nhu draft bill

8/11/2019 nhu draft bill

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National Mental Health

Programme

Revision Proposed for the 11th

five Year Plan-Overview


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National Mental Health Program

(NMHP) Implementation 1982.

It aims at providing mental health care as wellas health care in general, utilizing the available

resources including manpower and

infrastructures to the total population of the

entire country


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Main objectives To ensure availability and accessibility of minimum

mental health care for all

To encourage application of mental health

knowledge in general health care

To promote community participation in developingmental health services, and to stimulate efforts

towards self-help in the community.


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Specific approaches

Diffusion of mental health skills to the periphery ofsystem.

Appropriate allotment of tasks in mental health carefor health personnel.

Equitable & balanced territorial distribution ofresources.

Integration of basic mental health care into generalhealth services.

Linkages to other community developmentprogrammes.


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Need for Developing a District

Model: Earlier efforts to integrate mental health with PHC

involved only population of 40,000 to 60,000 andpersonal of one PHC.

Field level evaluation of trained PHC personalhighlighted the need for developing a district model.

NMHP- envisage implementation in atleast one

district of every state.

All health care and welfare programmes areimplemented and monitored at a district level.


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Advantages of Mental Health

Care at district The district is an independent administrative unit

with district commissioner as the head.

DHO (District Health Officer) has powers ofplanning activities in the district.

Monitoring of programmes occur at the district level.

Inter-sectoral coordination is possible at the districtlevel.


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Advantages.. District.. contd....

Mobilization of additional resources are possible.

All existing staff can be best utilized by involving the

total district for care programme.

A district, not a PHC, is the planning and

implementation unit for most other health and

welfare programmes.


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DMHP..Bellary DMHP was formally inaugurated at Bellary on 20th

July 1985 with technical inputs from NIMHANS

Covering a population of 1.5 million distributed in 7

talukas at Bellary district, in Karnataka state,


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Results..During the first three years of the project (1985-1988),

1200 psychotics,

3525 epileptics,

750 neurotics and

380 mentally retarded persons were registered. Of the psychotics, 42% took treatment regularly

and showed improvement.


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DMHP Progress

DMHP launched - national level 1996-97

DMHP was progressively implemented inselected 27 dis tr icts in 21 states acrossthe country -9thplan


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NMHP10thPlan

Rs. 139 crore was sanctioned.

NMHP was restrategised in 2003.


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10thPlan Strategies

Integration of Mental Health with primary health care

through DMHP

Strengthening psychiatry wings of medical colleges Modernisation of existing Mental Hospitals

IEC

Research and Training


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Physical Targets Achieved10thPlan

Scheme Grants

Sanctioned

Grants

Released

Target 10thPlan

DMHP

(No. of Districts)

129 109 100

Mental Hospital

(No. of Mental

hospitals funded)

23 23 25

Psychiatry Wing ofMC/Gen. Hosp.

(No. of inst.funded)

70 70 75


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Strategy for 11thplan

Was developed through National consultations at New

Delhi in April 2006 and Oct 2006 in Bangalore (2 days

workshop) with all the nodal officers/ other stake

holders at NIMHANS

Inputs received from the State governments during

National review meetings


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Contd

Revise the list of essential drugs for DMHP

Prescribe the minimum training requirements for staff to

be recruited in DMHP. Review the current content & curriculum and develop

standard training programmes for health personnel.

Develop time bound target of activities to be completed

by DMHP at each center.


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Administrative Barriers

Lack of Clarity in guidelines

Lack of manpower resources

Motivational barriers

General Issues

Barriers in implementation of DMHP


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Mental Health Care is available in many States at

the District level in the country due to

implementation of DMHP.

Minimum range of essential drugs was available at

the district level in adequate quantities while that of

the primary health center and distt. hospital varied.

Most of the centers had given training to doctors in

mental health care. However, the duration of

training and the number of doctors trained varied.

Evaluation in 2003 of DMHP (27 Districts),

significant observations were ..


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Some had good records while others were poor.

Registration of cases and reporting format was not

uniform across the centers.

Some had developed their own material for public

education, while others were using the ones

provided. IEC activities were not uniform across all

the centers.

Nearly 50% of the DMHP sites had organized

mental health cam in the district hos ital

Contd .


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There are 94 DMHP sites in the country as on

2005-2006.

Less than 20% of the centers responded to a

review questionnaire.

Most of the centers have trained doctors, health

workers and other paramedical workers. Instead

training all doctors, the training was provided for

only 15-16 doctors for twothree weeks.

Current Status of DMHP in India

(Review in Sep, 2005)


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The program officer is a Psychiatrist in many of the

DMHP states.

DMHP a specialist operated programme rather than

a primary health care team managed mental health

care programme.

Mental health care programme in India has

progressed to some extent.

Contd ..


