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National Mental Health Policy of India-New Pathways New Hope-A Journey on Enchanted Path

  • December 2015
DOI:10.5005/EJP-18-2-1
Authors:
Om Prakash Singh at West Bengal University of Health Sciences
Om Prakash Singh
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Eastern Journal of Psychiatry | July – December 2015 Volume 18, Issue 2
Editorial
1
National Mental Health Policy of India - New Pathways
New Hope — A Journey on Enchanted Path
Om Prakash Singh
Indian government, in particular, Ministry of Health
and Family Welfare, came out with a visionary
document titled : National Mental Health Policy
of India - New Pathways, New Hope in October,
2014 for promotion of mental health, prevention of
mental illness, enabling recovery of mental illness,
promoting destigmization and desegregation,
and ensuring socio-economic inclusion of persons
affected by mental illness by providing accessible,
affordable and quality health and social care to all
persons through their life span, within a right –
based framework.
Values and principles as envisioned in the document
are equity, justice, integrated care, evidence based
care, quality, participatory and right based approach,
governance and effective delivery, value based in
all training and teaching programmes and holistic
approach to mental health.
GOALS AND OBJECTIVES
Goals
1. To reduce distress, disability, exclusion
morbidity and premature mortality associated
with mental health problems across life-span of
the person
2. To enhance understanding of mental health in
the country.
3. To strengthen the leadership in the mental
health sector at the national, state, and district
levels.
Objectives
1. To provide universal access to mental health
care.
2. To increase access to and utilisation of
comprehensive mental health services (including
prevention services, treatment and care and
support services) by persons with mental health
problems.
3. To increase access to mental health services
for vulnerable groups including homeless
person(s), person(s) in remote areas, difficult
terrains, educationally / socially / economically
deprived sections.
4. To reduce prevalence and impact of risk factors
associated with mental health problems.
5. To reduce risk and incidence of suicide and
attempted sucide.
6. To ensure respect for rights and protection from
harm of person(s) with mental health problems.
7. To reduce stigma associated with mental health
problems.
8. To enhance availability and equitable
distribution of skilled human resources for
mental health.
9. To progressively enhance financial allocation
and improve utilisation for mental health
promotion and care.
10. To identify and address the social, biological
and psychological determinants of mental
health problems and to provide appropriate
interventions.
Cross Cutting Issues were identified as stigma, right
based approach, vulnerable populations, poverty,
homelessness, persons inside custodial institutions,
orphaned persons with mental illness, children
of persons with mental health problem,elderly
caregivers, internally displaced persons, persons
affected by disaster and emergencies, other
marginalized populations.
Policy has provision for adequate funding,
promotion of mental health and special emphasis on
research, and building research capacity.(1)
2Eastern Journal of Psychiatry | July – December 2015Volume 18, Issue 2
MENTAL HEALTH ACTION PLAN 365 was made
with specific responsibility for all the sectors to be
covered. It clearly defines the role of each sector(2)
Two years have elapsed since this ambitious policy
has been passed but mental health care is languishing
and it has the same fate as District Mental Health
Program (DMHP) initially had. It promises the
earth and the moon and even points towards the
pathways, and shows how it can be achieved and
provides action map but still it is more of a document
of intention rather than a document of action.
Mental Health Policy takes upon itself the goal of
poverty eradication and social inclusion and rightly
so, but implementing it requires a higher level of
general development of country which is sadly
lacking at the moment. Political will behind the
policy is abating.
IPS task force on mental health policy in its report
has pointed out following facts :
1. The National Mental Health Policy has already
been notified whereas the National Mental
Health Care Bill is yet to be passed. There are
several discrepancies between the Policy and
the Bill (including that of definition of mental
illness, definition of mental health professional,
etc) that need to be addressed. There should be
synchrony between the Policy and the Mental
Health Care Bill.
2. There are certain areas of conflict and contrad-
iction between the Policy and the fundamental
rights in the Constitution, particularly with
regard to right to freedom and right to
treatment.
3. Since the Persons with Disability Bill has been
passed now, there is need to make the Policy
concordant with that.
4. Already two years have elapsed since the Policy
was notified in 2014. It is time to revisit the
Policy in the light of the above.(3)
It is time that key provisions of this policy are
implemented and at the start it should address the
lack of technical capacity in most states and districts
to implement this approach.(4) It will aggressively
need to reform 40 odd mental hospitals in country
to transform them into institutions which are
seamlessly linked to community.(4)
India has done path breaking work in the field of
community psychiatry but still all the programmes
are hampered by the mindset of health bureaucracy.
