This presentation includes the changing viewpoint on mental health in Indian scenario. It also briefly describes the various mental health programs currently active in the country including the people with disability act 1995.

1. SERVICE DELIVERY SYSTEM OF
MENTAL HEALTH IN INDIA
BY:
DR. ROBIN VICTOR
PGT, DEPT. OF PSYCHIATRY
SMCH
1

2. PLAN OF PRESENTATION
 INTRODUCTION
 PREVIOUS VEIWPOINT ON MENTAL HEALTH
 NATIONAL MENTAL HEALTH PROGRAMME
 DISTRICT MENTAL HEALTH PROGRAM
 SCHOOL MENTAL HEALTH PROGRAM
 ROLE OF NGO’S
 PERSON WITH DISABILITY ACT 1995
 PRIORITIES FOR FUTURE
 BIBLIOGRAPHY
2

3. INTRODUCTION
 It is estimated that 7-10% of population of world
suffers from mental disorders.
 The World Bank report (1993) revealed that the
Disability Adjusted Life Year (DALY) loss due to
neuropsychiatric disorder is much higher than
diarrhea, malaria, worm infestations and
tuberculosis if taken individually.
 One in four families is likely to have at least one
member with a behavioral or mental disorder (WHO
2001).
3

4. EXISTING SERVICES IN INDIA AND PREVALENCE OF MENTAL
DISORDERS
 70 million mentally ill in the Country of 1.25 billion population
 20,000 beds in 42 mental hospitals.
 Point prevalence- 10 to 20/1000 population are affected by serious
mental disorder.
 MANPOWER AVAILABLE IN INDIA
Psychiatrists (qualified) in India = ~4000
 Per 100,000 population = 0.2 (World = 1.2)
 Total qualified doctors in India =9.36 lacs
Clinical psychologists in India =~1000
 Per 100,000 population = 0.03 (World = 0.6)
Psychiatric social workers = ~1000
 Per 100,000 population = 0.03 (World = 0.4) 4
Source: Atlas:
Mental Health
Resources in
the World,
2010, WHO

5. PREVIOUS VEIWPOINT ON MENTAL
HEALTH
 INDIAN LUNANCY ACT was passed in Pre independence times in the
year 1912 and terms like “lunatic”,”criminal lunatic”,”asylum” etc
were used in this act.
The BHORE Committee Report (1946)
 It laid the foundation for the community health movement in India,
not only combined the ‘top down’ and the ‘bottoms up’ approaches
but also included substantive emphasis on issues of mental health but
within the limitations of that period, much before some of the noted
western movements of community mental health. 5

6. The MUDALIAR Committee report (1959)
 It assumed the population of mental health patients 2/1000
 Shortage of mental health professionals.
 Recommended inclusion of preventive mental services as well
(school counselling, orientation of public professionals).
 Recommended need for increased research.
The SRIVASTAVA Committee report(1974)
 It recommended establishment of 3 cadres of health workers
namely – multipurpose health workers, health assistants
between the community level workers and doctors at PHC.
6

7. NATIONAL MENTAL HEALTH PROGRAMME
 Mental health is a state of wellbeing characterized by the
absence of mental or behaviour disorder whereby the person
has made a satisfactory adjustment as an individual, and to the
community, in relation to emotional, personal, social and
spiritual aspects of there life”- K PARK
 According to WHO:
“Mental health has been defined as a state of balance between
the individual and the surrounding world, a state of harmony
between oneself and others, a coexistence between the realities
of the self and that of other people and that of the environment.”
7

8. FACTORS WHICH CONTRIBUTED TO THE DRAFTING OF
THE NATIONAL MENTAL HEALTH PROGRAMME FOR
INDIA DURING THE EARLY 1980’s
1. The organization of mental health services in developing
countries” – a set of recommendations by an expert committee
of the World Health Organization.
2. Starting of a specially designated “Community Mental Health
Unit” at the National Institute of Mental Health and Neuro
Sciences (NIMHANS), Bangalore – 1975.
3. World Health Organization (WHO) Multi-country project:
“Strategies for extending mental health services into the
community” (1976-1981)
8

9. 4. The “Declaration of Alma Ata”- to achieve “Health for All by
2000” by universal provision of primary health care (1978) .
5. Indian Council of Medical Research – Department of Science
and Technology (ICMR-DST) Collaborative project on ‘Severe
Mental Morbidity’
9

