National Mental Health

Programme



Revision Proposed for the 11
th

five Year Plan-Overview
National Mental Health Program
(NMHP)
Implementation 1982.

It aims at providing mental health care as well
as health care in general, utilizing the available
resources including manpower and
infrastructures to the total population of the
entire country
Main objectives
To ensure availability and accessibility of minimum
mental health care for all

To encourage application of mental health
knowledge in general health care

To promote community participation in developing
mental health services, and to stimulate efforts
towards self-help in the community.
Specific approaches
Diffusion of mental health skills to the periphery of
system.

Appropriate allotment of tasks in mental health care
for health personnel.

Equitable & balanced territorial distribution of
resources.

Integration of basic mental health care into general
health services.

Linkages to other community development
programmes.
Need for Developing a District
Model:
Earlier efforts to integrate mental health with PHC
involved only population of 40,000 to 60,000 and
personal of one PHC.

Field level evaluation of trained PHC personal
highlighted the need for developing a district model.

NMHP- envisage implementation in atleast one
district of every state.

All health care and welfare programmes are
implemented and monitored at a district level.
Advantages of Mental Health
Care at district
The district is an independent administrative unit
with district commissioner as the head.

DHO (District Health Officer) has powers of
planning activities in the district.

Monitoring of programmes occur at the district level.

Inter-sectoral coordination is possible at the district
level.
Advantages.. District.. contd....
Mobilization of additional resources are possible.

All existing staff can be best utilized by involving the
total district for care programme.

A district, not a PHC, is the planning and
implementation unit for most other health and
welfare programmes.
DMHP..Bellary
DMHP was formally inaugurated at Bellary on 20
th

July 1985 with technical inputs from NIMHANS

Covering a population of 1.5 million distributed in 7
talukas at Bellary district, in Karnataka state,

Results..
During the first three years of the project (1985-1988),
1200 psychotics,
3525 epileptics,
750 neurotics and
380 mentally retarded persons were registered.
Of the psychotics, 42% took treatment regularly
and showed improvement.
DMHP Progress
DMHP launched - national level 1996-97

DMHP was progressively implemented in
selected 27 districts in 21 states across
the country -9
th
plan


NMHP 10
th
Plan
Rs. 139 crore was sanctioned.

NMHP was restrategised in 2003.

10
th
Plan Strategies
Integration of Mental Health with primary health care
through DMHP
Strengthening psychiatry wings of medical colleges
Modernisation of existing Mental Hospitals
IEC
Research and Training

Physical Targets Achieved 10
th
Plan


Scheme Grants
Sanctioned
Grants
Released
Target 10
th
Plan
DMHP
(No. of Districts)
129 109

100
Mental Hospital
(No. of Mental
hospitals funded)
23 23 25
Psychiatry Wing of
MC/Gen. Hosp.
(No. of inst.funded)
70 70 75
Strategy for 11
th
plan
Was developed through National consultations at New
Delhi in April 2006 and Oct 2006 in Bangalore (2 days
workshop) with all the nodal officers/ other stake
holders at NIMHANS

Inputs received from the State governments during
National review meetings
OVERVIEW OF PROPOSED
DMHP MODIFICATIONS
2003 Review Recommendations
A `central coordinating & monitoring cell to oversee the
overall development & functioning of the DMHP.
Develop operational manual for DMHP.
Review of priority conditions be taken up by DMHP.
Review current infrastructure & budgetary provisions of
DMHP & revise them meaningfully.






Contd
Revise the list of essential drugs for DMHP
Prescribe the minimum training requirements for staff to
be recruited in DMHP.
Review the current content & curriculum and develop
standard training programmes for health personnel.
Develop time bound target of activities to be completed
by DMHP at each center.



Administrative Barriers
Lack of Clarity in guidelines
Lack of manpower resources
Motivational barriers
General Issues



Barriers in implementation of DMHP
Mental Health Care is available in many States at
the District level in the country due to
implementation of DMHP.

Minimum range of essential drugs was available at
the district level in adequate quantities while that of
the primary health center and distt. hospital varied.

Most of the centers had given training to doctors in
mental health care. However, the duration of
training and the number of doctors trained varied.

Evaluation in 2003 of DMHP (27 Districts),
significant observations were ..
Some had good records while others were poor.
Registration of cases and reporting format was not
uniform across the centers.
Some had developed their own material for public
education, while others were using the ones
provided. IEC activities were not uniform across all
the centers.
Nearly 50% of the DMHP sites had organized
mental health camp in the district hospital


Contd .
There are 94 DMHP sites in the country as on
2005-2006.
Less than 20% of the centers responded to a
review questionnaire.
Most of the centers have trained doctors, health
workers and other paramedical workers. Instead
training all doctors, the training was provided for
only 15-16 doctors for two three weeks.


Current Status of DMHP in India
(Review in Sep, 2005)
The program officer is a Psychiatrist in many of the
DMHP states.
DMHP a specialist operated programme rather than
a primary health care team managed mental health
care programme.
Mental health care programme in India has
progressed to some extent.



Contd ..

