District Mental Health Program Research Articles

Mental health services in rural India: a big challenge still to be met

There has been a decline in the rural population of India from nearly 82% to about 65% over the past six decades. The National Mental Health Survey of India (2015–2016) reported a lower prevalence of mental disorders in rural areas compared with urban ones. Mental health services in the country are skewed towards the urban areas, and more families are pushed below the poverty line while getting treatment for a member with mental illness. India has expanded its District Mental Health Programme over the past two decades, and it now covers nearly all the districts in the country. Despite that, significant numbers of people with mental disorders, ranging from 70–90%, do not receive adequate treatment. This paper discusses the rural–urban divide in the mental health services, examining the problem and need, and the initiatives taken by the government of India in this direction.

District mental health program: Then and now.

District Mental Health Program (DMHP) is part of the broader National Mental Health Program (NMHP) launched in 1982. In India, DMHP has evolved over the years, moving from a pilot project to an integrated component of the NMHP. Efforts have been made to expand services, protect the rights of individuals with mental illness, and integrate mental healthcare into the primary healthcare system. Recent updates and efforts taken by the Government of India and state governments (60% and 40% budget share respectively) have improved the quality of services provided under DMHP. With the increasing use of the internet and mobile technology, DMHP has spread its arena of services more deeply and widely in the last few years reaching up to 738 districts in the country. However, there is still work to be done to address many challenges associated with mental health in India though the recent developments seem promising as a substantial number of patients are now having access to the programme. This narrative review is the summary of information available to date on the evolution of implementation and expansion of DMHP over the years and provides a gist of the positive aspects as well as limitations of the DMHP witnessed in recent years.

Attitudes Towards the Mentally Ill: A Comparative Study Between Medical Officers and Nurses in the Ahmedabad City of Gujarat

Context: Medical Officers (MO) and nurses are the most important contact of healthcare for all patients, including Mentally Ill persons. Therefore, it is important to analyze their attitudes towards MI. Aims: To assess and compare the attitudes of MO and nurses on the community attitude toward the mentally Ill (CAMI) scale. Settings and Design: The study was cross-sectional and census sampling was used to collect data. Methods and Material: The study was conducted on 67 MO and 85 nurses of 74 urban primary health centers in Ahmedabad. The questionnaire comprised socio-demographic data and the CAMI scale. Statistical analysis: The frequency of each item and mean (SD) of all subscales were calculated for both groups. T-test and ANOVA were applied to compare socio-demographic data with the CAMI scale. Results: Mean (SD) of authoritarianism (AU), benevolence (BE), social restrictiveness (SR), and Community Mental Health Ideology (CMHI) subscales were 24.97 (±3.14), 36.69 (±33.69), 21.61 (±3.76), 38.52 (±3.74) respectively for MO and 29.13 (±3.87), 35.51 (±4.17), 23.64 (±4.36), 36.01 (±4.37), respectively for nurses (p-value is <0.05 in AU, SR and CMHI). Joint families, rural areas, lower education and higher income are associated with higher stigma. Conclusion: Although we found NA among nurses as compared to MO, it is highly prevalent in both groups. This requires widespread mental health educational programs by tertiary care hospitals and psychiatrists under the District Mental Health Program. Key Messages: MO and nurses displayed stigmatizing attitudes toward MI in ample questions of the CAMI scale, especially in AU and SR subscales. This necessitates training them under DMHP.

Perceptions of key stakeholders on peer led strength building program for suicide prevention among young adolescents: A qualitative study from Karnataka, India.

Adolescent suicides are a significant public health concern in India and understanding the intersecting perspectives becomes imperative for the prevention of various mental health concerns. Assessing perceptions of various key stakeholders, that is, mental health experts, school and college teachers, and District Mental Health Program staff about peer-led strength building programs for suicide prevention. A cross-sectional qualitative design using two Focus Group Discussions (FGDs) with mental health experts and teachers and one FGD with DMHP staff was conducted. The sample comprised 45 participants from Bengaluru urban district. The data were analyzed manually by the method of direct content analysis, and themes were determined using existing literature. The teachers and the DMHP highlighted the need for an intensive training program/module that is necessary to be developed in order to train the peer leaders first. The mental health experts opined that creating a network will help in easy identification of the cases and appropriate treatment could be provided without delays. This study indicated that suicide is a preventable public health emergency and inaccessibility to existing as well as proper support systems was perceived as a major concern. Therefore, peer-led programs are beneficial in steering and improving help seeking behavior in suicidal adolescents.

Mapping of mental health care facilities and psychiatrists in a North Indian district of India.

