NATIONAL MENTAL HEALTH PROGRAMME

INTRODUCTION:

Health is defined as a state of complete physical, mental and social wellbeing,

and not merely absence of disease or deformity.(WHO). Mental health therefore forms
an essential part of total health and as such forms an integral part of the national health
policy. Mental health is one of the essential component of patient care, this aspect was
neglected earlier. It is well established fact that mental health principles can improve
the health delivery care to patients. The government of India realizing that mental
health is an integral component of the total health formulated the- National Mental
Health Programme.

EVOLUTION OF NMHP:

The government of India felt the necessity of evolving a plan of action aimed at
the mental health component of the National Health Programme. For this, an expert
group was formed in 1980, who met a number of times and discussed the issue with
many important people concerned with mental health in India as well as with the
Director, Division of Mental Health, WHO, Geneva. Finally, in February 1981, a small
drafting committee met in lucknow and prepared the first draft of NMHP. This was
presented at a workshop of experts (over60 professionals) on mental health, drawn
from all over India at New Delhi on 20-21 july 1981. Following the discussion, the
draft was substantially revised and a new one was presented at the second workshop
on 2 August 1982 to agroup of experts from not only the psychiatry and medical
stream but also educaton, administration, law and social welfare. The final draft was
submitted to the Central Council of health, India’s highest health policy making body
at its meeting held on 18-20 August 1982, for its adoption as the National Mental
Health Programme for India. In this way NMHP came into existence.

Aims

Three aims are specified in the NMHP in planning mental health services for the
country:

1. Prevention and treatment of mental and neurological disorders and their

associated disabilities.
2. Use of mental health technology to improve general health services.
 3. Application of mental health principles in total national development to
improve quality of life.

OBJECTIVES
1. To ensure availability and accessibility of minimum mental health care for all in
the foreseeable future, particularly to the most vulnerable and underprivileged
sections of population
2. To encourage application of mental health knowledge in general health care and
in social development
3. To promote community participation in the mental health services development
and to stimulate efforts towards self-help in the community.

STRATEGIES FOR ACTION

Two strategies, complementary to each other were planned for immediate
action:
1. Centre to periphery strategy: establishment and strengthening of psychiatric
units in all district hospitals, with OPD clinics and mobile teams reaching the
population for mental health services.
2. Periphery to centre strategy : training of an increasing number of different
categories of health personnel in basic mental health skills, with primary
emphasis towards the poor and the underprivileged, directly benefiting about
200 million people.
APPROCHES TO NATIONAL MENTAL HEALTH PROGRAMME:
To achieve the objectives the following approaches were formed:

1.Diffusion of mental health skills: Instead of centralising mental health skills and
expertise in an urbanised community it should reach periphery (i.e. the primary health
care structure at the community level like PHC, Sub centres and Village level
workers). Mental health care must start at the grass root level.

2.Appropriate appointment of tasks in mental health care: the tasks to be performed at

each level (village workers, sub centre, PHC, district hospital, regional hospital) will
be specified and a referral system set up so that the total system works in an integrated
fashion.

3.Equitable and balanced territorial distribution of resources: Every effort will be made
to introduce or strengthen mental health first in those regions which are at present
deprived of it or where it is seriously deficient.
 4.Integration of basic mental health care into general health services: This will
facilitate in dealing with patients without gross psychiatric disturbances. It will enable
the health worker to identify psychosocial problems. Psychiatric mental health worker
will be able to identify and relate psychosocial factors contributing to ill health.
 Rehabilitation sub programmes: The components of this sub-programme
include maintenance treatment of epileptics and psychotics at the community levels
and development of rehabilitation centres at both the district level and the higher
referral centres.
 Prevention sub programme: The prevention component is to be community
based, with the initial focus on prevention and control of alcohol related problems.
Later, problems like addictions, juvenile delinquency and acute adjustments problems
like suicidal attempts are to be addressed.
 Mental health training.
 Mental retardation and drug dependence: Though these are not mental illness
still the health workers should be able to counsel the parents, provide public education
and knowledge to refer such children to social welfare agencies for rehabilitation.
REVISED GOALS FOR THE MENTAL HEALTH PROGRAMME
I. Strengthening families and communities for the care of persons suffering from
mental disorders.
II. Organisation of a wide range of mental health initiatives to support individuals
and families, with special focus on immediate delivery of the most essential services to
the ones with greater needs.
III. Supporting through mental health initiatives rebuilding of social cohesion,
community development, promotion of mental health and the rights of the persons
with mental disorders.
IV. Eradicating stigmatization of mentally ill patient and protecting their rights
through regulatory institutions like the central mental health authority and state mental
health authority.
V. Provision of tertiart care institutions for treatment of mental disorders. E.g
(NIMHNS)
The plan of action to achieve the goals consists of nine components:
 Organising services
 Provide community mental health care facilities
 Support to families
 Human resourse development
 Public mental health education
 Private sector mental health care
 Support to voluntary organisations
 Promotion and preventive activities
 Administrative support

DISTRICT MENTAL HEALTH PROGRAMME (DMHP)

The District Mental Health Programme as component of NMHP was launched in

1996-97 in four districts one each in Andhra Pradesh, Assam, Rajasthan and
Tamilnadu on the recommendation of the central council of health in 1995 and a
workshop for health administrators of the country was held in feb 1996 to discuss
about the problem of mental health. The DMHP was extended to 7 districts in 1997-
98, five districts in 1998-99 and six in 1999-2000, with the addition of 3 more districts
in 2000-01, this programme is under implementation in 25 districts in 20 states and
union territories.

