National Mental Health Programme was launched in 1982 keeping in view the heavy burden of mental illness in the community, and the absolute inadequacy of mental health care infrastructure in the country to deal with it.

1. NATIONALMENTALHEALTH
PROGRAMME(NMHP)
PRESENTED BY:
MS. MONIKA KANWAR
NURSING TUTOR
M.Sc. (N) MENTAL HEALTH NURSING

2. INTRODUCTION
◦ Mental Health is an integral and essential component of health.
◦ WORLD HEALTH ORGANIZATION defines the mental health as a
“state of well-being in which an individual realizes his or her own
abilities, can cope with the normal stressors of life and can work
productively and is able to make a contribution to his or her
community.
◦ In the positive sense, mental health is the foundation for individual
well-being and the effective functioning of the community.
◦ Globally, the mental health problems are rising and the burden of
illness resulting from the psychiatric and behavioral disorders is
enormous.

3. CONTD….
◦ In 1980, the Government of India felt the necessity of evolving a plan of action
aimed at the mental health component of the National Health Programme.
◦ In February 1981, a drafting committee met in Lucknow and prepared the first
draft of NMHP. This was presented at a workshop at New Delhi on 20th -21st
July 1981.
◦ The National Mental Health Programme (NMHP) was launched during 1982
with a view to ensure availability of Mental Health care services for all,
especially the community at risk and underprivileged section of population.
◦ Eleven institutions have been identified for imparting basic knowledge and
skills in the field of Mental Health to the primary health care Physicians and
paramedical personnel, at present this programme covers 94 districts.

4. CONTD….
◦ The Government of India launched the National Mental Health Programme
(NMHP) on 2nd August, 1982 keeping in view the heavy burden of mental
illness in the community, and the absolute inadequacy of Mental Health Care
infrastructure in the country to deal with it and fulfil the unmet needs.
◦ The District Mental Health Programme was added to the Program in 1996.
The programme was re-startized in 2003 to include Two schemes:
- Modernization of State Mental Health Hospitals
- Upgradation of Psychiatric wings of Medical Colleges/General Hospitals
The Manpower Development Scheme became part of Programme in 2009.

5. AIMS
◦ To Prevent and Treat Mental neurological disorders and their associated
disabilities.
◦ Use of Mental Health Technology to improve General Health Services.
◦ Application of Mental Health principles in total national development
to improve Quality of life.

6. OBJECTIVES
◦ To ensure the availability and accessibility of Minimum mental
healthcare for all in the foreseeable future.
◦ To provide mental health care facility to every individual of specified
population and specifically to those who are in need of it.
◦ To encourage the application of mental health knowledge in general
health care and in social development.
◦ To advance community participation in the mental health service
development.
◦ To enhance human resources in Mental Health Subspecialities.

7. STRATEGIES
◦ Integration of Mental Health with Primary health care through the
NMHP.
◦ Provision of tertiary care institution for treatment of Mental disorders.
◦ Eradicating stigmatization of mentally ill patients and protecting their
rights through regulatory institutions like the Central Mental Health
Authority, and State Mental Health Authority.

8. SPECIFIC APPROACHES
◦ Diffusion of Mental Health Skills to the periphery of Health Services.
◦ Appropriate appointment of Tasks.
◦ Equitable and balanced distribution of Resources
◦ Integration of basic Mental Health care with General Health Services.
◦ Linkage with community development.

9. GOALS OF NMHP
Within One Year
◦ Each state will have adopted the plan.
◦ Government of India will have appointed a focal point within the
ministry of Health specifically of Mental Health action.
◦ National coordinating group will be formed comprising representative
of each state, senior health administrator, professional from psychiatry,
social welfare and Education

10. CONTD….
Within Five Year
◦ 5000 of target non-medical professionals will have undergone Two weeks training in
Mental Healthcare.
◦ Creation of Post of Psychiatrist in atleast 50% of districts.
◦ To be fully operational in atleast half of all districts in some states and Union
Territories.
◦ Each state will appoint a programme officer responsible for organization and
supervision of Mental Health Programme.
◦ Appropriate Psychotropic drugs to be made essential drugs and available at PHC level.
◦ Psychiatric unit with in-patient facility will be made available in all Medical College
Hospitals in the country.

11. COMPONENTS
I. TREATMENT: MULTIPLE LEVELS
(A)Village and sub-centre level – Multipurpose workers (MPW) and
Health Supervisors (HS) , under the supervision of Medical Officer
(MO) to be trained for:
- Management of Psychiatric Emergencies
- Administration and supervision of Maintenance treatment for Chronic
Psychiatric Disorders
- Diagnosis and Management of Grandmal epilepsy, especially in
Children
- Liaison between local school teacher and parents regarding Mental
Retardation and behavioral problems in Children.
- Counselling problems related to Alcohol and Drug Abuse.

12. CONTD….
(B) Medical Officer of PHC aided by HS, To be trained for–
- Supervision of Multipurpose Health Worker (MPW) performance
- Elementary diagnosis
- Treatment of Functional Psychosis
- Treatment of Uncomplicated cases of Psychiatric disorders associated
with Physical disease.
- Management of uncomplicated Psychosocial problems.
- Epidemiological survey/Surveillance of Mental Morbidity.

