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Gujarat Mental Healthcare Policy PDF Print E-mail
Thursday, 18 August 2011 16:27

Introduction

Health is a state of complete physical, mental, and social well-being of an individual. Mental health thus is an integral part of health care system. The government of Gujarat has taken a number of initiatives to strengthen the health system. Through a network of primary, secondary and tertiary care institutions, the state meets growing healthcare needs of large segment of population. NGOs and private sector also play significant role in provision and financing of health care.

Primary health care system is not yet adequately geared to address mental health problems. Through the National Mental Health Programme and state level initiatives, the DoHFW has initiated a number of steps to strengthen the mental health care system in the state. Inadequate institutional for training and education in Gujarat have rendered various interventions in this sector ineffective. Iner alia there is a need for strategic and focused emphasis on mental health programme to enhance effectiveness of programme interventions. The recent developments in this field also suggest having more strategic and focused approach to address the emerging issues. Some of these provide

  • Need for quality assurance measures. In 1999 the National Human Rights Commission published its report on minimum standards for in-patient mental health services (Quality Assurance in Mental Health, NCHR, New Delhi, 1999). The discussions following this report called for the formulation of a state policy
  • Experiences with the National Mental Health Programme (NMHP). The NMHP is a centrally sponsored programme aiming at improving mental health interventions at the community level. In Gujarat it started in 1999. Implementation of this programme can be improved if policy directions are provided.
  • Supreme Court Judgment. In 1999 a judgment was passed that each state should have its own policy on mental health
  • WHO annual report. The WHO World Health Report 2001 focuses specifically on mental health. It actively promotes the formulation of mental health policies by its member states. 1.3 The inclusion of mental aspects of health was reflected, for the first time, in the Ninth Five-Year Plan when a separate scheme for ‘Strengthening of Mental Health Services’ was included. The Tenth Five-Year Plan envisages continuation of this emphasis; in particular, it aims to ‘integrate mental health with rural health

The inclusion of mental aspects of health was reflected, for the first time, in the Ninth Five-Year Plan when a separate scheme for ‘Strengthening of Mental Health Services’ was included. The Tenth Five-Year Plan envisages continuation of this emphasis; in particular, it aims to ‘integrate mental health with rural health care and provide special care for mental disorders of all types by scientific surveillance and identification’.

The approach and strategy in the area of mental health, takes into consideration the guidelines contained in the National Health Policy (NHP)–2002. Specifically focusing on mental health, the NHP under Para 2.13.1 states that mental health disorders are actually much more prevalent than is apparent on the surface. While such disorders do not contribute significantly to mortality, they have a serious bearing on the quality of life of the affected persons and their families. Sometimes, based on religious faith, mental disorders are treated as spiritual affliction. This has led to the establishment of informal mental institutions as an adjunct to religious institutions where reliance is placed on faith cure. Acute/chronic mental disorders may require hospitalisation and treatment under trained supervision. Mental health institutions are woefully deficient in physical infrastructure and trained manpower. NHP-2002 will address itself to these deficiencies in the public health sector. ”

The NHP recommends setting up of a network of decentralized mental health services for ameliorating the more common categories of disorders (section 4.13.1.1). The programme outline for such a disease would involve the diagnosis of common disorders, and the prescription of common therapeutic drugs, by general duty medical staff.” In regard to mental health institutions the NHP further envisages for in-door treatment of patients and proposes the upgrading of the physical infrastructure of such institutions at Central Government expenses so as to secure the human rights of this vulnerable segment of society (section 4.13.1.2).

Mental illness burden
It is estimated that there are 2.8 million adults with common and severe mental disorders at any point of time in Gujarat. Each year about 11000 new cases of schizophrenia are added to mental disorder burden. The population burden of all severe mental disorders is more than four times the number of persons affected by schizophrenia. Co-morbidity with physical disorders is common. The recent happenings of natural disaster and communal violence in Gujarat have significantly contributed to the number of reported cases of depression, trauma and anxiety. Given this mental disorder burden, less than one per cent of the total health budget is spent on mental health. Most of these funds are being spent on hospitals and institutional services which cater specially to severe mental illnesses. Also, most of these funds are towards salaries rather than other components of MH service delivery.

Private expenditures account for about 90 per cent of total spending on mental health. The financial burden on the population due to mental disorders is very high, even though only a small percentage of the people in need of mental health services receive appropriate care. The public health delivery system in Gujarat needs considerable support and strengthening to address the mental health needs of the population. An important measure would be to integrate the private sector into the overall mental health policy of the state to ensure access and quality care at affordable costs. Mental health service delivery at present is structured more towards treatment and care of severe mental disorders (SMDs) whereas the need is to develop a delivery structure which also focuses on common mental disorders (CMDs).

Some of the specific challenges faced by mental health sector include:

  • shortage of trained human resources, · inadequate training capacity,
  • lacunae in laws and regulation, · absence of multidisciplinary approach,
  • poor or non-existent linkages between community and hospital based care, and
  • weak institutional framework including government, private sector and civil society in general
  • absence of rehabilitation services.

This policy provides a framework for evolving and implementing strategies to develop MH sector in Gujarat in the context of these challenges. Many of the emerging strategic responses require sustained and long-term efforts. Given the fact that the institutional environment for MH is weak, considerable effort is required in creating learning experiences which will contribute to developing an improved and effective structure to programmes and interventions in this sector.

Historical Background

The treatment of mentally ill persons is governed by the Mental Health Act, 1987 which repealed the Indian Lunacy Act of 1912. The act came into force from 1st April 1993. The state government notified, in May 1993, the Additional Director, Medical Services, as the licensing authority under the Mental Health Act, 1987. State Mental Health Rules have been notified by the Central government in December 1990. The State Mental Health Authority has been set up.

Gujarat was the first state in the country having a Mental Health advisor to advise the State in all matters relating to mental health. It was at the initiative of the state government that District Psychiatry units for out-door patients were set up in eight District centers in 1980-81. 3.3 A pilot project for providing mental health services at the district level was in operation in the district of Sabarkantha before a district general psychiatric unit was set up in 1999-2000 in Navsari with the assistance of Central government.

A major landmark in the implementation of the mental health programme has come from the guidelines of the Supreme Court in the Sheela Barse case and the publication of a report on ‘Quality Assurance in Mental Health’ by the National Institute of Mental Health and Allied Sciences (NIMHANS) at the instance of the National Human Rights Commission (NHRC).

