Understanding the Burden of Mental Disorders and the District Mental Health Program
Mental disorders such as depression, schizophrenia, and dementia affect a significant portion of the population in India. The National Mental Health Survey highlighted the prevalence of these conditions and the need for intervention. The District Mental Health Program aims to provide essential mental health services to the community, including early detection, treatment, and integration with general health services. Core components of the program involve human resource support, training, community awareness, and inter-sectoral linkages. Various services are provided under the program at different levels of healthcare facilities.
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Burden of Mental Disorders Mental disorders include: depression, bipolar affective disorder, schizophrenia and other psychosis, dementia, intellectual disabilities and developmental disorders. Ministry of Health and Family Welfare conducted a National Mental Health Survey through NIMHANS, Bengaluru in 12 States. Report of the Survey was released on 10/10/2016. Key findings of the survey are as under: Prevalence of mental morbidity, excluding tobacco use, of individuals above the age of 18 years was 10.6%. 150 million people in India were in need of intervention for mental disorders. 1 in 20 person in the country currently suffered from depression out of which 39% suffered from Severe Depression 0.9 % of the population was at high risk of suicide 3 out of 4 persons with mental disorders had disabilities affecting their work, family, education and other aspects of life. 2
District Mental Health Program (DMHP) Objectives : To provide basic mental health services to the community early detection & treatment of mental illness at the District Hospital Level and below (OPD/ Indoor & follow up) to integrate mental health services with general health services support of up-to Rs. 83.20 lakhs per district. Till date, a total of 692 districts have been supported under the Programme; 625 functional 3
District Mental Health Program (DMHP) - Core Components Human Resource Support Support for engagement of Psychiatrists, Clinical Psychologists, Psychiatric Social Workers, Medical Officer, Psychiatric and Community Nurse, Monitoring & Evaluation Officer, Case Registry Assistant and Ward Assistant Training of Medical Officers, Community Health Workers, Nurses, Pharmacists of CHC and PHC for integration of mental healthcare in general health care, for increasing reach of mental healthcare and to facilitate early diagnosis and management and follow-up of chronic cases. Community awareness- Awareness generation to increase help seeking behaviour and address stigma and discrimination faced by mentally ill people. Inter-sectoral linkages- with schools and colleges and Outreach clinics and camps Psychotropic drugs, equipment, IPD services and ambulatory support 4
Services Provided under DMHP S.No Level Services 1 District Hospital Outpatient services, Assessment Counseling /Psycho-social Interventions, Inpatient treatment (10 bedded) services, Psychotropic Drug 2 CHC level Outpatient services, Counseling services, Continuing care and support to persons with Severe Mental Disorders, Drugs, Ambulance Services 3 PHC level
SUPPORT UNDER DMHP S.No. Level Support Funds 1 District Hospital Manpower (Psychiatrist, Clinical Psychologist, Psychiatric Nurse, Psychiatric Social Community Nurse, Monitoring & Evaluation Registry Assistant, Assistants) Equipments, Drugs, Targeted Infrastructure of DMHP Centre Upto Rs 83.20 Lakhs (Recurring Rs. 74.20 lakhs for HR, IEC, Drugs, Training etc. Non-Recurring Rs. 9 lakhs Equipments (Rs. 6 lakhs) and Infrastructure ( Rs. 3 lakhs) Worker, Officer, Case Ward Interventions, 2 CHC level Manpower Clinical Psychologist/ Psychiatric Social Worker (Medical Officer, Rs.14.40 lakhs 3 PHC level Manpower (Community Health Worker) Training Rs.5.68 lakhs
DISTRICT MENTAL HEALTH PROGRAMME: ISSUES Out of all the districts in the country, States/UTs have sought support for implementation of the DMHP in only 692 districts. States/UTs should submit proposals through their PIPs for extending coverage to all remaining districts. States/UTs to ensure that all districts supported under the programme are functional: Bihar (81.5%), Haryana (86.36%), Jharkhand (41.66%), Telangana (60.60%), West Bengal (39.28%), Tripura (75%), A & N Islands (33.33%) & Puducherry (50%) States/UTs shall ensure timely release of funds to the State Program Division as per RoP. TRAINING OF MEDICAL PROFESSIONALS UNDER NIMHANS DIGITAL ACADEMY State Governments to encourage their Doctors, Psychologists, Social Workers and Nurses to enroll themselves for courses on mental health in the Digital Academy being run by NIMHANS, Bangalore, Lokpriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur & Central Institute of Psychiatry, Ranchi. 7
