CURTAIN RAISER <br> NHRC convenes meeting of State Health Secretaries on Mental Healthcare in New Delhi tomorrow (03.9.2015)

New Delhi, 3rd September, 2015

The National Human Rights Commission, NHRC is organising a day-long meeting of the State Health Secretaries on Mental Healthcare tomorrow on the 4th September, 2015 at Seminar Hall, India International Center, New Delhi with the following objectives:

(i) Discuss ways for better implementation of the National Mental Health Programme (NMHP) and especially the District Mental Health Programme (DMHP), infrastructure and manpower developments in the States/UTs;
(ii) Discuss ways for better utilization of funds allocated by Government of India for various components of NMHP;
(iii) Sharing of good practices on mental care including rehabilitation in States/UTs; and
(iv) Discuss ways for proper rehabilitation of cured patients in the community.

2. It has been observed that in large number of places, the mentally ill patients in mental hospitals continue to stay there even after treatment and being cured. There are no proper facilities for their rehabilitation back into their families and community. Sometimes, the families also are reluctant to accept the cured patients because of the stigma attached to mental problems. Hence, there is need to focus on the community care and rehabilitation. There is need for creation of adequate facilities in the form of day care centers, half-way homes etc. for gradual rehabilitation of cured patients from mental hospitals, back into their families and community.

3. The NHRC filed a petition before the Supreme Court vide No. CRLMP.NO.8032/2013 in Writ Petition (Crl.) No. 1900 of 1981, Dr. Upendra Baxi Vs. State of U.P. & Ors apprising it about the efforts made by the Commission in this matter, the improvements made and shortcomings still remaining. The Commission sought its intervention in the form of appropriate directions to concerned authorities for improving the situation regarding mental health infrastructure. During the course of its hearings, it came to the forefront that State Governments have not been able to fully utilize the funds sanctioned under DMHP by the Centre. Furthermore, the utilization certificates of the funds utilized by the State Governments have also not been submitted to the Centre.

4. India is perhaps the first country in the world, and certainly the first among developing countries to recognize the need to integrate mental health services with general health services at the primary care level. The year 1982 is a significant in the history of mental health care in India as it saw the birth of the NMHP with the following objectives:

¢ 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;
¢ To encourage the application of mental health knowledge in general healthcare and in social development; and
¢ To promote community participation in the mental health service development and to stimulate efforts towards self-help in the community.

5. The NMHP was re-strategized in the year 2003 (in 10th Five Year Plan) with the following components:

¢ Extension of DMHP to 100 districts
¢ Up gradation of Psychiatry wings of Government Medical Colleges/ General Hospitals
¢ Modernization of State Mental hospitals
¢ IEC
¢ Monitoring & Evaluation

6. In the 11th Five Year Plan, the NMHP has the following components/schemes:

¢ District Mental Health Programme (DMHP)
¢ Manpower Development Schemes - Centers Of Excellence And Setting Up/ Strengthening PG Training Departments of Mental Health Specialities
¢ Modernization Of State Run Mental Hospitals
¢ Up gradation of Psychiatric Wings of Medical Colleges/General Hospitals
¢ IEC
¢ Training & Research
¢ Monitoring & Evaluation

7. The District Mental Health Programme (DMHP) was initiated in 1996 during the Ninth Five Year Plan based on Bellary Model developed by the National Institute of Mental Health and Neuro-Sciences (NIMHANS), Bengaluru. During the Plan period, 27 districts were covered under DMHP. At present DMHP is covering 123 districts in 30 States and Union Territories. In addition to early identification and treatment of mentally ill, DMHP has now incorporated promotive and preventive activities for positive mental health which include:

¢ School Mental Health Services;
¢ College Counselling Services;
¢ Work place Stress Management; and
¢ Suicide Prevention Services.
¢ The issues of awareness regarding mental illness and availability of treatment are addressed through Information, Education and Communication (IEC) activities at District level by the DMHP.

8. The DMHP envisages a community based approach to the problem, which includes:

¢ Training programmes of all workers in the mental health team at the identified Nodal Institute in the State;
¢ Public education in the mental health to increase awareness and reduce stigma; for early detection and treatment, the OPD and indoor services are provided;
¢ Giving valuable data and experience at the level of community to the State and Centre for future planning, improvement in service and research.

9. Funds are provided by the Government of India to the State Governments and the nodal institutes to meet the expenditure on staff, equipments, vehicles, medicine, stationary, contingencies, training, etc. for initial 5 years and thereafter they should manage themselves.

10. As per the Mental Health Act, 1987, there is provision for constitution of Central Mental Health Authority (CMHA) at central level and State Mental Health Authority (SMHA) at State Level. These statutory bodies are entrusted with the task of development, regulation and coordination of mental health services in a State/Union Territory, etc.

11. The National Human Rights Commission also monitors the conditions in the mental hospitals along with the Government of India, and the states are acting to ensure quality in delivery of mental care.

