NATIONAL MENTAL HEALTH PROGRAM

SUBMITTED TO: SUBMITTED BY:

• DR. SUKHBIR KAUR • ROOPKIRAN KAUR
• ASSOCIATE PROFESSOR • M.SC NURSING 1ST YEAR
• SGRD COLLEGE OF NURSING • SGRD COLLEGE OF NURSING
INTRODUCTION
• India is the first among the developing countries to formulate the national mental
health program based on the principle of decentralized and deprofessionalized
mental health care.
• The government of India felt the necessity for evolving a plan of action aimed at
mental health component of national health program.
• The first draft of national mental health program, was designed by 68 experts
from the field of mental health, general health and health administration and was
accepted for implementation in the country in 1982.
 OBJECTIVES

• The integration of mental health services with general health services.

• To ensure availability and accessibility of minimum health care for all in the
foreseeable future particularly to the most vulnerable and underprivileged sections of
populations.
• To encourage application of mental health knowledge in general health care and in
social development.
• To promote community participation in the mental health services development and to
stimulate efforts towards self help in community.
 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.
CONTI..

• Two strategies complementary to each other, were planned for immediate

action:
i. Centre to periphery strategy: establishment and strengthening of
psychiatric units in all district hospitals, with outpatient clinics and mobile
teams reaching the population for mental health services.
ii. 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 200 million people.
 FIVE YEAR PLAN AMENTMENTS
• During the 10th five year plan (2003), NMHP was re-strategized and it became from
single pronged to multi-pronged program for effective reach and impact on mental
illnesses, main strategies were as follows:
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. Information education and communication (IEC).
5. Monitoring and evaluation.
 CONTI..

• In the 11th five year plan, the NMHP has the following components/schemes:
1. District mental health program (DMHP).
2. Manpower development schemes- centers of excellence and setting up/ strengthening PG training
departments of mental health specialties.
3. Modernization of state run mental hospitals.
4. Up gradation of psychiatric wings of medical colleges/general hospitals.
5. Information education and communication (IEC).
6. Training and research.
7. Monitoring and evaluation.
 CONTI..

During the 11th five year plan an allocation of rs.1000 crore has been made for the national mental health
program. A sum of 70 crore has been provided in 2008-09 for implementation of NMHP. During the 11 th
five year plan, it has been proposed to decentralize the program and synchronize with national rural health
mission for optimizing the results. The main components of NMHP that have been proposed are as under:
• To establish Centres of Excellence in Mental Health by upgrading and strengthening of identified existing
mental hospitals for addressing acute manpower shortage.
• To provide impetus for development of Manpower in Mental Health, other training centres (Govt. Medical
Colleges/General Hospitals, etc.) would also be supported for starting PG courses in Mental Health or
increasing intake capacity.
 CONTI..
• Spill over of 10th plan schemes for modernization of state run mental hospitals and up-gradation of
psychiatric wings of medical colleges/general hospitals.
• District mental health program with added components of life skills training and counseling services in
schools and colleges, work place stress management and suicide prevention services.
• Research- there is huge gap in research in mental health which needs to be addressed.
• IEC- a lot of stigma is attached to mental illnesses. It needs to be stressed that the mental illness is treatable.
An intensive media campaign is planned for 11th plan duration.
• NGO’s and public private partnership for implementation of the program. This would increase the outreach
of community mental health initiatives under DMHP.
• Monitoring implementation and evaluation-effective monitoring at central/ state/district level will facilitate
implementation of various components of NMHP.
CONTI..

• The government has accorded high priority particularly to child and adolescent mental healthcare
during the 12th five year plan (2012-2017). The government is integrating different components
of national mental health program with the components of national rural health mission namely
school health, reproductive child health and adolescent friendly clinics during the twelfth five
year plan to reach out to the community in a more effective manner.
 TARGETS OF NATIONAL MENTAL
HEALTH PROGRAM

• Within one year

• Each state of India will have adopted the present plan of action in the field of mental health.
• The Government of India will have appointed a focal point within the Ministry of Health specifically
for mental health action.
• A national coordinating group will be formed comprising representatives of all State senior health
administrators and professionals from psychiatry, education, social welfare and related professions.
• A task force will have worked out the outlines of a curriculum of mental health for the health workers
identified in the different states as most suitable to apply basic mental health skills and for medical
officers working at PHC level.
 CONTI..

• Within 5 years.
• At least 5000 of the target non-medical professional will have undergone 2 week training in mental
healthcare.
• At least 20% of all physicians working in PHC centers will have undergone 2 weeks training in mental
health.
• Creation of the post of a psychiatrist in at least 50% of the districts.
• A psychiatrist at the district level will visit all PHC settings regularly and at least once in every month
for supervision of the mental health program for continuing education.
• This program will be fully operational in at least one district in every state and union territory and at
least 50% of all districts in some states.
CONTI..

