The development of mental health services within primary care in India: learning from oral history

Abstract

BackgroundIn India very few of those who need mental health care receive it, despite efforts of the 1982 National Mental Health Programme and its district-level component the District Mental Health Programme (DMHP) to improve mental health care coverage.AimsTo explore and unpack the political, cultural and other historical reasons for the DMHP’s failures and successes since 1947 (post-independence era), which may highlight issues for today’s current primary mental health care policy and programme.MethodsOral history interviews and documentary sourcing were conducted in 2010–11 with policy makers, programme managers and observers who had been active in the creation of the NMHP and DMHP.ResultsThe results suggest that the widely held perception that the DMHP has failed is not entirely justified, insofar that major hurdles to the implementation of the plan have impacted on mental health coverage in primary care, rather than faults with the plan itself. These hurdles have been political neglect, inadequate leadership at central, state and district levels, inaccessible funding and improperly implemented delivery of services (including poor training, motivation and retention of staff) at district and community levels.ConclusionAt this important juncture as the 12th Five Year Plan is in preparation, this historical paper suggests that though the model may be improved, the most important changes would be to encourage central and state governments to implement better technical support, access to funds and to rethink the programme leadership at national, state and district levels.

Using the SAPAS to identify risk for personality disorders among psychiatric outpatients in India: A feasibility study

“…The data were collected from the psychiatric outpatient clinic of a private hospital, where the patients were fee paying. Whilst much psychiatric care in India is delivered by private institutions, and the present sample thus represents an important subset of the Indian psychiatric population, the sample was, in general, high‐functioning and the findings are unlikely to be representative of those receiving care from public psychiatric institutions. Within the busy environment of an outpatient clinic, access to collateral information from family and carers was limited, which is extremely useful for a diagnosis of PD.…”

Five-year plans and once-in-a-decade interventions: Need to move from filling gaps to bridging chasms in mental health care in India

“…[2] Reviews of the DMHP have been both appreciative and critical. Reviews of the DMHP in 2003,[1] 2009,[18] and 2012[19] concluded that the programme was partially successful at the district level (though not at the primary health-care level) with better awareness of mental illness in implemented districts compared to nonimplemented districts. However, several criticisms have been made of the DMHP which include inadequate leadership at the central, state, and district levels, political neglect, inaccessible funding, and various other administrative and programmatic problems.…”

“…Added to this complexity, there is yet another often cited reason – that as per the Constitution of India, health is a state subject and not under the control of the central government. [1]…”

Integration of behavioural and medical care: What was old is new again

“…Scaling up such programmes or implementation in a national health system is an additional challenge. van Ginneken describes such challenges in an article entitled ' The development of mental health services within primary care in India: Learning from oral histories ' (van Ginneken et al, 2014). Conclusions of van Ginneken ' s work indicate that while capacity is important in scaling up implementation, consistent leadership, policy prioritization and ongoing technical support are also critical elements.…”