10. STARTING OF A SPECIALLY DESIGNATED “COMMUNITY
MENTAL HEALTH UNIT” AT NIMHANS, BANGALORE –
1975
 Mental health needs assessment and situation analysis at Rural mental
health center at Sakalwara in Bangalore rural district covering a
population of about 100,000.
 Simple methods of identification and management of persons with
mentally illness by primary care personnel.
 Pilot training programs in basic mental health care for primary health
care (PHC) personnel were conducted
 Draft manuals of instructions written & pilot tested.
 CMHU at NIMHANS developed a strategy for taking mental health care to
the rural areas through the existing primary health care network
10

11. WHO MULTI-COUNTRY PROJECT: “STRATEGIES FOR
EXTENDING MENTAL HEALTH SERVICES INTO THE
COMMUNITY” (1976-1981)
 Model of integrating mental health with general health services
and providing basic mental health care by trained health
workers and doctors, supported by Multi-country collaborative
project initiated by the WHO and carried out in 7
geographically defined areas in 7 developing countries.
 The department of psychiatry (PGIMER)in Chandigarh was the
centre in India and the model was developed in the Raipur Rani
block in Haryana state.
11

12. DECLARATION OF ALMA ATA(U.S.S.R-
1978)
Concept of primary health care was defined as
 “Essential health care based on practical, scientifically sound
and socially acceptable methods and technology made
universally accessible to individuals and families in the
community through their full participation and at a cost that
the community and the country can afford to maintain at every
stage of the development in the spirit of self determination”
 India is a signatory to the Alma Ata declaration of 1978.The national
health policy, approved by the parliament in 1983 clearly indicates
India’s commitment to the goal of “Health for All by the Year 2000
AD”
12

13. INDIAN COUNCIL OF MEDICAL RESEARCH – DEPARTMENT OF
SCIENCE AND TECHNOLOGY (ICMR-DST) COLLABORATIVE
PROJECT ON ‘SEVERE MENTAL MORBIDITY’
 During the late 1970s and the early 1980s, ICMR and the
Department of science and Technology (DST) ,Government of
India funded a 4 center collaborative study to evaluate the
feasibility of training PHC staff to provide mental health care as
part of their routine work.
 Evaluation was carried out for 1 year covering a population of
40,000 in a PHC at four centres, one each from the South,
North, East and West of the country, Bangalore, Patiala,
Calcutta and Baroda
13

14.  At the end of one year period about 20% of the actual cases of
mental illness were identified and managed by the PHC
personnel under the overall supervision of the centre staff.
14

15. BIRTH OF NATIONAL MENTAL HEALTH
PROGRAM
15
Expert group was formed in
1980
A Draft copy of the program was prepared by February,1981
at Lucknow
Draft was discussed in July,1981 at a national level workshop
Revised draft program incorporating some of the points from
the previous workshop was made.

16. 16
A larger workshop in a/w experts from psychiatry,
other medical specialties, education ,administration
,law and social welfare was held in august,1981
The program document was then prepared and then
submitted to the central council of health,1982
After detailed evaluation of the document the council
adopted a resolution to implement it across states and
union territories

17. OBJECTIVES OF NMHP (1982)
1. To ensure the availability and accessibility of minimum mental
healthcare for all in the foreseeable future, particularly to the
most vulnerable and underprivileged sections of the
population.
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 to stimulate efforts towards self-help
in the community.
17

18. STRATEGIES
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 and State Mental health
Authority.
18

19. GOALS OF NMHP (1982)
 WITHIN ONE YEAR:
1. Each state will have adopted the present plan.
2. Government of India will have appointed a focal point within
the ministry of health specifically for Mental Health action.
3. National coordinating group will be formed comprising
representatives of each state, senior health administrators,
professionals from psychiatry, social welfare and education.
4. Task force will have worked out outlines curriculum of mental
health workers and for MO’s at PHC level.
19

20.  WITHIN FIVE YEAR:
1. 5000 of target non-medical professionals will have undergone 2
weeks training in mental healthcare.
2. 20% of all Physicians working in PHC will have gone 2 week
training programme in mental health.
 Creation of a post of psychiatrist in at least 50% of districts.
 Psychiatrist at the district level will visit all the PHC’s regularly at
least once a month for supervision and education. This is to be
fully operational in at least one district in every states and UT and
in at least half of all districts in some states within 5 years.
20

21.  Each state will appoint a program officer responsible for
organization and supervision of mental health program
 Each state will provide additional support for incorporating
common mental health components in teaching curricula
 On recommendation of the task force appropriate psychotropic
drugs to be made essential drugs and available at PHC level
 Psychiatric units with in-patient facility will be made available
in all medical college hospitals in the country
21

22. PROGRESS OF NMHP BETWEEN 1982-2002
 ICMR launched a mental morbidity demonstration project that
examined the feasibility and effectiveness of the above approach in
four centers namely- Kolkata, Baroda, Bangalore and Patiala.
 In 1984 district model for mental health care was initiated at
NIMHANS, Bangalore in collaboration with the district administration
and the director of health service, Karnataka which showed the
possibility of improving mental health care at PHC level.
22

23.  This same model was adopted along with the District Mental
Health Program (DMHP) and was implemented to 25 districts in
20 states between 1995-2000.
 A wide variety of community care alternatives have come to light
specially from voluntary sectors. These include day care centers,
half way homes, long-stay homes, suicide prevention program
and school mental health program.
23
It was anticipated that in the 10th five
year plan this would be extended to
100 districts.