Current Status

The government infrastructure in the mental health sector comprises four hospitals for mental health at Ahmedabad (317 beds), Vadodara (300), Jamnagar (50) and Bhuj (16). These hospitals provide psychiatric care, especially in long-term care of the mentally ill. Psychiatry departments of (government) teaching hospitals at Ahmedabad, Vadodara, Jamnagar, Surat, Rajkot and Bhavnagar provide additional 157 psychiatric beds. Psychiatric beds are also available in the teaching colleges run by municipal corporations at Ahmedabad and Surat; and at private medical colleges at Karamsad and Surendranagar.

At the district level, the government health delivery system consists of honorary psychiatrists who visit district hospitals 2-3 days in a week, with a mental health worker who maintains records. Currently, such services are available in six of the twenty five districts: Bharuch, Panchmahals, Sabarkantha, Junagadh, Mehsana and Banaskantha.

A more comprehensive programme (Centrally sponsored National MH Programme), including activities for sensitization and training of medical and paramedical staff at the primary health centres and community health centres has been initiated in Navsari district from 1999.

There are only a handful of clinical psychologists – only two in the government sector both located in the medical colleges. Five posts of clinical psychologists – four for hospitals for mental health; and one for Navsari District Hospital – have been sanctioned but are vacant for want of suitably qualified candidates. Paramedical staff (psychiatric nurses and occupational therapists) too is less than a handful in the state. There are about 60 psychiatric hospitals / nursing homes in the private sector. There are about 150 psychiatrists in private practice in the state.

Very few civil society organisations are involved in mental health. There are a variety of organisations offering counselling services as a part of their other activities. Many of them have a team of volunteers working under the guidance of qualified MH professionals.

Guiding principles for policy development

The guiding principles for drafting the MH policy have been as follows:

  • Stakeholder participation: This policy development has been interactive. Suggestions by various stakeholders have been actively pursued and comments at all stages of drafting taken into consideration.
  • Patient orientation: The access, quality and affordability, and help seeking behaviour (stigma, misconceptions etc.) of the patient are an essential element in policy formulation. The primary providers of services, i.e. the entry points for service provision, carers and family physicians are an important focus for future programmes.
  • Poverty alleviation: The relation between mental illness and poverty is well known. A well functioning MH sector will contribute to alleviating poverty.
  • Value orientation: Since the MH sector involves working with vulnerable sections of society, the policy should be sensitive to the underlying personal values (safety, autonomy, wellness, human rights, equity in care) and systemic values (justice, participation, honour).
  • Broad view on mental health: Mental health is seen from a bio-psychosocial perspective. This implies a multi-disciplinary approach, both in diagnosis and in treatment. Medical, psychological and socioeconomical factors are to be taken into account simultaneously.
  • Focus on skills and social institutions: The MH sector has its own body of knowledge and research. It is guided by standards of good practices. Involvement of skilled professionals will strengthen the process of ensuring implementation of standards. Policy for sector development will include identification of expertise and skills needed for adequate development and strengthening of this sector. Strengthening of social institutions in areas of counselling, care and rehabilitations will be focused.
  • The legal structure: The main legislations governing the MH sector are the Mental Health Act and the Persons with Disabilities Act. The policy will back up these legislations with operational programmes and provide a mechanism to document and highlight areas of weaknesses and dysfunctionalties to strengthen these legislations.

Challenges for the Gujarat MH sector

Analysis of the existing situation in Gujarat indicates that a variety of promising initiatives in the field of MH are already taking place, both in rural and urban settings, by government, non-government and private practitioners. These initiatives cover all levels of service provision as well as prevention and promotion activities. Even though these activities are small scale and uncoordinated, they provide valuable insights for future developments. Looking at the mental health sector in Gujarat, there are a number of priorities for improving the system of MH service delivery. These are described below.

Matching of service demand and delivery It is estimated that there are 2.8 million adults with common and severe mental disorders at any point of time in Gujarat. Each year about 11000 new cases of schizophrenia are added to the mental illness burden. The population burden of all severe mental disorders is more than four times the number of persons affected by schizophrenia. Co-morbidity with physical disorders is common. The recent events of natural disaster and communal violence in Gujarat have significantly contributed to the number of reported cases of depression, trauma and anxiety.

Taking into account the current burden of mental illness in the state, there is an urgent need to augment services. At present the services are provided in a limited number of settings and focus mainly on in-patient and out-patient care. Promotion, prevention and rehabilitation are hardly covered. Table 1 provides a mapping of MH services in various settings (public, private, NGOs etc.). The MH sector not only needs to urgently improve and expand the existing facilities, but also develop new modalities of service delivery to adequately serve the demand among those needing service.

Human Resource Development

The MH sector requires a major effort in capacity building. Current services are insufficient to cope with the growing demand. Motivational levels, both in private and public sector, are too low. Human resources need to be strengthened in three ways: quantity, quality and organisation structure. The numbers of MH professionals will need to increase. This will be for all types of professionals:

  • Psychiatrists
  • Clinical psychologists
  • Psychiatric social workers
  • Psychiatric nurses
  • Occupational therapists (including life skills and rehabilitation)
  • Counsellors

MH component in other related courses (MBBS, nursing courses, educational courses, child development courses) needs to be strengthened.

The increase of professionals in the MH services leads to increased availability of services and an increased opportunity to introduce the multidisciplinary approach.

Merely increasing the number of MH professionals will not improve the services. Quality standards also need attention:

  • The MH professionals currently working in the sector – government, NGO and private - need a continuous education programme
  • The non-mental health professionals who deal with mental illness in their day-to-day practice (e.g. GPs, nurses, rehabilitation staff, NGOs) need focused support on mental health related topics.
  • Mental health aspects in the education for medical students and nurses need more attention.

These quantity and quality improvements need a large effort in training and onthe- job support programmes. This training capacity is to be strengthened and to a certain extent newly to be developed. In Gujarat there is a need for an organisation specifically focusing on MH capacity development.

Service providers in the communities
The first entry point for most patients with symptoms associated with mental illness is the general practitioner or tradition/faith healers. If available, patients also consult the PHC medical officer. At primary care level, it can be very helpful to have a systematic "on the job" training of primary care staff covering the common conditions, and the skills they will need to handle them. This can be reinforced by:

  • distribution of good practice guidelines for assessment, diagnosis, management and criteria for referral (e.g. by developing a Gujarat adaptation of the WHO primary care guidelines)
  • routine data collection at PHC level covering the common conditions such as depression, anxiety, schizophrenia, bipolar disorders, dementia, alcohol, drug abuse, PTSD, childhood emotion and conduct diseases, toxic confusional state, epilepsy etc.
  • regular supervision and support from the secondary level including meetings to discuss issues such as criteria for referral, discharge letters, shared care procedures, need for medicines, information transfer, training, good practice guidelines and research.

