Mental Health and De Addiction

THE HARYANA MENTAL HEALTH PROGRAM

Introduction

The National Mental Health Programme (NMHP) was started in 1982 with the objectives to ensure availability and accessibility of minimum mental health care for all, to encourage mental health knowledge and skills and to promote community participation in mental health service development and to stimulate self-help in the community. The strategies of National Mental Health Programme were - integration of mental health with primary health care through the NMHP; provision of tertiary care institutions for treatment of mental disorders; to eradicating stigmatization of mentally ill patients and protecting their rights through regulatory institutions like the Central Mental Health Authority, and State Mental Health Authority.

The Mental Health Program in Haryana started in district Kurukshetra in the year 1999. In 2006, two more districts were added i.e. Hisar and Gurugram. Now, the program is being implemented in 21 of 22 districts.

It is a well known fact that mental health disorders are increasingly recognized as a major public health problem. According to the National Institute of Health and Neuro Sciences (NIMHANS), about 1-2% of the population suffers from major mental problems and about 5% of the population from minor depressive disorders. About 25% of the population attending PHCs suffer from various psychological problems. Most of them do not require hospitalization but it is estimated that about 1% of them have severe mental disorders that may require hospitalization.

Structure

The Mental Health Program has the following components:

  • The District Mental Health Program (Health Dept)
  • State Institute of Mental Health (Medical Education Dept)
  • Centre of Excellence (Medical Education Dept)
  • State Mental Health Authority

District Mental Health Program

The District Mental Health Program is currently being implemented in 21 of 22 districts in Haryana. Charkhi Dadri shall be included with the permission of the National Health Mission in the Program Implementation Plan of 2020–21.

The objectives of DMHP are:-

  1. Prevention, promotion and long term continuing care at different levels.
  2. Augmentation of infrastructure, equipment and human resource.
  3. Promoting community awareness and participation.
  4. To broad base mental health into other related programs.

The components of DMHP are:-

  1. Service provision: Management of Mental Health Disorders and counselling
  2. Capacity building: Training and development of manpower, early identification and management of mental disorders
  3. Awareness generation: through IEC activities for early identification of mental disorders

Finances:-

The program is financed by National Health Mission in the Non-Communicable Diseases Flixipool. The total amount (including salaries) approved for 2019 – 20 is Rs. 577 lacs.

Activities:

  1. Private Psychiatrist with degree or diploma in psychiatry can now be hired by the districts. Approved rates are Rs. 1,25,000 per month for MD Psychiatry and Rs. 95,000 per month for Diploma in Psychiatry.
  2. Training of Medical Officers in basic psychiatry with the help of trainers from Civil Hospital Panchkula, Hisar and Kurukshetra is a regular activity. To date, total number of Medical Officers trained is 116. Next two training sessions (in 2019) will focus only on Health and Wellness Centers.
  3. Collaboration with private psychiatrists in the development of IEC material: IEC material has been received from private psychiatrist community in the form of posters and booklets that can be used in the IEC activities of the program. In some cases the private psychiatrists have even given written consent to use their material.
  4. IEC activities that are conducted yearly include observation of the following days:
    1. International Day Against Drug Abuse and Illicit Trafficking – 26th June
    2. Suicide Prevention Day – 10th September
    3. National anti drug addiction day -2nd October
    4. World Mental Health Day – 10th October
  5. Training of Para medical staff by DMHP Team regarding mental health issues. To date, about 495 Para medical staff have been trained in the districts.
  6. Advertisements have to be given in two newspapers on the occasion of World Mental Health Day 2019.
  7. Radio Jingles regarding mental health issues on All India Radio are a regular feature and will be repeated in 2019-20.
  8. To overcome the problem of stigma associated with drug addiction and related issues, the Health Department has started Project Recovery, a project with the help of an NGO based in Gurugram in which community participation is encouraged by formation of self help groups. This is a new initiative and at the moment, it is operational only in Gurugram and Panchkula but it is already showing great promise as family members of persons with mental illness as well as drug addicts who are under treatment now find a common platform to find help and seek answers.
  9. The first batch of 9 Medical Officers have received Diploma in Community Psychiatry from NIMHANS. The next batch of at least one medical officer per district will be slated for October- November, 2019.
  10. Coordination with other programs: we have collaborated with programs like the AIDS Control Program as well as RBSK / RKSK. Our teams regularly visit Red Ribbon Clubs in colleges to sensitize students about mental health issues, suicide prevention, and conflict management. Similarly, our teams collaborate with the RBSK teams in their outreach activities to visit schools.