24.  At the time of formulation of the NMHP, the number of psychiatrist
were less than 1000. In these 20 years it had nearly tripled to
3000.
 There was an increase in the public awareness enormously due to
community based mental health care, initiatives of the voluntary
health organization, trained mental health professionals working in
remote areas in private sector and availability of the modern
mental health information to the general pubic via these
professionals.
 Many legislations were passed related to mental health namely:
 NARCOTIC DRUGS AND PSYCHOTROPIC SUBSTANCE ACT (NDPS)1985.
 MENTAL HEALTH ACT 1987.
 PEOPLE WITH DISABILITY ACT 1995.
24

25.  Revision of the National Health Policy in 2002.
In 1983 the NHP had not referred to mental health in any
significant manner. This was redressed in the revision of the NHP in
2002 which clearly recognized mental health as apart of general
health and importance of human rights of mentally ill.
 Growth of the mass media in 20 years.
Television and radio stations were available in many languages
which addressed mental health issues through phone in program,
serials, features, movies, panel discussion and audio participation
programs.
25

26. STRENGTHS
1. Proposed mutually synergistic integration of mental health
care with primary health care
2. Proposed to use Primary Health Centre machinery
3. Integration of all aspects of teaching, research and
therapeutics.
26

27. WEAKNESSES
1. Emphasis on curative rather than promotive or preventive
aspects of mental health.
2. Community resources like family was not given due
importance.
3. No clear cut model for macro implementation.
27

28. BARRIERS TO THE IMPLEMENTATION OF
NMHP
 Limited undergraduate training in psychiatry.
 Inadequate mental health human resources.
 Lack of policy driven epidemiological data and research driven
mental healthcare policies.
 Limited number of models and their evaluation.
 Uneven distribution of resources across states.
 Non-implementation of the MHA, 1987.
 Privatization of healthcare in the 1990s.
28

29. HOW EFFECTIVE IS THE IMPLEMENTATION
OF NMHP?
 Most reports suggest that the implementation is far from optimal and
the reasons are numerous
 A variety of lacunae in the current implementation of NMHP have
been reported. These include:
1. Absence of full time programme officer for NMHP in many states
2. Inadequacies in the training for PHC personnel.
3. Inadequate record maintenance.
4. Non-availability of basic information about patients undergoing
treatment at various centres (regularity of treatment, outcome of
treatment, drop-out rates etc) 29

30. 5. Difficulties in recruitment and retention of mental health professionals in
the DMHP
6. Non-involvement of the NGOs and the private sector.
7. Inadequate mental health educational and community awareness activities
absence of programme outcome indicators and monitoring
8. Inadequate technical support from mental health experts.
9. As the NMHP primarily focuses on rural areas, the need for decentralized
mental health care in urban areas has been highlighted.
10.While funding itself has not been a problem, delayed receipt of funds,
irregular dispersal of funds, administrative blocks in the full utilization of
available funds and a variety managerial issues have bogged down the
proper implementation of the NMHP in many states and Union Territories.
30

31. REVISED GOALS FOR THE
MENTAL HEALTH PROGRAMME
 Redesigning DMHP around a nodal institution.
 Strengthening medical colleges to develop manpower,
secondary facilities, encourage general hospital psychiatry.
 Modernization of mental hospitals.
 Strengthening of state mental health authorities.
 Research and training on epidemiology, course/outcome, needs,
cost effective intervention models.
31

32.  Strengthening families and communities for the care of persons
suffering from mental disorders.
 Organization of a wide range of mental health initiatives to
support individuals and families.
 Special focus on immediate delivery of the most essential
services to the ones with the greatest needs.
32

33. DISTRICT MENTAL HEALTH PROGRAM (DMHP)
 In 1996 the Ministry Of Health and Family Welfare,
Govt. Of India formulated District Mental Health
Program (under national mental health program) as a
fully centrally funded program.
 DMHP was launched in four districts in 1996 and later
extended to 27 districts in 22 States/UTs during the
Ninth plan with a total outlay of Rs. 28 crore.
33

