NATIONAL MENTAL HEALTH PROGRAMME INTRODUCTION: Health is defined as a state of complete physical, mental and social wellbeing,and not merely absence of disease or deformity.( WHO). Mental health thereforeforms an essential part of total health and as such forms an integral part of thenational health policy. Mental health is one of the essential component ofpatient care, this aspect was neglected earlier. It is well establish ed fact thatmental health principles can improve the health delivery care to patients. Thegovernment of India realizing that mental health is an integral component of thetotal health formulated the- National Mental Health Programme.EVOLUTION OF NMHP: The government of India felt the necessity of evolving a plan of action aimed atthe mental health component of the National Health Programme. For this, anexpert group was formed in 1980 , who met a number of times and discussedthe issue with many important people concerned with mental health in India aswell as with the Director, Division of Mental Health, WHO, Geneva. Finally, inFebruary 1981, a small drafting committee met in lucknow and prepared thefirst draft of NMHP. This was presented at a worksho p of experts (over60professionals) on mental health, drawn from all over India at

New Delhi on 20 -21 july 1981. Following the discussion, the draft was substantially revised and anew one was presented at the second workshop on 2 August 1982 to agroup ofexperts from not only the psychiatry and medical stream but also educaton,administration, law and social welfare. The final draft was submitted to theCentral Council of health, India¶s highest health policy making body at itsmeeting held on 18 -20 August 1982, for its adoption as the National MentalHealth Programme for India. In this way NMHP came into existence.Aims Three aims are specified in the NMHP in planning mental health services for the country:

Prevention and treatment of mental and neurological disorders and theirassociated 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 1. To ensure availability and accessibility of minimum mental health carefor all in the foreseeable future, particularly to the most vulnerable andunderprivileged 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 services

development and to stimulate efforts towards self -help in the community. STRATEGIES FOR ACTION Two strategies, complementary to each other were planned for immediate action:

1. Centre to periphery strategy: establishment and strengthening ofpsychiatric units in all district hospitals, with OPD clinics and mobileteams reaching the population for mental health services.

2. Periphery to centre strategy : training of an increasing number of differentcategories of health personnel in basic mental health skills, with primaryemphasis towards the poor and the underprivileged, directly benefitingabout 200 million people.APPROCHES TO NATIONAL MENTAL HEALTH PROGRAMME: To achieve the objectives the following approaches were formed:

I. Diffusion of mental health skills: Instead of centralising mentalhealth skills and expertise in an urbanised community it shouldreach periphery (i.e. the prima ry health care structure at thecommunity level like PHC, Sub centres and Village level workers).Mental health care must start at the grass root level.

II. Appropriate appointment of tasks in mental health care: the tasks tobe performed at each level (villag e workers, sub centre, PHC,district hospital, regional hospital) will be specified and a referralsystem set up so that the total system works in an integratedfashion.III. Equitable and balanced territorial distribution of resources: Every effort will be made to introduce or strengthen mental health first in

those regions which are at present de prived of it or where it is seriously deficient.

IV. Integration of basic mental health care into general health services:This will facilitate in dealing with patients wi thout grosspsychiatric disturbances. It will enable the health worker to identifypsychosocial problems. Psychiatric mental health worker will beable to identify and relate psychosocial factors contributing to illhealth.

V. Linkage to community development: Involvement of state, districtand block leadership in the implementation of the mental healthprogramme to ensure community involvement in preventive effortsdirected at psychosocial problems like alcohol, drug abuse,behaviour of childhood and adolescence, delinquency and otheravoidable problems.

VI. Mental health care:The mental health care service was envisaged to include threecomponents or subprograms namely treatment, rehabilitation

andprevention.y Treatment sub programme

Multiple levels were planned: those regions which are at present de prived of it or where it is seriously deficient. Treatment sub programme

Multiple levels were planned: A. Village and sub centre level: multi-purpose workers(MPW) and health supervisors, under the

supervision of medical officer(MO), to be trained for:i. Management of psychiatric emergencies.ii. Administration and supervision of maintenance,treatment of chronic psychiatric disorders. iii. Diagnosis and management of grandma epilepsy, especially in children.

iv. Liaison with local school teacher and parentsregarding mental retardation and behaviourproblems in children.v. Counselling in problem related to alcohol and drug abuse. B. Primary health centre(PHC):MO, aided by HS, to be trained for: i. Supervision of MPW¶s performance ii. Elementary diagnosis

Treatment of functional psychosis¶ iv. Treatment of uncomplicated cases of

psychiatric disorders associated with physicaldiseasesv. Management of uncomplicated psychosocial problems vi. Epidemiological surveillance of mental

morbidity. C. District hospital: it was recognised that there should

be at least one psychiatrist attached to every districthospital as an integral part of district health services.The district hospital should have30 -50 psychiatricbeds. The psychiatrist in a district hospital wasenvisaged to devote only a part of his time in clinicalcare and grater part in training and supervision onnon-specialist health workers.