Tertiary Level Activities: The continuation of the Scheme has been approved for implementation till March, 2021 Manpower Development Schemes Establishment of Centre of Excellence (Scheme A) 25 Institutes Financial support upto Rs. 36.96 Cr is provided towards construction, technical & non-technical equipments, library and faculty salary to the existing Central and State Mental health Institutions for creation of PG Seats (Psychiatry: 4 seats; Clinical Psychology: 16 seats; Psychiatric Social Work: 16 seats; Psychiatric Nursing: 40 seats) Total 76 PG seats/ CoE Progress State Delhi Rajasthan Madhya Pradesh Uttar Pradesh Pradesh Institute IHBAS, Delhi (2010-11) SMS Medical College, Jaipur (2016-17) MGM Medical College, Indore (2016-17) King George Medical University, Lucknow (2016-17) 0 % Telangana Kakatiya Medical College, Warangal (2017-18) Institute of Mental Health, Hyderabad (2009-10) Institute of Psychiatry and Human Behaviour, Bambolim (2015-16) Institute of Mental Health, Amritsar (2015-16) S.P. Medical College, Bikaner (2016-17) Telangana Goa Punjab Rajasthan 0 % - 25 % 8
Strengthening/Establishment of Post Graduate Departments in mental health specialties (Scheme-B) - 47 PG Departments Financial support upto Rs. 2.90 Cr is provided towards capital works and faculty support to the existing Central and State Mental health Institutions for strengthening/establishment of one or more of the Post Graduate Departments in mental health specialties for creation of PG Seats (Psychiatry: 2 seats; Clinical Psychology: 8 seats; Psychiatric Social Work: 8 seats; Psychiatric Nursing: 20 seats) Progress State Institute Maharashtra Regional Mental Hospital, Pune (2015-16) Regional Mental Hospital, Thane (2015-16) Regional Mental Hospital, Nagpur (2015-16) J & K Sher-i-Kashmir Institute of Medical Sciences, Srinagar (2015-16) 0 % Madhya Pradesh Shyam Shah Medical College, Rewa (2016-17) Himachal Pradesh Indira Gandhi Medical College & Hospital, Shimla (2017-18) Karnataka Karnataka Institute of Medical Sciences, Hubbali (2017-18) 9
TERTIARY LEVEL ACTIVITES UNDER NATIONAL MENTAL HEALTH PROGRAMME: ISSUES The Institutes already supported under the Programme are to be made fully operational by March, 2021. PG courses under each mental health specialty to be conducted/ initiated with the required number of seats As per approval for continuation of the Scheme upto 2021, for the projects to be implemented by States/UTs, first instalment of the approved Central share will be released as an advance to the State/UTs. The remaining funds, are to be released on reimbursement basis after submission of the Utilization Certificates for the funds already released. Release of funds to the Institutes supported under Manpower Development Schemes would henceforth be on the basis of submission of UCs for the funds already released and further claims for reimbursement of expenditure incurred by the State Government from its own budget. 10
MENTAL HEALTHCARE ACT, 2017 Mental Healthcare Act, 2017 (came into force w.e.f. 29/05/2018) In pursuance of the provisions of the Mental Healthcare Act, 2017, Rules under the Act were also framed by the Central Government Provisions of the Act are to be implemented primarily by the State Governments. Priority actions required from the States Governments : establishment of State Mental Health Authorities creation of State Mental Health Authorities Funds establishment of Mental Health Review Boards framing of Rules and Regulations 11
MAJOR ISSUES MENTAL HEALTHCARE ACT, 2017 ISSUES State Mental Health Authorities yet to be established in Bihar, Haryana, Rajasthan, West Bengal, Delhi, A & N Islands, Chandigarh, Dadra & Nagar Haveli and Daman & Diu, Lakshadweep, Puducherry, Jammu & Kashmir, Ladakh Expeditious action needed on: Establishment of Mental Health Review Boards for a district or group of districts Creation of State Mental Health Authority Fund Adoption of the Rules framed by the Central Government/framing of rules by the States/UTs under Section 121 of the Act. Framing of Regulations by the State Mental Health Authorities under Section 123 of the Act. 12 .
THANK YOU 13
Seats created in Institutes supported under Scheme-A (Centres of Excellence) S.No. State Name of the Institute Year of initiation PG seats created/enhanced since implementation of the Scheme in the institute Total Clinical Psychology Psychiatric Social Work Psychiatri c Nursing Psychiatry Andhra Pradesh Hospital for Mental Care, Vishakhapatnam 1 2017-18 0 0 0 0 0 Delhi (Central Govt.) 2 Dr. RML Hospital, Delhi 2016-17 8 12 10 20 50 3 Delhi IHBAS, Delhi 2010-11 0 0 0 0 0 Institute of Psychiatry and Human Behaviour, Bambolim 4 Goa 2015-16 8 0 0 0 8 Dr. Rajendra Prasad Govt. Medical College, Kangra, Tanda Himachal Pradesh 5 2016-17 0 0 0 0 0 Psychiatric Diseases Hospital, Govt. Medical College, Srinagar 6 J&K 2009-10 21 8 0 0 29 14
