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Here is a compilation of essays on ‘National Mental Health Programme’ for class 11 and 12. Find paragraphs, long and short essays on ‘National Mental Health Programme’ especially written for school and college students.
Essay on the National Mental Health Programme
Essay Contents:
- Essay on the History of National Mental Health Programme
- Essay on the Prevalence of Mental Illness in India
- Essay on the National Mental Health Programme (1982)
- Essay on the Mental Health Services in India
- Essay on the Organizations Helping in Mental Health Services
Essay # 1. History of National Mental Health Programme:
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In 1939, Indian Psychiatric Society (IPS) was constituted. In 1960, the first conference of superintendents of mental hospitals was held, which called for training selected medical auxiliaries working in medical and health fields to be given a short period of training in Psychiatry after their normal training.
In 1971, a workshop on ‘Priorities in Mental Health Care’, called for all the health workers to be provided instructions in mental health and mental illness suited to their level of professional training. A further extension of these concerns was the National Mental Health Programme in 1982.
Born in 1963, the community psychiatry movement has been hailed as the third psychiatric revolution. The first revolution was the age of enlightenment following the middle ages, when mental illness was viewed as a consequence of sin and witchcraft.
The second revolution was the development of psychoanalysis which offered hope for a causative explanation of psychiatric disorders. However, the community psychiatry movement was made possible by another revolution, the one ushered by the advent of psychopharmacology. Therefore it may be more appropriate to refer to community psychiatry as the fourth psychiatric revolution.
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The ‘community psychiatry’ concept has its antecedents in Clifford Beers’ (1908) mental hygiene movement and Adolf Meyer’s recommendation (1913) of establishment of treatment centers in the community.
The period between 1955 to 1980 was an era of de-institutionalization (consisting of discharging mentally ill patients from mental hospitals, to be cared for in community mental health centers) in USA and other Western countries. This provided an impetus to the development of community psychiatry.
In 1975, the World Health Organization strongly recommended the delivery of mental health services through primary health care system as a policy for the developing countries. In India, attempts to develop models of psychiatric services in the PHC (primary health centre) setting were made nearly simultaneously at PGI, Chandigarh in 1975 (Raipur Rani block of Ambala district) and NIMHANS, Bangalore in 1976 (Sakalwara).
The basic model of community mental health was defined by Gerald Caplan in 1967.
The predominant characteristics of community psychiatry are:
1. Responsibility to a population for mental health care delivery.
2. Treatment close to the patient in community based centers.
3. Provision of comprehensive services.
4. Multi-disciplinary team approach.
5. Providing continuity of care.
6. Emphasis on prevention as well as treatment.
7. Avoidance of unnecessary hospitalization.
Essay # 2. Prevalence of Mental Illnesses in India:
At least 10-20 per thousand suffer from severe mental illness at any given time (requiring urgent care) and at least 3 to 5 times that number suffer from other forms of distressing and socio-economically incapacitating emotional disorders.
It has also been shown that at least 15 – 20% of the people who visit general health services such as a medical OPD or a private practitioner or a primary health care centre have in fact some underlying psychiatric problem appearing as physical symptoms.
In India, depressive neurosis is the commonest psychiatric illness followed by anxiety neurosis whereas a majority of psychiatric beds are occupied by those suffering from schizophrenia. This is in contrast to United Kingdom and other Western countries where anxiety neurosis is believed to be the commonest psychiatric problem.
Among the geriatric population in India, depression is the commonest psychiatric problem whereas in Western countries, dementia is the commonest psychiatric illness encountered. (This may be due to lower average life span in India in contrast to the Western countries).
In India, the average prevalence of mental disorders in women is higher than men. The problem of drug abuse is rapidly exhausting the already available meagre resources for mental health. Mental illness is equally common in rural and urban areas.
