National Mental Health Programme Revision Proposed for the 11 th five Year Plan-Overview

1. National Mental Health ProgrammeRevision Proposed for the 11th five Year Plan-Overview

2. Magnitude of Mental Disorders • Prevalence : 6-7 % of the population (Reddy and Chandrashekhar 1998; and Ganguli 2000) • Estimate as per World Health Report (2001) : 10% • Neuropsychiatry disorders account for 12% of the Global Disease Burden (World Health Report, 2001) • Preliminary Data from ECA Multicentric study: 9.6 %

3. Magnitude of Mental Disorders • Burden of these disorders is likely to increase to 15% by 2020 (World Health Report, 2001) • Estimated that a minimum of 7 crore persons would need immediate care for severe and moderate mental health problems

4. NMHP – 10th Plan • Rs. 139 crore was sanctioned. • NMHP was restrategised in 2003.

5. 10th Plan Strategies • Integration of Mental Health with primary health care through DMHP • Strengthening psychiatry wings of medical colleges • Modernisation of existing Mental Hospitals • IEC • Research and Training

6. Physical Targets Achieved – 10th Plan Funds Released: Rs.106.46 Crores

7. NMHP 10th Plan - Constraints • Lack of complete proposals from State governments • The releases are not fully utilised for want of proper monitoring mechanism at State level • DMHP could not be implemented effectively mainly due to shortage of manpower • States are not willing to undertake the responsibility after 5 years • Programme was not getting integrated in the district health plan

8. Strategy for 11th plan • Was developed through National consultation (2 days workshop) with all the nodal officers/ other stake holders at NIMHANS • Inputs received from the State governments during National review meetings

9. Proposal for 11th Plan Main components • DMHP – Re-strategised • Establishment of Regional Institutes of Mental Health & Neurosciences • Training & Research • IEC/NGO • Monitoring & Evaluation

10. State Mental Health Cell • Nodal officer (Deputy Director Mental Health or the Joint Director Health) for monitoring the implementation of NMHP • Mental Health Technical Support Team -one consultant (psychiatrist) -one assistant/ DEO. • SMHC in consultation with P.O.s will work out a District specific plan based on the mental health resources available.

11. DMHP Activities • Service provision to mentally ill • Ensuring regular drug supply • Referral to identified Med. College/Pvt. Psychiatrist • Community mental health care by visiting CHCs/PHCs • Training PHC doctors/health functionaries • IEC • Record keeping and reporting

12. DMHP Additional Services : Counseling Center School Mental Health Services College Counseling services Stress Management at work place Suicide prevention Participation of NGOs

13. DMHP - Proposed changes • Instead of Psychiatrist/ psychiatric social worker/ clinical psychologist/psychiatric nurse, the programme would be run through trained medical officer/ social worker / psychologist/ nurse • The District would be prepared before the programme is launched- separate provision has been made for engagement of required staff/ training /setting up of counseling center/identification of partner organisations • Funds released through district health society

14. DMHP - Proposed changes

15. DMHP - Proposed changes

16. Implementation of DMHP • A Programme officer (P.O.) for each district would be identified and appointed by the State Govt. (in service M.O.)/ taken on contract • P.O. will be trained in Psychiatry and managerial skills for 3 months at identified institutions • Three months training for psychologist, social worker and four weeks training for nurses for manning DMHP • District will be linked with the nearby zonal Medical College for techno-managerial support • The funds for DMHP would be released through State Health Society/DHS

17. DMHP – Preparatory Phase After approval in State Health Society, DMHP team would be recruited & sent for training. Linkages would be established and a PIP for the district would be worked out. Infrastructure like counseling center, DMHP center etc. would be put in place

18. School Mental Health Services • Life Skills Education using standard training manuals • Counselling services through trained teachers/ Hired Counsellors • Involvement of the NGOs

19. College Counselling Services • Provided by trained teachers of psychology department of the colleges • The P.O. will organise the training at the district level in close co-ordination with the Dept of Collegiate Education • The trained teachers will act as counselors and as referral and support-giving agents in their respective colleges

20. Suicide Prevention Services • Sensitization workshops • Crisis Helplines • Timely care for high risk groups • School, college and work place intervention programmes • IEC activities focused on suicide prevention

21. Workplace stress management • Imparting skills for time management, improving coping skills, relaxation techniques like Yoga, Meditation etc. • Identify workplaces with sizeable population and organize stress management workshops for them • District Counseling Centre will also address this group

22. DMHP Funding Pattern 10th & 11th plan

23. Training & Research • To address shortage of manpower in mental health • Research related to NMHP • Budget for Training & Research – Rs.20 crores

24. Regional Institutes of Mental Health & Neurosciences • On the pattern of NIMHANS -by upgrading 8 identified existing mental health hospitals/institutes/Med. colleges. • For addressing the acute manpower gap & provision of state of the art mental health care facilities • To have psychiatry, neurology, neurosurgery, clinical psychology, psychiatric social work, psychiatric nursing and supportive departments • Training facilities in psychiatry, clinical psychology, psychiatric social work & psychiatric nursing • Proposed budgetary support Rs. 40 crores per center

25. IEC • Innovative IEC strategies involving Electronic/ Print/local media at Central/State/District/ Grassroot level to reduce stigma attached to mental illness and increase awareness regarding available treatment and health care facilities • Increased awareness regarding provisions under Mental Health Act 1987

26. Monitoring & Evaluation • Centre – Central Mental Health cell • State – State Mental Health cell • District and below – DMHP unit Regular supervision through Visits/Reporting by all levels Outside evaluation Budget – Rs. 21 crores

27. Outcome Indicators • Number of new patients starting on treatment; • %age of “drug non-compliant cases” amongst the diagnosed cases; • Case identification rates • % of drop outs to treatment • Increased awareness levels • Availability of trained manpower

28. Proposed Summary Budget for DMHP (in cr.) • 500 new districts to be added in 11th Plan. • More than 100 districts from 10th Plan will be funded as per the revised pattern of funding. Total projected budget: 572 crores

29. Proposed budget allocation under various domains in the 11th plan TOTAL PROPOSED BUDGET FOR 11th PLAN Rs. 1083 CRORES

30. THANK YOU