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

National Mental Health Programme

Revision Proposed for the 11th five Year Plan-Overview

Magnitude of Mental DisordersPrevalence : 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 %Magnitude of Mental DisordersBurden 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 problemsNMHP 10th PlanRs. 139 crore was sanctioned.

NMHP was restrategised in 2003.

10th Plan StrategiesIntegration of Mental Health with primary health care through DMHP Strengthening psychiatry wings of medical collegesModernisation of existing Mental Hospitals IEC Research and Training

Physical Targets Achieved 10th PlanSchemeGrants SanctionedGrants ReleasedTarget 10th PlanDMHP(No. of Districts)129109

100Mental Hospital(No. of Mental hospitals funded)232325Psychiatry Wing of MC/Gen. Hosp.(No. of inst.funded)70 7075Funds Released: Rs.106.46 Crores NMHP 10th Plan - ConstraintsLack of complete proposals from State governmentsThe releases are not fully utilised for want of proper monitoring mechanism at State levelDMHP could not be implemented effectively mainly due to shortage of manpower States are not willing to undertake the responsibility after 5 yearsProgramme was not getting integrated in the district health plan

Strategy for 11th planWas 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 Proposal for 11th Plan Main components DMHP Re-strategisedEstablishment of Regional Institutes of Mental Health & NeurosciencesTraining & ResearchIEC/NGO Monitoring & EvaluationState Mental Health CellNodal officer (Deputy Director Mental Health or the Joint Director Health) for monitoring the implementation of NMHPMental 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. DMHP Activities Service provision to mentally illEnsuring regular drug supplyReferral to identified Med. College/Pvt. PsychiatristCommunity mental health care by visiting CHCs/PHCs Training PHC doctors/health functionariesIECRecord keeping and reportingDMHPAdditional Services :

Counseling Center School Mental Health Services College Counseling services Stress Management at work place Suicide preventionParticipation of NGOsDMHP - Proposed changesInstead 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

DMHP - Proposed changes10th Plan11th PlanP.O. - PsychiatristTrained M.O. (3 months)Training of PHC doctor 2-3 weeks3 +3 (6) daysM.O.s trained/district15-20% 100%Training of Health workers 2-3 weeks1+1 (2) daysTraining not standardizedTraining by standardized training modulesDMHP - Proposed changes10th Plan11th PlanSchool Mental Health Services, College Counseling services, Work place stress mgmt., Suicide prevention - Nil +Involvement of NGOs - Nil +District Preparatory phase Not specifiedPre requisiteRecord keeping and Reporting -IrregularRegularMonitoring - IrregularRegularImplementation of DMHPA Programme officer (P.O.) for each district would be identified and appointed by the State Govt. (in service M.O.)/ taken on contractP.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 DMHPDistrict will be linked with the nearby zonal Medical College for techno-managerial supportThe funds for DMHP would be released through State Health Society/DHSDMHP Preparatory PhaseAfter 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 placeSchool Mental Health ServicesLife Skills Education using standard training manuals

Counselling services through trained teachers/ Hired Counsellors

Involvement of the NGOs College Counselling ServicesProvided 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 collegesSuicide Prevention ServicesSensitization workshopsCrisis HelplinesTimely care for high risk groupsSchool, college and work place intervention programmesIEC activities focused on suicide preventionWorkplace 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 DMHP Funding Pattern 10th & 11th planComponent10th plan (in lacs)11th plan (in lacs)Non Recurring for infrastructure62Staff Salary for DMHP staff51.7 39.66Training12 23.16IEC1027.18Drugs/miscellaneous/travel/contingency3245 (25 for drugs)Targeted interventionsnil58Operational expenses district centre:rent, telephone ,website, stationary, etcnil5

Total112.5200Training & Research To address shortage of manpower in mental healthResearch related to NMHPBudget for Training & Research Rs.20 croresRegional 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 facilitiesTo 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 centerIECInnovative 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 facilitiesIncreased awareness regarding provisions under Mental Health Act 1987Monitoring & EvaluationCentre Central Mental Health cellState State Mental Health cellDistrict and below DMHP unit

Regular supervision through Visits/Reporting by all levelsOutside evaluationBudget Rs. 21 crores

Outcome IndicatorsNumber 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 levelsAvailability of trained manpowerProposed 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

SL NOComponent Budget in crores1Spill over of 10th plan activities (modernization of remaining M.H.s (14), Med. college psychiatry depts. (30)502DMHP(500 New & 100 Old)5723RIMHANS3204IEC activities /NGOs1005Monitoring & Evaluation (incl. Central & State Cell) 216Research & Training 20Total 1083Proposed budget allocation under various domains in the 11th planTOTAL PROPOSED BUDGET FOR 11th PLAN Rs. 1083 CRORESTHANK YOU