The programme envisages a community based approach to deal with menatal health
problems in the country. It includes the following interventions:

1. Training programmes of all workers in the mental health team at the identified
Nodal Institute in the State.
2. Public education in the mental health to increase awareness and reduce stigma.
3. For early detection and treatment, the OPD and indoor services are provided.
4. Providing valuable data and experience at the level of community to the state and
Centre for future planning, improvement in service and research.

5. Funds are provided by the Government of india to the state government and the
nodal institutes to meet the expenditure on staff, equipments, vehicles, medicines,
stationery, training ,IEC activities etc.

6. The training to the trainer at the state level is being provided regularly by the
National Institute Of Mental Health and Neuro Sciences, Bangluru under the NMHP.

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 in order to modify their present

custodial role.
3. Upgrading department of psychiatry in medical colleges and enhancing the
psychiatry content of the medical curriculum at the undergraduate as well as
postgraduate level.

4. Strengthening the Central and State Mental Health Authorities with a permanent
secretariat. Appointment of medical officers at state headquarters in order to make
their monitoring role more effective;

5. Research and training in the field of community mental health, substance abuse and
child/ adolescent psychiatric clinics.

ROLE OF NURSE

 Three primary goals of community health nurse, Promotion of mental health,

Prevention of mental illness, Provision of holistic care and support for
individuals experiencing mental ill health.
 ROLE OF CHN IN PRIMARY PREVENTION
 Child care and child-rearing measures include: Antenatal care to mother
and educating her regarding the adverse effects of irradiation, drugs and
prematurity.
 Essential timely and efficient obstetrical assistance to guard against the ill
effects of anorexia, injury at birth,
 Liberalisation of laws regarding termination of pregnancy, when it is
unwanted
 Counselling of the parents of physically and mentally handicapped
children.
 Programmes to enrich child mother relationship by stressing the
importance of warm accepting intimate relationship.
 Programmes Oriented to the child in the school : Early signs of learning
difficulties or behavioural abnormalities should be detected, teachers
should be taught to identify the early symptoms of abnormal conduct and
behaviour in the children and refer cases.
 Family-Centred Activities Programs: Attitudes of mutual trust, love and
respect for one ,another need to be fostered . Educational services in the
field of mental health ,Parent -teacher associations Home-maker
services ,Child guidance clinics, Marital counselling.
 Programmes for Families in Crisis Crises like adolescence, Birth of a new
baby, Retirement or menopause, Death of a wage earner in the family,
 Desertion by the spouse can be Handled at mental hygiene clinics,
psychiatric first-aid centres, walk-in-clinics.
 Society-centred Preventive Measures Community development social
administration. Collection and evaluation of epidemiological, biostatisical
data. Budgeting These measures require coordinated activities among
persons belonging to different norms and disciplines.

ROLE OF CHN IN SECONDARY PREVENTION

 Early Diagnosis and Case Finding achieved by educating the

public and community leaders,mahila Mandals, Balwadis etc.
in recognising early symptoms.
 Early Reference.
 Screening programmes: Simple questionnaires should be
developed and administered.
 Early and Effective Treatment
 Mental Health Education: Mass camps and through film
shows, flash cards, and also through mass media
communication.
 Training of Health Personnel Orientation courses.
 Crisis Intervention

ROLE OF CHN IN TERTIARY PREVENTION

Accomplished by preventing complications of the mental illness & promoting

achievement of each individual’s maximum level of functioning through Regular
follow up, Diversion therapy, Recreation therapy, Community Mental Health
Facilities, Day-Evening Treatment/ Partial Hospitalization Programs, Community
Residential Facilities,
SUMMARY:
In this seminar we had learned about the definition of community mental
health, historical development of community mental health, development of
community mental health service in India, Inspiration for the community mental
health movement in India comes from three sources, critical account of the mental
health services in India and alternatives to institutional care. Today we have

discussed about NMHP, its evolution, objectives of NMHP, various approaches

to achieve the objectives of NMHP. Then we have discussed about DMHP
(District Mental Health Programme), its components and finally the role of
nurse in the implementation of National Mental Health Programme.

CONCLUSION:

National mental health programme is designed with a view to prevent

mental illness, promote mental health of the people. Therefore being a graduate
nurse, the knowledge and understanding of NMHP is essential, so that we can
better understand our role and take part in the implementation of these
programmes. Operationally community mental health means the process of
involving in raising the level of mental health among people in a community and
reducing the number of those suffering from mental disorders. Hence community
care has a better effect than institutional treatment on the outcome and quality of life
of individuals with chronic mental disorders. Community based services can lead to
early intervention and reduce the stigma of taking treatment.
BIBLIOGRAPHY:

 GAIL W.STUART “Principles and practice of Psychiatric Nursing” eighth

edition; published by Mosby; page no: 779

 Dr.K.LALITHA; “ Mental Health and Psychiatric Nursing an Indian

Perspective; First Edition 2007; VMG Book house publishers; page No: 635-

641

 KAREN SAUCIER LUNDY AND SHARYN JANES; “ Essentials of

Community based Nursing; First edition 2003; Jones and Barlett publishers;

page no: 34

 STANHOPE LANCASTER; “ Community health Nursing Process and

Practice for promoting health” Third Edition; 1992; Mosby Publishers; page

no:45-50

 K. PARK., “Text Book Of Preventive And Social Medicine” 20th Edition, M/s.
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 http://www.pubmed.nl/
 http://nnlm.gov/training/resources/pmtri.pdf
 www.ncbi.nlm.nih.gov/pubmed