CLASS PRESENTATION ON

NATIONAL MENTAL HEALTH PROGRAM & DISTRICT

MENTAL HEALTH PROGRAM

PRESENTED TO: SHAILZA SHARMA MAM PRESENTED BY:

KANU
ASSOCIATE PROFESSOR M.SC. NURSING
1ST YEAR
 Class presentation on
National mental health program
&
District mental health program
 INTRODUCTION

• The Government of India Launched the

national mental health program(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 OF NMHP:
1. Prevention and treatment of mental
neurological and their associated disabilities.
2. Use of mental health technology to improve
general health services
3. Application of mental health principles in
total national development to improve quality
of life.
 OBJECTIVES OF NMHP:

1. To ensure availability and accessibility of minimum mental

health care for all in the foreseeable future, particularly to
the most vulnerable and underprivileged section of the
population
2. To encourage application of mental health knowledge in
general health care and social development
3. To promote community participation in the mental health
services development and to stimulate efforts towards self-
help in the community
STRATEGIES:

1. Integration of mental health with primary health care

through NMHP
2. Provision of tertiary care institutions for treatment of
mental disorders
3. Eradicating stigmatization of mentally ill patients and
protecting their rights through mental health authority
and state mental health authority.
APPROACHES TO ACHIEVE THE
OBJECTIVES:
In order to achieve the objectives formulated above, the program will
adapt the following approaches
 Diffusion of mental health skills to periphery of the health care
system : Instead of exclusively centralizing and concentrating mental
health skills in specialized facilities, mental health care will be spread
over the existing network of services .The aim is to incorporate mental
health awareness and skills at the levels of health care. Mental health
care must start at the grass-root level . Appropriate appointment of
tasks in mental health care were introduced and these tasks have to
be performed at each level.
Appropriate appointment of tasks in mental health care:
The tasks have to be performed at each level.
• Community health volunteer (1/1000 population)- to act
as liaison between mental health care and the community.
• Multipurpose worker (1/5000 population)-Multipurpose
worker is a first level full time health personnel to provide
health care service and act as the first person to link with
health service system by providing first aid care and follow-
up service.
• Senior and more experienced primary health personnel
(Health Supervisor, health inspectors, Lady health visitors,
etc.) Entrusted with the tasks of early recognition and
management of psychiatric conditions on priority basis.
• Medical Officer-has the responsibility of organizing and
supervising the primary level mental health care for the
entire population under Primary Health Center (PHC).
• The referral system will operate to help the individuals
with mental health problems.
Equitable and balanced territorial distribution of
resources: Coverage of unserved or underserved population
with highest priority . Strengthen the mental health care in
the regions with deficient or deprived mental health.
Integration of mental health care into general health
services: This will facilitate the application of mental health
skills when dealing with patients without gross psychiatric
disturbances. It will also enable the health worker to identify
psychosocial problems under the disguise of physical
complaints and manage them more adequately.
Linkage to community development: An important
approach would be the involvement of State, District and
Block leadership in the implementation of the mental health
program to ensure community involvement in preventive
efforts directed toward psychosocial problems like alcohol
or drug abuse, behavior problems of childhood and
adolescence including delinquency, etc.
Mental health care: The service component will include
three subprograms:
SUBPROGRAMS:

1.Treatment 2.Rehabilitation

3.Prevention
1. TREATMENT SUBPROGRAM:
MULTIPLE LEVELS OF THIS SUBPROGRAM ARE GIVEN BELOW:
1. VILLAGE AND SUBCENTER LEVEL: MULTIPURPOSE WORKERS
AND HEALTH SUPERVISORS UNDER THE SUPERVISION OF
MEDICAL OFFICER (MO) TO BE TRAINED FOR:
➤ MANAGEMENT OF PSYCHIATRIC EMERGENCIES.
➤ ADMINISTRATION AND SUPERVISION OF MAINTENANCE
TREATMENT FOR CHRONIC PSYCHIATRIC DISORDERS &
DIAGNOSIS AND MANAGEMENT OF GRAND MAL EPILEPSY,
ESPECIALLY IN CHILDREN.
➤ LIAISON WITH LOCAL SCHOOL TEACHERS AND PARENTS
REGARDING MENTAL RETARDATION AND BEHAVIORAL
PROBLEMS IN CHILDREN.
➤ COUNSELING PROBLEMS RELATED TO ALCOHOL AND DRUG
ABUSE.
2. Medical Officer of Primary Health Center (PHC)aided by health
supervisor to be trained for :
➤ Supervision of multipurpose worker's performance
➤ To diagnose the patient's condition & treatment of
functional psychosis.
➤ Treatment of uncomplicated cases of psychiatric disorders
associated with physical diseases.
➤ Management of uncomplicated psychosocial problems.
➤ Epidemiological surveillance of mental morbidity.
3. District Hospitals: It was recognized that there should be at least
one psychiatrist attached to every district hospital as an integral part
of health services. The district Hospital should have 30-50 psychiatric
beds
4. Mental hospitals and teaching psychiatric units; Major activities of
these higher centers include:
• Help in care of difficult cases
• Teaching
• Specialized facilities like occupational therapy units, psychotherapy,
counselling and behavioral therapy
2. REHABILITATION
The components of this sub-programs include
treatment of epileptics and psychotics at the
community level and development of
rehabilitation centers both the district and higher
referral centers.
3.PREVENTION

