National Mental Health Programme

More than 6-7 % of India’s population suffers from mental disorders. The World Bank report (1993) revealed that the Disability Adjusted Life Year (DALY) loss due to neuro-psychiatric disorder is much higher than diarrhea, malaria, worm infestations and tuberculosis if taken individually. Together these disorders account for 12% of the global burden of disease (GBD) and an analysis of trends indicates this will increase to 15% by 2020 (World Health Report, 2001).

It is estimated that one in four families is likely to have at least one member with a behavioral or mental disorder (WHO 2001). Most of them (>90%) remain un-treated due to lack of awareness about symptoms of mental illness and also due to myths & stigma related to the disease. Other issues that negatively impact people from seeking help are lack of knowledge regarding treatment and availability and potential benefits of seeking treatment.

With the objective of addressing these issues, the Government of India has launched the National Mental Health Programme (NMHP) in 1982, with the following objectives:

• To ensure the availability and accessibility of minimum mental healthcare for all in the foreseeable future, particularly to the most vulnerable and underprivileged sections of the population.
• To encourage the application of mental health knowledge in general healthcare and in social development; and
• To promote community participation in the mental health service development and to stimulate efforts towards self-help in the community.

The NMHP has four schemes being run to fulfill above mentioned objectives. Given below are the schemes with their description, objectives, eligibility criteria and financial assistance available.

• District Mental Health Programme (DMHP)
• Manpower Development Schemes-Centers Of Excellence And Setting Up/ Strengthening PG Training Departments of Mental Health Specialities (Started in 11th five year plan)
• Modernization Of State Run Mental Hospitals
• Up-gradation of Psychiatric Wings of Medical Colleges/General Hospitals

1. District Mental Health Programme (DMHP)

   The main objective of DMHP is to provide Community Mental Health Services and integration of mental health with General health services through decentralization of treatment from specialised Mental Hospital based care to primary health care services. Presently the DMHP is being run in 123 districts.

   DMHP envisages a community based approach to the problem, which includes:

   • Training of mental health team at identified nodal institutions.
   • Increase awareness & reduce stigma related to Mental Health problems.
   • Provide service for early detection & treatment of mental illness in the community (OPD/ Indoor & follow up).
   • Provide valuable data & experience at the level of community at the state & center for future planning & improvement in service & research.

   Based upon evaluation conducted by an independent agency in 2008 and feedback received from a series of consultations, the Government of India revised the programme and added components of Life skills education, counselling in schools and colleges, work place stress management and suicide prevention services. These are in addition to the existing components of clinical services, training of general health care functionaries, and IEC activities in DMHP.

2. Manpower Development Scheme
   With the objective of improving training infrastructure in mental health, Government of India has approved the Manpower Development Components of NMHP for 11th Five Year Plan. It has two schemes delineated below.
   1. Centers of Excellence (Scheme A)
      Under Manpower Development Component at least 11 Centres of Excellence in mental health would be established in the 11th plan period by upgrading existing mental health institutions/medical colleges.
   2. Setting Up/ Strengthening PG Training Departments of Mental Health Specialities (Scheme B)
      To provide further impetus to Manpower development in Mental Health training centers other than Mental Hospitals, Government Medical Colleges/ Government General Hospitals/ State run Mental Health Institutes are being provided support to start PG courses in Mental Health or to increase the intake capacity for PG training in Mental Health.
      Steps have also been taken to modernize infrastructure of state run mental hospitals.
3. Modernization of State Run Mental Hospitals
   Steps are being initiated to modernize existing state run mental hospitals by changing their approach from custodial care to comprehensive management. The emphasis is to improve the infrastructure of these hospitals like psychiatry ward, OPD, ECT room, equipments, kitchen, laundry, safe water, toilets, occupational therapy, etc.
4. Up-gradation of Psychiatric Wings of Medical Colleges/General Hospitals
   Steps are being taken to upgrade the Department of Psychiatry with minimum of three faculty members and inpatient facilities of about 30 beds as per the norms laid down by the Medical Council of India. Out of the existing medical colleges in the country, approximately 1/3rd of them do not have department or adequate psychiatric services.

IEC Activities

A comprehensive IEC (Information, Education, and Communication) plan has been formulated under NMHP for sensitizing the public and increasing awareness and removal of stigma regarding mental illness.