Since 1990, the proportional contribution of mental disorders to India's total disease burden has nearly doubled, but the number of psychiatrists has not increased proportionately. Even after two decades of District Mental Health Programme (DMHP) launch, a considerable treatment gap still exists for mental illness. The present study aimed to map all health facilities providing mental health services and all psychiatrists in district Faridabad, Haryana. The starting point was the information available with the DMHP and district health office. This was supplemented by web search and snowball sampling. All identified facilities were visited to map the mental health services provided. All the mental health care providers and health care facilities were mapped using "Google my Maps". 2011 census data on population were used. In Faridabad, 0.88 psychiatrists per lakh population were present. Most psychiatrists were concentrated in the urban area. The number of psychiatrists per lakh population was 1.1 in urban, compared to 0.54 in rural Faridabad. Clustering of mental health facilities was also observed more in urban areas (8.7 per 100 Sq Km) compared to rural areas (0.95 per 100 Sq Km) of district Faridabad. There was a scarcity of psychiatric manpower and facilities in the district with a distinct urban skew.

Mental Health Disorders Post-Stroke: A Scenario in India

Mental health disorders were reported in more than 33% of stroke survivors, which lead to increased comorbidities, delayed care, affect recovery, and impact physical and social functioning. Furthermore, it diminishes the quality of life and has impact on the well-being of both their families and caregivers. However, existing screening tools available for diagnosis of mental health disorders post-stroke detect many undiagnosed and underreported stroke survivors. Globally and in India, there has been a significant prevalence of post-stroke depression and anxiety. Pseudobulbar affect (PBA) ranged from 11% to 34%, worldwide. However, in India, only few case reports were reported for post-stroke psychosis, mania, and PBA. Although guidelines exist in developed countries for screening, referral, and rehabilitation of mental health disorders, there are lack of such resources in India. Also, the District Mental Health Program (DMHP) has received conflicting evaluations regarding its successes and shortcomings. Hence, this situation highlights the need for robust evidence-based strategies to develop effective screening, referral, and rehabilitation guidelines tailored to the Indian context. Also, by leveraging existing resources and collaborating with experts in the field, India can develop a comprehensive and effective approach to addressing post-stroke mental health disorders.

Inclusion of Mental Health in National Rural Health Mission (NRHM): Challenges and Prospects

Health, according to the World Health Organization, is “a state of complete physical, mental and social well-being and not merely the absence of disease and infirmity”. Over time, different definitions have been given for various objectives. Healthy behaviors may be motivated, like regular exercise and getting sufficient sleep, while unhealthy behaviors, like smoking or more stress, can be reduced or ignored. Some variables that impact health are caused by individual decisions, such as whether for busy in high-risk activities, while others are the result of structural factors, such as how society is structured and how easy or difficult it is for individuals to get primary healthcare services. Others, including hereditary illnesses, are independent of individual and societal preferences. The National Rural Health Mission (NRHM) was introduced by the Indian government on April 12th, 2005. The mission's objective is to increase peoples' access to and availability of high-quality healthcare, particularly for those living in rural regions, the underprivileged, disabled, women, and children. To address the mental health issues and challenges, it must be the part of NRHM. In this paper the objective is to analyses the importance of inclusion of mental health in NRHM and to examine the role of National Mental Health Program (NMHP) and District Mental Health Program (DMHP) since its inception.

District Mental Health Program: Inception, Evolution and Challenges

In 1982, National Mental Health Program (NMHP) was launched in India. In order to suffice its aim and objectives and effective coverage of mental health care, a district level program was suggested and for which NIMHANS did a pilot project in between 1985-90 and finally District Mental Health Program (DMHP) was started in Bellary district of Karnataka. Since then, the DMHP has been running in entire nation for fulfilling its aim and objectives and delivering mental health care services. In the span of almost three decades, the Program has been monitored and assessed periodically in terms of its effectiveness by keeping the vision of fulfillment of its goals. In this article we are reviewin theachievements of DMHP and how far we have reached to achieve the goals.

Integrating nutrition and mental health screening, risk identification and management in prenatal health programs in India.

Pregnancy is a period of major physiologic, hormonal, and psychological change, increasing the risk of nutritional deficiencies and mental disorders. Mental disorders and malnutrition are associated with adverse pregnancy and child outcomes, with potential long-standing impact. Common mental disorders during pregnancy are more prevalent in low- and middle-income countries (LMICs). In India, studies suggest the prevalence of depression is 9.8%-36.7% and of anxiety is 55.7%. India has seen some promising developments in recent years such as increased coverage of the District Mental Health Program; integration of maternal mental health into the Reproductive and Child Health Program in Kerala; and the Mental Health Care Act 2017. However, mental health screening and management protocols have not yet been established and integrated into routine prenatal care in India. A five-action maternal nutrition algorithm was developed and tested for the Ministry of Health and Family Welfare, aiming to strengthen nutrition services for pregnant women in routine prenatal care facilities. In this paper, we present opportunities and challenges for integration of maternal nutrition and mental health screening and a management protocol at routine prenatal care in India, discuss evidence-based interventions in other LMICs including India, and make recommendations for public healthcare providers.

