LEARNING OBJECTIVES

At the end of the class, students will be able to

• List out the Aims, Objectives, Strategies and

approaches of NMHP

• Explain the activities of NMHP

• Describe the National Health Authority, Policy

and Revised NMHP

 CONTENT- OVERVIEW

• Introduction
• Aims of NMHP
• Objectives
• Strategies
• Approaches
• Mental Health Care
• Activities
• Revised National Mental Health Program
 INTRODUCTION

The Government of India has launched the

National Mental Health Programme (NMHP) in
1982, keeping in view the heavy burden of mental
illness in the community, and the absolute
inadequacy of mental health care infrastructure in
the country to deal with it.
 AIMS

1.To provide mental health care to the total

population within the available resources.

2.Prevention and treatment of mental and

neurological disorders and their associated
disabilities.
 Contd.,

3.Use of mental health technology to improve

general health services.

4.Application of mental health principles in total

National development to improve quality of life.
 OBJECTIVES

1. To ensure availability and accessibility of

minimum mental health care for all in the
foreseeable future, particularly to the most
vulnerable and underprivileged sections of
population.

2. To encourage application of mental health

knowledge in general health care and in social
development.
 Contd.,

3. To promote community participation in the

mental health service development and to
stimulate efforts towards self-help in the
community.
 STRATEGIES

1.CENTRE
TO PERIPHERY
 Contd..
1. Centre to periphery strategy
o Psychiatric units in all hospitals
o Outpatient clinics
o Mobile teams

2. Periphery to centre strategy

o Training of different categories of health personnel.
 APPROACHES

1. Diffusion of Mental Health skills to the periphery

of the Health care service system.

2. Appropriate appointment of tasks in Mental

Health care.

3. Equitable and balanced territorial distribution of

resources
 Contd.,

4.Integration of Basic Mental Health care into

General Health Services.

5.Linkage to community development.

6. Mental Health care.

7.Mental Health Training

8.Mental Retardation & Drug Dependence.

 MENTAL HEALTH CARE: THREE
COMPONENTS OR SUB-PROGRAMMES
 1.TREATMENT SUB-PROGRAMME

A. Village and sub Centre level:

Multipurpose workers & Health
supervisors, under the supervision of Medical
Officer , to be trained for:
 Management of psychiatric emergencies
 Administration & supervision of maintenance
treatment for chronic psychiatric treatment.
 Contd.,

 Diagnosis and management of grandmal

epilepsy, especially in children.

 Liaison with local school teachers & parents

regarding mental retardation and behavior
problems in children.

 Counseling in problems related to alcohol and

drug abuse.
 Contd.,

B. Primary Health Centre (PHC):

The Medical Officer, aided by the Health
supervisor, to be trained for
 Supervision of the Multipurpose worker’s
performance.
Elementary diagnosis
Treatment of functional psychosis
 Contd.,

 Treatment of uncomplicated cases of psychiatric

disorders associated with physical illness.

 Epidemiological surveillance of mental morbidity.

 Contd.,

C. District Hospital :
 At least one psychiatrist to be appointed to each
district hospital as an integral part of the district
health services.
 The district hospital should have 30 to 50
psychiatric beds.
 Contd.,

 The psychiatrist in the district hospital was

envisaged to devote only a part of his time in
clinical area and greater part in training &
supervision of non-specialist health workers.
 Contd.,

D. Mental Hospitals and Teaching Psychiatric

units:
The major activities of these higher centers of
psychiatric care include:
Help in care of ‘difficult cases’
Teaching
Specialized facilities like occupational
therapy units, psychotherapy, counseling &
behavior therapy.
Contd….
2. REHABILITATION SUB-PROGRAMME

Components include
 Maintenance treatment of epileptics &
psychotics at the community level.
 Development of rehabilitation centers at both
district level & higher referral centers.
 3.PREVENTION SUB-PROGRAMME

Prevention & Control of alcohol-related problems.

To tackle the following problems later:
Addictions
Juvenile delinquency
Acute adjustment problems
Suicidal attempts
 ACTIVITIES

 Community Mental Health Programme at

primary health care level in state & union
territories.
 Training of existing primary health personnel
without additional staff.
 Development of state level Mental Health
Advisory Committee & identification of state
level programme officer, preferably a
psychiatrist.
 Contd.,

 Establishment of regional centers of community

mental health.
 Development of a task force for mental
hospitals.
 Prevention & promotion of Mental Health

 Task force for mental health education for

undergraduate medical students.
 Contd.,

 Voluntary agencies to be involved in mental

health care.
 Priority areas to be identified such as:
Child mental health
Public mental health education
Drug dependence
 Mental health training of atleast one doctor at
every district hospital.
 Contd.,

 Establishment of a department of psychiatry

in all the medical colleges & strengthening of
existing ones.
 Provision of at least 3 or 4 psychotropic
drugs in adequate quantities at PHC level.
REVISED NATIONAL MENTAL HEALTH
PROGRAMME (2003)
 Revised National Mental Health
Programme (2003)

The programme comprises five closely networked strategic

components with a total outlay of Rs. 19 billion during the
10th five year plan.
Redesigning the DMHP, around a modal institution,
which in most instances will be the zonal medical
college.
Strengthening the medical colleges.
 Contd.,

Strengthening of central and state mental

health authorities.
Modernization of mental hospitals.

