NATIONAL MENTAL

HEALTH PROGRAM

Ms. Abha Verma

M.Sc Nursing
RAKCON
INTRODUCTION
• Mental health is not just the an absence of mental
disorders.
• It is defined as the state of wellbeing in which every
individual realizes his or her own potential, can cope
with the normal stresses of life, can work productively
and fruitfully, and is able to make a contribution to
his/her community (WHO 2007).
• The focus should be on promoting mental health
throughout the life span to ensure a healthy start in life
for children and to prevent mental disorders in
adulthood and old age.
• Mental disorders are often neglected due to its non-
specificity in diagnosis, vague clinical representations,
long term and varied treatment and various myths and
belief systems leading to social stigma.
NATIONAL MENTAL HEALTH PROGRAM
• The Government of India launched the National Mental
Health Programme (NMHP) in 1982.
• The Program envisages primary health care community
based approach in the rural areas supported by
professional psychiatric supervision from the district
level and referral services by the mental hospitals and
mental health units of the general hospitals.
• The district Mental Health Program was added to the
Program in 1996.
• The Program was re-strategized in 2003 to include two
schemes, viz. Modernization of State Mental Hospitals
and Up-gradation of Psychiatric Wings of Medical
Colleges/General Hospitals.
3 main components of NMHP

Prevention and
promotion of Treatment of
positive mental Mentally ill
health.

Rehabilitation
OBJECTIVES
1. To ensure the availability and accessibility of
minimum mental healthcare for all in the foreseeable
future;
2. To encourage the application of mental health
knowledge in general healthcare and in social
development;
3. To promote community participation in the mental
health service development; and
4. To enhance human resource in mental health sub-
specialties.
STRATEGIES
1. Integrating 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 AT VARIOUS LEVELS

District Teaching
Village/SC PHC
Hospital Hospitals
1. The Mental Morbidity requires priority in Health Care
Delivery and Treatment
Acute mental disorders of varying etiology resulting in
temporary disability can be treated. Proper recognition
and treatment is very important to reduce the morbidity
of mental disorders in the community.
2. Primary Health Care at Village and Subcenter level
Multi-Purpose Worker (MPW) and health supervisor will
be trained to deal with management of emergencies,
maintenance of treatment advised from the higher center,
management of children with mental retardation,
behavior problems and counseling of patients suffering
from alcohol and drug use disorders.
3. At Primary Health Center level
• Medical officers will be trained to provide the following
services:
• Supervision of the MPWs and health supervision,
• Producing mental diagnosis with the help of charts and
neurological examination,
• Treatment of mental disorders that can be managed at
PHC, and
• Epidemiological surveillance of mental disorders.
4. At the District Hospital level
There is an urgent need for psychiatric speciality to be
attached to every district hospital with a strength of 30-50
beds as an integral part of the district health services.
There should be a provision of admission and treatment
of all kinds of mental disorders, ECT, and further referral
services.
5. Mental Hospital and teaching Psychiatric Units
• These higher centers of psychiatric care will actively and
dynamically function with links to the periphery.
• This calls for a change in the role of the psychiatrist
from a clinical specialist to a leader and planner of
mental health services in his territory.
DISTRICT MENTAL HEALTH PROGRAM
• The program is based upon the Bellary Model.
• The district of Bellary in Karnataka was the first district where
mental health care program was pilot tested by NIMHANS
between 1986-1995.
• It was found that mental health delivery was possible in primary
care settings.
• This program was later implemented in 27 districts in 1996.
Objectives
1. To provide sustainable basic mental health services to the
community and to integrate these with other services.
2. Early detection and treatment of patients in the community
itself.
3. To see that the patients and their relatives do not have to travel
long distances to go to hospitals or nursing homes in cities.
4. To take pressure off mental hospital: To ease the pressure in
mental hospitals by providing mental health care at primary
level only.
5. To reduce the stigma attached towards mental illness through
change in attitude and public education.
6. To treat and rehabilitate mental patients discharged from the
mental hospital within the community.
7. To detect, manage, and suitably refer cases of epilepsy and
ensure availability of anti-epileptic drugs and others so as to
reduce stigma towards epilepsy.
Components of DMHP
1. Expansion of DMHP to 500 districts all over the country with
some modifications.
2. Improvement of Health manpower
3. Availability of outsourced vehicle for mobility of DMHP team.
4. Availability of all essential drugs in every primary health
center and primary health unit.
5. IEC activities in the district.
6. Health promotion using Life skills approach in the schools.
7. Training program for medical offciers and nurses.
8. Monitoring, support and supervision- visits to PHC/CHC by the
psychiatrist.
9. Support money for implementing Mental Health Act.
10. School Mental Health Program to be implemented by imparted
life skills education.
11. College counselling services, workplace stress management.
Current status of DMHP in India
• At present, the program is in place in only 123 districts with an
average population of 20 lakhs.
• Most of the centres have trained doctors, health workers and
other paramedical workers.
• The program officer is a psychiatrist in many centres.
• PHCs are providing referrals to the patients to districts where
psychiatrist is visiting rather than handling their problems then
and there only. Mental health program is progressing in India
very slowly.
Barriers in implementation of DMHP
Lack of
Administrative
manpower
Barrier
resources

