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PRESENTER:-
SIMERPREET KAUR
NATIONAL MENTAL
HEALTH PROGRAMME

INTRODUCTION:
Health is defined as a state of complete physical, mental
and social wellbeing and merely absence of disease or
infirmity(WHO).
Mental health therefore forms an essential part of total
health and as such forms an integral part of the national
health policy.
Mental health is one of the essential components of patient
care, this aspect was neglected earlier.

The government of India realizing that mental health is an
integral component of the total health so formulated the-
National Mental Health Programme.
National Mental Health Program was launched in
1982 in order to create awareness of mental illness and
for improving the magnitude of mental illness
improving the availability of infrastructure and trained
manpower in India.

EVOLUTION OF NMHP:
The government of India felt the necessity of evolving a plan of
action aimed at development of the National Mental Health
Programmed.
• For this, an expert group was formed in 1980, which met a number of
times and discussed the issue with many important people concerned
with mental health in India as well as with the Director, Division of
Mental Health, WHO, Geneva.
• Finally, in February 1981, a small drafting committee met in
Lucknow and prepared the first draft of NMHP.
• The final draft was submitted to the Central Council of health. Its
meeting held on 18-20 August 1982, for its adoption as the National
Mental Health Programme for India. In this way NMHP came into
existence

OBJECTIVES:
1. To ensure the availability and accessibility of minimum
mental health care for all in the future, particularly to
the most vulnerable and underprivileged sections of the
population.
2. To encourage the application of mental health
knowledge in general health care and in social
development.
3. To promote community participation in the mental
health service development and to stimulate efforts
towards self-help in the community.

AIMS:
Three aims are specified in the NMHP in planning
mental health services for the country:
1.Prevention and treatment of mental and
neurological disorders and their associated
disabilities.
2.Use of mental health technology to improve
general health services.
3.Application of mental health principles to
improve quality of life.

STRATEGIES FOR ACTION:
Two strategies, complementary to each other were planned
for immediate action:
1. CENTRE TO PERIPHERY STRATEGY: Establishment
and strengthening of psychiatric units in all district
hospitals, with OPD clinics and mobile teams reaching
the population for mental health services.
2. PERIPHERY TO CENTRE STRATEGY: Training of an
increasing number of different categories of health
personnel in basic mental health skills, with primary
emphasis towards the poor and the underprivileged,
directly benefiting about 200million people.

TARGETS:
 Adoption of the plan by each state of India.
 Formation of National Mental Health advisory body as
Focal point.
 A national coordination group will be formed
comprising representatives of all state senior health
administrators and professionals from psychiatry,
education, social welfare and related professions.
 Formation of curriculum of health personnel of
different levels.
 Organization of mental health training programs for
primary health care personnel at the state levels.

 Provision of programming officers for mental health at
state level.
 Provision of psychiatrist at district level.
 Enhancing mental health training in under graduate
medical education.
 Development of linkage with other developmental
programs like Integrated Child Development Services
Scheme (ICDS).
 Improvement of mental hospitals and psychiatric
teaching units.

APPROCHES TO NATIONAL MENTAL
HEALTH PROGRAMME:
To achieve the objectives the following approaches were formed:
1. DIFFUSION OF MENTAL HEALTH SKILLS: Instead of
centralizing mental health skills and expertise in an urbanized
community it should reach periphery (i.e. the primary health care
structure at the community level like PHC, Sub-centres and Village
level workers). Mental health care must start at the grass root level.
2. APPROPRIATE APPOINTMENT OF TASKS IN MENTAL
HEALTH CARE: The tasks to be performed at each level (village
workers, sub centre, PHC, district hospital, regional hospital) will be
specified and a referral system set up so that the total system works in
an integrated fashion.

3.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 deprived of it or where it is seriously deficient.
4.INTEGRATION OF BASIC MENTAL HEALTH CARE
INTO GENERAL HEALTH SERVICES: This will facilitate in
dealing with patients without gross psychiatric disturbances. It will
enable the health worker to identify psychosocial problems.
Psychiatric mental health worker will be able to identify and relate
psychosocial factors contributing to ill health.

5. LINKAGE TO COMMUNITY DEVELOPMENT:
Involvement of state, district and block leadership in the
implementation of the mental health program to ensure
community involvement in preventive efforts directed at
psychosocial problems like alcohol, drug abuse,
behaviour of childhood and adolescence, delinquency
and other avoidable problems.
6.MENTAL HEALTH CARE: The mental health care
service was to include three components namely
treatment, rehabilitation and prevention.