12. The main strength of the NMHP, undoubtedly, was the envisaged mutually synergistic integration of mental healthcare with general primary healthcare. There were, however, some inherent weaknesses in the NMHP. The first and foremost barrier was lack of proper funding and its utilization. The subsequent Five Year Plans after 1982 did not make adequate funding allocation. It was only during the 9th and 10th Five Year Plans that substantial amount was made available. But, the same has not been used for the purpose for which it was allocated.

13. In order to improve the training infrastructure in mental health, Government of India has approved the Manpower Development Components of NMHP. It has two schemes:

¢ Scheme 'A' refers to Establishment of Centres of Excellence; and
¢ Scheme 'B' known as Setting Up/ Strengthening PG Training Departments of Mental Health Specialties.

14. Under Scheme 'A', at least 11 Centres of Excellence in the field of Mental Health were to be established by upgrading and strengthening identified existing mental health hospitals/institutes for addressing the acute manpower shortage with the aim to fulfill manpower needs of the NMHP. Budgetary support up to Rs.30 crore per centre is available. The support includes capital work (academic block, library, hostel, lab, supportive departments, lecture theatres etc.), equipments and furnishing, support for faculty induction and retention. It has been further proposed to extend the said scheme to 10 more institutions. Taking into consideration the increase in the cost of construction, technical & non-technical equipments and faculty salary, the outlay of Rs.33.70 crore per Centre during the 12th Plan period is also proposed as against Rs.30 crore per Centre during the 11th Plan period.

15. Under Scheme 'B', 'Setting Up/ Strengthening PG Training Departments of Mental Health Specialties', the NMHP provides for further impetus to manpower development in Mental Health by assisting Government Medical Colleges, General Hospitals and State run Mental Health Institutes to start PG courses in Mental Health or to increase the intake capacity for PG training in Mental Health. This support would also involve capital work for establishing/improving mental health departments (Psychiatry, Clinical Psychology, Psychiatric Social Work, and Psychiatric Nursing), equipments, tools and basic infrastructure, support for engaging required/deficient faculty for starting/enhancing the PG courses. The support of up to Rs.51 lakh to Rs.1 crore per PG Department is available. During the 12th Five Year Plan period, it has been proposed to strengthen additional 93 PG Departments in Mental Health specialties besides, 27 PG Departments in 11 institutes/medical colleges. The funds under this Scheme are to be provided by the Government of India to these institutions to increase their intake capacity of PG students in mental health specialties thereby producing more mental healthcare professionals in the country.

16. Another component of NMHP is upgradation of psychiatric wings of Government Medical Colleges/General Hospitals. There is a provision under NMHP that every medical college should ideally have a Department of Psychiatry with minimum of three faculty members and inpattient facilities of about 30 beds as per the norms laid down by the Medical Council of India. As per the provision, there should also be outpatient facilities, as well as facilities for providing different kinds of therapy sessions. In addition to psychiatrists, clinical psychologists, psychiatric social workers and psychiatric nurses are essential for an ideal psychiatric department in a medical college. Out of the existing medical colleges in the country, approximately one-third of them do not have adequate psychiatric services. Looking at the huge manpower gap in the psychiatry and concerned disciplines, this scheme was adopted for upgradation of the UG and PG training in psychiatry in medical colleges. Under this scheme one-time grant is provided to the psychiatry departments of Government Medical Colleges which have not been funded earlier under NMHP. Some of the deserving areas, where there is no well-established Government Medical colleges, Government General hospitals/district hospitals could be funded for establishment of a psychiatry wing. The grant to be provided would cover non-recurring expenditure of up to Rs.50 lakh per college for upgradation of infrastructure and equipments.

17. Modernization of state-run mental hospitals is one more component of NMHP. There are 43 state-run mental hospitals in the country. Out of them 29 mental hospitals have been funded for modernization and some still remain to be modernized. A one-time grant of up to Rs.3 crore per mental hospital is provided to mental hospitals based upon submission of firmed up proposal under NMHP through the concerned state government for modernization of facilities and equipments from custodial to a modern therapeutic setup. The grant covers activities such as construction/repair of existing building(s), purchase of cots and equipments, provision of infrastructure such as water-tanks and toilet facilities etc. It does not cover recurring expenses towards running the mental hospitals and cost towards drugs and consumables. This is the grant for modernization of the mental hospitals only and any increase in the number of beds in the hospital is not permitted.

19. NMHP has dedicated funds for IEC activities for the purpose of increasing awareness and removal of stigma for mental illness. The funds are allocated at central and state levels for IEC activities. An amount of Rs.1 crore is allocated for the purpose of IEC activities at Central level.


20. In 12th Five Year Plan, the components of NMHP have been mainstreamed under the overall umbrella of National Rural Health Mission so that the States are able to plan requirements concerning mental health services as part of their respective Programme Implementation Plans (PIPs).

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