mental health india - in parliamentary committee on health meetings

8/4/2019 Mental Health India - in Parliamentary Committee on Health meetings

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Table of Contents2000 April 24 : 91st Parliamentary Committee HRD (ISM AYURVEDA).................................................................12001 February : 98th Parliamentary Committee HRD (NIMHANS)..........................................................................2

OBSERVATIONS/RECOMMENDATIONS AT A GLANCE...................................................................................13MINUTES OF THE COMMITTEE XV FIFTEENTH MEETING............................................................................14

2002 April : 116th parliamentary report HRD Grant requests 2002-03.....................................................................172003 April 10 : 125th Report HRD.............................................................................................................................19

CENTRAL INSTITUTE OF PSYCHIATRY, RANCHI.............................................................................................20NATIONAL MENTAL HEALTH PROGRAMME.....................................................................................................21

2003 April : 135th REPORT ON DEMANDS FOR GRANTS 2003-2004..................................................................23X IMPLEMENTATION OF HEALTH PROGRAMMES IN NORTH EAST SECTOR....................................24

2004 February 4 : 148th REPORT ON DEMANDS FOR GRANTS 2003-2004.......................................................25(X) IMPLEMENTATION OF HEALTH PROGRAMMES IN NORTH EAST SECTOR.....................................26

2004 August : Health 1st Meeting..............................................................................................................................272005 March 11 : Health 4th Meeting..........................................................................................................................282005 April 28 : Health 7th Meeting.............................................................................................................................292005 December 12 : Health 15th Meeting.................................................................................................................312005 April 28 : 9th parliamentary report Grant requests 2005-06 - AYUSH..............................................................332005 December 21 : 14th parliamentary report Grant requests 2005-06 AYUSH.....................................................33

Advanced Ayurvedic Centre for Mental Health in NIMHANS................................................................................332005 December 21 : 15th parliamentary report Grant requests 2005-06..................................................................342006 May 22 : 16 th Parliamentary committee report grant request 2006-07...........................................................352007 February 26 : 108th Parliamentary committee report review of Papers Laid on Table.....................................36

NATIONAL INSTITUTE OF MENTAL HEALTH AND NEURO SCIENCES (NIMHANS), BANGALORE.............362007 March 8 : 20th Parliamentary committee report grant request 2006-07...........................................................392007 May 3 : 22nd Parliamentary committee report on grant requests 2007-08......................................................402010 April 28 : 39th REPORT HEALTH......................................................................................................................42

2000 April 24 : 91 st Parliamentary Committee HRD (ISMAYURVEDA)

http://164.100.24.167/book2/reports/HRD/91streport.htm

3.7 The Committee observes that there was a nominal provision of Rs. 1 lakh asGrant-in-aid for Advanced Ayurveda Centre for Mental Health in NIMHANS in BE 1997-98.However, allocation was increased to Rs. 25 lakhs at the RE stage which was fully utilised. In1998-99 also, allocation of Rs. 20 lakhs was fully utilised. However, the Committee issurprised to note that provision of Rs. 20 lakhs in 1999-2000 had to be reduced to Rs. 1 lakhas the issue of sharing of project cost between the Department of Health and the Departmentof ISMH is pending, hence, no further grants were required to be released. The Committeeis not convinced by the explanation given by the Department and expresses its seriousconcern over such an element of uncertainty in starting a new Scheme. The Committee,therefore, is of the view that decision in the matter should be taken at the earliest.

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2001 February : 98 th Parliamentary Committee HRD (NIMHANS)http://164.100.24.167/book2/reports/HRD/98threport.htm

PARLIAMENT OF INDIARAJYA SABHA

98

DEPARTMENT-RELATED PARLIAMENTARY STANDINGCOMMITTEE ON HUMAN RESOURCE DEVELOPMENT NINETY-EIGHTH REPORT ON ACTIONTAKEN BY GOVERNMENT ON THE RECOMMENDATIONS/OBSERVATIONS CONTAINED IN THE54TH REPORT ON NATIONAL INSTITUTE OF MENTAL HEALTH AND NEURO SCIENCES (NIMHANS),BANGALORE

(PRESENTED TO THE RAJYA SABHA ON 27TH FEBRUARY, 2001)LAID ON THE TABLE OF LOK SABHA ON 27TH FEBRUARY, 2001)

C O N T E N T S 1. COMPOSITION OF THE COMMITTEE2. PREFACE3. REPORTCHAPTER I Recommendations/Observations that have been

Accepted by the GovernmentCHAPTER II Recommendations/Observations which the Committee

Does not desire to pursue in view of theGovernments repliesCHAPTER III Recommendations/Observations in respect of which

Replies of the Government have not been acceptedBy the Committee

CHAPTER IV Recommendations/Observations in respect of whichGovernment has not given any reply

4. OBSERVATIONS/RECOMMENDATIONS AT A GLANCE5. MINUTES

COMPOSITION OF THE COMMITTEE 1. Shri S.B. Chavan ChairmanMEMBERSRAJYA SABHA2. Shri Mourice Kujur 3. Shri Akhilesh Das4. Shri Eduardo Faleiro5. Shri Rajnath Singh Surya6. Shri Dina Nath Mishra7. Prof. R.B.S. Varma8. Shri Bratin Sengupta9. Dr. Ramendra Kumar Yadav Ravi10. Shri Raj Mohinder Singh11. Chaudhary Harmohan Singh Yadav
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12. Shri Mrinal Sen13. Dr. C. Narayana Reddy14. Shri M.P. Abdussamad Samadani15. Dr. Alladi P. Rajkumar LOK SABHA16. Shrimati Jaskaur Meena17. Shri Shankar Prasad Jaiswal18. Shri Ramakant Angle19. Shri Kirti Jha Azad20. Shri Baliram Kashyap21. Shri Ramanand Singh22. Shri Dileep Sanghani23. Shri Kishan Singh Sangwan24. Shri G. S. Baswaraj25. Shri V. M. Sudheeran26. Shrimati Shyama Singh27. Shri Sunil Dutt28. Shri Ramesh Chennithala29. Shri Kantilal Bhuriya30. Dr. Ram Chandra Dome

31. Shri Samik Lahiri32. Dr. D.V.G. Shankar Rao33. Shri Davendra Singh Yadav34. Shrimati Renu Kumari35. Shri Shivaji Mane36. Shri Anandrao Vithoba Adsul37. Dr. Baliram38. Dr. A.D.K. Jayaseelan39. Dr. V. Saroja40. Shri Trilochan Kanungo41. Shri Mohammed Anwarul Haque42. Shri Vanlal Zawma43. Smt. Kumudini Patnaik

SECRETARIAT Shri Satish Kumar, Additional SecretarySmt. Vandana Garg, Director Shri C.B. Rai, Under SecretariatShri Gurnam Singh, Committee Officer

PREFACE

I, the Chairman of the Department-related Parliamentary Standing Committee onHuman Resource Development, having been authorised by the Committee to present theReport on its behalf, do hereby present this Ninety eighth Report of the Committee onAction Taken by the Government on the recommendations contained in the 54 th Report onNational Institute of Mental Health and Neuro Sciences (NIMHANS), Bangalore.

2. The Seventy-third Report of the Department-related Parliamentary StandingCommittee on Human Resource Development was presented to Rajya Sabha and laid on theTable of Lok Sabha on 27 th February, 2001. Replies of the Government on therecommendations contained in the Report, received from the Department of Health, Ministryof Health and Family Welfare were considered by the Committee. Clarifications were also


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sought by the Committee from the representatives of the Department. .

3. The Committee considered the Draft Report and adopted the same at its meeting heldon 22 nd January, 2001.

NEW DELHI;

January 22, 2001

Magha 2, 1922 (Saka)

S.B. CHAVAN

Chairman

Department-related

Parliamentary

Standing Committee

on

Human Resource

Development

REPORT

The Report of the Committee deals with the action taken by the Government on therecommendations contained in its Fifty-fourth Report on the Functioning of National Instituteof Mental Health and Neuro Sciences (NIMHANS), Bangalore which was presented to RajyaSabha and laid on the Table of Lok Sabha on 25 th February, 1997.

2. Action Taken Notes have been received from the Government in respect of therecommendations contained in the Report. They have been categorized as follows:-

(i) Recommendations/Observations which have been accepted by theGovernment: 3, 5, 5.1, 5.2, 11 (Chapter I)

(ii) Recommendations/Observations which the Committee does not desire to pursuein view of the Governments replies: 8, 9, 9.1, 10, 10.2, 10.3, 12, 13.1 (Chapter II)

(iii) Recommendations/Observations in respect of which replies of the Governmenthave not been accepted by the Committee: 4, 6, 7, 10.1, 13, 13.2, 13.3 (Chapter-III)

(iv) Recommendations/Observations in respect of which replies of the Governmenthave not been received Nil (Chapter IV)

CHAPTER-I

RECOMMENDATIONS/OBSERVATIONS ACCEPTED BY THE GOVERNEMNTIII Recommendation

3. When the Committee sought to know as to whether the Institute is equipped withlatest technology and sufficient equipments in all the departments, the Director stated thatefforts have always been made to equip all the departments with the advanced technologyand equipments. However, due to lack of funds they are not able to keep pace with latestimprovements in technology, he added. The Committee was also informed that if a specialgrant is made available to the Institute then it would be possible to acquire the necessary


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equipments. The Committee feels that the Institute is in need of sophisticated equipments for diagnosis, treatment & research and the Department of Health may consider making availablesufficient funds for the purpose.

