15june[d] National Mental Health Policy - suggestions invited by Policy Group

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From: Policy Group <mentalhea...@gmail.com>

Dear Friends,

The Ministry of Health and Family Welfare, Government of India has constituted a Policy Group to frame a National Mental Health Policy and Plan. Your attention is also called to the dedicated website, www.mhpolicy.org, which gives more details and provides some links to a range of published and unpublished materials relevant to the subject. The Policy Group can also be contacted on a dedicated email (mentalhea...@gmail.com).

A National Mental Health Policy and Plan is being drafted for the first time and the Policy Group which met on 3rd May 2011 has agreed that action towards framing a policy statement which is relevant to India’s needs must commence with reaching out to and consulting with as many stakeholders from the entire spectrum. This necessarily includes persons with mental illness, family & non family care-givers, health professionals, professional bodies, activists, non-governmental organizations and those working on health systems, community health and development to name just a few. Knowing of your involvement in this area we seek your opinions and suggestions.

A mental health policy for India ought to address both immediate and anticipated future concerns. Government is aware that there is a need for better implementation of existing programmes; the Policy Group is accordingly addressing the issue of restructuring the National and District Mental Health Programmes. Policy will also have to address the causes of mental illness as well as the steps to be taken to promote mental health. Issues of poverty and social exclusion are as important as issues of treatment and care. A policy must also recognize the rights of all stakeholders, the role of the community and the range of treatments and facilities for care. Policy must pay particular attention to the mental health needs of women and children. Policy must also address the requirement of training of health professionals of all types as also the need for mental health research.

The Policy Group is aware that this exercise of sending an email inviting suggestions runs the risk of involving only those with access to email or to the English language. This is not representative of the concerns and wishes of the broader stakeholder community in this country and we request you to share this email and its contents with as many interested persons as possible.

We also trust it will be possible for you to translate the contents of this mail for the benefit of persons known to you. The Policy Group will be happy to receive inputs in any language.

We would also be grateful for suggestions on how better we could engage with other stakeholder interests

The Policy Group will broadly use the WHO definitions of Policy, Plan and Programme when drafting the National Mental Health Policy and Plan. These are given below at the end of this email.

The Policy Group accordingly requests :

a) Your suggestions regarding important issues and priorities for inclusion in the Policy and Plan

b) Information including data, reports, etc. (both published as well as unpublished) regarding mental health problems and mental health services in the country. In particular, information on innovative service delivery programmes from different parts of the country.

c) Inputs on the following issues

i) District Mental Health Programme and suggestions for restructuring the programme to make it more effective

ii) Models of community care of persons living with mental illness

iii) Norms and Standards for different types of health services relevant to mental illness

iv) improving access to all types of care, therapy and health services relevant to mental illness

iv) Promotion of mental health in all its aspects

The Policy Group will be obliged if you can send the above information/suggestions by writing to us at mentalhea...@gmail.com to reach us by 15th June 2011.

Thanking you

on behalf of the Policy Group

for National Mental Health Policy and Plan

WHO Definitions of Policy, Plan and Programmes

Mental health policy is an organized set of values, principles and objectives for improving

mental health and reducing the burden of mental disorders in a population. It defines a

vision for the future and helps to establish a model for action.

Mental health plan: A detailed pre-formulated scheme for implementing strategic

actions that favour the promotion of mental health, the prevention of mental disorders,

and treatment and rehabilitation. Such a plan allows the implementation of the vision,

values, principles, and objectives defined in the policy. A plan usually includes strategies,

time frames, resources required, targets to be achieved, indicators and activities.

Mental health programme: An intervention or series of interventions with a highly

focused objective for the promotion of mental health, the prevention of mental disorders,

and treatment and rehabilitation. A programme usually focuses on a specific mental health

priority

From: Vaishnavi Jayakumar <vaishnavi...@inclusiveindia.info>

MENTAL HEALTH POLICY GROUP

The Ministry of Health and Family Welfare, Government of India has appointed a Policy Group to prepare a National Mental Health Policy and Plan.

The Members of the Policy Group are : Keshav Desiraju, Jagdish Prasad, Akhileshwar Sahay, Nirmala Srinivasan, Vikram Gupta, Thelma Narayan, Sanjeev Jain, Vikram Patel, Anirudh Kala, Vandana Gopikumar, Alok Sarin and Soumitra Pathare.

