COMMUNITY MENTAL HEALTH PROGRAM-NATIONAL MENTAL HEALTH PROGRAM AND CHANGING FOCUS OF CARE, COMMUNITY MENTAL HEALTH IN INDIA, NATIONAL MENTAL HEALTH PROGRAM DISTRICT MENTAL HEALTH PROGRAMME. COMMUNITY MENTAL HEALTH-PSYCHIATRIC NURSE ATTRIBUTES
CCOMMUNITY MENTAL HEALTH PROGRAM-NATIONAL MENTAL HEALTH PROGRAM AND CHANGING FOCUS OF CARE
1. SEMINAR ON COMMUNITY MENTAL
HEALTH PROGRAM-NATIONAL MENTAL
HEALTH PROGRAM AND CHANGING FOCUS
OF CARE
Presented by
Selvaraj.p
Ph.D Scholar
Oct-2019 Batch Guide
Dr.Sasi.Vaithilingan
Professor Cum Vice-Principal
VMCON Pondicherry.
2. OBJECTIVES
Define the concepts of care associated with the public
health model
Articulate how the components of community-based
health care compared with those of community
mental health
Identify the types of community mental health
services that are available to psychiatric clients
Discuss primary, secondary, tertiary prevention of
mental illness within the community.
Analyze the role of the community mental health
nurse. 1/13/2021 VMRF (DU) NSG 19 OCT 07
3. INTRODUCTION
• Community Mental Health Nursing is the
application of knowledge of psychiatric nursing in
promoting and maintaining mental health of
people, to help in early diagnosis and care and to
rehabilitate the clients after mental illness.
• The Community Mental Health Programme includes
all community facilities pertinent in any way to
prevention, treatment and rehabilitation1/13/2021 VMRF (DU) NSG 19 OCT 07
4. DEFINITION
• COMMUNITY PSYCHIATRY - The branch of Psychiatry
concerned with the development of an adequate
and coordinated program of mental health care for
residents of specified catchment areas.
• Psychiatry focusing on the detection, prevention,
early treatment, and rehabilitation of patients with
emotional disorders and social deviance as they
develop in the community.
1/13/2021 VMRF (DU) NSG 19 OCT 07
5. Con’t
• Community psychiatric nursing is the application of
specialized knowledge to population communities
• To promote and maintain mental health,
• To rehabilitate population at risk.
• Psychiatric nurse must possess knowledge about
community resources.
• The Community health nurse conducts a continuing
and comprehensive practice that is preventive, curative
and rehabilitative1/13/2021 VMRF (DU) NSG 19 OCT 07
6. CREATIVE COMMUNITY-BASED MENTAL HEALTH
PROGRAMS
Type of Program Description of Program Goal of Program
Nurse–family
partnership
Located in 270 communities
in 23 states; nurses visit high-
risk pregnant women
Teach positive
parenting and coping
skills
School-based
mental health
Located in Dallas, Texas;
formed by a school principal
and physician; nurses and
counselors visit students
Identify mental health
problems of students
Tailor classroom
activities to meet
specific needs1/13/2021 VMRF (DU) NSG 19 OCT 07
7. Improving Mood &
Providing Access to
Collaborative
Treatment (IMPACT
Located in California;
consists of a mental
health professional
and medical team
Identify depression in
older adults
Care for the homeless Located in California Identify the homeless
Provide safe housing
Engage them in care
Suicide prevention Located in the U.S. Air
Force
Encourages personnel
to seek help for
emotional pain and
trauma Provides
education and training1/13/2021 VMRF (DU) NSG 19 OCT 07
8. COMMUNITY MENTAL HEALTH IN INDIA
• The Western concept of Community Psychiatry is in
short, the extension of a wide mental health
infrastructure already in existence.
• The development of the mental health services in India
shows interesting trends over the last 45 years.
• The initial emphasis was on mental hospitals, which
shifted to setting up of the general hospital psychiatry
units - as suggested by The Bhore Committee (1946),
which later shifted to a community program.1/13/2021 VMRF (DU) NSG 19 OCT 07
9. PHASE OF DEVELOPMENT
• Primary Health Center
• Mental health services - the setting up of General
Hospital Psychiatric Units (GHPUs)
• Mental health services - the community care
approach.
