Indian Journal of Psychiatric Nursing

CONCEPT ARTICLE
Year
: 2019  |  Volume : 16  |  Issue : 1  |  Page : 52--54

Models and roles in National Mental Health Programme


G Balamurugan1, G Radhakrishnan2, M Vijayarani3,  
1 HoD-Department of Mental Health Nursing Ramaiah Institute of Nursing Education and Research, Bangalore, India
2 Faculty of Nursing, National Institute of Mental Health And Neuro Sciences (NIMHANS), Bangalore, India
3 Assistant Professor, ESIC College of Nursing, Bangalore, India

Correspondence Address:
Dr. M Vijayarani
ESIC College of Nursing, Bengaluru, Karnataka
India

Abstract

In India, National Mental Health Programme (NMHP) was started in 1982 with the primary objectives of ensuring availability and accessibility of minimum mental healthcare for all. In 1985, National Institute of Mental Health and Neuro Sciences, Bengaluru, had developed Bellary model of District Mental Health Programme (DMHP), to achieve the objectives of National Mental Health Programme (NHMP). The current DMHP has more scope for the nurses to deliver mental health services as psychiatric nurse and community nurse. Hardly, one-third of districts in India are covered under DMHP and the service utilization is also to be strengthened. Psychiatric nurses have greater scope to transform all these existing challenges into opportunities.



How to cite this article:
Balamurugan G, Radhakrishnan G, Vijayarani M. Models and roles in National Mental Health Programme.Indian J Psy Nsg 2019;16:52-54


How to cite this URL:
Balamurugan G, Radhakrishnan G, Vijayarani M. Models and roles in National Mental Health Programme. Indian J Psy Nsg [serial online] 2019 [cited 2023 Jan 29 ];16:52-54
Available from: https://www.ijpn.in/text.asp?2019/16/1/52/269161


Full Text



 Introduction



In 1974, WHO Expert Committee on Mental Health released a report on “organization of mental health services in developing countries” at Addis Abada.[1] Based on the recommendations of 1974, seven countries (Brazil, Colombia, Egypt, India, Philippines, Senegal, and Sudan) initiated a project “Strategies for Extending Mental Health Care” (1975–1981).[2]

In India, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, and Post Graduate Institute of Medical Education and Research, Chandigarh, had developed “decentralized and de-professionalized mental healthcare model” at Sakalwara (Karnataka) and Raipur Rani (Haryana), respectively.[3] These two projects revealed that a large number of public were deprived of essential mental healthcare services, and also, this poor mental health made an adverse impact on ill individuals, family, and community as a whole.[4] In 1981, 70 mental health professionals have attended a 2-day workshop at New Delhi and deliberated on National Mental Health Programme (NMHP) draft. The second such workshop was conducted early 1982, with a limited number of experts at New Delhi, and finalized the NMHP draft with the incorporation of few suggestions, e.g., interdisciplinary coordination. In August 1982, the Central Council of Health had approved NMHP draft and made India as one of the first nations in developing countries to formulate NHMP.[5]

 Objectives of Nhmp



To ensure availability and accessibility of minimum mental healthcare for all in the foreseeable future, particularly to the most vulnerable and underprivileged sections of populationTo encourage application of mental health knowledge in general healthcare and in social developmentTo promote community participation in the mental health service development and to stimulate efforts toward self-help in the community.[6]

 Specific Approaches Suggested for the Implementation of the National Mental Health Programme



Diffusion of mental health skills to the periphery of the health service systemAppropriate appointment of tasks in mental healthcareEquitable and balanced territorial distribution of resourcesIntegration of basic mental healthcare with general health servicesLinkage to community development, there was a framework for the planners and professionals to develop the mental health program for the country.[6]

 Genesis of District Mental Health Programme



Bellary model

While implementing NMHP, a lot of hurdles were raised such as funding (Who has to fund the program? central or state government) and feasibility in implementing in larger population. The majority of the stakeholders stressed upon finding out a model to implement NMHP at district level. Hence, in 1985, the NIMHANS developed a model (Bellary model) to deliver NHMP at Bellary district, Karnataka.

Additional strategies in Bellary model

A provision of six essential psychotropic and antiepileptic drugs (chlorpromazine, amitriptyline, trihexyphenidyl, injection fluphenazine decanoate, phenobarbitone, and diphenylhydantoin) at all primary health centers (PHCs) and subcenters (SCs)A system of simple mental health case recordsA system of monthly reporting, regular monitoring, and feedback from the district level mental health team.[7]

Team of Bellary model at district level

PsychiatristClinical psychologistPsychiatric social workerStatistical clerk.

