• Users Online: 117
  • Print this page
  • Email this page


 
 
Table of Contents
CONCEPT ARTICLE
Year : 2019  |  Volume : 16  |  Issue : 1  |  Page : 52-54

Models and roles in National Mental Health Programme


1 HoD-Department of Mental Health Nursing Ramaiah Institute of Nursing Education and Research, Bangalore, India
2 Faculty of Nursing, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bangalore, India
3 Assistant Professor, ESIC College of Nursing, Bangalore, India

Date of Web Publication15-Oct-2019

Correspondence Address:
Dr. M Vijayarani
ESIC College of Nursing, Bengaluru, Karnataka
India
Login to access the Email id

Source of Support: None, Conflict of Interest: None


DOI: 10.4103/IOPN.IOPN_18_19

Rights and Permissions
  Abstract 


In India, National Mental Health Programme (NMHP) was started in 1982 with the primary objectives of ensuring availability and accessibility of minimum mental healthcare for all. In 1985, National Institute of Mental Health and Neuro Sciences, Bengaluru, had developed Bellary model of District Mental Health Programme (DMHP), to achieve the objectives of National Mental Health Programme (NHMP). The current DMHP has more scope for the nurses to deliver mental health services as psychiatric nurse and community nurse. Hardly, one-third of districts in India are covered under DMHP and the service utilization is also to be strengthened. Psychiatric nurses have greater scope to transform all these existing challenges into opportunities.

Keywords: District Mental Health Programme, National Mental Health Programme, Bellary Model, NMHP


How to cite this article:
Balamurugan G, Radhakrishnan G, Vijayarani M. Models and roles in National Mental Health Programme. Indian J Psy Nsg 2019;16:52-4

How to cite this URL:
Balamurugan G, Radhakrishnan G, Vijayarani M. Models and roles in National Mental Health Programme. Indian J Psy Nsg [serial online] 2019 [cited 2019 Nov 22];16:52-4. Available from: http://www.ijpn.in/text.asp?2019/16/1/52/269161




  Introduction Top


In 1974, WHO Expert Committee on Mental Health released a report on “organization of mental health services in developing countries” at Addis Abada.[1] Based on the recommendations of 1974, seven countries (Brazil, Colombia, Egypt, India, Philippines, Senegal, and Sudan) initiated a project “Strategies for Extending Mental Health Care” (1975–1981).[2]

In India, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, and Post Graduate Institute of Medical Education and Research, Chandigarh, had developed “decentralized and de-professionalized mental healthcare model” at Sakalwara (Karnataka) and Raipur Rani (Haryana), respectively.[3] These two projects revealed that a large number of public were deprived of essential mental healthcare services, and also, this poor mental health made an adverse impact on ill individuals, family, and community as a whole.[4] In 1981, 70 mental health professionals have attended a 2-day workshop at New Delhi and deliberated on National Mental Health Programme (NMHP) draft. The second such workshop was conducted early 1982, with a limited number of experts at New Delhi, and finalized the NMHP draft with the incorporation of few suggestions, e.g., interdisciplinary coordination. In August 1982, the Central Council of Health had approved NMHP draft and made India as one of the first nations in developing countries to formulate NHMP.[5]


  Objectives of Nhmp Top


  1. To ensure availability and accessibility of minimum mental healthcare 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 healthcare and in social development
  3. To promote community participation in the mental health service development and to stimulate efforts toward self-help in the community.[6]



  Specific Approaches Suggested for the Implementation of the National Mental Health Programme Top


  1. Diffusion of mental health skills to the periphery of the health service system
  2. Appropriate appointment of tasks in mental healthcare
  3. Equitable and balanced territorial distribution of resources
  4. Integration of basic mental healthcare with general health services
  5. Linkage to community development, there was a framework for the planners and professionals to develop the mental health program for the country.[6]



  Genesis of District Mental Health Programme Top


Bellary model

While implementing NMHP, a lot of hurdles were raised such as funding (Who has to fund the program? central or state government) and feasibility in implementing in larger population. The majority of the stakeholders stressed upon finding out a model to implement NMHP at district level. Hence, in 1985, the NIMHANS developed a model (Bellary model) to deliver NHMP at Bellary district, Karnataka.

