CONCEPT ARTICLE

Year : 2019  |  Volume : 16  |  Issue : 1  |  Page : 52-54

Models and roles in National Mental Health Programme

G Balamurugan¹, G Radhakrishnan², M Vijayarani^3
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

Correspondence Address:
Dr. M Vijayarani
ESIC College of Nursing, Bengaluru, Karnataka
India

Source of Support: None, Conflict of Interest: None

3

DOI: 10.4103/IOPN.IOPN_18_19

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

Introduction

Objectives of Nhmp

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

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

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]

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

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.

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.

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

• 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

• 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

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]

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.

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

References

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].
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.
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].
4.	Wig NN, Murthy SR. The birth of National Mental Health Program for India. Indian J Psychiatry 2015;57:315-9.   [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.
6.	Murthy RS. National Mental Health Programme in India (1982-1989) mid-point appraisal. Indian J Psychiatry 1989;31:267-70.   [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].
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].
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].
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].
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].

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