• Each state will appoint a program officer responsible for organization and supervision of the mental
health program.
• Each state will provide additional support for creating or augmenting community mental health
components in the teaching institutions.
• On the recommendation of a task force, appropriate psychotropic drugs to be used at PHC level
will be included in the list of essential drugs in India.
• In psychiatric units with in-patients, beds will be provided at medical college
hospitals in the country.
 APPROACHES TO NMHP

• Diffusion of mental health skills to the periphery of health service system.

• The appropriate appointment of tasks in mental health care.
• The equitable and balanced territorial distribution of resources.
• The integration of basic mental health care into the general health services.
• Linkage to community development.
 CONTI..

• Mental health care which includes treatment rehabilitation and prevention

provided through all the health care delivery systems.
• Improved and specialized care made available through mental hospitals and
teaching psychiatric hospitals.
• Mental health training; minimum essentials of mental health should be taught to
all health care workers at undergraduate level and specialized training at various
levels.
• The care of the mentally retarded and treatment program for drug dependence.
 FUNCTIONING

• NMHP suggests that the involvement of mental hospitals, teaching hospitals, district and
taluk hospitals, primary health centres, general practitioners and private psychiatrists
jointly to look after the mental health care of the community.
• Mental hospitals are required for very chronic and disturbed patients who cannot be
looked after in the community, many of whom may have to be certified and admitted into
the mental hospitals as voluntary patients.
 CONTI..
• The department of psychiatry in medical colleges will take the responsibility of training the
general practitioners and the medical officers in the phc’s so that they will be able to look
after the common psychiatric disorders in the community. They will function as referral and
research centers.
• The district and taluk hospitals will have department of psychiatry and the psychiatrists in
these hospitals supervise the medical officers in the phc’s as well as the general
practitioners.
• There will be community health workers who belong to the community and who are
attached to the phc’s and these health workers will identify the patients who suffer from
common psychiatric disorders and bring them to the phc’s for treatment.
COMPONENTS OF NMHP

TREATMENT REHABLITATION PREVENTION

SUBPROGRAM SUBPROGRAM SUBPROGRAM
TREATMENT SUBPROGRAM

Village and sub

PHC
centre level

Mental hospitals
District hospital and teaching
psychiatric units
 VILLAGE AND SUB CENTRE LEVEL

• Multipurpose workers and health supervisors, under the supervision of the medical officer
to be trained for:
i. Management of psychiatric emergencies.
ii. Administration and supervision of maintenance treatment for chronic psychiatric
disorders.
iii. Diagnosis and management of grandmal seizures, especially in the children.
iv. Counselling in problems related to alcohol and drug abuse
PRIMARY HEALTH CENTRE

MO aided by health supervisors to be trained for:

i. Supervision of the multipurpose workers performance.
ii. Elementary diagnosis
iii.Treatment of functional psychosis
iv.Treatment of uncomplicated cases of psychosocial
problems.
v. Epidemiological surveillance of mental morbity.
 DISTRICT HOSPITAL

It was recognized that there should be at least 1

psychiatrist attached to every district hospital
as an integral part of the district health services.
The district health hospitals should have 30-50
psychiatric beds.
 MENTAL HOSPITALS AND TEACHING
PSYCHIATRIC UNITS

The major activities of these higher health centres of psychiatric care

include:
i. Help in care of difficult cases
ii. Teaching
iii.Specialized facilities like occupation therapy units, psychotherapy,
counselling and behavior therapy.
 REHABLITATION SUBPROGRAM

The components of this subprogram includes

maintenance treatment of epileptics and
psychotics at the community levels and
development of rehabilitation centres at both the
district level and the higher referral centres
 PREVENTIVE SUBPROGRAM

The prevention component is to be community based, with the initial

focus on the prevention and control of alcohol related problems like
addictions, juvenile delinquency and acute adjustment problems like
suicidal attempts are to be addressed.
 CONTI..

• Mental health legislation: the legislation has been strengthened to provide

explicit provisions for the rights of people with mental illnesses.
• Expansion of program scope: the program has expanded to include areas like
child and adolescent mental health and suicide prevention.
• Tertiary care: the program has sanctioned 25 centres of excellence to provide
tertiary level treatment facilities.
• Government medical colleges: the government has supported 19 government
medical colleges and institutions to strengthen 47 pg departments in mental
health specialties.
THE NATIONAL MENTAL HEALTH
PROGRAMME (NMHP) IN INDIA HAS
UNDERGONE SEVERAL CHANGES
• Program implementation: the program has been implemented at the district
level through the district mental health programme (DMHP). The DMHP has
been integrated with the national rural health mission (NRHM) for better
implementation, evaluation, and regular budgetary increases.
• Mental health services at primary healthcare level: the government has
upgraded more than 1.73 lakh sub health centres (shcs) and primary health
centres (phcs) to ayushman arogya mandirs. These centers provide mental
health services as part of comprehensive primary health care.
CONTI..