S.No. State Name of the Institute Year of initiation PG seats created/enhanced since implementation of the Scheme in the institute Total Clinical Psychology Psychiatric Social Work Psychiatri c Nursing Psychiatry 7 Kerala IMHANS, Kozikode 2010-11 2 24 48 40 114 SCB Medical College Hospital, Cuttack 8 Odisha 2010-11 27 56 24 120 227 Institute of Mental Health, Hyderabad 9 Telangana 2009-10 0 0 0 0 0 Kakatiya Medical College, Warangal 10 Telangana 2017-18 0 0 0 0 0 West Bengal Institute of Psychiatry, Kolkata 11 2009-10 18 72 144 140 374 West Bengal Calcutta National Medical College 12 6 2017-18 6 0 0 0 15
Seats created in Institutes supported under Scheme-B (PG Departments) S.No. State Name of the Institute PG seats created/enhanced since implementation of the Scheme in the institute Total Clinical Psychology Psychiatric Social Work Psychiatric Nursing Psychiatry Delhi (Central Govt.) Dr. RML Hospital, Delhi (3 PG Departments in 2009-10) 1 - 32 18 60 110 Indira Gandhi Medical College & Hospital, Shimla (2 PG Departments in 2017-18) Himachal Pradesh 2 - 0 0 - 0 Sher-i-Kashmir Institute of Medical Sciences, Srinagar, (4 PG Departments in 2015-16) Jammu and Kashmir 3 0 0 0 0 0 Ranchi Institute of Mental Health & Neuro Sciences, Ranchi (4 PG Departmetns in 2009-10) 4 382 Jharkhand 10 138 138 96 Govt. medical College, Trivandrum (4 PG Departments in 2010-11) 5 24 Kerala 24 0 0 0 Institute of Mental Health, Chennai (3 PG Departments in 2010-11) 16 6 Tamil Nadu - 32 - 4 36
District Mental Health Programme Status update on the conditionalities for implementation of NMHP (Indicators for 2020-21) Sl. No Name of the State /UT % district covered under Mental Health Progrmme and providing services as per framework Total Number of Districts Approved 20-21 Action taken for fulfillment of provisions under Mental Healthcare Act, 2017 (MHCA 2017) Percentage % Constituted State Mental Health Authority (Yes/No) 100% Yes No of Districts No of Districts Functional Constituted State Mental Review Board (Yes/No) Created State Mental Health Authority fund (Yes/No) 1 Andhra Pradesh 13 13 13 No No 2 3 4 5 6 7 Bihar Chhattisgarh Goa Gujarat Haryana Himachal Pradesh 38 27 02 33 22 12 31 27 02 33 22 12 31 27 02 33 19 12 81.5% 100% 100% 100% 86.36% 100% No Yes Yes Yes No Yes No Yes No Yes No Yes No Yes Yes Yes No Yes 8 J&K Jammu J&K Kashmir Jharkhand Karnataka Kerala Madhya Pradesh 10 10 24 31 14 51 10 10 12 31 14 51 10 10 5 31 14 51 100% 100% 41.66% 100% 100% 100% No No Yes Yes Yes Yes No No Yes Yes No No No No No Yes No No 9 10 11 12 13 14 15 16 17 18 Maharashtra Odisha Punjab Rajasthan Tamil Nadu Telegnana 36 30 22 33 37 33 34 30 22 33 32 33 34 30 22 33 32 20 100% 100% 100% 100% 100% 60.60% Yes Yes Yes No Yes Yes No No Yes No Yes No No Yes Yes No Yes Yes 17
District Mental Health Programme Status update on the conditionalities for implementation of NMHP (Indicators for 2020-21) % district covered under Mental Health Progrmme and providing services as per framework Action taken for fulfillment of provisions under Mental Healthcare Act, 2017 (MHCA 2017) Sl. No Name of the State /UT Total Number of Districts No of Districts Approved 20-21 No of Districts Functional Percentage % Constituted State Mental Health Authority (Yes/No) Constituted State Mental Review Board (Yes/No) Created State Mental Health Authority fund (Yes/No) 19 Uttar Pradesh 75 75 75 100% Yes 13 Yes 20 21 22 Uttarakhand West Bengal Arunachal Pradesh Assam Manipur Meghalaya Mizoram 13 27 25 13 28 09 13 11 06 100% 39.28% 66.33% Yes No Yes Yes No No Yes No Yes 23 24 25 26 27 16 11 9 27 16 11 9 27 16 11 9 100% 100% 100% 100% Yes Yes Yes Yes No Yes Yes No Yes Yes No Yes 27 28 29 Nagaland Sikkim Tripura 11 4 8 11 4 8 5 4 6 100% 100% 75% Yes Yes Yes No Yes Yes No Yes Yes 18
District Mental Health Programme Status update on the conditionalities for implementation of NMHP (Indicators for 2020-21) Sl. No Name of the State /UT % district covered under Mental Health Progrmme and providing services as per framework Total Number of Districts d 20-21 Action taken for fulfillment of provisions under Mental Healthcare Act, 2017 (MHCA 2017) Constitute d State Mental Health Authority (Yes/No) (Yes/No) No of Districts Approve No of Districts Functional Percenta ge % Constituted State Mental Review Board Created State Mental Health Authority fund (Yes/No) No No No No No No No No 30 31 32 A& N Islands Chandigarh D&N Haveli Daman & Diu Delhi Ladhak Lakshadweep Pondicherry 3 1 1 2 11 2 1 4 3 1 1 1 5 2 1 2 1 1 1 1 5 2 1 1 33.33% 100% 100% 100% 100% 100% 100% 50% No No No No No No No No No No No No No No No No 33 34 35 36 19