This first contact is varied in approach: it can be a conventional medical doctor, an ISM- practitioner or a less qualified healer, like religious healers. There is desirability of liaison with traditional healers in order to reduce harmful practices, encourage referral when appropriate, and enhance community support to people with mental illness. From a policy perspective, directions will need to be formulated how to involve these various types of service providers into the MH sector. The policy will also encourage more professional regulation amongst traditional healers, so that charlatans are extruded from their system.

Care giver involvement
Care givers form the backbone of the MH delivery system. They detect illness in an early stage and feel the responsibility for the continuous care of the patient. They are also the ones most burdened with the consequences of the disease. Parents, husbands, wives, children and other family members are severely affected by having a mentally ill patient in the family. If provided with information, counselling and other types of support, they can form a crucial part in care and treatment.

The creation of organisations of care givers would result in having valuable discussion partners for service providers and administrators. They would also be effective partners for community based NGOs and advocacy groups. In this way, institutional linkages with care givers would be established. From the side of the MH professionals attention is needed to create an attitude to actively involve care givers in the treatment process, to assist them in organising care givers to support each other and to promote contacts with advocacy groups.

Financial resources/government budget/private spending: Allocations to the MH sector are less than one per cent of the total health sector budget. Most of these funds are being spent on hospital and institutional services which cater specially to severe mental illnesses. Also, most of these funds are just sufficient for meeting salary expenditures and not much is available for other programme components. Lower budget allocation limits the availability of services within the government system. Under these circumstances people in need of services depend on the private sector. About 90 per cent of total expenditure in the MH sector is out-of-pocket expenses. Financial protection mechanisms are not available to the populations in general.

The cost of seeking services is high. This is because the treatment is long term in nature. Because of limited availability of MH facilities, patients and their relatives have to travel long distances and transportation is one significant component of the total costs. The policy observes that with the focus on community based approaches financing of services need to be addressed as the risk of financial burden shifts and increases on communities. More decentralisation of public sector programmes, effective involvement of NGOs, and public-private partnerships are broad strategic directions to take care of these problems in this area.

Mental health is a topic with medical, social and economical aspects. Therefore it is not restricted to the Department of Health and Family Welfare. Other departments involved would be:

  • Social Justice and Empowerment
  • Women and Child
  • Education

These other departments have programmes which involve mental health related areas. Coordination mechanisms need to be established to streamline policies and programmes. At the operational level, linkages are needed between MH professionals and other services who are in contact with people with mental disorders, like judiciary, police and various NGOs.

Focus on prevention and MH promotion
Community based prevention and promotion activities have proven to have a positive influence on incidence of mental illness and the stigma attached to it in society. Mental Health promotion is directed towards the general public to promote healthy living conditions and create awareness on mental illness. Prevention is directed towards groups at risk aiming at early detection. More severe problems will be prevented. In this sense early treatment can be seen as a form of (secondary) prevention.

For effective MH promotion, indigenous coping mechanisms will form an important basis for programme development. For policy and programme development it is essential to involve citizens and MH service consumers in finding out the most suitable mechanisms for health promotion and stigma reduction.

Policy goal
In order to achieve the goals of the MH policy, the government will facilitate the development of interventions which also focuses on common mental disorders and rehabilitative services. The future efforts in service delivery will need to:

  • Improve the current level of services, including public-private partnerships
  • Increase its focus on Common Mental Disorders (CMD) instead of Severe Mental Disorders (SMD)
  • Bring services closer to the communities § Promote MH service delivery among NGOs
  • Involve families and other care givers in the services
  • Introduce measures for prevention and MH promotion

7.2 Table 2 proposes how the MH Policy proposes to structure the sector in terms of provision of services in various settings. Table 2 provides the desired mapping of service providers. The starting point for service delivery improvement will be the patient’s help seeking behaviour, which implies a strong community focus. This community focus will be the core of the government’s policy towards MH sector improvements. The policy goal is formulated as:

Table 2 proposes how the MH Policy proposes to structure the sector in terms of provision of services in various settings. Table 2 provides the desired mapping of service providers. The starting point for service delivery improvement will be the patient’s help seeking behaviour, which implies a strong community focus. This community focus will be the core of the government’s policy towards MH sector improvements. The policy goal is formulated as:

Develop effective, efficient and adequate provision and mechanisms for community based mental health including promotion, prevention, treatment and rehabilitation, supported by a network of primary, secondary and tertiary services in public and private sectors.

Important indicators for achieving policy goal are described as follows:

  • Preventive and promotive areas of mental health will be focused so that risk patients are identified at early stages and treated earlier
  • In order to strengthen the above and provide treatment of common mental illnesses patients will have increased access to treatment facilities close to their homes by strengthening OPDs and counselling centres.
  • Patients will receive rehabilitation closer to their homes (within their village/town/city ward etc.)
  • Care givers and family members will be equipped and supported to enable them to play more effective role in care, treatment and rehabilitation.
  • People will have more knowledge on mental illness and possibilities for treatment. IEC strategies for various segments/stake holders/society groups will be developed to strengthen this.

Community based mental health approaches will have two focus points: delivery of services and care giver support. Services will focus on alternative ways of care, treatment and prevention like rehabilitation, multidisciplinary work and capacity building. Care giver support focuses on topics like providing information, advocacy and mutual support counselling the care giver, training, economic support, help lines etc. As the result of improved community based MH services, it is expected that prevalence and incidence of mental illnesses will decrease.

This policy document provides policy directions which would lead to an improved mental health situation in the state. Resource constraints – financial and human – necessitate choices and the government envisages implementing various interventions in phased manner. One of the foremost and important task is to augment the supply of human resources in this sector and secondly, improving access or new modalities of service delivery. Development of any intervention in this sector has to focus on these issues. At the same time the following criteria will guide the implementation process:

  • Cost-effectiveness of the intervention § Impact on vulnerable groups in society
  • sustainability
  • Addressing patient interest and increase in quality of care ( for example right to care)

Through this policy the government will address the following areas to strengthen the mental healthcare sector in Gujarat

Policy directions
The main directions through which the policy goal will be achieved are divided into four areas:

  • Service provision § Institutional development and finance (including policy formulation and planning capacity)
  • Organisational linkages
  • Boundary conditions

These areas are elaborated below. Together they form the framework for action for the years to come. The details and strategic action plan is elaborated in Appendix 1. The implementation arrangements for this framework are presented in the next section.