• National tele mental health programme (ntmhp): launched in

2022, this program aims to improve access to quality mental health
care and counseling services.
• Expansion of dmhps: the dmhp has been expanded to cover 90% of
the country's districts.
STATE MENTAL HEALTH AUTHORITY

• SMHP was launched in order to provide mental health services from the grass
route level that is village.
• Various actions were planned under the action plan for the implementation of the
national mental health Programme in the 7th five year plan, like community
mental health programme at the primary health care level in states and union
territories; training of existing health personnel for mental health care delivery,
development of state level program officer, establishment of the regional centres
of community mental health.
 DISTRICT MENTAL HEALTH PROGRAM
1996
• Government of India funded to launch the district mental health
program as per the guidelines of national mental health program.
• In 1996, dmhp was launched in four districts under 9 th five-year plan
and it extended to 123 districts in 12 th five-year plan.
• In 1997, dmhp was launched in Trichy, extended to Ramanathapuram
and Madurai in 2003.
• District mental health program is further extended into 13 districts.
 AIMS

• Develop the awareness about mental health to public.

• Promote the community participation in the mental health services by self-
help group.
• To integrate the mental healthcare with general health services.
• To provide the accessible mental health services to the vulnerable and
under-privileged people.
OBJECTIVES

• Early detection of cases and to provide the prompt treatment

within the community.
• To decrease the stigma and discrimination.
• To reduce the work pressure of mental hospitals.
• To give treatment and to provide rehabilitation services to the
patient after the discharge from psychiatric patient.
 COMPONENTS
• District mental health program was developed based on the “bellary model”.
It emphasized on the following components:
• Early detection of cases and providing necessary treatment.
• Conduct short-term training program to general physicians in regard with the
treatment process of mental illness. Health workers also need to be trained.
• Information education communication(iec): creating awareness among
public.
• Monitoring and having a complete documentation.
ADMINISTRATIVE PLAN OF DISTRICT
MENTAL HEALTH PROGRAM
• DMHP has central mental health authority at national level, state mental
health authority at state level, district mental health team (DMHT) at
district level and community health centers (chcs)/primary health
centers (phcs)/trained staff members at sub-district or state level.
• Dmht includes program officer/psychiatrist, psychiatric nurse/trained
general nurse, clinical psychologist, psychiatric social worker,
community nurse/ case manager, case registry assistant and record
keeper.
 MILESTONES AND ACHIVEMENTS IN
DISTRICT MENTAL HEALTH
PROGRAMME
• Psychiatrist has been appointed in all districts, appointments of
psychologist/psychiatric social worker is in progress.
• Basic psychotropic agents/drugs are made available in primary
health centers (phc).
• Suicide prevention centers have been established in 16 districts.
• Survey has been conducted all over india to ensure the quality of
services rendered through dmhp. Madurai in tamil nadu is leading
with high satisfactory score.
CONTI..

• Regular supervision is done by the district collector.

• Ten bedded psychiatric wards equipped with boyle's machine, bp
apparatus and ophthalmoscope have been established.60% of districts
are able to render mental healthcare at district level and 20% of them
are able to render mental healthcare at primary health level.
• At present dmhp has been achieved in 123 districts which is
extendable to all districts (on progress).
 INITIATIVES TAKEN AND THE
PRESENCE OF TREATMENT GAP

• Treatment gap is present among the general health physicians due to lack of
knowledge so NIMHANS organizes three months training program to the
doctors. It was observed that primary care doctors were reluctant of tele
psychiatric services.
• Mental health care act (2017) states that, only the emergency treatment can
be provided by the general physician (72 hours) and the further treatment
has to be referred to the higher level center.
CONTI..

• There is no provision for the non-mental health professionals to treat

the psychiatric patient in their follow-up. Hence, the resource
building, workforce development with adequate proper legal
framework is essential for the successful progress of DMHP.
 CONCLUSION

• National mental health program is aimed at doing “the greatest good to the largest number” through five
interdependent and mutually synergistic strategies, to be implemented in a phased manner over the next two
decades
• 1. Extension of basic mental health care facilities to, the primary level.
• 2. Strengthening of psychiatric training in medical colleges at the undergraduate as well as postgraduate level.
• 3. Modernization and rationalization of mental hospitals to develop them into tertiary care centers of excellence.
• 4. Empowerment of central and state mental health authorities for effective monitoring, regulation and planning
of mental health care delivery systems.
• 5. Promoting research in frontier areas to evolve better and more cost-effective therapeutic interventions as well
as to generate seminal inputs for future planning
BIBLIOGRAPHY
• Raj DEB. Debr’s Mental health Nursing. EMMESS medical publisher. First edition. New Delhi.
2014. page no 20-22.
• Prakash P. textbook of mental health and psychiatric nursing. CBS publisher. First edition. New
Delhi. 2020. page no 10-12.
• Sreevani R. A guide mental health and psychiatric nursing. Jaypee publisher. 2 nd edition. New
Delhi. 365-370.
• https://nhm.gov.in/index1.php?lang=1&level=2&sublinkid=1043&lid=359