Implications for

Psychiatric
Rehabilitation

Dr Chethan B
Chair Person: Dr Devvarta Kumar
Terminologies

Preamble Vision

Executive
Values & Principles
summary

Chapters Goals & Objectives 2 sections

Cross-cutting issues 9 sections

Strategic directions &

7 sections
recommendations of action
 Terminology
• Mental disability refers to disability associated
with mental illness. It is better understood using
a medico-social model
• Persons affected by mental illness includes
significant others
• Recovery is defined as the process of change
through which individuals improve their health
and wellbeing, live a self-directed life and strive
to reach their full potential
 Preamble
• By 2020, depression, the most common mental disorder, will
be the second leading cause of disability worldwide
• Untreated mental illness results in stigma, marginalization and
discrimination often worsening one's quality of life. This leads
to a substantial loss of social and human capital, adversely
impacting a large number of individuals and families
• The access to mental health care is not universal and
significant treatment gaps are experienced by many
• A strategic, integrated and holistic policy
• This policy is intended to be dynamic; all encompassing and
growing with regular review and feedback from people
 Executive Summary
• April 2011 - a Policy Group to recommend a mental health policy for the
country
• This Policy is inclusive in nature and incorporates an integrated,
participatory, rights and evidence based approach
• The strategic areas identified for action are, inter alia, effective
governance and accountability, promotion of mental health, prevention of
mental disorders and suicide, universal access to mental health services,
enhanced availability of human resources for mental health, community
participation, research, monitoring and evaluation
• The 65th World Health Assembly held in 2013 approved and adopted
Resolution WHA 65.4 on global burden of mental disorders and the need
for a comprehensive, co-ordinated response from the health and social
sectors at the community level. India was one of the main sponsors of this
resolution. This National Mental Health Policy is in consonance with the
intent of this WHA Resolution
 Vision
The vision of the National Mental Health Policy is to
promote mental health, prevent mental illness,
enable recovery from mental illness, promote de-
stigmatization and desegregation, and ensure socio-
economic inclusion of persons affected by mental
illness by providing accessible, affordable and quality
health and social care to all persons through their
life-span, within a rights-based framework
 Values and Principles
• Equity
• Justice
• Integrated care
• Evidence based care
• Quality
• Participatory and rights based approach
• Governance and effective delivery
• Value base in all training and teaching programs
• Holistic approach to mental health
 Goals and Objectives
Goals
• To reduce distress, disability, exclusion morbidity
and premature mortality associated with mental
health problems across life-span of the person
• To enhance understanding of mental health in the
country
• To strengthen the leadership in the mental health
sector at the national, state, and district levels
Objectives
• To provide universal access to mental health care
• To increase access to and utilization of comprehensive mental health services (including
prevention services, treatment and care and support services) by persons with mental
health problems
• To increase access to mental health services for vulnerable groups including homeless
person(s), person(s) in remote areas, difficult terrains,
educationally/socially/economically deprived sections
• To reduce prevalence and impact of risk factors associated with mental health problems
• To reduce risk and incidence of suicide and attempted suicide
• To ensure respect for rights and protection from harm of person(s) with mental health
problems
• To reduce stigma associated with mental health problems
• To enhance availability and equitable distribution of skilled human resources for mental
health
• To progressively enhance financial allocation and improve utilization for mental health
promotion and care
• To identify and address the social, biological and psychological determinants of mental
health problems and to provide appropriate interventions
 Cross cutting issues
• Stigma
• Rights-based approach
• Vulnerable populations
– Poverty
– Homelessness
– Persons inside custodial institutions
– Orphaned persons with mental illness (OPMI)
– Children of persons with mental health Problems
– Elderly care-givers
– Internally displaced persons
– Persons affected by disasters and emergencies
– Other marginalized populations
• Adequate funding
– Provision of Funds
– Provision of Funds across related departments
• Support for families
• Inter-sectoral collaboration
• Institutional care
• Promotion of mental health
• Research
– Research questions
– Monitoring and evaluation
– Building research capacity
Strategic directions and recommendations of action

• Effective governance and delivery mechanisms for mental

health
• Promotion of mental health
• Prevention of mental illness, reduction of suicide and
attempted suicide
• Universal access to mental health services
• Improved availability of adequately trained mental health
human resources to address the mental health needs of the
community
• Community participation for mental health and development
• Research
 Promotion of mental health
• Re-design Anganwadi Centres
• Train Anganwadi workers and school teachers
• The Life Skills Education (LSE) programme facilitated by teachers and trainers who are
appropriately skilled
• Provision of LSE skills to young people outside the formal schooling system should be
ensured via youth clubs, or any other suitable fora
• Individual attention in the school by teachers trained in mental health promotion and
distress alleviation
• Programmes to assist adults in handling of stressful life circumstances should be
incorporated in workplace
• Mental health promotion actions should be broad based, embedded in all spheres of
life, and not become sole prerogative or responsibility of the mental health program,
failing which this could stigmatise mental health initiatives
• Practitioners of Ayurveda and Yoga systems are a resource who need to be included
as activists for promotion of mental health
 Prevention of mental illness
• Encourage persons with mental health problems to actively and
fully participate in social and economic activities
• Ensure there is no discrimination against persons with mental
health problems in all aspects of seeking and retaining work,
including participating in all work related activities. Mental
disorders should be treated as a disability and suitably factored in
employment policies
• Create an environment where persons with mental health problems
are enabled to take part in regular activities (e.g. operate bank
account, obtain identity documents, obtain driving license, writing a
will, etc.) and are not discriminated against. Mental disability should
be treated on par with any other form of disability
• Facilitate education for person(s) with mental health problems to
improve their employability
 Universal access to mental health services