Service Provision: The delivery of MH services will need substantial improvement. Priority strategies are:

For the public sector

  • Increasing budget allocation to sector
  • Strengthen efficiency of existing allocations within the health sector
  • Design and develop new interventions
  • Administrative reforms (including policy and planning mechanisms and capacities)
  • Monitoring

For the Private sector

  • Strengthen pubic-private partnerships by designing and developing new interventions
  • Set up regulation, accreditation and continuous professional education
  • Integrate less qualified practitioners in the mainstream For the NGO sector
  • Capacity strengthening in mental health aspects
  • Develop appropriate models for NGO interventions in community MH

For the role of care givers

  • Stimulate self-help, support and advocacy groups
  • Start pilot activities to decrease burden (e.g. crisis intervention, help-lines, short-term shelters, half-way homes)

Institutional development and finance: Strengthening the institutional environment of the MH sector is a long term effort. Priority strategies are:

Towards institutional mechanisms

  • Organise a MH Platform for professional interaction/networking/ collaboration
  • Create and support Foundation for Mental health and Allied Sciences
  • Develop mechanisms for output monitoring (these reviews will be half-yearly and policy review every 2 years)

For human resource development

  • Create and operationalise state institution for MH capacity building/research
  • Make HR systems performance oriented
  • Improve work place environment in government provider setting For resource mobilisation and allocation
  • Increase budget allocation and improve efficiency of existing allocations
  • Evolve mechanisms for enabling/accessing alternative sources of funding
  • Focus on health impact of intervention designs

For MH research

  • Introduce research component in field work and implementation of various interventions
  • Institutionalise MH research in research organisations such as medical colleges and universities

Organisational linkages: Coordination and cooperation among key players in the MH sector is crucial for effective improvements. Priority strategies are:

For integration of MH in general health

  • Start with community based pilot projects
  • Use NMHP/DMHP to stimulate integration
  • Integrate MH in School Health Education Programme

For coordination with other departments

  • Set up committee to stimulate and guide integration activities. Application fields: Family counselling centres, De-addiction centres, Child welfare programmes, School counselling, MH promotion

Boundary Conditions: There are a number of interfaces with other areas which lie outside of the control of the MH sector itself. Still these need to be addressed in order to achieve the policy goal. Priority strategies are:

For the interface with law

  • Develop framework for legal issues in MH
  • Create permanent ‘Committee for Law and MH’ which proposes actions in legal field
  • Capacity strengthening of police, judiciary, legal services authority and mental health in prisons and need to educate prison health and custodial staff about mental health

For ethical practices

  • Define and implement minimum standards and best practices guidelines
  • Enforce implementation of regulations/rules/guidelines For addressing stigma and ignorance
  • Developing a communication strategy with focus on communities and families
  • Strengthen interface between family, GP and MH professional · Design media strategy

Based on these policy directions a detailed strategic action plan has been provided in Appendix 1.

Implementation mechanisms
The policy goal of creating new approaches to community mental health will require experimentation, documentation and evaluation before decisions can be taken on overall application in the State. Practical information has to be gathered on best practices elsewhere and pilot activities in Gujarat need to be carefully monitored and evaluated. The method for arriving at improved mechanisms for MH service delivery is presented in the figure below.

The priority directions formulated in the previous section provide numerous opportunities for developing pilot projects within the broad policy goal and the conditions for sustainable sector development. Separate monitoring and evaluation research will provide information as to efficiency and effectiveness of the projects.

Model For MH Sector Improvements

In order to make informed decisions on place and type of services, a condition would be to develop a documentation system on topics like patient flows, patient backgrounds, service quality and outputs, and community needs. This documentation will need to be established within the next three years.

With reliable and quality data on projects and documentation, annual policy discussions will be held. Results of these discussions will lead to possible policy adjustments and to decisions on wider scale implementation and the regulatory framework.

Organisation and management: In order to facilitate innovations in the MH Sector, the government is in the process of establishing an organisation which will stimulate, fund, and guide innovation projects in the sector. This organisation - the Gujarat Foundation for Mental Health and Allied Sciences – is registered as a not-for-profit company. The mission of this Foundation is formulated as follows:

The Gujarat Foundation for Mental Health and Allied Sciences aims at managing and facilitating the process of developing and designing appropriate interventions and advocating policies and laws in mental health sector which ensure availability and accessibility of mental health services especially to most vulnerable and under-privileged sections of the population with gender focus. This will be done by strengthening of capabilities and capacities in mental health services by facilitating, promoting and stimulating effective partnerships with civil society. The Foundation also aims at promoting the use of ethical mental health knowledge and best practices in the general health care and integrating psycho-social development efforts for the purpose of improving the well being of people.

The main tasks of the MH Foundation will be:

  • Invite interested parties to submit project proposals within the scope of the policy directions
  • Monitor and evaluate project implementation § Prepare recommendations for policy decisions
  • Advise the Government on administrative reform issues § Promote multi-stakeholder cooperation in MH Sector development § Set up a MH documentation system

Until the MH Foundation is operational, the government has requested IIM-A to carry out the Foundation’s task as the managing agent of pilot projects.

Role of the government in sector development
The Government of Gujarat would like to play important role in strengthening the enabling conditions for policy implementation and various strategies outlined in this policy than directly get involved in the provision of services, particularly at community levels. This stewardship role of the government would cover a number of areas:

Development of regulations: The government will set up mechanisms to:

  • Ensure development of quality standards for MH service delivery
  • Provide mechanisms for peer review § Develop an accreditation system, in cooperation with the professional bodies
  • Guarantee implementation of laws, norms, codes and provisions
  • Strengthen the functioning of the Mental Health Authority

Setting up a public information base: Information for the public is very scanty in the health sector in general and in the MH sector in particular. Various stakeholders, including care givers, do not have adequate information about the provision of services and what they are expected to do when they are faced with a problem. Moreover, the consumer will need information on where to go when in need. The government will set up an information data base on service providers so that patients and care givers acquire the necessary information timely.

Facilitate decentralization: The government has a number of implementation responsibilities in MH, especially in the Mental Hospitals, the Teaching Hospitals and the Psychiatric Wards of the General Hospitals. In the past few years initiatives have been taken to work towards more autonomy for health organisations, leading to increased efficiency and staff motivation. The government will seek ways to continue with providing increased autonomy. The government will also take action in facilitating decentralised management of schemes sponsored by the federal government.