A. TREATMENT SUB PROGRAM MULTIPLE LEVELS
WERE PLANNED: those regions which are at present deprived
of it or where it is seriously deficient. Treatment sub program
Multiple levels were planned:
i. VILLAGE AND SUB CENTRE LEVEL: Multi-purpose
workers(MPW) and health supervisors, under the supervision of
medical officer(MO), to be trained for:
 Management of psychiatric emergencies.
 Administration and supervision of maintenance, treatment of
chronic psychiatric disorders.
 Diagnosis and management of grandmal epilepsy, especially in
children.
 Liaison with local school teacher and parents regarding mental
retardation and behavior problems in children.
 Counselling in problem related to alcohol and drug abuse.

II. PRIMARY HEALTH CENTRE (PHC): Medical officer aided
by health supervisors, to be trained for:
 Supervision of MPW’s performance
 Elementary diagnosis
 Treatment of functional psychosis
 Treatment of uncomplicated cases of psychiatric disorders
associated with physical diseases.
 Management of uncomplicated psychosocial problems.
 Epidemiological surveillance of mental morbidity.
III. DISTRICT HOSPITAL: It was recognized that there should be
at least one psychiatrist attached to every district hospital as an
integral part of district health services. The district hospital should
have 30-50 psychiatric beds.

IV. MENTAL HOSPITALS AND TRAINING PSYCHIATRIC
UNITS: the major activities of these higher centre’s of psychiatric
care include:
 Help in case of difficult cases.
 Teaching.
 Specialized facilities like occupational therapy units, psycho
therapy, and counselling and behaviour therapy.
B. REHABILITATION SUB PROGRAM: The components of this
sub-program include maintenance treatment of epileptics and
psychotics at the community levels and development of rehabilitation
centre’s at both the district level and the higher referral centres.

C.PREVENTION SUB PROGRAM: The prevention component is
to be community based, with the initial focus on prevention and
control of alcohol related problems. Later, problems like addictions,
juvenile delinquency and acute adjustments problems like suicidal
attempts are to be addressed.
D. MENTAL HEALTH TRAINING: Mental health training plays
a vital role in creating awareness about mental health for reducing
stigma about mental illness and this training help us to explore more
ideas and issues related to mental health among health professionals
such as nurses, nursing students.

7.TRAIN PARENTS AND HEALTH CARE PROVIDERS IN
THE MANAGEMENT OF MENTALLY RETARDED
CHILDREN:
COMPONENTS:
1) WORKSHOPS: Workshops were organized to sensitize and
motivate health care professional to implement NMHP as
considering the local priorities and resources.
2)MENTAL HEALTH TRAINING:
To provide first level of care, training programmes for Para
professional and professionals will be conducted. Involvement of
community leaders, volunteers, focus groups in mental health training
programmes is essential.
3)MENTAL RETARDATION:
Counselling of parents, referring the cases, utilizing welfare agencies
in rehabilitation of services.

4)RESEARCH:
Evaluate research programmes will be conducted to
determine the outcome of service deliveries and different
levels of functioning and on outcome of training
programmes.
After in depth situation analysis and extensive
consultations with state authorities. The NMHP
underwent radical restructuring to have a balance
between various components of mental health care
delivery system, and clearly specified budget allocations.

DISTRICT MENTAL HEALTH PROGRAM (DMHP):- The
Central Government launched the District Mental Health Program
(DMHP) as a 100% centrally sponsored scheme for first five
years, at the national level in 1996-97 during the 9th five year plan
as pilot project in 4 districts under NMHP and was expanded to 27
districts of the country by the end of 9th Five year plan period.

OBJECTIVE:-
 To provide sustainable basic mental health services to the
community and to integrate these services with other health
services.
 Early detection and treatment of patients within the community
itself.
 To reduce the stigma of mental illness through public awareness.
 To treat and rehabilitate mental patients within the community.

FIVE YEAR PLANS: -
1. TENTH FIVE YEAR PLAN (2002-2007)
The NMHP was re-strategized in the year 2003 (in X Five
Year Plan) with the following components:
DMHP was extended to 100 districts across the country.
Infrastructure support has to be provided psychiatry departments
in the hospitals and strengthening of medical college hospitals.
Modernization of mental health hospitals to reduce chronicity of
mental disorders.
Usage of outreach services, promoting care of chronically ill. At
their doorsteps by ensuring qualitative mental health services.
Ensure effective coordination in all areas of activity.
Sponsoring community based research projects.
Innovation Information Education Communication strategies will
be generated through multidisciplinary collaboration.

