this will be beneficial

1. NATIONAL MENTAL HEALTH PROGRAMME
INTRODUCTION:
Health is defined as a state of complete physical, mental and
social wellbeing,
and not merely absence of disease or deformity.( WHO).
Mental health therefore
forms an essential part of total health and as such forms an
integral part of the
national health policy. Mental health is one of the essential
component of
patient care, this aspect was neglected earlier. It is well
establish ed fact that
mental health principles can improve the health delivery care to
patients. The
government of India realizing that mental health is an integral
component of the
total health formulated the- National Mental Health Programme.
EVOLUTION OF NMHP:
The government of India felt the necessity of evolving a plan of
action aimed at
the mental health component of the National Health
Programme. For this, an
expert group was formed in 1980 , who met a number of times
and discussed
the issue with many important people concerned with mental
health in India as
well as with the Director, Division of Mental Health, WHO,
Geneva. Finally, in
February 1981, a small drafting committee met in lucknow and
prepared the
first draft of NMHP. This was presented at a worksho p of
experts (over60
professionals) on mental health, drawn from all over India at
New Delhi on 20 -
21 july 1981. Following the discussion, the draft was
substantially revised and a

2. new one was presented at the second workshop on 2 August
1982 to agroup of
experts from not only the psychiatry and medical stream but
also educaton,
administration, law and social welfare. The final draft was
submitted to the
Central Council of health, India¶s highest health policy making
body at its
meeting held on 18 -20 August 1982, for its adoption as the
National Mental
Health Programme for India. In this way NMHP came into
existence.
Aims
Three aims are specified in the NMHP in planning mental health
services for
the country:
Prevention and treatment of mental and neurological
disorders and their
associated disabilities.
2. Use of mental health technology to improve general
health services. 3. Application of mental health principles in
total national development to
improve quality of life.
Objectives
1. To ensure availability and accessibility of minimum mental
health care
for all in the foreseeable future, particularly to the most
vulnerable and
underprivileged sections of population.
2. To encourage application of mental health knowledge in
general health
care and in social development.
3. To promote community participation in the mental health services
development and to stimulate efforts towards self -help in the
community.

3. STRATEGIES FOR ACTION
Two strategies, complementary to each other were planned for
immediate
action:
1. Centre to periphery strategy: establishment and strengthening
of
psychiatric units in all district hospitals, with OPD clinics and
mobile
teams reaching the population for mental health services.
2. Periphery to centre strategy : training of an increasing number
of different
categories of health personnel in basic mental health skills, with
primary
emphasis towards the poor and the underprivileged, directly
benefiting
about 200 million people.
APPROCHES TO NATIONAL MENTAL HEALTH
PROGRAMME:
To achieve the objectives the following approaches were formed:
I. Diffusion of mental health skills: Instead of centralising mental
health skills and expertise in an urbanised community it should
reach periphery (i.e. the prima ry health care structure at the
community level like PHC, Sub centres and Village level
workers).
Mental health care must start at the grass root level.
II. Appropriate appointment of tasks in mental health care: the tasks
to
be performed at each level (villag e workers, sub centre, PHC,
district hospital, regional hospital) will be specified and a
referral
system set up so that the total system works in an integrated
fashion.
III. Equitable and balanced territorial distribution of resources: Every
effort will be made to introduce or strengthen mental health first in
those regions which are at present de prived of it or where it is

4. seriously deficient.
IV. Integration of basic mental health care into general health
services:
This will facilitate in dealing with patients wi thout gross
psychiatric disturbances. It will enable the health worker to
identify
psychosocial problems. Psychiatric mental health worker will be
able to identify and relate psychosocial factors contributing to ill
health.
V. Linkage to community development: Involvement of state, district
and block leadership in the implementation of the mental health
programme to ensure community involvement in preventive
efforts
directed at psychosocial problems like alcohol, drug abuse,
behaviour of childhood and adolescence, delinquency and
other
avoidable problems.
VI. Mental health care:
The mental health care service was envisaged to include three
components or subprograms namely treatment, rehabilitation
and
prevention.
y Treatment sub programme
Multiple levels were planned:
those regions which are at present de prived of it or where it is
seriously deficient.
Treatment sub programme
Multiple levels were planned:
A. Village and sub centre level: multi-purpose
workers(MPW) and health supervisors, under the
supervision of medical officer(MO), to be trained for:
i. Management of psychiatric emergencies.
ii. Administration and supervision of maintenance,
treatment of chronic psychiatric disorders.
iii. Diagnosis and management of grandma
epilepsy, especially in children.

5. iv. Liaison with local school teacher and parents
regarding mental retardation and behaviour
problems in children.
v. Counselling in problem related to alcohol and
drug abuse.
B. Primary health centre(PHC):MO, aided by HS, to be
trained for:
i. Supervision of MPW¶s performance
ii. Elementary diagnosis
Treatment of functional psychosis¶
iv. Treatment of uncomplicated cases of
psychiatric disorders associated with physical
diseases
v. Management of uncomplicated psychosocial
problems
vi. Epidemiological surveillance of mental
morbidity.
C. District hospital: it was recognised that there should
be at least one psychiatrist attached to every district
hospital as an integral part of district health services.
The district hospital should have30 -50 psychiatric
beds. The psychiatrist in a district hospital was
envisaged to devote only a part of his time in clinical
care and grater part in training and supervision on
non-specialist health workers.
D. Mental hospitals and training psychiatric units: the
major activities of these higher centres of psychiatric care
include:
i. Help in case of µdifficult¶ cases.
ii. Teaching.
iii. Specialised facilities like occupational therapy
units, psycho therapy, and counselling and
behaviour therapy.
y Rehabilitation sub programmes: The components