Inter-sectoral coordination: There are a number of institutions which are directly or indirectly involved in the delivery of MH services. Many of the activities carried out by these institutions, both inside and outside the health sector, have a mental health component. The government will, in the coming years, set up a mechanism for coordination between MH services from various government agencies. In order to carry out this stewardship role, and to facilitate policy implementation, the government will take actions to create a separate Directorate for Mental Health under the Additional Director of MH.

table1

table2

Resource mobilisation and allocation
The government spends less than 1 per cent of its total health budget on mental health services. The strengthening of the sector will need more resources. Given the fiscal position and budgetary allocations, it does not seem likely in the near future for the government to be able to raise all the resources required. Demand is also currently low because of lack of awareness about MH illnesses. While effective interventions will increase the demand for services, some resources can be mobilised through the user charges. However, this will not be adequate. Therefore, mobilisation of additional resources from other sources has to be followed vigorously. Good quality and well planned intervention programmes will attract funding from other sources such as private sector and various international donor agencies.

DoHFW also need to focus on reorienting existing budget expenditures and reallocating some of these resources for effectiveness of programmes. For example, if 1 in 3 adults in primary care are suffering from CMDs and they are being treated albeit not explicitly for mental illnesses, then one-thirds of primary care resources spent on adults in PHC setting are already in mental health care. It is now a case of reorienting these service providers by sensitising, training and supervision. Finally, cost effectiveness of interventions will add to availability of resources.

The government will focus on:

Increasing budget allocation to MH sector
  • Allocate more resources to the mental healthcare sector
  • Develop plan for raising resources from central government under NMHP
  • Develop strategies to raise resources from donors
    and the private sector
Strengthen the efficiency of existing allocations
  • Examine the existing allocations and reprioritise
    the allocations
  • Allocate resources for sensitisation and reorientation at various levels to improve efficiency of existing allocations
Strategising design and development of interventions
  • Developing cost effective interventions
  • Focus on preparation of project proposals which has maximum health impact and presentation to various stakeholders to raise resources. Welldesigned interventions should interest donors and the private sector.

Strengthening the ethics of care
Across all provider setting and provision of services the sector has to strength the culture of caring for ethics. The implementation of MH services is partly influenced by the values of service providers on a number of mental health topics:

  • core areas of service delivery (costs, drugs, outcomes);
  • best practices treatment (ECT, medication, psychotherapy, counselling);
  • patient ethics (consent, confidentiality, transparency, doctor-patient relationship);
  • gender ethics (appropriate touch, relationships with clients, sexual abuse); and
  • institutional ethics (using and sharing information, research, assessments, evaluations).

The formulation and enforcement of ethical guidelines is crucial for quality of care in mental health services.

Towards formulating an appropriate environment for ethical practices, the government will initiate steps in collaboration with mental health professionals to define and implement minimum standards and best practices guidelines. For developing these guidelines the following would be included:

  • partnership with patient in design/implementation of service
  • evidence based and tested protocols for treatment
  • evaluation of outcomes and quality of care indicators

In order to ensure that ethical practices are followed, the government will strengthen the mechanisms and functional linkages with the regulatory system. One of the areas the regulations can focus on is promoting mechanisms for institutional ethics. The government will initiate steps to set up an institutional review board which can look into the standards, ethics and other humanitarian aspects of mental health and laws related to mental health. The professional bodies have an important role to play in strengthening these mechanisms.

Providing information on best practices is another critical factor in strengthening the quality of services. IEC strategies in the MH sector will address this. Consumer associations play important role in disseminating the information and these bodies will be strengthened. The government will also strengthen the mechanism to develop professional codes and start the process of formulating patient bill of rights. Implementation and strengthening of various mechanisms promoting ethical practices would require research and consultation to finalise the proposed strategies.

The broad action plan would be as follows:

Define and implement minimum standards and best practices guidelines
  • Developing appropriate instruments and mechanisms focusing on core areas of service delivery, best practices treatment, patient ethics, gender ethics and institutional ethics
  • Strengthening partnerships with patient in design/implementation of service
  • Promoting evidence based and tested protocols for treatment
  • Developing mechanisms for evaluation of outcomes and quality of care indicators
Strengthening implementation of regulations /rules/ guidelines
  • Strengthen the mechanisms and functional linkages with regulatory system
  • Promoting mechanisms for institutional ethics committees
  • Creating awareness (informing), educating and empowering various target groups
  • Stimulate consumer organisations, empowering of consumer initiatives to ensure consumer rights
  • Strengthening the role of professional bodies
  • Drafting a bill - rights of persons with psychiatric disability

Addressing stigma and ignorance
The stigma surrounding mental illness is pervasive and influences the main areas of MH sector improvement, including those who are responsible for budget allocation. Mechanisms of mental health manifest in reluctance, hiding and segregation. Research findings suggest that only media campaigns targeted at the general public will probably only increase stigma levels. Increasing knowledge about mental health issues alone is not adequate to address the stigma issue. Stigma reduction, therefore, is an effort which needs an integrated approach. Attention is needed on the interface between family, general physicians and mental health professional, to opinion leaders in communities, and to the mass media. Destigmatisation would require understanding and managing the attitude-behaviour relationship through interchanges between medicine, behavioural science, health system, social activism, patients, families and community. Also service providers are not free from stigma. They carry stigma put on them by the communities and less-trained staff stigmatise their patients. Stigma is amenable to communication management and can be addressed. Family's role is critical in acceptance of the ailment and continued treatment.

Developing communication strategy
  • Keeping focus on communities and families
  • Strengthening family, GP, and MH professional interface
  • Developing appropriate strategy for media as it can be important influencer and it is not fully aware of all the aspects of mental illness


Strengthening the public mental health system
The public health delivery system through a three-tier structure of primary, secondary and tertiary facilities caters to the health needs of the population. Despite the fact that mental health is one of the components at primary and secondary level, very little is being provided towards meeting MH needs. Utilisation data at district level indicate that during 2001 less than 5000 people were provided mental health services at district level hospitals in the state. At PHC/CHC level there is no record of utilisation. Given the MH burden in the population, there are significant gaps between utilisation and need of MH services. At present MH services are provided mainly at hospitals for mental health and six teaching hospitals.

The government will strengthen the PHC/CHC services to handle routine mental illness cases. For this purpose the government will develop community based approaches and this will be done in collaboration with the NGOs and private sector. In the initial phase, interventions would focus on strengthening counseling services and developing mechanisms which help in identification of risk cases. Over a period of time these facilities will be equipped to handle psychiatric emergencies through appropriate referral. Decentralisation of MH services will be vigorously pursued.