Proposal for 11
th
Plan
Main components
DMHP Re-strategised
Establishment of Regional Institutes of Mental Health
& Neurosciences
Training & Research
IEC/NGO
Monitoring & Evaluation
Spill over Activity of X plan

Budget increased to 1083 crores

DMHP - Proposed changes
Instead of Psychiatrist/ psychiatric social worker/ clinical
psychologist/psychiatric nurse, the programme would
be run through trained medical officer/ social worker /
psychologist/ nurse

The District would be prepared before the programme
is launched- separate provision has been made for
engagement of required staff/ training /setting up of
counseling center/identification of partner organisations

Funds released through district health society


DMHP - Proposed changes
10
th
Plan 11
th
Plan
P.O. - Psychiatrist Trained M.O. (3 months)
Training of PHC doctor 2-3
weeks
3 +3 (6) days
M.O.s trained/district
15-20%
100%
Training of Health workers
2-3 weeks
1+1 (2) days
Training not standardized Training by standardized
training modules
DMHP - Proposed changes
10
th
Plan 11
th
Plan
School Mental Health Services, College
Counseling services, Work place stress
mgmt., Suicide prevention - Nil
+
Involvement of NGOs - Nil +
District Preparatory phase Not
specified
Pre requisite
Record keeping and Reporting -
Irregular
Regular
Monitoring - Irregular Regular
DMHP
Hospitalisation Communitisation
Manpower would be Recruited for Central Mental
Health Cell, State Mental Health Cell & District Cell.
Mainstreamed by Integration with NRHM
Partnership with a Community based organisation
Drug Distribution would be done through District, Sub
District, CHC, PHC, Sub centres.
DMHP Activities
Service provision to mentally ill
Referral to identified Med. College/Pvt. Psychiatrist
Community mental health care by visiting
CHCs/PHCs
IEC
Training of personnel
Provision of drugs
Simple recording system
District mental health clinic
Review cum training as part of visits to the periphery
Monthly reporting, monitoring and feedback
Community participation
DMHP activities contd.
DMHP
Additional Services :

Counseling Center
School Mental Health Services
College Counseling services
Stress Management at work place
Suicide prevention
Participation of NGOs

Implementation of DMHP
A Programme officer (P.O.) for each district would
be identified and appointed by the State Govt. (in
service M.O.)/ taken on contract
P.O. will be trained in Psychiatry and managerial
skills for 3 months at identified institutions
Three months training for psychologist, social
worker and four weeks training for nurses for
manning DMHP
District will be linked with the nearby zonal Medical
College for techno-managerial support
The funds for DMHP would be released through
State Health Society/DHS
DMHP Preparatory Phase
After approval in State Health Society, DMHP team
would be recruited & sent for training.

Linkages would be established and a plan for the
district would be worked out.

Infrastructure like counseling center, DMHP center
etc. would be put in place.

School Mental Health Services

Life Skills Education using standard training manuals

Counselling services through trained teachers/ Hired
Counsellors

Involvement of the NGOs
College Counselling Services
Provided by trained teachers of psychology department
of the colleges

The P.O. will organise the training at the district level in
close co-ordination with the Dept of Collegiate
Education

The trained teachers will act as counselors and as
referral and support-giving agents in their respective
colleges
Suicide Prevention Services
Sensitization workshops
Crisis Helplines
Timely care for high risk groups
School, college and work place intervention
programmes
IEC activities focused on suicide prevention
Imparting skills for time management, improving
coping skills, relaxation techniques like Yoga,
Meditation etc.

Identify workplaces with sizeable population and
organize stress management workshops for them

District Counseling Centre will also address this
group
Workplace stress management
State Mental Health Cell
Nodal officer (Deputy Director Mental Health or the
Joint Director Health) for monitoring the
implementation of NMHP

Mental Health Technical Support Team
- one consultant (psychiatrist)
- one assistant/ DEO.

SMHC in consultation with P.O.s will work out a
District specific plan based on the mental health
resources available.
Training & Research
To address shortage of manpower in mental health

Research related to NMHP

Budget for Training & Research
On the pattern of NIMHANS -by upgrading 8 identified
existing mental health hospitals/institutes/Med.
colleges.
For addressing the acute manpower gap & provision of
state of the art mental health care facilities
To have psychiatry, neurology, neurosurgery, clinical
psychology, psychiatric social work, psychiatric nursing
and supportive departments
Training facilities in psychiatry, clinical psychology,
psychiatric social work & psychiatric nursing
Proposed budgetary support
Regional Institutes of Mental
Health & Neurosciences
IEC
Innovative IEC strategies involving Electronic/
Print/local media at Central/State/District/ Grass root
level to reduce stigma attached to mental illness and
increase awareness regarding available treatment and
health care facilities

Increased awareness regarding provisions under
Mental Health Act 1987
Monitoring & Evaluation
Centre Central Mental Health cell
State State Mental Health cell
District and below DMHP unit
Regular supervision through Visits/Reporting by all
levels
Outside evaluation


Monitoring DMHP-Structure
Minister of Health
and Family Welfare
DGHS
Central monitoring agency for DMH
Programme

A secretariat with staff
(Coordinator, Project assistant, Data entry
operator/statistician, Clerk)
State monitory agency

Project coordinator (Medical background)
District Mental Health Programme
Programme Officer
Monitoring DMHP-Function
Central monitoring agency for DMH
In touch with State monitoring agency and each DMHP
by dedicated fax line and e-mail
Meet with State monitoring agency and Programme
Officers of DMHP every 6 - 12 months.
Visit each DMHP with State monitoring agency
personnel once in a year
State monitoring agency
Meets each DMHP Programme Officer once in 3 months
Visit each DMHP and meets Medical Officers in 6 months
District Programme Officer
Meets Medical Officer each distt., monthly
State monitoring agency
Outcome Indicators
Number of new patients starting on treatment;
%age of drug non-compliant cases amongst the
diagnosed cases;
Case identification rates
% of drop outs to treatment
Increased awareness levels
Availability of trained manpower
Pathway of care for a new patient or
for a patient on follow-up
Conclusion
Massive budget provision to cover almost all
districts of the country
Quantitative & Qualitative change
Need for comprehensive & integrated mental
health care
Hope to achieve best to most
THANK YOU