Additional strategies in Bellary model

  1. A provision of six essential psychotropic and antiepileptic drugs (chlorpromazine, amitriptyline, trihexyphenidyl, injection fluphenazine decanoate, phenobarbitone, and diphenylhydantoin) at all primary health centers (PHCs) and subcenters (SCs)
  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.[7]


Team of Bellary model at district level

  1. Psychiatrist
  2. Clinical psychologist
  3. Psychiatric social worker
  4. Statistical clerk.


Role of team members

  1. Health professionals at PHC and SC were trained in handling common mental disorders
  2. The medical officer at PHC was trained to diagnose and treat common mental disorders, and they were asked to refer the complex cases to district hospital
  3. The psychiatrist at district hospital ran the mental health clinic and had provision to admit 10 patients
  4. The district health officer reviewed the program every month with medical officers of all PHCs at Bellary district.


Conclusions of Bellary model

  1. Mental healthcare delivery was possible in the primary healthcare setting
  2. Primary care physicians could be adequately trained to provide such care
  3. Appropriate supervision/support from the program officer/psychiatrist empowers the public healthcare system to provide pertinent mental healthcare to the population.


District Mental Health Programme

The Ministry of Health and Family Welfare, Government of India, formulated the District Mental Health Programme (DMHP) based on the “Bellary model.” In 1996, DMHP was started in 27 districts across the country with the objectives.

  1. To provide sustainable basic mental health services to the community
  2. To integrate mental health services with primary healthcare services
  3. Early detection and treatment of mental illness in the community itself
  4. To obviate the need for the patient/relatives to travel large distances to tertiary care facilities in big cities
  5. To ease pressure on psychiatry departments in teaching/mental hospitals
  6. To reduce the stigma of mental illness by change of attitude through public health education
  7. Treatment and rehabilitation within the community, of patients, discharged from psychiatry units, by adequate provision of medicines and strengthening family support system
  8. To detect/manage/refer epilepsy cases, ensure supply of antiepileptics, and reduce the stigma/misconceptions about epilepsy in the community.[5]



  Progress So Far Top


  • Eighth 5-year plan[8]


    1. Bellary project.


  • Ninth 5-year plan[7]


    1. 27 districts in 20 states
    2. Budget allocation – 28 crore.


  • Tenth 5-year plan (2002–2007)[9]


    1. Extension of DMHP to 100 districts
    2. Up-gradation of psychiatry wings of government medical colleges/general hospitals
    3. Modernization of state mental hospitals
    4. Information Education and Communication (IEC)
    5. Monitoring and evaluation
    6. Budget – 190 crore.


  • Eleventh 5-year plan (2007–2012)[10]


    1. DMHP – 123 districts
    2. Workforce development schemes – Centers of excellence and setting up/strengthening postgraduate training departments of mental health specialties
    3. Modernization of state-run mental hospitals
    4. Up-gradation of psychiatric wings of medical colleges/general hospitals
    5. IEC
    6. Training and research
    7. Monitoring and evaluation.


  • Twelfth 5-year plan (2012–2017)[11]


  • As of now, 241 districts have been covered under the scheme, and it is proposed to expand DMHP to all districts in a phased manner with the following components.



  Out-Reach Component Top


Satellite clinics: DMHP team should conduct 4 satellite clinics per month at Community Health Centres (CHCs)/ Primary Heatlh Centres (PHCs)

  • Targeted interventions


    1. Life skills education and counseling in schools
    2. College counseling services
    3. Workplace stress management
    4. Suicide prevention services.


    1. Public Private Partnership (PPP) model activities
    2. Daycare center (financial support at 50,000 per center per month)
    3. Residential/long-term continuing care center (financial support at 75,000 per center per month).



  Role of Nurses Top


Job title: Psychiatric nurse

Job requirements/responsibilities

  1. To examine and manage healthcare needs of the mentally ill patients
  2. To provide inpatient care to the mentally ill patients
  3. To do the outreach activity/plan and manage psychiatric clinics in PHCs/CHCs and other sites periodically
  4. To impart training to the health personnel of CHC and PHC as per guidelines issued by the National Mental Health Cell.[11]


Job title: Community nurse

Job requirements/responsibilities

  1. To keep track of follow-up patients availing treatment at CHC and PHC
  2. To do the outreach activity/plan and manage psychiatry clinics in PHCs/CHCs and other sites periodically
  3. To impart training to the health personnel of CHC and PHC as per guidelines issued by the National Mental Health Cell.