34.  Launched in 1996–97 in four districts, one each in Andhra
Pradesh, Assam, Rajasthan, and Tamil Nadu
 At present the program is in place in 127 districts
 DMHP is also being started in 325 new districts
 The central grant for implementation of DMHP per district with
average population of 20 lakh for five years will be Rs. 2.5
crore.
34

35. BIRTH OF DMHP
 1982-1990 – Development of the pilot district mental health
programme at “Bellary district” in Karnataka by NIMHANS.
 The successful implementation and outcome of this programme
led to formulation of the DMHP
 Bellary district :
 population of about 20 lakhs
 located about 350 kms. away from Bangalore
 chosen for the pilot development of a (DMHP).
35

36. COMPONENTS OF THE BELLARY PROGRAM
 Training for all primary care staff.
 Provision of 6 essential psychotropic and anti epileptic drugs
(chlorpromazine, amitryptaline, trihexyphenidyl, injection fluphenazine
deaconate, phenobarbitone and diphenyl hydantoin) at all PHCs and sub-
centres,
 A system of simple mental heath case records.
 A system of monthly reporting.
 Regular monitoring and feed back from the district level mental health
team.
36

37.  Mental health clinic at the district hospital to review patients
referred from the PHCs.
 Admit up to 10 patients at the district hospital for brief in
patient treatment.
 The mental health programme was reviewed every month at the
district level by the district health officer during the monthly
meeting of primary health centre medical officers.
37

38. OBJECTIVES OF DISTRICT MENTAL HEALTH
PROGRAM
1. To provide sustainable mental health services to the community
and to integrate these services with other services.
2. Early detection and treatment of patients within the community
itself.
3. To see that patient and their relatives do not have to travel long
distances to go to hospitals or nursing homes in cities.
4. To take pressure off mental hospitals.
5. To reduce the stigma attached towards mental illness through
change of attitude and public education.
6. To treat and rehabilitate mentally ill patients discharged from
the mental hospital within the community.
38

39. COMPONENTS OF SERVICES PROVIDED BY DMHP
(REVISED IN 11th FIVE YEAR PLAN)
Personnel:The team of workers at the district under the program consists
of:
 Psychiatrist.
 Clinical or trained psychologist.
 Trained social worker.
 Trained nurses or psychiatric nurses.
 Statistician-cum-clerk.
 Program Manager.
 Program/Case Registry Assistant.
 Record Keeper.
39

40.  Equipment, vehicles and other infrastructure
 Medicines & other contingencies etc
 IEC components: Use of print, electronic media, conducting health
mela’s etc.
 Training programme for various workers such as nurses, social workers,
non- proffesionals like panchayat leaders, ANM’s, teachers, Anganwadi
workers among others in identified institutions.
 Development of training capsules for various workers and their
translation in regional languages .Work done in NIMHANS, Bangalore and
CIP, Ranchi in this direction was taken in to consideration.
40

41.  Currently DMHP is being
implemented in 127
districts in the country.
41

42.  There are three districts which have/are receiving 100% central
assistance for District Mental Health Program (DMHP) under
National Mental Health Program. This scheme is for a period of 5
years, after which the state has to takeover the scheme.
These districts are as given below:-
42
SL. NO DISTRICT NODAL
INSTITUTE
YEAR OF
IMPLEMENTA
TION
REMARKS
1 Muktsar GMC,
Amritsar
2003 Completed 5
years on
31.3.2008
2 Hoshiarpur GMC,
Amritsar
2007 -
3 Sangrur GMC,
Amritsar
2007 -

43. 2002 TO 2007 - X FIVE YEAR PLAN PERIOD
The NMHP was re-strategized in the year 2003 (in X Five Year
Plan) with the following components:
1. Extension of DMHP to 100 districts.
2. Up gradation of Psychiatry wings of Government Medical
Colleges/ General Hospitals .
3. Modernization of State Mental hospitals.
4. IEC.
5. Monitoring & Evaluation.
43

44. UP GRADATION OF PSYCHIATRIC WINGS OF
MEDICAL COLLEGES/GENERAL HOSPITALS
 Every medical college should ideally have a Department of
Psychiatry with:
 Minimum of three faculty members and
 In-patient facilities of about 30 beds as per the norms laid down by
the MCI
 Scheme for strengthening of the psychiatric wings of government
medical colleges/hospitals which provides for a one-time grant of
Rs.50 lakhs for up gradation of infrastructure and equipment as per
the existing norms.
44

45.  Aim of the scheme was to strengthen the training
facilities for UG & PG at Psychiatry wings of government
medical colleges/hospitals.
 Grant covers construction of new ward, repair of existing
ward, procurement of items like cots, tables and
equipments for psychiatric use such as modified ECTs.
45