There is a huge gap between any national programme
and its implementation. Planners sitting in their
insulated chambers devise plans for the benefit of
masses, it comes from colonial legacy and some time
they show complete lack of ground realities. Author
can recall afforestation programme in its initial stage
in which there was monetary input for tree plantation
but no provision for money for manpower to look
after the plants or protect them from cattle resulting
in complete failure of the scheme.
However, this policy has inputs from psychiatric
professionals and we require an understanding of
this policy in devising future plans of development
both in private and government sector because
National Mental Health Policy is a tool to demand
better services and allocation for promotion of
mental health.It is a new path ,may be an enchanted
path but mastering the journey will lead to quantum
leap in the field of mental health in India.
REFERENCE
1) National Mental Health Policy of India - New Pathways
New Hope – MOHFW, Government of India, 2014
2) Mental Heath Action Plan 365 - MOHFW, Government of
India, 2014
3) Communication of Honorary General Secretary, IPS
4) Vikram Patel – State of the Mind – Indian Express
... 68 The National Mental Health Policy of India, launched in 2014, aimed to reduce suicide deaths and suicide attempts through various means-eg, suicide prevention programmes, restricting access to the means of suicide (pesticides in particular), framing guidelines for responsible media reporting, training community leaders in recognising suicide risk, improving data on suicide deaths and attempted suicides, and addressing alcohol misuse and depression as key risk factors. 69 An important component of this policy is the District Mental Health Programme run by the Ministry of Health and Family Welfare, in which 500 of the 725 districts in the country currently have a functional mental health programme with a psychiatrist as part of a multi disciplinary team. 69 However, substantial challenges have been highlighted in the implementation of the national mental health programme, which will have to be addressed for effective suicide prevention. ...
... 69 An important component of this policy is the District Mental Health Programme run by the Ministry of Health and Family Welfare, in which 500 of the 725 districts in the country currently have a functional mental health programme with a psychiatrist as part of a multi disciplinary team. 69 However, substantial challenges have been highlighted in the implementation of the national mental health programme, which will have to be addressed for effective suicide prevention. 70 Other national laws and programmes, under which reduction of risk factors for suicide can be facilitated, include the National Programme for Adolescent Health, 71 the National Programme for Prevention and Control Of Cancer, Diabetes, Cardiovascular Diseases and Stroke, 72 the National Programme for Healthcare for the Elderly, 27 and the National Programme of Palliative Care. ...
The national suicide prevention strategy in India: context and considerations for urgent action
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India reports the highest number of suicide deaths in the world. At this time when the Indian Government is formulating a national suicide prevention strategy, we have reviewed the current status of suicides in India, focusing on epidemiology, risk factors, and existing suicide prevention strategies to identify key challenges and priorities for suicide prevention. The suicide rate among Indian girls and women continues to be twice the global rate. Suicide accounts for most deaths in the 15–39 years age group compared with other causes of death. Hanging is the most common method of suicide, followed by pesticides poisoning, medicine overdose, and self-immolation. In addition to depression and alcohol use disorders as risk factors, several social and cultural factors appear to increase risk of suicide. The absence of a national suicide prevention strategy, inappropriate media reporting, legal conflicts in the interpretation of suicide being punishable, and inadequate multisectoral engagement are major barriers to effective suicide prevention. A scaffolding approach is useful to reduce suicide rates, as interventions provided at the right time, intensity, and duration can help navigate situations in which a person might be susceptible to and at risk of suicide. In addition to outlining research and data priorities, we provide recommendations that emphasise multilevel action priorities for suicide prevention across various sectors. We call for urgent action in India by integrating suicide prevention measures at every level of public health, with special focus on the finalisation and implementation of the national suicide prevention strategy.
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... Consequently, NMHPolicy has not been free from criticism from different sections of society, especially regarding its ground-level implementation and performance. [7][8][9] Despite the significance of this policy in the lives of persons with mental illness (PWMI) and having spanned six years since its launch, little has been discussed about it in the Indian psychiatric parlance. Moreover, the available literature, mostly from public health, has primarily focused on challenges with its implementation. ...