Action Taken

Government of India has released the entire funds and the equipment has beenpurchased by the Institute.

V Recommendation

5. One of the three important objectives of the Institute is manpower development in thefield of mental health and Neuro Sciences. The Committee notes that the Institute offers PostGraduate Courses including M.Phil, Post-certificate courses in nursing i.e. (Diploma inPsychiatric Nursing DPN and Diploma in Neurological Nursing DNN) are also offered in theInstitute. Facilities to pursue PH.D Programmes are also available, it was added.

Action Taken

The Institute has introduced new courses:

a) Post Doctoral Certificate course in Neuroanaesthesiab) M.Phil course in Speech Language Pathology.

Recommendation

5.1 The Committee was informed by the Director that the courses conducted by theInstitute are always in great demand due to the limited intake capacity of the Institute. Whenasked to explain the steps taken to meet the demand, the Director replied that recently it hasbeen proposed to increase the number of seats in the following courses:

MD-Psychiatry 8 to 14 seats

DM-Neurology 4 to 6 seats

M.CH Neurosurgery 4 to 6 seatsM.Phil Clin. Psychology 12 to 15 seats

M.Phil in PSW 12 to 15 seats

5.2 The Committee desires that this proposal may be finalized as early as possible. For increasing the seats, the staff strength is also required to be increased. Necessary steps maytherefore, be taken to sanction additional posts.

Action Taken

Medical Council of India has agreed to increase the number of seats as proposed bythe Director, NIMHANS, Bangalore and the Institute has also increased the M.Phil ClinicalPsychology and M.Phil in PSW as proposed.11. Recommendation

To overcome the problems occurring due to accidents and epilepsy, prevention isrequired for which public awareness is essential. To a question as to whether the Institute ispublishing any literature for the awareness of the common public on the mental health relatedproblems, the Director of the Institute responded that they are planning in this direction. Oneof the faculty members of the Institute has published nearly forty books in Kannada. TheInstitute is also planning to publish them in the regional languages, he added. The Director


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also stated that the Health Education Bureau in the Institute is working on it. He also statedthat the Institute is in a position to supply posters on mental health in case any State is inneed of it. The Committee is of the opinion that there is need to publish the materials aboutmental health and related problems in all the regional languages so that people of all theregions/states can be benefited. Necessary steps may be taken in this direction. TheDepartment should take the responsibility of publishing the material in various regional

languages in a time-bound manner.Action Taken

State Health Secretaries have been informed about the IEC materials developed byNIMHANS and have been requested to make use of these materials after getting it translatedinto local languages for generating public awareness. The Central Health Education Bureauhas also been asked for the same.

CHAPTER-II

OBSERVATIONS/RECOMMENDATINS WHICH THE COMMITTEE DOES NOT DESIRE TO

PURSUE IN VIEW OF THE GOVERNMENTS REPLYRecommendation

8. The Committee has learnt that a sixty bedded drug dependence unit is functioning inthe Institute and funds are not being given for this by the Ministry of Health and FamilyWelfare while similar centres established in PGI Chandigarh, AIIMS, Delhi etc. are funded bythe Govt. of India under the National Drug De-Addiction programme. The unique feature of the Centre in this Institute is, it has been started with community based activity. TheCommittee was also informed that the Ministry has been approached for providing additionalfunds for De-Addiction programme. The Committee, however, feels that the Institute shouldnot over-burden itself with the Drug De-addiction programme, particularly when sufficientfunds are not being received.

Action Taken

Ministry of Health has approved the inclusion of existing Drug De-addiction Centre of NIMHANS under National Drug De-addiction programme and sanctioned Rs. 517 lakhs in the9 th Five year plan and to make it a Regional Centre.

Recommendation

9. The Committee has noted that a survey conducted on more that one lakh populationon neurological disorders showed that approximately 31 people out of 1000 suffer fromneurological disorders, the commonest being headache and epilepsy. Considering the gravityof the situation, the Committee feels that there is need for evolving a national strategy onepilepsy and other neurological disorders.

Action Taken

Under National Mental Health Programme, epilepsy is also included as one of thedisorders and NIMHANS has taken up training of PHC doctors in the management of Mentaldisorders including epilepsy.

Recommendation

9.1 The Committee also learnt that basic research studies on Yoga have helped in the


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application of Kriya Yoga in the successful treatment of patients with depression. Since yogatreatment does not require any medicines and is free from side effects, it needs to beextensively used. The Committee, therefore, recommends that steps should be taken by theInstitute to involve more yoga experts in treating the patients who suffer from depression.The yoga unit may be further developed.

Action Taken

The proposal for establishment of advanced centre in Ayurveda at NIMHANS hasbeen agreed to by Deptt.of ISM&H and has released amount for providing infrastructure.

Recommendation

10. The Institute caters to the needs of Patients suffering from Psychiatric andneurological disorders. The Institute has a bed capacity of 805. Besides this, the Institutealso offers a combined neuro psychiatric out-patient service to impart better co-ordinatedpatient care. When the Committee sought to know as to whether the bed capacity isproposed to be increased, it was stated that they propose to increase the beds in casualtyunit by 50 beds. They also propose to increase bed capacity in head injury unit and strokeunit, it was added. The Committee desires that necessary steps may be taken to increase thebeds at the earliest.Action Taken

Providing emergency care in the city is a State responsibility and NIMHANS being anapex referral Hospital should normally not be handling emergency cases which can detractfrom their primary focus which is aimed at evolving the best standards for teaching clinicalresearch and patient care. However, subject to receiving State Govt.s financial support theproposal for establishing a 50 bedded casualty will be taken forward in the IX Plan.

Recommendation

10.2 To save a number of lives from head injuries the Director apprised the Committee that

by making wearing of helmets compulsory for two wheeler drivers all over the country, thisproblem can be solved to a large extent. The Committee feels that the suggestion is goodand it should be looked into.

Action Taken

Ministry of Surface Transport has reiterated instruction to all States/UTs TransportCommissioners for imposing compulsory wearing of helmets by Two Wheeler drivers/pillionriders as prescribed under Section 129 of the Motor Vehicles Act, 1988.

Recommendation

10.3 The Committee has noted that the Institute does not get sufficient kits for HIV testing.

The Director informed that National Aids Control Organisation (NACO) has been requested toincrease the number of HIV kits supplied. The Committee feels that the Institute is in need of HIV Kits and NACO may increase the supply of HIV Kits. The Committee is, however, of theview that the Institute should not over-burden itself with treating HIV cases.

Action Taken

NACO has provided sufficient HIV Kits to NIMHANS through State Government.Further, patients of HIV/AIDS having neurological and Psychiatric disorders are treated inNIMHANS. Other AIDS patients are not treated in NIMHANS.


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Recommendation

12. There is a small unit under the control of Central Council of Ayurveda functioning inthe Institute which is not a part of NIMHANS. The Committee was informed by the Director that there is a proposal to establish an advanced centre of Ayurveda in the Institute. TheCommittee, is, however,` of the opinion that the opening of advanced centre of Ayurveda is anadditional burden for the Institute. Such a centre could be located elsewhere in an Ayurvedic

Institute and the patients requiring treatment in Ayurveda could be referred there.Action Taken

The proposal for setting up of advanced centre in Ayurveda at NIMHANS has beensanctioned by the Department of ISM&H. It is felt that patients should get the benefit of boththe Ayurvedic System of medicine and the Modern Allopathic system of Medicine.

Recommendation

13.1 The Committee was also informed that aid for development plans is received frommany foreign countries such as Germany, Japan, U.S.A. etc. The Director pleaded that suchaid should be made available to NIMHANS also. The Committee recommends that the

Department of Health may look into the matter.Action Taken

As and when such assistance is available all efforts would be made to make NIMHANS also arecipient of such assistance.

CHAPTER-III

RECOMMENDATIONS/OBSERVATIONS IN RESPECT OF WHICH REPLIES OF THEGOVERNMENT HAVE NOT BEEN ACCEPTED BY THE COMMITTEE

4. Recommendation

The Committee has noted that the Institute proposes to have collaboration with foreignuniversities and when asked as to how far they are able to finalise the proposal, the Director informed the Committee that it has already developed collaboration with a renownedUniversity and for making further efforts in this direction the active support of the Ministry of Human Resource Development is required. The Committee feels that it is a premier Instituteof its kind in the country and collaboration with eminent and renowned foreign universitieswould further strengthen the Institute. The Committee, therefore, recommends that theDepartment of Health should take up the matter with the Ministry of HRD in this regard.

