Mental health presentation

1. Mental health: An over view

2. Tables of contents
 Definition
 Assessment of mental health
 Types of mental illness
 Causes of mental illness
 Burden
 Prevention
 Evolution of National Mental Health programs
 District Mental Health program
 Mental health action plan
 Mental Health policy
 Mental Health act

3. Definition
 Health is a state of complete physical, mental and
social well-being and not merely an absence of disease
or infirmity .
 Mental health is defined as a state of well-being in
which the individuals realize their own abilities, can
cope with the normal stresses of life, can work
productively and fruitfully, and are able to make a
positive contribution to their community.

4.  Not at war with self, free from internal conflicts
 Well-adjusted, accepts criticism & not easily upset.
 Searches for identity
 Has a strong sense of self-esteem
 Knows oneself, ones needs, problems & goals
 Has good self control, balances rationality & emotionality
 Tries to cope up with stress & anxiety
 Feels right towards others.
 Responsibility for fellowmen
 Meet demands of life.
 Not bowled over by his emotions

5. MENTAL ILLNESS
 is a medical condition that disrupts a person's thinking,
feeling , mood, ability to tolerate others and daily
functioning.
 Mental illnesses are medical conditions that often result in
a diminished capacity for coping with the ordinary
demands of life”.
National Alliance on Mental Illness(NAMI)

6. Warning signs for Poor mental health
Menninger drew up the following questions
Q.1- Are you always worrying?
Q.2- Are you unable to concentrate because of unrecognized reason?
Q.3- Are you continuously unhappy without justified cause?
Q.4- Do you loose you temper easily and often?
Q.5- Are you troubled by a regular insomnia?
Q.6- Do you have wide fluctuations in your mood?
Q.7- Do you continually dislike to be with people?

7. Q.8- Are you upset if the routine of your life is disturbed ?
Q.9-Do your children consistently get on your nerves ?
Q.10- Are you “browned off’’ and contently bitter?
Q11-Are you afraid with out real cause ?
Q12-Are you always right and the other person always wrong?
Q13-Do you have Nemours aches and pains for which no doctor can find a physical causes ?
( acc to Menninger if answer to any question is yes ------- person needs help

8. Mental Illness- Types
Major (Psychosis):
 Schizophrenia(Split personality).
 Manic depressive psychosis (Bipolar).
 Paranoid: extreme suspicion.
Minor illness:
 Neurosis: unable to react to normal situations.
 Personality and character disorders.
Vast, broad and difficult to precise.
Individual suffer one or more disorders

9. ICD-10 classification:
 Organic including symptomatic mental disorder : Alzheimer , Delirium
 Due to psychotropic substances: Alcohol, opioid dependence syndromes.
 Delusional disorders: Schizophrenia.
 Mood disorders: Bipolar affective disorders,
 Neurotic , stress related and somatoform disorders: GAD, OCD,
Hypochondriasis.
 Behavioural Syndromes: eating disorders, sleep disorders
 Adult personality disorders: Trans-sexualism.
 Psychological development disorders:
 Behavioural and emotional disorders - Hyperkinetic disorders, Autism.
 Unspecified mental disorder

10. BURDEN
Global
 10% prevalence of mental morbidity .
 450 million worldwide suffer mental morbidity . (WHO)
India
Prevalence of mental morbidity is 13.7%( NMHS 2015 -2016 )
 1in 20 people suffer from depression , prevalence is higher in females
 1 % of population reported higher suicidal tendencies.
 1.9% are affected by sever mental disorder
 prevalence in teenager is 7.3%

11. According to Kashmir Mental health survey 2015
 1.8 million (45%) adults having significant symptoms of mental
distress
 1.6 million adults (41%) in valley are living with significant symptoms
of depression,
 10% meets diagnostic criteria for sever depression
 1 million adults(26%) have symptoms of GAD
 1 in 5 adults(19%) are living with PTSD
 District Baramulla and Budgam have highest prevalence of these
mental disorder.
Dept of psychology KU,IMHANS Srg

12. Causes of Mental Illness
 Multifactorial.
Organic condition:
 cerebral arterioslerosis, neoplasms, chronic diseases etc
Heridity:
 Child of schizophrenic parents more likely to develop same condition.
Social patholgical causes:
 Emotional stress , anxieties, broken marriages and homes, Cruelty, rejection, neglection
 Industrialization, Urbanization, migration, poverty.
Others:
 Toxic substances, Psychotropic substances, Nutritional factors, Minerals, Infective agents,
Trauma and Radiation.

