NATIONAL MENTAL HEALTH PROGRAMMEINTRODUCTION:Health is defined as a state of complete physical, mental andsocial wellbeing,and not merely absence of disease or deformity.( WHO).Mental health thereforeforms an essential part of total health and as such forms anintegral part of thenational health policy. Mental health is one of the essentialcomponent ofpatient care, this aspect was neglected earlier. It is wellestablish ed fact thatmental health principles can improve the health delivery care topatients. Thegovernment of India realizing that mental health is an integralcomponent of thetotal health formulated the- National Mental Health Programme.EVOLUTION OF NMHP:The government of India felt the necessity of evolving a plan ofaction aimed atthe mental health component of the National HealthProgramme. For this, anexpert group was formed in 1980 , who met a number of timesand discussedthe issue with many important people concerned with mentalhealth in India aswell as with the Director, Division of Mental Health, WHO,Geneva. Finally, inFebruary 1981, a small drafting committee met in lucknow andprepared thefirst draft of NMHP. This was presented at a worksho p ofexperts (over60professionals) on mental health, drawn from all over India atNew Delhi on 20 -21 july 1981. Following the discussion, the draft wassubstantially revised and a
new one was presented at the second workshop on 2 August1982 to agroup ofexperts from not only the psychiatry and medical stream butalso educaton,administration, law and social welfare. The final draft wassubmitted to theCentral Council of health, India¶s highest health policy makingbody at itsmeeting held on 18 -20 August 1982, for its adoption as theNational MentalHealth Programme for India. In this way NMHP came intoexistence.AimsThree aims are specified in the NMHP in planning mental healthservices forthe country: 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 toimprove quality of life.Objectives1. To ensure availability and accessibility of minimum mentalhealth carefor all in the foreseeable future, particularly to the mostvulnerable andunderprivileged sections of population.2. To encourage application of mental health knowledge ingeneral healthcare and in social development.3. To promote community participation in the mental health servicesdevelopment and to stimulate efforts towards self -help in thecommunity.
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. APPROCHES 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 prima ry 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.II. Appropriate appointment of tasks in mental health care: the tasks to be performed at each level (villag e workers, sub centre, PHC, district hospital, 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 de prived of it or where it is
seriously deficient.IV. Integration of basic mental health care into general health services: This will facilitate in dealing with patients wi thout 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. V. 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.VI. Mental health care: The mental health care service was envisaged to include three components or subprograms namely treatment, rehabilitation and prevention. y Treatment sub programme Multiple levels were planned: those regions which are at present de prived of it or where it is seriously deficient. 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 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 have30 -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 µdifficult¶ cases. ii. Teaching. iii. Specialised facilities like occupational therapy units, psycho therapy, and counselling and behaviour therapy. y Rehabilitation sub programmes: The components
of this sub-programme include maintenancetreatment of epileptics and psychotics at thecommunity levels and development ofrehabilitation centres at both the district level andthe higher referral centres.y Prevention sub programme: The preventioncomponent is to be community based, with theinitial focus on prevention and control of alcoho lrelated problems. Later, problems like addictions,juvenile delinquency and acute adjustmentsproblems like suicidal attempts are to be addressed.VII. Mental health trainingTamilnadu on the recommendation of the central council ofhealth in 1995 and aworkshop for health administrators of the country was held infeb 1996 todiscuss about the problem of mental health. The DMHP wasextended to 7districts in 1997-98, five districts in 1998-99 and six in1999-2000, with theaddition of3 more districts in 2000 -01, this programme is underimplementationin 25 districts in 20 states and union territories.The programme envisages a community based approach to deal withmenatalhealth problems in the country. It includes the followinginterventions:1. Training programmes of all workers in the mental healthteam at theidentified Nodal Institute in the State.2. Public education in the mental health to increase awarenessand reducestigma.3. For early detection and treatment, the OPD and indoor services areprovided.
4. Providing valuable data and experience at the level of communityto the stateand Centre for future planning, improvement in service and research.5. Funds are provided by the Government of india to the stategovernment andthe 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 providedregularly by theNational Institute Of Mental Health and Neuro Sciences,Bangluru under theNMHP.Thrust areas for 10th Five Year Plan1. District mental health programme in an enlarged and more effectiveformcovering the entire country.2. Streamlining/ modernisat ion of mental hospitals in order to modifytheirpresent custodial role.3. Upgrading department of psychiatry in medical colleges andenhancing thepsychiatry content of the medical curriculum at the undergraduate aswell aspostgraduate level.4. Strengthening the Central and State Mental HealthAuthorities with apermanent secretariat. Appointment of medical officers at stateheadquarters inorder to make their monitoring role more effective;5.Research and training in the field of community mental heal th,substanceabuse and child/ adolescent psychiatric clinics.ROLE OF NURSE
Three primary goals of community health nurse, Promotion ofmentalhealth, Prevention of mental illness, Provision of holistic care andsupportfor individuals experiencing mental ill health. ROLE OF CHN IN PRIMARYPREVENTION Child care and child-rearing measures include: Antenatal care tomother and educating her regarding the adverse effects ofirradiation, drugs and prematurity.i Essential timely and efficient obstetrical assistance to guardagainstthe ill effects of anorexia, injury at birth,t Liberalisation of laws regarding termination of pregnancy, whenitis unwantedi Counselling of the parents of physically and mentallyhandicappedchildren.c Programmes to enrich child mother relationship by stressing theimportance of warm accepting intimate relationship.i Programmes Oriented to the child in the school : Early signs oflearning difficulties or behavioural abnormalities should bedetected, teachers should be taught to ide ntify the earlysymptomsof abnormal conduct and behaviour in the children and refercases .c 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 h ealth ,Parent-teacher associations Home-maker services ,Child guidanceclinics, Marital counselling. Programmes for Families in Crisis Crises like adolescence,Birth of
a new baby,Retirement or menopause, Death of a wage earnerinthe family, Desertion by the spouse can be Handled at mentalhygiene clinics, psychiatric first -aid centres, walk-in-clinics.- Society-centred Preventive Measures Community developmentsocial administration. Collection and evaluation ofepidemiological, biostatisical data. Budge ting These measuresrequire coordinated activities among persons belonging todifferentnorms and disciplines. ROLE OF CHN IN SECONDARYPREVENTION Early Diagnosis and Case Finding achieved byeducating the public and community leaders,mahilaMandals, Balwadis etc. in recognising earlysymptoms.s EarlyReference. Screening programmes: Simple questionnaires shouldbe developed and administered.b Early and Effective Treatmen t Mental Health Education: Mass camps and throughfilm shows, flash cards, and also through mass mediacommunication.c Training of Health Personnel Orientation courses . Crisis Intervention ROLE OF CHN IN TERTIARYPREVENTIONAccomplished by preventing complications of the mentalillness & promoting achievement of each individual¶smaximum level of functioning throughRegular follow up ,Diversion therapy,Recreation therapy, Community MentalHealth Facilities, Day-Evening Treatment/ PartialHospitalization Programs, CommunityResidential Facilities,Support Groups.SUMMARY:
Today we have discussed about NMHP, its evolution,objectives of NMHP, various approaches to achieve theobjectives of NMHP. Then we have discussed about DMHP(District Mental Health Programme), its components andfinally the role of nurse in the implementation of NationalMental Health Programme.ASSIGNMENT: What is NMHP? Briefly explain itsobjectives and role of nurse in the implementation ofprogramme.CONCLUSION: National mental health programme isdesigned with a view to prevent mental illness, promotemental health of the people. Therefore being a graduate