Action Taken

The matter regarding collaboration with foreign universities has been taken up withMinistry of Human Resource Development.

Comments of the Committee

The Committee feels that collaboration with foreign universities is very importantbecause it provides additional funds for being spent on plan-programmes. The Committee isnot satisfied with the effort of Department of Health in this regard and strongly recommendsthat it should vigorously pursue the matter of foreign collaboration with the Ministry of HumanResource Development.


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6. Recommendation

The Committee has noted that the Staff Position in the Institute is as under:-

Sanctioned Working Vacant

Teaching 143 122 21

Non-teaching 830 737 93

As regards the vacancies on teaching side it was stated that for five faculty posts,interviews were already held. It was also stated that 14 posts are reserved for SCs/STs andrecruitment is under process under special recruitment drive. Action is being taken to fill upthe remaining posts, it was added. The Committee recommends that immediate steps maybe taken to fill up the posts reserved for SCs/STs. The Committee also desires that thevacancies on the non-teaching side also may be filled up at the earliest. The Director alsoinformed the Committee that some posts have to be kept vacant due to paucity of funds. TheCommittee views this with concern and strongly recommends that in future no post should bekept vacant just because of paucity of funds.

Action Taken

All reserved posts on the non-teaching side have been filled up. As regards thefaculty posts, the Institute is facing difficulties in filling up the reserved posts even after resorting to a special recruitment drive. The Institute has re-advertised the posts and is inthe process of conducting interviews.

Further Comments

The Committee specifically wanted to know whether the teaching posts in thereserved category were vacant due to paucity of funds or non-availability of qualifiedcandidates. The Additional Secretary clarified that paucity of funds was not the reason for

vacancies in the teaching category. It was the non availability of qualified candidates due towhich these posts were vacant. It was informed that out of 21 vacant posts on the teachingside, 14 posts were reserved for SCs/STs and candidates with adequate qualifications werenot available in spite of repeated advertisements. The Secretary subsequently informed theCommittee that as per the reservation policy they had to keep attempting, by way of advertisements, to fill up the reserved posts.


The Committee is anguished to note that in a prestigious institute like NIMHANS,which is a deemed university and only one of its kind in the country, teaching has beenallowed to be affected adversely for long because of non-availability of suitable candidates

from reserved category. The Committee observes that such a situation cannot be allowed tocontinue indefinitely, specially in a teaching institution. The Committee, therefore,recommends that if suitable candidates from reserved category are not available, the vacantposts should be filled up immediately on ad-hoc basis, as per the guidelines laid down byGovernment of India. The Committee may also be kept informed in the matter.

7. Recommendation

Research activity encompasses a large spectrum from cellular mechanisms to socialsystems associated with various neurological and behavioural disorders. However, theCommittee learnt that it has not been possible to spend adequate time for research in the


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Neuro-surgery Department. When the Committee sought to know the reasons for this, it wasstated that the Departments faculty are fully occupied with the operations and follow-up of theneuro-surgical patients leaving them with very little time for research. The gap can be bridgedby increasing the staff strength, it was added. Neuro-surgery Department is a very importantDepartment and research needs to be developed. The Department of Health may takenecessary action to ensure that research activities are not hampered in the Neuro-surgery

Department.Action Taken

NIMHANS is initiating action to create posts by putting up proposals before thecompetent authorities.

Further Comments

The Director General of Health Services was of the opinion that the operational type of research, namely, which treatment is suited to what patient should be done by the surgeonsthemselves but basic research should be done by the Physiologists and Pathologists.


The Committee was earlier informed that neuro-surgeons, being very busy with theoperations and the follow up of the neuro-surgical patients, generally did not find much timefor research. Therefore, some research issues were incorporated in the training programmeof the Institution. The Committee, however, is of the view that a surgeon due to his or her direct exposure in handling neuro-surgical operations, has got lot of first hand practicalexperience which ought to be put to optimum use while carrying out basic research. TheCommittee expresses its reservations for creation of posts for such purpose.

Recommendation

10.1 The Committee also learnt that people with even small accidents come from longdistances for treatment in the hospital. This would only increase the burden of the Institute.

For this, some kind of screening should be done at the local level General Hospitals fromwhere a case should be referred to NIMHANS only if it requires specialized treatment. For this, the Committee feels that the matter should be taken up with the State Governmentrequesting them to issue necessary circular to the general hospitals stating that whenever head injury cases come, they have to examine and admit unless it needs a special neuro-surgical intervention. The Director assured the Committee that needful would be done in thematter. The Committee desires that it should be pursued by the Institute at regular intervals.

Action Taken

The matter regarding reducing the patient load on NIMHANS by screening thepatients in the General Hospitals of the State Government has been taken up with the

Secretary, Department of Health and Family Welfare, Govt. of Karnataka, Bangalore. Theyare in the process of establishing super-specialty hospital at Raichur.


The Committee feels that NIMHANS should function as a referral Institute. The matter should be taken up with all the State Govts. that only such cases should be referred to theInstitute which require special-neuro surgical intervention.

13. Recommendation

The Committee noted that NIMHANS has been provided with Rs. 21.08 crores for


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1996-97. On being asked as to whether this amount is sufficient to meet the requirements of the Institute, it was stated that a minimum of Rs. 30 crores was required. The Director alsoinformed the Committee that the main problem faced by the Institute is the lack of funds for development. The Institute needs special grants for this purpose, he stated. Presently, theInstitute is not getting any grants from UGC and the Director requested that since it is aDeemed University it may also be given development funds on the pattern of other

Universities. The Committee recommends that this may be considered. He further explainedthat in the routine grants, every year 10% growth is there and due to escalation of costs, theyare not able to meet the demand. While the number of patients are increasing every year, thenon-plan expenditure is kept at the same level of 10% increase as per the Governmentnorms. Due to this, the Committee was told, the Institute has to keep some posts vacant tohave some non-plan money to spend for patient care. The Committee is also constrained tonote that in view of this, it would be difficult to fill up all the posts and if all the posts are filled,there is no money for food for patients, drugs and other hospital management. TheCommittee feels that this would only hamper the activities of the Institute from doing goodwork. The Committee, therefore, recommends that the full requirements of the Institute maybe taken care of by the Department of Health. The Committee feels that NIMHANS, being theonly National Institute of its kind, should not starve for want of funds. The Ministry shouldplead the case properly with the Finance Ministry and Planning Commission for providingadequate funds.

Action Taken

The Budgetary requirements of NIMHANS, Bangalore are met on a sharing basis bythe Central Government and the Government of Karnataka. While the sharing of Plan fundsby the Centre and State Government is 75% and 25%, for non-Plan funds it is 45% and 55%respectively. Therefore, any increase in Central funds will have to be matched by increase inState funds to the Institute.

The budgetary allocation for NIMHANS, Bangalore during the last five years from

Govt. of India has been as under: (Rs. in crores)

Year Plan Non-Plan Total

1993-94 4.42 4.38 8.80

1994-95 4.40 4.95 9.35

1995-96 6.50 5.20 11.70

1996-97 5.50 6.10 11.60

1997-98 7.00 6.50 13.50

1998-99 8.55 13.00 21.55

The Institute has been advised to take up the matter with the University GrantCommission for development grants or project specific grants.

Further Comments


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Clarifying the matter of contribution by the Karnataka Government to meet theBudgetary requirements of NIMHANS, the Secretary replied that earlier NIMHANS was amental hospital under the Government of Karnataka which was later taken over by theGovernment of India and upgraded as a National Institute. It was further clarified by theSecretary that as per the agreement at the time of taking over the Karnataka Governmentwas to put in one third of the money and the Government of India was to put in two third. The

Secretary also stated that NIMHANS being an autonomous body did not require matchingfunds from the state government. Furthermore, the Central Government has beencontributing larger percentage towards plan as well as non-plan budget over the years.


The Committee notes that the Central Government is meeting its part of financialobligation, so far as NIMHANS is concerned. The Committee is of the view that sinceNIMHANS has been taken over by the Central Government and upgraded as a NationalInstitute, it has, therefore, the sole responsibility to ensure its smooth and proper functioning.Efforts should by made to make required funds available for the Institute.

Recommendations

The Committee was surprised to find that different methods were being followed in the caseof committed expenditure of the previous plan. According to the understanding of theCommittee, committed expenditure will not get reflected in any shape or form in thesubsequent plan. What is termed as a non-plan expenditure of the subsequent plan becomesrelevant only to the expenditure of new non-plan expenditure of the subsequent plan period.This applies in the case of both autonomous as well as deemed university institutions. Inorder to get further clarification in the matter the Secretary and the Financial Advisor of theMinistry of Health and Family Welfare were specially called to clarify as to whether this viewof the Committee is correct or not. The Secretary could not come because of illness. TheFinancial Advisor appeared before the Chairman and he confirmed that the non-plancommitted expenditure of the previous plan should not get reflected into the non-planexpenditure of the subsequent plan. He also confirmed that they are not making anydistinction between the Government institution and other autonomous and deemed universityinstitutions which naturally means that the confusion which is prevailing in some of institutions in treating committed expenditure as part of the new non-plan expenditure shouldbe clarified by the department concerned to all the institutions in the country so that thereshould be uniformity in matters of procedure of not including the committed non-planexpenditure in the subsequent plans non-plan expenditure.