Role of team members

Health professionals at PHC and SC were trained in handling common mental disordersThe medical officer at PHC was trained to diagnose and treat common mental disorders, and they were asked to refer the complex cases to district hospitalThe psychiatrist at district hospital ran the mental health clinic and had provision to admit 10 patientsThe district health officer reviewed the program every month with medical officers of all PHCs at Bellary district.

Conclusions of Bellary model

Mental healthcare delivery was possible in the primary healthcare settingPrimary care physicians could be adequately trained to provide such careAppropriate supervision/support from the program officer/psychiatrist empowers the public healthcare system to provide pertinent mental healthcare to the population.

District Mental Health Programme

The Ministry of Health and Family Welfare, Government of India, formulated the District Mental Health Programme (DMHP) based on the “Bellary model.” In 1996, DMHP was started in 27 districts across the country with the objectives.

To provide sustainable basic mental health services to the communityTo integrate mental health services with primary healthcare servicesEarly detection and treatment of mental illness in the community itselfTo obviate the need for the patient/relatives to travel large distances to tertiary care facilities in big citiesTo ease pressure on psychiatry departments in teaching/mental hospitalsTo reduce the stigma of mental illness by change of attitude through public health educationTreatment and rehabilitation within the community, of patients, discharged from psychiatry units, by adequate provision of medicines and strengthening family support systemTo detect/manage/refer epilepsy cases, ensure supply of antiepileptics, and reduce the stigma/misconceptions about epilepsy in the community.[5]

 Progress So Far



Eighth 5-year plan[8]

Bellary project.

Ninth 5-year plan[7]

27 districts in 20 statesBudget allocation – 28 crore.

Tenth 5-year plan (2002–2007)[9]

Extension of DMHP to 100 districtsUp-gradation of psychiatry wings of government medical colleges/general hospitalsModernization of state mental hospitalsInformation Education and Communication (IEC)Monitoring and evaluationBudget – 190 crore.

Eleventh 5-year plan (2007–2012)[10]

DMHP – 123 districtsWorkforce development schemes – Centers of excellence and setting up/strengthening postgraduate training departments of mental health specialtiesModernization of state-run mental hospitalsUp-gradation of psychiatric wings of medical colleges/general hospitalsIECTraining and researchMonitoring and evaluation.

Twelfth 5-year plan (2012–2017)[11]

As of now, 241 districts have been covered under the scheme, and it is proposed to expand DMHP to all districts in a phased manner with the following components.

 Out-Reach Component



Satellite clinics: DMHP team should conduct 4 satellite clinics per month at Community Health Centres (CHCs)/ Primary Heatlh Centres (PHCs)

Targeted interventions

Life skills education and counseling in schoolsCollege counseling servicesWorkplace stress managementSuicide prevention services.

Public Private Partnership (PPP) model activitiesDaycare center (financial support at 50,000 per center per month)Residential/long-term continuing care center (financial support at 75,000 per center per month).

 Role of Nurses



Job title: Psychiatric nurse

Job requirements/responsibilities

To examine and manage healthcare needs of the mentally ill patientsTo provide inpatient care to the mentally ill patientsTo do the outreach activity/plan and manage psychiatric clinics in PHCs/CHCs and other sites periodicallyTo impart training to the health personnel of CHC and PHC as per guidelines issued by the National Mental Health Cell.[11]

Job title: Community nurse

Job requirements/responsibilities

To keep track of follow-up patients availing treatment at CHC and PHCTo do the outreach activity/plan and manage psychiatry clinics in PHCs/CHCs and other sites periodicallyTo impart training to the health personnel of CHC and PHC as per guidelines issued by the National Mental Health Cell.

The way forward for psychiatric nurses in District Mental Health Programme

Opportunities to get involved in PPP model activitiesRunning day center with the support of DMHPStarting of residential/long-term continuing care center with financial support from DMHPInvolvement in teaching activities

Life skills education and counseling in schoolsCollege counseling servicesWorkplace stress managementSuicide prevention services.Conducting independent research in NMHP evaluation.

 Conclusion



Last 35 years of learning from NMHP, it is observed that the focus on community mental health is of the highest importance. Hardly, one-third of districts in India are covered under DMHP (241 out of 718), which show a long way to go in future to cover entire districts, and the service utilization is also to be strengthened. While focusing on rural mental health, the urban mental health needs to be addressed equally; hence, NMHP has been gradually been mainstreamed into National Health Mission (National Rural Health Mission and National Urban Health Mission). Psychiatric nurses have great scope to convert all these challenges into opportunities and being part in achieving national goal.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.

References

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