Changing Scene of Mental Health Care in Shivpuri District of M.P.

DELHI PSYCHIATRY JOURNAL Vol. 13 No.1 APRIL 2010
Original Article
Changing Scene of Mental Health Care in
Shivpuri District of M.P.
Tushar Jagawat*, Ramghulam Rajdan**, S.B. Joshi***, Rahul Sharma****
*Mahatma Gandhi Medical College & Hospital, Jaipur
**Mahatma Gandhi Memorial Medical College, Indore, ***Gwailor Mansik Arogyashala (GMA) Gwalior,
& ****DMHP, Gandhi Medical College, Bhopal (M.P.)
District Mental Health Programme
In developing countries like India, the awareness
in community on mental illnesses is a challenge
even in present modern era. The Community
Psychiatry is accepted as the “Fourth Pillar of
Mental Health” The government of India initiated
the National Mental Health Programme (NHMP)
in 1982 with the objective of improving mental
health services at all levels of health care (primary,
secondary and tertiary) for early recognition,
adequate treatment and rehabilitation of the patients
with mental health problems within the community
and in the hospital 1 . During the Eighth Plan,
National Institute of Mental Health and Neurosciences
(NIMHANS) developed a district mental
health care model in Bellary 2 District of Karnataka
and Tamilnadu 3 . The District Mental Health
Programme(DMHP) is the part of National Mental
Health Programme. DMHP is the Community based
Mental health Programme in which awareness
regarding mental health and illness is on top priority.
98
ABSTRACT
Objectives: To ensure availability and accessibility of minimum mental health care for all
in the future; to provide sustainable basic mental health services to the community and to
integrate these services with other health services; early detection and treatment of patients
within the community itself; to see that patient and their relatives do not have to travel
long distance to go to hospitals or nursing homes in the cities; to take pressure off the
mental hospitals; to change the attitude of people towards mental illnesses by public
education. Methodology: Retrospective analysis of OPD records of GMA and District
Mental Health Programme (DMHP) to find out the total numbers of patients in the
psychiatric OPD of the Mental Hospital, (GMA) Gwalior and DMHP-Shivpuri. Results/
conclusions: The observation showed that with the implementation of DMHP, higher
number of psychiatric patients are availing mental health facilities in the community. It
was observed that the number of the patients taking institutional care is going down
gradually.
Keywords: District Mental Health Programme (DMHP), pattern of care
Delhi Psychiatry Journal 2010; 13:(1) © Delhi Psychiatric Society
The Objectives of the programme are:
1. To ensure availability and accessibility of
minimum mental health care for all in the
future. Particularly to the most vulnerable
and underprivileged section of the population.
2. To provide sustainable basic mental health
services to the community and to integrate
these service with other health services.
3. Early detection and treatment of patients
within the community itself
4. To see that patient and their relatives do
not have to travel long distance to go to
hospitals or nursing homes in the cities.
5. To take pressure off the mental hospitals.
6. To reduce the stigma attached towards
mental illness through change of attitude
and public education.
7. To treat and rehabilitate mental patients
discharged from the mental hospital within
the community.