Action Taken

Specific guidelines of Planning Commission in this regard have been brought to thenotice of all institutions under the Ministry of Health and Family Welfare.

Recommendations

13.3 The Committee also noticed that in some of the Institutions where vacancies wereavailable, they were utilizing the funds meant for vacancies, for the purpose of non-planexpenditure, which according to the Committee is not a desireable feature. Plan money cannot be diverted for non-plan side or even the non-plan expenditure should not have anyelement of the scheme provided under the plan. All the vacancies prevailing in differentinstitutions will have to be filled in against the non-plan expenditure of the subsequent plan asthe burden of the expenditure will not be there.


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Action Taken

The observations of the Committee have been noted for guidance.

Further Comments

The Financial Advisor informed the Committee that in respect of transfer of committedliability, the Department had taken up the matter with the Ministry of Finance and got the

following response:-The proposal of the Department of Health has been considered and it has been decided withthe approval of Secretary (Expenditure), that a provision of additional Rs. 110 crores to theDepartment of Health under non-plan in lieu of transfer of a committed liability of variousEighth plan schemes will be considered at RE stage by making an equal cut in the PlanOutlay.

It was further clarified that in case of the Department of Health, the total committedliability of Rs. 110 crores had been shifted from plan to non-plan side. Out of this, thecommitted liability of NIMHANS was Rs. 5.13 crores which had been shifted to Non-Plan side.


The Committee expresses deep anguish at the entire approach, which is not onlytotally against the recommendations of the Finance Commission but also against the mandateof the Constitution. The Committee has been repeatedly and strongly observing regardingcommitted liability but this issue has not been sorted out as yet. It once again reiterates itsearlier observation and hopes that the issue will be sorted out at the earliest in consultationwith the concerned Ministries/Departments.

CHAPTER-IV

RECOMMENDATIONS/OBSERVATIONS IN RESPECT OF WHICH REPLIES OF THE

GOVERNMENT HAVE NOT BEEN RECEIVEDNIL

OBSERVATIONS/RECOMMENDATIONS AT A GLANCEComments of the Committee

The Committee feels that collaboration with foreign universities is very importantbecause it provides additional funds for being spent on plan-programmes. The Committee isnot satisfied with the effort of Department of Health in this regard and strongly recommends

that it should vigorously pursue the matter of foreign collaboration with the Ministry of HumanResource Development.(Para 4)


The Committee is anguished to note that in a prestigious institute like NIMHANS,which is a deemed university and only one of its kind in the country, teaching has beenallowed to be affected adversely for long because of non-availability of suitable candidatesfrom reserved category. The Committee observes that such a situation cannot be allowed tocontinue indefinitely, specially in a teaching institution. The Committee, therefore,


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recommends that if suitable candidates from reserved category are not available, the vacantposts should be filled up immediately on ad-hoc basis, as per the guidelines laid down byGovernment of India. The Committee may also be kept informed in the matter. (Para 6)


The Committee was earlier informed that neuro-surgeons, being very busy with theoperations and the follow up of the neuro-surgical patients, generally did not find much timefor research. Therefore, some research issues were incorporated in the training programmeof the Institution. The Committee, however, is of the view that a surgeon due to his or her direct exposure in handling neuro-surgical operations, has got lot of first hand practicalexperience which ought to be put to optimum use while carrying out basic research. TheCommittee expresses its reservations for creation of posts for such purpose. (Para 7)


The Committee feels that NIMHANS should function as a referral Institute. The matter should be taken up with all the State Govts. that only such cases should be referred to theInstitute which require special-neuro surgical intervention. (Para 10.1)

Comments of the CommitteeThe Committee notes that the Central Government is meeting its part of financial

obligation, so far as NIMHANS is concerned. The Committee is of the view that sinceNIMHANS has been taken over by the Central Government and upgraded as a NationalInstitute, it has, therefore, the sole responsibility to ensure its smooth and proper functioning.Efforts should by made to make required funds available for the Institute. (Para 13)


The Committee expresses deep anguish at the entire approach, which is not onlytotally against the recommendations of the Finance Commission but also against the mandateof the Constitution. The Committee has been repeatedly and strongly observing regarding

committed liability but this issue has not been sorted out as yet. It once again reiterates itsearlier observation and hopes that the issue will be sorted out at the earliest in consultationwith the concerned Ministries/Departments. (Para 13.3)

MINUTES OF THE COMMITTEE XV FIFTEENTH MEETING

The Committee met at 10.00 A.M on Friday the 22 nd September, 2000 in Committee Room A`, GroundFloor, Parliament House Annexe, New Delhi.

MEMBERS PRESENT

1. Shri S.B. Chavan Chairman

RAJYA SABHA


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2. Shri Mourice Kujur

3. Shri Rajnath Singh Surya

4. Shri Dina Nath Mishra

5. Prof. R. B. S. Varma

6. Shri Bratin Sengupta

7. Dr. Ramendra Kumar Yadav Ravi8. Dr. C. Narayana Reddy

LOK SABHA

9. Shri Shankar Prasad Jaiswal

10. Shri Satyabrata Mookherjee

11. Shri Baliram Kashyap

12. Shri Kishan Singh Sangwan

13. Shri G.S. Baswaraj

14. Shrimati Shyama Singh

15. Dr. D.V.G. Shankar Rao

16. Shri Davendra Singh Yadav

17. Shri Mohammed Anwarul Haque

SECRETARIAT

Shri Satish Kumar, Additional Secretary

Shrimati. Vandana Garg, Director

Shri C. B. Rai, Under Secretary

Shri Gurnam Singh, Committee Officer

WITNESSES

Representatives of the Department of Health

1. Shri J.A. Chowdhury, Secretary

2. Dr. S.P. Agarwal, DGHS

3. Shri JUR Prasada Rao, Addl. Secretary

2. At the outset, the Chairman welcomed the Members of the Committee and officials of theDepartment of Health. The Committee then took up for discussion the Action Taken by the Government onthe 54 th Report of the Committee on the Functioning of National Institute of Mental Health and Neuro Sciences(NIMHANS), Bangalore. Members raised certain queries on the number of teaching posts lying vacant,particularly in the reserved categories and shortage of funds.

3. Thereafter, the Committee discussed the Action Taken by the Government on the 73 rd Report of the


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Committee on Dreaded Diseases. The Secretary and other officials of the Department answered the queries putby the Members.

4. The Chairman informed that the Committee could taken up Higher Education and UGC in its subsequentmeetings, besides other business. A verbatim record of the proceedings of the meeting was kept.

5. The Committee then adjourned at 12.30 P.M.

FIRST MEETING

The Committee met at 10.30 A. M. on Monday, the 22 nd January, 2001 in Committee Room `D , GroundFloor, Parliament House Annexe, New Delhi. The following were present:

MEMBERS PRESENT

1. Shri S.B. Chavan Chairman

RAJYA SABHA

2. Shri Eduardo Faleiro

3. Prof. R.B.S. Varma

4. Shri Bratin Sengupta

5. Chaudhary Harmohan Singh Yadav

6. Dr. C. Narayana Reddy

LOK SABHA

7. Shri Shankar Prasad Jaiswal

8. Shri Ramakant Angle

9. Shri Baliram Kashyap

10.Shri Dileep Sanghani

11.Shri Kishan Singh Sangwan

12.Shri G. S. Baswaraj

13.Shri V. M. Sudheeran

14.Shrimati Shyama Singh

15.Shri Sunil Dutt

16.Dr. Ram Chandra Dome

17.Shri Samik Lahiri18.Shri Davendra Singh Yadav

19.Shrimati Renu Kumari

20.Shri Shivaji Mane

21.Dr. A.D.K. Jayaseelan

22.Shri Vanlal Zawma

SECRETARIAT


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Shri .Satish Kumar Additional Secretary

Shrimati. Vandana Garg, Director

Shri C. B. Rai, Under Secretary

Shri Gurnam Singh, Committee Officer

2. The Committee considered the Draft Action Taken Reports on 54th Report on NationalInstitute of Mental Health and Neuro Sciences (NIMHANS), Bangalore and 73rd Report onDreaded Diseases. The Committee, after some discussion, suggested some modifications inthe Draft Reports and authorised the Chairman of the Committee to effect them.2. The Committee then decided that both the Reports may be presented/laid inboth the Houses on 27th February, 2001. The Committee, in this connection, authorisedShri Eduardo Faleiro and Prof. R.B.S.Verma to present the Reports in the Rajya Sabha andShri Ramakant Angle and Smt. Shyama Singh to lay the Reports in the Lok Sabha.3. The Committee also directed the Secretariat to get copies of Draft NationalHealth Policy from the Deparment of Health for circulation to the Members of the Committee.4. The Committee, thereafter, adjourned at 12.45 P.M.~

2002 April : 116th parliamentary report HRD Grant requests2002-03

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VI. CENTRAL INSTITUTE OF PSYCHIATRY, RANCHI

6.1 The Plan allocation for the Central Institute of Psychiatry, Ranchi in BE 2001-2002 wasRs.7.00 crores which was drastically reduced to Rs.2.50 crores at the RE stage. Planallocation for 2002-03 is Rs. 3.50 crores against the projected demand of Rs. 8.30 croresmade by the Institute. On being asked to specify the reasons for drastic cut made in theallocation, the Department has clarified that the Plan budget of the Department of Health wasreduced by Rs.104 crores at RE stage which had to be apportioned amongst the Institutesand Programmes. The amount of Rs.4.80 crores for purchase of equipments for the Institutewas sanctioned only in December, 2001, by which time the RE had been decided andallocation of the Institute was cut due to low expenditure upto that date.