Validity of biopsychosocial model of intervention in contemporary medical practice: Walking a few extra miles

Validity of biopsychosocial model of intervention in contemporary medical practice: Walking a few extra miles

Strengthening Response Toward Promoting Mental Health in India: A Narrative Review.

Mental health is an essential component of human development. It deals with human ideas and emotions, and it helps to lead a good life by paving the way for healthy minds. The absence of a healthy mind is a substantial hindrance to personal, societal, and national economic, political, and social functioning. For a long time in India, mental illness has been shrouded in stigma, ignorance, and superstition. The National Mental Health Program (NMHP) has undergone major strategic revisions throughout its existence, from instituting a district as the entity for program planning and implementation under the District Mental Health Program (DMHP) to integrating it with the National Rural Health Mission to productively scale up the program. Many researchers reviewed the program, which was also evaluated by governing and non-governmental institutions. Financial and human capital restrictions, a lack of public involvement, inefficient training, poor non-governmental organization/private cooperation, and a deficit of solid monitoring and evaluation system have all hampered the program's impact. A thorough study of the literature on India's unique mental health initiatives was conducted using particular Medical Subject Heading (MeSH) terms, including "community mental health program,""mental health project,""innovative in mental health programs," and "India,"and Boolean operators "AND/OR." The MeSH keywords used were as follows: mental health projectOR ("mental health project" [Mesh] OR "innovative in mental health programs" [Mesh]) AND community mental health program AND("community mental health program" [Mesh]), India OR ("India" [Mesh]). A preliminary search was conducted in Google Scholar and the PubMed database. A total of 55 indexed papers were found, of which 24 articles were duplicates, hence they were removedand the research eventually contained 31 investigations. Over time, it has become clear that a strong focus on community mental health is critical, and that the DMHPand NMHP, in terms of coverage and utilization of their service components, need to be strengthened. As with many other public health programs, public awareness and information, education, and communication programs must be the most important components for change to occur at the community level.Many tactics and innovations also help to democratize mental health care by allowing the integration of mental health programs into primary care, which is more equitable in the long run and leads to "good mental health for everyone."

What role can a homoeopathic psychiatrist play in restoring mental health in an unequal world?

World Mental Health Day, observed on the 10 October, is an occasion for the mental health professionals to dedicate themselves to bringing succour to the numerous persons suffering from mental health disorders. The World Mental Health Federation has declared this year’s theme as ‘Mental Health in an Unequal world.’ The call is timely considering the distress wrought on different communities due to the pandemic and the social and economic distress which has affected all sections of the population, albeit with different intensities causing differing impacts. The article explores the theme in the historical context and outlines the various concerns which mental health professionals should concern themselves with. It is a common knowledge that they are in short supply all over the world. Homoeopaths, due to their approach to health, disease and individuals are uniquely equipped to fill this gap and thus make a difference. There are very few examples, at the institutional level, where community-based activities addressing the mental health issues have been successfully undertaken and have made an impact. The article draws on the almost two-decade-long experience of the Department of Homoeopathic Psychiatry, Dr. M. L. Dhawale Memorial Homoeopathic Institute in this area, thereby illustrating the possibility of incorporating similar practices in the District Mental Health Programme. Clinical activity needs to be reported in peer-reviewed journals and initiating research in priority areas would help homoeopathy to be recognised as a discipline which can be a part of Integrated Mental Health Care for mental disorders.

BPSS Award

BPSS Award

Role of accredited social health activists in treatment of persons with severe mental illness in the community.

Role of accredited social health activists in treatment of persons with severe mental illness in the community.

Mindfulness Based Interventions Framework in District Mental Health Programme in India

The management of Common Mental Disorders (CMDs) in the Indian context is a complex issue and India has constrained mental health services infrastructure in District Mental Health Programme (DMHP) setting. Mental health interventions should be specific and feasible and relevant in the Indian population. DMHP is an important tier and bridged the gap between the tertiary care centres and the primary health care centres. Mindfulness-based interventions are effective in the management of common mental disorders in the community setting. Mindfulness based Cognitive therapy would reduce depressive relapse in patients. Mindfulness skills improves effective self-regulation of anxiety related cognition, emotion, sensation and behaviour. In DMHP training framework of mindfulness skills based sub-modules, mindfulness-based stress reduction, mindfulness-based cognitive therapy, acceptance and commitment therapy (ACT) modules could be incorporated. This framework targets relationship to thoughts and feelings (both physical and emotional) via decentring. This framework which is a practical, feasible strategy in the management of CMDs in DMHP setting of various states in India. Developing a need-based mindfulness-based interventions framework would be instru-mental in guiding the planning and prioritization of mental health care in India in 21st century

Community perception of accessibility and barriers to utilizing mental health services.