Motivational
Barriers
School mental health program
• The NMHP for India in the 11th five year plan envisages
health promotion using life skills approach for
adolescents by institutionalizing life skills education in
the schools.
• In 2010, this program has been sanctioned to be
implemented in all the DMHP districts in the country.
Health promotion through life skill
education
• Life skill education is a novel promotion program that
teaches generic Life Skills through Participatory
Learning Methods of games, debates, role-plays and
group discussions.
• Such initiatives provide the individual with a wide
range of alternatives and creative ways of solving
problems pertaining to various health and psychological
issues like Drug Use, Sexual abuse, teenage pregnancy,
etc.
• Repeated practicing of these skills leads to a certain
mastery and application of such skills to real life
situations and gain control over the situation.
• These skills improve positive health and self esteem.
The Life Skills, which need to be taught at the schools level
especially to adolescents are as follows:
• Critical thinking and creative thinking.
• Decision making and problem solving.
• Communication skills and interpersonal relationships
• Coping with emotions and stress
• Self awareness and empathy
 Non Government Voluntary Organization-
Role in NMHP
• Information, education and communication
• Support for health promotion using life skills approach.
• Support for follow up of severely mentally patients in the
community.
• Support for mentally retarded children and their families-
organization of self help groups.
• Organization of mental health camps with the help of elected
representatives and volunteers in the community.
• Networking with primary health care team, ASHA
workers of rural health mission, and other voluntary
agencies in the community.
• Facilitation of disability welfare benefits for the
mentally ill and mentally challenged persons in the
community.
• Home care for the severely mentally person who are
unable to use outpatients services in the primary health
centers.
• Organizing street plays to disseminate information that
mental illness is treatable in primary health centers.
Problems faced:
• No initiatives from the mental health professionals.
• Shortage of qualified psychiatrists, psychiatric nurses
and mental health workers.
• Poor commitment of the government, psychiatrists
towards the program.
• Mental health services are deficient in both rural and
urban areas.
• No system for annual reporting of mental health data.
Mental Health Care Act, 2017
• In India, the Mental Health Care Act 2017 was passed on 7 April
2017 and came into force from July 7, 2018.
• “An Act to provide for mental healthcare and services for persons
with mental illness and to protect, promote and fulfil the rights of
such persons during delivery of mental healthcare and services
and for matters connected therewith or incidental thereto.”
• This Act superseded the previously existing Mental Health Act,
1987 that was passed on 22 May 1987.
• "Mental healthcare" includes analysis and diagnosis of a
person's mental condition and treatment as well as care
and rehabilitation of such person for his mental illness
or suspected mental illness.
Mental Health Care Act, 2017
• Mental illness and capacity to make mental
healthcare and treatment decisions
• Capacity to make mental healthcare and
treatment decisions by the patient.
• Advance directive
• Every person, who is not a minor, shall have a right to
make an advance directive in writing, specifying any or
all of the following, namely:––
• (a) the way the person wishes to be cared for and treated
for a mental illness;
• (b) the way the person wishes not to be cared for and
treated for a mental illness;
• Nominated representative
• Appointment and revocation of nominated
representative.
• Rights of persons with mental illness
• Right to access mental health care.
Role of community health nurse
Role of community health nurse
Surveys:
• Conducting surveys in the community to find the
prevalence of mental health disorders.
• Level of awareness among people regarding mental
illness and management.
Education and awareness generation:
• Creating awareness among people regarding mental
illnesses through IEC material.
• The nurse plays a vital role in eliminating the stigma
associated with mental illness by the means of
Behaviour Change Communication (BCC)
Care Provider and counsellor:
• She is the care giver of the psychiatric patients admitted
in the wards.
• Mental assessment of school children
• Preventive addictions (drugs, alcoholism) among
children
• Life skills educator for school children
Records and reports:
• Maintaining the records of patients
• Survey records
• Maintaining the records of school children assessment
Advocating and coordinating:
• Cooperation with the NGOs/ voluntary organization
• Coordinating with ASHA workers and other health
team.
CONCLUSION
• Mental health is a critical issue which is often unaddressed in our
country not only by the uneducated people; but also by the
educated groups. People don’t have timely accurately
information, and this has caused serious problems, especially
with the children and younger group. The program needs a
stronger commitment by the government and the health workers.
THANK YOU