The number of new cases of serious mental disorders which become manifest each year (incidence) can be estimated to be roughly 35 per lac in the country. With the methods for treatment and prevention available in modern health care, chronicity and disability can be avoided in about 80% of the cases. Complete and lasting recovery is possible in no less than 60%.
In India, about 1-2% of all children have some underlying psychiatric disturbance. (See Table 32.1).
Essay # 3. National Mental Health Programme (1982):
(a) Health:
Health has been defined as a positive state of well-being physical, mental and social and not merely an absence of illnesses. Mental health is thus an integral component of total health.
(b) Objectives:
National Mental Health Programme (NMHP) has been formulated with the following objectives:
i. To ensure availability and accessibility of minimum mental health care for all in the foreseeable future, particularly to the most vulnerable and under-privileged sections of population;
ii. To ensure application of mental health knowledge in general health care and in social development;
iii. To promote community participation in the mental health service development and to stimulate efforts towards self-help in the community.
(c) Aims:
The following three aims are important in planning mental health services for the country i.e.:
I. Prevention and treatment of mental and neurological disorders and their associated disabilities.
II. Use of mental health technology to improve general health services.
III. To utilize the existing infrastructure of health services and also to deliver the minimum mental health care service.
IV. To provide appropriate task oriented training to the existing health staff.
V. To link mental health services with the existing community development programme.
(d) Components:
There are three components of National Mental Health Programme:
i. Treatment:
The treatment programme has been planned keeping the primary health care (PHC) as the sheet anchor. At the same time, it consists of the creation of an appropriate referral system at various levels. It is proposed that the specialized psychiatric services should be made available at the district level.
The other major responsibilities for the health personnel at district level would be to provide training and supervision to the workers at the PHC level. The mental hospitals, mental institutes, medical colleges and teaching institutions are linked together into the national mental health care particularly in the field of education and research.
ii. Rehabilitation:
Rehabilitation of psychiatric patients will be facilitated greatly by maintenance treatment of epileptics and psychotics at community level. The counselling regarding principles of rehabilitation would be provided by the medical officer at PHCs.
Linkage with the services at district level psychiatric centre and state mental hospital would remain through referral system. Whenever practical, the rehabilitation centres would be developed at the district level as well as the higher referral centres.
iii. Prevention:
This component of the service programme will be community based with only a united involvement of the health service personnel. The main focus of this sub-programme in its initial phase will be the prevention and control of alcohol related problems.
It will be possible to expand its concerns to problems like addiction, juvenile delinquency, acute adjustment problems (suicidal attempts) and to an ability to anticipate, community mental health needs from the citizens’ point of view. The main carriers of this sub-programme (prevention) will be the medical officer and community leaders at the primary health centre levels,
(e) Targets (of 1982 Programme):
i. Within one year.
i. Each State of India will have adopted the present plan of action in the field of mental health.
ii. The Government of India will have appointed a focal point within the Ministry of Health specifically for mental health action.
iii. A national coordinating group will be formed comprising representatives of all state senior health administrators and professionals from psychiatry, education, social welfare and related professions.
iv. A task force will have worked out the outlines of a curriculum or mental health for the health workers identified in the different states as most suitable to apply basic mental health skills and for medical officers working at PHC level.
ii. Within 5 years:
i. At least 5000 of the target non-medical professional will have undergone 2 week training in mental health care.
ii. At least 20% of all physicians working in PHC centres will have undergone 2 weeks training in mental health.
iii. Creation of the post of a psychiatrist in at least 50% of the districts.
iv. A psychiatrist at the district level will visit all PHC settings regularly and at least once in every month for supervision of the mental health programme for continuing education. This programme will be fully operational in at least one district in every State and Union Territory and at least half of all districts in some states.
v. Each State will appoint a programme officer responsible for organization and supervision of the mental health programme.
vi. Each State will provide additional support for creating or augmenting community mental health components in the teaching institutions.
vii. On the recommendation of a task force, appropriate psychotropic drugs to be used at PHC level will be included in the list of essential drugs in India.
viii. Psychiatric units with in-patients beds will be provided at medical college hospitals in the country.