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Proposal for 11thPlan

Main components

DMHPRe-strategised

Establishment of Regional Institutes of Mental Health& Neurosciences

Training & Research

IEC/NGO

Monitoring & Evaluation

Spill over Activity of X plan

Budget increased to 1083 crores


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DMHP - Proposed changes

Instead of Psychiatrist/ psychiatric social worker/ clinicalpsychologist/psychiatric nurse, the programme wouldbe run through trained medical officer/ social worker /

psychologist/ nurse

The District would be prepared before the programmeis launched- separate provision has been made for

engagement of required staff/ training /setting up ofcounseling center/identification of partner organisations

Funds released through district health society


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DMHP - Proposed changes

10thPlan 11thPlan

P.O. - Psychiatrist Trained M.O. (3 months)

Training of PHC doctor 2-3weeks 3 +3 (6) days

M.O.s trained/district

15-20%

100%

Training of Health workers2-3 weeks

1+1 (2) days

Training not standardized Training by standardized

training modules


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DMHP

Hospitalisation Communitisation

Manpower would be Recruited for Central MentalHealth Cell, State Mental Health Cell & District Cell.Mainstreamed by Integration with NRHM

Partnership with a Community based organisation

Drug Distribution would be done through District, Sub

District, CHC, PHC, Sub centres.


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DMHP Activities

Service provision to mentally ill

Referral to identified Med. College/Pvt. Psychiatrist

Community mental health care by visitingCHCs/PHCs

IEC


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Training of personnel

Provision of drugs

Simple recording system

District mental health clinic

Review cum training as part of visits to the periphery

Monthly reporting, monitoring and feedback

Community participation

DMHP activities contd.


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DMHP

Additional Services :

Counseling Center School Mental Health Services

College Counseling services

Stress Management at work place

Suicide prevention

Participation of NGOs


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DMHPPreparatory Phase

After approval in State Health Society, DMHP teamwould be recruited & sent for training.

Linkages would be established and a plan for thedistrict would be worked out.

Infrastructure like counseling center, DMHP centeretc. would be put in place.


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School Mental Health Services

Life Skills Education using standard training manuals

Counselling services through trained teachers/ HiredCounsellors

Involvement of the NGOs


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College Counselling Services

Provided by trained teachers of psychology departmentof the colleges

The P.O. will organise the training at the district level inclose co-ordination with the Dept of CollegiateEducation

The trained teachers will act as counselors and asreferral and support-giving agents in their respectivecolleges


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Suicide Prevention Services

Sensitization workshops

Crisis Helplines

Timely care for high risk groups School, college and work place intervention

programmes

IEC activities focused on suicide prevention


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Imparting skills for time management, improvingcoping skills, relaxation techniques like Yoga,Meditation etc.

Identify workplaces with sizeable population andorganize stress management workshops for them

District Counseling Centre will also address thisgroup

Workplace stress management


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State Mental Health Cell

Nodal officer (Deputy Director Mental Health or theJoint Director Health) for monitoring theimplementation of NMHP

Mental Health Technical Support Team

- one consultant (psychiatrist)

- one assistant/ DEO.

SMHC in consultation with P.O.s will work out aDistrict specific plan based on the mental health

resources available.


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On the pattern of NIMHANS -by upgrading 8 identifiedexisting mental health hospitals/institutes/Med.colleges.

For addressing the acute manpower gap & provision ofstate of the art mental health care facilities

To have psychiatry, neurology, neurosurgery, clinicalpsychology, psychiatric social work, psychiatric nursing

and supportive departments Training facilities in psychiatry, clinical psychology,

psychiatric social work & psychiatric nursing

Proposed budgetary support

Regional Institutes of MentalHealth & Neurosciences


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IEC

Innovative IEC strategies involving Electronic/

Print/local media at Central/State/District/ Grass root

level to reduce stigma attached to mental illness and

increase awareness regarding available treatment andhealth care facilities

Increased awareness regarding provisions underMental Health Act 1987


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Monitoring & Evaluation

CentreCentral Mental Health cell

StateState Mental Health cell

District and belowDMHP unit Regular supervision through Visits/Reporting by all

levels

Outside evaluation


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Monitoring DMHP-Structure

Minister of Health

and Family Welfare

DGHS

Central monitoring agency for DMH

Programme

A secretariat with staff

(Coordinator, Project assistant, Data entry

operator/statistician, Clerk)

State monitory agency

Project coordinator (Medical background)

District Mental Health Programme

Programme Officer


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Monitoring DMHP-Function

Central monitoring agency for DMH

In touch with State monitoring agency and each DMHP

by dedicated fax line and e-mail

Meet with State monitoring agency and Programme

Officers of DMHP every 6 - 12 months.

Visit each DMHP with State monitoring agencypersonnel once in a year

State monitoring agency

Meets each DMHP Programme Officer once in 3 months

Visit each DMHP and meets Medical Officers in 6 months

District Programme Officer

Meets Medical Officer each distt., monthly


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State monitoring agency


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Outcome Indicators

Number of new patients starting on treatment;

%age of drug non-compliant cases amongst the

diagnosed cases; Case identification rates

% of drop outs to treatment

Increased awareness levels

Availability of trained manpower

P th f f ti t


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Pathway of care for a new patient or

for a patient on follow-up


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Conclusion

Massive budget provision to cover almost all

districts of the country

Quantitative & Qualitative change

Need for comprehensive & integrated mental

health care

Hope to achieve best to most


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THANK YOU

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