13. Crucial points in Life cycle
 Prenatal period- pregnancy is stressful period for some women they need
help not only physically but emotionally as well .
 First 5 years child requires love and care. Broken homes produce disorders.
 School child- everything that happen in school affect the mental health .
 Adolescence- transition from adolescent to manhood is often a stormy period
 Old age- also prone to mental disorders due to organic cause ,economic
insecurity ,lack of homes etc.

15. Prevention
Primary:
community based, improving social environment and promotion of the
social ,emotional and physical well being.
Secondary:
Early diagnosis of mental illness by screening programs.
 Provision of treatment facility and effective community resources.
 Family based health services with counselling.
Tertiary:
Reduced duration of illness, reduce mental stress and prevent further
breakdown and disruption .

16. Evolution of Mental Health in India
 1960: need for setting up of district psychiatric clinic (Mudaliar Committee.)
 1970: Important national-level initiative were taken, to integrate mental
healthcare with general healthcare
 1975, WHO published a document titled ‘Organization of mental health
services in developing countries’
 1975–81: The ideas generated by this documents were put to test at NIMHANS
& PGI, Chandigarh, to integrate mental health with general health services,
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17. 1975: starting of Community
Mental Health unit by
NIMHANS
1975-1981:WHO multi-
country project “ Strategies
for extending Mental Health
Services to the community (
focus on testing and
evaluating Model)

18. 1980
• Expert group formed who discussed the issue with people
concerned
1980
• Meeting with Director, Division of mental health WHO , Geneva
1981
• First draft was prepared atLucknow
• Draft presented at a workshop of experts in July, New Delhi
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1982
• Draft revised and presented again.
• Final draft submitted to Central Council Of health in August.
• The National Mental Health Programme came into existence.
1992
• World Mental Health Day

19.  In 1992 on 10 oct World Federation for Mental Health ,
a Global mental health organization with members
from more than 150 countries celebrate
World Mental Health Day for the Ist time.
 On this day thousands of supporters came to
celebrate this annual awareness program to bring
attention to mental illness and major effect
on peoples life worldwide.

20. VARIOUS MENTAL HEALTH DAY THEMES
 In 2017- Theme for world health day was also
about mental health it was ----
DEPRESSION LET’S TALK
 2017- MENTAL HEALTH IN THE WORK PLACE
 2016- PSYCHOLOGICAL FIRST AID
 2015- DIGNITY IN MENTAL HEALTH
 2014- LIVING WITH SCHIZOPHERNIA

21. 1996 •DMHP
2013-
2020
•Mental Health Action plan
2014 •Mental Health Policy
2017 •Mental Health Care act

22. NATIONAL MENTAL HEALTH PROGRAME

23. AIMS
 Prevention and treatment of mental and neurological disorders and their
associated disabilities.
 Use of mental health technology to improve general health services.
 Application of mental health principles in total national development to
improve quality of life.
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24. OBJECTIVES
(1) To ensure the availabilityand accessibilityof minimum mental
healthcare for all , 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 participationin the mental health service
development and to stimulate efforts towards self-help in the community.

25. INITIAL PROBLEMS
Nobudgetary estimates or provisions were made for
the implementation of the programme.
 There was a very lukewarm response to the programmeby
psychiatrists .
 Difficulty in implementing the programme in
larger populations and in real world settings.
RealizingthattheNMHPwasnotlikelytobe implemented
onalargerscalewithoutdemonstrationof its feasibilityin
larger populations,theneedfor planning forthe
implementationoftheprogrammeata districtlevelwas
highlighted.

26.  February 1996 : A national workshop was organized by
NIMHANS, in collaboration with Ministry of Health and Family
Welfare ,Govt. of India involving the health departments of all
the states
 to implemented District Mental Health Programme
 and then later they merge District Mental Health Programme
(under National Mental Health Programme) with NRHM
as a fully centrally funded programme

27.  Initially DMHP was launched by NIMHANS as Bellary Model in 4 districts
 In the states of Andhra Pradesh , Tamil Nadu, Assam and Rajasthan
 The Program was re-strategized in 2003 to include two schemes, viz.
Modernization of State Mental Hospitals and Up-gradation of Psychiatric
Wings of Medical Colleges/General Hospitals.
 Presently programme covers 241 district in India, it is proposed to
expand DMHP to all districts in a phased manner
In Kashmir this programme is launched in 4 District
Bandipora
Ganderbal
Kulgam
Pulwama