• Two canters that took up community mental health
work in 1975were Bangalore and Chandigarh
1/13/2021 VMRF (DU) NSG 19 OCT 07
10. FOCUSES OF CMHP
• Provide mental health care in the community
• Focus services on a total community or population
• Focus on preventive and promotive services
• Provide continuity and comprehensiveness of services
• Provide indirect services such as consultation and
mental health education
• Include selection and training of primary care workers
from the local community in order to provide basic
mental health care 1/13/2021 VMRF (DU) NSG 19 OCT 07
11. NATIONAL MENTAL HEALTH PROGRAM
• The World Bank report (1993) revealed that the
Disability Adjusted Life Year (DALY) loss due to
neuro-psychiatric disorder is much higher than
diarrhea, malaria, worm infestations and
tuberculosis if taken individually.
• According to the estimates daily loss due to mental
disorders are expected to represent 15% of the
global burden of diseases by 2020.
1/13/2021
VMRF (DU) NSG 19 OCT 07
12. Con’t
• These initial attempts have been taken by the Severe
Mental Morbidity study of ICMR since 1979,
• All these studies and experiences have made it possible
to consider launching community psychiatry programs
in a bigger scale.
• The National Mental Health Programme (NMHP) which
was recommended for implementation by the Central
Council of Health and Family Welfare in its meeting on
18-20 August 1982.
1/13/2021 VMRF (DU) NSG 19 OCT 07
13. AIMS
• Prevention and treatment of mental and
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.
1/13/2021 VMRF (DU) NSG 19 OCT 07
14. OBJECTIVES
• Basic mental health cares to all the needy especially the poor
• Application of mental health knowledge in general health care
• Promotion of community participation in mental health service
development.
• Prevention and treatment of mental and neurological disorders.
• Use of mental health technology to improve general health
services.
• Application of mental health principles in total national
development to improve quality of life.
1/13/2021 VMRF (DU) NSG 19 OCT 07
15. APPROACHES
• Integration of mental health care services with the
existing general health services.
• Utilization of the existing infrastructure of health
services and also delivers the minimum mental health
care services.
• Provision of appropriate task-oriented training to the
existing health staff.
• Linkage of mental health services with the existing
community development program.
1/13/2021
VMRF (DU) NSG 19 OCT 07
16. STRATEGIES
• Integration mental health with primary health care
through the NMHP
• Provision of tertiary care institutions 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.
1/13/2021 VMRF (DU) NSG 19 OCT 07
17. MENTAL HEALTH CARE
• The mental morbidity requires priority in mental
health treatment
• Primary health care at village and sub center level
• At Primary Health Center level
• At the District Hospital level
• Mental Hospital and teaching Psychiatric Units
1/13/2021 VMRF (DU) NSG 19 OCT 07
18. COMPONENTS OF NMHP
NMHP has 3 components:
• Treatment of Mentally ill
• Rehabilitation
• Prevention and promotion of positive
mental health
1/13/2021 VMRF (DU) NSG 19 OCT 07
19. Treatment-Multiple levels
A. Village and sub-canter level multipurpose workers (MPW)
and health supervisors (HS), under the supervision of
medical officer(MO)
• Management of psychiatric emergencies
• Administration and supervision of maintenance treatment
• Diagnosis and management of grandmal epilepsy, especially
in children
• Liaison with local school teachers and parents regarding
mental retardation and behavioral problems in children
1/13/2021 VMRF (DU) NSG 19 OCT 07
20. B. MO of Primary Health Centre (PHC) aided by HS
• Supervision of MPW's performance
• Elementary diagnosis
• Treatment of functional psychosis
• Treatment of uncomplicated cases of psychiatric
disorders associated with physical diseases
• Management of uncomplicated psychosocial
problems
• Epidemiological surveillance of mental morbidity
1/13/2021 VMRF (DU) NSG 19 OCT 07
21. C. District hospital
• It was recognized that there should be at least one
psychiatrist attached to every district hospital as an
integral part of the district health services.
• The district hospital should have 30-50psychiatric beds.