Various health facilities which provide MH services need to develop out-reach services and collaborate with other out-reach services already being provided under other health sector programmes. This would also facilitate integration of mental healthcare services in general health. The facilities immediately to start these outreach programmes are the hospitals for mental health, psychiatry wards of teaching hospitals, and district hospitals. All district hospitals will be equipped to provide mental healthcare services. Human resources are a major constraint in developing effective service delivery. In the short run, DoHFW will issue appropriate guidelines which would enable these facilities to hire mental health professionals on a contract basis.

Granting autonomy to hospitals for mental health (HMH) would improve both effectiveness and efficiency of services. Other facilities such as psychiatry departments of teaching hospitals should also be provided adequate autonomy which gives them flexibility to hire personnel. National mental health programme (NMPH) is an important step towards developing and implementing community based approaches. However, the performance of this programme has also suffered because of inadequate autonomy and the way the programme has been structured. The programme has also suffered because of poor monitoring and lack of programme guidelines. DoHFW will review the NMHP structure and develop appropriate monitoring systems.

Increasing budget allocation to MH sector
  • State government to allocate more resources to the MH sector at PHC/CHC and district levels
  • Develop plan for raising resources from GoI under NMHP
  • Explore and develop resources mobilisation from various sources
Strengthen the efficiency of existing allocations
  • Examine the existing allocations and reprioritise the allocations
  • Allocate resources for sensitisation and reorientation at various levels to improve efficiency of existing allocations
Strategising design and development of interventions
  • Developing cost effective interventions
  • Presentation to various donors. Welldesigned interventions should interest donors and the private sector.


Strengthening the involvement and role of caregivers
Caregivers assume significant importance in the MH sector. They are generally not provided adequate information about the process of treatment; they lack adequate knowledge; and have less access to mechanisms which help them in addressing and coping with their difficult task. Caregivers belonging to lower income groups face financial problems in sustaining long-term care. There are problems in managing legal interfaces. They are vulnerable to serious social discrimination. However, their role is critical in the process of diagnosis, treatment, and care. Since they bear the major burden of care, they need to be supported and their role needs to be strengthened.

The government will focus on and develop appropriate interventions which ensure that caregivers can assume their roles effectively. These will include psychoeducation about the illness, strengthening coping skills and family counselling and support. They will be provided more information on case handling. A programme focusing on providing awareness and training in coping skills needs will be developed. Appropriate financial support mechanisms will be developed to provide support.

In order to strengthen their involvement, Department of Health and Family Welfare in collaboration with the Social Justice and Empowerment will consider developing and designing a spectrum of services to reduce the burden on the family as well as disability in the patient. The Department of Health and Family Welfare will set-up inter-sectoral coordination mechanism to develop appropriate interventions. Interventions in this sector should focus on promoting setting up crisis intervention centres, 24-hour helpline and short-term shelters as well as DoHFW can consider developing and designing a spectrum of services for reduction of disability such as day care centres, sheltered workshops, half-way homes, and long term residential facilities. Increasing budget allocation to MH sector · State government to allocate more resources to the MH sector at PHC/CHC and district levels · Develop plan for raising resources from GoI under NMHP · Explore and develop resources mobilisation from various sources Strengthen the efficiency of existing allocations · Examine the existing allocations and reprioritise the allocations · Allocate resources for sensitisation and reorientation at various levels to improve efficiency of existing allocations Strategising design and development of interventions · Developing cost effective interventions · Presentation to various donors. Welldesigned interventions should interest donors and the private sector.

There are various other areas of concern, which need to be addressed to strengthen the role of family caregivers. One of which is being to have a legal regime which recognises the disabilities, induced by mental illness. And consequently provide proactive support to mainstream the concerns of both the caregiver and the person with mental illness. In 1995 the mental illness was recognised as a disability in the Persons with Disability Act. This inclusion did not yield major benefits as till recently mental illness was not considered a measurable disability like blindness or other disabilities. However, in case of mental illnesses WHO as well as the Indian Psychiatric Society have set standards for disability measurement. The initiative such as the International Disability Exchanges and Studies (IDEAS) should help us addressing the concerns with respect to persons with mental disorder. There is need to balance the hardship induced by constant re-evaluations with the fear of extending services to the undeserved. Family caregivers have also been asking for the explicit inclusion of mental illness in the National Trust Act so that state support may be available for their wards after them. Currently only mental illness, which coexists with other disabilities, stands included as multiple disability. The government will initiate steps towards implementing these measures. 15.5 From a rehabilitation angle other advocacy issues which merit attention are: work opportunities, self-employment and reservations in government jobs, sheltered workshops and occupational therapy. A major role can be played by various offices such as the Disability Commissioner's Office, the Social Justice and Empowerment Department and the Department of Health and Family Welfare etc. As suggested the Department of Health and Family Welfare will constitute an inter-sectoral committee to look into these coordination issues.

Decrease burden for caregivers Start pilot activities on services like crisis intervention centres, 24-hour help line, shortterm shelters, half-way homes, etc.
Strengthen the efficiency of existing allocations

Start with caregivers of in-patients and hire (contract) psychiatric social workers to provide:

  • General information on case handling
  • Assistance in acquiring financial support
  • Education awareness of life skills training
  • Assistance to set up caregiver organisations
Inter-sector collaboration Set-up a mechanism to take care of inter-sector collaboration issues

Strategies towards private sector
The private health sector plays a dominant role in provision and financing of MH services in Gujarat. More than 80 per cent of qualified doctors in Gujarat are working in the private sector. Out of 163 qualified psychiatrists 85 per cent are working in the private sector. About 70 per cent of practising psychiatrists have indoor patient facilities for psychiatric care. Utilisation data suggest that a large number of patients in need of mental health services go to private practitioners. More than 90 per cent of expenditure on mental health care is private out-of-pocket expenditure. It is important to involve the private sector as strategic partner in the process of MH sector development. However, promoting the role of the private sector is not without problems. It is well known that private health markets are subject to a number of unintended consequences. High cost and quality of care are two major concerns.

The government has an important role in ensuring that the private sector grows with the public goal in mind. This can be done through public-private partnerships. For ensuring effective partnerships, the Department of Health and Family Welfare will develop an appropriate incentive system; ensure there is mutual trust across agencies and develop appropriate institutional mechanisms which bring various stakeholders together. One of the prerequisites for these partnerships will be developing an effective regulation and accreditation system. Licensing is an important way to regulate the private sector. The objective is to ensure basic minimum quality of services and reduce variation in quality and costs.

