Sie sind auf Seite 1von 783

Mental Health Care in IndiaOld AspirationsRenewed Hope

------------------------------------------------------------------------------------------------------------------------------

Report of the Technical Committee on


Mental Health
Constituted by the National Human Rights Commission

to evaluate mental health services in India


Pratima Murthy
Sudhir Kumar
Nimesh Desai
Balbir Kaur Teja

_________________________________
With inputs from:
Dr Sumit Kumar Gupta & Dr Pankaj Kumar, IHBAS, New Delhi
Dr Anil Sisodia, IMHH Agra
Dr Naveen Kumar, Dr Suresh Badamath, Dr Soundarya S & Mr Prem, NIMHANS
Mr JS Kochher, Dr Savita Bhakre, Mr Guljeet Singh, National Human Rights Commission

Special Rapporteurs
Shri Ajay Kumar
Shri Anil Pradhan

Dr KS Challam
Dr Damodar Sarangi

Smt S Jalaja
Shri S Narayan

LIST OF ABBREVIATIONS
AAA
AIIMS
BIMHAS

Aashray Adhikar Abhiyan


All India Institute of Medical Sciences
Bihar State Institute of Mental health
and Allied Sciences
Central Advisory Group
Community Based Organization
Central Institute of Psychiatry
Central Mental Health Authority

MC
MCI
MGNREGS

NCRB
NCW
NDPS

DLSA
DME

Community Mental Health Programme


Directorate of Health Services
Dharwad Institute of Mental Health ad
Neuro Sciences
District Legal Services Authority
Directorate of Medical Education

DMHP
DMO
DPN
DPM
GH
GHPU

District Mental Health Programme


District Medical Officer
Diploma in Psychiatric Nursing
Diploma in Psychological Medicine
General Hospital
General Hospital Psychiatry Unit

NMHP
NR
NSSO
NTA
PG
PGIMER

GMA
GMHC
GO/GOVT
HHMH&R

Gwalior Manasik Arogyashala


Government Mental Health Centre
Government Organization
Himachal Hospital of Mental Health and
Rehabilitation
Hospital for Mental Health

PIL
PWD
PVT
RCI

Inspection Committee
Information, Communication, Education
Institute of Human Behaviour and Allied
Sciences
Institute of Mental Health
Institute of Mental Health and Hospital
Institute of Psychiatry and Human
Behaviour
LG Bordoloi Regional Institute of Mental
Health

RMH
SIMH
SMHA

Ranchi Institute of Neuro-Psychiatry and


Allied Sciences
Regional Mental Hospital
State Institute of Mental Health
State Mental Health Authority

TCMH
UG
UT

Technical Committee on Mental Health


Under Graduate
Union Territory

WHO

World Health Organization

CAG
CBO
CIP
CMHA
CMHP
DHS
DIMHANS

HMH
IC
IEC
IHBAS
IMH
IMHH
IPHB
LGBRIMH

MO
NA
NALSA
NCPCR

NHRC
NIMHANS

RINPAS

Medical College
Medical Council of India
Mahatma Gandhi National Rural
Employment Guarantee Act
Medical Officer
Not Available
National Legal Services Authority
National Commission for Protection of
Child Rights
National Crime Records Bureau
National Commission for Women
Narcotic Drugs and Psychotropic
Substances Act
National Human Rights Commission
National Institute of Mental Health and
Neuro Sciences
National Mental Health Programme
Not Recorded
National Sample Survey Organization
National Trust Act
Post Graduate
Post Graduate Institute of Medical
Education and Research
Public Interest Litigation
Persons with Disabilities Act
Private
Rehabilitation Council of India

TABLE OF CONTENTS- Volume 1 and Volume 2


Volume 1.

Foreword by NHRC
NATIONAL SCENARIO

Introduction

Background to the Technical Committee Report

Methodology and Sources

Report on the Status of Mental Health Care

Summary observations of the Technical Committee

Summary and Recommendations

VOLUME 2. STATE LEVEL REPORTS ON THE STATUS OF MENTAL HEALTH


Self-assessment of mental health need
Existing Responses
- State Level Questionnaire
- Specialised psychiatric institutions
- Medical Colleges/ General Hospital Psychiatry Units/District hospitals
- NGOs involved in Mental Health Care
- District Mental Health Programme
Appendices
State level Questionnaire
Appendix 1: Information pertaining to current structure and functioning of
psychiatric hospitals (Govt and Private)
Appendix 2: General Hospital Psychiatry Unit/District Hospital Appendix 3:
Information pertaining to NGOs/Agencies involved in Mental Health Care
Appendix 4: Monitoring of the District Mental Health Programme

Volume 2
STATE LEVEL REPONSES ON
QUESTIONNAIRE
AFFIDAVITS

MENTAL HEALTH CARE PLANNING,


DEVELOPMENT, IMPLEMENTATION
AND MONITORING
Report of the Technical Committee on Mental Health Care in the Country based on the
Affidavits submitted by States/UTs to the Honble Supreme Court (2014-2015)

JANUARY 2016

Preamble
In this section, a summary of the affidavit information provided by the respective states is
detailed. Most of the information here is based on what has been provided in the affidavits.
The general principle guiding this section (Volume 2) is that what has been documented is
what has been done.
However, an attempt has been made to point out the deficiencies in both existence of services
and documentation by supplementing the information provided with information from the
Rapporteurs Report and Inspection Committee Reports as well a other sources.
This is intended to stimulate states to develop a regular reporting system on mental health in
their states, improve the template, improve data collection, documentation and reporting
mechanisms.
Regular monitoring and evaluation needs to form an important component of any Programme.
It is particularly important in mental health service delivery, which is human resource intensive,
needs to be responsive to peoples needs and adapt itself to newer challenges.
It is possible that the figures mentioned in this section are sometimes at variance with the
figures mentioned in Volume 1. That is because this section is based primarily on the affidavit
based information. Some of the information (e.g. pertaining to psychiatric hospitals) were
updated/rectified during the physical verification of the Inspection Committee.
The objective of this section is to provide state governments a feedback on where they stand,
so that they can update their information, prepare a time-bound comprehensive mental health
care plan for their respective states and regularly monitor and modify the plan according to the
mental health care needs of their citizens. The maps have mostly been downloaded from the
site www.maps of india.com.
Volume 1 carries the consolidated report of these findings, review of the area, summary of
Special Rapporteur observations, reports of the Inspection Committee and the
Recommendations of the Techical Committee.
5

Table of Contents- Volume 2


Name of State/UT

Page Numbers

Andaman and Nicobar


Andhra Pradesh
Arunachal Pradesh
Assam
Bihar
Chandigarh
Chattisgarh
Dadra and Nager Haveli
Daman and Diu
Delhi
Goa
Gujarat
Haryana
Himachal Pradesh
Jammu and Kashmir
Jharkhand
Karnataka
Kerala
Lakshadweep
Madhya Pradesh
Maharashtra
Manipur
Meghalaya
Mizoram
Nagaland
Odisha
Puducherry
Punjab
Rajasthan
Sikkim
Tamil Nadu
Telengana
Tripura
Uttarakhand
Uttar Pradesh
West Bengal

7-18
19-36
37-57
58-83
84-106
107-122
123-143
144-159
160-173
174-204
205-225
226-248
249-272
273-293
294-313
314-336
337-367
368-395
396-410
411-436
437-460
461-480
481-500
501-518
519-538
539-558
559-588
589-605
606-627
628-644
645-666
667-686
687-707
708-729
730-753
754-783

ANDAMAN AND NICOBAR

SECTION 1. STATE LEVEL REPORT


1. GENERAL INFORMATION REGARDING THE STATE ANDAMAN AND NICOBAR
1.1. Area: 8249 sq. kms
1.2. No of districts: 3
1.3. Population, age distribution (as per census 2011): 379944
Age0-9 years
10-19 years
20-44 years
45-79 years
80 years and above

59208
(15.6%)
66493
(17.5%)
174137
(45.8%)
77902
(20.5%)
2473
(0.8%)

1.4. Gender distribution: Males=202330 (53.3%); Females=177614 (46.7%)


1.5. Life expectancy at birth male and female: NA
1.6. Per capita State Government expenditure on health: 1560 in 2006-07 (Economic survey
report available in Archives Section of official website)
1.7. Any health indicators for the state:
Crude Birth Rate : 14.6 (SRS2013)
Infant Mortality Rate : 24 (SRS2013)
Sex Ratio : 878 (Census 2011)
Completeness/quality of information provided: Deficient
Areas of deficiency: There is information about 2 Psychiatrists, but no information about any
Psychiatric Services offered by them in Appendix 1 or 2. There is mention of an NGO providing
Mental Health Services in Overall Information for the State, but details in Annexure 3 not
provided. There is no information on treatment seeking.

2. MENTAL ILLNESS BURDEN/ INFORMATION REGARDING MENTAL ILLNESS


N
(prevalence)
2.1. Total number of persons with
mental illness (all ICD categories)

Around
30000

N
(treatment
seeking)

7.9%

Source of
information
Affidavit

3. MENTAL HEALTH SERVICES IN THE STATE:


3.1. Organization of Services (description of number of psychiatric hospitals, medical college
depts, district hospitals)

N/N

No with dept/facility
Total No of units

% coverage

3.1.a No of district
general hospitals with
separate department of
psychiatry
3.1.b No of medical
colleges with department
of psychiatry
3.1.c No of district
general hospitals
providing psychiatric care
3.1.d No of District
Mental Health
Programmes in the State

25%

0%*

33%

0%

3.1.e No of government
psychiatric hospitals
3.1.f No of private
psychiatric hospitals
3.1.g Total No of
psychiatric hospitals in
the state
3.1.h No of NGOs
providing mental health
care

0
0

*Although not mentioned in the submitted affidavit, The permitted Medical College
Andaman & Nicobar Islands Institute of Medical Sciences has a Department of Psychiatry with
an OPD schedule (Source: www.andssw1.and.nic.in)
8

3.2. INPATIENT SERVICES


There are no in-patient services at present. However, all Medical Colleges mandatorily
have to ensure In-patient Psychiatry Services. Hence, it is implied that Medical College
will initiate In-patient Services in near future.
3.3. OUTPATIENT SERVICES
OPD services are available at GB Pant Hospital (Associated with Andaman & Nicobar
Islands Institute of Medical Sciences) (Source: www.andssw1.and.nic.in)
4. REHABILITATION FOR PERSONS WITH MENTAL ILLNESS
4.1. Government residential rehabilitation/longstay facilities : No and description: 0
4.2. Government day care/outdoor rehabilitation facilities: No and description: 0
4.3. Government run half-way homes: No and description. If none, plans to establish and
details: 0, NO Plan
4.4. NGO participation in the half way homes:NA
4.5. Longstay rehabilitation facilities: No and description; NGO participation: 0
5. MENTAL HEALTH CARE IN OTHER COMMUNITY FACILITIES
State Level, in the Govt Sector

5.1. No of shelter homes, observation homes,


special homes and childrens homes
5.2. No of counsellors trained in mental health in
the above institutions
5.3. No of protection homes for destitute women
5.4. No of counsellors trained in mental health in
the above institutions
5.5. No of old age homes
5.6. No of counsellors trained in mental health in
the above institutions
5.7. No of Central Jails and District Jails in the State
5.8. No of counsellors trained in mental health in
the above institutions
5.9.No of counsellors trained in mental health in
the above institutions

Helplines for Mental Health: None

0
0

0
0
NA
0
0

6. MENTAL HEALTH HUMAN RESOURCES


Mental Health Care Professionals

6.1. No of
Psychiatrists
6.2. No of Clinical
Psychologists
6.3. No of
Psychiatric Social
Workers
6.4. No of
psychiatric nurses
6.5. No of nurses
trained in mental
health
6.5. No of trained
counselors

Government
Sector medical
colleges/hospitals
(include district
general hospital
information also)
2

Private
medical
colleges

Private
Practice
(Licensed
Nursing
Homes)

Total

7. MENTAL HEALTH HUMAN RESOURCE DEVELOPMENT


7.1. Degree/Diploma Courses
In Entire state, Annual No of
Seats in

MD Psychiatry
DNB Psychiatry
Diploma in Psychiatry
PhD Clinical Psychology
MPhil Clinical Psychology
PhD Psychiatric Social Work
MPhil Psychiatric Social Work
PhD Psychiatric Nursing
MSc Psychiatric Nursing
BSc Psychiatric Nursing
Basic Diploma in Psychiatric
Nursing (DPN)

0
0
0
0
0
0
0
0
0
0
0

Institutions where the Programme is offered

7.2. Other training in mental health: Nil


10

7.2.a. Details of Undergraduate MBBS training in psychiatry


None at present.
7.2.b. Details of in-service training for Govt medical officers (No trained, duration)
2 at AIIMS
7.2.c. Any other training courses in mental health offered by the state
None
8. GOVERNANCE:
8.1. Nodal Authority and responsibilities :
No information provided
8.2. Presence of a State Mental Health Plan: No
8.3. Enactment of State Mental Health Rules: No information
8.4. Oversight of policies and Programmes related to mental health: No information
8.5. Specific oversight of the DMHP programme.
As per affidavit submitted before Honble Supreme Court on 8th October, 2014 by Resident
Commissioner of ANI, the UT plans to initiate DMHP and PIP (project Implementation Plan) has
been submitted for 2014-17, but approval from National Programme Coordination Committee ,
MOHFW, GOI is awaited.
The ROP (Record of Proceedings) of MOHFW, GOI shows no funds approved for 2015-16 against
a proposal of 5.09 by the UT. (Source: NRHM website)
8.6. Attempts towards integration of mental health care into general health care, NCD
management etc.: None
8.7. Examples of commitment to develop mental health services (high level involvement,
budgeting, networking: None
8.8. Examples of inter-sectoral collaboration to improve mental health services (including PPP
intitiatives): None
8.9. Attempts towards mental health promotion: No information
COMMENT: Strengths and weaknesses
11

9. FINANCING
9.1. Sources of financing of different categories: The Medical College is being financed by UT
administration.
9.2 Budget provision from State and Centre in INR : NA
9.3. Mental Health Expenditure as proportion of Total Health Expenditure in State: NA
10. ANY OTHER SIGNIFICANT INFORMATION: NA
11. INNOVATIONS: None

12. OVERALL SUMMARY OF STATE LEVEL MENTAL HEALTH SERVICES


As there is very little activity in the UT apart from 2 psychiatrists delivering out-patient services,
no summary can be provided.
SECTION 2
2.1. PSYCHIATRIC INSTITUTIONS
None

SECTION 3
3. General Hospital Departments of Psychiatry and District Hospital Departments
Although not mentioned in the submitted affidavit, The permitted Medical College Andaman &
Nicobar Islands Institute of Medical Sciences has a Department of Psychiatry with an OPD
schedule in associated GB Pant Hospital, Port Blair (Source: www.andssw1.and.nic.in)
SECTION 4
4. NGOS WORKING IN MENTAL HEALTH:
4.1. A brief description of the NGO and its location
SAATHI - Details not available

12

SECTION 5
5. DISTRICT MENTAL HEALTH PROGRAMME

13

NONE
5.12. SUMMARY OBSERVATIONS OF DMHP AND RECOMMENDATIONS:
The Ministry of Health & Family Welfare needs to relook into PIP submitted by the UT and
facilitate implementation of DMHP. Even if there is any disagreement with submitted PIP, it
may be modified, rather being abandoned.

SECTION 6
6. SUMMARY OF MENTAL HEALTH CARE INDICATORS IN ANDAMAN AND NICOBAR
6.1. Availability of mental health facilities
Only 1 govt hospital providing psychiatric care with 2 Psychiatrists
6.2. Access to Care
Data not available
6.3. Information Systems
Data not available

6.4. Human Resources at the State Level


Health professionals working
in the mental health sector
Rate per 100,000
Psychiatrists
Medical doctors not specialised
in psychiatry
Clinical Psychologists
Psychiatric Social Workers
Psychiatric Nurses
Occupational therapists
Other health workers

0.52
0

Training of health
professionals in educational
institutions
Rate per 100,000
0
0

0
0
0
0
0

0
0
0
0
0

6.5. INFORMAL HUMAN RESOURCES (Family and User Associations)


Data not available
14

6.6. MEDICINES
Data not available

SECTION 7
1. STATE MENTAL HEALTH REPORT CARD
SUMMARY OF SECTIONS 1-7.
Summary of areas where state has achieved good progress/little progress/no progress
From the affidavit, apart from a proposal for a DMHP which has still not materialised, there
seems to be little or no progress in the area of mental health care.
Although not mentioned in the affidavit, it appears that an out-patient department has been
started at the GB Pant Hospital, but no further information is available.
STATE MENTAL HEALTH REPORT CARD
SUMMARY OF SECTIONS 1-7.
Summary of areas where state has achieved good progress/little progress/no progress
Main problem Lack of data mining
Areas of some progress
Attempt to start a DMHP

MENTAL HEALTH REPORT CARD (needs to be revised after all the information is obtained)
Area
1

Mental Health
Services
(Secondary
and Tertiary)

Focus
Medical
College
Depts,
General
Hospitals,
Specialised
psychiatric
hospitals

Parameters

Rating

Adequacy of inpatient
beds
Functional Departments
Functional OP services

100- present, fully


satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent

15

Score (out
of 100)
25

Primary
Health Care
mental health
services

District
Mental
Health
Programme

% of functional DMHPs

Rehabilitation
services

At all levels

Vocational training, day


care, longstay facilities in
govt sector/ppp

Specialised
services

Whether existing, level


of functionality, present
at different levels of care

Human
Resources

Services for
substance
use
disorders,
old age,
mental
retardation,
child
psychiatry,
community
services,
forensic
services
(exclude
DMHP staff
here)

Adequacy of
psychiatrists/clinical
psychologists/psychiatric
social
workers/psychiatric
nurses or mental health
trained nurses
16

100 All districts


covered; fully
satisfactory
75 majority of
districts covered
and functioning
50 half the
districts covered
and functioning
25 one-fourth
of the districts
covered and
functioning
0- No districts
covered/although
DMHP exists, not
functioning
100- present, fully
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100- present, fully
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent

100 fully
adequate
75 moderately
adequate
50 somewhat
adequate
25- inadequate

0 grossly
inadequate
6

Financing for
mental health

State level

Existence of separate
budget for mental
health/mental health
activities

Governance
and Policy

State
Mental
Health
Authority
and other
authorities

Availability of
psychiatric
medication

At every
level

Separate Mental Health


Nodal Officer
Functioning Mental
Health Authority
Nodal persons for mental
health in SHRC/Legal
Services
Authority/Others
State Mental Health
Rules
State Mental Health
Programme
Range of medications
Regular supply and
dispensing
Standard procurement
arrangements

Affirmative
action for
persons with

At every
level

Disability assessment
Pension
Travel concession
17

10% -separate
budget, fully
adequate
75 separate
budget,
moderately
adequate
50 separate
budget,
somewhat
adequate
25 no separate
budget, but some
financial
resources
available annually
0 no separate
budget/marginal
financial resource
allocation
100 Existing,
fully functional
75- Existing,
mostly functional
50- Existing,
somewhat
functional
25- Partial
0 Non existent

100- Fully
No
satisfactory
information
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100- Fully
0
satisfactory
75- Mostly

mental illness

10

Treatment
Gap

Health insurance
Special assistance
Educational benefits
Job reservation

Overall

Approximate number of
persons with mental
illness approximate
numbers totally receiving
treatment in the state

satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100 no
treatment gap
75 25%
treatment gap
50 -50%
treatment gap
25 -75%
treatment gap
0- 100%
treatment gap

Total Score (out of 1000)


Average Score (%)

No
information
on patients
seeking
services

25
2.5

RECOMMENDATIONS:
It is possible that there is more information and there are more services available that are not
mentioned in the affidavit.
The UT will have to identify its nodal oversight body, develop a time-bound mental health care
delivery plan and a budget is needed.
There is an urgent need to augment human resources. A plan to recruit the same may urgently
be made.
The DMHP needs to be initiated urgently.
Inpatient treatment services need to be developed.
A multi-sectoral action plan needs to be developed.
The UT may need handholding to develop a comprehensive mental health plan.

18

ANDHRA PRADESH
SECTION 1. STATE LEVEL REPORT
1. GENERAL INFORMATION REGARDING THE STATE (Andhra Pradesh)
1.1.
Area- 160205 sq.kms
1.2.
No of districts- 13
1.3.
Population, age distribution (as per census 2011)- 49380000
1.4.
Gender distribution pop(male)-24730000, pop(female)-24640000
1.5.
Life expectancy at birth male and female: Males: Females:
1.6.
Per capita State Government expenditure on health:
1.7.
Any health indicators for the state: Crude Birth Rate; Crude Death Rate; Infant
Mortality Rate; Sex Ratio
1.8.
Completeness/quality of information provided: Deficient. Information from
GHPUs, medical colleges, NGOs not available; No adequate information on service
utilization
2. MENTAL ILLNESS BURDEN/ INFORMATION REGARDING MENTAL ILLNESS
N
(prevalence)
2.1. Total number of persons with
mental illness (all ICD categories)
2.2. Broad categories
2.2.a Severe mental disorders
(BPAD, psychosis)
2.2.b Common mental disorders
2.2.c Substance use disorders
(alcohol and other drugs)
2.2.d Mental Retardation
2.3. No of Males with mental health
problems
2.4. No of females with mental
health problems
2.5. No of children with mental
health problems
2.6. No of elderly with mental health
problems
2.7. No of homeless mentally ill
persons

No record

N
(treatment
seeking)
4728

Source of
information
Affidavit

9672
828
576
948
No record

No record

19

COMMENT: These figures total 12024, but it is not clear whether they represent new cases, and
where they are from. These appear to be cases that were being registered under the DMHP,
but the DMHP is no longer functioning.
Individually tallying the numbers provided, when the DMHPs were functional, annual new
registrations across the facilities mentioned total 18672.

3. MENTAL HEALTH SERVICES IN THE STATE:


3.1.
Organization of Services (description of number of psychiatric hospitals, medical
college depts, district hospitals)

3.1.a No of district
general hospitals with
separate department of
psychiatry
3.1.b No of medical
colleges with department
of psychiatry
3.1.c No of district
general hospitals
providing psychiatric care
3.1.d No of District
Mental Health
Programmes in the State

N/N No with dept/facility


Total No of units
01 (District General Hospital,
Vizianagaram)

% coverage

09

36%

01

7.7%

03

23.1%

7.7%

N
3.1.e No of government
psychiatric hospitals
3.1.f No of private
psychiatric hospitals
3.1.g Total No of
psychiatric hospitals in
the state
3.1.h No of NGOs
providing mental health
care

01
NR
1

NIL

COMMENT (affidavit dated 25.4.2014): Under the Government of India scheme for
upgradation of psychiatric wings of government medical colleges/general hospitals, a total of 7

20

state run institutions were funded between 2005-2007 (in the common Andhra Pradesh). The
GHMC Vishakapatnam was strengthened with a 300 lakh grant in 2005-2006.
INPATIENT SERVICES
DESCRIPTION: Information is provided only for the GHMC Vishakapatnam.

3.2.a. Total Inpatient


sanctioned/available
beds
3.2.b No of male
beds
3.2.c. No of female
beds
3.2.d. No of beds for
children
3.2.e. No of beds for
elderly
3.2.f. No of beds for
substance use
disorders
3.2.g. No of beds for
forensic psychiatry
3.2.h. Occupancy (%)
3.2.i. No of
admissions during
previous year
3.2.j. No of
discharges during
previous year
3.2.k. Average
duration of inpatient
stay in days mean
3.2.l. Average
duration of inpatient
stay in days median
3.2.m. No of closed
wards
3.2.n. No of closed
ward beds
3.2.o. No of open
wards
3.2.p. No of open
ward beds

Psychiatric
hospitals
(Govt)
300

Psychiatric
hospitals
(Private)

General
Hospitals

District
Hospitals
N=

NGOs
N=

Total

225
75

63%
3058

2493

29535

4908

6
96
3
90

21

3.2.q. No of paid
wards
3.2.r.No of paid beds
3.2.s.No of
admissions through
courts
3.2.t. No of deaths in
the last year
3.2.u. No of suicides
in the last year

18
18
27

1
0

COMMENT: Overall information for the state includes only the information from the GHMC
Vishakapatnam. A list of 25 medical colleges is mentioned in the annexure. There is no
information on beds available in the general hospital and the patient loads carried by the
general hospitals.

