Guidelines for Schemes under National Mental Health Programme District Mental Health Programme 1.

The proposal of DMHP for a district shall be made in the approved format. DMHP focuses on integration of basic mental health services in general health care by training general health care functionaries to identify and manage a majority of mental disorders near the community. This would go a long way in addressing the perils of desocialisation and stigma widely associated with mental hospitals and mental illnesses. This would also maintain the family & community support which are vital for reintegration of the mentally ill individual in the community. Availability of essential psychotropic drugs, effective IEC, simple record keeping, establishment of linkages & community support are other measures in this integration. 2. State nodal officer of NMHP shall coordinate with district, zonal medical college /zonal mental health institute & health department in preparing proposals for DMHP for implementation in districts of the state. 3. Special care needs to be taken to provide the name of the nodal officer for the district and undertaking of the state government as per the format 4. In proposing a district for DMHP preference shall be given to districts underserved in psychiatric infrastructure i.e. districts not having a medical college psychiatric department or a mental health institute. 5. Adequate mechanism for implementation of DMHP (esp. Administrative) may be worked out before sending the proposal. Once proposal has been sub mitted state govt. must ensure its implementation and the DMHP activities shall not be delayed. 6. The Grant- in- Aid for DMHP shall be kept in a separate bank account opened for this specific purpose. The account shall be operated by two joint signatories’ viz. the nodal officer of the district and dean/principal/director/medical superintendent of the nodal institute. 7. If a psychiatrist is not available to run a DMHP, a GDMO from govt. service may be trained at NIMHANS, Bangalore or identified institutes for the DMHP so as not to delay the implementation of DMHP. State shall identify and send GDMO, for training in psychiatry to man DMHPs in district. 8. The CMO/DHO/Civil surgeon of the DMHP district must be involved from the beginning and DMHP shall be included in the monthly review meetings of the district. For all training activities advance intimation shall be given to the CMO/DHO/Civil surgeon for deputing doctors and staff for the training. The nodal institute may be roped in for conduction of activities. 9. The DMHP team must establish referral linkages for mental health care in the district from the primary to secondary and then tertiary level keeping in mind the available resources in the district and surrounding areas. 10. The DMHP team should be based at district headquarters preferably in the district hospital. It should travel to the field to supervise functioning of the programme, conduct awareness camps, and training of health workers and other concerned persons. The training of primary care physicians shall be undertaken at the district level. 11. Primary care doctors and staff must be involved in IEC activities under NMHP. Intensive IEC activities focusing on awareness creation, reducing stigma and availability of drugs and services at the primary level must be disseminated.

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12. In its regular report the nodal officer for the district should also indicate the number of cases of mentally ill seen by the primary care doctors who were trained by them. For this purpose they may provide a brief reporting format with broad diagnostic categories like Depression, Anxiety disorder, Psychosis, Mental Retardation, Seizure disorder, Substance abuse disorder, other disorder etc. and this may be collected monthly for compiling. Progress report should include the patients seen by primary care physicians in each block/PHC, availability of drugs , simple record keeping, training activities carried out, IEC activities conducted, fund utilised & fund remaining in each head, and difficulties encountered, if any regularly ( data should be collected month wise and forwarded to the center quarterly) by the state nodal officer for NMHP. 13. It should be ensured to stick to the budget heads as much as possible and utilise one installment within a year and put in a request for next installment as soon as 90 % fund is utilised. In the event of possibility of exhausting money in one or more budget head and where sufficient funds remain in other heads an application should be made to the Govt. of India for reappropriation. The request for reappropriation should be accompanied by the proposed reappropriation required from one head to the other well in advance so that programme doesn’t suffer adversely. 14. When 90% of the fund is utilised a UC in the prescribed proforma should be sent to the center by the nodal officer for the district. UC must be given financial year wise as much as possible. Only in the event of funds likely to be exhausted before the end of financial year a UC for part of the financial year should be sent. 15. The staff structure for DMHPs started in 10th plan and in the year 2007-08 till now is given in Annexure IV of the NMHP scheme guidelines. There is provision of a Psychiatrist, a Clinical Psychologist, a Psychiatric Social Worker, a Psychiatric nurse, a Record Keeper/Clerk and a Nursing orderly. The DMHP shall stick to this structure only. The staff for DMHP could either be appointed on contract basis or deputed from state government service. Remuneration of staff appointed under DMHP is either to be as per state government norms for similar staff or as per the scale given in Annexure IV. The staff working in DMHP is to be given usual allowances as admissible to similar staff in government service (e.g. DA, DP, HRA, NPA, CCA, TA etc.). Staff of DMHP may be given yearly increments as per scale upon satisfactory renewable of the contract as an incentive. 16. There is no provision of purchasing vehicle & employing driver under the DMHP. Field travel for supervision, IEC and training should be done by arranged/hired vehicle/public transport and the expense in this head should be covered under the head Miscellaneous/Contingency. 17. TA/DA for training activities shall be as per govt. norms. 18. If the funds remain unutilized for more than 18 months the institution has to refund it with interest to the center.

