NEW DELHI: The Union Health and Family Welfare Ministry proposes to re-strategise the National Mental Health Programme (NMHP) during the 11th Plan period, making it more expansive and effective. Suicide prevention will be an important part of the programme, as such incidents have increased of late.

Heavy burden

Mental disorders impose a heavy burden on the family and society in terms of morbidity, loss of productivity and mortality by suicide in extreme cases. A large number of people with mental problems do not seek help out of ignorance, for fear of stigma and for lack of service. Just one psychiatrist is available for every three-lakh population. The psychiatrist-population ratio in rural areas is estimated to be less than one for every million.

Besides focussing on stress management and awareness campaigns to remove the stigma associated with the disease, the expanded NMHP will create more infrastructure for training personnel to address the acute shortage of professionals. Non-governmental organisations will be involved and public-private partnership promoted in community-based care of mentally ill patients. Standardised training manuals will be prepared for doctors and health care workers.

The Ministry already made an increased allocation of Rs. 70 crore for the programme during 2007-08.

Figures available with it show that at any given time 10 per cent of the population — approximately 10 crore people — suffer from mental disorders; 10 per cent of these suffer from severe disorders while 10 per cent of those with severe mental disorders require long-term treatment. Again, 10 per cent of those requiring long-term treatment need hospitalisation.

Most of these ailments can be treated in the out-patient ward itself and only a very small proportion requires hospitalisation that has led to acceptance of community-based treatment worldwide. Besides, being less expensive, community-based interventions are more accessible, acceptable and less stigmatising and less prone to human rights abuse. Thus early integration of the patient with the community is possible.

The NMHP was launched in 1982 to provide comprehensive community services fully integrated with general health care services. It was extended to the district level in the 9th Plan, begun 1996, with a budget of Rs. 28 crore. At present, 129 districts across 30 States and Union territories are covered.

In 1999, the National Human Rights Commission reported the poor status of mental hospitals and is regularly monitoring the situation. Following the 2001 fire tragedy,in which more than 25 mentally ill inmates of a religious institution at Erwadi in Tamil Nadu's Ramanathapuram district were burnt alive, the Supreme Court took suo motu notice of the case and has since been monitoring the mental health situation.

An evaluation of the NMHP was undertaken in 2003. Following the NHRC directions for minimum quality in mental health care, the programme was revamped for being expanded to 100 districts; psychiatry wings in general hospitals and medical colleges were upgraded and research and training activities were improved, besides an increase in the budgetary outlay to Rs. 139 crore.

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