3.2.

OUTPATIENT SERVICES

3.3.a. No of new OP
registrations in the
previous year
3.3.b. No of
emergency
attendees in the
previous year
3.3.c Total no of OP
follow-up in the
previous year

Govt.
Psychiatric
hospitals
N=1
4728

Private
Psychiatric
hospitals
N=

General
Hospitals

District
Hospitals

NGOs

N=

N=

N=

Total

1123

47832

COMMENT: No information is provided for the other hospitals.


*common diagnostic categories in rank order in each of the different facilities
4. REHABILITATION FOR PERSONS WITH MENTAL ILLNESS
4.1.
Government residential rehabilitation/longstay facilities : NIL
4.2.
Government day care/outdoor rehabilitation facilities: No and description: NIL
4.3.
Government run half-way homes: No and description. If none, plans to establish
and details: NIL
4.4.
NGO participation in the half way homes: Nil
22

4.5.

Longstay rehabilitation facilities: NIL

Comment: There is a dearth of long-stay facilities in both government and private sectors.
There appears to be no NGO presence according to the affidavit.

5. MENTAL HEALTH CARE IN OTHER COMMUNITY FACILITIES


State Level, in the Govt Sector
5.1. No of shelter homes, observation homes,
special homes and childrens homes
5.2. No of counsellors trained in mental health in
the above institutions
5.3. No of protection homes for destitute women
5.4. No of counsellors trained in mental health in
the above institutions
5.5. No of old age homes
5.6. No of counsellors trained in mental health in
the above institutions
5.7. No of Central Jails and District Jails in the State
5.8. No of counsellors trained in mental health in
the above institutions
5.9.No of counsellors trained in mental health in
the above institutions

N
0
NIL

NIL
NIL
NIL
02
NIL
NA

Helplines for Mental Health:


COMMENT: It is surprising that there are no shelter homes or protection homes for children
and women recorded in the affidavit. No mental health counselling is provided in the jails.
6. MENTAL HEALTH HUMAN RESOURCES
Mental Health Care Professionals

6.1. No of
Psychiatrists
6.2. No of Clinical
Psychologists
6.3. No of

Government
Sector medical
colleges/hospitals
(include district
general hospital
information also)
N=14
14

Psychiatrists
in medical
colleges

Psychiatrists
in Private
Practice

Total

12

NA

26

01

02

NA

03

NIL

01

NA

01

23

Psychiatric Social
Workers
6.4. No of nurses
trained in mental
health
6.5. No of trained
counselors

NIL

NIL

NA

NIL

NIL

NA

COMMENT:
Mental health professional resources are grossly deficient.
7. MENTAL HEALTH HUMAN RESOURCE DEVELOPMENT
7.1. Degree/Diploma Courses
In Entire state, Annual No of
Seats in
MD Psychiatry
DNB Psychiatry
Diploma in Psychiatry
PhD Clinical Psychology
MPhil Clinical Psychology
PhD Psychiatric Social Work
MPhil Psychiatric Social
Work
PhD Psychiatric Nursing
MSc Psychiatric Nursing
BSc Psychiatric Nursing
Basic Diploma in Psychiatric
Nursing (DPN)

Institutions where the Programme is offered

07
NIL
02
NIL
NIL
NIL
NIL

Details not mentioned

NIL
NIL
NIL
NIL

COMMENT: There are a large number of medical colleges where potential for psychiatric
training may be explored. There needs to be a concerted effort to recruit other mental health
professionals.
7.2. Other training in mental health 7.2.a. Details of Undergraduate MBBS training in psychiatry: Details NA
7.2.b. Details of in-service training for Govt medical officers (No trained, duration)---NONE,
No plans
7.2.c. Any other training courses in mental health offered by the state
24

NONE
8. GOVERNANCE:
8.1. Nodal Authority and responsibilities : DME 040-24602515
8.2. Presence of a State Mental Health Plan: None
8.3. Enactment of State Mental Health Rules: Not specified
8.4. Oversight of policies and Programmes related to mental health: None
8.5. Specific oversight of the DMHP programme. 03
8.6. Attempts towards integration of mental health care into general health care, NCD
management etc.: Not evident
8.7. Examples of commitment to develop mental health services (high level involvement,
budgeting, networking: Not evident
8.8. Examples of inter-sectoral collaboration to improve mental health services : None evident
8.9. Attempts towards mental health promotion : None evident
COMMENT: There has been little attempt in the State to have a good mental health
development and monitoring infrastructure. It is not possible for only the DME without
involvement of other agencies to strategise and oversee the effective functioning and
expansion of mental health services.
9. FINANCING
9.1. Sources of financing of different categories : Not specified
9.2 Budget provision from State and Centre in INR (for different facilities if required): NA
9.3. Mental Health Expenditure as proportion of Total Health Expenditure in State: NA
(If available % spending on Health in the State may also be provided)

10. ANY OTHER SIGNIFICANT INFORMATION


There are 8 cases related to Mental Illness pending with State Human Right Commission.

25

11. INNOVATIONS
Nil
7. OVERALL SUMMARY OF STATE LEVEL MENTAL HEALTH SERVICES
It is evident that the information collected is not comprehensive. Apart from the GHMC
Vishakapatnam, no information has been obtained from the other facilities including medical
college departments of psychiatry, general hospitals and district hospitals.
It is surprising that there is no documentation of community level facilities in the state.
The figures from the DMHP indicate a moderate reach, but the information also suggests
that the Programmes have been discontinued.
SECTION 2
2.1. PSYCHIATRIC INSTITUTIONS
Govt. Hospital for Mental Care, Vishakapatnam
Domains
Infrastructure

Amenities and facilities

Financial arrangements
Diet

Status in 2008
Developments since 2008
A separate OPD block has
been constructed with
dedicated emergency services
working 24 hours, waiting hall
for patients,
toilets for patients
and relatives, drinking water,
canteen services, OPD, lab
services.
There is a separate
children's ward with
specialised children's services.
Specialised geriatric, forensic,
deaddiction services are
available.
The report places the current
patient to toilet ratio at
4:1. There is 24 hour running
water with fans and
coolers. Separate dining facility
is available.
52 Rs for food per patient
3180 K Cal per patient per day
Equipments in the kitchen are
new and adequate, setting is
clean and hygienic.
26

Investigations and treatment

Basic biochemistry and


pathology tests are available

Staff and training

There is currently
1 GMO.
There is one CP
working on contract basis
There are 42 general nurses, 12
trained psychiatric nurses 1
occupational therapist

Recreation/Occupational
therapy/Rehabilitation

The report states that IP


rehabilitation services are
available

All medications in essential


drug list are available free of
cost. Laboratory setup is
modern.
There are vacant posts of
psychiatrists, clinical
psychologist and psychiatric
social workers.

SERVICES
i. Outpatient: available
ii. Inpatient (improvement in in-patient facilities; any increase in open compared to closed ward
admissions; further reduction in court admissions; improvement particularly in the care of
women, children and elderly; use of disposables needles and syringes; no re-use of shaving
blades; any illness outbreaks and how contained; availability of psychotropic medication
including free medicines; use of ECTs including direct ECT): Modified ECT available.
Diagnostic categories seen:
iii. DIAGNOSTICS AND THERAPEUTICS

Investigations: all drugs and investigations available free of cost


Therapeutic facilities: all drugs and investigations available free of cost
Improvements in rehabilitation: Not mentioned

iv. ENGAGEMENT: NR

Attempts to involve families of persons with mental illness:


Disability certification and number of certificates issued in the previous year:

v. ADMINISTRATIVE

Annual number of adverse events: 0


Mechanisms for redressal of patient complaints: Not mentioned

27

vi. COMMUNITY OUTREACH AND NETWORKING

Community Programmes: No details


Networking with external agencies: 4 NGOs
Public mental health education: No details

vii. TRAINING

Post-graduate training new Programmes, enhancement of seats and measures to


maintain/improve quality of training: 7 MD Psychiatry seats, 2 DPM seats, 6-9
PhD/Mphil in psychiatric nursing
Any other training Programmes: NR

vii. RESEARCH:

Research (areas, funding agencies, findings), - Nil

viii. ANY OTHER SALIENT CONTRIBUTIONS OF THE HOSPITAL/INSTITUTE: NR


ix. Any monitoring of hospital (internal or external)- by State Mental Health Authority.
x. Special Rapporteurs observation: Dr KS Chalam was the special rapporteur to Andhra
Pradesh. In his report, he expresses concern about the mental hospital area having been
allocated for the Regional Laboratory, ESI Hospital, Chest and ID hospitals, the spaces of which
in turn has been made available to IT companies. This is a dangerous move and must be
countered. The GHMC runs a PG Programme in collaboration with Andhra Medical
College.There are many vacancies and no fresh recruitments. Patient care is reported as
satisfactory, although minor repairs are required and the doctors report difficulty in regular
procurement of medicines. The proposal of the GHMC as a Centre of Excellence is pending.
xi. Any other observations (including Inspection Committee Reports): No specific observations
are recorded by the IC.
xii. Summary and Recommendations from SECTION 2: Major concerns include the utilization of
the land of the mental hospital for other activities; staff vacancies and the discontinuation of
the DMHP involvement because of lack of funds.

28

SECTION 3
3. General Hospital Departments of Psychiatry and District Hospital Departments
The broad outline for this section: Information not available
Dr Chalam mentions that Andhra Medical College received funding under Scheme B of the
Ministry.
8 medical institutions are listed- RIMS Shrikakulam, Rangaraya Medical College, Kakinada,
Siddharta Medical College, Vijayawada, Guntur Medical College, Guntur, Kurnool Medical
College, SV Medical College, Tirupathi, GMC, Ananthapur, King George Hospital,
Vishakapatnam- but no details are provided.

SECTION 4
4. NGOS WORKING IN MENTAL HEALTH: information not available.
The State affidavit however mentions that a few NGOs are involved- Nirmala Hruday Bhavan,
Mother Teresa Home- but no further details are provided.
SECTION 5
5. DISTRICT MENTAL HEALTH PROGRAMME (information in the prescribed format is not
available)
5.1. A brief description of the location of the DMHP, when it started, total population covered:
3 partially implemented
5.2. A summary of annual registrations old and new, treatment outcomes in terms of those on
regular treatment and those dropped out, with diagnostic categories if provided. Would be
useful to know what kind of clientele is serviced under the DMHP: approximately 10,000 new
patients and 13,000 old patients.
Programmes stopped in 2008

29

DMHP- Guntur Medical college not functional as no grants received.


Dr Chalam also visited the DMHP in the Vizianagaram district. He was informed that many of
the tribal areas require mental health services. He interacted with members of the Dalit Sangha
who requested that the mental health care needs of the tribals and Dalits may be addressed.
He has suggested that a separate hospital for mental health care be opened in
Rambhadrapuram and other tribal Mandal (Taluk HQ). He has also suggested that the 10 beds
in the district hospital be enhanced to 25 beds.
He reports serious problems with the administrative arrangements for the DMHP.
Dr Chalam also followed up with the UCs for Kurnool and Prakasam district, SVRR Tirupati.
Problems faced in the Prakasam dt (22/11/2010)30

Lack of co-operation by district hospital authorities


Hospital not providing diet to patients
Funds not released after July 2009

5.3. Frequency of home visits carried out by the HW/ANM; numbers covered and for what
diagnostic categories, no of admissions facilitated: NR
5.4. Kinds of essential drugs available, number dispensed, number of patients receiving
medication under the DMHP in a month: NR
5.5. Duration of untreated mental illness for different diagnostic categories if provided:NR
5.6. Monitoring of the DMHP by the concerned officer /impressions and trouble-shooting
(mention if there is a committee and its composition):NR
5.7. IEC activities of the DMHP: NR
5.8. Training calendar of the DMHP (doctors, health workers, nurses, pharmacists, school
teachers/Anganwadi workers (whether any training conducted): NR
5.9. Activities to sensitize the gram panchayats NR
5.10. Special Rapporteurs report on the activities of the DMHP, its reach, areas of good
performance, areas of poor performance, barriers for effective service delivery, measures to
streamline functioning, funding flow and barriers thereof:
5.11. Inspection Committees observations5.12. SUMMARY OBSERVATIONS OF DMHP AND RECOMMENDATIONS:
The DMHP has not been functioning in many of the earlier districts where it was earlier
functioning. There is no question of a discussion on its role in sensitizing the community,
providing home based care etc, when this is the situation.
SECTION 6
6. SUMMARY OF MENTAL HEALTH CARE INDICATORS IN ANDHRA PRADESH
6.1. Availability of mental health facilities

Mental health outpatient


facilities in the state
Day treatment facilities

Total No of
facilities/beds
NR

Rate per 100,000


population
Cannot be calculated

0
31

Psychiatric beds in general


hospitals
Community residential facilities
Beds/places in community
residential facilities
Psychiatric hospitals
Beds in psychiatric hospitals

0
0
0
1
300*

0.002
0.61

Incomplete because beds in other sectors not included


6.2. Access to Care

Persons treated in mental


health outpatient facilities
Persons treated in mental
health day care facilities
General hospital admissions
Community residential
facilities
Persons staying in community
residential facilities at the end
of the year
Admissions to mental hospitals

Rate per 100,000


population
37.87*

Females %

0
0

*Including DMHPs when they were functional. No data available for medical college hospitals,
general hospitals, private sector.
6.3. Information Systems

Persons with mental


disorders treated in
primary health care
Interventions delivered
in primary health care
for persons with
mental disorders
Persons treated in
mental health
outpatient facilities
Contacts in mental
health day treatment

Data on No of
persons/activities
collected and reported
YES/NO
N

Data on age and


gender are collected
and reported
YES/NO
N

Data on patients
diagnosis are collected
and reported
YES/NO
N

32

facilities
Admissions in general
hospitals with
psychiatric beds
Admissions in mental
hospitals
Days spent in mental
hospitals
Admissions in
community residential
facilities

6.4. Human Resources at the State Level


Health professionals working
in the mental health sector

Psychiatrists
Medical doctors not specialised
in psychiatry
Clinical Psychologists
Psychiatric Social Workers
Psychiatric Nurses
Occupational therapists
Other health workers

12
NA
01
01
NA
NA
NA

Training of health
professionals in educational
institutions
Rate per 100,000
0.02

0.002
0.002

6.5. INFORMAL HUMAN RESOURCES (Family and User Associations)


Present in the state
No of members
Participation in the
formulation/implementation of
policy/plan/legislation

User
N
N
N

Family
N
N
N

6.6. MEDICINES
Type of Medication
All psychotropic medication
Mood stabilisers
Antipsychotics
Anxiolytics
Antidepressants
Anti-craving medication/ Substitution
treatments

Availability
Available
Available
Available
Available
Available at few centres

33

MENTAL HEALTH REPORT CARD (needs to be revised after all the information is obtained)
Area

Focus

Parameters

Rating
100- present, fully
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100 All districts
covered; fully
satisfactory
75 majority of
districts covered
and functioning
50 half the
districts covered
and functioning
25 one-fourth
of the districts
covered and
functioning
0- No districts
covered/although
DMHP exists, not
functioning
100- present, fully
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100- present, fully
satisfactory
75- present,

Mental Health
Services
(Secondary
and Tertiary)

Medical
College
Depts,
General
Hospitals,
Specialised
psychiatric
hospitals

Adequacy of inpatient
beds
Functional Departments
Functional OP services

Primary
Health Care
mental health
services

District
Mental
Health
Programme

% of functional DMHPs

Rehabilitation
services

At all levels

Vocational training, day


care, longstay facilities in
govt sector/ppp

Specialised
services

Services for
substance
use

Whether existing, level


of functionality, present
at different levels of care

At one time were


functioning

34

Score (out
of 100)
25

0 (needs to
be verified
whether
any are still
functional)

Human
Resources

Financing for
mental health

Governance
and Policy

disorders,
old age,
mental
retardation,
child
psychiatry,
community
services,
forensic
services
(exclude
DMHP staff
here)

reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent

Adequacy of
psychiatrists/clinical
psychologists/psychiatric
social
workers/psychiatric
nurses or mental health
trained nurses

100 fully
adequate
75 moderately
adequate
50 somewhat
adequate
25- inadequate
0 grossly
inadequate

25

State level

Existence of separate
budget for mental
health/mental health
activities

State
Mental
Health
Authority
and other
authorities

Separate Mental Health


Nodal Officer
Functioning Mental
Health Authority
Nodal persons for mental
health in SHRC/Legal
Services
Authority/Others

10% -separate
budget, fully
adequate
75 separate
budget,
moderately
adequate
50 separate
budget,
somewhat
adequate
25 no separate
budget, but some
financial
resources
available annually
0 no separate
budget/marginal
financial resource
allocation
100 Existing,
fully functional
75- Existing,
mostly functional
50- Existing,
somewhat
functional
25- Partial

35

50

State Mental Health


Rules
State Mental Health
Programme
Range of medications
Regular supply and
dispensing
Standard procurement
arrangements

Availability of
psychiatric
medication

At every
level

Affirmative
action for
persons with
mental illness

At every
level

Disability assessment
Pension
Travel concession
Health insurance
Special assistance
Educational benefits
Job reservation

10

Treatment
Gap

Overall

Approximate number of
persons with mental
illness approximate
numbers totally receiving
treatment in the state

Total Score (out of 1000)


Average Score (%)

0 Non existent

100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100 no
treatment gap
75 25%
treatment gap
50 -50%
treatment gap
25 -75%
treatment gap
0- 100%
treatment gap

No
information

No
information
on patients
seeking
serviices

100
10

It is possible that there is more information and there are more services available that are not
mentioned in the affidavit.
RECOMMENDATIONS:
With the bifurcation of the state, there may have been a slow down, but the information
provided is very deficient and makes it very difficult to offer recommendations. The State
should first update the information, start working at all levels. The DMHP needs to be revived.
36

ARUNACHAL PRADESH
SECTION 1. STATE LEVEL REPORT
1. GENERAL INFORMATION REGARDING THE STATE (Arunachal Pradesh)
a. Area
83743 Sq.Mtr.
b. No of districts
c. Population, age distribution (as per census 2011)
d. Gender distribution

e.
f.
g.
h.

19
1382611
Male 720227
Female - 662379

Life expectancy at birth male and female


N.A.
Per capita State Government expenditure on health
N.A.
Any health indicators for the state (life expectancy, etc) N.A.
Completeness/quality of information provided: Complete/Partially
Complete/Deficient

If deficient, areas of deficiency: No information of the extent of the problem of mental illness;
inadequate resource mapping
2. MENTAL ILLNESS BURDEN/ INFORMATION REGARDING MENTAL ILLNESS
N
(prevalence)
2.1. Total number of
persons with mental
illness (all ICD categories)
2.2. Broad categories
2.2.a Severe mental
disorders (BPAD,
psychosis)
2.2.b Common mental
disorders
2.2.c Substance use
disorders (alcohol and
other drugs)
2.2.d Mental Retardation

N.A.

2.3. No of Males with


mental health problems
2.4. No of females with
mental health problems

N.A.

309

467
68

06

N.A.

37

N
(treatment
seeking)

Source of
information

2.5. No of children with


mental health problems
2.6. No of elderly with
mental health problems
2.7. No of homeless
mentally ill persons

08
N.A.
N.A.

COMMENT: The states information on mental illness burden is limited to treatment seeking
from 1 institution.
3. MENTAL HEALTH SERVICES IN THE STATE:

Organization of Services (description of number of psychiatric hospitals, medical college depts,


district hospitals)
N/N
3.1.a No of district general
hospitals with separate
department of psychiatry

3.1.b No of medical colleges with


department of psychiatry

N.A.

3.1.c No of district general


hospitals providing psychiatric
care
3.1.d No of District Mental Health
Programmes in the State

3.1.e No of government
psychiatric hospitals
3.1.f No of private psychiatric
hospitals
3.1.g Total No of psychiatric
hospitals in the state

3.1.h No of NGOs providing


mental health care

No with dept/facility
Total No of units

% coverage

Nil
1

COMMENT: Limited facilities


38

a. INPATIENT SERVICES
DESCRIPTION:
Psychiatric hospitals
(Govt) (Midpu Mental
Hospital, Papampare
district, Arunachal
Pradesh)
3.2.a. Total Inpatient
sanctioned/available
beds
3.2.b No of male beds
3.2.c. No of female
beds
3.2.d. No of beds for
children
3.2.e. No of beds for
elderly
3.2.f. No of beds for
substance use
disorders
3.2.g. No of beds for
forensic psychiatry
3.2.h. Occupancy (%)
3.2.i. No of admissions
during previous year
3.2.j. No of discharges
during previous year
3.2.k. Average
duration of inpatient
stay in days mean
3.2.l. Average duration
of inpatient stay in
days median
3.2.m. No of closed
wards
3.2.n. No of closed
ward beds
3.2.o. No of open
wards
3.2.p. No of open
ward beds
3.2.q. No of paid
wards
3.2.r.No of paid beds
3.2.s.No of admissions

Psychiatric
hospitals
(Private) N=

10

General
Hospitals
N=(Arunach
al State
Hospital,
Naharlagun)
N.A.

05
05

N.A.
N.A.

N.A.

N.A.

N.A.

N.A.

N.A.

N.A.

N.A.

N.A.

N.A.
N.A.

N.A.
N.A.

N.A.

N.A.

7-15 days

N.A.

N.A.

N.A.

N.A.

N.A.

N.A.

N.A.

N.A.

N.A.

N.A.

N.A.

N.A.

N.A.

N.A.

N.A.
N.A.
39

District
Hospitals
N=

NGOs
N=

Total

through courts
3.2.t. No of deaths in
the last year
3.2.u. No of suicides in
the last year

N.A.

N.A.

N.A.

N.A.

COMMENT: Very little information has been provided.


b. OUTPATIENT SERVICES

3.3.a. No of new OP
registrations in the
previous year

Psychiatric
hospitals (Govt)
(Midpu Mental
Hospital,
Papampare
district,
Arunachal
Pradesh)
40

Private
Psychiatric
hospitals
N=

General
District
Hospitals
Hospitals
N=(Arunachal N=
State
Hospital,
Naharlagun)

664

3.3.b. No of
emergency attendees
in the previous year

N.A.

N.A.

3.3.c Total no of OP
follow-up in the
previous year

N.A.

631

NGOs
N=

Total

704

COMMENT: There are very few registrations. No information of emergency attendees and
follow-up is provided.
4. REHABILITATION FOR PERSONS WITH MENTAL ILLNESS
a. Government residential rehabilitation/longstay facilities : No and description:
NIL
b. Government day care/outdoor rehabilitation facilities: No and description: NIL
c. Government run half-way homes: No and description. If none, plans to establish
and details Yes, Two with twenty inmates each.
d. NGO participation in the half way homes: Yes
40

e. Longstay rehabilitation facilities: No and description; NGO participation:Yes, 3


MENTAL HEALTH CARE IN OTHER COMMUNITY FACILITIES
State Level, in the Govt Sector

5.1. No of shelter homes, observation homes, special homes and


childrens homes
5.2. No of counsellors trained in mental health in the above
institutions
5.3. No of protection homes for destitute women
5.4. No of counsellors trained in mental health in the above
institutions
5.5. No of old age homes
5.6. No of counsellors trained in mental health in the above
institutions
5.7. No of Central Jails and District Jails in the State
5.8. No of counsellors trained in mental health in the above
institutions
5.9.No of counsellors trained in mental health in the above
institutions

3
N.A.
N.A.
N.A.
N.A.
N.A.
1 Central Jail
N.A.
N.A.

Helplines for Mental Health: (Nature of helpline, who runs it, for whom, any information on
its utilization)
COMMENT: The information is inadequate. There are no mental health trained personnel in
the limited facilities mentioned.
5. MENTAL HEALTH HUMAN RESOURCES
Mental Health Care Professionals
Government Sector
medical
colleges/hospitals
6.1. No of
Psychiatrists
6.2. No of Clinical
Psychologists
6.3. No of Psychiatric
Social Workers
6.4. No of nurses
trained in mental
health
6.5. No of trained
counselors
6.6. Record Keeper
6.7. Case Registry
Assistant

Psychiatric
Hospital

05
1
1
06

Nil
N.A.
N.A.
41

Private
Practice

Total

COMMENT: There is a shortage of human resources.