The other prerequisite for a healthy development of private sector involvement is emphasising continuing professional education. In order to ensure this, the government will strengthen institutions responsible for education programmes.

Given the wide diversity of providers, there has to be strategic planning framework which ensures that services are not duplicated across different settings. The government will develop strategic planning framework so that duplication of services are minimised.

There is need to develop a plan to integrate traditional healers with the main stream. The government will develop appropriate guidelines so as to ensure that their roles and responsibilities are limited to providing and maintaining village MH information, help CMDs through counselling and refer SMDs through referral pathways. They will be encouraged to provide adequate cooperation in detection of risk cases. It is important that for effective planning they are registered. Registration system will be put in place for this purpose.

Strengthen publicprivate partnerships Experiment with private providers in public settings and develop mechanisms for general application
Set up regulation, accreditation, and continuous professional education
  • Set up committee for regulation and accreditation
  • Strengthen the continuing professional education programme
Integrate traditional healers in the main stream
  • Registration of traditional healers
  • Assist in CMD, referral of SM

Human resources and capacity strengthening at various levels
There is a shortage of trained MH professionals in MH sector. Gujarat has 163 qualified psychiatrists (0.4 per 100000 of population) and less than 50 clinical psychologists. Despite the fact that Gujarat has 23 general nursing colleges, there are few trained psychiatrist nurses. Availability of other para-MH professionals such as trained social workers in this area is also low. Involvement of these professionals is considered to be the basic condition for developing and implementing community based and cost-effective interventions in the MH sector. Non-availability of trained human resources hinders the process of developing interventions. This constraint is experienced at all levels and in all settings of care. Lack of professionals also hinders the use of multidisciplinary approaches to improve quality of care.

Training facilities do not exist and significantly limit the availability of trained manpower for immediate future. At the same time, initiatives such as district level MH programmes remain less effective in the absence of performance based monitoring mechanisms. The government will take appropriate steps to strengthen the training and education of mental health professionals at all levels. This would start with recognised programmes of mental health professionals in clinical psychology and nursing. At graduate level, psychiatry modules will be strengthened. Post-graduate education in psychiatry will be reoriented to make multidisciplinary work more relevant.

Hospitals of MH can become nodal agencies for developing training material and imparting training programmes. Human resource systems will be made performance oriented so that there is no training loss and there is adequate monitoring at implementation levels. This will be done by developing an appropriate health information system which includes data on utilisation of MH services. In order to promote the effective use of multidisciplinary approaches, an appropriate working environment will be created where MH professionals can use each other’s expertise.

Work-place environment is an important determinant of performance and in need of increased attention. The government will take steps to update the basic infrastructure.

Human resource policies would give adequate emphasis to interventions which help increase research capacities in the mental healthcare sector. The staff will be encouraged and given adequate support to develop collaborative national and international programme

Develop a state institution for MH capacity building, using existing organisations
  • Set up organisation development project which makes use of the capacity building experiences in various pilot projects
  • Develop state institution for mental health training and education and research by involving medical colleges, HMH, BM Institute, and SIHFW.
Make HR systems performance oriented Formulate guidelines based on experiences gathered from autonomous organisations and public-private cooperation
Improve work place environment
  • Strengthening basic infrastructure

Strengthening role of NGOs
There are more than 1500 NGOs in Gujarat. A few of them are working in the mental health sector. NGOs working in health and other allied fields admit that there is relatively little capacity available in the mental health area. Many of these NGOs work in the field of general health, mother and child care, social welfare, or disabilities. Limited skills and inadequate knowledge base of these institutions are major constraints which affect their ability to think through and propose good intervention projects in the mental health area. Inadequate knowledge of legal issues related to mental health and perceived threat from various provisions of the Mental Health Act also hinders the process of many NGOs thinking and developing community based MH interventions. The NGOs have little exposure in the area of community based approaches and effective models of these approaches in the mental health sector.

The capacity strengthening of NGOs in the area of mental health is very critical to promote the role of NGOs in this sector. The government will facilitate developing structured training programmes which include training on counselling skills and referral pathways for NGOs. The experience of pilots elsewhere will be used to develop knowledge base on implementing community based interventions. These capacity strengthening programmes for NGOs will also include: (a) visit to these places which would help these institutions to develop insight into community based interventions and (b) addressing various legal-ethical issues.

Rehabilitation of persons with mental illness is being seen today as a fundamental health-care right by mental health advocates. This is especially in the context of institutionalised patients, inmates of remand homes and shelters and mentally ill persons with criminal records. NGOs can be partners in addressing the needs of specific groups of population. They can play an important role in developing rehabilitation services. The strategy to promote the role of NGOs in mental health should also focus on building on existing set of activities of NGOs and synergising to improve access and ensuring cost- effective interventions. The Rehabilitation Council of India (RCI) which has been active in mental retardation is just beginning training programmes for psychosocial rehabilitation of the mentally ill. The government in collaboration with RCI will develop a plan to strengthen this capacity building role. This is needed to enable the development of services and to introduce NGO involvement.

Strengthen NGO capacity in mental health (counselling, detection, referral, rehabilitation)
  • Developing and initiating NGO capacity development programme including development of capacities to address legal and ethical issues in MH service delivery
  • Rehabilitation service
Make HR systems performance oriented
  • Generate information and draft models based on research components from the NGO pilot projects
  • Presentation and discussion of models with NGOs


Integration of mental health in health and other sectors
The mental healthcare component is officially part of primary care but little is being delivered. One of the reasons for this is that the mental healthcare components are not integrated with general health care. There are a number of vertical national health programmes. There is no integration of the mental healthcare component with these programmes. The mental health sector has considerable interface and linkages with other sectors in the state. Other departments of the government have programmes which, if they integrate mental healthcare components, can be more effective. The Mission observes that the main measure through which the mental health sector can be strengthened is through integration of mental health services in general health and across sectors.

