration of DMHP
with NRHM.
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JOURNAL PRESENTATION
Title:- Impact evaluation of the community
mental health program at habra
Aims: The primary aim of the following study is
to assess the impact of the CMHP on the local
population and secondary aim is to evaluate that
what extent the CMHP have been able to prepare
them to take responsibility of the CMHP as a
whole.
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95
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Materials and Methods: Using systematic random
sampling method 1486 respondents were selected
and data collect using a questionnaire. In-depth
interviews, focus group discussions, participant's
observation and secondary data sources were also
used. Inferences drown based on above all data
sources.
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96
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Results and Conclusion: Two-third of the
studied population and more so in the
target area expressed that the community
can take responsibility of running their
own CMHPs. Though, the larger population
of them is still not acquainted with the
activities of the CMHP, the program
deserves support to sustain.
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THEORY APPLICATION
HEALTH BELIEF MODEL.
98
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CONCLUSION
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. According to the
estimates DALYs loss due to mental disorders are
expected to represent 15% of the global burden of
diseases by 2020.So NMHP help to develop a
infrastructure for mental health service delivery in
all aspects.
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.
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100
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REFERENCES
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
beyond numbers. In Agarwaal S.P, Goel D.S, Ichhpujani R.L, et al (eds);
Mental Health- An Indian perspective (1946-2003). New Delhi:
Elsevier for Directorate General of Health Services, Ministry of Health and
Family Welfare; 2004: 37-61.
3. World Health Organization. Organization of mental health services in
developing countries. Technical Report Series 564. Geneva: World
Health Organization. 1975
4. World Health Organization. The declaration of Alma Ata. Geneva:
World Health Organization, 1878
5. World Health Organisation. World Health Report 2001- Mental
Health- new understanding, new hope. Geneva: World Health
Organization, 2001.
6. World Health Organization. Integrating mental health into primary
health care - a global perspective. Geneva: WHO-WONCA, 2008
7. Park,K.Textbook of preventive and social medicine.(2011),1st ed, pg:
231-244. BANARSIDAS BHANOT publishers.
8. Sridhar,R.B.(2011). Textbook for community health nursing.2nd
ed; pp.no:196-204, AITBS publishers: INDIA
9. Kumari.N.(2011). A Textbook of community health nursing.1st
ed,pp.no:39-41. VIKAS & company publishers. INDIA
10. Sunder.L.,Adarsh & Pankaj.(2009). Textbook of community
medicine-preventive and social medicine.1st ed.pp.no:435-463:CBS
publisher, NEW DELHI
11. Taneja DK, Health Policies Programmes in India,10th Ed.PP
no:370-75. Doctors Publication, Delhi.
12. http://mohfw.nic.in/,Mnistry of health and family welfare
13. Kishore.J,National health programs of India ,10th Ed PP487-
92,Century Publications
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THANK YOU
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