7. MENTAL HEALTH HUMAN RESOURCE DEVELOPMENT
7.1. Degree/Diploma Courses
In Entire state, Annual No of
Seats in
MD Psychiatry
DNB Psychiatry
Diploma in Psychiatry
PhD Clinical Psychology
MPhil Clinical Psychology
PhD Psychiatric Social Work
MPhil Psychiatric Social Work
PhD Psychiatric Nursing
MSc Psychiatric Nursing
BSc Psychiatric Nursing
Basic Diploma in Psychiatric
Nursing (DPN)

Institutions where the Programme is offered

7.2. Other training in mental health : HIV / IDU counselling for trainers of OST.
7.2.a. Details of Undergraduate MBBS training in psychiatry
Name of medical
college

No of hours of
theory

Duration of
psychiatry
posting during
UG

Duration of
psychiatry
posting during
internship

Qualifying
Examination
includes
competency
evaluation in
psychiatry

COMMENT: No undergraduate or postgraduate training facility mentioned.


7.2.b. Details of in-service training for Govt medical officers (No trained, duration) : 6 Medical
Officers on drug addiction, 2 medical officer on mental health for one year.
*If not trained, plans to train and timeline
7.2.c. Any other training courses in mental health offered by the state : Psychiatric Training to
Homeopathic interns
* Describe the type of course/duration/participants
42

8. GOVERNANCE:
8.1. Nodal Authority and responsibilities : 1. Medical Education Dr. M. Jini, 2. State Medical
and Health Department Dr. M. Jini, 3. Social Welfare Department Shri Tawtobin, 4. SMHA
Dr. H. Payee, 5. District Legal Services Authority Shri Bodi Habung
8.2. Presence of a State Mental Health Plan: NR
8.3. Enactment of State Mental Health Rules: NR
8.4. Oversight of policies and Programmes related to mental health : NR
8.5. Specific oversight of the DMHP programme: NR
8.6. Attempts towards integration of mental health care into general health care, NCD
management etc.NR
8.7. Examples of commitment to develop mental health services (high level involvement,
budgeting, networking: NR
8.8. Examples of inter-sectoral collaboration to improve mental health services (including PPP
intitiatives) -NR
8.9. Attempts towards mental health : NR
COMMENT: Strengths and weaknesses
Cannot be commented on because of lack of information provided.
9. FINANCING
9.1. Sources of financing of different categories
9.2 Budget provision from State and Centre in INR (for different facilities if required)
9.3. Mental Health Expenditure as proportion of Total Health Expenditure in State
(If available % spending on Health in the State may also be provided)
10. ANY OTHER SIGNIFICANT INFORMATION (e.g. litigation, insurance schemes for persons
with mental illness, pension and other assistance, job reservations)
11. INNOVATIONS
NR

43

12. OVERALL SUMMARY OF STATE LEVEL MENTAL HEALTH SERVICES :


Very little information. Hence no comments can be offered. The utlisaiton of the Midpu
Mental Hospital is very low. The General Hospital registers more outpatients but follow-ups
are low. There are no training resources for human resource generation.
SECTION 2
2.1. PSYCHIATRIC INSTITUTIONS (Midpu Mental Hospital, Arunachal Pradesh)
Name and a para on status in 2008 (refer to NHRC book Mental Health Care and Human
Rights)
Domains
Infrastructure
Amenities and facilities
Financial arrangements
Diet
Investigations and treatment
Staff and training
Supportive services
Recreation/Occupational
therapy/Rehabilitation
Networking with other agencies

i.

Status in 2008

Developments since 2008

Outpatient: Adequate Waiting Hall, Toilets, Separate Interview Rooms, Drinking


Water facilities. There are separate medical record section, education material for
patients are available. Medicines are available in free of cost. Total no. Of OPD
registrations (New) in previous year = 40.
Organic Psychiatric Disorders
Schizophrenia
Bipolar Mood Disorder
Other Psychotic Disorders
Obsessive Compulsive Disorder
Other anxiety Disorders
Depressive Disorders
Adjustment Disorders
Alcohol and drug Abuse Disorders
Personality Disorders
Children with Psychiatric illness

04
05
02
12
02
15
-

44

ii. Inpatient (improvement in in-patient facilities; any increase in open compared to closed ward
admissions; further reduction in court admissions; improvement particularly in the care of
women, children and elderly; use of disposables needles and syringes; no re-use of shaving
blades; any illness outbreaks and how contained; availability of psychotropic medication
including free medicines; use of ECTs including direct ECT):
Diagnostic categories seen: NR
iii. DIAGNOSTICS AND THERAPEUTICS :

Investigations:
Therapeutic facilities:
Improvements in rehabilitation:
iv. ENGAGEMENT:
Attempts to involve families of persons with mental illness:
Disability certification and number of certificates issued in the previous year: N.A.

v. ADMINISTRATIVE

Annual number of adverse events:


Mechanisms for redressal of patient complaints:

vi. COMMUNITY OUTREACH AND NETWORKING


Community Programmes:
1. Networking with external agencies:
2. Public mental health education:
vii. TRAINING

Post-graduate training new Programmes, enhancement of seats and measures to


maintain/improve quality of training:

Any other training Programmes:

vii. RESEARCH:

Research (areas, funding agencies, findings),


viii. ANY OTHER SALIENT CONTRIBUTIONS OF THE HOSPITAL/INSTITUTE:

ix. Any monitoring of hospital (internal or external)- details :

45

x. Special Rapporteurs observation: Shri Anil Pradhan (Special Rapporteur date of visit July
28th, 2015 Mental Hospital, Midpu), The facility was completed in the year 2011 it consists
of two separate blocks, one is the administrative block and other is indoor ward. The indoor
block has rooms for male and female patient with a common kitchen. This mental hospital at
Midpu locality also suffer from erosion by river Pare which flows about hundred feet below
the hillock on which this facility stands . The 10 bedded mental hospital attached to civil
hospital, Naharlagun was dismantled to make way for a three hundred bedded General
Hospital and Medical College, with Central Funds. Like in Mizoram the doctor and nurses
employed under NMHP and DMHP of Arunachal Pradesh were absorbed as regular govt.
Employees once the funds stopped from Govt. Of India.
xi. Any other observations (including Inspection Committee Reports): Not visited
xii. Summary and Recommendations from SECTION 2: Cannot be commented upon
Areas of positive change

Areas of poor progress

SECTION 3
3. General Hospital Departments of Psychiatry and District Hospital Departments
The broad outline for this section:
3.1. Names of GH/DH and their location. : Arunachal State Hospital, Naharlagun-79110
(If there are many, this could be done in a tabular column).
The following areas may be mentioned as a summary of all the units; where needed , examples
could be made of a specific dept to highlight both positives and negatives.
3.2. Areas (distribution throughout the states): N.A.
3.3. Whether separate funding and adequacy: N.A.
3.4. Whether OP/IP and emergency services available : OPD Services are available.
3.5. Diagnostic categories in rank order that present in the outpatient : No. Of OPD new
registrations in previous year = 664, No. Of follow-up in previous year = 631, Diagnostic
Breakup is given below
Organic Psychiatric Disorders
Schizophrenia

09
2
46

Bipolar Mood Disorder


Other Psychotic Disorders
Depressive Disorders
Alcohol and drug Abuse Disorders
Children with Psychiatric illness

58
285
59
68
8

Psychotic disorders, bipolar mood disorders and alcohol and drug abuse disorders are the
most common diagnostic categories in the outpatient.
3.6. Adequacy of OP facilities : Waiting Halls, Toilets, Separate Interview Rooms, Drinking
Water, Canteen Services, OPD Lab services are adequate, There are counselling facilities for
children and drug de-addiction.
3.7. Inpatient occupancy, free and paying beds, average cost of inpatient stay per week; rank
order of diagnostic categories : No. Of beds occupied as on 1st April (Previous year Male 15,
Female-7), Free beds are available duration of inpatient stay = 7 to 15 days, Free cost of
inpatient stay
The breakup as per ICD 10 is as follows
Organic Psychiatric Disorders
Schizophrenia
Bipolar Mood Disorder
Other Psychotic Disorders
Obsessive Compulsive Disorder
Other anxiety Disorders
Depressive Disorders
Adjustment Disorders
Alcohol and drug Abuse Disorders
Personality Disorders
Children with Psychiatric illness

02
02
03
03
08
-

3.8. Extent of family involvement : Always involved


3.9. Measures to protect rights including complaint redressal : Rights of patients are displayed
in wards.
3.10. Any networking : No
3.11. Staffing details and any shortages/vacancies :
Qualified psychiatrists
General Medical Officers

02
47

Clinical Psychologists
Psychiatric / Medical Social Workers
Trained Psychiatric Nurses
General Nurses
Other (Specify)

01
01
04
-

3.12. Psychotropic medication availability/free/cost : Yes, Tab. Risperidone, Tab.


Trihexiphenydil, Tab.Sertraline, Imipramine, Amitrypline are available.
3.13. ECTs (Nos given across the facilities or average/No of direct ) : N.A.
3.14. Observations of extent to which counselling and psychotherapy are provided : Provided
to some
3.15. Whether disability certification is available (if available numbers certified/year) : No
3.16. Extent and nature of community involvement : Yes, one community outreach activity per
month
3.17. Whether engagement with the DMHP and extent : N.A.
3.18. Nature and partnership with NGOs for networking : Yes, Mother Homes, Prayer Centres,
Harahappa, Missionary of Charity,
3.19. Presence of PG training- whether adequately distributed throughout the state : No
3.20. Nature of public mental health material prepared and distributed/ activities to educate :
Yes, Pamphlets, posters, banners, T.V. Talk
3.21. Areas of research, sources of funding and major findings : Nil
3.22. Whether monitored and by whom. What were the observations? : Yes, Monitoring is
done by the State Govt. and by the High Court for Midpu Mental Hospital.
3.23. Special Rapporteurs observations
3.24. Inspection Committees observations
3.25. SUMMARY AND RECOMMENDATIONS WITH RESPECT TO SECTION 3:
The State needs to have more resources for mental health care and determine how many
persons are in need of care. The geographical terrain also poses challenges which require
innovations.
Information on patient profiles is incomplete.
48

There are no opportunities for PG training.


SECTION 4
4. NGOS WORKING IN MENTAL HEALTH:
4.1. A brief description of the NGO and its location : 1. Mothers Home, Lekhi Village,
Naharlagun, Papumpare District, Arunachal Pradesh.
4.2. Nature of work carried out by the NGO in the domains mentioned and details of each :
Advocacy, Awareness, Education both for Mental illness and Health Promotion.
4.3. Description of clientele seen by the NGO and number of persons who use the services in
the previous year : Residential Care, Counselling, Medicines, Follow-up, Aftercare, Home
based Programme,
4.4. Research details : NO
4.5. Details of any training carried out by the NGO : N.A.
4.6. Networking activities of the NGO : Networking with Arunachal State Hospital, Psychiatry
Department.
4.7. Salient contributions of the NGO : N.A.
4.8. Special Rapporteurs observations : N.A.
4.9. Inspection Committees observations : N.A.
4.8. SUMMARY AND RECOMMENDATIONS FOR SECTION 4
There are a few NGOs, but more organisations must be encouraged to come forward.
SECTION 5
5. DISTRICT MENTAL HEALTH PROGRAMME: NO DETAILED INFORMATION IS AVAILABLE
5.1. A brief description of the location of the DMHP, when it started, total population covered:
In 1997-98, Naharlagun was listed as a DMHP district and in 2006-07 East Siang was included1.

NHRC. Mental Health and Human Rights. Kumar K, Murthy P. Realizing the objectives of the National Mental
Health Programmeme: a look at States and innovations. In Nagaraja D, Murthy P Eds. NHRC 2008, Page 183

49

5.2. A summary of annual registrations old and new, treatment outcomes in terms of those on
regular treatment and those dropped out, with diagnostic categories if provided. Would be
useful to know what kind of clientele is serviced under the DMHP:

5.3. Frequency of home visits carried out by the HW/ANM; numbers covered and for what
diagnostic categories, no of admissions facilitated: Details are not available.
5.4. Kinds of essential drugs available, number dispensed, number of patients receiving
medication under the DMHP in a month:
5.5. Duration of untreated mental illness for different diagnostic categories if provided:
5.6. Monitoring of the DMHP by the concerned officer /impressions and trouble-shooting
(mention if there is a committee and its composition):
5.7. IEC activities of the DMHP:
5.8. Training calendar of the DMHP (doctors, health workers, nurses, pharmacists, school
teachers/Anganwadi workers (whether any training conducted):
5.9. Activities to sensitize the gram panchayats
5.10. Special Rapporteurs report on the activities of the DMHP, its reach, areas of good
performance, areas of poor performance, barriers for effective service delivery, measures to
streamline functioning, funding flow and barriers thereof.
5.11. Inspection Committees observations: Not visited

50

5.12. SUMMARY OBSERVATIONS OF DMHP AND RECOMMENDATIONS: No detailed


information on the 2 districts, but poor coverage.
SECTION 6
6. SUMMARY OF MENTAL HEALTH CARE INDICATORS IN ARUNACHAL (name of state)
6.1. Availability of mental health facilities
Total No of
facilities/beds
Mental health outpatient facilities in
the state

Rate per 100,000 population


0.329

Day treatment facilities


51

Psychiatric beds in general hospitals

0.823

Community residential facilities


Beds/places in community residential
facilities
Psychiatric hospitals

0.004

Beds in psychiatric hospitals

1.469

6.2. Access to Care


Rate per 100,000
population

Females %

Persons treated in mental health


outpatient facilities
Persons treated in mental health
day care facilities
General hospital admissions
Community residential facilities
Persons staying in community
residential facilities at the end of the
year
Admissions to mental hospitals

14.52

6.3. Information Systems


Data on No of
persons/activities
collected and reported
YES/NO

Data on age and


gender are collected
and reported
YES/NO

Persons with mental


disorders treated in
primary health care
Interventions delivered
in primary health care
for persons with
mental disorders
52

Data on patients
diagnosis are collected
and reported
YES/NO

Persons treated in
mental health
outpatient facilities
Contacts in mental
health day treatment
facilities
Admissions in general
hospitals with
psychiatric beds
Admissions in mental
hospitals
Days spent in mental
hospitals
Admissions in
community residential
facilities

Yes

Yes

Yes

Yes

Yes

Yes

No

No

No

6.4. Human Resources at the State Level

Psychiatrists

Health professionals working


in the mental health sector
Rate per 100,000

Training of health professionals


in educational institutions
Rate per 100,000

0.301

0.0364

Medical doctors not specialised


in psychiatry

2.893

Clinical Psychologists

0.047

0.010

Psychiatric Social Workers

0.033

0.003

Psychiatric Nurses

0.166

0.016

Occupational therapists
Other health workers

6.5. INFORMAL HUMAN RESOURCES (Family and User Associations)


Present in the state
No of members
Participation in the
formulation/implementation of
policy/plan/legislation

User
Yes

Family
Yes

Not routinely

Not routinely

53

6.6. MEDICINES
Type of Medication

Expenditure at State level per year and per


100,000 population (in INR)
NR

All psychotropic medication


Mood stabilisers
Antipsychotics
Anxiolytics
Antidepressants
Anti-craving medication/ Substitution
treatments

SECTION 7
6. STATE MENTAL HEALTH REPORT CARD
SUMMARY OF SECTIONS 1-7.
Summary of areas where state has achieved good progress/little progress/no progress

MENTAL HEALTH REPORT CARD (needs to be revised after all the information is obtained)
Area

Focus

Parameters

Rating
100- present, fully
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100 All districts
covered; fully
satisfactory
75 majority of
districts covered
and functioning
50 half the
districts covered
and functioning
25 one-fourth

Mental Health
Services
(Secondary
and Tertiary)

Medical
College
Depts,
General
Hospitals,
Specialised
psychiatric
hospitals

Adequacy of inpatient
beds
Functional Departments
Functional OP services

Primary
Health Care
mental health
services

District
Mental
Health
Programme

% of functional DMHPs
At one time were
functioning

54

Score (out
of 100)
25

25

Rehabilitation
services

At all levels

Specialised
services

Human
Resources

Services for
substance
use
disorders,
old age,
mental
retardation,
child
psychiatry,
community
services,
forensic
services
(exclude
DMHP staff
here)

Financing for
mental health

State level

of the districts
covered and
functioning
0- No districts
covered/although
DMHP exists, not
functioning
Vocational training, day
100- present, fully
care, longstay facilities in satisfactory
govt sector/ppp
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
Whether existing, level of 100- present, fully
functionality, present at
satisfactory
different levels of care
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent

Adequacy of
psychiatrists/clinical
psychologists/psychiatric
social
workers/psychiatric
nurses or mental health
trained nurses

100 fully
adequate
75 moderately
adequate
50 somewhat
adequate
25- inadequate
0 grossly
inadequate

25

Existence of separate
budget for mental
health/mental health
activities

10% -separate
budget, fully
adequate
75 separate
budget,
moderately
adequate

55

Governance
and Policy

State
Mental
Health
Authority
and other
authorities

Separate Mental Health


Nodal Officer
Functioning Mental
Health Authority
Nodal persons for mental
health in SHRC/Legal
Services
Authority/Others
State Mental Health
Rules
State Mental Health
Programme
Range of medications
Regular supply and
dispensing
Standard procurement
arrangements

Availability of
psychiatric
medication

At every
level

Affirmative
action for
persons with
mental illness

At every
level

Disability assessment
Pension
Travel concession
Health insurance
Special assistance
Educational benefits
Job reservation

10

Treatment
Gap

Overall

Approximate number of
persons with mental
illness approximate
56

50 separate
budget,
somewhat
adequate
25 no separate
budget, but some
financial
resources
available annually
0 no separate
budget/marginal
financial resource
allocation
100 Existing,
fully functional
75- Existing,
mostly functional
50- Existing,
somewhat
functional
25- Partial
0 Non existent

100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100 no
treatment gap
75 25%

50

50

Inadequate
to
comment

numbers totally receiving


treatment in the state

Total Score (out of 1000)


Average Score (%)

treatment gap
50 -50%
treatment gap
25 -75%
treatment gap
0- 100%
treatment gap
175
17.5

It is possible that there is more information and there are more services available that are not
mentioned in the affidavit.
RECOMMENDATIONS:
The state needs better collection of information.
It needs to seriously plan how to augment its human resources and mental health services.
The State must be provided assistance in assessing the present state of mental health
resources, preparing and executing a comprehensive plan.

57

ASSAM
SECTION 1. STATE LEVEL REPORT
7. GENERAL INFORMATION REGARDING THE STATE (Assam)
a. Area
78438 Sq.Kms. (As per
Census 2011)
b. No of districts
27 (As per Census 2011)
c. Population, age distribution (as per census 2011)
Total Population
31205576
Distribution by
Age 0 06 Years : 4638130
d. Gender distribution
Males : 15939443
Females : 15266133
e. Life expectancy at birth male and female
N.A.
f. Per capita State Government expenditure on health
N.A.
g. Any health indicators for the state (life expectancy, etc) N.A.
h. Completeness/quality of information provided: Complete/Partially
Complete/Deficient
If deficient, areas of deficiency:
8. MENTAL ILLNESS BURDEN/ INFORMATION REGARDING MENTAL ILLNESS
N
(prevalence)
2.1. Total number of
persons with mental
illness (all ICD categories)

N
(treatment
seeking)

1 2%
People are
suffering
from
Severe
Mental
illness
(Psychosis)
Common
Mental
Disorders
(Neurosis)
is 10 20
times
higher
than
psychosis
58

Source of
information

2.2. Broad categories


2.2.a Severe mental
disorders (BPAD,
psychosis)
2.2.b Common mental
disorders
2.2.c Substance use
disorders (alcohol and
other drugs)
2.2.d Mental Retardation

N.A.

2.3. No of Males with


mental health problems
2.4. No of females with
mental health problems
2.5. No of children with
mental health problems
2.6. No of elderly with
mental health problems
2.7. No of homeless
mentally ill persons

N.A.
N.A.
N.A.
N.A.
238

Survey by
DHS and
NGO
Ashadeep

COMMENT: There is no estimation of the approximate persons in need of mental health


care.
9. MENTAL HEALTH SERVICES IN THE STATE:
Organization of Services (description of number of psychiatric hospitals, medical college depts,
district hospitals)
N/N
3.1.a No of district general
hospitals with separate
department of psychiatry

12

3.1.b No of medical colleges with


department of psychiatry

3.1.c No of district general


hospitals providing psychiatric
care
3.1.d No of District Mental Health
Programmes in the State

12

No with dept/facility
Total No of units

% coverage

N
59

3.1.e No of government
psychiatric hospitals
3.1.f No of private psychiatric
hospitals
3.1.g Total No of psychiatric
hospitals in the state

Nil

3.1.h No of NGOs providing


mental health care

11

N.A.
N.A.

COMMENT: Out of 27 districts, 5 are covered by te DMHP. The state does not mention
LGBRIMH as a psychiatric institution. There is no recording of facilities in the private sector.
Less than half of the districts are providing psychiatric services.
The NGO presence in the State in the area of mental health is encouraging.
a. INPATIENT SERVICES
DESCRIPTION:

3.2.a. Total
I.npatient
sanctioned/available
beds
3.2.b No of male
beds
3.2.c. No of female
beds
3.2.d. No of beds for
children
3.2.e. No of beds for
elderly
3.2.f. No of beds for
substance use
disorders
3.2.g. No of beds for
forensic psychiatry
3.2.h. Occupancy (%)
3.2.i. No of
admissions during
previous year
3.2.j. No of
discharges during

Psychiatric
Psychiatric
hospitals (Govt)
hospitals
(LGBRIMH,Tezpur) (Private) N=
336/336

246
90
N.A.
N.A.
24

21
100%
1825

1825
60

General
Hospitals
N=

District
Hospitals
N=

NGOs
N=

Total

previous year
3.2.k. Average
duration of inpatient
stay in days mean
3.2.l. Average
duration of inpatient
stay in days median
3.2.m. No of closed
wards
3.2.n. No of closed
ward beds
3.2.o. No of open
wards
3.2.p. No of open
ward beds
3.2.q. No of paid
wards
3.2.r.No of paid beds
3.2.s.No of
admissions through
courts
3.2.t. No of deaths in
the last year
3.2.u. No of suicides
in the last year

30-60 days

N.A.

N.A.
N.A.
N.A.
N.A.
N.A.

34

4
0

COMMENT: Here, information on the LGBRIMH has been included after it was obtained.
b. OUTPATIENT SERVICES
Govt.
Psychiatric
hospitals
N=
3.3.a. No of new OP
registrations in the
previous year

18494

3.3.b. No of
emergency attendees
in the previous year

N.A.

3.3.c Total no of OP
follow-up in the
previous year

81213

Private
Psychiatric
hospitals
N=

61

General
Hospitals

District
Hospitals

NGOs

N=

N=

N=

Total

COMMENT:
No complete details are provided for the medical colleges and the general hospitals, and
the district hospitals.
10. REHABILITATION FOR PERSONS WITH MENTAL ILLNESS
a. Government residential rehabilitation/longstay facilities : No and description:
N.A.
b. Government day care/outdoor rehabilitation facilities: No and description:
Details are not available
c. Government run half-way homes: No and description. If none, plans to establish
and details Details are not available
d. NGO participation in the half way homes: Details are not available
e. Longstay rehabilitation facilities: No and description; NGO participation: Details
are not available

11. MENTAL HEALTH CARE IN OTHER COMMUNITY FACILITIES


State Level, in the Govt Sector

5.1. No of shelter homes, observation homes, special homes and


childrens homes
5.2. No of counsellors trained in mental health in the above
institutions
5.3. No of protection homes for destitute women
5.4. No of counsellors trained in mental health in the above
institutions
5.5. No of old age homes
5.6. No of counsellors trained in mental health in the above
institutions
5.7. No of Central Jails and District Jails in the State
5.8. No of counsellors trained in mental health in the above
institutions
5.9.No of counsellors trained in mental health in the above
institutions

Detailed information is
not available

Helplines for Mental Health: (Nature of helpline, who runs it, for whom, any information on
its utilization): NR
COMMENT: The information with regard to the existing facilties for rehabilitation of persons
with mental illness, mental health training of staff in custodial homes must be provided.

