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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