6.2 The exercise of purchasing the required equipments for the Institute has been continuing

for a considerable period of time. The Committee has been informed that the amount of Rs.4.80 crores for purchasing equipments was sanctioned in December, 2001. The Committeeis, however, constrained to observe that the formal letter conveying the approval of theCompetent Authority in this regard could be issued only on 19thFebruary, 2002. It isunderstood that at that time the Institute was having an unspent balance of Rs. 3,01,76,510against which some of the equipments out of the sanctioned equipments could have beenpurchased during 2001-02 itself. The Committee apprehends that this amount could not havebeen utilized for want of completion of procedural formalities. This becomes clear from therequest of the Institute for increased allocation of Rs. 8.30 crores for meeting the expenditure


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towards purchase of equipments amounting to Rs. 4.80 crores. It seems that the Institute willhave to wait upto the RE stage as the allocation of only Rs. 3.50 crores has been made for 2002-03. The Committee is deeply anguished at this state of affairs. The Committee, stronglyrecommends that the Department should suitably enhance the allocation of CIP, Ranchi sothat these equipments which are essential to meet the needs of the patients can be procuredat the earliest. 6.2 The Department has further informed that a proposal for

creation/recreation of 41 posts at the Central Institute of Psychiatry based on the reports of the two Study Groups (one under the Chairmanship of Smt. Sunila Basant, then JointSecretary in the Ministry and another Expert Group from NIMHANS, Bangalore) has beenunder the consideration of DGHS. Out of these 41 posts, Directorate General recommendedfor creation of only 24 posts, which are primarily required for augmenting the Institute. It wasalso indicated by the Ministry that 13 posts could be abolished to find some savings towardscreation of the 24 posts, the expenditure for which after abolition of 13 posts was computed atRs.38.00 lakhs per annum. The proposal was forwarded to the Department of Expenditure on17.7.2001, which sought some additional information in a statement showing cases handledin the last 10 years, posts sanctioned in various grades and in existence, number of postsnow to be created discipline-wise. The said information has been sent to the Department of Expenditure through the Internal Finance in January, 2002 for their approval and the approvalis awaited.

6.4 The issue of creation of required posts for CIP, Ranchi started with an IWSU studyconducted as early as in 1997. Thereafter, another study was conducted by NIMHANS IN2000. Final outcome has been that out of the proposal for creation/recreation of 41 posts, only24 posts have been recommended for creation by DGHS.

6.5 On a specific query about the scaling down of number of proposed posts, the Departmenthas clarified that austerity measures and the ban on creation/revival /filling up of posts led torevision of the proposal. The Committee expresses its serious reservations on thisdevelopment. What is more shocking is that as a bargain for creating these 24 posts, theMinistry has wished for abolishing 13 existing posts.

6.6 The Committee strongly feels that the position is very bad in CIP, Ranchi. Creation of required posts apart, even sanctioned posts are not filled up. Out of 19 teaching posts of Associate/Assistant/Professor, only 6 are filled up. Similarly, out of 24 non-teaching posts,only 9 are in position. The Committee is of the view that drastic steps need to be taken by allthe concerned authorities so that the Central Institute of Psychiatry, Ranchi can provide theservices in the area of mental health care which is very much required in the presentscenario.

IX NATIONAL MENTAL HEALTH PROGRAMME

19.1 The Programme, started in 1982, envisages a community based approach to theproblem. Funds are provided by the Govt. to the State Govts. and the nodal institutes to meetthe expenditure on staff, equipments, training, IEC activities etc. At present, District MentalHealth Programme is under implementation in 25 districts in 20 States.

19.2 Against a Plan allocation of Rs. 4.00 crores in RE 2001-02, allocation in BE 2002-2003


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has been astronomically increased to Rs. 27.00 crores. The Department has informed that anincreased allocation has been made for 2002-2003 based on the Tenth Five Year Planproposal which envisages apart from sustaining the existing District Mental HealthProgramme, adding more districts to provide assistance for upgrading the infrastructure andmodernization of the existing mental health facilities in mental hospitals and psychiatricdepartments of medical colleges; to undertake research in the field of mental health and to

develop, disseminate and use IEC programmes at national level.19.3 The Committee notes that shortage of trained psychiatric manpower and lack of awareness regarding treatment are the two main barriers to the provision of mental healthservices in the country. The Committee has been given to understand that about 4000 clinicalpsychologists, psychiatric social workers and psychiatric nurses are working in the countrywhich is inadequate to meet the total needs of persons with mental disorders in the country.The shortage of psychiatric manpower is felt in all the States, specially in rural areas. TheCommittee strongly feels that there is a need for having systematic evaluation regardingStatewise requirement of manpower. The Committee also observes that mental healthprogrammes are being implemented in a varying degree by different States. The Committeehas been informed that the District Mental Health Programme is to be enlarged and mademore effective covering the entire country during the Tenth Plan. The Committee feels thatthere is an urgent need for expanding the mental health services. While appreciating thesubstantive allocation of funds for this programme for 2002-03, the first year of Tenth Plan,the Committee would like to emphasise that there should be regular and extensive monitoringat all levels to ensure optimum and judicious utilization of funds.

~

2003 April 10 : 125th Report HRD

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DEPARTMENT-RELATED PARLIAMENTARY STANDING COMMITTEE ON HUMANRESOURCE DEVELOPMENT HUNDRED TWENTY FIFTH REPORT ON ACTION TAKENBY GOVERNMENT ON THE RECOMMENDATIONS/OBSERVATIONS CONTAINED IN THEHUNDRED SIXTEENTH REPORT ON DEMANDS FOR GRANTS 2002-2003 (DEMAND NO.42) OF THE DEPARTMENT OF HEALTH (MINISTRY OF HEALTH AND FAMILY WELFARE)

CENTRAL INSTITUTE OF PSYCHIATRY, RANCHI

Recommendation/Observation

6.6 The Committee strongly feels that the position is very bad in CIP, Ranchi. Creation of required posts apart, even sanctioned posts are not filled up. Out of 19 teaching posts of Associate/Assistant/Professor, only 6 are filled up. Similarly, out of 24 non-teaching posts,only 9 are in position. The Committee is of the view that drastic steps need to be taken by allthe concerned authorities so that the Central Institute of Psychiatry, Ranchi can provide theservices in the area of mental health care which is very much required in the presentscenario.
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Action Taken

6.6 The Directorate General of Health Services and the Central Institute of Psychiatry, Ranchihave been advised to take immediate urgent necessary action for filling up all vacant posts,including the 21 newly revived scientific posts. Action has been initiated to fill up these posts.

CHAPTER-II

RECOMMENDATIONS/OBSERVATIONS WHICH THE COMMITTEE DOES NOT DESIRETO PURSUE IN VIEW OF GOVERNMENT'S REPLY

CENTRAL INSTITUTE OF PSYCHIATRY, RANCHIRecommendation/Observation

6.2 The exercise of purchasing the required equipments for the Institute has beencontinuing for a considerable period of time. The Committee has been informed that the

amount of Rs.4.80 crores for purchasing equipments was sanctioned in December, 2001.The Committee is, however, constrained to observe that the formal letter conveying theapproval of the Competent Authority in this regard could be issued only on 19th February,2002. It is understood that at that time the Institute was having an unspent balance of Rs.3,01,76,510 against which some of the equipments out of the sanctioned equipmentscould have been purchased during 2001-02 itself. The Committee apprehends that thisamount could not have been utilised for want of completion of procedural formalities. Thisbecomes clear from the request of the Institute for increased allocation of Rs.8.30 crores for meeting the expenditure towards purchase of equipments amounting to Rs.4.80 crores. Itseems that the Institute will have to wait up to the RE stage as the allocation of only Rs.3.50crores has been made for 2002-03. The Committee is deeply anguished at this state of

affairs. The Committee, strongly recommends that the Department should suitably enhancethe allocation of CIP, Ranchi so that these equipments, which are essential to meet the needsof the patients, can be procured at the earliest.

