SYMBIOSIS COLLEGE OF NURSING

Mental health nursing

VIDIO ASSISTED
TEACHING

SUBMITTED TO, SUBMITTED BY

DR. SHEELA UPENDRA MS. KAJAL MORE
DEPUTY DIRECTOR, M.SC NURSING 2ND YEAR
PROFESSOR SCON, PUNE
SCON, PUNE

SUBMITTED ON:

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
components of patient care, this aspect was neglected earlier. It is well
established 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
Programmed.

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 Programmed. 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 workshop 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 new one was presented at the second workshop on 2 August 1982 to a group
of experts from not only the psychiatry and medical stream but also education,
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 Programmed 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:

1. 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.
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 center 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 centralizing mental
health skills and expertise in an urbanized community it should
reach periphery (i.e. the primary health care structure at the
community level like PHC, Sub centers 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 (village workers, sub
center, 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 deprived of it or where it is
seriously deficient.
IV. Integration of basic mental health care into general health
services:
This will facilitate in dealing with patients without 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 programmed to ensure
community involvement in preventive efforts directed at
psychosocial problems like alcohol, drug abuse, behavior 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.
 Treatment sub programmed

MULTIPLE LEVELS WERE PLANNED

A. Village and sub center 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.
iv. Liaison with local school teacher and parents regarding mental
retardation and behavior problems in children.
v. Counselling in problem related to alcohol and drug abuse.
B. Primary health center (PHC):MO, aided by HS, to be
trained for:
i. Supervision of MPW’s performance
ii. Elementary diagnosis
iii. 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 recognized 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 have 30-50 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 centers of psychiatric care
include:
i. Help in case of ‘difficult’ cases.
ii. Teaching.
iii. Specialized facilities like occupational therapy units,
psychotherapy, and counselling and behavior therapy.
 Rehabilitation sub programmed: The components of this sub-
programmed include maintenance treatment of epileptics and
psychotics at the community levels and development of
rehabilitation centers at both the district level and the higher referral
centers.
 Prevention sub programmed: The prevention component is to be
community based, with the initial focus on prevention and control of
alcohol related problems. Later, problems like addictions, juvenile
delinquency and acute adjustments problems like suicidal attempts
are to be addressed.

VII. Mental health training.

VIII. Mental retardation and drug dependence: Though these are not
mental illness still the health workers should be able to counsel
the parents, provide public education and knowledge to refer such
children to social welfare agencies for rehabilitation.
REVISED GOALS FOR THE MENTAL HEALTH
PROGRAMME
I. Strengthening families and communities for the care
of persons suffering from mental disorders.
II. Organization of a wide range of mental health initiatives to
support individuals and families, with special focus on
immediate delivery of the most essential services to the
ones with greater needs.
III. Supporting through mental health initiatives rebuilding
of social cohesion, community development, promotion
of mental health and the rights of the persons with mental
disorders.
IV. Eradicating stigmatization of mentally ill patient and
protecting their rights through regulatory institutions like
the central mental health authority and state mental health
authority.
V. Provision of tertiary care institutions for treatment of
mental disorders. E.g. (NIMHNS)
The plan of action to achieve the goals consists of nine
components:

 Organizing services
 Provide community mental health care facilities
 Support to families
 Human resource development
 Public mental health education
 Private sector mental health care
 Support to voluntary organizations
 Promotion and preventive activities
 Administrative support
 DISTRICT MENTAL HEALTH PROGRAMME (DMHP)

The District Mental Health Programmed as component of NMHP was

launched in 1996-97 in four districts one each in Andhra Pradesh, Assam,
Rajasthan and Tamil Nadu 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 of 3 more districts in 2000-01,
this programmed is under implementation in 25 districts in 20 states and
union territories.

The programmed envisages a community-based approach to deal with

mental health problems in the country. It includes the following
interventions:

1. Training programmed 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.
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,
equipment’s, 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,
Bengaluru under the NMHP.

Thrust areas for 10th Five Year Plan

1. District mental health programmed in an enlarged and more

effective form covering the entire country.

2. Streamlining/ modernization 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 health,
substance abuse and child/ adolescent psychiatric clinics.

ROLE OF NURSE

 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 PRIMARY PREVENTION

 Child care and child-rearing measures include: Antenatal care

to mother and educating her regarding the adverse effects of
irradiation, drugs and prematurity.
 Essential timely and efficient obstetrical assistance to guard
against the ill effects of anorexia, injury at birth,
 Liberalization of laws regarding termination of pregnancy, when
it is unwanted
 Counselling of the parents of physically and mentally
handicapped children.
 Programmers to enrich child mother relationship by stressing
the importance of warm accepting intimate relationship.
 Programmers Oriented to the child in the school:
Early signs of learning difficulties or behavioral abnormalities
should be detected; teachers should be taught to identify the early
symptoms of abnormal conduct and behavior in the children and
refer cases.
 Family-Centered Activities Programs:
Attitudes of mutual trust, love and respect for one, another need
to be fostered. Educational services in the field of mental health,
Parent -teacher associations Home-maker services, Child guidance
clinics, Marital counselling.
 Programmers for Families in Crisis Crises like adolescence, Birth
of 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 centers, walk-in-clinics.

 Society-centered Preventive Measures Community development

social administration. Collection and evaluation of
epidemiological, biostatistical data. Budgeting These measures
require coordinated activities among persons belonging to
different norms and disciplines.

ROLE OF CHN IN SECONDARY PREVENTION

 Early Diagnosis and Case Finding achieved by

educating the public and community leaders, mahila Mandals,
Bal wadis etc. in recognizing early symptoms.
 Early Reference.
 Screening programmed: Simple questionnaires should
be developed and administered.
 Early and Effective Treatment
 Mental Health Education: Mass camps and through film
shows, flash cards, and also through mass media communication.
 Training of Health Personnel Orientation courses.
 Crisis Intervention

ROLE OF CHN IN TERTIARY PREVENTION

Accomplished by preventing complications of the mental illness &

promoting achievement of each individual’s maximum level of
functioning through Regular follow up, Diversion therapy,
Recreation therapy, Community Mental Health Facilities, Day-
Evening Treatment/ Partial Hospitalization Programs, Community
Residential Facilities, Support Groups.
 SUMMARY:

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
Programmed), its components and finally the role of nurse in the
implementation of National Mental Health Programmed.

ASSIGNMENT:

What is NMHP? Briefly explain its objectives and role of

nurse in the implementation of programmed.

CONCLUSION:

National mental health programmed is designed with a view to

prevent mental illness, promote mental health of the people.
Therefore, being a graduate nurse, the knowledge and
understanding of NMHP is essential, so that we can better
understand our role and take part in the implementation of these
programmed.
 BIBLIOGRAPHY:

1. Ahuja Niraj, A Short Textbook of Psychiatry, Vith Edition, New

Delhi; Jaypee Brothers (Pvt) Ltd,2001: Pp 251-254.
2. Kapoor Bimla, Textbook of Psychiatric Nursing, Vol- II, New Delhi;
Kumar Publishing House, 2006: Pp 424-425.
3. Park K, Textbook of Preventive & Social Medicine,18th Edition,
Jabalpur; Banarsidas Bhanot: Pp 347.
4. Literature from IGNOU, BNS-108, Mental Health Nursing, Block-4,
IGNOU, New Delhi:2005: Pp 58- 62.
5. www.google.com