D. Mental hospitals and training psychiatric units: themajor activities of these higher centres of psychiatric care include:i. Help in case of µdifficult¶ cases. ii. Teaching. iii. Specialised facilities like occupational therapy units, psycho therapy, and counselling and behaviour therapy. y Rehabilitation sub programmes: The components

of this sub-programme include maintenancetreatment of epileptics and psychotics at thecommunity levels and development ofrehabilitation centres at both the district level andthe higher referral centres.y Prevention sub programme: The prevention

component is to be community based, with theinitial focus on prevention and control of alcoho lrelated problems. Later, problems like addictions,juvenile delinquency and acute adjustmentsproblems like suicidal attempts are to be addressed.VII. Mental health training

Tamilnadu on the recommendation of the central council of health in 1995 and aworkshop for health administrators of the country was held in

feb 1996 todiscuss about the problem of mental health. The DMHP was extended to 7districts in 1997-98, five districts in 1998-99 and six in 1999-2000, with theaddition of3 more districts in 2000 -01, this programme is under implementationin 25 districts in 20 states and union territories.The programme envisages a community based approach to deal with menatal health problems in the country. It includes the following interventions: 1. Training programmes of all workers in the mental health team at theidentified Nodal Institute in the State.2. Public education in the mental health to increase awareness and reducestigma.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. 5. Funds are provided by the Government of india to the state government andthe nodal institutes to meet the expenditure on staff, equipments, vehicles,medicines, stationery, training ,IEC activities etc.6. The training to the trainer at the state level is being provided regularly by theNational Institute Of Mental Health and Neuro Sciences, Bangluru under theNMHP.

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/ modernisat ion 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 apermanent secretariat. Appointment of medical officers at state headquarters inorder to make their monitoring role more effective;

5.Research and training in the field of community mental heal th, substance abuse and child/ adolescent psychiatric clinics. ROLE OF NURSE Three primary goals of community health nurse, Promotion of mental health, Prevention of mental illness, Provision of holistic care and support for individuals experiencing mental ill health. ROLE OF CHN IN PRIMARYPREVENTION Child care and child-rearing measures include: Antenatal care to mother and educating her regarding the adverse effects of irradiation, drugs and prematurity.

Essential timely and efficient obstetrical assistance to guard against the ill effects of anorexia, injury at birth, Liberalisation of laws regarding termination of pregnancy, when it is unwanted Counselling of the parents of physically and mentally handicapped children. Programmes to enrich child mother relationship by stressing the importance of warm accepting intimate relationship. Programmes Oriented to the child in the school : Early signs of learning difficulties or behavioural abnormalities should bedetected, teachers should be taught to ide ntify the early symptomsof abnormal conduct and behaviour in the children and refer cases . Family-Centred Activities Programs: Attitudes of mutual trust, love and respect for one ,another need to be fostered . Educational services in the field of mental h ealth ,Parent -teacher associations Home-maker services ,Child guidance clinics, Marital counselling. Programmes for Families in Crisis Crises like adolescence, Birth of a new baby,Retirement or menopause, Death of a wage earner inthe family, Desertion by the spouse can be Handled at mentalhygiene clinics, psychiatric first -aid centres, walk-in-clinics. Society-centred Preventive Measures Community development

social administration. Collection and evaluation ofepidemiological, biostatisical data. Budge ting These measuresrequire coordinated activities among persons belonging to differentnorms and disciplines. ROLE OF CHN IN SECONDARYPREVENTION

Early Diagnosis and Case Finding achieved by educating the public and community leaders,mahilaMandals, Balwadis etc. in recognising earlysymptoms. EarlyReference. Screening programmes: Simple questionnaires should be developed and administered. Early and Effective Treatmen t Mental Health Education: Mass camps and through film shows, flash cards, and also through mass media communication. Training of Health Personnel Orientation courses . Crisis Intervention ROLE OF CHN IN TERTIARYPREVENTION Accomplished by preventing complications of the mentalillness & promoting achievement of each individual¶smaximum level of functioning throughRegular follow up ,Diversion therapy,Recreation therapy, Community MentalHealth Facilities, Day-Evening Treatment/ PartialHospitalization Programs, CommunityResidential Facilities,Support Groups. SUMMARY: Today we have discussed about NMHP, its evolution,objectives of NMHP, various approaches to achieve theobjectives of NMHP. Then we have discussed about DMHP

(District Mental Health Programme), its components andfinally the role of nurse in the implementation of NationalMental Health Programme.ASSIGNMENT: What is NMHP? Briefly explain its objectives and role of nurse in the implementation of programme. CONCLUSION: National mental health programme is designed with a view to prevent mental illness, promote mental health of the people. Therefore being a graduate