The way forward for psychiatric nurses in District Mental Health Programme

  1. Opportunities to get involved in PPP model activities
  2. Running day center with the support of DMHP
  3. Starting of residential/long-term continuing care center with financial support from DMHP
  4. Involvement in teaching activities


    1. Life skills education and counseling in schools
    2. College counseling services
    3. Workplace stress management
    4. Suicide prevention services.
  5. Conducting independent research in NMHP evaluation.



  Conclusion Top


Last 35 years of learning from NMHP, it is observed that the focus on community mental health is of the highest importance. Hardly, one-third of districts in India are covered under DMHP (241 out of 718), which show a long way to go in future to cover entire districts, and the service utilization is also to be strengthened. While focusing on rural mental health, the urban mental health needs to be addressed equally; hence, NMHP has been gradually been mainstreamed into National Health Mission (National Rural Health Mission and National Urban Health Mission). Psychiatric nurses have great scope to convert all these challenges into opportunities and being part in achieving national goal.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
World Health Organization. Organization of Mental Health Services in Developing Countries: 16th Report of the WHO Expert Committee in Mental Health; 1975. p. 1-44. Available from: http://www.apps.who.int/iris/bitstream/10665/38212/1/WHO_TRS_564_eng.pdf. [Last accessed on 2019 Jun 02].  Back to cited text no. 1
    
2.
Sartorius N, Harding TW. The WHO collaborative study on strategies for extending mental health care, I: The genesis of the study. Am J Psychiatry 1983;140:1470-3.  Back to cited text no. 2
    
3.
Murthy RS, Kala R. Mentally ill in a rural community: Some initial experiences in case identification and management. Indian J Psychiat 1978;20:143-7. Available from: http://www.indianjpsychiatry.org/temp/IndianJPsychiatry202143-3143449_084354.pdf. [Last cited on 2018 Feb 26].  Back to cited text no. 3
    
4.
Wig NN, Murthy SR. The birth of National Mental Health Program for India. Indian J Psychiatry 2015;57:315-9.  Back to cited text no. 4
[PUBMED]  [Full text]  
5.
Roy S, Rasheed N. The National Mental Health Programme of India. Int J Curr Med Appl Sci 2015;7:7-15.  Back to cited text no. 5
    
6.
Murthy RS. National Mental Health Programme in India (1982-1989) mid-point appraisal. Indian J Psychiatry 1989;31:267-70.  Back to cited text no. 6
[PUBMED]  [Full text]  
7.
NIMHANS. National Mental Health Survey of India, 2015-16; 2016. Available from: http://www.nimhans.ac.in/sites/default/files/u197/NMHS Report %28Mental Health Systems%29 1.pdf.[Last accessed on 2019 Jun 07].  Back to cited text no. 7
    
8.
Khurana S, Sharma S. National mental health program of India: A review of the history and the current scenario. Int J Community Med Public Health. 2016;3:2697-704. Available from: http://www.ijcmph.com/?mno=240035. [Last accessed on 2019 Jun 07].  Back to cited text no. 8
    
9.
Planning Commission of India. Health Tenth Five-Year Plan 2002-2007; 2002. p. 81-152. Available from: http://planningcommission.nic.in/plans/planrel/fiveyr/10th/volume2/v2_ch2_8.pdf. [Last accessed on 2019 Jun 05].  Back to cited text no. 9
    
10.
MOHFW. Implementation of NMHP during 11th Five Year Plan;2011. Available from: http://164.100.158.44/WriteReadData/l892s/5471980538Revised guidelines NMHP.pdf. [Last accessedon 2019 Jun 12].  Back to cited text no. 10
    
11.
MOHFW. Guidelines for Implementing of District Level Activities under the NMHP during 12th Five Year Plan; 2015. Available from: http://164.100.158.44/showfile.php?lid=3238. [Last accessed on 2019 Jun 04].  Back to cited text no. 11
    




 

Top
 
  Search
 
    Similar in PUBMED
   Search Pubmed for
   Search in Google Scholar for
 Related articles
    Access Statistics
    Email Alert *
    Add to My List *
* Registration required (free)  

 
  In this article
Abstract
Introduction
Objectives of Nhmp
Specific Approac...
Genesis of Distr...
Progress So Far
Out-Reach Component
Role of Nurses
Conclusion
References

 Article Access Statistics
    Viewed60    
    Printed1    
    Emailed0    
    PDF Downloaded25    
    Comments [Add]    

Recommend this journal