28. GOAL Of DMHP
 To improve Health and Social out comes
related to mental illness

29. OBJECTIVE OF DMHP
1. To provide sustainable health services to community and to integrate these
services with other services.
2. Early detection and treatment of patients withinthe
community itself.
3. Tosee that patient and their relatives do not have to travel long
distances
4. Totake pressure off mental hospitals.
5. Toreduce the stigma attached towards mental illness through change
of attitude and public education.
6. Totreat and rehabilitate mentally ill patients

30. COMPONENTS OF DMHP
 Training programmes of all workers in the mental health
team at the identified nodal institute in the state.
 Sensitization & training of health personnel: at the district &
sub-district levels
 Awareness camps: for dissemination of awareness regarding
mental illnesses and related stigma through involvement of
local PRIs, faith healers, teachers, leaders etc
 For early detection and treatment , the OPD and indoor
services are provided.
 Providing valuable data and experience at the level of
community to the state and centre for future planning ,
improvement in the service and research.

31.  Linkages with Self-help groups, family and
caregiver groups & NGOs working in the field of
mental health
 Sensitization of enforcement officials regarding
legal provisions for effective implementation of
Mental Health Act

32. BASIC DISTRICT MENTAL HEALTH
SERVICES
Out reach components
 Satellite clinics ; 4 satellite clinics per month at CHC/PHC
Target intervention
 SCHOOL HEALTH SERVICES - life skills education in schools , counselling services.
 COLLEGE MENTAL HEALTH SERVICES - Counselling through trained teachers/Counsellor .
 WORK PLACE STRESS MANAGEMENT – Formal & Informal sectors ,including farmers, women etc.
 SUICIDE PREVENTION SERVICES – Counselling centre at district level, sensitization workshops , IEC,
helplines etc.

33. DMHP TEAM
Manpower (on contractual basis):
 Psychiatrist/ Trained medical officer act as programme officer
mental health (POMH)
 Clinical Psychologist,
 Psychiatric Nurse,
 Psychiatric Social Worker,
 Community Nurse,
 Monitoring & Evaluation Officer,
 Case Registry Assistant,
 Ward Assistant/ Orderly
 Financial support @ Rs. 83.2 lakhs per DMHP

34. SERVICES PROVIDED BY DMHT
 Conduct daily out patient services
 Providing 10 beds indoor facilities
 Referral services
 Liaising with primary health services
 Follow up services
 Undertaking community survey ,if feasible

35. Other activities
 PPP Model Activities (financial support @ Rs. 5 lakhs per NGO):
 Day Care Centre (financial support @ 50,000 per centre per month):
 Residential/ Long Term Continuing Care Centre (financial support @ 75,000 per
centre per month):
 Community Health Services
 Primary Health services :
 Mental Health Services:
 Mental Health Helpline
 Tertiary level activities:
 Support to Central and State Mental Health Authorities:
 Training/Workshops
 Research & Survey:
 Monitoring & Evaluation:
 IEC:

36.  PPP Model Activities (financial support @ Rs. 5 lakhs per
NGO):
 Under this component, there is a provision for the state
governments to execute activities related with mental health
in partnership with Non-Government Organizations/Agencies
as per the guidelines of the NRHM in this regard.
 The levels and the areas of partnership of the state
government with the Non-Government Organizations/Agencies
may be as follows

37. LEVELS AREAS OF PARTICIPATION
District
Local IEC, Day-care, Residential/Long-term Residential Continuing Care Centres,
Supplementation or Innovative Mental Health Services, Training/Sensitization of
health workers;
Hiring of a private Psychiatrist/Clinical Psychologist/Psychiatric Social
Worker/Psychiatric Nurse on contract.
Psychiatrists @ Rs 2500/- per day (ten days a month + 4 days/ month for
outreach activity/training);
Clinical Psychologists/Psychiatric Social Worker @Rs 2000/- per day (ten days a
month + 4 days/ month for outreach activity/training);
Psychiatric Nurse @Rs 1000/- per day
State
Advocacy, Local IEC, Dedicated Mental Health Help-line, Training/Sensitization of
health workers, Ambulance services.

38. Day Care Centre (financial support @ 50,000 per
centre per month):
 Provides rehabilitation and recovery services to persons with
mental illness
 initial intervention with drug & psychotherapy is followed up and
relapse is prevented.
 enhancing the skills of the family/caregiver in providing better
support care.
 Provides opportunity for people recovering from mental illness for
successful community living.
 Financial support of Rs. 6.00 lakhs is earmarked per year.