62

12. MENTAL HEALTH HUMAN RESOURCES


Mental Health Care Professionals

6.1. No of
Psychiatrists
6.2. No of Clinical
Psychologists
6.3. No of Psychiatric
Social Workers
6.4. No of nurses
trained in mental
health
6.5. No of trained
counselors
6.6. Record Keeper
6.7. Case Registry
Assistant

Government Sector
medical
colleges/hospitals
(include district
general hospital
information also)
47

Psychiatric
medical colleges

N.A.

10

Nil

Nil

Nil

1
1

Nil
Nil

Private
Practice

Total

Nil

COMMENT:
The information of human resources outside the government sector has not been provided.
7. MENTAL HEALTH HUMAN RESOURCE DEVELOPMENT
7.1. Degree/Diploma Courses
In Entire state, Annual No of
Seats in

Institutions where the Programme is offered

MD Psychiatry

10+2
seats/yr
6 SEATS /YR
4

MEDICAL COLLEGES OF STATE , LGBRIMH,TEZPUR

8
N.A.
6

LGBRIMH

10

LGBRIMH

30

LGBRIMH

DNB Psychiatry
Diploma in Psychiatry
PhD Clinical Psychology
MPhil Clinical Psychology
PhD Psychiatric Social Work
MPhil Psychiatric Social Work
PhD Psychiatric Nursing
MSc Psychiatric Nursing
BSc Psychiatric Nursing
Basic Diploma in Psychiatric
Nursing (DPN)

LGBRIMH
MEDICAL COLLEGES OF STATE

LGBRIMH

63

COMMENT: The LGBRIMH is active in its post graduate training. The potential of the 6
medical colleges and other organizations for post-graduate training needs to be explored.
7.2. Other training in mental health : The state support for Mental Health Programme has
imparted training of Medical Officers and Nurses.
7.2.a. Details of Undergraduate MBBS training in psychiatry
Name of medical
college

No of hours of
theory

Duration of
psychiatry
posting during
UG

Duration of
psychiatry
posting during
internship

Qualifying
Examination
includes
competency
evaluation in
psychiatry

COMMENT: Six Medical Colleges of state has 30 hours lecture classes, two weeks bed side
clinics in the fifth semester and two weeks Clinical Postings as PRCA in Psychiatry
Department.
* If many medical colleges and all uniform UG training, mention the number of colleges and the
details of UG training
7.2.b. Details of in-service training for Govt medical officers (No trained, duration) : Training
under DMHP and state support for Mental Health Programme since 2006 192 Govt. Medical
Officers have been trained.
Under DMHP, Morigaon district 22 (2007-08)
Under DMHP, Nalbari 27 (2008-09)
Under State Support for Mental Health Programme 143 (2011-14) Duration - two weeks.
*If not trained, plans to train and timeline
7.2.c. Any other training courses in mental health offered by the state : The state support for
Mental Health Programme has imparted in service training courses in psychiatric nursing for
Govt. Nurses :
No. Of Govt. Nurses who have been imparted training so far 272
No. Of Govt. Nurses being imparted training in psychiatric nursing per annum on average and
duration of training :

64

Under DMHP Morigaon 46 (2007-08)


Under DMHP Nalbari 44 (2008-09)
Under state support for Mental Health Programme 182 (2011-14)
* Describe the type of course/duration/participants
8. GOVERNANCE:
8.1. Nodal Authority and responsibilities : Nodal Officers with responsibilities for mental
health care in the state health services are
1. Medical Education

: DME, Assam

2. State Medical & Health Department

: DHS, Assam

3. State Mental Health Authority

: SMHA, Assam

4. District Legal Services Authority

: Member Secretary, ASLSA

5. Social Welfare Department

: DSW, Assam

8.2. Presence of a State Mental Health Plan: NR


8.3. Enactment of State Mental Health Rules: NR
8.4. Oversight of policies and Programmes related to mental health : DMHP in Assam is
functioning since 2006 and state support for mental health Programme (Govt. of Assam) is
functioning since 2011.
8.5. Specific oversight of the DMHP programme. Brief description of districts where fully
implemented, where partially implemented and details of reasons for incomplete
implementation. Also mention here a brief summary of availability of medicines and
psychosocial care for patients with mental illness. No. Of district Mental Health Programme
(DMHP) in the state = 5
No. Of districts in which DMHP has been implemented = 5
No. Of district in which DMHP has been fully implemented = 2 (Nagaon and Goalpara
districts)
No. Of districts in which DMHP has been partially implemented 3 (Morigaon, Tinsukia &
Nalbari)

65

The reasons for in complete implementation of DMHP in the districts Non availability of
funds
The State Nodal Officer has proposed six additional no. Of districts for DMHP, Assam during
the next five years beginning (2015-16).
8.6. Attempts towards integration of mental health care into general health care, NCD
management etc.
8.7. Examples of commitment to develop mental health services (high level involvement,
budgeting, networking
8.8. Examples of inter-sectoral collaboration to improve mental health services (including PPP
intitiatives)
8.9. Attempts towards mental health promotion (e.g. SMHA Karnataka had organised regular
phone in Programmes related to mental health and mental disorders. Public responses were
evaluated and were very encouraging)
COMMENT: The State has set up a broad-based nodal authority to plan and monitor mental
health services.
9. FINANCING
9.1. Sources of financing of different categories LGBRIMH , TEZPUR- PLAN (RS)- FY2014-15=66
CRORES
9.2 Budget provision from State and Centre in INR (for different facilities if required)
9.3. Mental Health Expenditure as proportion of Total Health Expenditure in State
(If available % spending on Health in the State may also be provided)
10. ANY OTHER SIGNIFICANT INFORMATION (e.g. litigation, insurance schemes for persons
with mental illness, pension and other assistance, job reservations)
11. INNOVATIONS
12. OVERALL SUMMARY OF STATE LEVEL MENTAL HEALTH SERVICES : As per census 2011, the
state has total area of 78438 Sq.Kms., the total population of 31205576, total no. Of districts
are 27. Approximately 1-2% people are suffering from major psychiatric disorders (Psychosis).
The number of minor psychiatric disorder (Neurosis) is 10-20 times higher, than psychosis.
The no. Of homeless mentally ill persons is 147. The 12 Government district general hospitals
are having a separate department of psychiatry to provide psychiatric care. The state in
66

government sector including both government medical colleges and government hospitals
has 47 psychiatrists, 3 clinical psychologists, 10 psychiatrics social workers in mental health, 2
trained nurses in mental health. The number of non government organizations providing
mental health care in the state is 11. DMHPs are running in 5 of the 27 districts.
SECTION 2
2.1. PSYCHIATRIC INSTITUTIONS (LGBRIMH, Tezpur)
Name and a para on status in 2008 (refer to NHRC book Mental Health Care and Human
Rights)
Domains
Infrastructure

Amenities and facilities

Financial arrangements
Investigations and treatment
Staff and training

Supportive services
Recreation/Occupational
therapy/Rehabilitation

Status in 2008
The institute has been handed
over to Ministry of Health and
Family Welfare, Govt. of India.
Government is planning its
expansion and development in
phased manner.
Presently there is no facility for
children and special wards in
the hospital.

Developments since 2008


A new hospital with all the
latest facilities is under
construction in the campus.

Training Courses have been


started for DNB, Psychiatry,
M.Sc. Psychiatry Nursing.
Inspection
by
Guwahati
University for starting M.D.
Psychiatry done in May 2008.

Adequate provision for


manpower and support
facilities are to be created.
M.D. course in psychiatry has
already being started.

The facilities for neurosurgery


and neurology in the institute
are in process of developing to
meet the requirement for the
patients of north eastern
region.

Comprehensive center is being


newly built with funds
received from Ministry of
Govt. of India and facility is on
way of completion. Trade
Instructors,
Occupational
Therapist are appointed and
looking after the rehabilitation
facilities of institute.

Networking with other agencies

There are 7 NGOs with whom


the institute has developed
liaisoning.
67

SERVICES (LGBRIMH, TEZPUR, ASSAM)


i. Outpatient: In the OPD care is provided through a multidisciplinary team of psychiatrists,
clinical psychologists, psychiatric social workers and psychiatric nurses. It also houses the
pharmacy, medical record department, a nursing station, laboratory sample collection centre
and facilities of public convenience.
ii. Inpatient (improvement in in-patient facilities; any increase in open compared to closed ward
admissions; further reduction in court admissions; improvement particularly in the care of
women, children and elderly; use of disposables needles and syringes; no re-use of shaving
blades; any illness outbreaks and how contained; availability of psychotropic medication
including free medicines; use of ECTs including direct ECT): The functional bed strength of the
hospital is 336 beds out of which 246 beds are for male and 90 beds are for female. Out of the
total beds, 21 beds (15 male, 6 female) are reserved for psychiatric patients sent from the
various jails. The patients are looked after by a team of mental health professionals,
residents, nurses, warders and attainders.
Diagnostic categories seen:
iii. DIAGNOSTICS AND THERAPEUTICS : Laboratory services are an integral part of hospital
settings. A total of 209530 diagnostic tests were conducted in the Central Laboratory of the
institute from April 2014 to March 2015 under the department of pathology, Microbiology,
Biochemistry and Radiology. The department is also running a HIV Counselling and Testing
(FICTC) centre at OPD.

Investigations:
Therapeutic facilities:
Improvements in rehabilitation: Currently, the rehabilitation services of the Institute
are carried out through the Occupational Therapy Unit, Physiotherapy Unit, Special
Education Unit and a Wellness Clinic. A total number of 4543 physiotherapy sessions
and 1563 vocational therapy sessions respectively were administered for the benefit
of patients till October, 2014.

iv. ENGAGEMENT:

Attempts to involve families of persons with mental illness:


Disability certification and number of certificates issued in the previous year: N.R.

v. ADMINISTRATIVE
68

Annual number of adverse events: 1-2 incidents per year like assault, misbehave
towards patients. Disciplinary action taken accordingly.
Mechanisms for redressal of patient complaints:

vi. COMMUNITY OUTREACH AND NETWORKING

3.
4.
5.
6.
7.
8.
9.

Community Programmes: The institute organizes community treatment on a monthly


basis in three different centers i.e. Scootea Extension Clinic, Jakhalabanda Extension
Clinic and Missionary of Charity Extension Clinic and extends mental health services at
community levels. A total number of 8071 patients received treatment from April
2014 to March 2015.
Networking with external agencies: The networking with NGOs is being done by the
institute, the following are the names of the NGOs
NEVARD, Bongaigaon Placement of homeless persons and treatment of mentally ill
persons.
Help AID, Panikhaiti, Guwahati Placement of homeless persons and treatment of
mentally ill persons.
ASHADEEP, Guwahati Placement of homeless persons and treatment of mentally ill
persons.
NERM School and Mental Handicap Training Centre, Balipukhuri Placement of
homeless persons and treatment of mentally ill persons.
Missionary of Charity, Tezpur Placement of homeless persons and treatment of
mentally ill persons.
Human Welfare Society, Nizara, Sibsagar Placement of homeless persons and
treatment of mentally ill persons.
INCENSE Project (Collaborative project with Parivaratan, Pune and LGBRIMH, Tezpur
for persons with severe mental disorder).
Public mental health education:

vii. TRAINING

Post-graduate training new Programmes, enhancement of seats and measures to


maintain/improve quality of training: The details of the different academic courses are
as follows :
1. Diploma in Psychiatric Nursing (DPN) Course : Started in 2001 and currently has 3 seats
per annum.
2. DNB in Psychiatry course : Started in 2006 with 4 seats per annum. The seats were
increased to 6 seats in 2008-09 sessions.

69

3. M.Sc. Nursing (Psychiatric Nursing) : Started in 2007 with 2 seats per year. In 2009-10
the seats were increased to 12 seats every session.
4. M. Phil in Psychiatric Social Work : Stared in 2009 with 2 seats per annum under
Gauhati University. In 2011-12 the seats were increased to 5 seats every session. In
2014-15 the seats were increased to 6 seats every session.
5. M.D. in Psychiatry : Started in 2010 with 2 seats per annum affiliated under Gauhati
University.
6. M. Phil in Clinical Psychology : Started in 2011 with 4 seats per session under Gauhati
University. In 2015-16 the seats were increased to 8 seats every session.
Any other training Programmes:
vii. RESEARCH:

Research (areas, funding agencies, findings), : The ongoing community project entitled
Integration of Mental Health Service towards development of Community Based
rehabilitation has entered the final phase.
The research project INCENSE has been initiated in 2011 in collaboration with
Sangath, Goa with funding from Sir Dorabjee Tata Trust. The aim of this project is to
design a model for care persons with severe mental illness and further initiate the
intersectoral collaboration for continued care and rehabilitation.
The Department of Psychiatric Social Work is a consultant for collaborative
programme by IGSSS (Guwahati) for the intervention programme titled Psychosocial
care for persons affected by communal violence in Assam in Mizoram.

viii. ANY OTHER SALIENT CONTRIBUTIONS OF THE HOSPITAL/INSTITUTE:


ix. Any monitoring of hospital (internal or external)- details : Yes, Monitoring done by NHRC,
Two times visits by NHRC during the last 2 years.
(i)
(ii)

Shri Anil Pradhan, Special Rapporteur on 13.06.2014.


Shri Anil Pradhan, Special Rapporteur along with Shri Prabir Kumar Dutta, ACS &
EM Tezpur on 03.02.2015.

x. Special Rapporteurs observation: As per observation by Special Rapporteur Shri Anil


Pradhan (Date of Visit February 3, 2015).
The new structure being constructed is adjacent to the present building of Lokopriya
Gopinath Bordoloi Institute of Mental Health. The campus is a large area and is being
developed as a state-of-art institute for better services, manpower development and
knowledge generation. When complete, it will replace the old asylum structure with modern
facilities.
70

xi. Any other observations (including Inspection Committee Reports):


Issues with LGBRIMH, Tezpur:
1. Existing old wards require renovation
2. Facilities for neurology and neurosurgery on the same campus, to meet the requirement of the
region
3. Care facilities for longstay and abandoned patients
4. Boundary of the institute to be strengthened
5. Approach road to be made motorable
6. Sports and recreation facilities to be augmented
7. Recognition of MD course pending with MCI
8. Human resource requires augmentation to maintain the care and service facilities at a high level
-need to create posts of senior faculty and support staff
9. Several employee related issues to be sorted out (state versus institution affilitation; post
retirement benefits/pensions

xii. Summary and Recommendations from SECTION 2:


Areas of positive change

Areas of poor progress

There have been positive changes in many


areas

SECTION 3
3. General Hospital Departments of Psychiatry and District Hospital Departments
The broad outline for this section:
3.1. Names of GH/DH and their location. : Medical Colleges of Assam (GMC, AMC, SMC, JMC,
FAAMC and TMC) Health and Family Welfare Department, Govt. of Assam, Dispur, Guwahati6.
(If there are many, this could be done in a tabular column).
The following areas may be mentioned as a summary of all the units; where needed , examples
could be made of a specific dept to highlight both positives and negatives.
3.2. Areas (distribution throughout the states):
3.3. Whether separate funding and adequacy:
3.4. Whether OP/IP and emergency services available : Psychiatry emergency services are
available.
71

3.5. Diagnostic categories in rank order that present in the outpatient : No. Of outpatients new
psychiatry registrations in the previous year 15051. Broad ICD categories are as follows :
Organic Psychiatric Disorders
Schizophrenia
Bipolar Mood Disorder
Other Psychotic Disorders
Obsessive Compulsive Disorder
Other anxiety disorders
Depressive Disorders
Adjustment Disorders
Alcohol and drug Abuse Disorders
Personality Disorders
Children with Psychiatric illnesses
Mental Retardation
Sexual Disorder

357
1352
1039
655
278
1390
1477
374
1609
173
926
40
51

3.6. Adequacy of OP facilities : Waiting Halls, Toilets, Separate Interview Rooms, Drinking
Water, Canteen Services, OPD Lab and Rehabilitation Services are adequate. There are special
clinic like Drug de-addition Clinic and Child Guidance Clinic.
3.7. Inpatient occupancy, free and paying beds, average cost of inpatient stay per week; rank
order of diagnostic categories : Total number of allotted beds 191, no. Of beds occupied 141,
No. Of Free beds 191, No. Of Paying Beds 10, Average cost of inpatient stay per week Rs.
35/- + Cost of Investigations. For BPL patients the cost is free.
Over no. Of admissions during the previous year 2575. The breakup as per ICD 10 is as
follows
Organic Psychiatric Disorders
Schizophrenia
Bipolar Mood Disorder
Other Psychotic Disorders
Obsessive Compulsive Disorder
Other anxiety Disorders
Depressive Disorders
Adjustment Disorders
Alcohol and drug Abuse Disorders
Personality Disorders
Children with Psychiatric illness

53
445
234
218
30
235
193
26
753
10
75

3.8. Extent of family involvement : Always


72

3.9. Measures to protect rights including complaint redressal : Verbally informed


3.10. Any networking : Yes (with NGOs)
3.11. Staffing details and any shortages/vacancies :
Qualified psychiatrists
General Medical Officers
Clinical Psychologists
Psychiatric / Medical Social Workers
Trained Psychiatric Nurses
General Nurses
Other (Specify)

35
Nil
3
8
3
30

3.12. Psychotropic medication availability/free/cost : Free of Cost available


3.13. ECTs (Nos given across the facilities or average/No of direct ) : Modified ECT given in
previous year 119.
3.14. Observations of extent to which counselling and psychotherapy are provided : Provided
to all
3.15. Whether disability certification is available (if available numbers certified/year) : Yes, 218
certificates issued in previous year.
3.16. Extent and nature of community involvement : Yes
3.17. Whether engagement with the DMHP and extent : Department of Psychiatry, GMCH and
AMCH.
3.18. Nature and partnership with NGOs for networking : Yes
3.19. Presence of PG training- whether adequately distributed throughout the state : Yes
MD 10, DPM 4,
3.20. Nature of public mental health material prepared and distributed/ activities to educate :
Under IEC activities of DMHP and State support for Mental Health Programme.
3.21. Areas of research, sources of funding and major findings : Yes
3.22. Whether monitored and by whom. What were the observations? : Monitoring is being
done by State Mental Health Authority, Assam
3.23. Special Rapporteurs observations
73

3.24. Inspection Committees observations


3.25. SUMMARY AND RECOMMENDATIONS WITH RESPECT TO SECTION 3:
(Overall impressions about the mental health service delivery through the General and District
Hospitals).

The 12 Government District General Hospitals are having a separate department of


Psychiatry to provide psychiatric care;
The State in Government Sector including both Government Medical Colleges and
Government Hospitals has :
Psychiatrists : 47
Clinical Psychologist 2 trained and 1 untrained.
There are 10 Clinical Psychiatric Social Workers in mental health : 10;
Trained Nurses in mental health : 2.
Trained Counsellor in Government Sector hospitals and other institutions;
Number of Non-government organizations providing mental health care in the State is
11.
SECTION 4

4. NGOS WORKING IN MENTAL HEALTH:


4.1. A brief description of the NGO and its location : There are 11 NGOs in the state of Assam.
These NGOs have been designated by the Governor of Assam for rehabilitation of Mentally ill
persons with coverage of the nearest districts. The names of NGOs and their address are as
follows :
1. Perona Pratibandhi, Sishu Unnayan, Cinamara, Jorhat.
2. Dhula Regional Physically Handicapped Development Association, Dhula, Darrang.
3. North East Voluntary Association for Rural Development, Dakhingaon, Kahillipara,
Guwahati-19.
4. Ashadeep Kanaklata Path, Lachit Nagar, Guwahati-7.
5. North Eastern Regional Multipurpose School and Handicapped Training Centre,
Baliphukuri, P.O. Burigang, Sonitpur, Assam.
6. Zila Bahumukhi Uninayan Samaj, Hilapara, Darrang.
7. Destination, Bhadattapur, Kahilipara, Guwahati.
8. Dikrong Valley, H.O. No. 1 Barpathar, P.O. Gosaibazri, Lakhimpur.
9. Kahara, Tarun Sangha Barpeta.
10. WODWICHEE, Lakshirbond, Hailakandi.
11. Guwahati Youth Society, Dakhingaon, Tiniall, Kahilipara, Guwahati.
4.2. Nature of work carried out by the NGO in the domains mentioned and details of each : N.A.
74

4.3. Description of clientele seen by the NGO and number of persons who use the services in
the previous year : N.A.
4.4. Research details : N.A.
4.5. Details of any training carried out by the NGO : N.A.
4.6. Networking activities of the NGO :
1. NEVARD, Bongaigaon Placement of homeless persons and treatment of mentally ill
persons.
1. Help AID, Panikhaiti, Guwahati Placement of homeless persons and treatment of
mentally ill persons.
2. ASHADEEP, Guwahati Placement of homeless persons and treatment of mentally ill
persons.
3. NERM School and Mental Handicap Training Centre, Balipukhuri Placement of
homeless persons and treatment of mentally ill persons.
4. Missionary of Charity, Tezpur Placement of homeless persons and treatment of
mentally ill persons.
5. Human Welfare Society, Nizara, Sibsagar Placement of homeless persons and
treatment of mentally ill persons.
6. INCENSE Project (Collaborative project with Parivaratan, Pune and LGBRIMH, Tezpur
for persons with severe mental disorder).
4.7. Salient contributions of the NGO : N.R.
4.8. Special Rapporteurs observations : N.R.
4.9. Inspection Committees observations : N.R.
4.8. SUMMARY AND RECOMMENDATIONS FOR SECTION 4
There is a good NGO presence in Assam. Encouraging initiatives including rehabilitation of
longstay patients and placement of the homeless provide valuable lessons on the
complexities and care required for rehabilitation.
SECTION 5
5. DISTRICT MENTAL HEALTH PROGRAMME
5.1. A brief description of the location of the DMHP, when it started, total population covered:
The DMHP is operational in six districts namely Nagaon, Golpara, Darrang, Morigaon, Nalbari
and Tinsukiya. Out of the six districts, two districts Nagaon and Golpara have been taken over
by the State Govt. The districts have been delivery training to the Doctors, Paramedical Staff
75

and General Nurses in the districts. There have been awareness activities in the districts with
ranges from regular camps to other Programme media activities.
5.2. A summary of annual registrations old and new, treatment outcomes in terms of those on
regular treatment and those dropped out, with diagnostic categories if provided. Would be
useful to know what kind of clientele is serviced under the DMHP:
5.3. Frequency of home visits carried out by the HW/ANM; numbers covered and for what
diagnostic categories, no of admissions facilitated:
5.4. Kinds of essential drugs available, number dispensed, number of patients receiving
medication under the DMHP in a month:
5.5. Duration of untreated mental illness for different diagnostic categories if provided:
5.6. Monitoring of the DMHP by the concerned officer /impressions and trouble-shooting
(mention if there is a committee and its composition):
5.7. IEC activities of the DMHP:
5.8. Training calendar of the DMHP (doctors, health workers, nurses, pharmacists, school
teachers/Anganwadi workers (whether any training conducted):
5.9. Activities to sensitize the gram panchayats
5.10. Special Rapporteurs report on the activities of the DMHP, its reach, areas of good
performance, areas of poor performance, barriers for effective service delivery, measures to
streamline functioning, funding flow and barriers thereof.
5.11. Inspection Committees observations

76

5.12. SUMMARY OBSERVATIONS OF DMHP AND RECOMMENDATIONS:


Total Population of the State as per census 2011 (Final Data released in December, 2013) is
approximately 31205576. So far DMHP is extended only upto 6 out of 27 districts. Rest of the
schemes under NMHP namely up gradation of Psychiatric Wings of Govt. Medical Colleges /
General Hospitals, strengthening of state run Mental Hospitals and Manpower Development,
Scheme-B may be further extended in the State. The districts have been delivering training to
the doctors, paramedical staff and general nurses. There have been awareness activities in
the districts which ranges from regular camps to other Programme media activities.