The Terms of Reference of the Policy Group are :

a. To prepare a situational analysis of the need for mental health care in the country and the current provision of mental health care in the country, including issue of human resources, essential drug procurement and distribution, advocacy, prevention of mental illness, rehabilitation and care and promotion of mental health and rehabilitation.

b) To carry out a systematic review of the evidence base for the policy measures proposed below.

c) To take the draft Mental Health Care Act into account when drafting the National Mental Health Care Policy and Plan and recommend changes to the proposed draft Mental Health Care Act, if necessary, to support the National Mental Health Care Policy and Plan.

d) To prepare an evidence based National Mental Health Care Policy for the Ministry of Health and Family Welfare stating  guiding values, principles and objectives of such a policy and identifying priority areas for action.

e) To prepare a National Mental Health Care Plan with specific reference to the National Mental Health Programme and the District Mental Health Programme with specific strategies and activities to implement the priority areas of action identified in the National Mental Health Care Policy and to further prepare an estimate of  financial resources required to implement the Plan.

f) To conduct broad-based consultations on the above issues with mental health stakeholders in the country before finalizing the Situational Analysis, the National Mental Health Care Policy and the National Mental Health Care Plan.

http://mhpolicy.org/

 PROCEEDINGS OF FIRST MEETING OF POLICY GROUP TO FRAME A NATIONAL  MENTAL HEALTH POLICY 

                   

         The   first   meeting   of   the   Policy   Group   to   frame   a   National   Mental   Health   Policy  

constituted   by  Ministry   of   Health   &   Family  Welfare’s   order   of   15.4.2011,   as   amended   in  

Ministry’s order of 2.5.2011 was held at the Ministry of Health & Family Welfare, Nirman  

Bhawan, New Delhi on Tuesday, 3.5.2011. The following were present: 

    i)         Dr. Vikram Gupta 

    ii)        Dr. Soumitra Pathare 

    iii)       Dr. Alok Sarin 

    iv)        Dr. Anirudh K. Kala 

    v)         Dr. S.K. Deuri 

    vi)        Prof. Sanjeev Jain 

    vii)       Dr. Nirmala Srinivasan 

     viii)    Shri Akhileshwar Sahay 

     ix)       Dr. Thelma Narayan 

     x)        Dr. Jagdish Prasad 

     xi)       Shri Keshav Desiraju 

2.       Dr. Vikram Patel and Ms. Vandana Gopikumar had expressed their regret at their being  

unable to attend the meeting. Ms. Sujaya Krishnan, Director and Dr. Jagdish Kaur, CMO were in  

attendance. 

3.       Introducing the subject, Shri Keshav Desiraju, Additional Secretary, Health presented the  

background against which the Policy Group has been constituted. India is unusual in not having a  

stated policy for mental health though there has been legislation for a very long time as also a  

centrally funded national programme. The need for a policy has been continuously voiced. In  

taking a decision to constitute the Policy Group, the Ministry also took note of the fact that the  

National   Mental   Health   Programme   and   the   District   Mental   Health   Programme   also   need  

attention. DMHP is currently under implementation in 123 districts of the country. Activities in  

these districts have been recently reviewed and there is enough evidence to suggest that the  

programme   needs   substantial   modification.   The   success   of   DMHP  depends   largely   on   the  

availability, even part time, of appropriately qualified mental health professionals; however,  

these professionals are not available in several districts. There is some indication that DMHP will  

be extended, possibly in more districts, during the period of the 12th    Plan, 2012-2017. It was  

therefore felt that this is the most appropriate time for the structure of the DMHP, and also of  

NMHP, to be reviewed. Given the requirements for preparing the 12th Plan, the Policy Group has  

been given a period of 6 months to undertake the review, and re-drafting, of the DMHP / NMHP.  

The task of framing and drafting a mental health policy is expected to be completed within a  

period of 12 months. 

4.       The meeting was informed that following the constitution of the Policy Group, several  

requests / suggestions have been made regarding inclusion of persons in the Policy Group. Shri  

Javed Abidi has recommended the inclusion of Ms. Bhargavi Davar of NAAJMI and Dr. Achal  

Bhagat from the Disabled Rights Group (DRG). Ms. Vandana Gopikumar has suggested the  

association  of Prof.  M. Thirunavukarasu, President  of  the  IPS.  Dr. Nirmala  Srinivasan  has  

suggested the association of Shri Milesh Hamlai, caregiver working with an NGO in Gujarat.  

Col. Mehendiratta, who has been closely associated with the draft legislation, has suggested the  

name of Shri Amrit Bakshy of Pune. It was generally felt that every effort should be made to  

associate experts  and other  interested persons  from a range  of interests  in the work to be  

undertaken by the Policy Group. 

