WELCOME TO CNE

PROGRAM
Mental Health Nursing
department
Sri Devaraj Urs College of
Nursing
Tamaka, Kolar.

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 DEVELOPMENT OF

MENTAL HEALTH SERVICES IN

INDIA

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 RESOURCE PERSONS
Mrs. R. Sreevani, Professor & H.O.D

Mrs. Asha S, Assistant Lecturer

Department of Mental Health

Nursing

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 OUT LINE OF PRESENTATION

• Land marks in development of mental

health services in India
• Innovative programs in mental health
• Organization of mental health services in
India
• Prevalence of Psychiatric Disorders in
India
• Mental health services available in India
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 OUT LINE OF PRESENTATION

• National Mental Health Program

 Objectives
 Approaches

• District Mental health Program

• National Mental Health Act 1987

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 OUT LINE OF PRESENTATION

• National Mental Health Policy

• National Health Policy

• Considerations related to Mental health

• Major developments during past two

decades
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Land marks in development of
mental health services in India

Karl Menninger (1947) defines

Mental health as “an adjustment of
human beings to the world and to
each other with a maximum of
effectiveness and happiness”.

contd…
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Land marks in development of
mental health services in India
• The institutional treatment for mental
disorders in India and the use of allopathic
medicine were introduced by the
European rulers

• The various event which influenced the

development of psychiatric services in
India have occurred over five discernible
phases.
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 PHASE I
• The first is the colonial period prior to India’s
attaining independence. From the later half of
the 18th century onwards, several lunatic
asylums were built in different parts of the
country.

• The first mental asylum was established in

Bombay (1745), the second in Calcutta (1781),
the third in Madras (1794) and the fourth in
Bihar. These asylums had acquired all the bad
qualities and treated mentally ill at par with
criminals.

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 PHASE I
• Till 1946, the approach of the Indian
Government was to establish
custodial centres.
• Col. M Taylor (1946) superintendent
of the European Mental Hospital at
“Ranchi”, surveyed 17 mental
hospital and observed outdated care.
• Recommendations of Bhore
Committee 1946.
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 PHASE II
• Establishment of mental hospitals at
various states, most of the mental health
care services in the country were centered
around the mental hospitals.

• In 1957, Dr.Vidya sagar, superintendent of

Amritsar Mental Hospital, involved the
family members of the mentally ill in the
management, by allowing them to stay
with their patients in open tents pitched in
the hospital campus. He showed that the
patients recovered fast and were taken
back to their homes. Based on this
principle family wards were established in
Bangalore Mental hospital and CMC
Vellore. 11
 PHASE III
• The third phase began in the mid 1960s with the
establishment of General Hospital Psychiatric
Units (GHPUs).
Advantages are :
• Shorter periods of hospitalization
• Involvement of family members
• Greater acceptance of services
• Easily approachable without stigma
• Attracted more patients with minor mental health
problems
• Encourage more outpatient care
• Integration of mental health into the general
health system
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 PHASE IV
• Extension of care from mental hospitals
and general hospitals to the primary
health care centers and the community.
• By the mid 1970s it was realized that the
existing mental health services were
highly centralized and situated
predominantly in urban areas, catering to
the needs of only a small proportion of the
population. Indian psychiatrists
emphasized the need to integrate mental
health into the general health care and
provide through primary care approach.
Contd..
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 PHASE IV
• An expert committee of the WHO
had recommended that developing
countries should organize mental
health services by integrating these
services with their existing system of
primary health care. It brought out a
technical report in 1974 and paved
the way for community mental
health program.
contd… 14
 PHASE IV
• Community care approach was
developed in two centres –
Sakalwara village near Bangalore
and Raipur Rani Block of Ambala
District, Haryana state. These
programs demonstrated that basic
mental health care can be provided
by health workers and doctors in
primary health care centres, if they
are adequately trained. contd…
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 PHASE V
• A series of media exposed about the poor
and scandalous situation in many mental
hospitals and the media also focused its
attention on the rights of the mentally ill
and the situation of the mentally ill
persons housed in jails.

• These have resulted in commissions of

inquiry and certain momentous
pronouncements by the Supreme Court of
India, contributing to substantial
increases in funding and
improvements in the conditions of
many mental hospitals.
contd…
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 PHASE V
• The Indian Lunacy Act of 1912 has now
been replaced by a new Mental Health Act
(1987).
• Mental hospitals are steadily acquiring
newer roles and functions. Many of them
have opened out-patient services for
ambulatory care of new patients and
follow-up and after-care of discharged
patients.
• Rehabilitation services of various types
which never existed before are being
added. contd…
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 PHASE V
• In recent years, there has been a
growth of voluntary and non-
governmental organizations taking
an active interest in various aspects
of mental health.

• These organizations, in different

parts of the country, are involved in
a variety of programs. contd…
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 PHASE V
• Another visible development during
the past few years has been the
growth of a private sector in
psychiatric services, especially in the
urban areas. Numbers of private
nursing homes and hospitals for the
mentally ill as well as psychiatry
wards in private general hospitals
have been on the increase.
contd…
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 Some of the innovative
programs in mental health

• NIMHANS crash programs

– Primary Health Centre (PHC) – based
rural mental health program
– General practitioner (GP) based urban
mental health program
– School mental health program
– Home-based follow up of psychiatric
patients
– Extension programs by “Satellite Clinics”
contd…. 20
 Some of the innovative
programs in mental health
– Extensive use of outdoor services
– involvement of ICDS personnel in child
mental health care
– Anganwadi workers are trained in basic
mental health care
– Training by volunteers
– Student enrichment program

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 ORGANIZATION OF MENTAL
HEALTH SERVICES IN INDIA
Mental Health Services are delivered
through:
• Central level Psychiatric Hospitals
• State level Psychiatric Hospitals
• General Hospital Psychiatric Units
• Community Mental Health Centers
• Primary Health Centers
• Sub Centers
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 PREVALENCE & INCIDENCE
• Analysis of fifteen epidemiological studies
shows prevalence rates as follows
(Ganguli HC,2000).
– All mental disorders are 73/1000 population
– (with rural and urban rates of 70.5 and
73/1000 respectively)
– Schizophrenia - 2.5/1000
– Affective disorder (depression) – 34/1000
population
– Anxiety neurosis – 16.5/1000
– Hysteria – 3.3/1000 population
– Mental retardation – 5.3/1000 population
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PREVALENCE & INCIDENCE
• Analysis of 10 epidemiological studies
shows prevalence rates as follows
(Madhav MS 2001).
– Schizophrenia – 2.3/1000 population
– Affective disorder – 31.2/1000 population
– Anxiety neurosis – 18.5/1000 population
– Hysteria – 4.1/1000 population
– Mental retardation – 4.2/1000 population

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 MENTAL HEALTH SERVICES
AVAILABLE IN INDIA
• Psychiatric Hospitals
• Partial Hospitalization (Day care centers)
• Quarterway homes
• Halfway Homes
• Self help groups
• Suicide Prevention Centers
• Hostels
• District Rehabilitation Centers
• Home Care Programs
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