The routine components of MH will form part of the PHC/CHC delivery system. The referral pathways need to be strengthened to make these efforts more effective. The government will also consider and develop strategies to integrate mental health in other systems of medicines by involving ISM practitioners to increase service provision at village and taluka level. Developing this intervention will need training of ISM practitioners and other community level staff in areas of counselling, identification, and referral. Currently DoHFW has a School Health Education programme. Psychological aspects of health need to be integrated with this programme. Other programmes where the MH components can be included are RCH and STD/HIV/AIDS. DoHFW will develop appropriate institutional mechanisms which ensure integrating mental health aspects in various programmes. Strategies to integrate mental health in other programmes would also ensure provision of mental healthcare services catering to vulnerable groups. For example, the Department of Women and Child Welfare has programmes such as family counselling centres and ICDS (integrated child development scheme). By adding mental healthcare components in these programmes, the overall gains can be significant. Similarly, the Department of Social Justice and Empowerment has programmes on de-addiction and child welfare activities. In the same way the Department of Education can include components of positive mental health at school education level. Strengthening of counselling services at school level is an important means for early detection and prevention. There are many unknowns in this area and the government proposes to initiate pilots to gain understanding and experience and develop initiatives which can be up-scaled later.

Integration in the health sector (intrasector)
  • Pilot projects
  • Integrate MH aspects in the School Health Education Programme
Integration between sectors (inter-sector)
  • Set up committee to guide integration activities. Fields of application:
  • Family Counselling Centres
  • De-addiction Centres
  • Child Welfare programmes
  • Counselling services at school
  • MH promotion in schools


Strengthening the interface with law
Mental health law must be an integral part of Mental Healthcare Policy. This requires the overall concerns of law and policy to be in consonance and not contradiction. The development of legal framework is part of an evolution process. The absence of a framework which could provide the basis for development of mental healthcare laws has resulted in having enactments which are without adequate weightage to concerns of community care and human rights. The government will initiate a dialogue with stakeholders to develop the framework for mental health laws. Legal interaction with mental illness will inevitably happen. This framework would be instrumental in controlling the manner of that interaction. The law can be a vehicle of social change and this framework will guide the development of mental health laws in appropriate direction. This framework along with the public education when in consonance with rights of persons with mental illness will also help in reducing the social stigma.

An important instrument in this process is the "UN Principles for Protection of Persons with Mental Illness and the Improvement of Mental Health Care". Implementing these in the local context would involve mooting amendments to existing legislations; constructing new legislations such as a Right to Rehabilitation Act; and challenging existing laws and practices through class action and public interest petitions. The legal framework will help us in this direction.

It has been experienced that lack of research and documentation in mental health law has been a block in examining the local context. It is necessary to document the various legislative and adjudicative efforts in Gujarat, encompassing comparative legal studies, and research on state relevant rules, notifications, case records, and schemes. There is also a need to form a coalition or network of partners that will deliberate upon local needs in the mental health law, amendments to rules, utilisation and adjudication. The government will encourage increasing the interaction of legal players, disability administrators, NGOs, patient groups, carer groups, consumer adjudicators and activists. Appropriate forums would be created for this purpose. Such interactions will assist in placing mental health law reform on the agenda of diverse groups. Against the context of low awareness in the area of mental health law, the government will suggest developing pilots to prepare training curricula for various stakeholders including police and the judiciary. Going by the present motivation of legal actors, building local training capacities in this area would be an important future agenda of this policy.

Framework for legal issues Developing framework for legal issues in mental
health
Make existing system of law and adjudication human rights compliant Strengthen documentation to aid informed interventions

UN principles, proposing bill on right to rehabilitation

Strengthen documentation to aid informed interventions Create a permanent Committee for ‘Law and Mental Health’ which proposes actions in the legal field. First priorities are documentation and capacity building.

Capacity strengthening of police, judiciary and legal services authority Developing appropriate training material


Strengthening institutional mechanisms
The Mental Healthcare Policy recognises that given the limited information base, inadequacy of regulatory structures and capacities, passive role of professional bodies, low level of caregiver awareness and education, absence of advocacy groups, and lack of mechanisms of inter-sectoral coordination, the stewardship role of the government needs to become more important.

Given the complexity of the MH sector and the action plan which needs to be developed based on various strategic directions as outlined above, the Mental Healthcare Office of the Department of Health and Family Welfare, Government of Gujarat will need considerable strengthening. This will be necessary in order to ensure: (a) promotion of public private partnerships and formalising mechanisms for these partnerships, (b) developing regulatory structures and capacities, (c) strengthening the role of professional bodies, (d) information and IEC, and (e) intraand inter-sector coordination.

Developing and organising the mental health platform, where the participants/organisations can discuss and advise on mental health policy and strategic issues, can strengthen the sector improvement efforts. The sector also needs to introduce measures which stimulate the formation and strengthening of self-help groups, support groups, and advocacy groups. The Mental Healthcare Office of the Department of Health and Family Welfare can play pivotal role in this process.

Because of various institutional constraints, the impact of programmes and interventions cannot be adequately measured. Appropriate mechanisms for impact monitoring will be put in place.

Organising a platform where organisations can discuss and advise on mental health policy and strategy issues Continue and expand current workshops with mental health platform
Strengthen the Mental Health Office in the Department of Health and Family Welfare to provide directions







Develop mechanisms for output monitoring

Specific tasks will include

  • Assign two additional staff on contract basis for three years
  • Promoting public-private partnerships and formalising mechanisms for these partnerships
  • Developing regulatory structures and capacities
  • Strengthening role of professional bodies
  • Information and IEC
  • Intra- and inter-sector coordination


Output monitoring systems – for example developing district health information systems which provides information on mental illness cases

Introduce measures to stimulate self-help groups, support groups, and advocacy groups

Stimulate MH Research
There are still many unknowns in the sector. Research would play an important role in demystifying and informing the government and programme managers to develop appropriate interventions. There is a need to introduce research component in field work. This will help in increasing the knowledge base. Departments of universities and medical schools will be involved in this process. This will also help in augmenting the research capacity in the MH sector in the long run. The Mental Healthcare Policy proposes to focus on the following research areas in the beginning: (a) coping mechanisms of communities, (b) effectiveness of various models of interventions, (c) impact of socio-economic development programmes, (d) integration of MH in public health programmes, (e) understanding needs of specific groups of population and (f) randomised controlled trials to determine the effectiveness of various treatment regimens.

Introduce research components in the field work Add research component to the pilot projects
Institutionalise mental health research in existing research organisations in the state






Annual meetings with research institutes on pilot research process and results, and on implications for their research agendas.

Priority areas for research:

  • Effectiveness of various models of interventions
  • Impact of socio-economic development programmes
  • Integration of MH in public health programmes
  • Needs of specific groups of population
  • Randomised controlled trials
  • Coping mechanisms of communities
Last Updated on Tuesday, 10 January 2012 16:26
 
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