5.       The meeting was also informed that the WHO (Dr. Shekhar Saxena, Director, Department  

of Mental Health & Substance Abuse) has expressed its willingness to provide technical support  

to the Policy Group with support in the following possible ways: 

     i)  WHO Normative Guidance on Mental Health Policy; 

     ii) Joining specific Sessions of the meetings of the Group either by phone or in person; 

     iii) Reviewing and providing inputs on the draft outline and text of the Policy. 

6.       The meeting was also informed of the progress made in the drafting of a Mental Health  

Care Bill, 2010 following a National Consultation on 22.3.2011. The major task of re-visiting the  

draft circulated to all State Governments has commenced. During discussion on the subject, the  

point also noted that the Ministry of Social Justice and Empowerment has undertaken a major  

review of the Persons with Disabilities Act, 1995. The Ministry of Health is awaiting the receipt  

of the draft of the revised Act from the Ministry of Social Justice and Empowerment. 

7.       Several issues were raised with regard to DMHP as it exists and relating to suggestions  

for the future. These included,  

     i)  The need to learn from community experiences; 

     ii) An assessment of the availability of qualified psychiatrists in the country; 

     iii) An understanding of the infirmities in the DMHP districts at present; 

     iv) Relationship between State Health Departments & DMHP in various states; 

     v)  In the context of integration into NRHM, the need for deliverables to be fixed; 

     vi) Linkages between each of the 314 medical colleges (167 private and 147 government)  

         with one or more of the DMHP districts; 

8.       It was generally agreed that while DMHP may well need restructuring, there was no  

alternative   to   organized   interventions   with   the   districts   as   to   the   focal   area.   It   was   also  

emphasized   that   if   no   review   or   restricting   of   DMHP  was   done   at   the   present   stage,   the  

likelihood is that we will go into the 12th   Plan with the DMHP as it presently stands but with  

many more than the present 123. The focus of the Policy Group, therefore, needs to be on  

restructuring DMHP without losing the district level focus. It was also highlighted  that districts  

tend to be geographically large and many persons find it difficult to access services at the district  

level. Therefore it was suggested that when restructuring DMHP provision should be made for  

some services at the Taluka level to improve access for persons with mental illness. There was a  

discussion about utilizing ASHA or a similar health workers for provision of mental health  

services in the community. It was felt that if ASHA or a similar health worker was proposed to be  

utilized for delivery of mental health services, then their roles, responsibilities and training needs  

should be clearly defined as such. 

9. The members discussed the issue of integrating mental health services into general health  

services   especially   at   the   primary   and   secondary   health   care   level.   Concerns   regarding  

integration   were   highlighted   during   this   discussion.   It   was   pointed   that   most   of   the   other  

integrated programmes initially started off as standalone programmes and only when they had  

developed very robust structures, they were integrated into general health care. The need for  

adequate training of general health workers before integration was also highlighted during this  

discussion.  

10.      The meeting was also informed that in the year 2011-12, the last year of the 11th Plan,  

DMHP will continue to be implemented in the identified 123 districts as per current guidelines.  

With a view towards ensuring a better level of performance, various regional meetings have been  

called at LHBRIMH, Tezpur on 25 and 26.5.2011, at CIP, Ranchi on 1&2.6.2011 at IPHB, Goa 

on 7&8.6.2011, at Government Medical College, Srinagar on 14&15.6.2011 and at NIMHANS  

Bangalore on 20&21.6.2011. Members of the Policy Group were requested to attend one or more  

of these review meetings with a view to discussions with State Government representatives on  

implementation   issues,   suggestions   for   DMHP   restructuring   and   also   to   suggest   better  

performance even within the current guidelines in this last year of the Plan period. The Ministry  

will support the travel of Policy Group members to these meetings. 

11.      During discussion on the framing of Mental Health Policy it was noted that several  

countries (Chile, Sri Lanka, Egypt, Portugal) have stated policy documents. It was agreed that  

these were need to be systematically studied. It was also noted that within the country Gujarat  

has framed a Mental Health Policy. The consensus was that the Policy Group members should  

attempt to put together as a wide range of material as possible. 