• The psychiatrist in a district hospital was envisaged to
devote only a part of his time to clinical care and a
greater part in training and supervision of non-
specialist health workers
1/13/2021 VMRF (DU) NSG 19 OCT 07
22. D. Mental hospitals and teaching psychiatric units
• Help in care of 'difficult' cases
• Teaching
• Specialized facilities like
Occupational Therapy Units,
Psychotherapy,
Counseling ,
Behavioral Therapy.1/13/2021 VMRF (DU) NSG 19 OCT 07
23. II. REHABILITATION
• The components of this sub-program include
treatment of epileptics and psychotics at the
community levels and development of
rehabilitation centres at both the district level
and higher referral canters.
1/13/2021 VMRF (DU) NSG 19 OCT 07
24. III. PREVENTION
• The prevention component is to be
community based, with initial focus on
prevention and control of alcohol-related
problems.
• Later on, problems like addictions, juvenile
delinquency and acute adjustment problems
like suicidal attempts are to be addressed1/13/2021 VMRF (DU) NSG 19 OCT 07
25. DISTRICT MENTAL HEALTH PROGRAMME
GOI launched DMHP in 1996 Following objectives :
• Provide basic mental health services and integration
of existing services
• Early detection and treatment
• Prevent long distance travelling for pts
• To take pressure of mental hospitals
• Reduce stigma attached to mental illness thru IEC
• To treat and rehabilitate discharged pts1/13/2021 VMRF (DU) NSG 19 OCT 07
26. COMPONENTS DMHP
• Training programmes of all workers in the mental health team
at the identified Nodal Institute in the State.
• Public education in the mental health to increase awareness
and reduce stigma.
• For early detection and treatment, the OPD and indoor
services are provided.
• Providing valuable data and experience at the level of
community to the state and Centre for future planning,
improvement in service and research.
1/13/2021 VMRF (DU) NSG 19 OCT 07
28. ROLE OF NURSE
• Provide basic care to patients
• Conducting therapies and health education to pts
and family
• Training of professionals and non professionals at
taluka and PHCs about mental health
• Supervise MPWs in mental health care delivery.
• Assist psychiatrists in research activties.
1/13/2021 VMRF (DU) NSG 19 OCT 07
29. THRUST AREAS FOR 10TH FIVE YEAR PLAN
1.District mental health programme in an enlarged and more
effective form covering the entire country.
2.Streamlining/ modernisation of mental hospitals.
3.Upgrading department of psychiatry in medical colleges and
enhancing the psychiatry content of the medical curriculum.
4.Strengthening the Central and State Mental Health Authorities
with a permanent secretariat.
5.Research and training in the field of community mental health,
substance abuse and child/ adolescent psychiatric clinics1/13/2021 VMRF (DU) NSG 19 OCT 07
30. THE PUBLIC HEALTH MODEL
• They include
• Primary prevention,
• Secondary prevention,
• Tertiary prevention
1/13/2021 VMRF (DU) NSG 19 OCT 07
31. PRIMARY PREVENTION
• Teaching parenting skills and child development
• Teaching physical and psychosocial effects of alcohol/drugs to
elementary school students
• Teaching techniques of stress management
• Teaching groups of individual’s ways to cope
• Teaching concepts of mental health to various groups
• Providing education and support to unemployed or homeless
• Providing education and support to other individuals
1/13/2021 VMRF (DU) NSG 19 OCT 07
32. SECONDARY PREVENTION
• Early identification of problems and prompts
initiation of effective treatment
• Ongoing assessment of individuals at high risk for
illness
• Provision of care for individuals in whom illness
symptoms have been assessed
• Referral for treatment of individuals in whom illness
symptoms have been assessed1/13/2021 VMRF (DU) NSG 19 OCT 07
33. TERTIARY PREVENTION
Helping clients learn or relearn socially appropriate behaviors
• Consideration of the rehabilitation process
• Teaching the client daily living skills and encouraging
independence
• Referring clients for various aftercare
• Monitoring effectiveness of aftercare services
• Making referrals for support services when required (e.g.,
some communities have programs linking individuals with
serious mental disorders to volunteers.
