National Mental Health

Program (NMHP)
INTRODUCTIO
N• 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 this 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 behavioural disorders is enormous.
BURDEN OF MENTAL
HEALTH PROBLEMS
International scenario :
• The prevalence of mental disorders as per World
Health Report is around 10% and it is predicted that
burden of disorders is likely to increase to 15% by
2020.
• Depression alone accounts for 4.3% of the global
burden of disease and is among the largest single
causes of disability worldwide
• The Director General, World Health Organization
launched the Mental Health Action Plan 2013 - 2020
on 7th October 2013.(2030)

• The Action plan recognizes the essential role of

mental health in achieving health for all.

• It aims to achieve equity through universal health

coverage and stresses the importance of prevention
in mental health.
 OBJECTIVES OF Mental Health Action Plan till 2030

•To strengthen effective leadership and governance for mental health

• To provide comprehensive, integrated and responsive mental health

and social care services in community-based settings

• To implement strategies for promotion and prevention in mental health

• To strengthen information systems, evidence and research for mental health

Indian scenario
• Lifetime Prevalence of mental disorders in India is
12.3% for common mental disorders and 1.95% for
severe mental disorders.

• With such a magnitude of mental disorders, it

becomes necessary to promote mental health services
for the wellbeing of general population, in addition
to provide treatment for mental illnesses.
• NMHS reported an overall treatment gap of 83% for
any mental health problem.

• The treatment gap reported for common mental

disorders (85.0%) was higher when compared to
those for severe mental disorders (73.6%)

• For substance use disorders, the NMHS reports a

treatment gap of 90%.
HISTORY OF MENTAL
HEALTH SERVICES AND
INITIATIVES
Bhore committee
• The Bhore committee report in 1946 stated that the
prevalence of mental illness during that period was
estimated to be 2/1000 general population and India
had only 10,000 psychiatric beds and 30 institutions
for a population of over 400 million.
Mudaliar committee
• The Government of India appointed Health Survey
and Planning Committee in 1959, chaired by Dr
Mudaliar to assess the state of health care and review
the progress after the implementation of Bhore
committee’s recommendation.

• Committee submitted their report in 1962 and

identified that;
1. Reliable statistics were not available regarding the
burden of mental health problems/morbidity in
India.
2. There must be a huge number of patients requiring
assistance and treatment.
3. The provision for treatment of psychosomatic
diseases was limited.
4. There were no avenues for education of mentally
sick.
Srivastava committee
• The Srivastava Committee recommended the
Community health volunteer (CHV) scheme.

• CHV were supposed to provide their services to a

population of 1000.

• They also recommended that one of the manuals of

these workers should deal with identifying and
managing mental health emergencies and problems.
 Conceptual Antecedents of
•NMHP
Cognizance of the need to include mental health care in
the general public health care system was taken by the
NIMHANS, Bengaluru by starting of a “Community
Mental Health Unit” in 1975.

• Mental health needs assessment and situation analysis

in over 200 villages situated around the rural mental
health centre at Sakalwara in Bangalore rural district
covering a population of about 100,000 were carried
out.
• Simple ways of identifying and managing persons
with mental illness, epilepsy, mental retardation were
developed.

• The Mental Health education material was developed

which could be used by the MPW in rural areas.

• Manuals for PHC personnel were developed and it

was also decided that how the training’s provided to
the PHC personnel can be evaluated.
• The overall experience of Sakalwara Project led to
development of strategy for provision of Mental
Health care to the rural areas through the existing
primary health care network.
Birth of the
NMHP
• The experience and knowledge acquired from the
above pilot studies became the basis for drafting of
the National Mental Health Programme (NMHP).
• It was written by an expert drafting committee which
consisted of some of the leading, senior psychiatrists
in India and was reviewed and revised in two
national workshops attended by a large number of
mental health professionals and other stakeholders
during 1981-82.
• It was finally adopted for implementation by the
Central Council of Health and Family Welfare
(CCHFW), Government of India in August 1982.

• India thus became one of the first countries in the

developing world to formulate a national mental
health programme.
 National Mental Health
Program (NMHP)
• The Government of India launched the National
Mental Health Programme (NMHP) 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.

• The District Mental Health Program was added to the

Program in 1996.
• The Program was re-strategized in 2003 to
include two schemes
i. Modernization of State Mental Hospitals
ii. Up-gradation of Psychiatric Wings of
Medical Colleges/General Hospitals.

