Mental Health Programme in India

DR.MAHESWARI JAIKUMAR

MENTAL HEALTH• Good mental health is the ability to respond to

the many varied experiences of life with flexibility & a sense of purpose.

• Mental health has been defined as s state of balance between the individual & the surrounding world, a state of harmony between oneself & others, a co existence between the realities of the self & that of other people & that of the environment.

Psychologist have mentioned the following characteristics as attributes of a mentally healthy person.

MENTALLY HEALTHY PERSON1. A mentally healthy person is free from

internal conflicts, he is not at war with himself.

2. He is well adjusted , i.e., He is able to get along well with others. He accepts criticism

& is not easily upset.

3. He searches for identity.

4. He has a strong sense of self esteem.

5. He knows himself; his needs, problems & goals. (Self Actualization).

6. He has good self control balances rationally & emotionally.

7. He faces problems & tries to solve them intelligently, i.e., coping with stress & anxiety.

WARNING SIGNS OF POOR MENTAL HEALTH

BY WILLIAM. C. MENINGER:1. Are you always worried?

2. Are you unable to concentrate because of un recognized reasons?

3. Are you continually unhappy?

4. Do you loose your temper easily & often?

5. Are you troubled by regular insomnia?

6. Do you have wide fluctuations in your moods from depression to elation, back to depression, which incapacitate you?

• 7. Do you continually dislike to be with people?

• 8. Are you upset if the routine of your life is disturbed?

• 9. Do your children consistently get on your nerves?

• 10. Are you “browned off” & constantly bitter?

11. Are you afraid without real cause?

12. Are you always right and the other person always wrong?

13. Do you have numerous aches & pains for which no doctor can find a physical cause?

• INFERENCE :

•HELP IS NECESSARY IF THE ANSWER TO ANY OF THE AFORE SAID QUESTIONS IS DEFINITELY “YES”

• 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.

• According to the estimates DALYs loss due to mental disorders are expected to represent 15% of the global burden of diseases by 2020.

INTRODUCTION• The Indian Lunacy Act of 1912 was

replaced by Mental Health Act of 1987 emphasizing focus to improve the quality of services /care and protect the rights of mentally ill.

MENTAL HEALTH PROGRAMME IN

INDIA

DR. MAHESWARI JAIKUMAR

• 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.Prevention and treatment of

mental and neurological disorders 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.

OBJECTIVES1. 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. 2. To encourage application of mental health knowledge in general health care and in 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 mental health with

primary health care through the NMHP

2. Provision of tertiary care institutions for treatment of mental disorders

3. Eradicating stigmatization of mentally ill patients and protecting their rights through regulatory institutions like the Central Mental Health Authority, and State Mental health Authority.

MENTAL HEALTH CARE

1. The mental morbidity requires priority in mental health

treatment

2. Primary health care at village and sub centre level

3. At Primary Health Centre level

4. At the District Hospital level

5. Mental Hospital and teaching Psychiatric Units

DISTRICT MENTAL HEALTH PROGRAMME

• COMPONENTS 1. Training programmes of all workers

in the mental health team at the identified Nodal Institute in the State.

2. Public education in the mental health to increase awareness and reduce stigma.

3. For early detection and treatment, the OPD and indoor services are provided.

4. Providing valuable data and experience at the level of community to the state and Centre for future planning, improvement in service and research.

District Mental Health Team will provide services to the mentally ill and their families as follows

• Daily Out-patient (OPD) services• Ten bedded in services facility (IPD)• Referral service• Liaison with Primary Health Center

(PHC)• Provide follow up service• Community Survey if feasible• Remove stigma of mental illness by

creating awareness in the community

SCHOOL MENTAL HEALTH SERVICES:• Life skills education in school.

• Counseling services.

• Focus on educational performance

• & difficulties.

• Focus on special children.

COLLEGE COUNSELLING SERVICES• Issues related peer group.

• Issues related to family

• interfering with education.

• Drug abuse.

• Sex experimentation.

• Issues related with job & future plans.

WORK PLACE STRESS MANAGEMENT

• Stress in formal & informal sectors.

• Stress of various group of employees.

SUICIDE PREVENTION CENTERS

• Counseling centers at Dt level.

• Sensitization workshops.

• IEC help.