13. CONTD….
(C) District Hospitals–
- It was recognized that there should be atleast one Psychiatrist attached
to every district hospital.
- District Hospital should have 30-50 Psychiatric beds.
- Psychiatrist in the district hospital have to devote a part of his time to
clinical area and greater part in training and supervision of non-
specialized Health workers.
(D) Mental Hospitals and Teaching Psychiatric Units- Major activities of
these higher centres of Psychiatric care includes:
- Help in case of difficult cases
- Teaching
- Specialised facilities like occupational therapy units, Psychotherapy etc.

14. CONTD….
II. REHABILITATION:
The components of this sub-program includes treatment of epileptics and
psychotics at the community level and development of Rehabilitation
centres at both the district and high rereferral centres.
III. PREVENTION:
- The component is to be community based, with initial focus on
prevention and control of Alcohol related problems.
- Later on, problems like addiction, Juvenile delinquency and acute
adjustment problems like suicidal attempts are to be addressed.

15. STRENGTHS
◦ Proposed mutually synergistic integration of Mental Health Care with
Primary Health Care .
◦ Proposed to use P H Machinery
◦ Integration of all aspects of Teaching, Research and Therapeutics.

16. BARRIERS TO
IMPLEMENTATION OF NMHP
- Poor funding in the initial period
- Limited undergraduate training in Psychiatry.
- Inadequate Mental Health Human Resources.
- Lack of policy driven epidemiological date and research driven mental
health care policies.
- Limited number of models and their evaluation.
- Uneven distribution of resources across states.
- Non-implementation of Mental Heath Act, 1987
- Privatization of Healthcare in the 1990s.

17. LIMITATION OR WEAKNESS OF
NMHP
- The programme emphasized more on curative components rather than
preventive and promotive components.
- Role of support of families in the treatment of patient was not given due
importance.
- Short-term goals were given priority over the long term planning.
- The administrative structure of the programme was not clearly outlined.

18. DISTRICT MENTAL HEALTH
PROGRAMME (DMHP)
◦ NIMHANS developed a programme to operationalize and implement the
NMHP in a district. DMHP was launched in 1996 with an aim to achieve the
objectives of NMHP.
◦ Pilot project of District Mental Health Program was done at Bellary district in
Karnataka.
Components of the DMHP at Bellary were:
- Training for all primary care staff
- Provision of Six essential psychotropic and epileptic drugs (Chlorpromazine,
amitriptyline, trihexyphenidyl, injection fluphenazine deaconate,
phenobarbitone, and diphenylhydantoin) at all PHCs and subcentres.
- A system of simple mental health case records
- A system of monthly reporting
- Regular monitoring and feedback from the district level mental health team

19. OBJECTIVES OF DMHP
◦ To provide sustainable basic mental health services in community and
integration of these with other services.
◦ Early detection and treatment in community itself to ensure ease of care
givers.
◦ To see that patient and their relatives do not have to travel long
distances to go to hospitals or nursing homes in the cities
◦ To take pressure off mental hospitals
◦ To reduce stigma, to rehabilitate patients within the community.
◦ To detect as well as manage and refer cases of epilepsy.
◦ To treat and rehabilitate patients discharged from mental hospitals
within the community.

20. STRATEGIES OF DMHP
a) Service Provision: Provision of mental health out-patient and in-
patient mental health services with a 10 bedded inpatient facility.
b) Out-Reach Component:
◦ Satellite Clinics: 4 satellite clinics per month at CHCs/PHCs by DMHP
team
◦ Targeted Interventions: Life skills education and counselling in schools,
college counselling services, work place stress management and suicide
prevention services.
c) Sensitization and training of Health personnel: at the district and
sub-district levels

21. CONTD….
d) Awareness camps: For dissemination of awareness regarding mental
illness and related stigma through involvement of local faith healers,
teachers, leaders etc.
d) Community Participation: Linkage with self-help groups, family and
caregiver groups and NGOs working in the field of Mental Health.
◦ Sensitization of enforcement officials regarding legal provisions for effective
implementation of Mental Health Act.
◦ As of now, 241 districts have been covered under the scheme and it is
proposed to expend DMHP to all districts in a phased manner.
◦ Manpower (on contractual basis): Psychiatrist, Clinical Psychologist,
Psychiatric Nurse, Psychiatric Social worker, Community Nurse, Monitoring
and Evaluation Officer, Case Registry Assistant, Ward Assistant/ Orderly.
◦ Financial support @Rs. 83.2 Lakhs per DMHP.

22. NURSES ROLE IN NMHP
◦ Understanding the characteristics of mentally healthy person and
differentiate abnormal from normal behavior in the community.
◦ Provide first-aid during emergencies.
◦ Assist and co-ordinate the activities related to care of mentally ill in the
community health centre.
◦ Conduct mental health education to patient and their family members.
◦ Supervision and monitoring the activities of health worker related to
mental health care.
◦ Participate in various therapies, used in treating the psychiatric patients.
◦ Organize and coordinate the rehabilitation activity for mentally ill
people.