12.      After substantial discussion both on programme and policy aspects, it was decided as  

follows: 

    i)        A Sub-Group of the Policy Group consisting of Dr. Anirudh Kala, Dr. Vikram Patel,  

             Ms. Vandana Gopikumar, Dr. Vikram Gupta Prof. Sanjeev Jain and Dr. Alok Sarin,  

             assisted by Dr. Jagdish Kaur, CMO, MoHFW would address issues related to DMHP  

             and NMHP. It was also agreed that Dr. R. Kishore Kumar of NIMHANS, Bangalore  

             would be prominently associated with work of this Sub-Group in the light of his very  

             extensive experience of DMHP on the ground. In the first instance, the Sub-Group 

             would review available material, to be followed by visits as necessary to DMHP  

             districts and to medical colleges supported under NMHP. It is expected that along  

             with other Policy Group members they would participate in the DMHP workshops in 

             May and June, 2011. It was also made clear that the Sub-Group should feel free to  

             reach out to as many persons / institutions as may be necessary with a view to  

             securing a better understanding of DMHP activities. Dr. Anirudh Kala has kindly  

             agreed to convene the work of this Sub-Group. 

    ii)        Shri Akhileshwar Sahay and Dr. Vikram Gupta, with the assistance of Dr. Simmi,  

             WHO Consultant, MoHFW will work on collecting and studying mental health policy 

             documents from around the world. 

    iii)       A Sub-Group to the Policy Group consisting of Dr. Soumitra Pathare, Ms Vandana  

             Gopikumar, Dr. S.K. Deuri, Prof. Sanjeev Jain and Dr. Nirmala Srinivasan will work  

             specifically   on   drafting   the   norms   and   standards   for   mental   health   facilities   for  

             inclusion in the Rules section of the draft Mental Health Care Bill, 2010. 

    iv)       With a view to securing as wide a range of suggestions as is possible on ideas for  

             inclusion in the Mental Health Policy, it was agreed that a standalone website would  

         be created, with links to the website of Ministry of Health, and a dedicated email  

         address. The Policy Group would then circulate, initially to a larger group of about  

         250 to 300 persons known to have an interest in the subject, a statement of objectives  

         and intent. This statement will be drafted by the Ministry and shared with all the  

         members   of   the   Policy  Group   before   final   approval   and   should   be   used   by  all  

         members of the Policy Group in reaching out to interested persons. This statement  

         will encourage people to send to the Policy group their suggestions regarding the  

         national mental health policy, suggestions for the mental health plan, changes to the 

         DMHP and suggestions for priority areas of action to be considered by the Policy  

         Group. The statement will also request people to send any information that they  

         consider relevant for consideration by the Policy Group. Such information includes  

         data about mental illness, service provision and any other reports or research papers,  

         published as well as unpublished.  It was particularly noted that an exercise of this  

         type runs the danger of reaching out to only those persons with access to email and to  

         the English language. The need for including other opinions and other voices was  

         emphasized. Members of the Policy Group were, therefore, requested to use their own  

         networks and resources, and also their connections with other language groupings, to  

         seek feedback. It is anticipated that the Policy Group would be able to finalize its  

         proposed statement within the next 15 days with an expectation of receiving feedback  

         until the end of June, 2011. Once this feedback is received a few members of the  

         Policy Group will sift through the responses and summarize the key points made by  

         respondents which will be circulated to all members of the Policy Group and also to  

         the respondents.  

v)        All members of the Policy Group were requested to share with each other and with  

         the general public information / reports / documents likely to be relevant to the  

         general   discussion.   It   is   expected   that   this   would   become   a   publically  available  

         resource which would last beyond the life of the Policy Group itself. Some material  

         circulated at the meeting will be put on to this site at the earliest. 

vi)        Travel costs of the members of the Policy Group to attend meetings of the Policy  

         Group   as   also   other   activities   related   to   the   work   of   the   Policy   Group   will   be  

         reimbursed on a regular basis by the Ministry of Health. All members were requested  

         to     contact     Ms.     Sujaya     Krishnan,     Director     (Tel:     011-23062426,     Email:  

         sujayak...@yahoo.com) in this matter. It was also recognized that the Centre for  

         Mental Health Law and Policy at the Indian Law Society will be the Secretariat for  

         the Policy Group. The Ministry and the Centre will separately sort out the exact  

         nature of assistance which the Centre is expected to provide and the manner in which  

         reimbursements, etc. are to be made.    

vii)             The Policy group took note of the fact that there is considerable public interest,  

         including the press, in the constitution and activities of the Policy Group. It was  

         agreed that for the present any statement to be made on behalf of the Policy Group  

         would be made by the Ministry. 

viii)    It was agreed that the next meeting of the Policy Group would be in Bangalore on  

         Thursday, 1.7.2011. The location of the meeting will be decided in consultation with  

         Bangalore based members of the Policy Group. 

                                                 ***** 

 http://mhpolicy.org/2011/05/10/minutes-of-1st-meeting-of-policy-group/