BACKGROUND:The Government of India and State Government authorities are trying their best to provide adequate mental health services through various mental health policies and programs. To reduce the burden in psychiatric hospitals, Government has decentralized mental health services. Although Government has provided mental health services, the utilization has always been low due to many reasons. In the present study, an attempt was made to assess the accessibility and the barriers to utilizing mental health services with various community stakeholders.MATERIALS AND METHODS:This is a qualitative study wherein data was collected from youth, women, geriatric groups, community key leaders, and Anganwadi workers. The primary data were collected through focused group discussions and interview methods. The collected data were analyzed using thematic coding.RESULTS:A total of twenty-five factors have been identified in the study, which were categorized under eight themes. (a) Lack of awareness and misinformation on mental health, illness, and available services, (b) Perceived causes for mental illness, (c) Reasons for not approaching health professionals, (d) Treatment adherence-related issues, (e) No multidisciplinary team in private hospitals and lack of involvement in government sector (f) Manpower issues, (g) Quality of service issues and building confidence among community people, and (h) Belief system and stigma.CONCLUSIONS:Inadequate mental health services, lack of awareness of mental health, and illness are still persist. The District Mental Health Program and other service providers need to reach communities, especially in remote areas. Periodical evaluation should be carried out to improve the utilization of mental health services.

A camp approach of community psychiatry in India: Past, present, and the future.

Camps are a popular approach to deliver medical care in India. While it is usually a one-off event for physical ailments, it is a long-term affair in Psychiatry. One of the first camps in psychiatry was rolled out as early as in 1967 at Mandar, Ranchi, followed by Raipur Rani (Haryana) in 1976 and at Gunjur, Karnataka in 1977. This camp approach became extremely popular and got expanded across India as they were thought to be synonymous with community-based outreach for mental illnesses. In the past 5 years, however, newer models of community care have emerged, necessitating a relook at this traditional approach. In this paper, the authors trace the origin, utility and future directions of these camps, taking data from community psychiatry camps conducted by the National Institute of Mental Health and Neurosciences, Bengaluru, a premier neuropsychiatric tertiary care institute in India. Data have been collated from the annual reports of the Institute, database from the District Mental health Program, Government of Karnataka, India, and compared with published literature on the same field. While camps remain as one of the important avenues to reach the unreached, there is a need to change the approach of their functioning by incorporating training (primary care providers) aspects and collaborative care. The latter may make the initiative more meaningful and sustainable.

Comparative Profile of Patients Utilizing District Mental Health Programme (DMHP) and Tertiary Care Teaching Hospital Services: Study from North India

Comparative Profile of Patients Utilizing District Mental Health Programme (DMHP) and Tertiary Care Teaching Hospital Services: Study from North India

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Background:Psychiatric illness are a public health issue worldwide. The morbidity pattern in district mental health program psychiatry clinics differ from those in medical colleges and private setups.DMHP clinics serve large amount of population but they have seldom been evaluated systematically. It has been observed that people from rural background mainly visit these clinics. Hence this study was carried out to assess the morbidity among patients visiting these clinics.Aim:To analyze the clinical and sociodemographic characteristics of patients attending these clinics and dropout rates.Material and methods:patients visiting OPD between 1st June 2021 to 30th August 2021 were analyzed. This is a cross -sectional study.Results and conclusion:a total of 1177 patients visited clinic in this period. Psychiatric disorders comprised of Depressive disorders (52.7%),Headache (15.88%),Epilepsy(10.36%),Psychotic disorders(9.43%),Bipolar affective disorder(4.16),Dissociative disorder(2.63%),Substance use disorders(1.61%),Obsessive compulsive disorder(1.27%),Intellectual disability(0.84%),Dementia(0.50%),Sexual disorders(0.33%) and Conduct disorder(0.08%).They effect most productive age groups almost equal male and female and more of rural patients.

Initiative of Sikkim District Mental Health Program

Suicide is one of the major public health problems in Sikkim and the State has been facing the dramatic rise in suicide cases. According to the National Crime Records Bureau (NCRB) report, 2008 Sikkim had the highest suicide rate and in 2009, Sikkim (39.9) was recorded as second highest state in the country in terms of suicide. The major cause of concern in Sikkim is the unusually high rate of suicide. ......