National Mental Health Programme

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National Mental Health Programme

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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 2021 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 a group of experts from not only the psychiatry and medical stream but also education, 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. Approaches To National Mental Health Programme: To achieve the objectives the following approaches were formed: I. 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. Appropriate appointment of tasks in mental health care: the tasks to be performed at each level (village workers, sub centre, PHC, district hospital,

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regional hospital) will be specified and a referral system set up so that the total system works in an integrated fashion. III. 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. 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. Linkage to community development: Involvement of state, district and block leadership in the implementation of the mental health programme to ensure community involvement in preventive efforts directed at psychosocial problems like alcohol, drug abuse, behaviour of childhood and adolescence, delinquency and other avoidable problems. Mental health care:

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The mental health care service was envisaged to include three components or subprograms namely treatment, rehabilitation and prevention.  Treatment sub programme Multiple levels were planned: A. Village and sub centre level: multi-purpose workers(MPW) and health supervisors, under the supervision of medical officer(MO), to be trained for: i. Management of psychiatric emergencies. ii. Administration and supervision of maintenance, treatment of chronic psychiatric disorders. iii. Diagnosis and management of grandma epilepsy, especially in children. iv. Liaison with local school teacher and parents regarding mental retardation and behaviour problems in children. v. Counselling in problem related to alcohol and drug abuse.

B. Primary health centre(PHC):MO, aided by HS, to be trained for: i. Supervision of MPW’s performance ii. Elementary diagnosis iii. Treatment of functional psychosis’ iv. Treatment of uncomplicated cases of psychiatric disorders associated with physical diseases v. Management of uncomplicated psychosocial problems vi. Epidemiological surveillance of mental morbidity. C. District hospital: it was recognised that there should be at least one psychiatrist attached to every district hospital as an integral part of district health services. The district hospital should have 30-50 psychiatric beds. The psychiatrist in a district hospital was envisaged to devote only a part of his time in clinical care and grater part in training and supervision on non-specialist health workers. D. Mental hospitals and training psychiatric units: the major activities of these higher centres of psychiatric care include: i. Help in case of ‘difficult’ cases. ii. Teaching. iii. Specialised facilities like occupational therapy units, psycho therapy, and counselling and behaviour therapy.  Rehabilitation sub programmes: The components of this subprogramme 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.

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REVISED GOALS FOR THE MENTAL HEALTH PROGRAMME I. II. Strengthening families and communities for the care of persons suffering from mental disorders. 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. Supporting through mental health initiatives rebuilding of social cohesion, community development, promotion of mental health and the rights of the persons with mental disorders. Eradicating stigmatization of mentally ill patient and protecting their rights through regulatory institutions like the central mental health authority and state mental health authority. Provision of tertiart care institutions for treatment of mental disorders. E.g (NIMHNS)

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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, and walk-in-clinics.  Society-centred Preventive Measures Community development social administration. Collection and evaluation of epidemiological, biostatisical data. 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, Support Groups. SUMMARY: 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.

ASSIGNMENT: What is NMHP? Briefly explain its objectives and role of nurse in the implementation of 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.

BIBLIOGRAPHY: 1. Ahuja Niraj, A Short Textbook of Psychiatry, VIth Edition, New Delhi; Jaypee Brothers (Pvt) Ltd,2001:Pp 251-254. 2. Kapoor Bimla, Textbook of Psychiaric Nursing, Vol-II, New Delhi; Kumar Publishing House, 2006: Pp 424-425. 3. Park K, Textbook of Preventive & Social Medicine,18th Edition, Jabalpur; Banarsidas Bhanot: Pp 347. 4. Literature from IGNOU, BNS-108, Mental Health Nursing, Block-4, IGNOU, New Delhi:2005:Pp 58-62.

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