IJSP-2010(3-4) - Indian Association For Social Psychiatry

the national and expanded district programmes. The
movement towards specialization has also eroded the
standing of general and family practice. The community
psychiatry movement was led in the 1970s and 1980s by many
national institutes and centers of excellence. The very ideas
of decentralization and empowerment gradually lost ground
and are all but abandoned by these centers, resulting in a
leadership vacuum. The technology to translate psychiatric
research evidence into primary care practice does not exist in
low income countries (Srinivasa Murthy, 2004). While the
programme has ensured wider availability of essential
psychotropic medication, the failure to integrate mental health
care delivery into primary care has resulted in limited impact
on patient services (Jacob, 2010).
Restrategised NMHP
The proposed budget for the programme in the 11th Plan is
1,000 Crore with more than 400 Crore being allotted to be
utilized only for manpower development at primary,
intermediate and tertiary levels. Programmes have been
conducted for increasing awareness and reducing stigma.
The revised NMHP is also giving tremendous importance to
suicide prevention. According to the plan, the ministry will
give basic mental health training to physicians at the primary
health centers in the villages and block levels. The district
mental health programme (DMHP) has also been started in
325 new districts. Over the last two decades, the NMHP has
managed to overcome certain barriers for effective
implementation including poor funding, limited undergraduate
training in psychiatry, inadequacy of mental health human
resources, limited number of models and their evaluation,
uneven distribution of resources across states, nonimplementation
of the MHA,1987 and privatization of
healthcare in the 1990s (Srinivasa Murthy, 2007). The goals
of NMHP have drifted towards family and community care,
better organization of mental health services in the primary
care and supporting through mental health initiatives rebuilding
of social cohesion, community development, promotion of
mental health and the rights of the persons with mental
disorders.
BEYOND NMHP (1982): PROPOSED MODEL
The proposed model for an integrated mental health model
involves certain principles laid down in the WHO developed
Mental Health Gap Action Programme (WHO, 2008). This
Nizamie & Goyal
should include political commitment, assessment of needs
and resources, development of a policy and legislative
infrastructure, delivery of the programme efficiently, human
resource development, mobilization of financial resources and
strategy for monitoring and evaluation. Government of India
has proposed to make an India-Australia Advisory Committee
(IAAC) in order to restrategise feasibility and application of a
new mental health programme consisting of representatives
from Director General of Health Services (DGHS), National
Institute of Health and Family Welfare (NIHFW), Central
Government institutes (including NIMHANS, Bengaluru; AIIMS,
New Delhi, CIP, Ranchi and others), Asia Australia Mental
Health and its partners for the development of community
mental health models. The IAAC will focus on capacity building
in 5 parallel streams: facilitating community partnerships;
mental health policy; developing best-practice models;
workforce training and monitoring and evaluation. Certain
issues require attention and concern of the policy makers and
service providers, which are essential in achieving the goals
of the NMHP with maximum efficiency:
• Collaboration with various stakeholders as there is a
greater need for the stakeholders (families, community
groups, human rights activists, etc.) to join hands in
view of the multi-sectoral nature of mental health.
• To develop and modify the current models of service
organization to integrate services into general health
service provision at the primary health care level (apart
from DMHP, integrated approach with other health
programmes eg., collaborating child psychiatry
services with Integrated Community Developmental
Scheme (ICDS), Reproductive and Child Health (RCH)
and neuropsychiatric services with epilepsy prevention
programmes, etc. for better penetration and efficiency
with limited resources and manpower).
• To develop modules for early detection and
intervention. One example includes the life skills
education programmes for school children. Similarly,
psychosocial care of survivors of disasters should be
part of all relief, rehabilitation, reconstruction and
reconciliation programmes, following man-made and
natural disasters.
© 2010 Indian Association for Social Psychiatry
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