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... Hence, SDM has now been adopted at the national policy level in many Western countries (van Hoof et al., 2015) and has extended to Asian and African countries (Singh, 2015;Stein, 2014). Interventions or training programs to promote SDM for adults with SMI have been developed in both outpatient and inpatient settings. ...
Shared decision making for adults with severe mental illness: A concept analysis
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  • Aug 2020
Aim Shared decision making for adults with severe mental illness has increasingly attracted attention. However, this concept has not been comprehensively clarified. This review aimed to clarify a concept of shared decision making for adults with severe mental illness such as schizophrenia, depression, and bipolar disorder, and propose an adequate definition. Methods Rodgers' evolutionary concept analysis was used. MEDLINE, PsychINFO, and CINAHL were searched for articles written in English and published between 2010 and November 2019. The search terms were “psychiatr*” or “mental” or “schizophren*” or “depression” or “bipolar disorder”, combined with “shared decision making”. In total, 70 articles met the inclusion criteria. An inductive approach was used to identify themes and sub‐themes related to shared decision making for adults with severe mental illness. Surrogate terms and a definition of the concept were also described. Results Four key attributes were identified: user–professional relationship, communication process, user‐friendly visualization, and broader stakeholder approach. Communication process was the densest attribute, which consisted of five phases: goal sharing, information sharing, deliberation, mutual agreement, and follow‐up. The antecedents as prominent predisposing factors were long‐term complex illness, power imbalance, global trend, users' desire, concerns, and stigma. The consequences included decision‐related outcomes, users' changes, professionals' changes, and enhanced relationship. Conclusions Shared decision making for adults with severe mental illness is a communication process, involving both user‐friendly visualization techniques and broader stakeholders. The process may overcome traditional power imbalance and encourage changes among both users and professionals that could enhance the dyadic relationship.
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... The Indian government is striving to improve mental health care services with almost overlapping objectives through the three nationwide plans, namely, MHCA, 2017; NMHP; and National Mental Health Policy. [20][21][22] However, implementing these plans can be challenging due to the scarcity of psychiatrists/human resources (mental health professionals and administrative staffs, respectively), financial constraints, knowledge gap among service providers, and social stigma. 23 Capacity building and training mental health professionals are two of long-term strategies for overcoming this scarcity. ...
Inequity in Distribution of Psychiatry Trainee Seats and Institutes Across Indian States: A Critical Analysis
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  • Apr 2020
Background The delivery of mental health services largely depends on the adequacy of human resources. In India, the deficit of psychiatrists is more than 90% and is one of the major challenges that needs to be tackled to address the huge burden of mental illness. Psychiatry trainee institutes play a vital role in reducing human resource deficit and inequality in delivering mental health care. However, the distribution pattern of psychiatry trainee seats and institutes across Indian states is unknown. Therefore, we estimated the number of psychiatry trainee seats and institutes in each Indian state and union territory (UT). Materials and Methods In this cross-sectional study, psychiatry trainee seats and institutes were searched on the official web sites of Medical Council of India and National Board of Examinations. The data available on these web sites until December 2019 were included. State-wise data were compared using proportion and percentages. The psychiatry trainee index (PTI) was calculated and compared across Indian states and UTs. Results Among 221 Indian psychiatry trainee institutes considered in the present study, 116 (52.48%) were private institutes and 105 (47.51%) were government institutes. Overall, more psychiatry trainee seats were reported in government institutes (n = 565, 65.89%) than in private institutes. National PTI was considered fair (0.06), and based on their PTIs, Indian states and UTs were classified as follows: worst (n = 9), poor (n = 8), fair (n = 9), average (n = 7), good (n = 1), and excellent (n = 2). Conclusion A huge deficit of psychiatry trainees and institutes exists in more than two-thirds of Indian states and UTs, along with a huge maldistribution of seats. PTI and its distribution across the states and UTs are a crucial indicator of the need to improve the access and equity of mental health care.