Essay # 4. Mental Health Services in India:
The current status of mental health services in India can be best understood by reviewing the development of the service in the last few decades.
History:
Before Independence, the approach for the care of the mentally ill persons was largely concentrated to build ‘asylums’.
i. In 1946:
In 1946 the Bhore Committee presented the situation in regard to mental health services as, “-even if the proportion of mental patients be taken as 2 per thousand population in India, hospital accommodation should be available for at least 8 lac patients as against the existing provision for a little over 10,000 beds for the country as a whole.
In India, the existing number of mental hospital beds is in the ratio of one bed to about 40,000 of the population while in England, the corresponding ratio is approximately one bed to 300 population. A follow up Bhore committee recommendations, 5 mental hospitals, were set up-Amritsar (1947), Hyderabad (1953), Srinagar (1958), Jamnanagar (1960) and Delhi (1966).
An All India Institute of Mental Health, on the recommendations of this committee was set up at Bangalore. (National Institute of Mental Health and Neurosciences).
ii. Mudaliar Health Committee (1962):
It suggests that “Arranging such that ultimately each region, if not each state, becomes self-sufficient in the matter of training its total requirements of mental health personnel.” But till now, there are no mental hospitals in Haryana, Himachal Pradesh, Manipur, Meghalaya, and Chandigarh. Pondicherry, Lakshadweep, Andaman and Nicobar Islands, Arunachal Pradesh, Maharashtra has nearly one- third of the mental hospital beds.
iii. General Hospital Psychiatric Units (GHPUs):
Though such units for mentally ill persons were started as early as 1933, major spurts came in the 1960s. This period also coincides with the building of the last mental hospital in the country. These units provide a big support for the greater acceptance of psychiatric services by the public without fear of social stigma.
As of now, there are about 3500 beds under this facility in different parts of the country. An extension of these units has been the upcoming of District Hospitals Psychiatric Units (DHPUs) in at least two states- Kerala and Tamil Nadu. About 60% of the medical colleges at present have the Departments of Psychiatry. This lag has contributed to the poor undergraduate training in psychiatry.
iv. Community Care Approach:
This constitutes the next phase of development of mental health services.
The impetus for this approach has come from:
a) The commitment of the country to provide health services to all.
b) the Alma Ata recommendation of Primary Health Care (which includes 8 points including the promotional of mental health)’,
c) the existence of a large infrastructure for general health services (PHC system);
d) the approach to utilize multipurpose workers and rural doctors to provide health care to rural people and
e) the realization of the magnitude of severe mental disorders in the community (at least 1%) and availability of simple intervention for these conditions.
Various activities planned for implementation of National Mental Health Programme are:
i. Community mental health programs at primary health care level in states and union territories, with a plan to cover a population of about 3-5 lacs in the 7th Five-year plan.
ii. Training of existing PHC personnel for mental health care delivery, with no additional staff.
iii. Development of a state level Mental Health Advisory Committee and identification of a stage level program officer (preferably a psychiatrist).
iv. Establishment of Regional Centers of community mental health (at least 1 during the plan period).
v. Formation of National Advisory Group on Mental Health.
vi. Development of a task force for mental hospitals.
vii. Prevention and promotion of mental health.
viii. Task force for mental health education for undergraduate medical students.
ix. Voluntary agencies to be involved in mental health care.
x. Priority areas identified as child mental health, public mental health education and drug dependence.
xi. Mental health training of at least 1 doctor at every district hospital during the next 5 years.
xii. Establishment of a department of psychiatry in all medical colleges and strengthening the existing ones.
xiii. Provision of at least 3 to 4 essential psychotropic drugs in adequate quantity, at the PHC level.