46. MODERNIZATION OF STATE RUN MENTAL
HOSPITALS
 The assistance under this scheme is provided for modernization of
state run mental hospitals from custodial care to comprehensive
management.
 A one-time grant with a ceiling of Rs.3.00 crores per hospital is
provided.
The grant covers activities such as:
 Construction/repair of existing building(s),
 Purchase of cots and equipment's.
 Provision of infrastructure such as water- tanks and toilet facilities
etc. 46

47.  Does not cover recurring expenses towards running the
mental hospitals and cost towards drugs and consumables.
 Grant is for modernization of the mental hospitals only
and any increase in the number of beds in the hospital is
not permitted.
47

48. Effectiveness of DMHP
 An audit of DMHP carried out by NIMHANS in 2003 in the 27
districts where the program was started during 1996-2002
showed that there were numerous problems and bottlenecks in
the actual implementation of DMHP.
 The efficiency and the effectiveness of the program varied
widely between districts and states / union territories.
48

49.  Factors attributed to the differential effectiveness include:
1. Motivation and commitment of the nodal officer and the
programme staff
2. Interest and administrative support of the state health
authorities (which include senior officers of Directorate of
Health Services, Directorate of Medical Education, Principal of
Medical College, Head of the District Hospital etc.)
3. Absence of an effective Central Support and Monitoring
mechanism at the Government of India level.
49

50. The audit highlighted the need to :
 Develop an operational manual for the DMHP.
 Review the content, curriculum and method of training the PHC
personnel.
 Provide continued support, supervision and on-the-job training for
PHC personnel after the initial training.
 Review the priority conditions covered by the DMHP and make
necessary amendments to include common mental disorders.
 Enhance IEC activities.
 Monitor the program regularly and develop time bound targets.
 Incorporate aspects prevention and promotion of mental health
such as life skills training and counseling in schools.
50

51. 2007-2012 XI FIVE YEAR PLAN
 Revised goal setting for District Mental Health Programme
(DMHP).
 Manpower Development Schemes - Center Of Excellence And
Setting Up/ Strengthening PG Training Departments of Mental
Health Specialities.
 Training & Research
 Monitoring & Evaluation
51

52. MANPOWER DEVELOPMENT SCHEMES
 Manpower Development Schemes – Center of Excellence and
Setting Up/ Strengthening PG Training Departments of Mental
Health Specialities are the new schemes/components.
 It has two schemes which are as follows:
 A. Centers of Excellence (Scheme A)
 B. Setting Up/ Strengthening PG Training Departments of Mental
Health Specialities (Scheme B)
52

53. CENTRES OF EXCELLENCE (SCHEME A)
 At least 11 Centres of Excellence in mental health were to be
established in the XIth plan period by upgrading existing mental
health institutions/hospitals.
 A grant of up to Rs.30 crores is available for each centre.
 The commitment to take over the entire funding of the scheme
after the 11th five year plan period from the state government
is required.
 The proposal of the State Governments for these centres must
include definite plan with timelines for initiating/ increasing PG
courses in Psychiatry, Clinical Psychology, PSW and Psychiatric
Nursing.
53

54. SETTING UP/ STRENGTHENING PG TRAINING
DEPARTMENTS OF MENTAL HEALTH SPECIALITIES
(SCHEME B)
 To provide further impetus to manpower development in Mental Health,
Government Medical Colleges/ Hospitals are supported to start PG courses in
Mental Health.
 To increase the intake capacity for PG training in Mental Health.
 The support involves capital work for:
 Establishing/improving mental health departments (Psychiatry, Clinical
Psychology, Psychiatric Social Work, and Psychiatric Nursing),
 Equipment's, tools and basic infrastructure,
 Support for engaging required/deficient faculty for starting/enhancing the PG
courses.
 The support of up to Rs. 51 lacs to Rs.1 crore per PG department is available.54

55.  Based on the evaluation conducted by ICMR in 2008 and feedback
received from a series of consultations DMHP has now
incorporated promotive & preventive activities for positive
mental health which includes:
 SCHOOL MENTAL HEALTH SERVICE
 COLLEGE COUNSELING SERVICES: through trained teachers/
counselors
 WORK PLACE STRESS MANAGEMENT: formal & informal sector,
including farmers, women etc.
 SUICIDE PREVENTION SERVICES: Counseling center at district
level, sensitization workshops, IEC, helpline
55