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Shared decision‐making interventions for people with mental health conditions
Article
Full-text available
  • Nov 2022
Background: One person in every four will suffer from a diagnosable mental health condition during their life. Such conditions can have a devastating impact on the lives of the individual and their family, as well as society. International healthcare policy makers have increasingly advocated and enshrined partnership models of mental health care. Shared decision-making (SDM) is one such partnership approach. Shared decision-making is a form of service user-provider communication where both parties are acknowledged to bring expertise to the process and work in partnership to make a decision. This review assesses whether SDM interventions improve a range of outcomes. This is the first update of this Cochrane Review, first published in 2010. Objectives: To assess the effects of SDM interventions for people of all ages with mental health conditions, directed at people with mental health conditions, carers, or healthcare professionals, on a range of outcomes including: clinical outcomes, participation/involvement in decision-making process (observations on the process of SDM; user-reported, SDM-specific outcomes of encounters), recovery, satisfaction, knowledge, treatment/medication continuation, health service outcomes, and adverse outcomes. Search methods: We ran searches in January 2020 in CENTRAL, MEDLINE, Embase, and PsycINFO (2009 to January 2020). We also searched trial registers and the bibliographies of relevant papers, and contacted authors of included studies. We updated the searches in February 2022. When we identified studies as potentially relevant, we labelled these as studies awaiting classification. Selection criteria: Randomised controlled trials (RCTs), including cluster-randomised controlled trials, of SDM interventions in people with mental health conditions (by Diagnostic and Statistical Manual of Mental Disorders (DSM) or International Classification of Diseases (ICD) criteria). Data collection and analysis: We used standard methodological procedures expected by Cochrane. Two review authors independently screened citations for inclusion, extracted data, and assessed risk of bias. We used GRADE to assess the certainty of the evidence. Main results: This updated review included 13 new studies, for a total of 15 RCTs. Most participants were adults with severe mental illnesses such as schizophrenia, depression, and bipolar disorder, in higher-income countries. None of the studies included children or adolescents. Primary outcomes We are uncertain whether SDM interventions improve clinical outcomes, such as psychiatric symptoms, depression, anxiety, and readmission, compared with control due to very low-certainty evidence. For readmission, we conducted subgroup analysis between studies that used usual care and those that used cognitive training in the control group. There were no subgroup differences. Regarding participation (by the person with the mental health condition) or level of involvement in the decision-making process, we are uncertain if SDM interventions improve observations on the process of SDM compared with no intervention due to very low-certainty evidence. On the other hand, SDM interventions may improve SDM-specific user-reported outcomes from encounters immediately after intervention compared with no intervention (standardised mean difference (SMD) 0.63, 95% confidence interval (CI) 0.26 to 1.01; 3 studies, 534 participants; low-certainty evidence). However, there was insufficient evidence for sustained participation or involvement in the decision-making processes. Secondary outcomes We are uncertain whether SDM interventions improve recovery compared with no intervention due to very low-certainty evidence. We are uncertain if SDM interventions improve users' overall satisfaction. However, one study (241 participants) showed that SDM interventions probably improve some aspects of users' satisfaction with received information compared with no intervention: information given was rated as helpful (risk ratio (RR) 1.33, 95% CI 1.08 to 1.65); participants expressed a strong desire to receive information this way for other treatment decisions (RR 1.35, 95% CI 1.08 to 1.68); and strongly recommended the information be shared with others in this way (RR 1.32, 95% CI 1.11 to 1.58). The evidence was of moderate certainty for these outcomes. However, this same study reported there may be little or no effect on amount or clarity of information, while another small study reported there may be little or no change in carer satisfaction with the SDM intervention. The effects of healthcare professional satisfaction were mixed: SDM interventions may have little or no effect on healthcare professional satisfaction when measured continuously, but probably improve healthcare professional satisfaction when assessed categorically. We are uncertain whether SDM interventions improve knowledge, treatment continuation assessed through clinic visits, medication continuation, carer participation, and the relationship between users and healthcare professionals because of very low-certainty evidence. Regarding length of consultation, SDM interventions probably have little or no effect compared with no intervention (SDM 0.09, 95% CI -0.24 to 0.41; 2 studies, 282 participants; moderate-certainty evidence). On the other hand, we are uncertain whether SDM interventions improve length of hospital stay due to very low-certainty evidence. There were no adverse effects on health outcomes and no other adverse events reported. Authors' conclusions: This review update suggests that people exposed to SDM interventions may perceive greater levels of involvement immediately after an encounter compared with those in control groups. Moreover, SDM interventions probably have little or no effect on the length of consultations. Overall we found that most evidence was of low or very low certainty, meaning there is a generally low level of certainty about the effects of SDM interventions based on the studies assembled thus far. There is a need for further research in this area.
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