STATE INSTITUTE OF MENTAL HEALTH (SIMH):

The State Institute of Mental Health is a tertiary care mental health institute under the Directorate of Medical Education & Research:

  • State Institute of Mental Health was established in 2011 at PGIMS Rohtak.
  • It is a 40 bedded tertiary care hospital.
  • It is responsible for referral services.
  • Chief Executive Officer is Dr. Rajiv Gupta, MD (Psychiatry)

CENTER OF EXCELLENCE (CoE):

The Centre of Excellence was made in the Department of Psychiatry, PGIMS, Rohtak. The purpose of the creation of this entity is the development of trained manpower in the State. Haryana does not have adequate numbers of psychiatrists, psychologists, psychiatric social workers and psychiatric nurses. The Head of Department of Psychiatry is Senior Professor, Dr. Rajiv Gupta (MD Psychiatry). The mandate of CoE is training of skilled manpower including:

  1. Psychiatrists,
  2. Psychiatric Social Workers,
  3. Clinical Psychologist,
  4. Psychiatric Nurses

STATE MENTAL HEALTH AUTHORITY (SMHA) Under the Mental Health Act 1987):

State Mental Health Authority was initially notified on 20.05.1994 under the Mental Health Act, 1987, and later reconstituted on 28.02.2014. The mandate of the State Mental Health Authority oversee the implementation of the Mental Health Act, 1987 in the State of Haryana. The members of the authority were:-

Official Members

  1. PS/ACS to Govt. of Haryana (Health) (Chairperson)
  2. Director General Health Services (Member)
  3. Head of Department Psychiatry, PGIMS, Rohtak (Member)
  4. Deputy Director (Health Education) (Convener)
  5. Dr. Rajeev Trehan (Psychiatrist), General Hospital, Panchkula (Member Secretary)

Non-Official Members

  1. Dr. Brahmdeep, Psychiatrist, General Hospital, Gurgaon (Member)
  2. Dr. Krishna Soni, Psychologist, SIMH, Rohtak, (Member)
  3. Dr. Vikas Ranjan Sharma, Psychiatric Social Worker, SIMH, Rohtak (Member)

The members of the SMHA are mandated to meet every six months.

Salient Features of SMHA (1987):-

• Regulatory Authority for Mental Health Act, 1987.

• Grant of licenses to Psychiatric Hospitals & Nursing Homes.

• Regular Monitoring of Psychiatric Nursing Homes.

Current situation of SMHA:

The Mental Health Care Act, 2017 has been adopted by the State and under this Act, a new SMHA has to be notified with official and non-official members. The official members had received the approval of the Chief Minister in early 2019 and notification of official members of SMHA was published in Gazette of Haryana on 16.08.2019. As of 07.08.2019, the approval for selection of non-official members has been received. An advertisement for calling applications of non official members of SMHA was published on 17.08.2019. Applications that have been received shall be submitted to the selection committee for non official members.  The selection committee will then recommend the names of the non – official members to the Government for nomination to SMHA. Approval of the same from the Government and Notification of the Official and Non- official members of SMHA will then be requested.

Once fully constituted, it is expected that in the agenda of the first meeting of the Haryana State Mental Health Authority the following topics shall be discussed:

  • Constitution of the Mental Health Fund and budget heads.
  • Constitution of Mental Health Review Boards in the State,
  • Drafting of Rules and Regulations under the Mental Health Care Act, 2017,
  • Development of quality and service provision norms for different types of mental health institutions,
  • Registration of mental health institutions
  • Registration of mental health professionals including psychiatrists, clinical psychologists, psychiatric social workers and psychiatric nurses.
  • Training of relevant persons including law enforcement officials etc about the provisions and implementation of this Act.
  • SMHA Website.
World Mental Health Day 2019