39. Residential/ Long Term Continuing Care Centre (financial
support @ 75,000 per centre per month):
 Chronically mentally ill individuals, who have achieved stability
with respect to their symptoms & have not been able to return to
their families and are currently residents of the mental hospitals,
will be shifted to these centers.
 they will get help of multidisciplinary team consisting of
psychologists, social workers, nurses, occupational therapists,
vocational trainers and support staff.
 Financial support of Rs. 9.00 lakhs is earmarked per centre per
year.

40.  Community Health Centers:
 Services available:
 Outpatient services & inpatient services for emergency psychiatry patients;
 Counseling services.
 Manpower:
 Medical Officer;
 Clinical Psychologist or Psychiatric Social Worker
 Primary Health Centers:
 Services available:
 Outpatient services;
 Counseling services in accessing social care benefits;
 Pro-active case findings and mental health promotion activities

41.  Additional mental health services will be delivered through government
mental hospitals or medical colleges/hospitals with department of psychiatry.
 Under the overall supervision of the Head of Psychiatry Department.
 Financial support of up-to Rs. 15.00 lakhs per year per medical
college/hospital/mental hospital
Mental Health Helpline:
A country wide 24 hours dedicated help-line is provided
 To give information to public on mental health resources, emergency
situation and crisis management,
 Registration of complaints on Human Rights Violation of mentally illness.
 and assistance on medico-legal issues .

42.  Tertiary level activities:
Manpower Development Schemes ( Scheme-A & Scheme-B):
Scheme A. Centers of Excellence in Mental Health
 Up- gradation of 10 existing mental hospitals/ institutes/ Med.
Colleges
 strengthen courses in psychiatry, clinical psychology, psychiatric
social work & psychiatric nursing.
 Financial Support of upto Rs. 33.70 cr will be provided to each centre
and would include capital work (academic block, library, hostel, lab,
supportive departments, lecture theatres etc.), equipments , faculty
induction .
 As of now, 15 mental health institutes have been funded for
developing as Centers of Excellence in Mental Health .

43. Scheme B. PG Training Departments of Mental Health facilities
 Government Medical Colleges/ Government Mental Hospitals
will be supported for starting / increasing intake of PG courses
in Mental Health.
 Financial support of upto Rs. 0.86 to 0.99 cr per dept. would be
provided.
 Till date, 39 PG Departments in 15 Medical Colleges/ Mental
Hospitals in mental health specialties viz. Psychiatry, Clinical
Psychology, Psychiatric Nursing and Psychiatric Social Work have
been provided support for their establishment /strengthening.

44. Up-gradation of two Central MH Institutes to provide Neurological and Neuro-
surgical Facilities on the pattern of NIMHANS (CIP, Ranchi & LGB, Tezpur):
 LGB Regional Institute of Mental Health, Tezpur and Central Institute of
Psychiatry, Ranchi to be up-graded.
 Basic Neurological & Neurosurgical facilities to be included on the pattern of
NIMHANS.
 Add. Support will be provided for establishing departments in Neurology &
Neurosurgery, equipments & tools and for engaging required faculty.

45. Support to Central and State Mental Health Authorities:
 Central Mental Health Authority (CMHA) & State Mental Health Authority (SMHA) are
meant for regulation & co-ordination of mental health services under the central &
state governments respectively.
 Support to be provided for purchase of infrastructure (non-recurring) and Office and
Professional Expenses (recurring).
 Non-Recurring support to CMHA & each SMHA: Rs. 2.0 lakh
 Recurring support to CMHA & each SMHA: Rs. 7.0 lakh

46. Training/Workshops:
 Trainings will be provided to master trainers from each state/UT
who shall further train DMHP team and other staff working in the
field of mental health.
 Trainings will be standardized and delivered at identified
centres.
 The standardized training manuals are being formulated and
circulated to all stakeholders.
 Budget for training programme is Rs. 15.00 cr (Rs. 5.00 cr per
year).

47. Research & Survey:
 Research & survey should be conducted in different regions of the country
in the field of mental health.
 It will help in understanding regional needs and framing plan and
strategies .
 Budget (Rs. 6.00 cr per year).

48. Monitoring & Evaluation:
 Standard formats for recording and reporting have been developed and circulated.
 These will be used by medical colleges/institutes (under Manpower Development
Scheme), District, CHC and PHC.
 Continuous evaluation of the activities of the program is being done.

49. IEC:
 The central level dedicated website will be introduced to provide on hands
information on mental health resources, activities, plans, policy and programmes.
 Extensive mass media activities will be supported at district and sub-district level.
 The support for TV /RADIO programs and innovative media campaigns on mental
health in vernacular languages through local channels and other media.