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Annexure -III YEAR WISE EXPENDITURE FOR NEW DISTRICTS UNDER DMHP S. No 1 2. 3. 4. 5. Item Staff Medicine/Stationery Contingencies Equipment Training IEC Total 1st Year 8.7 4.5 6.0 5.0 2.0 26.2 2nd Year 9.3 5.5 5.0 2.0 21.8 3rd Year 10.2 6.5 2.0 2.0 20.7 4th Year 11.2 7.5 2.0 20.7 Total 39.4 24.0 6.0 12.0 8.0 89.4

(As per 10th plan NMHP scheme)

Annexure -IV STAFF REQUIREMENT FOR EACH NEW DISTRICT AND ESTIMATED COST UNDER DMHP S. No 1. 2. 3. 4. 5. 6. Name of the Post Psychiatrist(Specialist) Clinical Psychologist Psychiatric Social Worker Psychiatric Nurse Record Keeper/ Clerk Nursing Orderly Total Scale of Pay (In Rs.) 10,000-15,200 6,500-10,500 5,500-9,000 5,000-8,000 3050-4950 2,550-3,200 Approx. Annual Cost (In Rs.) 2,68,800 1,62,000 1,46,000 1,36,600 80,000 69,000 8,61,800 (As per 10th plan NMHP sche me)

Up gradation of Govt. Medical College Psychiatry Department 1. The purpose of this Upgradation is to strengthen the training of Psychiatry at UG & PG Undergraduate, Postgraduate level and to assist the G ovt. medical colleges (including municipal medical colleges) to start PG training courses in psychiatry. 2. This assistance is for improvement of infrastructure like psychiatry ward, OPD, ECT room etc. & basic equipments related to psychiatry department. For physical work the proposal shall be accompanied by cost estimate by local engineering or works department.

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3. The Grant- in- Aid should be kept in a separate bank account opened for this specific purpose. The account should be operated by two joint signatories’ viz. the Head of Psychiatry department and the dean/principal/director/medical superintendent of the nodal institute. 4. Out of a maximum grant of Rs. 50 lacs equipments to the tune of Rs. 14 lacs could be purchased. The proposal should usually be as per the approved equipment list for this purpose (given as Annexure –I). In case other equipments are sought justification for the same should be provided. 5. As this is a one time grant for a department due care shall be taken for its optimal utilization. 6. The proposal of Upgradation of medical college Psychiatry department shall be made in the approved format. State nodal officer of NMHP shall coordinate with govt. medical colleges in the state for preparing proposal for upgradation of psychiatry departments in the state. 7. It is a pre requisite for need of funds The committed work shall finish within a period of 18 months(from release of funds) and UC and report should be submitted to the center 8. Regular progress report on quarterly basis must be sent to center by the head of the institute. This shall be ensured by the state nodal officer. 9. If the funds remain unutilized for more than 18 months the institution shall have to refund it with interest to the center. Annexure-I The approved list and rates for Equipment and machinery for funding under the scheme of Up gradation of Psychiatry Wing of Medical colleges/ General Hospitals by the Working Group on NMHP:
Equipment & Machinery List ECT machine with EEG monitoring Boyle’s Apparatus LCD Projector Computer 2 numbers ECG machine EEG machine Refrigerator (2 numbers) Water cooler Water filter Suction Apparatus ECG monitor + Oximeter Miscellaneous (e.g. Defibrilator) Total Approved rates 1 lakh 1 lakh 1 lakh 1 lakh 0.25 lakh 3 lakh 0.4 lakh 0.4 lakh 0.4 lakh 0.5 lakh 3 lakhs 2 lakhs 14 lakhs