1/13/2021 VMRF (DU) NSG 19 OCT 07
34. COMMUNITY FACILITIES FOR PSYCHIATRIC
PATIENTS
• Suitable well-supported carers
• Suitable accommodation
• Suitable occupation
• Arrangements to ensure the patient's collaboration with
treatment
• Regular reassessment, including assessment of physical
health
• Effective collaboration amongst carers
• Continuity of care and rapid response to crises
1/13/2021 VMRF (DU) NSG 19 OCT 07
35. FACILITIES
1. Psychiatric hospitals
2. Partial hospitalization
3. Quarter way homes
4. Halfway home
5. Self-help groups
6. Suicide prevention centres
1/13/2021 VMRF (DU) NSG 19 OCT 07
36. OTHER
• Community group homes
• Large homes for long-term care
• Hostels
• Home care programs
• District rehabilitation centers
1/13/2021 VMRF (DU) NSG 19 OCT 07
37. COMMUNITY MENTAL HEALTH-PSYCHIATRIC NURSE
ATTRIBUTES
• Awareness of self, personal and cultural values
• Non-judgmental attitude
• Flexibility
• Problem solving skills
• Ability to cross service systems
• Knowledge of community resources
• Willingness to work with the family or significant others
• Understanding of the social, cultural and political issues
• Knowledge of political activism 1/13/2021 VMRF (DU) NSG 19 OCT 07
38. COMMUNITY MENTAL HEALTH PROGRAMME IN
RURAL TAMILNADU
• This is a brief report of a community mental health
rehabilitation programme carried out in a rural area in
Tamil Nadu by the Schizophrenia Research Foundation
(SCARF).
• SCARF is a non-governmental, non-profit organisation
in Madras, working for people with chronic mental
illness, and has been involved in community mental
health work in the past decade in urban slums and rural
areas
1/13/2021 VMRF (DU) NSG 19 OCT 07
39. OBJECTIVES
• To operate a community mental health programme in
the defined catchment area,
• Training lay volunteer workers to detect and manage
mental disorders,
• Operating a mental health service system in the area,
• Integration of mental health with primary health care
infrastructure in the area,
• Conducting periodic awareness programmes in the
community.
1/13/2021 VMRF (DU) NSG 19 OCT 07
40. COMPONENTS
• Training
• Mental health services
• Integration of mental health into primary care
• Awareness programmes
• Community involvement and empowerment
1/13/2021 VMRF (DU) NSG 19 OCT 07
41. PROS AND CONS OF CMHP
• PROS
• Shortens length of inpatient Stay
• Helps transition from hospital to community
• Cost effective
• Increased Acceptance
• Better Rehabilitation
• Family involvement
1/13/2021 VMRF (DU) NSG 19 OCT 07
43. 4 P’S OF EFFECTIVE COMMUNITY
PROGRAMME
• Political or planners' commitment
• Professional commitment
• Progress in mental health know-how
• Participation of the Community.
1/13/2021 VMRF (DU) NSG 19 OCT 07
44. INITIATIVES BY INSTITUTE OF MENTAL HEALTH
Out Reach Services of Institute of Mental Health
1. Counseling & Rehabilitation services at Seva Sadan
and YWCA.
2. Community services at
• District Mental Health Program at Trichy
• Psychiatric Health Centre, Poonamallee
• Beggars Care Camp, Melapakkam
• Half way Home for women YWCA1/13/2021 VMRF (DU) NSG 19 OCT 07
45. THE CHANGING FOCUS OF CARE
• In 1841, Dorothea Dix, a former schoolteacher,
began a personal crusade across the land on
behalf of institutionalized mentally ill clients.
• Her efforts resulted in more humane treatment of
persons with mental illness and the establishment
of a number of hospitals for the mentally ill.
1/13/2021 VMRF (DU) NSG 19 OCT 07
46. Con’t
• Deinstitutionalization continues to be the changing
focus of mental health care in the United States.
• Care for the client in the hospital has become cost
prohibitive, whereas care for the client in the
community is cost effective.
• The reality of the provision of health-care services
today is often more of a political and funding issue than
providers would care to admit.
• Decisions about how to treat are rarely made without
consideration of cost and method of payment1/13/2021 VMRF (DU) NSG 19 OCT 07
47. Con’t
• Provision of outpatient mental health services not
only is the wave of the future but also has become a
necessity today.