56. SCHOOL MENTAL HEALTH PROGRAM
 In 2010, this program has been sanctioned to be
implemented in all DMHP districts in the country.
 AIMS AND OBJECTIVES:
 Provide Class Teachers with Knowledge and Skills to Identify
Emotional, Conduct Problems in their students
 Provide Class Teachers with a system of referral for
students with psychological problems to the District Mental
Health Team for inputs and treatment.
 Provide Class Teachers with Facilitative Skills to Promote
Life Skills among their Students.
56

57.  The life skills which need to be taught at the school level
especially to adolescent as are:
 Critical thinking & creative thinking.
 Decision making & problem solving.
 Communication skills & interpersonal relations.
 Coping with emotion & stress.
 Self awareness & empathy.
57

58. URBAN MENTAL HEALTH CARE
– Use of existing public health care infrastructure such as
Municipality hospitals/ Corporation hospital/ other Specialty
hospitals, Mental hospitals and Medical college hospitals
– Volunteers and extensive networking with NGOs and other
agencies
– Additional facilities like community based detoxification
centers; self help groups, halfway homes, day care centers,
long stay facilities, respite care centers, crisis intervention
centers and counseling services
– Sate home for women, state home for person with mental
handicap and the prisoners.
58

59. ROLE OF NGO IN NMHP
 Information, Education and Communication activities.
 Support for health promotion using life skill approach.
 Support for follow up of severely mentally ill persons in
community.
 Support for mentally retarded children & their families.
 Organization of mental health camps.
 Networking with primary health care team.
 Facilitation of disability welfare benefits for the mentally ill &
mentally challenged.
 Home care for severely mentally ill person.
59

60. 2012 ONWARDS-XII FIVE YEAR PLAN
1. Strengthening of the public sector health care.
2. Health sector expenditure by the Centre and States, to
be substantially increased by the end of the Twelfth Plan.
It has already increased from 0.94 per cent of GDP in the
Tenth Plan to 1.04 per cent in the Eleventh Plan.
3. Efforts would be made to find a workable way of
encouraging cooperation between the public and private
sector in achieving health goals.
4. Availability of skilled human resources remains a key
constraint in expanding health service delivery.
60

61. 5. National level tertiary care institutions
 A single Central Sector Scheme on ‘National Level Tertiary Care
Institutions’ will fund up-gradation of existing medical colleges and
converting tertiary care facilities of the Central Government across
different departments into teaching institutions.
 More AIIMS like Institutions (ALIs) will be established during the
Twelfth Plan period in addition to the eight already approved.
 The existing teaching institutions will be strengthened to provide
leadership in research and practice on different medical conditions,
and research themes. Priorities include Cancer, Child Health,
Diabetes, Mental Health and Neuro Sciences, Geriatrics,, Information
Technology and Tele- Medicine and Complementary Medicine.
61

62.  A new category of mid-level health-workers named Community
Health Officers, could be developed for primary health care. These
workers would be trained after Class XII for a three year period to
become competent to provide essential preventive and primary
care and implement public health.
6. Information technology in health
7. Drug regulation
8. Regulation of medical practice
 Provisions for registration and regulation of clinical establishments
would be implemented effectively; all clinical establishments
would also be networked on the Health Information System, and
mandated to share data on nationally required parameters
62

63. 9. AIDS control
 There has been a reduction of new HIV infections in the country
by 57 percent.
 Still, an estimated 20.9 lakh people were living with HIV/AIDS
(PLHA) in 2011.
 The programme includes Targeted Interventions focused on High
Risk Groups and Bridge populations, Link Workers Scheme,
Integrated Counselling and Testing Services, Community Care,
Support and Treatment Centres, Information, Education, and
Communication (IEC) and condom promotion
63

64. PERSON WITH DISABILITY ACT 1995
 Persons with disabilities act,1995 was passed by Loksabha in 12th
dec.1995 and come into enforcement on feb.7,1996.
 This act is extends to the whole of India except the state of
Jammu and Kashmir.
 This act explain the equal opportunities, protection of right and
complete involvement of disabled persons.
 In this act responsibilities are assigned to central and state
government, local corporation and municipalities to provide the
services and facilities and equal opportunities to disabled persons
so that he/she may also prove himself as productive citizen of
there society
64

65. AIMS AND OBJECTIVES
 To spell out the responsibility of the state towards the
prevention of disabilities, protection of rights, provision of
medical care, education, training, employment and
rehabilitation of persons with disabilities.
 To create a barrier free environment.
 To counteract any situation of abuse and exploitation of persons.
 To make special provision of the integration of persons with
disabilities into the social mainstream.
65

66. MAIN PROVISIONS OF THE ACT
 Prevention and early detection of disability
 Education
 Employment
 Non- discrimination
 Research and manpower development
 Affirmative action
 Social security
66