2. ELEVENTH FIVE YEAR PLAN (2007-2012)
. DMHP will be extended to another 200 districts.
Reinforcement of upgrading psychiatry departments with
adequate infrastructural facilities.
Construction of modern building with good infrastructure.
Provision of adequate man power for all psychiatry units.
Research training programmes have to be organized for
qualitative and quantitative improvements.
IEC training programmes has to be conducted by involving mass
media at central level and regional level to reduce stigma
attached to mental illness and increase awareness regarding
mental health, available treatment and mental health care
facilities.

3. TWELFTH FIVE YEAR PLAN (2012-2017)
DMHP will be extended to remaining 193 districts.
20 mental hospitals will be taken up for reconstruction.
Non-viable mental hospitals will be closed or merged with
general hospital.
Long term community based Research Projects will be initiated.
IEC activities will be planned to cover all sections of population.

REVISED NATIONAL MENTAL HEALTH
PROGRAMME (2003)
The main characteristics of revised Mental Health Program are:-
 Redesigning the District Mental Health Program
 Strengthening the medical colleges with the view to develop
manpower to deliver quality mental health care improvement of
psychiatric care facilities at secondary level and to promote the
development of general hospitals psychiatric units to reduce the
need of large mental hospitals.
 Modernization of existing mental hospitals to transform them
from custodial care centres to tertiary care centres which provide
holistic developmental care to mentally ill patients.

 Strengthening the central and state mental authorities to make
them effective in monitoring mental health care agencies, on
going mental health care program and promoting inter sectorial
collaboration.
 Motivating research and training to generate extensive data
regarding epidemiological information of mental illness, their
course, outcome, therapies needed, burden on family and society.
 Development of awareness with strengthening information and
communication drive by Involving nongovernmental
organizations and mass media.
 Services are focused to special section of high risk population
prone for stressful disorders.
 Social skill training programme, life skill education programmes
has to be conducted to focus groups like school children.

ROLE OF NURSE IN THE IMPLEMENTATION OF
NATIONAL MENTAL HEALTH PROGRAMME:-
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 MHN IN PRIMARY PREVENTION
CHILD CARE AND CHILD-REARING MEASURES
INCLUDE:
 Antenatal care to mother and educating her regarding the adverse
effects of radiations, drugs and prematurity.
 Essential timely and efficient obstetrical assistance to guard
against the ill effects of anorexia, injury at birth.
 Counseling 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 be detected, teachers should be
taught to identify the early symptoms of abnormal
conduct and behaviour in the children and refer cases.
•FAMILY-CENTERED ACTIVITIES PROGRAMS:
Attitudes of mutual trust, love and respect for one,
another need to be fostered. Educational services in the
field of mental health, like- Parent -teacher associations,
Child guidance clinics.

 Programmes for Families in Crisis like adolescence,
death of a new baby, Retirement or menopause, Death of
a wage earner in the family. Can be handled at mental
hygiene clinics, psychiatric first-aid centres, walk-in-
clinics.
 Society-centred Preventive Measures Community
development ,social administration, Collection and
evaluation of epidemiological data. Budgeting these
measures require coordinated activities among persons
belonging to different norms and disciplines.

ROLE OF MHN IN SECONDARY PREVENTION
 EARLY DIAGNOSIS and Case Finding achieved by
educating the public and community leaders , Mahila
Mandals, Balwadis etc. in recognizing early symptoms.
 Early Reference.
 SCREENING PROGRAMMES: Simple
questionnaires should be developed and administered.
 For Early and Effective Treatment.

ROLE OF MHN IN TERTIARY PREVENTION
Accomplished by preventing complications of the mental
illness & promoting achievement of each individual’s
maximum level of functioning through Regular follow up,
Diversion therapy, Recreation therapy, Community Mental
Health Facilities, Day-Evening Treatment/ Partial
Hospitalization Programs, Community Residential
Facilities, Support Groups.

MENTAL HEALTH AUTHORITY:
A central authority established by the central or
state government to regulate, develop, direct and
coordinate the Mental Health Services under the central
government.
Functions of mental health authority: -
These authorities also advise the government on Mental
Health matters.
They supervise the psychiatric hospitals and psychiatric
nursing homes and other mental health agencies.
These authorities have the jurisdiction to renew or
cancel the licenses.

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