4. Bhore Committee
1. A Health Survey and Development Committee, (Bhore Committee) started by the
Government of India In 1943
2. This Committee was tasked with
(a) conducting a broad survey of the health conditions andm infrastructure in British
India
(b) providing recommendations for future health Programmes in the country
1. The Bhore Committee submitted its report in 1946, in which it took note of the high
infant mortality and maternal mortality rates, low life expectancy and overall poor
health conditions of the population.
5. Recommendations by the Bhore Committee
(i) Psychiatric beds be increased
(ii) Mental health organisations be created at the Centre and in States
(iii)Training in mental health for all medical and ancillary personnel; and (iv) creation of
a department of mental health in the proposed All India Institute of Mental Health
(present day National Institute of Mental Health and Neurosciences [NIMHANS]).
6. Mudaliar Committee (1962)
set-up to
(i) review the implementation status of the Bhore Committee’s recommendations, and
(ii) make recommendations for the third and subsequent Five-Year Plans (FYP)
Srivastava Committee (1974)
Recommended the Community Health Volunteers (CHV) scheme and suggested that the
training for CHVs include mental health components, to equip them with the skills of
identifying persons with mental illness and provide support during crises.
7. National Mental Health
Program
● Dr. Norman Sartorius
● India was the first major country to adopt it at national
level
● Final draft in 1982 and NMHP was implemented in a
phased manner
● Feb 1981 - First Draft
● August 1982 - implemented all over the country
● Central council of health
8. National Mental Health Program
Dr. Norman
Sartorius
Meeting of WHO
Mental Health
Advisory Group,
1979, Manila
India was the first
major country to
adopt it at national
level
Final draft in 1982
and NMHP was
implemented in a
phased manner
Feb 1981 - First
Draft
August 1982 -
implemented all
over the country
9. Strategies of NMHP
1. Integration of 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
(CMHA) and State Mental Health Authority (SMHA)
10. Weaknesses of NMHP
More emphasis on
curative components
than promotive or
preventive aspects.
Short term goals
given more priority
over long term plans.
The administrative
structure of the
program not clearly
outlined.
Lack of adequate
funding.
Risk of Initiatives
dying down over a
period of time.
No timely delivery of
medications.
Lack of human
resources.
Problems of
mentoring and
monitoring etc.
11. Treatment Gap in India(as per
NMHS, 2015)
Mental Illnesses INDIA
Non-affective Psychosis 75.5
BPAD 70.4
MDD 85.2
Anxiety disorder 84
Alcohol use disorder 86.3
12. ● Reasons-
● Poor knowledge and attitude towards illness and need for treatment
● Poor family support
● Problematic family dynamics
● Financial constraints
● Lack of insight
● Community’s attitude and belief (Stigma)
Reddy et al,2014
13. Birth of DMHP
To overcome limitation of NMHP
Initiative where District
was considered to be the
administrative and
implementation unit of
the program
NIMHANS undertook a
pilot project at the
Bellary District of
Karnataka
(1985-1990)
14. District mental health programme
○ Pilot project – The Bellary model by NIMHANS (1985-1990)
○ Launched in 1996 in 4 districts
○ Currently covers 692 districts
Objectives Sustainable basic mental health services in community, and integration with
other services.
Early detection and treatment in community itself to ensure ease of caregivers.
Take pressure off of mental hospitals.
To reduce stigma, to rehabilitate patients within community.
To detect as well as manage and refer cases of epilepsy
15. Components of
DMHP at bellary
1. Training for all primary care staff.
1. Provision of 6 essential psychotropic drugs and
anti-epileptic drugs at all PHCs and subcenters.
1. System of simple mental health case records.
1. System of monthly reporting
1. Regular monitoring and feedback from the
district level mental health team (Psychiatrist,
Clinical Psychologist, Psw, Statistical Clerk)
18. Services at DMHP ● Clinical Services
● Training ground level workers
● Training medical officers
● IEC activities
● Targeted interventions-life skill education,
counselling
● Workplace stress management and suicide
prevention services
19. Achievements
of DMHP
Significant improvement in care
and satisfaction among users.
60% of districts are able to provide
mental health services at district
level and 20% at primary level.
20. Constraints
• Poor Community Awareness
regarding treatment of mental
disorders.
• Stigma attached to mental
illnesses.
• Poor Community Involvement.
• Limited treatment facilities in
community.
• Lack of skilled
manpower.
• Lack of Coordination
between various levels of
administration and
departments.
• Weak monitoring
mechanism.
21. Taluk Mental Health Program (TMHP)
1. Public mental health program, covering a taluk/tehsil/block, just as the District Mental Health
Program (DMHP) has the entire district under its purview.
1. TMHP is a new entrant in the arena of National Mental Health Program, which has the responsibility
of taking mental health care to the doorsteps of individuals.
1. TMHP has been started in the previous year in 10 taluks of Karnataka and depending on the need
and progress, is slated to increase its presence to many more places
1. Community Interventions in Psychotic Disorders (CoInPsyD)’ Programs started in Thirthahalli taluk
of Karnataka (Shivamogga district) with the aim of identifying, diagnosing, treating and following
up all patients with schizophrenia in the taluk in 2005.
1. Another Initiative of TMHP- Community Based Rehabilitation Services for persons with severe mental illnesses in the
taluk
22. Manpower:
a. 1 Psychiatrist
b. 1 Social Worker
c. 1 Community Nurse
Activities Under TMHP:
a. Outpatient Services
b. Training Programs for Non-MHPs
c. Training the PCDs
d. Liaison with alternative medical systems
e. Outreach programs
Activities Mandate Under DMHP (would be
followed as a part of TMHP as well)
a. IEC programs
b. College Counselling services
c. Suicide Prevention Program
d. Life skills education in Schools
e. Workplace Stress Management
f. Linkage with NGOs and other agencies
23. Role of Psychiatrist-
1. periodic visits either to the taluk hospital or the primary health centres to conduct outpatient
consultations.
1. Handling Inpatient unit along with emergency care.
1. Involving in training of PHC medical officers, social workers, community nurse,
ASHAs and ANMs for detection and basic intervention for mental illness in the
community.
1. Conducting camps, IEC programs, home visits and outreach programs.
24. Job of PSW-
1. scheduling follow-ups, tracking patients(particularly those who drop-out), making home-visits, co-
ordinating with the local health administration for smooth conduct of the programs
1. delivering low-intensity psychosocial interventions (including basic psychoeducation, rehabilitation
counselling, vocation counselling, adherence counselling etc), networking with other governmental and
non-governmental agencies to facilitate transfer of available (government or otherwise) benefits to
patients/families. They also are the first contact for all of patients’ needs to the health
25. New initiatives carried out
under DMHP(Karnataka)
● Manochaitanya Program(MCP)
● Manasadhara Program
● Manasakendras
● Assisted Home care services
● Primary Care Psychiatry Programs
● E-monitoring software solution for DMHP