• The Manpower development scheme (Scheme-A

& B) became part of the Program in 2009.
Components
:
1. Treatment of Mentally ill

2. Rehabilitation

3. Prevention and promotion of positive mental

health.
Aims
:1. Prevention and treatment of mental
neurological disorders and theirandassociated
disabilities

2. Use of mental health technology to

general health
improve
services

3. Application of mentalhealth principles in total

national development to improve quality of life
Objectives:
1. To ensure the availability and accessibility of
minimum mental healthcare for all in the
foreseeable future;
2. To encourage the application of mental health
knowledge in general healthcare and in social
development;
3. To promote community participation in the mental
health service development; and
4. To enhance human resource in mental health sub-
specialties.
Strategies
:1. Integration mental health with primary health care
through the NMHP

2. Provision of tertiary care institutions for treatment

of mental disorders

3. Eradicating stigmatization of mentally ill patients

and protecting their rights through regulatory
institutions like the Central Mental Health
Authority, and State Mental Health Authority.
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
District and Sub-district
Level Activities Under
NMHP
DISTRICT MENTAL
HEALTH PROGRAM
(DMHP)
• NIMHANS developed a program 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.
The main objectives of DMHP were;
1. To provide sustainable basic mental health services
in community and integration of these with other
services.
2. Early detection and treatment in community itself
to ensure ease of care givers.
3. To take pressure off mental hospitals.
4. To reduce stigma, to rehabilitate patients within the
community.
5. To detect as well as manage and refer cases of
epilepsy.
Strategies:
a) Service provision: provision of mental health out-
patient & 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 &
counseling in schools, college counseling services,
work place stress management, and suicide
prevention services
c) Sensitization & training of health personnel: at the
district & sub-district levels
d) Awareness camps: for dissemination of awareness
regarding mental illnesses and related stigma through
involvement of local faith healers, teachers, leaders etc
e) Community participation:
• Linkages with Self-help groups, family and caregiver
groups & 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 & it is proposed to expand DMHP to all
districts in a phased manner.
• Manpower (on contractual basis): Psychiatrist,
Clinical Psychologist, Psychiatric Nurse, Psychiatric
Social Worker, Community Nurse, Monitoring &
Evaluation Officer, Case Registry Assistant, Ward
Assistant/ Orderly.
• Financial support @ Rs. 83.2 lakhs per DMHP.
PPP Model
Activities
• Under this component, there is a provision for the
state governments to execute activities related with
mental health in partnership with Non-Government
Organizations/Agencies as per the guidelines of the
NRHM in this regard

• Financial support @ Rs. 5 lakhs per NGO

 Day Care
•Centre
Provides rehabilitation and recovery services to persons
with mental illness so that the initial intervention with
drug & psychotherapy is followed up and relapse is
prevented.
• Helps in enhancing the skills of the family/caregiver in
providing better support care.
• Provides opportunity for people recovering from mental
illness for successful community living.
• Financial support of Rs. 6.00 lakhs is earmarked per
centre per year.
Residential/ Long Term
Continuing Care Centre
• Chronically mentally ill individuals, who have
achieved stability with respect to their symptoms &
have not been able to return to their families and are
currently residents of the mental hospitals, will be
shifted to these centers.
• Residential patients in these centers will go through a
structured program which will be executed with the
help of multidisciplinary team consisting of
psychologists, social workers, nurses, occupational
therapists, vocational trainers and support staff.

• Financial support of Rs. 9.00 lakhs is earmarked per

centre per year.
Community Health
Centers
Services available:
• Outpatient services & services for
inpatient emergency psychiatry
patients;
• Counseling services.
Manpower:
• Medical Officer;
• Clinical Psychologist or Psychiatric Social Worker
Primary Health
Centers
Services available:
• Outpatient services;
• Counseling services in accessing social care benefits;
• Pro-active case findings and mental health promotion
activities

Manpower:
• Community Health Workers (Two)
THE TEAM OF WORKERS AT THE DISTRICT UNDER THE PROGRAME

● Psychiatrist
● Clinical Psychologist
● Psychiatric Social Worker
● Community Nurse
● Programme Manager
● Case Registry Assistant
● Record keeper
WARNING SIGNS OF MENTALLY ILL PERSONS
IN YOUNG C H I L D R EN
● Changes in school performance
● Poor grades despite strong efforts
● Changes in sleeping and eating habits.
● Hyperactivity
● Frequent temper tantrums.
IN O L D E R CHILDREN AND P R E
ADOLOSCENCE
● Substance used
● Inability to cope with problem and daily activities.
● Changes in sleeping and eating.
● Excessive complaint of physical alignment.
● Changes in ability to manage responsibilities at home
and school.
● Prolonged negative mood often accompanied by
poor appetite or thoughts of death.
IN ADULTS- YOUNG ADULTS
● Confused thinking
● Prolonged depression
● Feeling of extreme high and low
● Excessive fear and anxiety
● Social withdrawal.
● Dramatic changes in eating and sleeping habits
● Strong feeling of anger.
● Strong thoughts(Delusion)
● Seeing of hearing things that are not
there(Hallucination) & Suicidal thoughts.
Mental Health
Services
• Mental health services will be delivered through
Government Mental hospitals or Medical
colleges/hospitals with Department of Psychiatry.

• Under the overall supervision of the Head of

Psychiatry Department.