Research and training included.

 DISTRICT MENTAL HEALTH
PROGRAMME (DMHP)

This programme started as a part of

NMHP implementation. Initially 7 district
started this programme between 1997 to
1998. Gradually, other districts also started,
reaching 25 districts in 22 states of India.
 AIMS

1. Training programmes of all workers in

mental health team at the identified Nodal
institution in the state.

2. Public education in the mental health to

increase awareness & reduce stigma.
 Contd.,

3. For early detection & treatment, the OPD and

indoor services as provided.

4. Providing valuable data and experience at the

level of community to the state and center for
future planning, improvement in service &
research.
 TARGETS

DMHP covers the entire country.

 Streamlining/ modernisation of mental hospitals
in order to modify their present custodial role.
 Upgrading department of psychiatry in medical
colleges & enhancing the psychiatry content of
the medical curriculum at undergraduates as
well as post-graduate level.
 Contd.,
 Strengthening the central & state Mental Health
Authorities with a permanent secretariat.
 Appointment of medical officers at state
headquarters in order to make their monitoring
role more effective.
 Research and training in the field of community
mental health, substance abuse and
child/adolescent psychiatric clinics.
 CENTRAL MENTAL HEALTH
AUTHORITY

Constitution of the Authority:

Official members:

a)Secretary or Additional secretary, Ministry of

health and family welfare, Government of India.

b)Joint secretary, Ministry of Health and family

welfare dealing with mental health.
 Contd.,

c)Additional Director-General of Health services

dealing with mental health.

d)Director, General Institute of psychiatry, Ranchi

e)Director, National Institute of Mental Health and

Neurosciences, Bangalore

f)Medical superintendent, Hospital for Mental

diseases, Shahdara.
 Non-Official members

a)One social worker

b)Clinical psychologist

c)One Medical psychiatrist-who has special

interest in the field of Mental Health.

 STATE MENTAL HEALTH AUTHORITY

State Mental Health Authority was formed and

notified on 1-8-1994.
Ex-officio Members:
1. The secretary, Health & Family welfare
- Chairman
2. Deputy secretary, Health and Family welfare
- Member
3. Director of Medical & Rural Health services
- Member
NATIONAL MENTAL HEALTH POLICY
 NATIONAL MENTAL HEALTH POLICY

According to WHO ‘Mental health policies describes

the values, objectives and strategies of the government
to reduce the mental burden and to improve the mental
health.

The first draft of national mental health policy was

prepared in late 2001 and came into existence in 2003.
 POLICY OBJECTIVES

• The district mental health programme is

redesigned around a nodal institution ,where most
instances will be the zonal medical colleges.
• Strengthening the medical college psychiatry
departments with a view to develop psychiatric
manpower.
 Contd.,

• Streamlining and modernization of mental

hospitals to transform them from the present.
• Strengthening of central and state mental health
authorities in order that they may effectively fulfill
their role of monitoring on going mental health
programme.
• Research and training aimed at building up an
extensive database of epidemiological
information relating to mental disorder and their
courses.
• Focused information, education and
communication activities with the active
collaboration of professional agencies.
• Strengthening of central and state mental health
authorities by facilitating the establishment of
permanent secretaries and networking of state
authorities with national level.

• IEC training and research by sponsoring,

relevant community based research projects and
binding up an extensive data base .
ELEVENTH FIVE
Eleventh five year YEAR PLAN (2007-2012)
plan(2007-2012)

The DMHP will be extended to another 200 districts

while consolidating same 200 districts covered at the
end of 10th plan.

Qualitative and quantitative improvement will be

introduced in the areas of research, training and IEC,
with more focused attention on epidemiological
catchment area surveys on a larger scale.
 PRIORITIZE THE GOAL

10th five year plan (2002-2007)

✸District mental health program will be
extended to one district attached to each of the
100 medical colleges in the country.
✸Strengthening of medical colleges with
allocation of Rs.50 lakhs each to 100 medical
colleges.
✸Streamlining and modernization of mental
hospitals with the aim of reduction in chronicity
through intensive therapeutic intervention.
 Twelth Five Year Plan (2012-2017)

• The DMHP will be extended to the remaining

193 districts and the gains made in the previous
plans will be consolidated, further up gradation
of the psychiatric department in medical colleges
will be undertaken and 20 mental hospitals will
be contracted.
 NATIONAL HEALTH POLICY(NHP)

OBJECTIVES:

• To achieve the acceptable standard of good

health amongst the general population in the
country.
• To increase the access to the decentralized
public health system.
 Contd…

• Specific recommendation with regard to mental

health
• Upgrading infrastructure of institutions at central
government expense so as to secure human
rights.
• Envisages a network of decentralized mental
health services.
 SUMMARY

• Aims of NMHP
• Objectives
• Strategies
• Approaches
• Mental Health Care
• Activities
• Revised National Mental
Health Program