Action Taken

The delay in issue of the formal approval of the competent authority was due to incorrectinformation submitted by the Institute regarding the availability of funds at the disposal of theInstitute. The Institute was having only Rs.3.34 crores (Rs.3.29 crores under Plan and Rs.0.05 crores under Non-Plan) in the Budget Estimates 2001-02 under the sub-head Machinery& Equipments. During 2002-03 an amount of Rs.1.07 crores (Rs.1.02 crores under Plan andRs.0.05 crores under Non-Plan) has been provided to the Central Institute of Psychiatry under sub-head Machinery & Equipments in the Budget Estimates 2002-03. Additional requirementof funds under sub-head Machinery & Equipments will be taken up with Budget Division of theMinistry at the RE Stage.


The Department has further informed that a proposal for creation/recreation of 41 posts at theCentral Institute of Psychiatry based on the reports of the two Study Groups (one under theChairmanship of Smt.Sunila Basant, then Joint Secretary in the Ministry and another ExpertGroup from NIMHANS, Bangalore) has been under the consideration of DGHS. Out of these41 posts, Directorate General recommended for creation of only 24 posts, which are primarily


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required for augmenting the Institute. It was also indicated by the Ministry that 13 posts couldbe abolished to find some savings towards creation of the 24 posts, the expenditure for whichafter abolition of 13 posts was computed at Rs.38.00 lakhs per annum. The proposal wasforwarded to the Department of Expenditure on 17.7.2001, which sought some additionalinformation in a statement showing cases handled in the last 10 years, posts sanctioned invarious grades and in existence, number of posts now to be created discipline-wise. The said

information has been sent to the Department of Expenditure through the Internal Finance inJanuary, 2002 for their approval and the approval is awaited.


6.4 The issue of creation of required posts for CIP, Ranchi started with an IWSU studyconducted as early as in 1997. Thereafter, another study was conducted by NIMHANS IN2000. Final outcome has been that out of the proposal for creation/recreation of 41 posts,only 24 posts have been recommended for creation by DGHS.


6.5 On a specific query about the scaling down of number of proposed posts, theDepartment has clarified that austerity measures and the ban on creation/revival/filling up of posts led to revision of the proposal. The Committee expresses its serious reservations onthis development. What is more shocking is that as a bargain for creating these 24 posts, theMinistry has wished for abolishing 13 existing posts.

Action Taken

6.3 to 6.5 The 41 posts were proposed for creation/re-creation/re-designation, includesScientific and non-scientific posts by abolition of 13 posts. Out of these 41 posts, DirectorateGeneral of Health Services recommended for creation of 24 scientific posts, in the firstinstance, which are primarily required for functioning of the Institute. The proposal was takenup as recommended by the Directorate General of Health Services and orders for creation of these 21 scientific posts have been issued vide letter No. Z/15018/20/2000-RD Cell/PH dated15th May, 2002. The Central Institute of Psychiatry, Ranchi and the Directorate General of Health Services will be requested to submit the proposal for creation/re-creation/re-designation of non-scientific posts with justification for further taking up the matter with theDepartment of Expenditure.

NATIONAL MENTAL HEALTH PROGRAMMERecommendation/Observation

19.2 The Committee notes that shortage of trained psychiatric manpower and lack of

awareness regarding treatment are the two main barriers to the provision of mental healthservices in the country. The Committee has been given to understand that about 4000 clinicalpsychologists, psychiatric social workers and psychiatric nurses are working in the countrywhich is inadequate to meet the total needs of persons with mental disorders in the country.The shortage of psychiatric manpower is felt in all the States, specially in rural areas. TheCommittee strongly feels that there is a need for having systematic evaluation regardingStatewise requirement of manpower. The Committee also observes that mental healthprogrammes are being implemented in a varying degree by different States. The Committeehas been informed that the District Mental Health Programme is to be enlarged and made


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more effective covering the entire country during the Tenth Plan. The Committee feels thatthere is an urgent need for expanding the mental health services.

While appreciating the substantive allocation of funds for this programme for 2002-03, the firstyear of Tenth Plan, the Committee would like to emphasise that there should be regular andextensive monitoring at all levels to ensure optimum and judicious utilization of funds.

Action Taken

19.3 About 1-2% of the population suffer from major mental disorders and about 5% of thepopulation i.e., 50 million people suffer from minor depressive disorders. It is also estimatedthat 25% of people who attend primary health care clinics suffer from various types of psychological problems. However, most of these patients do not require hospitalization. Thereare presently 37 specialized mental hospitals in the country in the Government sector with atotal bed strength of over 18,000 beds. In addition, the various medical colleges and generalhospitals in the country have about 200 psychiatry units of varying sizes with bed strengthvarying 2-200, at an average of 20 beds. There are about 3,500 such beds available in suchunits. There are about 40 training centers for postgraduate study in psychiatry. In addition,there are about 40-50 private psychiatric facilities in the country. Availability of psychotropic

drugs is satisfactory and the cost of such drugs is reasonable/affordable. Two mentalhospitals namely NIMHANS, Bangalore and CIP, Ranchi are under the administrative controlof the Central Government.

A comprehensive study had been conducted in this regard by this Ministry in two workshopsheld in February 1999 for the Medical Superintendents of mental hospitals and in June, 1999for State Health Secretaries regarding the minimum standard of care in mental hospitals.Further, the National Institute of Mental Health and Neuro-sciences, Bangalore anautonomous body under this Ministry, also undertook a review of the functioning of all theState-run mental hospitals and psychiatric units in a project commissioned by NHRC in 1999.Another detailed study of mental health care in the country was also undertaken by this

Ministry in November-December, 2001 and in June-July, 2002 by all the State Governmentson the direction of the Honble Supreme Court. The overall condition of mental health caredelivery system in the country as assessed by Union Health Secretary on the basis of affidavits submitted by all the State Chief Secretaries, was placed before the HonbleSupreme Court. In the affidavit it was pointed out that the Courts direction to the CentralGovernment to set up at least one psychiatric hospital in each State for the purpose of makingavailable increased manpower and facilities in the field of mental health, may not be proper and be reviewed, since as per the new scientific thinking, community based treatment ispreferable and beneficial to the hospital based ones. The improved psychotic drugs can nowbe given in the community itself and the family bond between the patient and family membersis maintained which results in quicker cure and rehabilitation.

The mental health programme will, therefore, popularize community-based treatment requiredfor a large number of cases of mental illness. It is in this context that the District Mental HealthProgramme will provide community care with treatment shifting from custodial to therapeutic.It removes stigmatization and isolation of mentally ill persons in society. The mental healthprogramme will popularize community based treatment required for large number of cases of mental illness. Under the District Mental Health Programme, the mental hospitals and medicalcolleges which have professional expertise in the field are designated as nodal agencies tobuild a District Health Team to provide service to needy mentally ill patients at their families in


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the district and adjoining areas. In service candidates and personnel appointed as clinicalpsychologist, trained social worker, psychiatrist, psychiatric nurse on contract basis areexpected to perform the task of early detection of illness and quick treatment at thecommunity level itself. There are presently few people choosing the field of psychiatry as acareer, but still with the limited availability of personnel, through District Mental HealthProgramme, the activities have been expanded to cater to larger population.

As a sequel to this approach, there is shift in emphasis from mental hospitals to upgradingpsychiatric units in medical hospitals/colleges closer to the community. Secondly, as to theStates demand for overcoming shortage of trained manpower in the categories of psychiatrists, clinical Psychologists, Psychiatric Social Worker and Psychiatric Nurses inmental hospitals, it was suggested to the State Governments that one of the ways to tide over the problem is that in-service personnel (Medical Officers, Social Workers and Nurses) maybe detailed by the States/UT authorities concerned, for short-term skill-based training in thedisciplines at reputed institutions such as NIMHANS, Bangalore and CIP, Ranchi. With the up-gradation of infrastructure of mental hospitals, psychiatric units in medical colleges, expansionof District Mental Health Programme from 27 districts to 100 districts along-with IEC activitiesand research in the 10th Plan period, the need for proper mental health services withsufficient infrastructure and manpower is expected to be fulfilled.

~

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2003 April : 135th REPORT ON DEMANDS FOR GRANTS 2003-2004

IX NATIONAL MENTAL HEALTH PROGRAMME

9.1 Plan allocation for National Mental Health Programme in BE 2003-2004 is Rs. 28.00crores. The Committee notes that during 2002-2003, allocation for the Programme in BE wasRs. 27.00 crores which has been substantially reduced to Rs. 3.50 crores at the RE stage.Explaining the reasons the Department has given the information that an amount of Rs 27crores was proposed at BE stage to implement a comprehensive National Mental HealthProgramme during the year 2002-03. However, the EFC meeting to consider the saidprogramme for the 10th Five Year Plan was held only on 26.12.2002 and the minutesreceived in February, 2003. Further, the approval of the CCEA for the scheme is being taken.Therefore, the activities proposed for the year 2002-2003 viz; expansion of District MentalHealth Programme, Strengthening of Psychiatric hospitals and psychiatric departments of Medical colleges, IEC and Research activities, could not be undertaken during 2002-2003,which led to drastic cut in the Revised Estimate stage for the year 2002-2003. However,during the year 2002-2003, as per the decision taken by EFC, it is now proposed only tosustain the District Mental Health Programme in districts which are already under implementation under IX Plan and which have not received the full five year assistancesubject to submission of utilization certificate in respect of assistance provided during theprevious years. Apart from sustaining the District Mental Health Programme, it is proposed toundertake further expansion of the programme strengthening or psychiatric hospitals andpsychiatric departments of Medical Colleges IEC and Research activities during 2003-2004,on receipt of approval of CCEA; hence budget allocation has been increased.
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9.2 The Committee is aware that due to ever increasing materialization, and consequentchanges in life style, the cases of mental and psychological aberration are on the increase.The Committee notes with concern the delay in implementation of the comprehensive MentalHealth Programme caused solely due to delay in holding the EFC meeting. The EFC meetingshould have been held as per the requirements of the situation and not vice-versa. TheCommittee deprecates such delays and recommends that all out efforts should be made to

ensure that such a situation does not recur and the comprehensive Mental Health Programmebe fully implemented in the current year.