• Financial support of up-to Rs. 15.00 lakhs per year

per medical college/hospital/mental hospital
 Mental Health
•Helpline
A country wide 24 hours dedicated help-line to provide
information to public on mental health resources,
emergency situation and crisis management,
information pertaining to destitute mentally ill patients,
registration of complaints on Human Rights Violation
of mentally ill and assistance on medico-legal issues.
• Linked with district medical
college/hospitals, mental hospitals, private
hospitals,
health facilities, NGOs and all other mental mental
health service providers of the state.
Monitoring &
Evaluation
• Standard formats for recording and reporting have
been developed and circulated.

• These will be used by medical colleges/institutes

(under Manpower Development Scheme), District,
CHC and PHC.

• Continuous evaluation of the activities of the

program is being done.
Central IEC (information education and
communication)
• The central level dedicated website will
introduced to provide on hands information be
mental health resources, activities, plans, policy and
on
programmes.
• Extensive mass media activities will be supported at
district and sub-district level. The support for TV
/Radio programs and innovative media campaigns on
mental health in vernacular languages through local
channels and other media.
 Central Mental Health
•Team
A Central Mental Health Team would supervise and
implement the programme and provide support to the
Central Mental Health Authority.

• Team would consist of one Consultant (Mental Health),

one Consultant (Public Health) and two Research
Associates.

• Budget Provision for Central Mental Health Team for a

period of 3 years is Rs 1.17 cr
Mental Health Information
System
• An online data monitoring system and will also
facilitate bilateral communication between
participating units.

• It is expected to bring significant improvement in the

implementation as there shall be possibility of mid
course correction based on the feedback.
Training/Workshops
• Trainings will be provided to master trainers from
each state/UT who shall further train DMHP team and
other staff working in the field of mental health.
• Trainings will be standardised and delivered at
identified centres.
• The standardized training manuals are being
formulated and circulated to all stakeholders.
• Budget for the remaining Plan period is Rs. 15.00 cr
(Rs. 5.00 cr per year).
Limitations of
NMHP
On the other hand there was some inherent weakness
of this model of care:

1. The program emphasized more on curative

components rather than the preventive and
promotive components;

2. Role of support of families in the treatment of the

patient was not given due importance;
3. Short term goals were given priority over the long
term planning;

4. The administrative structure of the program

was not clearly outlined;
NURSES ROLE IN NMHP/MENTAL HEALTH SERVICES

● Understand the characteristics of mentally healthy person and

differentiate abnormal form normal behavior in the community.
● Identified refer follow up the mentally ill person in the community.
● Provide first aid during emergencies.
● Assist and co-ordinate the activities related to care of mentally ill in
the community health center.
● Conduct mental health education to pt. and there family
members.
● Providing training to health worker in mental health care.
● Supervision and monitor the activities of health worker related
mental health care.
● Participate in various therapies used in treating psychiatric pt.
● Assist medical officer and co-ordinate the progress activity related
to NMHP.
● Organize and co-ordinate the rehabilitation activity for mentally ill
the community.
CONCLUSION
• In the IXth five year plans, NMHP got specific
budgetary allocation of 28 crores and the major focus
during these five years was on DMHP.

• The Xth five year plans were introduced in 2003

after In-depth analysis and consultations with the
stakeholders.

• There was several folds increase in the budgetary

allocation for the program.
• XIth five year plan focused on centers of excellence in
mental health and the manpower development in the
field of mental health.

• Over the years it has been observed that the focus on

community mental health is of utmost importance and
DMHP needs to be strengthened in view of its
coverage and utilization of its service components.
• Public awareness and IEC programs need to be the
most important components for a change to happen
at the community level as is true for many other
public health programs.

• Further NMHP had major focus in rural sector but

the urban mental health needs to be addressed
equally hence NMHP has been gradually been
mainstreamed into National health mission.
• The NMHP in the XIIth plan will have expansion of
all existing components and additionally has a
special focus on the vulnerable and marginalized
sections of the society.

• The monitoring and evaluation component is inbuilt

in the program and the outcomes of the NMPH at the
end of the XIIth plan will set the ball rolling for
brainstorming over the success and the failures of
the program
References
• National Mental Health Programme, Directorate General of
Health Services, Ministry of Health & Family Welfare.
[internet] [cited on 19/02/2019] Available from
http://dghs.gov.in/content/1350_3_NationalMentalHealthProgr

amme.aspx

• Muthy RS. National Mental Health Survey of India 2015-

2016.
Indian J Psychiatry 2017;59(1):117

• National Mental Health Programme. National Health Portal.

[internet] Oct 24, 2018. [cited on 20/20/2019] Available from
• K. Park. Park’s Textbook of Preventive and Social Medicine.
23rd edition. Jabalpur. Bhanot. January 2015

• Roy S, Rasheed N. The National Mental Health Programme of

India. International Journal of Current Medical And Applied
Sciences, 2015, June, 7(1), 07-15.

• Khurana S, Sharma S. National mental health program of

India: a review of the history and the current scenario. Int J
Community Med Public Health. 2016 Oct;3(10):2696-2704