67. PREVENTION AND EARLY DETECTION OF
DISABILITY
 Undertake surveys, investigations and research concerning the cause
of occurrence of disabilities.
 Promote various methods of preventing disabilities
 Provide facilities for training to the staff at the primary health
center
 Take measures for pre-natal and post-natal care of mother and child
 Educate the public through the pre-schools, schools, primary health
centers, village level workers and anganwadi workers
 Create awareness amongst the masses through television, radio and
other mass media on the causes 67

68. EDUCATION
Governments and the local authorities shall:
 Ensure that every child with a disability has access to free
education in an appropriate environment till he attains the age of
eighteen years;
 Endeavour to promote the integration of students with disabilities
in the normal schools;
 Promote setting up of special schools in Government and private
sector for those in need of special education, in such a manner that
children with disabilities living in any part of the country have
access to such schools;
 Endeavour to equip the special schools for children with disabilities
with vocational training facilities.
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69.  Conducting part-time classes in respect of children with disabilities
who having completed education up to class fifth and could not
continue their studies on a whole-time basis;
 Conducting special part-time classes for providing functional literacy
for children in the age group of sixteen and above;
 Imparting non-formal education by utilizing the available manpower
in rural areas after giving them appropriate orientation;
 Imparting education through open schools or open universities;
 Conducting class and discussions through interactive electronic or
other media;
 Providing every child with disability free of cost special books and
equipments needed for his education.
69

70. EMPLOYMENT
Governments shall -
 a. identify posts, in the establishments, which can be reserved
for the persons with disability;
 b. at periodical intervals not exceeding three years, review the
list of posts identified and up-date the list taking into
consideration the developments in technology.
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71. NON-DISCRIMINATION
Government shall take special measures to-
 Adapt rail compartments, buses, vessels and aircrafts in such a way
as to permit easy access to such persons;
 Adapt toilets in rail compartments, vessels, aircrafts and waiting
rooms in such a way as to permit the wheel chair users to use them
conveniently.
 Installation of auditory signals at red lights in the public roads for
the benefit of persons with visual handicap.
 Causing curb cuts and slopes to be made in pavements for the easy
access of wheel chair users.
 Engraving on the surface of the zebra crossing for the blind or for
persons with low vision.
71

72. AFFIRMATIVE ACTION
 The appropriate Governments shall by notification make schemes to
provide aids and appliances to persons with disabilities.
 The appropriate Governments and local authorities shall by notification
frame schemes in favour of persons with disabilities, for the preferential
allotment of land at concessional rates for -
 a. house;
 b. setting up business;
 c. setting up of special recreation centres;
 d. establishment of special schools;
 e. establishment of research centres;
 f. establishment of factories by entrepreneurs with disabilities.
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73.  "PERSON WITH DISABILITY" means a person suffering from not
less than forty per cent of any disability as certified by a
medical authority;
CURRENTLY FOLLOWING ARE INCLUDED IN DISABILITY CATEGORY:
 Blindness
 Leprosy-cured
 Hearing impairment;
 Locomotor disability;
 Mental retardation;
 Mental illness
73

74. "BLINDNESS" refers to a condition where a person suffers from any of
the following conditions, namely:-
1. Total absence of sight; or
2. Visual acuity not exceeding 6/60 or 20/200 (snellen) in the better
eye with correcting lenses; or
3. Limitation of the field of vision subtending an angle of 20 degree or
worse
"PERSON WITH LOW VISION" means a person with impairment of visual
functioning even after treatment or standard refractive correction but
who uses or is potentially capable of using vision for the planning or
execution of a task with appropriate assistive device.
74

75. "HEARING IMPAIRMENT" means loss of sixty decibels or more in the better
ear in the conversational range of frequencies;
"LEPROSY CURED PERSON" means any person who has been cured of
leprosy but is suffering from -
 i. loss of sensation in hands or feet as well as loss of sensation and
paresis in the eye and eye-lid but with no manifest deformity;
 ii. manifest deformity and paresis but having sufficient mobility in their
hands and feet to enable them to engage in normal economic activity;
 iii. extreme physical deformity as well as advanced age which prevents
him from undertaking any gainful occupation, and the expression
"leprosy cured" shall be construed accordingly.
75

76. "LOCOMOTOR DISABILITY" means disability of the bones, joints or muscles
leading to substantial restriction of the movement of the limbs or any
form of cerebral palsy.
"MENTAL ILLNESS" means any mental disorder other than mental
retardation.
"MENTAL RETARDATION" means a condition of arrested or incomplete
development of mind of a person which is specially characterized by sub-
normality of intelligence.
76