X IMPLEMENTATION OF HEALTH PROGRAMMES INNORTH EAST SECTOR

Plan allocation for Implementation Of Health Programmes In North East Sector in BE 2003-2004 is Rs. 155 crores. The Committee notes that during BE 2002-2003, plan allocation was

Rs. 155 crores which was reduced to Rs. 137.50 crores at the RE stage.10.2 The scheme wise expenditure under Lumpsum Provision for projects /schemes of NEA andSikkim is as follows : (Rs. in crore)

S.No. Name of the Programme/scheme Fundsearmarked

Amount re-appropriatedfor exp.

1. National Vector Borne Disease Control Programme 38.00 29.052. National Leprosy Eradication Programme 2.50 2.503. National TB Control Programme 5.00 -4. National AIDS Control Programme 27.00 26.965. Integrated Disease Surveillance Programme - -6. National Blindness Control Programme 3.50 0.907. National Cancer Control Programme 5.00 -8. National Mental Health Programme 1.00 -9. Drug De-addiction Programme 0.50 0.2810. New Initiatives in the Tenth Plan - -11. National Iodine Deficiency Disorder Programme 1.00 0.5012. Assistance to States for Capacity Building 4.50 4.4413. C.G.H.S. 3.00 3.0014. NEIGRIHMS 40.00 40.00

15. Indian Council of Medical Research. 6.50 3.00Total 137.50 110.63

10.3 The Committee notes that in respect of programmes such as National TB Control,National Blindness Control, National Cancer Control, National Mental Health, Drug De-addiction, National Iodine Deficiency Disorder and Indian Council of Medical Research theamount re-appropriated for expenditure is much below the funds earmarked for them. TheCommittee deprecates the trend in view of the fact that the NE states, because of their inhospitable geography do not attract much of health care services. The Committee


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observes that these border states need to be assured that they are a part of nationalmainstream and need to be provided what is due to them. At the same time efforts need tomade to ensure optimum utilisation of funds to bring them at par with the rest of the Country.

The Committee observes that the Country is way behind in providing state-of-the-artfacilities and an efficient and responsive Health Care system in the Country. There is need for tremendous improvement all round and people must have the feeling that being a welfare

state, it cares for the people.~

2004 February 4 : 148th REPORT ON DEMANDS FOR GRANTS2003-2004

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ACTION TAKEN BY GOVERNMENT ON THE RECOMMENDATIONS/OBSERVATIONS

CONTAINED IN THE HUNDRED THIRTY FIFTH REPORT ON DEMANDS FOR GRANTS2003-2004 (DEMAND NO. 46) OF

THE DEPARTMENT OF HEALTH

III NATIONAL MENTAL HEALTH PROGRAMME:

Recommendations/Observation

9.1 Plan allocation for National Mental Health Programme in BE 2003-2004 is Rs. 28.00crores. The Committee notes that during 2002-2003, allocation for the Programme in BE wasRs. 27.00 crores which has been substantially reduced to Rs. 3.50 crores at the RE stage.Explaining the reasons the Department has given the information that an amount of Rs 27crores was proposed at BE stage to implement a comprehensive National Mental HealthProgramme during the year 2002-03. However, the EFC meeting to consider the saidprogramme for the 10th Five Year Plan was held only on 26.12.2002 and the minutesreceived in February, 2003. Further, the approval of the CCEA for the scheme is being taken.Therefore, the activities proposed for the year 2002-2003 viz; expansion of District MentalHealth Programme, Strengthening of Psychiatric hospitals and psychiatric departments of Medical colleges, IEC and Research activities, could not be undertaken during 2002-2003,

which led to drastic cut in the Revised Estimate stage for the year 2002-2003. However,during the year 2002-2003, as per the decision taken by EFC, it is now proposed only tosustain the District Mental Health Programme in districts which are already under implementation under IX Plan and which have not received the full five year assistancesubject to submission of utilization certificate in respect of assistance provided during theprevious years. Apart from sustaining the District Mental Health Programme, it is proposed toundertake further expansion of the programme strengthening or psychiatric hospitals andpsychiatric departments of Medical Colleges IEC and Research activities during 2003-2004,on receipt of approval of CCEA; hence budget allocation has been increased.


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Recommendations/Observation

9.2 The Committee is aware that due to ever increasing materialization, and consequentchanges in life style, the cases of mental and psychological aberration are on the increase.

The Committee notes with concern the delay in implementation of the comprehensive MentalHealth Programme caused solely due to delay in holding the EFC meeting. The EFC meetingshould have been held as per the requirements of the situation and not vice-versa. TheCommittee deprecates such delays and recommends that all out efforts should be made toensure that such a situation does not recur and the comprehensive Mental Health Programmebe fully implemented in the current year.

Action Taken

9.2 The recommendation of the Committee has been noted for compliance.

(X) IMPLEMENTATION OF HEALTH PROGRAMMES INNORTH EAST SECTOR Recommendations/Observation10.2 The scheme wise expenditure under Lump sum Provision for projects /schemes of

NEA and Sikkim is as follows :

(Rs. in crore)S.No. Name of the Programme/scheme Funds

earmarkedAmount re-appropriatedfor exp.

1. National Vector Borne Disease ControlProgramme

38.00 29.05

2. National Leprosy Eradication Programme 2.50 2.503. National TB Control Programme 5.00 -4. National AIDS Control Programme 27.00 26.965. Integrated Disease Surveillance Programme - -6. National Blindness Control Programme 3.50 0.907. National Cancer Control Programme 5.00 -8. National Mental Health Programme 1.00 -9. Drug De-addiction Programme 0.50 0.2810. New Initiatives in the Tenth Plan - -11. National Iodine Deficiency Disorder Programme 1.00 0.5012. Assistance to States for Capacity Building 4.50 4.4413. C.G.H.S. 3.00 3.0014. NEIGRIHMS 40.00 40.0015. Indian Council of Medical Research. 6.50 3.00

Total 137.50 110.63


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Recommendations/Observation 10.3 The Committee notes that in respect of programmes such as National TB Control,National Blindness Control, National Cancer Control, National Iodine Deficiency Disorder andIndian Council of Medical Research, the amounts re-appropriated for expenditure are much

below the funds earmarked for them. The Committee observes that these border states needto be assured that they are a part of national mainstream and need to be provided what is dueto them. At the same time efforts be made to ensure optimum utilization of funds to bringthem at par with the rest of the country.The Committee observes that the country is way behind in providing state-of-the-art facilitiesand an efficient and responsive Health Care system in the country. There is need for tremendous improvement all round and people must have the feeling that being a welfarestate, it cares for the people. Action Taken 10.3 National Mental Health Programme : The amount re-appropriated for expenditurehas been indicated as nil. The fact is that a sum of Rs.4.04 lakhs have been re-appropriatedvide letter No.G.23011/1/2002-Budget dated 31 st March, 2003 and was utilized.

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2004 August : Health 1 st Meetinghttp://164.100.24.167/book2/reports/health/1streport.htm

XIV. NATIONAL MENTAL HEALTH PROGRAMME

14.1 The District Mental Health Programme was launched in 1996-97 in four districts, oneeach in Andhra Pradesh, Assam, Rajasthan and Tamil Nadu. The programme envisages acommunity base approach to the problem which includes training of the mental health team atthe identified nodal institutes and also increasing awareness about mental health problems.The programme was extended to seven districts in 1997-98, five districts in 1998-99, districtsin 1999-2000 and three districts in 2000-01. With the addition of two more districts in 2001-02,this programme is being implemented in 27 districts in 22 states. Funds are provided by theCentral Government to State Governments for nodal institutes to meet the expenditure onstaff, equipment, medicine, training, IEC and contingencies for an initial period of five yearson the undertaking of the State Govts. to continue the programme on their own after thecommitted period of central assistance is over.

