National Mental Health Survey of India 2015-16

NMHS
professionals. Great doubts were expressed
about the feasibility of implementing the
programme in larger populations and in
real world settings as almost all the pilot
and feasibility projects were carried out
only by research and training institutes
and in smaller populations of up to 40,
000. There were many important concerns
like, whether results obtained by ‘highly
motivated’ personnel in a small population
could be replicated in ordinary health care
settings? Could the experiences from a
population of 40,000 be extrapolated to
a larger population (15 to 20 lakhs) of an
administrative unit like a district?(15) Most
significantly, the programme since the early
days and up till the present, did not have
a clearly articulated policy, governance
or structure. There were no action plans
or defined programmes including the
critical need of engaging the community.
While resource allocation and / or resource
development was poor, supportive
structures were either non-existent or where
available, they were inadequate. All this
indicated a lack of prioritisation of activities
and was further compounded by an absence
of coordination mechanisms between the
centre and the state and between reporting
and monitoring frameworks and evaluation
plans. In reality, all these components make
a public health framework and should
essentially lead to a systems approach.
In the early days after adoption of the NMHP,
there was a realization that the NMHP was
not likely to be implemented on a larger scale
without a demonstration of its feasibility
in larger populations. The Raipur Rani
experience(17) and the experience drawn
from the activities of the Community Mental
Health Unit at the then NIMHANS (15)
paved the way for developing a programme
to operationalise and implement the NMHP
in a district. Bellary district with a population
of about 2million, located about 350 kms
away from Bangalore was chosen for the
pilot development of a district level mental
health programme.
The “Bellary model”(18,19,20) was the
first community mental health initiative
undertaken at the district level in India.
This project was undertaken with the active
support of the Directorate of Health and
Family Welfare services, the Government
of Karnataka and the Bellary District
administration. The project was formalised
in 1984 and aimed at extending mental
health services to severely mentally ill
persons in the district through existing
health care personnel and institutions. The
specific objectives included (1) decentralised
training programme in mental health
for all categories of health personnel, (2)
provision of essential drugs for severely
mentally ill persons at peripheral health
care institutions, (3) developing a system of
simple recording and reporting by health
care personnel, (4) monitoring the effect of
the service programme in terms of treatment
utilisation and treatment outcome, (5)
community participation in the provision of
mental health care, and (6) studying the costeffectiveness
of the programme.
In brief, under the Bellary model, medical
officers and health workers from all the
primary health centres in the district were
trained in mental health care in a staggered
and decentralised manner. They were
supported, supervised and provided with
additional training whenever needed.
Besides the training of all primary health
care staff, the following components
were added to the District Mental Health
Programme (DMHP) at Bellary: provision
of 6 essential psychotropic and anti-epileptic
drugs (chlorpromazine, amitriptyline,
trihexyphenidyl, injection fluphenazine
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SMHSA