The prevention component is to be community

based with initial focus on prevention and control
of alcohol-related problems. Later on problems like
addictions, juvenile delinquency and acute
adjustment problems are to be adressesd.
• Mental health training: Mental health specialist like
psychiatrists would not be enough in the near future our
country to deliver mental health care to all those who
immediately require it. As an immediate solution we have
to train a large number of health personnels of all
categories as much as possible in the minimum esstimate
of mental health tasks at their own level of performance
• Mental retardation and drug dependence: Mental
retardation is not mental illness but often associate it as
physical illness. Often the mentally retarded first come to
the notice of medical services. Therefore, health workers
are able course the parents, provide public education in
this subject, teaching them how to approach social welfare
agencies for rehabilitation Simultaneously, Integrated Child
Development Services (ICDS) personnel should know to
refer the mentally recognized patient by them to medical
agencies when indicated.
COMPONENTS OF NMHP IN DIFFERENT 5 YEAR PLAN
 DISTRICT MENTAL HEALTH
PROGRAM
Realizing that the NMHP was not likely to be implemented on
a larger scale without demonstration of its feasibility in larger
population, the NIMHANS in 1985 developed a program to
operationalize and implement the NMHP in a district besides
training for all primary care staff, the other components of the
district mental health program were operationalized under
Bellary model
• Bellary Model : A pilot of district mental health program was done
at Bellary district in Karnataka. The main components of this mode
are:
1. Provision of 6 essential psychotropic and anti epileptic
drugs( chlorpromazine, amitriptyline, trihexyphenidyl etc.) at all
primary health centers and sub centers.
2. A system of simple mental health case records
3. A system of monthly reporting, regular monitoring and feedback
from the district level mental health team.
4. .regular monitoring and feedback from the district level mental
health team.
 OBJECTIVES:
• The objectives of DMHP includes:
To provide sustainable basic mental health services to community
Early detection and treatment of mental illness in the community
To obviate the need of patient/relatives to travel large distances to
tertiary care facilities in big cities
To ease pressure on psychiatry department in teaching/mental hospitals
To reduce stigma of mental illness by change in attitude through public
health education
To detect , manage and refer epilepsy cases
SERVICE PROVISION :
Expansion of the DMHP to 500 district of India
Provision of staff and equipment for 10 beds for acute mental health care
in district mental hospital
Appointing 1 program officer per district who is medical officer with a least
5 years of experience and trained for 3 months in mental health care
Availability of essential psychotropic drugs at PHC level and more
sophisticated ones like lithium/valproate/olanzapine at district level.
Referral services
Liaisons with PHCs
Community survey if feasible
• 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.
DMHP includes program officer/psychiatrist, psychiatric
nurse/trained general nurse, clinical psychologist,
psychiatric social worker, community nurse/case manager,
case registry assistant and record keeper
STAFF AT DMHP
TRAINING PROGRAMS
• The medical officers and para medical staff to be
trained at district headquarters by the psychiatrist /
program officer 500 Taluk level medical officers for
5-12 months.
• PUBLIC EDUCATION ON MENTAL HEALTH ISSUE:
Information, education and communication
activities in district to be upgraded with 25 crores
per year including school mental health programs.
Milestones and Achievements in District Mental Health program:
• 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.
• 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 health
care at district level and 20% of them are able to render mental health care 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. There is no provision for
the nonmental 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.
BARRIERS TO IMPLEMENT NMHP
 Poor funding in initial period
 Limited under graduated training in psychiatry
 Inadequate mental health human resources
 Uneven distribution of resources across the states
 Non implementation of MHA(1987)
 Privatization of health care in the 1990.
CRITICISM OF THE NMHP:
 IT IS TOP DOWN( ALL PLANNING DONE AT
CENTRAL LEVEL
 IT IS NOT BASED ON THE SOCIAL
PERSPECTIVE OF THE COUNTRY
 THE COMMUNITY VOICES HAVE NOT
BEEN INCLUDED.
BIBLIOGRAPHY:
SREEVANI R “ A GUIDE TO MENTAL HEALTH &
PSYCHIATRIC NURSING” ,4TH EDITION, JAYPEE PUBLISHES,
PP NO 17-18.

PAREEK BHARAT “ TEXTBOOK OF MENTAL HEALTH

NURSING “,3RD EDITION, VISION PUBLISHERS, PP NO 452-
454’

PRAKASH P “ TEXTBOOK OF MENTAL HEALTH?

PSYCHIATRIC NURSING” 2ND EDITION, CBS PUBLISHERS,
PP NO 421-423.