77

SECTION 6
6. SUMMARY OF MENTAL HEALTH CARE INDICATORS IN ASSAM (name of state)
6.1. Availability of mental health facilities
Total No of
facilities/beds
Mental health outpatient facilities in
the state

Rate per 100,000 population


0.329

Day treatment facilities


Psychiatric beds in general hospitals

0.823

Community residential facilities


Beds/places in community residential
facilities
Psychiatric hospitals

0.004

Beds in psychiatric hospitals

1.469

6.2. Access to Care


Rate per 100,000
population
Persons treated in mental health
outpatient facilities
Persons treated in mental health day
care facilities
General hospital admissions
Community residential facilities
Persons staying in community
residential facilities at the end of the
year
Admissions to mental hospitals

14.52

78

Females %

6.3. Information Systems


Data on No of
persons/activities
collected and reported
YES/NO

Data on age and


gender are collected
and reported
YES/NO

Data on patients
diagnosis are collected
and reported
YES/NO

Yes

Yes

Yes

Yes

Yes

Yes

No

No

No

Persons with mental


disorders treated in
primary health care
Interventions delivered
in primary health care
for persons with
mental disorders
Persons treated in
mental health
outpatient facilities

Contacts in mental
health day treatment
facilities
Admissions in general
hospitals with
psychiatric beds
Admissions in mental
hospitals
Days spent in mental
hospitals
Admissions in
community residential
facilities

6.4. Human Resources at the State Level

Psychiatrists

Health professionals working


in the mental health sector
Rate per 100,000

Training of health professionals


in educational institutions
Rate per 100,000

0.301

0.0364

Medical doctors not specialised


in psychiatry

2.893

Clinical Psychologists

0.047

0.010

Psychiatric Social Workers


Psychiatric Nurses

0.033
0.166

0.003
0.016

Occupational therapists

79

Other health workers

6.5. INFORMAL HUMAN RESOURCES (Family and User Associations)


Present in the state
No of members
Participation in the
formulation/implementation of
policy/plan/legislation

User
Yes

Family
Yes

Not routinely

Not routinely

6.6. MEDICINES
Type of Medication

Expenditure at State level per year and per


100,000 population (in INR)

All psychotropic medication


Mood stabilisers
Antipsychotics
Anxiolytics
Antidepressants
Anti-craving medication/ Substitution
treatments

SECTION 7
13. STATE MENTAL HEALTH REPORT CARD
SUMMARY OF SECTIONS 1-7.
Summary of areas where state has achieved good progress/little progress/no progress
Areas of good progress include setting up of psychiatric facilities in district hospitals,
enhancing PG training opportunities in LGBRIMH, NGO collaborations.
There is a lot of lacunae in the information, which needs to be obtained.
Since the report is deficient in providing information in many domains, it is possible that the
mental health report card may improve once an effort to obtain this information is made.

80

MENTAL HEALTH REPORT CARD (needs to be revised after all the information is obtained)
Area

Focus

Parameters

Mental Health
Services
(Secondary
and Tertiary)

Medical
College
Depts,
General
Hospitals,
Specialised
psychiatric
hospitals

Adequacy of inpatient
beds
Functional Departments
Functional OP services

Primary
Health Care
mental health
services

District
Mental
Health
Programme

% of functional DMHPs

Rehabilitation
services

At all levels

Vocational training, day


care, longstay facilities in
govt sector/ppp

Specialised
services

Services for
substance
use

Whether existing, level of


functionality, present at
different levels of care
81

Rating

100- present, fully


satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100 All districts
covered; fully
satisfactory
75 majority of
districts covered
and functioning
50 half the
districts covered
and functioning
25 one-fourth of
the districts
covered and
functioning
0- No districts
covered/although
DMHP exists, not
functioning
100- present, fully
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100- present, fully
satisfactory
75- present,

Score
(out of
100)
50

25

25

25

Human
Resources

Financing for
mental health

Governance
and Policy

disorders,
old age,
mental
retardation,
child
psychiatry,
community
services,
forensic
services
(exclude
DMHP staff
here)

reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent

Adequacy of
psychiatrists/clinical
psychologists/psychiatric
social
workers/psychiatric
nurses or mental health
trained nurses

100 fully
adequate
75 moderately
adequate
50 somewhat
adequate
25- inadequate
0 grossly
inadequate

25

State level

Existence of separate
budget for mental
health/mental health
activities

25

State
Mental
Health
Authority
and other
authorities

Separate Mental Health


Nodal Officer
Functioning Mental
Health Authority
Nodal persons for mental
health in SHRC/Legal
Services
Authority/Others

10% -separate
budget, fully
adequate
75 separate
budget,
moderately
adequate
50 separate
budget,
somewhat
adequate
25 no separate
budget, but some
financial
resources
available annually
0 no separate
budget/marginal
financial resource
allocation
100 Existing,
fully functional
75- Existing,
mostly functional
50- Existing,
somewhat
functional
25- Partial

82

50

State Mental Health


Rules
State Mental Health
Programme
Range of medications
Regular supply and
dispensing
Standard procurement
arrangements

Availability of
psychiatric
medication

At every
level

Affirmative
action for
persons with
mental illness

At every
level

Disability assessment
Pension
Travel concession
Health insurance
Special assistance
Educational benefits
Job reservation

10

Treatment
Gap

Overall

Approximate number of
persons with mental
illness approximate
numbers totally receiving
treatment in the state

0 Non existent

100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100 no
treatment gap
75 25%
treatment gap
50 -50%
treatment gap
25 -75%
treatment gap
0- 100%
treatment gap

Total Score (out of 1000)


Average Score (%)

50

25

25

325
32.5

RECOMMENDATIONS:
Detailed assessment of the problem, resources available.
Formulation of a comprehensive state mental health plan.
Systematic increase in human resources and explore the use of medical college and
universities teaching humanities andsocial sciences to augment human resources.

83

BIHAR
SECTION 1. STATE LEVEL REPORT
14. GENERAL INFORMATION REGARDING THE STATE (Bihar)
a. Area
94163 Sq.Mtr.
b. No of districts
38
c. Population, age distribution (as per census 2011)
104099452
0 4 Years
15882590
5 9 Years
16005378
10 14 years 13829721
15 19 years 8987735
20 above 49042712
d. Gender distribution
Male 54278157
Female - 49821295
e.
f.
g.
h.

Life expectancy at birth male and female


N.R.
Per capita State Government expenditure on health
N.R.
Any health indicators for the state (life expectancy, etc) N.R.
Completeness/quality of information provided: Complete/Partially
Complete/Deficient

If deficient, areas of deficiency:


15. MENTAL ILLNESS BURDEN/ INFORMATION REGARDING MENTAL ILLNESS
N
(prevalence)
2.1. Total number of
persons with mental
illness (all ICD categories)

2.2. Broad categories


2.2.a Severe mental
disorders (BPAD,
psychosis)
2.2.b Common mental
disorders
2.2.c Substance use
disorders (alcohol and
other drugs)
2.2.d Mental Retardation

20819890 (20% of
population
Source IJP Jan.
2010 Supplement
S95 to S103
9122983 (IJP Jan.
2010)

2602486
3643480
572550
84

N
(treatment
seeking)

Source of
information

2.3. No of Males with


mental health problems
2.4. No of females with
mental health problems
2.5. No of children with
mental health problems
2.6. No of elderly with
mental health problems
2.7. No of homeless
mentally ill persons

N.R.
N.R.
11971437
2862735
N.R.

COMMENT: There is an over-estimate and it will become impossible for the state to find the
resources to deal with these numbers.
16. MENTAL HEALTH SERVICES IN THE STATE:
Organization of Services (description of number of psychiatric hospitals, medical college depts,
district hospitals)
N/N
3.1.a No of district general
hospitals with separate
department of psychiatry
3.1.b No of medical colleges
with department of psychiatry
3.1.c No of district general
hospitals providing psychiatric
care
3.1.d No of District Mental
Health Programmes in the
State

No with dept/facility
Total No of units

Nil

7 Govt. + 3 private medical colleges


Nil

1
In later part, mentions 11
N

3.1.e No of government
psychiatric hospitals
3.1.f No of private psychiatric
hospitals
3.1.g Total No of psychiatric
hospitals in the state
3.1.h No of NGOs providing
mental health care

1
Nil
1
4

85

% coverage

COMMENT: According to the report, none of the district hospitals either have a department
of psychiatry or offer psychiatric services. This is a cause of great concern.
There are 10 medical colleges. There is no mention of the staff in the private colleges.
a. INPATIENT SERVICES
DESCRIPTION:
Psychiatric hospitals
(Govt) (Bihar State
Institute of Mental
Health & Allied
Sciences, Bhojpur)
3.2.a. Total Inpatient
sanctioned/available
beds
3.2.b No of male beds
3.2.c. No of female
beds
3.2.d. No of beds for
children
3.2.e. No of beds for
elderly
3.2.f. No of beds for
substance use
disorders
3.2.g. No of beds for
forensic psychiatry
3.2.h. Occupancy (%)
3.2.i. No of admissions
during previous year
3.2.j. No of discharges
during previous year
3.2.k. Average
duration of inpatient
stay in days mean
3.2.l. Average duration
of inpatient stay in
days median
3.2.m. No of closed
wards
3.2.n. No of closed
ward beds
3.2.o. No of open
wards
3.2.p. No of open

Psychiatric
hospitals
(Private)
N=

General
Hospitals
N=

District
Hospital
s
N=

NGOs
N=

Total

265

155
110
N.A.
N.A.
N.A.

N.A.
17%
111
100
Male 39 days
Female 91 days

Male 24 days
Female 67 days

N.A.
05
Nil
Nil
86

ward beds
3.2.q. No of paid
wards
3.2.r.No of paid beds
3.2.s.No of admissions
through courts
3.2.t. No of deaths in
the last year
3.2.u. No of suicides in
the last year

Nil
Nil
Nil
1
Nil

COMMENT:
The admission rates are very low. It is very important for the state to figure out how
to use the scarce resources it has.
b. OUTPATIENT SERVICES
Psychiatric
hospitals
(Govt) (Bihar
State Institute
of Mental
Health &
Allied
Sciences,
Bhojpur)
3.3.a. No of new OP
registrations in the
previous year

5382

3.3.b. No of
emergency
attendees in the
previous year
3.3.c Total no of OP
follow-up in the
previous year

94

Psychiatric General
hospitals
Hospitals
(Private)
N=
N=

District
Hospitals
N=

NGOs
N=

Total

19506

COMMENT: If there are no psychiatric services being offered in any other settings outside the
mental hospital, the people getting services is clearly a miniscule number.

87

17. REHABILITATION FOR PERSONS WITH MENTAL ILLNESS


a. Government residential rehabilitation/longstay facilities : No and description:
NIL
b. Government day care/outdoor rehabilitation facilities: No and description: NIL
c. Government run half-way homes: No and description. If none, plans to establish
and details N.R.
d. NGO participation in the half way homes: Yes
e. Longstay rehabilitation facilities: No and description; NGO
participation:Dishayein at Aara (Bhojpur) under Ujjawala Scheme.
18. MENTAL HEALTH CARE IN OTHER COMMUNITY FACILITIES
State Level, in the Govt Sector
5.1. No of shelter homes, observation homes, special homes
and childrens homes

5.2. No of counsellors trained in mental health in the above


institutions

5.3. No of protection homes for destitute women


5.4. No of counsellors trained in mental health in the above
institutions
5.5. No of old age homes
5.6. No of counsellors trained in mental health in the above
institutions
5.7. No of Central Jails and District Jails in the State

N
8, 11, 1, 19 children homes
(Govt. 3 and NGO 16)
1 Counsellor in each of the
19 children homes and 8
open shelters. Out of the
11 observation homes and
special home, there are
counsellor in 3 homes.
17
16
08
1 counsellor in each
institution
Central Jail 8, District Jail
32, Subjail - 16
No

5.8. No of counsellors trained in mental health in the above


institutions
5.9.No of counsellors trained in mental health in the above None
institutions
Helplines for Mental Health: (Nature of helpline, who runs it, for whom, any information on
its utilization)
COMMENT: There are several custodial institutions. The affidavit mentions that there is 1
counselor in each institution (whether each one trained in mental health needs to be
ascertained).

88

19. MENTAL HEALTH HUMAN RESOURCES


Mental Health Care Professionals
Government Sector
medical
colleges/hospitals

6.1. No of
Psychiatrists
6.2. No of Clinical
Psychologists
6.3. No of Psychiatric
Social Workers
6.4. No of nurses
trained in mental
health
6.5. No of trained
counselors
6.6. Record Keeper
6.7. Case Registry
Assistant

Psychiatric
Hospital

Private
Practice

28

Nil

Nil

Nil

Nil

Total

N.A.
N.A.

COMMENT: The state has a great shortage of all mental health human resources. There is no
record of the number of psychiatrists in the private sector.
7. MENTAL HEALTH HUMAN RESOURCE DEVELOPMENT
7.1. Degree/Diploma Courses
In Entire state, Annual No of
Seats in

MD Psychiatry
DNB Psychiatry
Diploma in Psychiatry
PhD Clinical Psychology
MPhil Clinical Psychology
PhD Psychiatric Social Work
MPhil Psychiatric Social Work
PhD Psychiatric Nursing
MSc Psychiatric Nursing
BSc Psychiatric Nursing
Basic Diploma in Psychiatric
Nursing (DPN)

Institutions where the Programme is offered

89

COMMENT: Very few PG seats for such a large state.


No. Of PGs posted for 15 days or more M.D. (Medicines PGs, Interns 15 days).
7.2. Other training in mental health : HIV / IDU counselling for trainers of OST.
7.2.a. Details of Undergraduate MBBS training in psychiatry
Name of medical
college

No of hours of
theory

Duration of
Duration of
Qualifying
psychiatry posting psychiatry posting Examination
during UG
during internship includes
competency
evaluation in
psychiatry

COMMENT: Two week mandatory training during the internship for every intern in each govt.
medical college during course all medical students in psychiatry department are given
lecturers for 30 hrs. Appr. Duration.
7.2.b. Details of in-service training for Govt medical officers (No trained, duration) : Yes,
Orientation for one medical officer each from all districts was organized by the state. 35
Medical Officers were trained in the year 2014 in April month.
*If not trained, plans to train and timeline
7.2.c. Any other training courses in mental health offered by the state : Training Programme
has been finalized however training has not began in the absence of financial guidelines
awaited from Govt. of India.
* Describe the type of course/duration/participants
8. GOVERNANCE:
8.1. Nodal Authority and responsibilities : 1. Medical Education Dr. Ashok Kumar Yadav
(Deputy Director Health Services), 2. State Medical and Health Department Dr. (Moh.)
Sajjad Ahmed,
3. Social Welfare Department Mohd. Immadduin Ahmed (Director
Social Welfare Deparment), 4. SMHA Dr. Santosh Kumar (Asstt. Professor, Deptt. of
Psychiatry, NMCH Patna), 5. District Legal Services Authority Respective District Magistrate.
8.2. Presence of a State Mental Health Plan: NR
8.3. Enactment of State Mental Health Rules: NR
8.4. Oversight of policies and Programmes related to mental health : NR

90

8.5. Specific oversight of the DMHP Programme: NR


Positions for 11 DMHP has been sanctioned and recruitment is in process which will be
completed soon.
8.6. Attempts towards integration of mental health care into general health care, NCD
management etc. NR
8.7. Examples of commitment to develop mental health services (high level involvement,
budgeting, networking: NR
8.8. Examples of inter-sectoral collaboration to improve mental health services (including PPP
initiatives) NR
8.9. Attempts towards mental health promotion NR
COMMENT: Strengths and weaknesses
It is not possible to comment. Overall, there do not seem to be any comprehensive activities to
improve mental health care.
9. FINANCING
9.1. Sources of financing of different categories Bihar State Institute of Mental Health and
Allied Sciences, Plan Funds (Amount in Rs. 2012-13) 2,00,00,000.00, (Amount in Rs. 2013-14)
2,09,00,000.00.
9.2 Budget provision from State and Centre in INR (for different facilities if required): NR
9.3. Mental Health Expenditure as proportion of Total Health Expenditure in State: NR
(If available % spending on Health in the State may also be provided)
10. ANY OTHER SIGNIFICANT INFORMATION (e.g. litigation, insurance schemes for persons
with mental illness, pension and other assistance, job reservations)
11. INNOVATIONS
NR
12. OVERALL SUMMARY OF STATE LEVEL MENTAL HEALTH SERVICES : Bihar is the third most
populous State in India. Majority of the population resides in rural areas. In the state, around
33% of the population lives below the poverty line. According to the State Government
presently there are altogether 28 psychiatrists in Govt. And 03 in the private sector in the
State. Other mental health professionals include 02 Clinical Psychologists in Govt. And none
91

in private sector; 02 Psychiatric Social Workers in Govt. and none in private sector and no
nurses trained in mental health in Govt. and nil in private hospitals. No trained counsellors
are available their in Govt. or in private sector. Thus in the State there is extreme paucity
mental health resources.
SECTION 2
2.1. PSYCHIATRIC INSTITUTIONS : State Institute of Mental Health & Allied Sciences, Bhojpur,
Bihar
Domains

Status in 2008

Developments since 2008

Infrastructure

Started in 2003, functional


since 2006
Full fledged infrastructure not
available

Amenities and facilities


Financial arrangements
Diet
Investigations and treatment
Staff and training
Supportive services
Recreation/Occupational
therapy/Rehabilitation
Networking with other agencies

i. Outpatient: Separate OPD Building, waiting hall the patients, toilets for patients and
relatives, separate interview rooms and drinking water facilities are adequate, OPD lab
services are available, separate medical records section and educational material for patients
are available.
ii. Inpatient Overall no. Of allotted beds 265, Medicines are available free of costs, No ECT
services are available.
Diagnostic categories seen:
Organic Psychiatric Disorders
Schizophrenia
Bipolar Mood Disorder
Other Psychotic Disorders
Obsessive Compulsive Disorder
Other anxiety disorders
Depressive Disorders
Adjustment Disorders
Alcohol and drug Abuse Disorders
Personality Disorders
Children with Psychiatric illnesses

3
28
61
08
02
09
92

Mental Retardation
Sexual Disorder

iii. DIAGNOSTICS AND THERAPEUTICS :

Investigations:
Therapeutic facilities:
Improvements in rehabilitation:
iv. ENGAGEMENT:
Attempts to involve families of persons with mental illness: Psycho-education,
counselling and psycho-therapy are provided to families.
Disability certification and number of certificates issued in the previous year: Yes, No. Of
Certificate issued in previous year 09.

v. ADMINISTRATIVE

Annual number of adverse events: Non-significant


Mechanisms for redressal of patient complaints:

vi. COMMUNITY OUTREACH AND NETWORKING


Community Programmes: No
10. Networking with external agencies:
11. Public mental health education:
vii. TRAINING

Post-graduate training new Programmes, enhancement of seats and measures to


maintain/improve quality of training: No

Any other training Programmes:

vii. RESEARCH:

Research (areas, funding agencies, findings), : N.R.


viii. ANY OTHER SALIENT CONTRIBUTIONS OF THE HOSPITAL/INSTITUTE:

ix. Any monitoring of hospital (internal or external)- details : Monitoring by SHRC, NHRC are
being done, one visit by each.
x. Special Rapporteurs observation: Smt. S. Jalaja, Special Rapporteur, NHRC. Started in 2003
by the State Government as an autonomous institute, it is the only dedicated mental health
93

facility at the state level. BIHMAS is located in Loilwar, Arrah, Bhojpur district, 56 km. Away
from Patna. It became functional in August, 2006. Dr. P.K. Singh is Director of the institute
since 2012 and is continuing as such till date. The 60 year old building of formerly TB Hospital
was renovated to accommodate the institute. Two-three pre-fabricated temporary structures
have been put up stated to be on the orders of Patna High Court. Different Departments set
up in the Institute include Departments of Psychiatry, Clinical Psychology, Psychiatric Social
Work, Occupational Therapy, Neuro-Physiology and Pathology. All have HODS, although not
regular. Full-fledged infra-structure is not available for conducting OPD services.
xi. Any other observations (including Inspection Committee Reports):
xii. Summary and Recommendations from SECTION 2:
Areas of positive change
Medications are available

Areas of poor progress


Services and infrastructure are sub-optimal
SECTION 3

3. General Hospital Departments of Psychiatry and District Hospital Departments


The broad outline for this section:
3.1. Names of GH/DH and their location. :
a. Patna Medical College and Hospital, Ashok Rajpath, Patna.
b. Nalanda Medical College and Hospital, Agam Kuan, Patna.
c. A.N.M.M.C.H. Sherghati Road, Gaya.
d. S.K.M.C.H. Muzaffarpur.
e. Jawahar Lal Nehru Medical College & Hospital, Bhagalpur.
f. Darbhanga Medical College & Hospital, Laheriya Sarai.
(If there are many, this could be done in a tabular column).
The following areas may be mentioned as a summary of all the units; where needed , examples
could be made of a specific dept to highlight both positives and negatives.
3.2. Areas (distribution throughout the states): N.R.
3.3. Whether separate funding and adequacy: Amount of Funds for the psychiatry unit was not
marked separately. All expenses for psychiatry unit was met from the budget allocated for
medical colleges.
94

3.4. Whether OP/IP and emergency services available : Yes OPD, IP and emergency services are
available.
3.5. Diagnostic categories in rank order that present in the outpatient : Except for AMMMCH,
numbers are not specified for the other colleges.
Sr.
No.

Diagnostic
Breakup

1.

Organic
Psychiatric
Disorders
Schizophrenia

A.M.M.M.C.H

S.K.M.C.H

J.M.M.C.H

5%

Nalanda
Medical
College
6%

58

5%

3 5%

Darbhanga
Medical
College
3%

8%

4%

214

2.5%

15.20%

2%

3.

Bipolar Mood
Disorder

10%

7%

361

15%

15 20%

21%

4.

Other
Psychotic
Disorders
Obsessive
Compulsive
Disorder

11%

8%

52

2%

2 5%

19%

5%

6%

108

5%

2 3%

2%

6.

Other anxiety
disorders

15%

14%

558

5%

5 10%

12%

7.

Depressive
Disorders
Adjustment
Disorders

14%

16%

599

30%

25 35%

14%

5%

6%

59

3 5%

5%

Alcohol and
drug Abuse
Disorders
Personality
Disorders
Children with
Psychiatric
illnesses

15%

19%

65

10%

10 15%

9%

3%

5%

20

1%

1 2%

1%

9%

9%

298

2%

3 5%

9%

2.

5.

8.

9.

10.
11.

PMCH
Patna

3.6. Adequacy of OP facilities : Waiting Halls, Toilets, Separate Interview Rooms, Drinking
Water, Canteen Services, OPD Lab services are adequate.

95

3.7. Inpatient occupancy, free and paying beds, average cost of inpatient stay per week; rank
order of diagnostic categories :
Sr.
No
.

Diagnostic
Breakup

1.

Organic
Psychiatric
Disorders
Schizophrenia
Bipolar Mood
Disorder
Other Psychotic
Disorders
Obsessive
Compulsive
Disorder
Other anxiety
disorders
Depressive
Disorders
Adjustment
Disorders
Alcohol and
drug Abuse
Disorders
Personality
Disorders
Children with
Psychiatric
illnesses

2.
3.
4.
5.

6.
7.
8.
9.

10.
11.

PMCH
Patna

Nalanda
Medical
College

A.M.M.M.C.H
.

S.K.M.C.H
.

J.M.M.C.H
.

Darbhanga
Medical
College

58

Nonfunctional

14

No. Indoor
service

13
33

5
3

15

28
42

42

20

15

20

19

11

14

21

3.8. Extent of family involvement : All families are educated and counselled there is
involvement of consumers in treatment decision always.
3.9. Measures to protect rights including complaint redressal : 3.10. Any networking : No
3.11. Staffing details and any shortages/vacancies :
Sr.No.

Staff details

PMCH,
Patna

1.

Qualified
Psychiatrist

Nalanda
Medical
College
3

A.M.M.M.C.H.

S.K.M.C.H.

J.M.M.C.H.

96

Darbhanga
Medical
College
3

2.

3.
4.

5.

6.