An important example of the District Mental Health Program is at Bellary district, Karnataka (about 320 km from Bangalore). Started in 1985, it caters to a population of 1.5 million. District hospital psychiatry units have been opened in every district of Kerala and Tamil Nadu.
Following the implementation of National Mental Health Program in India 1982, other neighbouring countries soon followed the example by drawing national programs for mental health (Sri Lanka 1982; Bangladesh 1982; Pakistan 1986; Nepal 1987).
v. Mental Health Manpower and Training Facilities:
i. Psychiatrist:
In 1955, Diploma in Psychological Medicine (DPM) was started. At present about 35 centres provided training for DPM and MD courses. It is estimated that over 150 psychiatrists qualify annually and currently, there are about 2,500 to 3,000 psychiatrists in the country.
ii. Clinical Psychologists:
Training of clinical psychologists is available at Ranchi, Bihar and Bangalore. The annual capacity for training is about a dozen. About 400-500 clinical psychologists are working in the country.
iii. Psychiatric Social Workers:
Training of Psychiatric social workers is currently going on only at Bangalore and annually a dozen professionals are trained.
iv. Psychiatric Nurses:
Training is available both at Bangalore and Ranchi which offer a diploma course of 10 months. Both at Chandigarh and Delhi, a two year course in psychiatric nursing is available. The total number of psychiatric nurses in the country is estimated to be 500.
v. PHC Personnel:
These are trained at Bangalore, Chandigarh, Baroda, Kolkata, Hyderabad, Lucknow, Jaipur, Patiala, Delhi and Vellore.
vi. General Duty Medical Officers (GDMOs):
The psychiatrists are trained at Bangalore, to further train the GDMOs.
Essay # 5. Organizations Helping in Mental Health Services:
A. Institutional:
i. Indian Psychiatric Society (IPS):
It was founded in January, 1947. It had its first annual conference at Patna in January 1948 under the President ship of Dr. N.N. De and Dr. R.B. Davis was the General Secretary. Now it has about 1400 members. It holds its conference annually in January.
This society has important role in achieving scientific and academic excellence of profession of Psychiatry; educating lay people in mental health matters; implementing National Mental Health Programme (1982); helping the Government in formulating Mental Health Policy and also improving the teaching of psychiatry for the medical students. IPS has five zones (East, West, South, North and Central).
B. International:
i. World Health Organization (WHO):
According to WHO, around 40 million people in the world suffer from severe mental illness, over 80 million from alcohol and drug addiction, mental retardation and organic brain disorders and another 80 million suffer from other mental disorders such as neuroses. The mental disorders are believed to afflict more than 200 million people and wide.
WHO defines health as not simply absence of disease but a positive state of physical, mental and social well-being. WHO’s present program now integrates mental health concerns with the broad problems of overall health and socioeconomic development that must be faced by member countries. For example, this includes help to both prevent and control mental disorders.
Another important contribution of WHO has been its International Classification of Disease (now the 10th edition) which has enables clinicians and researchers in different countries to use a uniform set of diagnostic categories.
WHO has headquarters in Geneva and regional offices for Africa, the Americans, Southeast Asia, Europe, the Eastern Mediterranean and the Western Pacific.
ii. The United Nations Educational, Scientific and Cultural Organization (UNESCO):
By promoting collaboration among nations through educational, cultural, and scientific channels ‘UNESCO’ attempts to foster peace and respect for human rights, with fundamental freedoms for all. UNESCO initially arranged the use of satellites for educational and mental health purposes. It helps in the training of scientists as well as in the development of scientific research in developing countries.
iii. The World Federation For Mental Health:
It was established to 1948 as an international congress of nongovernmental organization and individuals concerned with mental health. Its purpose is to promote cooperation at the international level between governmental, nongovernmental mental health agencies and its membership now extends to more than 50 countries.
The Federation has been granted consultative status by both WHO and UNESCO, and it assists the UN agencies by collecting information on mental health conditions all over the world.