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Modernisation of State run Mental Hospitals 1. This assistance is for modernisation of state run mental hospitals from custodial care to comprehensive management. This would involve improvement of infrastructure like psychiatry ward, OPD, ECT room, Equipments, kitche n, laundry, safe water, toilets, occupational therapy, infrastructure required for starting PG courses related to mental health etc. For physical work the proposal shall be accompanied by cost estimate by local engineering or works department. 2. This grant is for modernisation only and increase in the number of beds in the hospital is not permitted. 3. This is a one time grant up to a ceiling of Rs.3 crore for one mental hospital from the existing list of 37 govt. mental hospitals. 4. The proposal of modernisation of state run mental hospitals shall be made in the approved format and shall be coordinated by the State nodal officer of NMHP. 5. The required undertakings in exact wordings shall be submitted. 6. The committed work shall finish within a period of 18 months from the date of release of grant from the center and UC and report should be submitted to the center. 7. Regular progress report on quarterly basis must be sent to center by the head of the institute. This shall be ensured by the state nodal officer. 8. If the funds remain unutilized for more than 18 months the institution shall have to refund it with interest to the center.

Further clarification with regards to NMHP schemes may be sought from: Dr. Jagdish Kaur, CMO, Room No. 352-A, Dte.G.H.S. Nirman Bhavan, New Delhi-110108. Telefax: 011-23063120, jagdish.kaur@nic.in

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Form I

10th Five Year Plan: National Mental Health Programme Proposal for Central assistance for Modernisation of state –run mental hospitals (To be submitted to the MoH & FW, GOI through the State Government) 1. Name/location of the Mental Health Institute 2. Brief history, current administrative status (including annual budget, sanctioned / posted staff, shortfalls if any and other details)

3. Detailed profile of the Hospital, including those relating to OPDs, Wards, beds (authorized/ occupied- av. daily occupancy over the past three years), state of buildings/ annexes, general infrastructure etc. 4. Detailed proposal with regards to the projected requirement, justification, estimated cost. Time frame for each head, e.g. renovation/ remodeling of existing buildings new construction, purchase of costs and equipment, provision of infrastructure such as water- tankers and toilet facilities. Proposal should not exceed Rs 3 crores. (Requests for capital –intensive / clinically irrelevant facilities such as costly EEG/ cardiovascular monitors, CT scan, MRI etc will not be entertained.)

5. Undertaking from the head of the institution to the effect that all possible steps will be taken within a defined time frame to transform the hospital from a primary custodial care facility to a modern, community oriented mental health institution and that the utilisation certificate and action taken report will be submitted to the central government in a time bound manner.
6. Undertaking from the state government underwriting the requirements outlined in

para 5 above, together with the assurance that adequate staff as well as funds to meet recurring expenditure on consumable, maintenance and staff salaries will be provided to the mental hospital.

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Form II

10th Five Year Plan: National Mental Health Programme. Proposal for central assistance for Up grading of Psychiatry Departments in Government Medical Colleges. (To be submitted to the Ministry of Health, Govt . of India through the State Health Secretary.) 1. Name/location of the Medical College 2. Details of the zone assigned to the medical college, including names of the district with location of district headquarters, essential demographical/other relevant characteristics, existing health infrastructure, availability of Mental Health Services.

3. Name of the Principal, with tele/ fax No. e-mail address 4. Brief profile of the medical college, including essential information relating to undergraduate/PG courses/status of recognition by MCI of the same and other infrastructure available.