14.2: The Committee observes that it has taken the entire Ninth Plan (1997-2002) to cover 27districts in 22 states. Mental Health Programme has the following objectives in the TenthPlan:

Adequate funding/infrastructural support under District Mental HealthProgrammes to ensure delivery of mental health care through PrimaryHealth Centres
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Strengthening of departments of psychiatry in medical colleges

Upgradation of Mental Hospitals

Promotion of R&D Activities

Promotion of IEC Activities

14.3: The Committee notes that an ambitious national Mental Health Programme with anapproved outlay of Rs. 190 crores is proposed to be launched in the Tenth Plan. TheCommittee is of the view that the Department will have to take specific steps for expansion of this programme in the maximum number of districts in the country to achieve the targets setout in the Tenth Plan. The Committee is not aware whether any survey has been conductedso far with regard to prevalence of mental health problems in different states of the country.The Committee is of the view that in order to have effective implementation and maximumcoverage; programme should first be extended to those districts where such cases have beennoticed more as compared to other areas.

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2005 March 11 : Health 4th Meetinghttp://164.100.24.167/book2/reports/health/4threport.htm


Recommendations/Observations

14.2 The Committee observes that it has taken the entire Ninth Plan (1997-2002) to cover 27districts in 22 States. Mental Health Programme has the following objectives in the TenthPlan:

Adequate funding/infrastructural support under District Mental Health Programmes toensure delivery of mental health care through Primary Health Centres

Strengthening of departments of psychiatry in medical colleges

Upgradation of Mental Hospitals

Promotion of R&D Activities

Promotion of IEC Activities

Action Taken

The Ministry has formulated a comprehensive National Mental Health Programme with anapproved outlay of Rs. 190 crores to be implemented during the Tenth Plan. The underlyingobjective has been to diagnose mentally ill persons at an early stage and treat them in thecommunity itself and therefore, improve the mental health care delivery system throughoutthe country. The mental health care is proposed to be improved at three levels: (a) at thedistrict level by increasing coverage of District Mental Health Programme from 27 districts to100 districts. Each such district will cover the adjacent 4 to 5 districts with a goal to cover all
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districts in the country, (b) to strengthen psychiatric units of 75 medical colleges/generalhospitals so that patients need not visit mental hospitals for minor and other major disorders,etc. (c) to improve the facilities at the 37 Government mental hospitals in order to cater to theneeds of growing number of mentally ill patients who require treatment for major disorders.

Action Taken

On the direction of Supreme Court of India in the Erwadi case, Chief Secretaries of all theStates have got conducted a need based survey about the mentally ill patients and thefacilities available. It is on this basis that the State/UTs were requested, during the launchworkshop on National Mental Health Programme held in October, 2003 by CentralGovernment, to identify specific districts, psychiatric units and mental hospitals which requireto be included in the programme for funding. On the basis of this criteria, the StateGovernments have submitted proposals which are under examination. It is felt that at the endof Tenth Plan, the National Mental Health Programme will have a maximum coverage of districts in the country and thus improve the mental health care.

Recommendations/Observations

14.3 The Committee notes that an ambitious National Mental Health Programme with anapproved outlay of Rs. 190 crores is proposed to be launched in the Tenth Plan. TheCommittee is of the view that the Department will have to take specific steps for expansion of this programme in the maximum number of districts in the country to achieve the targets setout in the Tenth Plan. The Committee is not aware whether any survey has been conductedso far with regard to prevalence of mental health problems in different states of the country.The Committee is of the view that in order to have effective implementation and maximumcoverage; programme should first be extended to those districts where such cases have beennoticed more as compared to other areas.

COMMENTS OF THE COMMITTEE

The Committee is of the view that in order to utilise the approved outlay of Rs. 190/- crores toimplement the National Mental Health Programme during the Tenth Plan, necessary stepsmay be taken urgently on priority basis to identify the districts so as to increase the coverageto 100 districts as planned. The Committee is of the opinion that unless the districts areidentified urgently the utilization of funds may not be achieved during the Tenth Plan (Para14.3)~

2005 April 28 : Health 7th Meeting

http://164.100.24.167/book2/reports/health/7threport.htm XIV NATIONAL MENTAL HEALTH PROGRAMME

14.1 It is estimated that about 5% of the population in the country suffers from variouspsychological disorders. About 1% of the population suffers from serious mental disordersand 0.5% of the population may be in the need of active treatment. The Central Govt.Supplements the efforts of the State Govts. in promoting mental health care. An amount of Rs. 139 crores has been allocated for this programme during the Tenth Plan, which wasmeant for expanding District Mental Health Programme to cover 100 districts, strengthening


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37 Govt. mental health institutes and psychiatric wings of 75 medical colleges, undertakingIEC activities and research and training.

14.2 The Committee notes that during the Ninth Plan, there was an allocation of Rs. 28 croresunder this Programme. However, utilization figures are only Rs. 18.19 crores. The Committeeis constrained to observe that a massive enhancement of Plan allocation for this Programmeduring the Tenth Plan, i.e. Rs. 139 crores has failed to make any noticeable impact for the

simple reason that allocated funds have remained unutilized so far. Against an allocation of Rs. 30.00 crore in 2002-03, the first year of Tenth Plan, utilization figures are only Rs. 9 lakhs.Actual expenditure figures for 2003-04 are not available. However, reduction of BE allocationof Rs. 30.00 to Rs. 5.00 crore at the RE stage clearly indicates the dismal achievement level.Full estimated expenditure of allocated funds of Rs. 33 crores in 2004-05 has been projected.In the event of success in achievement level in 2004-05, the fact remains that in the last year of the Tenth Plan, Rs. 100.91 crore out of total allocation of Rs. 139 crore are available under this programme.

14.3 The Committee finds that due to approval of the Scheme in December, 2002, no activitywas there during the first year of Tenth Plan. Situation does not seem to have improved muchas out of 48 districts envisaged to be covered during 2003-04, only 17 could be covered. Withregard to target of modernization of 37 mental hospitals and up gradation of 75 medicalcolleges, progress charts shows zero performance rate of similar targets in the 2004-05 is notyet known.

14.4 The Committee has been informed that on the direction of Supreme Court in the Erwadicase, Chief Secretaries of all the States have got conducted a need-based survey about thementally ill patients and the facilities available in the state. Subsequently, in a launchworkshop held in October, 2003, all Health Secretaries were requested to identity specificdistricts, psychiatric units and mental hospitals which required to be funded under theProgramme. The Committee is constrained to note that the appraisal exercise of proposalssubmitted by State Govts is still going on. The Committee would like to emphasize that the

Deptt. should make concerted efforts to expedite the process of approval so thatimplementation could be started. The Committee would also like to point out that the elevenStates/UTs which have failed to forward their proposals should be actively pursued for doingthe same.

14.5 The Committee notes that the Central Mental Health Authority is supposed to overseethe implementation of the Mental Health Act, 1987. The Act also provides for creation of StateMental Health Authority. The Committee would like to be apprised about the number of Stateswhere such Authorities have been created.

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2005 December 12 : Health 15th Meetinghttp://164.100.24.167/book2/reports/health/15threport.htm

CHAPTER- II RECOMMENDATIONS/OBSERVATIONS WHICH THE COMMITTEE DOESNOT DESIRE TO PURSUE IN VIEW OF THE GOVERNMENTS REPLIES


14.2& 14.3 Recommendations/Observations

The Committee notes that during the Ninth Plan, there was an allocation of Rs.28 crores


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under this Programme. However, utilization figures are only Rs.18.19 crores. The Committeeis constrained to observe that a massive enhancement of Plan allocation for this Programmeduring the Tenth Plan, i.e. Rs.139 crores has failed to make any noticeable impact for thesimple reason that allocated funds have remained underutilized so far. Against an allocationof Rs.30.00 crore in 2002-03, the first year of Tenth Plan, utilization figures are only Rs.9lakhs. Actual expenditure figures for 2003-04 are not available. However, reduction of BE

allocation of Rs.30.00 to Rs.5.00 crore at the RE stage clearly indicates the dismalachievement level. Full estimated expenditure of allocated funds of Rs.33 crores in 2004-05has been projected. In the event of success in achievement level in 2004-05, the factremains that in the last year of the Tenth Plan, Rs.100.91 crore out of total allocation of Rs.139 crore are available under this programme.

The Committee finds that due to approval of the Scheme in December, 2002, no activity wasthere during the first year of Tenth Plan. Situation does not seem to have improved much asout of 48 districts envisaged to be covered during 2003-04, only 17 could be covered. Withregard to target of modernization of 37 mental hospitals and upgradation of 75 medicalcolleges, progress charts shows nil progress. Performance rate of similar targets in 2004-05is not yet known.

Action Taken

During the 9th Plan, the National Mental Health Programme had only the component of District Mental Health Programme. Funds could not be released for the programme for wantof Utilisation Certificates from the implementing agencies. However, during the 10th Plan,NMHP has apart from DMHP, other components like upgradation OF 37 Government mentalhospitals, psychiatric wards of medical colleges/district hospitals, IEC, Research, etc.Accordingly increased outlay was provided. In the first two years of 10th Plan the funds couldbe released only to the districts under the on-going pilot project, as the revised NationalMental Health Programme was launched only in October, 2003. Si

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