6. of this sub-programme include maintenance
treatment of epileptics and psychotics at the
community levels and development of
rehabilitation centres at both the district level and
the higher referral centres.
y Prevention sub programme: The prevention
component is to be community based, with the
initial focus on prevention and control of alcoho l
related problems. Later, problems like addictions,
juvenile delinquency and acute adjustments
problems like suicidal attempts are to be addressed.
VII. Mental health training
Tamilnadu on the recommendation of the central council of
health in 1995 and a
workshop for health administrators of the country was held in
feb 1996 to
discuss about the problem of mental health. The DMHP was
extended to 7
districts in 1997-98, five districts in 1998-99 and six in
1999-2000, with the
addition of3 more districts in 2000 -01, this programme is under
implementation
in 25 districts in 20 states and union territories.
The programme envisages a community based approach to deal with
menatal
health problems in the country. It includes the following
interventions:
1. Training programmes of all workers in the mental health
team at the
identified Nodal Institute in the State.
2. Public education in the mental health to increase awareness
and reduce
stigma.
3. For early detection and treatment, the OPD and indoor services are
provided.

7. 4. Providing valuable data and experience at the level of community
to the state
and Centre for future planning, improvement in service and research.
5. Funds are provided by the Government of india to the state
government and
the nodal institutes to meet the expenditure on staff,
equipments, vehicles,
medicines, stationery, training ,IEC activities etc.
6. The training to the trainer at the state level is being provided
regularly by the
National Institute Of Mental Health and Neuro Sciences,
Bangluru under the
NMHP.
Thrust areas for 10th Five Year Plan
1. District mental health programme in an enlarged and more effective
form
covering the entire country.
2. Streamlining/ modernisat ion of mental hospitals in order to modify
their
present custodial role.
3. Upgrading department of psychiatry in medical colleges and
enhancing the
psychiatry content of the medical curriculum at the undergraduate as
well as
postgraduate level.
4. Strengthening the Central and State Mental Health
Authorities with a
permanent secretariat. Appointment of medical officers at state
headquarters in
order to make their monitoring role more effective;
5.Research and training in the field of community mental heal th,
substance
abuse and child/ adolescent psychiatric clinics.
ROLE OF NURSE

8.  Three primary goals of community health nurse, Promotion of
mental
health, Prevention of mental illness, Provision of holistic care and
support
for individuals experiencing mental ill health.
 ROLE OF CHN IN PRIMARYPREVENTION
Child care and child-rearing measures include: Antenatal care to
mother and educating her regarding the adverse effects of
irradiation, drugs and prematurity.
i Essential timely and efficient obstetrical assistance to guard
against
the ill effects of anorexia, injury at birth,
t Liberalisation of laws regarding termination of pregnancy, when
it
is unwanted
i Counselling of the parents of physically and mentally
handicapped
children.
c Programmes to enrich child mother relationship by stressing the
importance of warm accepting intimate relationship.
i Programmes Oriented to the child in the school : Early signs of
learning difficulties or behavioural abnormalities should be
detected, teachers should be taught to ide ntify the early
symptoms
of abnormal conduct and behaviour in the children and refer
cases .
c Family-Centred Activities Programs: Attitudes of mutual trust,
love and respect for one ,another need to be fostered .
Educational services in the field of mental h ealth ,Parent
-teacher associations Home-maker services ,Child guidance
clinics, Marital counselling.
Programmes for Families in Crisis Crises like adolescence,
Birth of

9. a new baby,Retirement or menopause, Death of a wage earner
in
the family, Desertion by the spouse can be Handled at mental
hygiene clinics, psychiatric first -aid centres, walk-in-clinics.
- Society-centred Preventive Measures Community development
social administration. Collection and evaluation of
epidemiological, biostatisical data. Budge ting These measures
require coordinated activities among persons belonging to
different
norms and disciplines.
 ROLE OF CHN IN SECONDARYPREVENTION
Early Diagnosis and Case Finding achieved by
educating the public and community leaders,mahila
Mandals, Balwadis etc. in recognising early
symptoms.
s EarlyReference.
Screening programmes: Simple questionnaires should
be developed and administered.
b Early and Effective Treatmen t
Mental Health Education: Mass camps and through
film shows, flash cards, and also through mass media
communication.
c Training of Health Personnel Orientation courses .
Crisis Intervention
 ROLE OF CHN IN TERTIARYPREVENTION
Accomplished by preventing complications of the mental
illness & promoting achievement of each individual¶s
maximum level of functioning throughRegular follow up ,
Diversion therapy,Recreation therapy, Community Mental
Health Facilities, Day-Evening Treatment/ Partial
Hospitalization Programs, CommunityResidential Facilities,
Support Groups.
SUMMARY:

10. Today we have discussed about NMHP, its evolution,
objectives of NMHP, various approaches to achieve the
objectives of NMHP. Then we have discussed about DMHP
(District Mental Health Programme), its components and
finally the role of nurse in the implementation of National
Mental Health Programme.
ASSIGNMENT: What is NMHP? Briefly explain its
objectives and role of nurse in the implementation of
programme.
CONCLUSION: National mental health programme is
designed with a view to prevent mental illness, promote
mental health of the people. Therefore being a graduate