• We must serve the consumer by providing the
essential services to assist with health promotion or
prevention, to initiate early intervention, and to
ensure rehabilitation or prevention of long-term
disability
1/13/2021 VMRF (DU) NSG 19 OCT 07
48. COMMUNITY PSYCHIATRY UNIT AT NIMHANS
• Community psychiatry unit started at NIMHANS on
October 1975
• Aim :To develop suitable training programme for
doctors and multipurpose workers from PHCs
• Objectives: Organizing services Human resource
• Development-develop training materials and
conducting training programs
• Developing community based research Developing
various models of care.
1/13/2021 VMRF (DU) NSG 19 OCT 07
49. RURAL M H SERVICES
• Rural Mental health Center at Sakalwara (1976)
Take care of Physical as well as Psychiatric cases
Trained GDMO, PSW, Cl. Psychologists and
psychiatric nurses
• One satellite clinic-Anekal
• Training center/ Laboratory
1/13/2021 VMRF (DU) NSG 19 OCT 07
50. SATELLITE CLINIC
Objective
• Availability of Service
• Anekal 22 km from Sakalwara
• Every Tuesday
• Last Tuesday- for epilepsy(500-900)
• 50-70 psy. Cases/clinic
1/13/2021 VMRF (DU) NSG 19 OCT 07
51. CONSULTATION SERVICES
Objective
Impart professional input when necessary
Sustaining the project
NGOs working with mentally ill ,Mentally retarded
,Homeless ,Mental health/counseling, Disaster
affected population
1/13/2021 VMRF (DU) NSG 19 OCT 07
52. HOME CARE SERVICES
• Started in 1980s (Pai & Nagarajaiah,1981)
Multidisciplinary team make Home Visits
• Provide drugs/counseling
• Crisis intervention
• Relapse rate is almost nil after two years of
1/13/2021 VMRF (DU) NSG 19 OCT 07
53. SCHOOL MENTAL HEALTH PROGRAMS
• Detection and treatment
• Training of teachers
• Impart life skills to children
• To enhance psychosocial competence
• Holistic approach
1/13/2021 VMRF (DU) NSG 19 OCT 07
54. DISASTER MANAGEMENT PROGRAMS
• Psychosocial assessments
• Capacity building
• Support provisions
• Working with NGOs
• Development of models
• Evaluation exercises
• Policy implications
1/13/2021 VMRF (DU) NSG 19 OCT 07
55. CONTINUUM OF CARE IN THE 21 CENTURY
• As a result of the increase in computer accessibility, a health
care revolution has occurred on the World Wide Web.
• In the past, psychiatric–mental health Internet resources
were limited to library holdings and journal abstracts.
• clinicians are now able to obtain practice updates,
• Mental health care providers and consumers are venturing
into more direct therapeutic resources on the Internet.
• Chat rooms provide the client with the opportunity to access
support groups online.
1/13/2021 VMRF (DU) NSG 19 OCT 07
56. Con’t
• The nurse informatics may serve in several
roles such as facilitator, educator, researcher,
project manager, implementation specialist,
or client safety expert.
• This emerging leadership role will help
advance the continuum of care delivery
invaluably in the years to come1/13/2021 VMRF (DU) NSG 19 OCT 07
58. SUMMARY
The trend in psychiatric care is shifting from that of
inpatient hospitalization to a focus of outpatient
care within the community. This trend is largely due
to the need for greater cost-effectiveness in the
provision of medical care to the masses. The
community mental health movement began in the
1960s with the closing of state hospitals and the
deinstitutionalization of many individuals with
severe and persistent mental illness.1/13/2021 VMRF (DU) NSG 19 OCT 07
59. REFERENCE
1. Mary C. Townsend, Essentials of Psychiatric Mental Health Nursing,
FA Davis company publication, Philadelphia, 4th edition.
2. Louise Rebraca Shives, Basic Concepts of Psychiatric Mental Health
Nursing, Lippincott Williams & Williams’s publication, Flordia.8th
edition.
3. Gail W Stuart, Principles and Practice of Psychiatric Nursing, Elsevier
publication, Newdelhi, 8th edition.
4. https://vikaspedia.in/health/mental-health/national-mental-health-
programme
5. https://www.dinf.ne.jp/doc/english/asia/resource/apdrj/z13jo0300/
z13jo0310.html1/13/2021 VMRF (DU) NSG 19 OCT 07