77. CERTIFICATIONS PROCESS FOR MENTAL RETARDATION
 A disability certificate shall be issued by a Medical Board consisting
of three members duly constituted by the Central/State
Government.
At least, one shall be a Specialist in the area of mental retardation,
namely Psychiatrist, Pediatrician and Clinical Psychologist.
 The examination process will consist of three components, namely,
clinical assessment, assessment of adaptive behaviour and
intellectual functioning.
 Categories of mental retardation based on IQ level:
a. MILD : 50-69
b. MODERATE : 35-49
c. SEVERE :20-34
d. PROFOUND :<20
77

78. CERTIFICATIONS PROCESS FOR MENTAL
ILLNESS
The Center and state Committee has recommended that certification
of disability for the purposes of the Act may be carried out by a
Medical Board comprising of the following members -
 THE MEDICAL SUPERINTENDENT/PRINCIPAL/DIRECTOR /HEAD OF THE
CHAIRPERSON INSTITUTION OR HIS NOMINEE
 PSYCHIATRIST MEMBER
 PHYSICIAN MEMBER
 Indian Disability Evaluation and Assessment Scale (IDEAS) is a
scale for measuring and quantifying disability in mental
disorders.
78

79. Different types of mental health condition which can lead to a
disability, include:
 Dementia
 Depression
 Bipolar disorder
 Obsessive compulsive disorder
 Schizophrenia
 Self-harm.
79

80.  There is a need to give special focus on the requirement of
persons with disabilities especially for Cerebral Palsy, Autism and
Mental Retardation.
 For this purpose, the National Trust for the welfare of persons
with Autism, cerebral palsy, mental retardation and multiple
disabilities should emphasize on prevention, early detection,
treatment and rehabilitation of the target groups in its
programmes.
80

81. IN THE TWELFTH PLAN EFFORTS ARE DIRECTED :
 To provide needed support and assistance Rehabilitation
Centres for treating mentally ill persons.
 Model multi-disability independent living Centre.
 Provisioning accessibility in State Government institutions.
 Making State Governments’ websites accessible.
 Preparation of comprehensive database and online State
depository of resources on disabilities.
 Establishment of State Missions and District Coordinators.
 Awareness generation and publicity training of care-givers.
 Establishment of National Institute of Mental Health
Rehabilitation.
81

82.  Establishment of State Disability Resource Centres.
 Establishment of Micro-enterprises Incubation Centres for
persons with disabilities.
 Grant of Association for Rehabilitation Under National Trust
Initiative of Marketing (ARUNIM) for supporting its marketing
activities.
 Research on disability related technology, products and issues.
82

83. PRIORITIES FOR FUTURE
 Approach of NMHP should be adapted to changing need with
strategies such as openness, continuous evaluation, learning from
the experiences.
 The nature of mental health requires that actions and
interventions be multidimensional, involving a number of sectors,
professionals, approaches.
 There is wide variations across the states of India, plans should be
developed for each of the states and union territories, besides
the national plan and program.
 All the Psychiatric care institutions should be upgraded with
trained personnel, treatment and rehabilitation facilities,
community outreach activities.
83

84.  All the medical colleges should have independent Departments
of Psychiatry to ensure UG & PG training in Psychiatry
 Setting up of District and Sub-district Mental Health Team for
adequate surveillance and monitoring of activities.
 Support from the government for the families of the mentally
ill persons in terms of community based services, financial
support for care, formation of self help groups, involvement in
future planning.
 Psychotropic drugs including 2nd generation antipsychotics and
antidepressants to be made essential and freely available.
 Enhanced involvement and aid to voluntary agencies to take
more wide initiatives.
84

85.  Planned mental health manpower development by increasing
the centers of training and creating opportunities for
employment.
 Community mental health facilities such as day care centers,
half way and long stay homes.
 Emphasis on public mental health education through all
available traditional and modern media.
 To understand the prevalence, nature, course, treatment
response and the impact of social changes and developmental
policies, researches at the National, regional and local level
should be supported.
 National level institutions to evaluate the models of care,
training of different categories of personnel and monitoring the
mental health programmes
85

86.  The advances in the understanding of human behavior and
mental disorders justify the optimism of developing meaningful
and realistic mental health programmes.
 It is mandatory to bring the fruits of science to the total
population of India.
86

87. BIBLIOGRAPHY
 MENTAL HEALTH- AN INDIAN PERSPECTIVE :S P AGGARWAL
 A SHORT TEXTBOOK OF PSYCHIATRY :NEERAJ AHUJA
 PARK’S TEXTBOOK OF PREVENTIVE & SOCIAL MEDICINE:
22ND ED
 WWW.MOHFW.NIC.IN
 WWW.NCBI.NLM.NIH.GOV
87

88. 88

89.  A+ B(90- A)/90
89