• Help Lines

THRUST AREAS FOR 10TH FIVE YEAR PLAN

1. District mental health programme in an enlarged and more effective form covering the entire country.

2. Streamlining/ modernization of mental hospitals in order to modify

their present custodial role.

3. Upgrading department of psychiatry in medical colleges and enhancing the psychiatry content of the medical curriculum at the undergraduate as well as postgraduate level.

4. Strengthening the Central and State Mental Health Authorities with a permanent secretariat. Appointment of medical officers at state headquarters in order to make their monitoring role more effective

5. Research and training in the field of community mental health,

substance abuse and child/ adolescent psychiatric clinics.

ACTIVITIES OF NMHP1. Integration of Mental health

Services to all existing general health services.

2. Early detection & follow up of cases.

3. Increase the awareness of mental health problems.

4. Eradicating stigmatization of mentally ill.

5. Providing rehabilitative services for chronically ill.

6. Providing counseling services for the alcoholic, drug addicts & delinquents.

7. Establishment of tertiary care institutions for treatment of mental disorders.

8. Training mental health team at nodal institutions in the state.

9. Training the trainers from states at NIMHANS, Bangalore.

10. Protection of mentally ill patients & their rights.

11. Providing rehabilitative services for chronically disabled mental patients.

12. Providing counseling services for alcoholics, drug addicts &

delinquents.

COMPONENTS OF MENTAL HEALTH PROGRAMME

TREATMENT

REHANBILITATION

PREVENTION

COMPONENTS

TREATMENT• The treatment programme is

planned in keeping the PRIMARY HEALTH CARE as the sheet of anchor.

• It consists of an appropriate referral system

REHABILITATION• Rehabilitation of patients with

mental disorders will be facilitated at the community level

PREVENTION• This component of the service

programme will be community based with a united involvement of the health service personnel

TERTIARY CARE INSTITUTIONS1. National Institute of Mental

Health & Neuro Sciences (NIMHANS), Bangalore.

2. Central institute of Psychiatry, Ranchi.

3. Institute of Human Behaviour & Allied Sciences, New Delhi.

INTEGRATION OF MENTAL HEALTH CARTE INTO PHC

• This was initiated by training health care personnel in PHC services to detect & manage mental illness.

• Active liaison with the government health & medical services departments established (well sustained efforts at ensuring a supply of basic psycho tropic medicines at PHC)

• Awareness programmes held periodically using local folklore, dance & music.

• The emphasis was is on early recognition of mental illness & prompt treatment.

• Community volunteers are to be identified & trained.

• Involvement & training lay community workers facilitates easier acceptance by the patients & their families.

• The interventions offered as a part of this programme have

facilitated community integration of the mentally ill.

• Establishment of rapport with the family & the community through the

involvement of local village leaders ensures the acceptance of such a programme by the population

11 TH FIVE YEAR PLAN: NATIONAL MENTAL HEALTH PROGRAMME

1. Up gradation of Psychiatric Wings of Govt. Medical Colleges/General Hospitals:

Establishment of a psychiatry wing in Government Medical Colleges

2. Modernization of State-run Mental Hospitals: grant of up to Rs. 3 crores per mental hospital for modernization of facilities and equipments

3. District Mental Health Programme: DMHP is presently under implementation

4. Programme Officer will represent the Programme in the District Health Society and facilitate proposals related to running of DMHP.

• 5. For effective implementation help of credible and community based organizations could be enlisted at the state and district level.

• 6. NMHP will be mainstreamed by integrating with NRHM. funds is routed through the State Health Society.

8. The Steering Committee on NMHP under the chairmanship of Secretary (H&FW) is authorized to carry out -any operational modifications

INTEGRATION OF MNHP INTO NRHM

ADVANTAGES:

• Optimal use of existing infrastructure at various level.

• Use of NRHM platform for transfer of funds to the states /UT

• Increased role of state / district level health authorities in the programme monitoring & implementation.

• Integrated IEC activities under NRHM.

• Involvement of NRHN infrastructure for training related to mental health in districts

• Use of NRHM machinery for procurement of drugs for use in NMHP.

• Involvement of community/PRI.

• Building of credible referral chains for appropriate management of cases detected at lower levels of health care delivery system

• Using improved linkages / communication under NRHM for MIS in respect of NMHP