5. Detailed information relating to the existing psychiatric faculty (Posts sanctioned / filled) department, including, number of dedicated beds/ wards (male/ female, deaddiction centre if any) OPD/ treatment and investigative facilities/ teaching block, PG courses etc. 6. Details of community based outreach services being run by: (a) Community Medicine Department (b) Psychiatry Department (c) Any other

7. Detailed proposal for strengthening of the psychiatry Department with separate estimates for: (a) Physical works, which may include construction/ repair of ward, electrical fittings, essential hospital / cots, tables and other office furniture etc. (b) Equipment, which may include an indigenously manufactured digital EEG machine, brief – pulse ECT and biofeedback equipment but not CT Scan / MRI etc. (The proposal will not include recurring cost such as salary and other recurring expenses. The cost estimate may not exceed Rs. 50 Lakhs) 8. Undertaking from the principal of the Medical College to the effect that:

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(a) The principal will be responsible for proper fiscal management / accounting of all Central assistance funds routed through his institution for strengthening of the Psychiatry Departments in accordance with the guidelines / instructions issued by the Central Government from time to time. (b) The funds specified above will be utilized only for the purpose envisaged in the Central Government scheme in an economical and cost effective manner in accordance with the financial rules/ regulations governing the same. (c) The Utilization Certificate and Action Report will be submitted to the Central Government in a time bound manner 9. Undertaking from the State government underwriting the conditions prescribed in para 8 above, and taking full responsibility for their full and effective implementation, including adequate provision for recurring expenses towards consumables, maintenance and staff-salaries.

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Form III 10th Five Year Plan: National Mental Health Programme Proposal for central assistance for implementing DMHP (To be submitted to the MoH & FW, GOI by the State Government) 1. Name of District/District Headquarters 2. Detailed profile of the district, including essential demographic/socioeconomic/ geographical / other relevant characteristics such as connectivity, communication network etc. 3. Details of existing health infrastructure, including the current status of the district hospital (state of buildings, number of beds/ departments, investigation/other facilities, equipments, staff etc), CHCs and PHCs with special reference to shortages if any in critical areas like personnel, medical stores (expendable/non-expendable) 4. Current availability of mental health services (public/private sector) within and around the district, including the present channel of evacuation of mental, patients for psychiatric treatment. 5. Brief profile of the zonal medical college to which the DMHP will be affiliated for techno- managerial control, with special reference to the psychiatric faculty and facilities (inpatient/ outpatient, investigative/ therapeutic) available therein. 6. Connectivity and communication linkages between the district headquarters/district hospital and the zonal medical college, including the distance/ journey period by road and rail between the two. 7. Name/ telephone No/ Fax / e-mail address of the : (a) (b) (c) (d) District Magistrate. Civil Surgeon/ chief Medical Officer of the district. Principal of the zonal medical college. HOD Psychiatry/ Senior psychiatric facility.

8. Any other relevant information, including details of any centrally assisted mental health programme implemented in the past. 9. Undertaking from the state government to the effect that: (a) The state government shall take full responsibility for effective implementation of the programme as per the guidelines issued by the Union MOH & FW from time to time, and for continuous online monitoring of the same to ensure cost-effective utilization of resources (b) The funds/staff/equipment intended for the programme will be made available expeditiously to the actual users and the same will not be used for any other purpose.

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(c) The necessary infrastructural as well as administrative support will be made available by the district administration as well as the health department for the effective, time-bound implementation of the programme. (e) The zonal medical college will provide all techno managerial support and other assistance for the effective, time-bound implementation of the programme and will provide referral/ specialized investigative services as and when required. (f) The utilization certificate and action taken report will be submitted to the Central Govt. in a time bound manner. (g) The Districts will be sustained by the State Govt. at the end of completion of Central Assistance.

Note: While proposing a district, following points may be taken into consideration: (1) The District should be underserved in terms of mental health services. (2) There should not be a government psychiatric department in a medical college/ government general hospital or a mental hospital in that district. (3) That district should be accessible to a government psychiatric department in a medical college/ general hospital or a mental hospital. (4) That district should have a functioning health infrastructure such as PHC/CHC etc. (5) That district should be in a position to cater to the needs of 3 or 4 adjoining districts with a long term objective to cover the maximum area in whole of the state. Name of the nodal officer for the proposed district:

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