General
Medical
Officers
Clinical
Psychologist
Psychiatric
Social
Worker
Trained
Psychiatric
Nurses
General
Nurses

19

3.12. Psychotropic medication availability/free/cost : The medicines are available free of cost.
3.13. ECTs (Nos given across the facilities or average/No of direct ) : Modified ECT are given
approximate no. 10.
3.14. Observations of extent to which counselling and psychotherapy are provided : Provide to
all, psycho-therapy provide to some.
3.15. Whether disability certification is available (if available numbers certified/year) : Yes, No.
Of certificate in previous year 102 (PMCH, Patna).
3.16. Extent and nature of community involvement : No
3.17. Whether engagement with the DMHP and extent : No
3.18. Nature and partnership with NGOs for networking : None
3.19. Presence of PG training- whether adequately distributed throughout the state : Yes, two
M.D. seats in psychiatry at PMCH Medical College, Patna.
3.20. Nature of public mental health material prepared and distributed/ activities to educate :
Yes, exhibition, health mela, Poster and Pamphlets.
3.21. Areas of research, sources of funding and major findings : In PMCH Patna, 2 M.D. thesis
per year, 1 multi centric study depression sponsored by Indian Psychiatric Society.
3.22. Whether monitored and by whom. What were the observations? : Yes, Monitoring is
being done by State Govt.
3.23. Special Rapporteurs observations : Smt. S. Jalaja, Special Rapporteur, NHRC. OPD is
being run with the help of Psychiatrists. No tracking of these cases in done. There is no data
97

on how many patients recovered from illnesses. Indoor facilities are virtually non-existent
with only 5-6 beds being occupied by MH patients that too in the General Wards. The indoor
patients are kept for about two weeks in PMCH; while in the other two hospitals it is seen
that they are discharged in 5-6 days. In these circumstances it is not clear as to what kind of
treatment is being given to the patients. Only acute and chronic patients are usually admitted
as indoor patients.
There appears to be no net-working with other institutions, especially custodial institutions.
No NGOs have been associated with patient care, including counselling. The Medical Colleges
are unable to take up community out-reach services in the absence of staff as well as funds.
Rehabilitation of recovered patients is not taken up either. Thus there is acute shortage of
human and material resources for providing psychiatric services through Medical Colleges in
the State.
3.24. Inspection Committees observations: The IC visited BIMHAS, but there are no specific
observations.
3.25. SUMMARY AND RECOMMENDATIONS WITH RESPECT TO SECTION 3:
Very inadequate
SECTION 4
4. NGOS WORKING IN MENTAL HEALTH:
4.1. A brief description of the NGO and its location : a. Home of Mentally Retarded and
Psychological sufferers, Moradpur, Patna, b. Akansha Institute for Mentally handicapped,
Gaya. C. Mother Touch Foundation for Mentally Handicapped, Muzaffarpur. D. Patliputra
Parent Association of Mentally Handicapped, Danapur, Patna.
4.2. Nature of work carried out by the NGO in the domains mentioned and details of each : NR
4.3. Description of clientele seen by the NGO and number of persons who use the services in
the previous year : NR
4.4. Research details : NR
4.5. Details of any training carried out by the NGO : NR
4.6. Networking activities of the NGO : NR
4.7. Salient contributions of the NGO : NR
4.8. Special Rapporteurs observations : 98

4.9. Inspection Committees observations : 4.8. SUMMARY AND RECOMMENDATIONS FOR SECTION 4 : NGOs : Name of Four NGOs
engaged in the field are reported by the State Govt. namely Home of Mental Retardants and
psychological Sufferers, Muradpur, Patna; Akanksha Institute for Mentally Handicapped,
Shiwala Road, Gaya; Mother Touch Foundation for Mentally Handicapped, Imlichatti,
Muzaffarpur and Pataliputra Parent association of Mentally Handicapped, Danapur, Bihar.
Partnership with NGOs : Dealing with patients requires a special understanding of mental
illness and unique issues that may arise. NGOs can provide necessary flexibility, sensitivity
and humane approach in handling those with mental illnesses. NOGs could be the interface
between the Govt. and the public and could help with counselling, training, survey and data
collection, care of the mentally ill etc.
SECTION 5
5. DISTRICT MENTAL HEALTH PROGRAMME

99

5.1. A brief description of the location of the DMHP, when it started, total population covered:
No. Of DMHP in the state = 11 (earlier tabulation says 1 which appears to be an error),
Recruitment for Sanctioned post in 11 districts is in process will be completed soon. State
intends to propose DMHP in remaining 27 districts in next five years beginning from 2015-16.
5.2. A summary of annual registrations old and new, treatment outcomes in terms of those on
regular treatment and those dropped out, with diagnostic categories if provided. Would be
useful to know what kind of clientele is serviced under the DMHP:
5.3. Frequency of home visits carried out by the HW/ANM; numbers covered and for what
diagnostic categories, no of admissions facilitated: NR
5.4. Kinds of essential drugs available, number dispensed, number of patients receiving
medication under the DMHP in a month: NR
5.5. Duration of untreated mental illness for different diagnostic categories if provided: NR
5.6. Monitoring of the DMHP by the concerned officer /impressions and trouble-shooting
(mention if there is a committee and its composition): NR
5.7. IEC activities of the DMHP: NR
5.8. Training calendar of the DMHP (doctors, health workers, nurses, pharmacists, school
teachers/Anganwadi workers (whether any training conducted):
5.9. Activities to sensitize the gram panchayats
5.10. Special Rapporteurs report on the activities of the DMHP, its reach, areas of good
performance, areas of poor performance, barriers for effective service delivery, measures to
streamline functioning, funding flow and barriers thereof: DMHP is currently being taken up in
11 districts. It is stated that Government of Bihar is committed to implement DMHP in all 38
districts of the state. The eleven selected under DMHP are Muzaffarpur, Vaishali, East and
West Champaran, Gopalganj, Purnea, Banka, Jamui, Rohtas and Kaimur.
The State Govt. reported to NHRC that 77 posts for 11 DMHPSs, including Posts of Programme
Officer (Psychiatrist), Clinical Psychologist, Psychiatric Social Worker, Psychiatric
Nurse/trained General Nurse, Record Keeper, Community Nurse (Case manager) and Case
Registry Assistant have been sanctioned and that recruitment was in progress and that by
April, 2015 the process would be complete.
5.11. Inspection Committees observations : -

100

5.12. SUMMARY OBSERVATIONS OF DMHP AND RECOMMENDATIONS: There is a plan to


expand the DMHP to all districts. However, it is still not clear how it is functioning in the 11
districts. This is important before expanding it. Linkages and monitoring mechanisms of the
DMHP need to be clear.
SECTION 6
6. SUMMARY OF MENTAL HEALTH CARE INDICATORS IN BIHAR (name of state)
6.1. Availability of mental health facilities
Total No of
facilities/beds
Mental health outpatient facilities in
the state

Rate per 100,000 population


0.329

Day treatment facilities


Psychiatric beds in general hospitals

0.823

Community residential facilities


Beds/places in community residential
facilities
Psychiatric hospitals

0.004

Beds in psychiatric hospitals

1.469

6.2. Access to Care


Rate per 100,000
population
Persons treated in mental health
outpatient facilities
Persons treated in mental health day
care facilities
General hospital admissions
Community residential facilities

101

Females %

Persons staying in community


residential facilities at the end of the
year
Admissions to mental hospitals

14.52

6.3. Information Systems

Persons with mental


disorders treated in
primary health care
Interventions delivered
in primary health care
for persons with
mental disorders
Persons treated in
mental health
outpatient facilities
Contacts in mental
health day treatment
facilities
Admissions in general
hospitals with
psychiatric beds
Admissions in mental
hospitals
Days spent in mental
hospitals
Admissions in
community residential
facilities

Data on No of
persons/activities
collected and reported
YES/NO

Data on age and


gender are collected
and reported
YES/NO

Data on patients
diagnosis are collected
and reported
YES/NO

Yes

Yes

Yes

Yes

Yes

Yes

No

No

No

6.4. Human Resources at the State Level

Psychiatrists

Health professionals working


in the mental health sector
Rate per 100,000

Training of health professionals


in educational institutions
Rate per 100,000

0.30

0.04

102

Medical doctors not specialised


in psychiatry

2.89

Clinical Psychologists

0.05

0.01

Psychiatric Social Workers

0.03

0.003

Psychiatric Nurses

0.17

0.016

Occupational therapists
Other health workers

6.5. INFORMAL HUMAN RESOURCES (Family and User Associations)


Present in the state
No of members
Participation in the
formulation/implementation of
policy/plan/legislation

User
Yes

Family
Yes

Not routinely

Not routinely

6.6. MEDICINES
Type of Medication

Expenditure at State level per year and per


100,000 population (inINR)

All psychotropic medication


Mood stabilisers
Antipsychotics
Anxiolytics
Antidepressants
Anti-craving medication/ Substitution
treatments

SECTION 7
20. STATE MENTAL HEALTH REPORT CARD
SUMMARY OF SECTIONS 1-7.
Summary of areas where state has achieved good progress/little progress/no progress
The utilisation of the BIMHANS needs to be improved. There is a huge paucity of human
resources. The information from the medical colleges, GH and district level services across the
11 districts is inadequate.
Since the report is deficient in providing information in many domains, it is possible that the
mental health report card may improve once an effort to obtain this information is made.
103

MENTAL HEALTH REPORT CARD (needs to be revised after all the information is obtained)
Area

Focus

Parameters

Mental Health
Services
(Secondary
and Tertiary)

Medical
College
Depts,
General
Hospitals,
Specialised
psychiatric
hospitals

Adequacy of inpatient
beds
Functional Departments
Functional OP services

Primary
Health Care
mental health
services

District
Mental
Health
Programme

% of functional DMHPs

Rehabilitation
services

At all levels

Vocational training, day


care, longstay facilities in
govt sector/ppp

Specialised
services

Services for
substance
use

Whether existing, level of


functionality, present at
different levels of care
104

Rating

100- present, fully


satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100 All districts
covered; fully
satisfactory
75 majority of
districts covered
and functioning
50 half the
districts covered
and functioning
25 one-fourth of
the districts
covered and
functioning
0- No districts
covered/although
DMHP exists, not
functioning
100- present, fully
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100- present, fully
satisfactory
75- present,

Score
(out of
100)
25

25

disorders,
old age,
mental
retardation,
child
psychiatry,
community
services,
forensic
services
(exclude
DMHP staff
here)

reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent

Human
Resources

Adequacy of
psychiatrists/clinical
psychologists/psychiatric
social
workers/psychiatric
nurses or mental health
trained nurses

Financing for
mental health

State level

Existence of separate
budget for mental
health/mental health
activities

Governance
and Policy

State
Mental
Health
Authority
and other
authorities

Separate Mental Health


Nodal Officer
Functioning Mental
Health Authority
Nodal persons for mental
health in SHRC/Legal
Services
Authority/Others
State Mental Health
105

100 fully
adequate
75 moderately
adequate
50 somewhat
adequate
25- inadequate
0 grossly
inadequate
10% -separate
budget, fully
adequate
75 separate
budget,
moderately
adequate
50 separate
budget,
somewhat
adequate
25 no separate
budget, but some
financial
resources
available annually
0 no separate
budget/marginal
financial resource
allocation
100 Existing,
fully functional
75- Existing,
mostly functional
50- Existing,
somewhat
functional
25- Partial
0 Non existent

12.5

25

25

Rules
State Mental Health
Programme
Range of medications
Regular supply and
dispensing
Standard procurement
arrangements

Availability of
psychiatric
medication

At every
level

Affirmative
action for
persons with
mental illness

At every
level

Disability assessment
Pension
Travel concession
Health insurance
Special assistance
Educational benefits
Job reservation

10

Treatment
Gap

Overall

Approximate number of
persons with mental
illness approximate
numbers totally receiving
treatment in the state

100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100 no
treatment gap
75 25%
treatment gap
50 -50%
treatment gap
25 -75%
treatment gap
0- 100%
treatment gap

Total Score (out of 1000)


Average Score (%)

50

25

187.5
18.8%

RECOMMENDATIONS:
Information needs to be properly collected.
Ways of improving utilisation and engagement of BIMHANS in engaging with the community
needs to be developed.
Human resource building up is an important requirement in Bihar.
Before extending the DMHP, a proper mechanism to ensure its effective functioning needs to
be undertaken.
106

CHANDIGARH
QUALITY ASSURANCE IN MENTAL HEALTH- 2015
REPORT ON STATE PERFORMANCE IN MENTAL HEALTH CARE PLANNING, DEVELOPMENT,
IMPLEMENTATION AND MONITORING
SECTION 1. STATE LEVEL REPORT
1. GENERAL INFORMATION REGARDING THE STATE
1.1.
Area 112 sq km
1.2.
No of districts 1
1.3.
Population, age distribution (as per census 2011) : 1109377
0-9 years

173048

10-19 years

197882

20-44 years

474877

45-79 years

201666

80 years and above

7631

1.4.
Gender distribution: 818 Females for 1000 males (2011)
1.5.
Life expectancy at birth male and female : NA
1.6.
Per capita State Government expenditure on health: 71 (public), 547 (Private)
(Source: Central Bureau of Health Intelligence. Latest data for 2004-05)
1.7.
Any health indicators for the state: Crude Birth rate:14.7; Crude death rate:4;
Infant Mortality Rate:21;
1.8.
Completeness/quality of information provided: Mostly Complete
2. MENTAL ILLNESS BURDEN/ INFORMATION REGARDING MENTAL ILLNESS
N
(prevalence)
2.1. Total number of persons with
mental illness (all ICD categories)

77656

107

N
(treatment
seeking)

Source of
information

2.2. Broad categories


2.2.a Severe mental disorders
(BPAD, psychosis)
2.2.b Common mental disorders
2.2.c Substance use disorders
(alcohol and other drugs)
2.2.d Mental Retardation
2.3. No of Males with mental health
problems
2.4. No of females with mental
health problems
2.5. No of children with mental
health problems
2.6. No of elderly with mental health
problems
2.7. No of homeless mentally ill
persons

COMMENT: Data provided on basis of some meta-analyis.


3. MENTAL HEALTH SERVICES IN THE STATE:
3.1.
Organization of Services (description of number of psychiatric hospitals, medical
college depts, district hospitals)

N/N
3.1.a No of district
general hospitals with
separate department of
psychiatry
3.1.b No of medical
colleges with department
of psychiatry
3.1.c No of district/
general hospitals
providing psychiatric care
3.1.d No of District
Mental Health
Programmes in the State
3.1.e No of government
psychiatric hospitals
3.1.f No of private
psychiatric hospitals
3.1.g Total No of

No with dept/facility
Total No of units

% coverage

1/1

100

1/1

100

2/2

100

1/1

100

N
0 (Will be functional in 2016-17)
2
2
108

psychiatric hospitals in
the state
3.1.h No of NGOs
providing mental health
care

COMMENT: Psychiatric hospital required. GHPUs may be designated as Psychiatric Hospital


for catering to immediate needs.
3.2.
INPATIENT SERVICES
DESCRIPTION:
Psychiatric
hospitals
(Govt) N=
3.2.a. Total Inpatient
sanctioned/available
beds

NR

Psychiatric
hospitals
(Private)
N=2
24

General
Hospitals
N=

District
Hospitals
N=

NGOs
N=

59

Total

83

COMMENT: Substance use disorders predominate admissions.


3.3.

OUTPATIENT SERVICES
Govt.
Psychiatric
hospitals

3.3.a. No of new OP
registrations in the
previous year
3.3.b. No of
emergency
attendees in the
previous year
3.3.c Total no of OP
follow-up in the
previous year

General
Hospitals

District
Hospitals

NGOs

N=
22659

N=

N=

Private
Psychiatric
hospitals
N=2
1076

Total

15

2166

2181

4630

87493

92123

23735

COMMENT:
Depression and Anxiety disorders most common.
4. REHABILITATION FOR PERSONS WITH MENTAL ILLNESS
4.1.
Government residential rehabilitation/longstay facilities : Nil
4.2.
Government day care/outdoor rehabilitation facilities: 2 (including Half Way
home listed below and 1 DART)
4.3.
Government run half-way homes: 1 with capacity of 20 patients
109

4.4.
NGO participation in the half way homes: Prayatan & Parivartan (2NGOs
involved)
4.5.
Longstay rehabilitation facilities: Nil
5. MENTAL HEALTH CARE IN OTHER COMMUNITY FACILITIES
State Level, in the Govt Sector
5.1. No of shelter homes, observation homes,
special homes and childrens homes
5.2. No of counsellors trained in mental
health in the above institutions
5.3. No of protection homes for destitute
women
5.4. No of counsellors trained in mental
health in the above institutions
5.5. No of old age homes
5.6. No of counsellors trained in mental
health in the above institutions
5.7. No of Central Jails and District Jails in the
State
5.8. No of counsellors trained in mental
health in the above institutions

N
3
2
2
3
Nil
1
Nil

Helplines for Mental Health: Asha Suicide Prevention Helpline, Civil Hospital, Manimarja
(Under DMHP)
6. MENTAL HEALTH HUMAN RESOURCES
Mental Health Care Professionals
Government
Sector medical
colleges/hospitals
40

6.1. No of
Psychiatrists
6.2. No of
14
Clinical
Psychologists
6.3. No of
3
Psychiatric Social
Workers
6.4. No of nurses 3
trained in mental

Private
medical
colleges
0

Private
Practice

Total

43

18

110

health
6.5. No of
trained
counselors

COMMENT:
Psychiatrists in Private practice are likely to be many times the figure compiled from affidavit
information. This needs to be updated.
7. MENTAL HEALTH HUMAN RESOURCE DEVELOPMENT
7.1. Degree/Diploma Courses
In Entire state, Annual No of
Seats in
MD Psychiatry
DNB Psychiatry
Diploma in Psychiatry
PhD Clinical Psychology
MPhil Clinical Psychology
PhD Psychiatric Social Work
MPhil Psychiatric Social Work
PhD Psychiatric Nursing
MSc Psychiatric Nursing
BSc Psychiatric Nursing
Basic Diploma in Psychiatric
Nursing (DPN)

Institutions where the Programme is offered

16
0
0
0
8
0
8
0
4
85
10

GMCH, PGIMER

PGIMER

7.2. Other training in mental health


7.2.a. Details of Undergraduate MBBS training in psychiatry
Name of medical
college

No of hours of
theory

Duration of
psychiatry
posting during
UG

Duration of
psychiatry
posting during
internship

GMCH

25

2 week

2 week

Qualifying
Examination
includes
competency
evaluation in
psychiatry
No

COMMENT: No student is coming to posting as attendance is not mandatory


7.2.b. Details of in-service training for Govt medical officers (No trained, duration)
No training conducted in last 1 year and no plans listed.

111

7.2.c. Any other training courses in mental health offered by the state
Caregiver training of 10 months by GMCH
8. GOVERNANCE:
8.1. Nodal Authority and responsibilities:
Designation
Secretary Health
DHS
Joint Secretary, Health
HOD Psychiatry, GMCH

Name
Sh Anurag Aggarwal
Dr VK Gangeja
Sh SK Setia
Dr BS Chavan

Contact Number
2740008
8556011888
9417270082
9646121611

8.2. Presence of a State Mental Health Plan: None


8.3. Enactment of State Mental Health Rules: No information
8.4. Oversight of policies and Programmes related to mental health: There are community
outreach activities, Home based treatment for mentally ill and Crisis Intervention Services run
by GMCH.
8.5. Specific oversight of the DMHP programme. DMHP is functional with nearly 125 new
registrations in a month.
COMMENT: There is no designated Psychiatric Hospital at present but is stated to be coming
up. Progress needs to be monitored.
9. FINANCING
No data available.
12. OVERALL SUMMARY OF STATE LEVEL MENTAL HEALTH SERVICES
Apart from information in this section, Special Rapporteur has stated that 1NGO-Umeed is
running an innovative scheme of employing Mentally Ill/Retarded persons in kiosks for selling
tea/coffee. Also, there is one Deaddiction Center being run by Red Cross.
Overall attention to Mental Health is very good. However, there is 85% treatment gap (Special
Rapporteur quoting GMCH).
Although facilities may be sufficient for UT itself, it also has to cater to needs of patients from
neighbouring States.

112

SECTION 2
2.1. PSYCHIATRIC INSTITUTIONS
There is none at present in government sector but a 100 bedded facility is coming up. There are
2 private Psychiatric Hospitals/Nursing Homes with total bed strength of only 24. They
predominantly cater to deaddiction.
SECTION 3
3. General Hospital Departments of Psychiatry and District Hospital Departments
3.1. Names of GH/DH and their location.
Government Medical College and PGIMER are two GHPUs in Chandigarh.
3.2. Areas (distribution throughout the states): Small UT (immaterial)
3.3. Whether separate funding and adequacy: No separate funding
3.4. Whether OP/IP and emergency services available: Wide range of services are available
3.5. Diagnostic categories in rank order that present in the outpatient: Depression and anxiety
disorders top the list.
3.6. Adequacy of OP facilities: Very good
3.7. Inpatient Very good facilities with good occupancy.
3.8. Extent of family involvement: good
3.9. Measures to protect rights including complaint redressal: Not apparent
3.10. Any networking: None
3.11. Staffing details and any shortages/vacancies: No deficit apparent
3.12. Psychotropic medication availability: Available free
3.13. ECTs: All modified ECTs (231 ECTs in a year combining both Departments)
3.14. Observations of extent to which counselling and psychotherapy are provided: To all
3.15. Whether disability certification is available: Yes 363 certificates/year
3.16. Extent and nature of community involvement: Both Departments have community
outreach clinics.
113

3.17. Whether engagement with the DMHP and extent: GMCH involved in DMHP.
3.18. Nature and partnership with NGOs for networking: GMCH partners with Parivartan for
unknown mentally ill
3.19. Presence of PG training- Very good infrastructure and number of seats.
3.20. Nature of public mental health material prepared and distributed/ activities to educate:
Pamphlets in OPD, Lectures on Radio and Schools.
3.21. Areas of research, sources of funding and major findings: PGIMER has commendable
track record and has researches across wide areas. ICMR and DST listed as major funding
agencies.
3.22. Whether monitored: No
3.23. Special Rapporteurs observations: Very good infrastructure and facilities
3.24. Inspection Committees observations: Not inspected.
3.25. SUMMARY AND RECOMMENDATIONS WITH RESPECT TO SECTION 3:
PGIMER is a pioneering institute and GMCH is also providing very good services. The gap of
Psychiatric Hospital can be bridged by designating one or both as Psychiatric Hospital for
purposes of Mental Health Act.
SECTION 4
4. NGOS WORKING IN MENTAL HEALTH:
Parivartan, DART services, Old GIMRC Building, Sector 32-C, Chandigarh
4.2. Nature of work carried out by the NGO in the domains mentioned and details of each:
Provides Social assistance and Rehabilitation.
4.3. Description of clientele: Legal Guardianship provide on Courts direction. Workshops for
promoting mental health. Caregiver support., Crisis intervention center, Home based
treatment and financial assistance to persons with mental illness without families.
4.6. Networking activities of the NGO: Liasion with Department Of Psychiatry, GMCH
4.7. Salient contributions of the NGO: Legal Guardianship, Home based treatment and crisis
intervention.

114

Prayatan, Half Way Home, Sector 47D, Chandigarh


4.2. Nature of work carried out by the NGO in the domains mentioned and details of each:
Provides Social assistance and Rehabilitation.
4.3. Description of clientele: Day Care Center (13 patients)
Kiosks for Vocational Rehabilitation
Plant Nursery
4.6. Networking activities of the NGO: Liasion with Department Of Psychiatry, GMCH
4.7. Salient contributions of the NGO: Maintains the only Half-way home in UT.
4.8. SUMMARY AND RECOMMENDATIONS FOR SECTION 4
There is huge scope for expanding NGO activities in providing pre and after hospital care,
advocacy for mentally ill and rehabilitation.
SECTION 5
5. DISTRICT MENTAL HEALTH PROGRAMME

115

5.1. A brief description of the location of the DMHP, when it started, total population covered:
DMHP is operating from Manimajra Civil Hospital , Chandigarh for more than 5 years and has
been taken over by UT administration.
5.2. A summary of annual registrations old and new, treatment outcomes in terms of those on
regular treatment and those dropped out, with diagnostic categories if provided.: Total new
registration (1648), Total old registration (4338) in 2014-15. Nearly half are under regular
treatment with nearly 15% first contact dropout. Depression, other neurosis and substance
use disorders top the list of diagnoses.
5.3. Frequency of home visits carried out by the HW/ANM; numbers covered and for what
diagnostic categories, no of admissions facilitated: Not reported.
5.4. Kinds of essential drugs available, number dispensed, number of patients receiving
medication under the DMHP in a month: Not reported
5.5. Duration of untreated mental illness for different diagnostic categories if provided: None
exceeding 12 months across all categories and in most cases it is less than a month.
5.6. Monitoring of the DMHP by the concerned officer /impressions and troubleshooting:Everything reported to be satisfactory
5.7. IEC activities of the DMHP: No details
5.8. Training calendar of the DMHP: No details
5.9. Activities to sensitize the gram panchayats: No details
5.10. Special Rapporteurs report on the activities of the DMHP: The MO of the PHC visted had
no training in Mental Health and there is no integration of Mental Health Care with General
Health Care. The DMHP activities like Crisis Intervention, Helpline are being managed by
GMCH.
5.11. Inspection Committees observations: Not visited
5.12. SUMMARY OBSERVATIONS OF DMHP AND RECOMMENDATIONS:
Duration of untreated mental illness needs to be verified and if true may be a Good practise
model to be followed. Training needs to be paid attention to.

