National mental health program was initiated in Tamil Nadu during the year 1986. Since then several training programs and workshops were conducted. Following the successful performance of the state unit of the National Mental Health Program, the state of Tamil Nadu was selected to implement the District Mental Health Program (DMHP) under the National Mental Health Program with financial assistance from Govt. of India.
District Mental Health Program (DMHP)
District mental health program envisages implementing the aims and objectives of the National Mental Health Program .The program is based on the district mental health program of NIMHANS Bangalore in Bellary district of Karnataka with suitable modifications. This pilot program of five years duration sponsored by Ministry of Health & Family Welfare, Government of India has commenced from the year 1997. Institute of Mental Health is the nodal agency identified by the Government of India for implementing the program. The health care delivery of the districts and villages were administered by Director of Medical and Rural Health Services (DMS). Hence, the Institute of Mental Health has submitted a joint proposal with DMS to Govt. of Tamilnadu under the guidance of Director of Medical Education. The services and guidance of Director of Public Health and Preventive Medicine were utilised for the implementation of the program
The Govt of Tamilnadu has selected Trichi district to implement the district mental health program. The Trichi District was selected for the DMHP program for the following reasons:
Heath Care Delivery of Trichi District:
Government and Non-Governmental agencies provide health care needs of Trichirapalli. District Government Hospital, Taluk Hospitals, panchayats Dispensaries and Primary Health Centres are the government agencies involved in the health care delivery system. There is one District Head Quarters Hospital, 6 Taluk hospitals, 4 dispensaries, 1 Tamilnadu special police hospital and 50 Primary Health centres including 2 upgraded primary health centres.
Govt Annal Gandhi Memorial Hospital, which has recently been affiliated to K.A.P.V Medical College, at Trichirapalli, has 603 beds with 12 speciality departments including Psychiatry. 76 Asst surgeons including one psychiatrist, 107 nurses, one extension educator and one social worker are posted to the Headquarters hospital. Total number of bed strength of six Taluk hospitals is 378. In addition Trichirapalli district has central Govt. hospitals like Railway hospital, Ordinance factory hospital, and BHEL hospital, which also cater the health needs of the industrial population. Private practitioners of medicine including Psychiatrists and private hospitals are the non-governmental agencies involved in the health care delivery system of Trichirapalli.
Since the mental health care at primary care level needs the involvement of administrators at different level, a broad based team for the implementation of DMHP was formed.
The DMHP has three components namely training of medical, para medical and community leaders, Mental Health Care delivery and Information, Education and Communication activities (IEC activities). Implementation of the program will be done jointly by Director of Medical Services and Institute of Mental Health. Services of the Director of Public Health and Director of Primary Health Centres will be utilised.
Mental Health Care Delivery:
The Mental Health Care Delivery under the DMHP has been planned taking into consideration the Governmental and Non Governmental agencies into account. Govt. Annal Gandhi Memorial Hospital, Trichirapalli will be the head office and administrative centre for the district mental health program. Psychiatrist attached to this hospital will be called DMHP psychiatrist and the psychiatrist recruited for the District Mental Health Team will be DMHT Psychiatrist. The Joint Director, Medical Services will be in charge of the whole program at district level and all the communications. The DMHP psychiatrist with the help of DMHT psychiatrist will carry out liaison activities. In addition to his routine duties the DMHP psychiatrist will guide the district mental health team, attend the inpatients and conduct review meetings to monitor the program. Whenever possible he will also take part in IEC activities of the district mental health program.
District Mental Health Team is a multidisciplinary team exclusively recruited for Mental Health Care Delivery of the DMHP. It consists of one psychiatrist, one clinical psychologist, one psychiatric social worker, 4 nurses, and one male nursing attendant and a driver. The Psychiatrist recruited for the district mental health Team will be called as DMHT psychiatrist and he will lead the Mental Health Team under the guidance of DMHP psychiatrist. For the purpose of mental health care the district is divided into six units belonging to six Taluks of the district. Six to eight primary health centres has been allotted to each Taluk. The existing psychiatric ward at the Annal Gandhi Hospital Trichi has been strengthened with additional 10 beds and equipment with the funds from DMHP. The DMHP psychiatrist will be in charge of the psychiatric ward. Cases requiring admission in the ward may be referred by DMHT psychiatrist from Taluk and villages to the psychiatric Out Patient room at Annal Gandhi Hospital, Trichi.