50. WHO MENTAL HEALTH ACTION PLAN, 2013-2020
Vision
A world in which mental health is valued, promoted &
protected, mental disorders are prevented and persons
affected by these disorders are able to exercise full range of
human rights and to access high quality, culturally appropriate
health & social care in a timely way to promote recovery, all to
attain the highest possible level of health and participate fully
in society.
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51. OBJECTIVE 1:
To strengthen effective
leadership & governance for
mental health
Target 1.1:
80% countries have developed / updated their
policies/ plans for mental health in line with
international and regional human rights
instruments (by year 2020).
Target 1.2:
50% countries have developed / updated their
law for mental health in line with international
and regional human rights instruments (by year
2020).
OBJECTIVE 2:
To provide comprehensive,
integrated, responsive mental
health & social care services in
Target 2:
Service coverage for severe mental disorders
will have increased by 20% (by the year 2020).
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52. OBJECTIVE 3:
To implement strategies for
promotion and prevention in
mental health
Target 3.1:
80% of countries will have at least 2
functioning national, multi-sectorial
mental health promotion and prevention
programmes (by the year 2020)
Target 3.2:
The rate of suicide in countries will be
reduced by 10% (by the year 2020).
OBJECTIVE 4:
To strengthen information
systems, evidence & research
for mental health
Target 4:
80% of countries will be routinely
collecting and reporting at least a core set
of mental health indicators every two
years through their national health and
social information systems (by the year
2020).
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53. Need for a Policy
 Enormous burden
 Mental illness - key predictor for an increase in suicide
and suicide attempts.
 Untreated mental illness - stigma, marginalization and
discrimination often worsening one's quality of life.
 a holistic approach
 treatment gaps

54. Launched on 10 0ctober 2014
 Addresses the mental health problems as they exist currently, and
to understand the mental health issues in context of our country.
 Involves stakeholders to initiate action across a wide spectrum of
mental health issues for a comprehensive mental health response
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Mental health policy

55. Vision
 promote mental health
 prevent mental illness
 enable recovery from mental illness
 promote de stigmatization and desegregation
 ensure socio-economic inclusion of persons affected by mental illness by
providing health and social care to all persons through their life-span.
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56. Goals
 To reduce distress, disability, exclusion morbidity and premature mortality
associated with mental health problems across life-span of the person.
 To enhance understanding of mental health in the country.
 To strengthen the leadership in the mental health sector at the national,
state, and district levels.
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57. Objectives
 To provide universal access to mental health care.
 To increase access to and utilization of comprehensive mental
health service.
 To increase access to mental health services for vulnerable groups
including homeless persons, persons in remote areas and provide
access to educationally/ socially/ economically deprived sections.
 To reduce prevalence and impact of risk factors associated with
mental health problems.
 To reduce risk and incidence of suicide and attempted suicide.
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58. Obj contd
To ensure respect for rights and protection from harm of persons with mental
health problems.
 To reduce stigma associated with mental health problems.
 To enhance availability and equitable distribution of skilled human resources
for mental health .
 To progressively enhance financial allocation and improve utilisation for
mental health promotion and care.
 To identify and address the social, biological and psychological determinants
of mental health problems and to provide appropriate interventions.
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59.  VULNERABLE POPULATIONS
Poverty
Homelessness
Persons inside custodial
institutions
Orphaned persons with
mental illness -OPMI
Children of persons with
mental health problems
Elderly care-givers
Internally displaced
persons
Persons affected by
disasters and emergencies
Other marginalized
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60. Mental Health Care Act 2017
 This act was passed by Ministry of law and justice on 7th
April 2017
 This act provide mental healthcare and service for persons
with mental illness and
 to protect ,promote and fulfil the right of such person
during delivery of mental health care and services

61. Key rights
Manner of treatment:
 The Bill states that every person would have the right to specify how
he would like to be treated for mental illness in the event of a mental
health situation.
 specify who will be the person responsible for taking decisions with
regard to the treatment, his admission into a hospital, etc.
Access to public health care:
The Bill guarantees every person the right to access mental health care
and treatment from the government.
it should be affordable, good quality, easy accessible.
Persons with mental illness also have the right to equality of treatment
and protection from inhuman and degrading treatment.

62. Suicide decriminalized:
 Currently, attempting suicide is punishable with imprisonment for up to a
year and/or a fine.
The Bill decriminalizes suicide. It states that whoever attempts suicide
will be presumed to be under severe stress, and shall not punished for it.
 Insurance:
The Bill requires that every insurance company shall provide medical
insurance for mentally ill persons on the same basis as is available for
physical illnesses.