APRIL 2010 DELHI PSYCHIATRY JOURNAL Vol. 13 No.1
DMHP- Shivpuri: (MP) 4
• During the period of 1995-2002, the DMHP
has been launched at the national level in
two main phases.
• In first phase (1996-2001) DMHP was
launched in 27 districts of India.
• In second phase (2002-2007) during 10th
Plan, the DMHP was expected to be
extended to 100 district of country.
• In Shivpuri district of M.P the DMHP was
started in 2001 for which the Gwalior
Mansik Arogyashala (GMA) was identified
as “ Nodal Center”.
• Shivpuri is the first district of M.P where
this programme is running successfully.
• The total population of Shivpuri is
14,74,640 in which 2,50,480 is urban while
12,24,186 is rural. The Tribal (Sahariya) is
the big component under this population.
• The DMHP-Shivpuri have a multidisciplinary
team in which following were
included-One Psychiatrist (From April-04
to December-04) one Clinical Psychologist,
one Social Worker, Four Psychiatric
Nurses, one Nursing Orderly, one
Statistician cum Clerk, one Driver and one
Safaikarmchari. A Psychiatrist from
Gwalior Mansik Arogyashala visited OPD
once in a week 4 .
• Under this Programme we were conducting
various activities related to mental health
care. Our main activities were: Running
OPD once in a week for psychiatric patients:
Screening of mentally retarded and help their
certification: Organizing mental health camps at the
level of district and peripheries: Providing the
facilities of psycho diagnostic. Psycho-behavior
therapy and counseling; Conducting mental health
awareness campaigns among patients, family
members, Teachers, Students, Advocates, Para
Millitary Forces, Prisoners, Villagers and Other
sections of community, Organizing training in
mental health for various sections of society;
Preparing materials on mental health and illness.
Aims/Objectives of the study
• To find out the overall changes in scenario
of mental health care in Shivpuri district
after the beginning of DMHP.
• To study the effects of DMHP on the patients,
seeking Mental health Care at the Gwalior
Delhi Psychiatry Journal 2010; 13:(1) © Delhi Psychiatric Society
Mansik Arogyashala (GMA,) Gwalior
(MP).
Methodology
• Retrospective analysis of OPD record of
GMA and DMHP to find out the total
numbers of patients in the psychiatric OPD
in Mental Hospital, (GMA)Gwalior and
DMHP-Shivpuri.
• Four years data was analyze to study
number of patients attended GMA from
district Shivpuri.(2002-Nov.2005). The two
years data of DMHP-Shivpuri OPD was
also analyzed to see the shift from GMA to
DMHP. (2004-Nov.2005)
Results
Table-1: Psychiatric Patients of Shivpuri
who attended Gwalior Mansik
Arogyashala (GMA) OPD
Years Male Female Total
2002 209 121 330
2003 183 097 280
2004 183 088 271
2005 170 072 242
Results/Conclusion
• In the OPD of GMA, Gwalior and DMHP Shivpuri
the number of Male Patients were higher
than female patients.
• The number of Psychiatric Patients attending
GMA , Gwailor is decreasing continuously
during last three years. Such scenarios were
developed after the starting of DMHP in
shivpuri.
• The numbers of Psychiatric patients are increasing
on DMHP-Shivpuri OPD, which attended the
Gwalior Mansik Arogyashala OPD previously.
• The numbers of mental patients in DMHP-
Shivpuri OPD is increasing continuously. The
average patients/OPD is increased more than
double in comparison to last year.
• Under DMHP, we organized various mental
health and De-addiction camps at district and
peripheries. The numbers of mental patients per
camp also increased even more than double.
• Along with pharmacological treatment there is
increased in the number of patients seeking the
Psycho-diagnostic and Psychotherapeutic
interventions.
99

DELHI PSYCHIATRY JOURNAL Vol. 13 No.1 APRIL 2010
Table-6: Patterns of Mental Disorders among
the Patients attended DMHP-Shivpuri OPD
No. Category Percentage (%)
1. Depression 27.2
2. Psychosis 18.0
(Schizophrenia and others)
3. Generalized Anxiety Disorder 14.6
4. Other Psychiatric Complaints 8.9
5. Mental Retardation 8.6
6. Bipolar Affective Disorser 5.8
(Manic Episode)
7. Neuropsychiatric Disorders 5.2
8. Epilepsy 4.9
9. Obsessive Compulsive Disorder 3.0
10. Addiction 2.7
11. Conversion/Dissociative Disorders 0.8
12. Phobia 0.3
• During the last two years, it has been observed
that the Depression was the most commonest
disorder followed by psychosis and GAD.
Our observation is showing that with the
implementation of DMHP, higher number of
Psychiatric patients are availing Mental Health
100
Table-2: Patients attended Psychiatric OPD in DMHP-Shivpuri
Years Male Female Old New Total Average Average
Patient’s/OPD Patient’s/month
2004 1167 810 1977 1977 016 199
2005 1512 908 1555 865 2420 037 220
Table-3: Psychiatric Patients in DMHP-Shivpuri OPD, who attended OPD of Gwalior Mansik
Arogyashala (GMA) in past
Years Male Female Total
2004 117 102 219
2005 149 126 275
Table-4 : No. of Psychiatric Patients who attended the Camps, organized by DMHP-Shivpuri: (MP)
Years Male Female Total Average Patient’s/Camp
2004 237 171 408 068
2005 270 185 455 155
Table-5: Patients who received the facilities of Psychological Testing/Psychotherapy and
Counselling under DMHP-Shivpuri
Years Male Female Total Average Patient’s/month
Psychological 2004 160 139 299 25
Testing 2005 210 187 397 36
Psychotherapy/ 2004 173 298 471 39
Counselling 2005 211 372 583 53
Delhi Psychiatry Journal 2010; 13:(1) © Delhi Psychiatric Society
facilities in the community. It was observed that
the number of the patients taking institutional care
is going down Gradually.
Limitations
1. There are no sufficient indoor facilities for
psychiatric patients in Shivpuri.
2. There is no full time Psychiatrist at DMHP,
Shivpuri (MP)
References
1. National Mental Health Programme for India
New Delhi: Ministry of Health and Family
Welfare. Government of India 1982.
2. Issac MK. Bellary District Mental health
Programme. Community Mental Health News,
11 and 12 ICMMR-CAR on Community Mental
Health, NIMHANS, Bangolre 1988.
3. District Mental Health Programme, Trichi,
Tamilnadu Heatlh and Family Welfare
Department Government of Tamilnadu, 1986.
4. Rajdan R, Jagawat T, Joshi SB, Sharma R:
District Mental Health Programme in India-
Shivpuri District, Madhya Pradesh. Delhi
Psychiatry J Oct 2009; Vol 12, No. 2, 202-205.