116

SECTION 6
6. SUMMARY OF MENTAL HEALTH CARE INDICATORS IN Chandigarh
6.1. Availability of mental health facilities

Mental health outpatient


facilities in the state
Day treatment facilities
Psychiatric beds in general
hospitals
Community residential facilities
Beds/places in community
residential facilities
Psychiatric hospitals
Beds in psychiatric hospitals

Total No of
facilities/beds
5

Rate per 100,000


population
0.45

2
59

0.18
5.36

0
0

0
0

2
24

0.18
2.18

Rate per 100,000


population
8374

Females %

6.2. Access to Care

Persons treated in mental


health outpatient facilities
Persons treated in mental
health day care facilities
General hospital admissions
Community residential facilities
Persons staying in community
residential facilities at the end
of the year
Admissions to mental hospitals

1.18
54
0
0

6.3. Information Systems

Persons with mental


disorders treated in
primary health care
Interventions delivered
in primary health care

Data on No of
persons/activities
collected and reported
YES/NO
N

Data on age and


gender are collected
and reported
YES/NO
N

Data on patients
diagnosis are collected
and reported
YES/NO
N

117

for persons with


mental disorders
Persons treated in
mental health
outpatient facilities
Contacts in mental
health day treatment
facilities
Admissions in general
hospitals with
psychiatric beds
Admissions in mental
hospitals
Days spent in mental
hospitals
Admissions in
community residential
facilities

NA

NA

NA

NA

NA

NA

NA

NA

NA

6.4. Human Resources at the State Level


Health professionals working
in the mental health sector
Rate per 100,000
Psychiatrists
Medical doctors not specialised
in psychiatry
Clinical Psychologists
Psychiatric Social Workers
Psychiatric Nurses
Occupational therapists
Other health workers

3.9
-

Training of health
professionals in educational
institutions
Rate per 100,000
1.45
-

1.63
0.45
0.54
0.36

0.72
0.72
9
-

6.5. INFORMAL HUMAN RESOURCES (Family and User Associations): No information


6.6. MEDICINES
Type of Medication
All psychotropic medication
Mood stabilisers
Antipsychotics
Anxiolytics
Antidepressants
Anti-craving medication/ Substitution
treatments

Availability
Available
Available
Available
Available
Available
Available

118

STATE MENTAL HEALTH REPORT CARD


SUMMARY OF SECTIONS 1-7.
Summary of areas where state has achieved good progress/little progress/no progress
Since the report is deficient in providing information in many domains, it is possible that the
mental health report card may improve once an effort to obtain this information is made.
MENTAL HEALTH REPORT CARD (needs to be revised after all the information is obtained)
Area

Focus

Parameters

Mental Health
Services
(Secondary
and Tertiary)

Medical
College
Depts,
General
Hospitals,
Specialised
psychiatric
hospitals

Adequacy of inpatient
beds
Functional Departments
Functional OP services

Primary
Health Care
mental health
services

District
Mental
Health
Programme

% of functional DMHPs

Rehabilitation
services

At all levels

Vocational training, day


care, longstay facilities in
govt sector/ppp

119

Rating

100- present, fully


satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100 All districts
covered; fully
satisfactory
75 majority of
districts covered
and functioning
50 half the
districts covered
and functioning
25 one-fourth of
the districts
covered and
functioning
0- No districts
covered/although
DMHP exists, not
functioning
100- present, fully
satisfactory
75- present,
reasonably
satisfactory

Score
(out of
100)
50

75

25

Specialised
services

Human
Resources

Financing for
mental health

50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100- present, fully
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent

Services for
substance
use
disorders,
old age,
mental
retardation,
child
psychiatry,
community
services,
forensic
services
(exclude
DMHP staff
here)

Whether existing, level of


functionality, present at
different levels of care

Adequacy of
psychiatrists/clinical
psychologists/psychiatric
social
workers/psychiatric
nurses or mental health
trained nurses

100 fully
adequate
75 moderately
adequate
50 somewhat
adequate
25- inadequate
0 grossly
inadequate

75

State level

Existence of separate
budget for mental
health/mental health
activities

10% -separate
budget, fully
adequate
75 separate
budget,
moderately
adequate
50 separate
budget,
somewhat
adequate
25 no separate
budget, but some
financial
resources
available annually
0 no separate
budget/marginal
financial resource

25

120

25

Governance
and Policy

State
Mental
Health
Authority
and other
authorities

Separate Mental Health


Nodal Officer
Functioning Mental
Health Authority
Nodal persons for mental
health in SHRC/Legal
Services
Authority/Others
State Mental Health
Rules
State Mental Health
Programme
Range of medications
Regular supply and
dispensing
Standard procurement
arrangements

Availability of
psychiatric
medication

At every
level

Affirmative
action for
persons with
mental illness

At every
level

Disability assessment
Pension
Travel concession
Health insurance
Special assistance
Educational benefits
Job reservation

10

Treatment
Gap

Overall

Approximate number of
persons with mental
illness approximate
numbers totally receiving
treatment in the state

Total Score (out of 1000)


Average Score (%)

allocation
100 Existing,
fully functional
75- Existing,
mostly functional
50- Existing,
somewhat
functional
25- Partial
0 Non existent

100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100 no
treatment gap
75 25%
treatment gap
50 -50%
treatment gap
25 -75%
treatment gap
0- 100%
treatment gap

75

75

25

25

475
47.5%

121

An emphasis on how to develop a multi-sectoral partnership with other ministries/depts and


extend the purview of mental health care beyond the health sector and the role of state
governments and NHRC to catalyse this process.

RECOMMENDATIONS: The UT of Chandigarh has been making considerable strides in the


development of mental health services, particularly in the area of human resource
development. It has innovative Programmes like home-based care, mobile units and crisis
intervention. It has submitted a plan for a government psychiatric hospital. Psychotropic
medications are available. Having only 2 districts and good governance have facilitated some
of the improvements.
Concerns include sub-optimal under-graduate training in psychiatry, lack of information of
private psychiatrists, lack of information on implementation of Mental Health Rules and lack
of a Mental Health Plan. There is scope for improving networking and NGO participation. The
gender ratios as per the 2011 census are a cause for serious concern with respect to gender
inequities. Information from PGIMER appears incomplete and this needs to be rectified.

122

CHATTISGARH
SECTION 1. STATE LEVEL REPORT
21. GENERAL INFORMATION REGARDING THE STATE (Chattisgarh)
a. Area
135194 Sq.Mtr.
b. No of districts
27
c. Population, age distribution (as per census 2011) 25540196
O 6 Years Male 1824987
Female - 175904
d. Gender distribution

e.
f.
g.
h.

Male 12827915
Female - 12712281

Life expectancy at birth male and female


N.A.
Per capita State Government expenditure on health
N.A.
Any health indicators for the state (life expectancy, etc) N.A.
Completeness/quality of information provided: Complete/Partially
Complete/Deficient

If deficient, areas of deficiency:


22. MENTAL ILLNESS BURDEN/ INFORMATION REGARDING MENTAL ILLNESS
N
(prevalence)
2.1. Total number of
persons with mental
illness (all ICD categories)

2.2. Broad categories


2.2.a Severe mental
disorders (BPAD,
psychosis)
2.2.b Common mental
disorders
2.2.c Substance use
disorders (alcohol and
other drugs)

1787814 (Source :
A study by H.C.
Ganguly
Prevalence of
Mental Disorders
in India
No data available

No data available
No data available

123

N
(treatment
seeking)

Source of
information

2.2.d Mental Retardation

No data available

2.3. No of Males with


mental health problems
2.4. No of females with
mental health problems
2.5. No of children with
mental health problems
2.6. No of elderly with
mental health problems
2.7. No of homeless
mentally ill persons

NR
NR
NR
NR
NR

COMMENT: The State needs an assessment of the extent of the problem in order to plan
mental health services.
23. MENTAL HEALTH SERVICES IN THE STATE:
Organization of Services (description of number of psychiatric hospitals, medical college depts,
district hospitals)
N/N

No with dept/facility
Total No of units

% coverage

3.1.a No of district general


hospitals with separate
department of psychiatry

16

59.3%

3.1.b No of medical colleges with


department of psychiatry

5 govt. + 1 private

100%

3.1.c No of district general


hospitals providing psychiatric
care
3.1.d No of District Mental Health
Programmes in the State

7.4%

33.3%

N
3.1.e No of government
psychiatric hospitals
3.1.f No of private psychiatric
hospitals

1
1

124

3.1.g Total No of psychiatric


hospitals in the state

3.1.h No of NGOs providing


mental health care

COMMENT: All the medical colleges have a deparment of psychiatry. But few general
hospitals have separate departments. Only a third of the districts are covered by the DMHP.
a. INPATIENT SERVICES
DESCRIPTION:
Psychiatric hospitals
(Govt) (State Mental
Hospital, Bilaspur)

3.2.a. Total Inpatient


sanctioned/available
beds
3.2.b No of male beds
3.2.c. No of female
beds
3.2.d. No of beds for
children
3.2.e. No of beds for
elderly
3.2.f. No of beds for
substance use
disorders
3.2.g. No of beds for
forensic psychiatry
3.2.h. Occupancy (%)
3.2.i. No of admissions
during previous year
3.2.j. No of discharges
during previous year
3.2.k. Average
duration of inpatient
stay in days mean
3.2.l. Average duration
of inpatient stay in
days median
3.2.m. No of closed
wards

100

Psychiatric
hospitals
(Private)
N=(Pragya
Hospital)
21

50
50

11
10

N.A.

N.A.

N.A.

N.A.

N.A.

N.A.

N.A.

N.A.

60%
117

65%
N.A.

116

N.A.

30 days

10 days

N.A.

10 days

Nil

125

General
Hospitals
N=

District
Hospitals
N=

NGOs
N=

Total

3.2.n. No of closed
ward beds
3.2.o. No of open
wards
3.2.p. No of open
ward beds
3.2.q. No of paid
wards
3.2.r.No of paid beds
3.2.s.No of admissions
through courts
3.2.t. No of deaths in
the last year
3.2.u. No of suicides in
the last year

30

Nil

30

10

11

6
3

11
Nil

N.A.

N.A.

N.A.

Nil

COMMENT: No information is provided from the General Hospitals and Medical Colleges,
though they all have departments. It is mentioned that many district hospitals have
Departments of Psychiatry, but also mentions that very few are providing care.
b. OUTPATIENT SERVICES
Psychiatric
hospitals (Govt)
(State Mental
Hospital,
Bilaspur)

Psychiatric General
hospitals
Hospitals
(Private)
N=
N=(Pragya
Hospital)

3.3.a. No of new OP
registrations in the
previous year

2267

867

3.3.b. No of
emergency attendees
in the previous year

77

34

3.3.c Total no of OP
follow-up in the
previous year

1200

N.A.

COMMENT: Same as earlier


126

District
Hospitals
N=

NGOs
N=

Total

24. REHABILITATION FOR PERSONS WITH MENTAL ILLNESS


a. Government residential rehabilitation/longstay facilities : No and description: Nil
b. Government day care/outdoor rehabilitation facilities: No and description: NIL
c. Government run half-way homes: No and description. If none, plans to establish
and details Nil
d. NGO participation in the half way homes: Nil
e. Longstay rehabilitation facilities: No and description; NGO participation: 1 for
female patients of strength 50
25. MENTAL HEALTH CARE IN OTHER COMMUNITY FACILITIES
State Level, in the Govt Sector
5.1. No of shelter homes, observation homes, special homes and
childrens homes
5.2. No of counsellors trained in mental health in the above
institutions
5.3. No of protection homes for destitute women
5.4. No of counsellors trained in mental health in the above
institutions
5.5. No of old age homes
5.6. No of counsellors trained in mental health in the above
institutions
5.7. No of Central Jails and District Jails in the State
5.8. No of counsellors trained in mental health in the above
institutions
5.9.No of counsellors trained in mental health in the above
institutions

N
3, 8, 3, 37
N.R.
3
N.R.
21
N.R.
5 Central Jail, 10 district jail
N.R.
N.R.

Helplines for Mental Health: (Nature of helpline, who runs it, for whom, any information on
its utilization)
COMMENT: Rehabilitation facilities need to be expanded. Staff in state institutions need
mental health training.
26. MENTAL HEALTH HUMAN RESOURCES
Mental Health Care Professionals
Government Sector
medical
colleges/hospitals
6.1. No of
Psychiatrists
6.2. No of Clinical
Psychologists

Psychiatric
Hospital

11
1

127

Private
Practice

Total

6.3. No of Psychiatric
Social Workers
6.4. No of nurses
trained in mental
health
6.5. No of trained
counselors
6.6. Record Keeper
6.7. Case Registry
Assistant

2
Nil

Nil
N.A.
N.A.

COMMENT: There is shortage of human resources. There is no record of mental health


human resources in the non-governmental sector.
7. MENTAL HEALTH HUMAN RESOURCE DEVELOPMENT
7.1. Degree/Diploma Courses
In Entire state, Annual No of
Seats in
MD Psychiatry
DNB Psychiatry
Diploma in Psychiatry
PhD Clinical Psychology
MPhil Clinical Psychology
PhD Psychiatric Social Work
MPhil Psychiatric Social Work
PhD Psychiatric Nursing
MSc Psychiatric Nursing
BSc Psychiatric Nursing
Basic Diploma in Psychiatric
Nursing (DPN)

Institutions where the Programme is offered

2 (Private)

Pragya Hospital

15 (Private)
15 (Private)

10

COMMENT: Apart from the few seats in the private sector, there are no post-graduation seats
in the government sector, despite their being 5 medical colleges.
7.2. Other training in mental health : HIV / IDU counselling for trainers of OST.
7.2.a. Details of Undergraduate MBBS training in psychiatry :
Name of medical
college

No of hours of
theory

Duration of
psychiatry
posting during
UG
128

Duration of
psychiatry
posting during
internship

Qualifying
Examination
includes
competency

evaluation in
psychiatry

COMMENT: Under-graduate students are trained in Psychiatry as per MCI curriculum


Details of UG training is not mentioned.
7.2.b. Details of in-service training for Govt medical officers (No trained, duration) : Planning
under NMHP for 15 days training for Govt. Medical Officers is under process.
*If not trained, plans to train and timeline
7.2.c. Any other training courses in mental health offered by the state : N.R.
* Describe the type of course/duration/participants
8. GOVERNANCE:
8.1. Nodal Authority and responsibilities : 1. Medical Education Dr. M.K. Sahu, 2. State
Medical and Health Department Dr. B.K. Banerjee, 3. Social Welfare Department Mr.
Rajesh Tiwari, 4. SMHA Dr. B.K. Banerjee, 5. District Legal Services Authority Dr. B.K.
Banerjee
8.2. Presence of a State Mental Health Plan: NR
8.3. Enactment of State Mental Health Rules: NR
8.4. Oversight of policies and Programmes related to mental health :
8.5. Specific oversight of the DMHP programme. Brief description of districts where fully
implemented, where partially implemented and details of reasons for incomplete
implementation. Also mention here a brief summary of availability of medicines and
psychosocial care for patients with mental illness. No. Of DMHP in the state = 9, No. Of District
in which it has been fully implemented = 1, The region for incomplete implementation of the
DMHP in the districts is non-availability of qualified mental health professional.
8.6. Attempts towards integration of mental health care into general health care, NCD
management etc. NR
8.7. Examples of commitment to develop mental health services (high level involvement,
budgeting, networking NR
8.8. Examples of inter-sectoral collaboration to improve mental health services (including PPP
intitiatives) NR
129

8.9. Attempts towards mental health promotion NR


COMMENT: Strengths and weaknesses
Without all the information being provided, it is difficult to comment on strengths and
weaknesses.
9. FINANCING
9.1. Sources of financing of different categories State Mental Hospital, Bilaspur (Chattisgarh)
F.Y. 2014-15
Sr.
No.

Budget

Funds received

1.
2.
3.
4
5.
6.
7.
8.

Salary
Office Expenses
Furniture
Other expenses
Medicines
Equipments
Cloths & Beds
Ration

46,60,000
50,000
1,25,000
1,20,000
7,40,000
1,00,000
50,000
4,50,000

9.2 Budget provision from State and Centre in INR (for different facilities if required) NR
9.3. Mental Health Expenditure as proportion of Total Health Expenditure in State
(If available % spending on Health in the State may also be provided) NR
10. ANY OTHER SIGNIFICANT INFORMATION (e.g. litigation, insurance schemes for persons
with mental illness, pension and other assistance, job reservations) NR
11. INNOVATIONS NR
In the COMMENTS, the observations of the Special Rapporteur or the high level committees
visit to the states may be incorporated
12. OVERALL SUMMARY OF STATE LEVEL MENTAL HEALTH SERVICES : Govt. Of Chattishgarh is
committed to provide adequate mental health services to all affected people of state. The
fact that the state which had one sanctioned post of psychiatrist with no inpatient beds in
govt. Sector in 2000 year, now has 11 psychiatrists in five separate psychiatry departments in
five medical colleges and a dedicated mental hospital having total of 150 beds.

130

SECTION 2
2.1. PSYCHIATRIC INSTITUTIONS : (State Mental Hospital, Sendari, Bilaspur)
Domains

Status in 2008 (Did not


exist)

Developments since 2008

Infrastructure
Amenities and facilities
Financial arrangements
Diet
Investigations and treatment
Staff and training
Supportive services
Recreation/Occupational
therapy/Rehabilitation
Networking with other agencies

i. Outpatient:
ii. Inpatient
Organic Psychiatric Disorders
Schizophrenia
Bipolar Mood Disorder
Other Psychotic Disorders
Obsessive Compulsive Disorder
Other anxiety Disorders
Depressive Disorders
Adjustment Disorders
Alcohol and drug Abuse Disorders
Personality Disorders
Children with Psychiatric illness

07
70
62
245
10
22
13
15
38
16
45

Diagnostic categories seen: A majority are psychotic disorders including schizophrenia. A few
children with psychiatric illness are also being seen.
iii. DIAGNOSTICS AND THERAPEUTICS :

Investigations: X-ray, ECG, ECT, Lab Tests Hematology, Serology, Clinical Chemistry,
Microbiology Test and Clinical Pathology.
Therapeutic facilities:
Improvements in rehabilitation:

131

iv. ENGAGEMENT: Psycho-education and counselling provided to all, Psycho-therapy


provided to some.
Attempts to involve families of persons with mental illness:
Disability certification and number of certificates issued in the previous year: Yes, 45

v. ADMINISTRATIVE

Annual number of adverse events:


Mechanisms for redressal of patient complaints:

vi. COMMUNITY OUTREACH AND NETWORKING

Community Programmes: Community outreach services are available. No. Of


community outreach activities per months = 1
12. Networking with external agencies: No
13. Public mental health education: Yes,
vii. TRAINING

Post-graduate training new Programmes, enhancement of seats and measures to


maintain/improve quality of training: No

Any other training Programmes: No

vii. RESEARCH:

Research (areas, funding agencies, findings), : No


viii. ANY OTHER SALIENT CONTRIBUTIONS OF THE HOSPITAL/INSTITUTE:

ix. Any monitoring of hospital (internal or external)- details : Yes, Monitoring by NHRC is being
done.
x. Special Rapporteurs observation: Professor S. Narayan date of visit 29th June to 5th July,
2015. While visiting a Maharani Medical College and Hospital and District Hospital, there are
less doctors in the hospital. Majority of population of Jagdalpur are the tribals and they still
use traditional herbs, plants, roots, fruits to treat themselves. There is no mental health
society. The incidence of mental health is on rise in the district specially among tribal
because of naxalism.
xi. Any other observations (including Inspection Committee Reports): Not visited by the IC.

132

xii. Summary and Recommendations from SECTION 2:


Areas of positive change

Areas of poor progress

A small increase in the number of psychiatrists

SECTION 3
3. General Hospital Departments of Psychiatry and District Hospital Departments
The broad outline for this section:
3.1. Names of GH/DH and their location. : 1. Lt. B.R.K. Memorial College and Maharani
Hospital, Jagdalpur, 2. Chhatisgarh Institute of Medical Sciences (CIMS), Billaspur, 3. Pt.
J.N.M. Medical College & Dr. B.R.A.M. Hospital, Jail Road, Raipur (Chhatisgarh)
(If there are many, this could be done in a tabular column).
The following areas may be mentioned as a summary of all the units; where needed , examples
could be made of a specific dept to highlight both positives and negatives.
3.2. Areas (distribution throughout the states): N.A.
3.3. Whether separate funding and adequacy: No separate funds for psychiatric units.
3.4. Whether OP/IP and emergency services available : OPD emergency and inpatient Services
are available.
3.5. Diagnostic categories in rank order that present in the outpatient :

Sr.No
.

Name of Psychiatric illness

1
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.

Organic Psychiatric Disorders


Schizophrenia
Bipolar Mood Disorder
Other Psychotic Disorders
Obsessive Compulsive Disorder
Other anxiety Disorders
Depressive Disorders
Adjustment Disorders
Alcohol and drug Abuse Disorders
Personality Disorders
Children with Psychiatric illness

Lt. B.R.K.
Memorial
College &
Maharani
Hospital
15
936
204
174
42
348
240
120
502
44
30

133

Chhatisgar
h Institute
of Medical
Sciences
336
1104
816
168
191
193
2760
76
432
4
160

J.N.M.
Medical
College &
B.RA.M.
Hospital
18
1390
1120
630
95
360
430
25
1072
5
30

3.6. Adequacy of OP facilities : Waiting Halls, Toilets, Separate Interview Rooms, Drinking
Water, Canteen Services, OPD Lab services are adequate.
3.7. Inpatient occupancy, free and paying beds, average cost of inpatient stay per week; rank
order of diagnostic categories :

Sr.No.

Name of Psychiatric illness

1
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.

Organic Psychiatric Disorders


Schizophrenia
Bipolar Mood Disorder
Other Psychotic Disorders
Obsessive Compulsive Disorder
Other anxiety Disorders
Depressive Disorders
Adjustment Disorders
Alcohol and drug Abuse Disorders
Personality Disorders
Children with Psychiatric illness

Lt. B.R.K.
Memorial
College &
Maharani
Hospital
4
4
15
45
2

Chhatisgarh
Institute of
Medical
Sciences
6
5
3
3
18
45
4
-

J.N.M.
Medical
College &
B.RA.M.
Hospital
3
123
59
35
15
17
13
62
-

3.8. Extent of family involvement : All families are educated and counselled. Consumers are
always involved in treatment decisions.
3.9. Measures to protect rights including complaint redressal : Rights of patients are displayed
in wards.
3.10. Any networking : No
3.11. Staffing details and any shortages/vacancies :

Sr.No.

Professionals

1
2.
3.
4.
5.
6.
7.

