Magnitude of Mental Disorders Prevalence : 6-7 % of the population (Reddy and Chandrashekhar 1998; and Ganguli 2000) Estimate as per World Health Report (2001) : 10% Neuropsychiatry disorders account for 12% of the Global Disease Burden (World Health Report, 2001) Preliminary Data from ECA Multicentric study: 9.6 %

Magnitude of Mental Disorders Burden of these disorders is likely to increase to 15% by 2020 (World Health Report, 2001) Estimated that a minimum of 7 crore persons would need immediate care for severe and moderate mental health problems

NMHP – 10 th Plan Rs. 139 crore was sanctioned. NMHP was restrategised in 2003.

10 th Plan Strategies Integration of Mental Health with primary health care through DMHP Strengthening psychiatry wings of medical colleges Modernisation of existing Mental Hospitals IEC Research and Training

Physical Targets Achieved – 10 th Plan SchemeGrants Sanctioned Grants Released Target 10 th Plan DMHP (No. of Districts) Mental Hospital (No. of Mental hospitals funded) Psychiatry Wing of MC/Gen. Hosp. (No. of inst.funded) Funds Released: Rs Crores

NMHP 10 th Plan - Constraints Lack of complete proposals from State governments The releases are not fully utilised for want of proper monitoring mechanism at State level DMHP could not be implemented effectively mainly due to shortage of manpower States are not willing to undertake the responsibility after 5 years Programme was not getting integrated in the district health plan

Strategy for 11 th plan Was developed through National consultation (2 days workshop) with all the nodal officers/ other stake holders at NIMHANS Inputs received from the State governments during National review meetings

Proposal for 11 th Plan Main components DMHP – Re-strategised Establishment of Regional Institutes of Mental Health & Neurosciences Training & Research IEC/NGO Monitoring & Evaluation

State Mental Health Cell  Nodal officer (Deputy Director Mental Health or the Joint Director Health) for monitoring the implementation of NMHP  Mental Health Technical Support Team -one consultant (psychiatrist) -one assistant/ DEO.  SMHC in consultation with P.O.s will work out a District specific plan based on the mental health resources available.

DMHP Activities Service provision to mentally ill Ensuring regular drug supply Referral to identified Med. College/Pvt. Psychiatrist Community mental health care by visiting CHCs/PHCs Training PHC doctors/health functionaries IEC Record keeping and reporting

DMHP Additional Services : Counseling Center School Mental Health Services College Counseling services Stress Management at work place Suicide prevention Participation of NGOs

DMHP - Proposed changes Instead of Psychiatrist/ psychiatric social worker/ clinical psychologist/psychiatric nurse, the programme would be run through trained medical officer/ social worker / psychologist/ nurse The District would be prepared before the programme is launched- separate provision has been made for engagement of required staff/ training /setting up of counseling center/identification of partner organisations Funds released through district health society

DMHP - Proposed changes 10 th Plan11 th Plan P.O. - PsychiatristTrained M.O. (3 months) Training of PHC doctor 2-3 weeks 3 +3 (6) days M.O.s trained/district 15-20% 100% Training of Health workers 2-3 weeks 1+1 (2) days Training not standardized Training by standardized training modules

DMHP - Proposed changes 10 th Plan11 th Plan School Mental Health Services, College Counseling services, Work place stress mgmt., Suicide prevention - Nil + Involvement of NGOs - Nil + District Preparatory phase – Not specified Pre requisite Record keeping and Reporting -Irregular Regular Monitoring - Irregular Regular

Implementation of DMHP  A Programme officer (P.O.) for each district would be identified and appointed by the State Govt. (in service M.O.)/ taken on contract  P.O. will be trained in Psychiatry and managerial skills for 3 months at identified institutions  Three months training for psychologist, social worker and four weeks training for nurses for manning DMHP  District will be linked with the nearby zonal Medical College for techno-managerial support  The funds for DMHP would be released through State Health Society/DHS

DMHP – Preparatory Phase After approval in State Health Society, DMHP team would be recruited & sent for training. Linkages would be established and a PIP for the district would be worked out. Infrastructure like counseling center, DMHP center etc. would be put in place

School Mental Health Services  Life Skills Education using standard training manuals  Counselling services through trained teachers/ Hired Counsellors  Involvement of the NGOs

College Counselling Services  Provided by trained teachers of psychology department of the colleges  The P.O. will organise the training at the district level in close co-ordination with the Dept of Collegiate Education  The trained teachers will act as counselors and as referral and support-giving agents in their respective colleges

Suicide Prevention Services Sensitization workshops Crisis Helplines Timely care for high risk groups School, college and work place intervention programmes IEC activities focused on suicide prevention

Workplace stress management Imparting skills for time management, improving coping skills, relaxation techniques like Yoga, Meditation etc. Identify workplaces with sizeable population and organize stress management workshops for them District Counseling Centre will also address this group

DMHP Funding Pattern 10 th & 11 th plan Component10 th plan (in lacs) 11 th plan (in lacs) Non Recurring for infrastructure 62 Staff Salary for DMHP staff Training IEC Drugs/miscellaneous/travel/co ntingency 3245 (25 for drugs) Targeted interventions nil58 Operational expenses district centre:rent, telephone,website, stationary, etc nil5 Total

Training & Research To address shortage of manpower in mental health Research related to NMHP Budget for Training & Research – Rs.20 crores

Regional Institutes of Mental Health & Neurosciences  On the pattern of NIMHANS -by upgrading 8 identified existing mental health hospitals/institutes/Med. colleges.  For addressing the acute manpower gap & provision of state of the art mental health care facilities  To have psychiatry, neurology, neurosurgery, clinical psychology, psychiatric social work, psychiatric nursing and supportive departments  Training facilities in psychiatry, clinical psychology, psychiatric social work & psychiatric nursing  Proposed budgetary support Rs. 40 crores per center

IEC Innovative IEC strategies involving Electronic/ Print/local media at Central/State/District/ Grassroot level to reduce stigma attached to mental illness and increase awareness regarding available treatment and health care facilities Increased awareness regarding provisions under Mental Health Act 1987

Monitoring & Evaluation Centre – Central Mental Health cell State – State Mental Health cell District and below – DMHP unit Regular supervision through Visits/Reporting by all levels Outside evaluation Budget – Rs. 21 crores

Outcome Indicators Number of new patients starting on treatment; %age of “drug non-compliant cases” amongst the diagnosed cases; Case identification rates % of drop outs to treatment Increased awareness levels Availability of trained manpower

Proposed Summary Budget for DMHP (in cr.) 500 new districts to be added in 11 th Plan. More than 100 districts from 10 th Plan will be funded as per the revised pattern of funding. Total projected budget: 572 crores

SL NOComponentBudget in crores 1Spill over of 10 th plan activities (modernization of remaining M.H.s (14), Med. college psychiatry depts. (30) 50 2DMHP(500 New & 100 Old) 572 3RIMHANS320 4IEC activities /NGOs 100 5Monitoring & Evaluation (incl. Central & State Cell) 21 6Research & Training 20 Total 1083 Proposed budget allocation under various domains in the 11th plan TOTAL PROPOSED BUDGET FOR 11 th PLAN Rs CRORES

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