District mental health team with one psychiatrist, one nurse, one psychiatric social worker, and one male nursing attendant will visit satellite Psychiatric clinics at one Taluk hospital a day for six days a week. Medical officers and paramedical staff of Taluk hospitals will collect cases to be shown to the DMHT on prescribed days. Other than these cases, PHC medical officers and health workers of the respective Taluk will bring the cases to be treated by mental health team. The follow-up of cases treated at The Satellite Clinic will be done at the primary care level. Whenever necessary mental health team will also make visits to villages to deliver mental health care subject to feasibility of the visit. In addition to mental health care the team will also engage in IEC activities with the help of the local health workers and community leaders.
Following is schedule of Taluk level satellite Psychiatric Clinics:
10 am to 1 pm
The satellite mental health clinics were started during the month of June 1998. From June 1998 to March 1999, 783 new cases and 2950 old cases were treated at satellite mental health clinics. And during the current year 986 new cases and 12326 old cases were treated at satellite mental health clinics. Totally 13312 patients were treated.
Following table gives the number of patients treated at satellite mental health clinics from April 1999 to March 2000.
Following personnel were redeployed for mental health care delivery
Following Medicines were supplied to Taluk hospitals and Primary Health Centres under DMHP:
List of Drugs with the quantity supplied:
Infra structure for health care delivery was established by purchasing following equipment and medicines.
Vehicle - Tata Sumo
Certain forms, case sheets and registers were printed for the DMHP. The forms, case sheets and registers have been designed by the Institute of Mental Health. Following are the forms, case sheets and registers printed for the Mental Health Care delivery:
1. Referral Slip for Health workers in Tamil
2. Referral Slip for Medical officers:
3. Psychiatric Case sheet to be used by DMHT at Taluk hospitals:
4. Nominal Register for DMHT:
5. Evaluation Forms:
6. Patients Follow up Books
The copy of the forms printed under DMHP, Trichi are annexed in the book titled Mental Health available in the same web site
Training is imparted at three levels. The medical officers, para-medical workers of Govt. Taluk and primary health centre and non-medical persons were trained in basic mental health diagnosis and care. District psychiatrists and faculty members from Institute of Mental Health took part in the training as resource persons.
Totally 23 medical officers, 40 Health Inspectors and 135 non-medical personnel were trained during the first year of implementation. All the training programs were conducted at the KAPV Medical College, Trichi. The training for non-medical persons were conducted at PHCs
Totally 36 medical officers and 290 Village Health Nurses were trained during the year 1998 - 1999
Totally 130 Health Inspectors were trained during the year 1999 - 2000
So far totally 59 medical officers, 290 Village Health Nurses, 170th Health Inspectors and 135 non- medical personnel were trained under District Mental Health Program.
Medical officers were trained for two weeks and para medical personnel had undergone one week training. All the training programs for medical and para medical were conducted at KAPV medical college, Trichi. Faculty members of Institute of Mental Health, DMHT psychiatrist, DMHP Psychiatrist and psychiatrist of Dept. of Psychiatry, KAPV Medical College have participated in the DMHP training program as resource persons.
III. Information, Education and Communication Programs (IEC):
The Information, Education and Communication (IEC) activities were planned according to the needs of the community. Following methods were used to create awareness about mental health and District Mental Health Program.
Following are the details of mental health festivals:
Mental Health Festivals:
The mental health delivery system is streamlined and more number of patients are attending the satellite clinics. Most of the referrals to the satellite clinics are from old patients of satellite clinics, which show the quality and popularity of the satellite clinics. Psychiatric medicines are issued to the patients for 14 days, which eliminates the frequent visits to the clinic and reduces the expenditure involved in travelling. The network for mental health care has been established at the Taluk level and the next logical step in mental health care under DMHP will be to extend the service to Primary Health Centres.
As far as training is concerned fairly good number of medical and para medical personnel had been trained in basic mental health care. 290-village health nurses and out 170 health inspectors and 59 of medical officers had been trained. With this the training component of DMHP comes to an end. Henceforth services of trained personnel should be utilized to extend the service to PHC and Sub centre level. Short refresher courses should be planned to maintain the mental health skills of the trained personnel.
DMHP has done extremely well in the sphere of IEC activities. Especially the mental health festivals had been a grand success in creating awareness about mental health. The mental health festivals were conducted from May to July. Success of the programs is reflected in the sudden increase in the new cases attending the satellite clinics during these months. Number of printed materials was prepared for awareness activities. School awareness meeting were inspiring and encouraging.
With these achievements, it is time to intensify the IEC activities and extend the mental health services to the Primary Health Centre level. During the coming years following activities will be undertaken:
Continuing and Strengthening the Taluk level Satellite Mental Health Clinics