• Comprehensive services for mental health problems should

be made universally accessible. A continuum of such services
should be available across facility, community and family.
Services should be family centric to address needs of persons
with mental health problems across life-span. All multi-
speciality Government hospitals should provide mental health
services to improve access
• Increase availability of a range of community based
rehabilitation services including day care centres, short stay
facilities and long stay community facilities to promote
recovery with support from local bodies and other sources of
support
• Facilitate mental health service users and their families and care-
givers formally and supported by law, if necessary, in designing,
implementing and monitoring of mental health services
• Implement community based programmes to support families and
care givers to foster recovery for persons with mental health
problems and mental illness family provides care and plays a critical
role in fostering recovery
• Caring for the carer
• Formation of care-givers groups with professional inputs to
facilitate a better and accurate understanding of the particular
mental health problem their family member is living with. Care
givers to be encouraged to pursue other activities to give them
space for their own personal growth
• Institutionalize a culture of respect for rights of persons with mental
illness and a culture of openness and integration with their local
communities
• Financial support including monetary benefits and tax benefits to
the primary care-giver needs to be addressed. These can be based
on criteria which take into account age of the care-giver, family
income, number of hours of caregiving, whether care is provided in
hospital or at home and whether the care-givers had to give up
their job to provide care
• A multidimensional, dynamic and well-being oriented approach is
essential to address the needs of homeless persons with mental
illness. While some homeless people with mental illness may
require in-patient facilities, others need access to open shelters,
community kitchens, adequate clothing, medical support and other
social entitlements. These services may be coordinated between
Local Self Government Institutions and Social Welfare/Disability
Departments based on a National Policy on Homelessness. The
Government Policy should formulate a response towards homeless
person with mental health problems. This should include adequate
attention to preventive measures and rehabilitative measures.
• Assisted Living Services for persons with mental health problems is
a type of domiciliary care for persons with chronic and long term
illness. Those on recovery pathways can have integrated
independent housing with some minimal support systems. Thereby
the exit of family care givers does not become a critical setback in
their recovery progress. However, the majority who live in their
families face a sudden withdrawal of all forms of support once the
care-givers are no more. The emerging contours of Indian families
as urban prototypes worsen the situation. This policy recommends
to explore ways and means of finding a solution to the question
-"Who after me"
• A suitable mix of all three different models of care - institutional,
community and family- has to be identified to suit the needs of the
orphaned persons. Extending assisted living in one's own home
could be a viable option for various categories of families across the
social strata. The question of the State monitoring such services has
an element of legal obligation to ensure safety and protect dignity
of the afflicted persons living alone on low or nil support
 Training resources
• The large numbers of Auxiliary Nursing
Midwives should be offered an opportunity for
skill upgradation in mental health
• Trained lay and community based counsellors,
psychiatric social workers, development
workers, psychologists, occupational therapists,
other mental health professionals
• Mental health should be recognized as
everybody's business
 Community participation
• Remove legislative, policy and programmatic barriers to
protect rights of persons with mental illness and promote the
full participation of persons with mental illness in all areas of
life including education, housing, employment/ livelihood and
social welfare. In particular, there is a need to simplify
procedures for disability certification of persons with mental
illness and enhancing compensation for mental disability
• Increase availability of appropriate housing with necessary
supports for homeless and other poorly resourced persons
with mental illness living in poverty and deprivation
• Implement programmes to help persons with mental health
problems to pursue education and vocational training
schemes to help improve their chances of employment
 Community participation
• Include person(s) with mental health problems in all social
welfare and disability benefit programmes and make suitable
modifications to such schemes to take into account the
unique requirements and contexts of persons with mental
illness
• Involve persons living with mental illness and care-givers in
Village Health, Sanitation, Water and Nutrition Committees
(Swasthya Gram Samiti) and in Rogi Kalyan Samiti (Patient
Welfare Committees) so that they can participate in
community planning and monitoring of the public health
system and in community action for health
 Summary & Critique
• In summary, the policy envisions integrated and evidence
based care.
• It recognizes the needs of OPMI, homeless, caregivers and
persons affected by mental illness, and also the lack of
funding. Hence it urges for inter-sectoral coordination,
involving community health workers, NGOs and existing
resources for the care of the MI in the community, but
does not forget the role of families and the institutions.
• At the outset the policy looks good, futuristic, aims high,
wants to achieve a lot. But, it is vague and at present stage
not feasible