Qualified psychiatrists
General Medical Officers
Clinical Psychologists
Psychiatric / Medical Social Workers
Trained Psychiatric Nurses
General Nurses
Other (Specify)

Lt. B.R.K.
Memorial
College &
Maharani
Hospital
1
1
1
-

134

Chhatisgarh
Institute of
Medical
Sciences
2
1
1
1
-

J.N.M.
Medical
College &
B.RA.M.
Hospital
4
3
1
1
10
-

3.12. Psychotropic medication availability/free/cost : Yes,


3.13. ECTs (Nos given across the facilities or average/No of direct ) : Facility for modify ECT,
available in Pt. J.N.M. Medical College, No. Of ECTs given in previous year 115.
3.14. Observations of extent to which counselling and psychotherapy are provided : Psychoeducation counselling provided to all, Psycho-therapy provide to some.
3.15. Whether disability certification is available (if available numbers certified/year) : Yes
3.16. Extent and nature of community involvement : Yes, Jail visit thrice a month.
3.17. Whether engagement with the DMHP and extent : Nil
3.18. Nature and partnership with NGOs for networking : Nil
3.19. Presence of PG training- whether adequately distributed throughout the state : No
3.20. Nature of public mental health material prepared and distributed/ activities to educate :
Yes, Display Board, Pamphlets in Hindi, Telemedicine facility is available.
3.21. Areas of research, sources of funding and major findings : Nil
3.22. Whether monitored and by whom. What were the observations? : Yes, Monitoring is
done by the State Govt.
3.23. Special Rapporteurs observations: As earlier mentioned for the Sendari Hospital
3.24. Inspection Committees observations: Not visited
3.25. SUMMARY AND RECOMMENDATIONS WITH RESPECT TO SECTION 3:
The potential of using the medical colleges to begin post-graduate courses must be
seriously examined. Many details of the government psychiatric hospital are not
provided as per proforma, suggesting that there may be a deficit of many services.
SECTION 4
(Detailed Information is not available)
4. NGOS WORKING IN MENTAL HEALTH:
4.1. A brief description of the NGO and its location :
4.2. Nature of work carried out by the NGO in the domains mentioned and details of each :

135

4.3. Description of clientele seen by the NGO and number of persons who use the services in
the previous year :
4.4. Research details :
4.5. Details of any training carried out by the NGO :.
4.6. Networking activities of the NGO :
4.7. Salient contributions of the NGO :
4.8. Special Rapporteurs observations :
4.9. Inspection Committees observations :
SECTION 5
(Detailed Information is not available)
5. DISTRICT MENTAL HEALTH PROGRAMME

136

5.1. A brief description of the location of the DMHP, when it started, total population covered:
5.2. A summary of annual registrations old and new, treatment outcomes in terms of those on
regular treatment and those dropped out, with diagnostic categories if provided. Would be
useful to know what kind of clientele is serviced under the DMHP:
5.3. Frequency of home visits carried out by the HW/ANM; numbers covered and for what
diagnostic categories, no of admissions facilitated: Details are not available.
5.4. Kinds of essential drugs available, number dispensed, number of patients receiving
medication under the DMHP in a month:
5.5. Duration of untreated mental illness for different diagnostic categories if provided:
5.6. Monitoring of the DMHP by the concerned officer /impressions and trouble-shooting
(mention if there is a committee and its composition):
5.7. IEC activities of the DMHP:
5.8. Training calendar of the DMHP (doctors, health workers, nurses, pharmacists, school
teachers/Anganwadi workers (whether any training conducted):
5.9. Activities to sensitize the gram panchayats
5.10. Special Rapporteurs report on the activities of the DMHP, its reach, areas of good
performance, areas of poor performance, barriers for effective service delivery, measures to
streamline functioning, funding flow and barriers thereof.
5.11. Inspection Committees observations 5.12. SUMMARY OBSERVATIONS OF DMHP AND RECOMMENDATIONS:
As no details are available, it is not possible to comment even on the third of the districts
where the DMHP is running. There are no details of the clinical reach, administrative
mechanisms, plans to expand, or challenges.

137

SECTION 6
6. SUMMARY OF MENTAL HEALTH CARE INDICATORS (name of state)
6.1. Availability of mental health facilities
Total No of
facilities/beds
Mental health outpatient facilities in
the state

Rate per 100,000 population


0.329

Day treatment facilities


Psychiatric beds in general hospitals

0.823

Community residential facilities


Beds/places in community residential
facilities
Psychiatric hospitals

0.004

Beds in psychiatric hospitals

1.469

6.2. Access to Care


Rate per 100,000
population
Persons treated in mental health
outpatient facilities
Persons treated in mental health day
care facilities
General hospital admissions
Community residential facilities
Persons staying in community
residential facilities at the end of the
year
Admissions to mental hospitals

14.52

138

Females %

6.3. Information Systems

Persons with mental


disorders treated in
primary health care
Interventions delivered
in primary health care
for persons with
mental disorders
Persons treated in
mental health
outpatient facilities
Contacts in mental
health day treatment
facilities
Admissions in general
hospitals with
psychiatric beds
Admissions in mental
hospitals
Days spent in mental
hospitals
Admissions in
community residential
facilities

Data on No of
persons/activities
collected and reported
YES/NO

Data on age and


gender are collected
and reported
YES/NO

Data on patients
diagnosis are collected
and reported
YES/NO

Yes

Yes

Yes

Yes

Yes

Yes

No

No

No

6.4. Human Resources at the State Level

Psychiatrists

Health professionals working


in the mental health sector
Rate per 100,000

Training of health professionals


in educational institutions
Rate per 100,000

0.301

0.04

Medical doctors not specialised


in psychiatry

2.89

Clinical Psychologists

0.047

0.01

Psychiatric Social Workers

0.033

0.003

Psychiatric Nurses

0.166

0.02

Occupational therapists
Other health workers
139

6.5. INFORMAL HUMAN RESOURCES (Family and User Associations)


Present in the state
No of members
Participation in the
formulation/implementation of
policy/plan/legislation

User
Yes

Family
Yes

Not routinely

Not routinely

6.6. MEDICINES
Type of Medication

Expenditure at State level per year and per


100,000 population (in INR)
NR

All psychotropic medication


Mood stabilisers
Antipsychotics
Anxiolytics
Antidepressants
Anti-craving medication/ Substitution
treatments

SECTION 7
STATE MENTAL HEALTH REPORT CARD

STATE MENTAL HEALTH REPORT CARD


SUMMARY OF SECTIONS 1-7.
Summary of areas where state has achieved good progress/little progress/no progress
There has been some increase of psychiatrists, but human resources are grossly deficient. The
details of functioning of the mental hospital in Sendari, Bilaspur are not complete. The DMHP
is functioning under one-third of districts and even these details are not available. Although
there are 5 government medical colleges, no PG Programmes have been initiated. Only two
centres have provided information on patient patterns.

140

MENTAL HEALTH REPORT CARD (needs to be revised after all the information is obtained)
Area

Focus

Parameters

Rating

Mental Health
Services
(Secondary
and Tertiary)

Medical
College
Depts,
General
Hospitals,
Specialised
psychiatric
hospitals

Adequacy of inpatient
beds
Functional Departments
Functional OP services

Primary
Health Care
mental health
services

District
Mental
Health
Programme

% of functional DMHPs

Rehabilitation
services

At all levels

Vocational training, day


care, longstay facilities in
govt sector/ppp

Specialised
services

Services for
substance
use
disorders,
old age,

Whether existing, level


of functionality, present
at different levels of care

100- present, fully


satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100 All districts
covered; fully
satisfactory
75 majority of
districts covered
and functioning
50 half the
districts covered
and functioning
25 one-fourth
of the districts
covered and
functioning
0- No districts
covered/although
DMHP exists, not
functioning
100- present, fully
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100- present, fully
satisfactory
75- present,
reasonably
satisfactory

141

Score (out
of 100)
50

25

Human
Resources

Financing for
mental health

Governance
and Policy

mental
retardation,
child
psychiatry,
community
services,
forensic
services
(exclude
DMHP staff
here)

50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent

Adequacy of
psychiatrists/clinical
psychologists/psychiatric
social
workers/psychiatric
nurses or mental health
trained nurses

100 fully
adequate
75 moderately
adequate
50 somewhat
adequate
25- inadequate
0 grossly
inadequate

25

State level

Existence of separate
budget for mental
health/mental health
activities

25

State
Mental
Health
Authority
and other
authorities

Separate Mental Health


Nodal Officer
Functioning Mental
Health Authority
Nodal persons for mental
health in SHRC/Legal
Services
Authority/Others
State Mental Health
Rules

10% -separate
budget, fully
adequate
75 separate
budget,
moderately
adequate
50 separate
budget,
somewhat
adequate
25 no separate
budget, but some
financial
resources
available annually
0 no separate
budget/marginal
financial resource
allocation
100 Existing,
fully functional
75- Existing,
mostly functional
50- Existing,
somewhat
functional
25- Partial
0 Non existent

142

50

State Mental Health


Programme
Range of medications
Regular supply and
dispensing
Standard procurement
arrangements

Availability of
psychiatric
medication

At every
level

Affirmative
action for
persons with
mental illness

At every
level

Disability assessment
Pension
Travel concession
Health insurance
Special assistance
Educational benefits
Job reservation

10

Treatment
Gap

Overall

Approximate number of
persons with mental
illness approximate
numbers totally receiving
treatment in the state

Total Score (out of 1000)


Average Score (%)

100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100 no
treatment gap
75 25%
treatment gap
50 -50%
treatment gap
25 -75%
treatment gap
0- 100%
treatment gap

50
(inadequate
information)

0 (no
information)

25

250
25%

An emphasis on how to develop a multi-sectoral partnership with other ministries/depts and


extend the purview of mental health care beyond the health sector and the role of state
governments and NHRC to catalyse this process.
RECOMMENDATIONS:
The state needs to provide more complete information on all its facilities for mental
health. There is no information from the medical colleges/district hospitals/general
hospitals abot their case loads. No details of undergraduate training are provided.
The state has a huge deficiency of mental health human resources. It must explore the
potential of initiating post-graduate training courses to meet this deficit.
Very few rehabilitation facilities and NGO engagement exist.
143

DADRA AND NAGER HAVELI


SECTION 1. STATE LEVEL REPORT
1. GENERAL INFORMATION REGARDING THE STATE (UT- DADRA & NAGAR HAVELI)
1.1.
Area- 491 sq.kms
1.2.
No of districts- 1
1.3.
Population, age distribution (as per census 2011) 343000
1.4.
Gender distribution pop(male)-, pop(female)1.5.
Life expectancy at birth male and female: Males: Females:
1.6.
Per capita State Government expenditure on health:
1.7.
Any health indicators for the state: Annual number of suicides: 96
1.8.
Completeness/quality of information provided: Partially Complete
2. MENTAL ILLNESS BURDEN/ INFORMATION REGARDING MENTAL ILLNESS
N
(prevalence)
2.1. Total number of persons with
mental illness (all ICD categories)
2.2. Broad categories
2.2.a Severe mental disorders
(BPAD, psychosis)
2.2.b Common mental disorders
2.2.c Substance use disorders
(alcohol and other drugs)
2.2.d Mental Retardation
2.3. No of Males with mental health
problems
2.4. No of females with mental
health problems
2.5. No of children with mental
health problems
2.6. No of elderly with mental health
problems
2.7. No of homeless mentally ill
persons

N
(treatment
seeking)

Source of
information

3000-5000

No record

COMMENT: Some of the basic information has not been provided. The hospital record
information has been provided as the source of information for the number of mentally ill in
the UT. This only represents 0.7% of the population. The numbers with mental illness in the
community are likely to be much larger. With 96 annual suicides the rate of suicide is
27.9/100000.
144

Estimates of mental health morbidity is very low.


3. MENTAL HEALTH SERVICES IN THE STATE:
3.1.
Organization of Services (description of number of psychiatric hospitals, medical
college depts, district hospitals)

N/N
3.1.a No of district
general hospitals with
separate department of
psychiatry
3.1.b No of medical
colleges with department
of psychiatry
3.1.c No of district
general hospitals
providing psychiatric care
3.1.d No of District
Mental Health
Programmes in the State

No with dept/facility
Total No of units

% coverage

01

N
3.1.e No of government
psychiatric hospitals
3.1.f No of private
psychiatric hospitals
3.1.g Total No of
psychiatric hospitals in
the state
3.1.h No of NGOs
providing mental health
care

0
NA
NA

NA

COMMENT: Apart from one general hospital providing psychiatric care, there appear to be no
mental health services.

145

3.2.
INPATIENT SERVICES
DESCRIPTION:

Psychiatric
hospitals
(Govt) N=0

Psychiatric
hospitals
(Private)
N=0

3.2.a. Total I.npatient


sanctioned/available
beds
3.2.b No of male
beds
3.2.c. No of female
beds
3.2.d. No of beds for
children
3.2.e. No of beds for
elderly
3.2.f. No of beds for
substance use
disorders
3.2.g. No of beds for
forensic psychiatry
3.2.h. Occupancy (%)
3.2.i. No of
admissions during
previous year
3.2.j. No of
discharges during
previous year
3.2.k. Average
duration of inpatient
stay in days mean
3.2.l. Average
duration of inpatient
stay in days median
3.2.m. No of closed
wards
3.2.n. No of closed
ward beds
3.2.o. No of open
wards
3.2.p. No of open
ward beds
3.2.q. No of paid
wards

General
Hospitals
N=1

District
Hospitals
N=

NGOs
N=

Total

10

146

3.2.r.No of paid beds


3.2.s.No of
admissions through
courts
3.2.t. No of deaths in
the last year
3.2.u. No of suicides
in the last year

COMMENT: Even for the GH, no information on the number of admissions and the nature of
admissions is provided. The Manochikitsa Kendra is located in the civil hospital in Silvassa. It
is reported in the affidavit (dated 23 August 2013) to have all facilities, a good hygienic
environment, proper santiation and good standard.

3.3.

OUTPATIENT SERVICES
Govt.
Psychiatric
hospitals
N=

Private
Psychiatric
hospitals
N=

3.3.a. No of new OP
registrations in the
previous year
3.3.b. No of
emergency
attendees in the
previous year
3.3.c Total no of OP
follow-up in the
previous year

General
Hospitals

District
Hospitals

NGOs

N=
10/day

N=

N=

Total

3600

COMMENT: The pattern of psychiatric morbidity as reflected in the diagnosis of the patients
provided in the updated affidavit (dated shows that there were 2556 outpatients seen in
2014 (of whom 2136 had common mental disorders, 180 severe mental disorders, 96 alcohol
and drug abuse, 144 mental retardation. The hospital saw 72 elderly with mental health
problems, 1032 women and 61 children.
4. REHABILITATION FOR PERSONS WITH MENTAL ILLNESS
4.1.
Government residential rehabilitation/longstay facilities : 0
4.2.
Government day care/outdoor rehabilitation facilities: No and description:0
4.3.
Government run half-way homes: No and description. If none, plans to establish
and details:0
147

4.4.
NGO participation in the half way homes:Nil
4.5.
Longstay rehabilitation facilities: 0
There is a 104 non emergency medical response service.
5. MENTAL HEALTH CARE IN OTHER COMMUNITY FACILITIES
State Level, in the Govt Sector
5.1. No of shelter homes, observation homes,
special homes and childrens homes
5.2. No of counsellors trained in mental health in
the above institutions
5.3. No of protection homes for destitute women
5.4. No of counsellors trained in mental health in
the above institutions
5.5. No of old age homes
5.6. No of counsellors trained in mental health in
the above institutions
5.7. No of Central Jails and District Jails in the State
5.8. No of counsellors trained in mental health in
the above institutions
5.9.No of counsellors trained in mental health in
the above institutions

N
0
NIL

NIL
NIL
NIL
1

NA

COMMENT: No rehabilitation facilities exist. There are no facilities for persons with special
needs. There is a subjail in Dadra and Nager Haveli, but these details are not mentioned.
6. MENTAL HEALTH HUMAN RESOURCES
Mental Health Care Professionals

6.1. No of
Psychiatrists
6.2. No of Clinical
Psychologists
6.3. No of
Psychiatric Social
Workers
6.4. No of nurses
trained in mental
health
6.5. No of trained
counselors

Government
Psychiatric
Sector medical
medical
colleges/hospitals colleges
1

Private
Practice

NA

NA

NIL

NA

NIL

NIL

NA

148

Total

COMMENT: There is only 1 psychiatrist. The UT has 8 nurses trained in mental health
(although a later affidavit in May 2015 mentions 4 trained nurses and 3 trained counsellors),
so this ratio is quite high, compared to clinical psychologists and psychiatric social workers.

7. MENTAL HEALTH HUMAN RESOURCE DEVELOPMENT


7.1. Degree/Diploma Courses
In Entire state, Annual No of
Seats in
MD Psychiatry
DNB Psychiatry
Diploma in Psychiatry
PhD Clinical Psychology
MPhil Clinical Psychology
PhD Psychiatric Social Work
MPhil Psychiatric Social Work
PhD Psychiatric Nursing
MSc Psychiatric Nursing
BSc Psychiatric Nursing
Basic Diploma in Psychiatric
Nursing (DPN)

Institutions where the Programme is offered

NONE
NONE
NONE
NONE
NONE
NONE
NONE
NONE
NONE
NONE
NONE

COMMENT: There are no training avenues for developing mental health professional
resources within the UT.
7.2. Other training in mental health
7.2.a. Details of Undergraduate MBBS training in psychiatry: Details NA
7.2.b. Details of in-service training for Govt medical officers (No trained, duration)---NONE
7.2.c. Any other training courses in mental health offered by the state
None
8. GOVERNANCE:
8.1. Nodal Authority and responsibilities : This includes the State Medical and Health
Department, the Social Welfare Department, the State Mental Health Authority and the
District Legal Services Authority.
8.2. Presence of a State Mental Health Plan:None
149

8.3. Enactment of State Mental Health Rules: Not specified


8.4. Oversight of policies and Programmes related to mental health: None
8.5. Specific oversight of the DMHP programme.
8.6. Attempts towards integration of mental health care into general health care, NCD
management etc.: Not evident
8.7. Examples of commitment to develop mental health services (high level involvement,
budgeting, networking: Not evident
8.8. Examples of inter-sectoral collaboration to improve mental health services : None evident
8.9. Attempts towards mental health promotion : None evident
COMMENT: Very little is occurring in Dadra and Nager Haveli with respect to mental health
services.
9. FINANCING
9.1. Sources of financing of different categories : Not specified
9.2 Budget provision from State and Centre in INR (for different facilities if required): NA
9.3. Mental Health Expenditure as proportion of Total Health Expenditure in State: NA
(If available % spending on Health in the State may also be provided)
10. ANY OTHER SIGNIFICANT INFORMATION: NIL
11. INNOVATIONS: NIL
12. OVERALL SUMMARY OF STATE LEVEL MENTAL HEALTH SERVICES: LIMITED
SECTION 2
2.1. PSYCHIATRIC INSTITUTIONS
NONE
SECTION 3
3. General Hospital Departments of Psychiatry and District Hospital Departments
The broad outline for this section:

150

3.1. Names of GH/DH and their location. Shri Vinoba Bhave Civil Hospital, Silvassa
3.2. Areas (distribution throughout the states): NR
3.3. Whether separate funding and adequacy: NR
3.4. Whether OP/IP and emergency services available: OPD, inpatient and emergency available.
3.5. Diagnostic categories in rank order that present in the outpatient: mostly common mental
disorder NR
3.6. Adequacy of OP facilities: adequate
3.7. Inpatient NR
3.8. Extent of family involvement NR
3.9. Measures to protect rights including complaint redressal: NR
3.10. Any networking: Liaison with Medicine Department and Neurosurgery department for
deaddiction and neuropsychiatry.
3.11. Staffing details and any shortages/vacancies: NR
3.12. Psychotropic medication availability/free/cost: NR
3.13. ECTs (Nos given across the facilities or average/No of direct ): NR
3.14. Observations of extent to which counselling and psychotherapy are provided: NR
3.15. Whether disability certification is available (if available numbers certified/year): NR
3.16. Extent and nature of community involvement: NR
3.17. Whether engagement with the DMHP and extent: NR
3.18. Nature and partnership with NGOs for networking: none
3.19. Presence of PG training- whether adequately distributed throughout the state: NONE
3.20. Nature of public mental health material prepared and distributed/ activities to educate
NR
3.21. Areas of research, sources of funding and major findings: mainly PG thesis and
presentations.
3.22. Whether monitored and by whom: none
151

3.23. Special Rapporteurs observations:


3.24. Inspection Committees observations: None
3.25. SUMMARY AND RECOMMENDATIONS WITH RESPECT TO SECTION 3:
(Overall impressions about the mental health service delivery through the General and District
Hospitals). There are no resources to increase trained human resources within the UT.
SECTION 4
4. NGOS WORKING IN MENTAL HEALTH:
NONE
SECTION 5

152

5. DISTRICT MENTAL HEALTH PROGRAMME (information in the prescribed format is not


available)
5.1. A brief description of the location of the DMHP, when it started, total population covered:
2007-08 in UT of Dadra & Nagar Haveli
5.2. A summary of annual registrations old and new, treatment outcomes in terms of those on
regular treatment and those dropped out, with diagnostic categories if provided. 5.3.
Frequency of home visits carried out by the HW/ANM; numbers covered and for what
diagnostic categories, no of admissions facilitated: NR
5.4. Kinds of essential drugs available, number dispensed, number of patients receiving
medication under the DMHP in a month: NR
5.5. Duration of untreated mental illness for different diagnostic categories if provided:
5.6. Monitoring of the DMHP by the concerned officer /impressions and trouble-shooting
(mention if there is a committee and its composition): NR
5.7. IEC activities of the DMHP: NR
5.8. Training calendar of the DMHP (doctors, health workers, nurses, pharmacists, school
teachers/Anganwadi workers (whether any training conducted):
5.9. Activities to sensitize the gram panchayats: NR
5.10. Special Rapporteurs report on the activities of the DMHP, its reach, areas of good
performance, areas of poor performance, barriers for effective service delivery, measures to
streamline functioning, funding flow and barriers thereof: None
5.11. Inspection Committees observations: 5.12. SUMMARY OBSERVATIONS OF DMHP AND RECOMMENDATIONS: Inadequate
information.

153

SECTION 6
6. SUMMARY OF MENTAL HEALTH CARE INDICATORS IN ____RAJASTHAN_ (name of state)
6.1. Availability of mental health facilities

Mental health outpatient


facilities in the state
Day treatment facilities
Psychiatric beds in general
hospitals
Community residential facilities
Beds/places in community
residential facilities
Psychiatric hospitals
Beds in psychiatric hospitals

Total No of
facilities/beds
1

Rate per 100,000


population
0.29

0
10

2.9

0
0
0
0

6.2. Access to Care

Persons treated in mental


health outpatient facilities
Persons treated in mental
health day care facilities
General hospital admissions
Community residential facilities
Persons staying in community
residential facilities at the end
of the year
Admissions to mental hospitals

Rate per 100,000


population
105

Females %

0
NR
0
0

None

6.3. Information Systems

Persons with mental


disorders treated in
primary health care

Data on No of
persons/activities
collected and reported
YES/NO
N

Data on age and


gender are collected
and reported
YES/NO
Y

154

Data on patients
diagnosis are collected
and reported
YES/NO
Y

Interventions delivered
in primary health care
for persons with
mental disorders
Persons treated in
mental health
outpatient facilities
Contacts in mental
health day treatment
facilities
Admissions in general
hospitals with
psychiatric beds
Admissions in mental
hospitals
Days spent in mental
hospitals
Admissions in
community residential
facilities

6.4. Human Resources at the State Level


Health professionals working
in the mental health sector
Rate per 100,000
Psychiatrists
Medical doctors not specialised
in psychiatry
Clinical Psychologists
Psychiatric Social Workers
Psychiatric Nurses
Occupational therapists
Other health workers

1
NA
1
1
8
NA
NA

Training of health
professionals in educational
institutions
Rate per 100,000
0.29

0.29
0.29
2.33

6.5. INFORMAL HUMAN RESOURCES (Family and User Associations)


Present in the state
No of members
Participation in the
formulation/implementation of
policy/plan/legislation

User
N
N
N

Family
N
N
N

155

6.6. MEDICINES
Type of Medication
All psychotropic medication
Mood stabilisers
Antipsychotics
Anxiolytics
Antidepressants
Anti-craving medication/ Substitution
treatments

NR
NR
NR
NR
NR
NR
NR

SECTION 7
1. STATE MENTAL HEALTH REPORT CARD
STATE MENTAL HEALTH REPORT CARD
SUMMARY OF SECTIONS 1-7.
Summary of areas where state has achieved good progress/little progress/no progress
MENTAL HEALTH REPORT CARD (needs to be revised after all the information is obtained)
Area

Focus

Parameters

Mental Health
Services
(Secondary
and Tertiary)

Medical
College
Depts,
General
Hospitals,
Specialised
psychiatric
hospitals

Adequacy of inpatient
beds
Functional Departments
Functional OP services

Primary
Health Care
mental health
services

District
Mental
Health
Programme

% of functional DMHPs

156

Rating

100- present, fully


satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100 All districts
covered; fully
satisfactory
75 majority of
districts covered
and functioning
50 half the
districts covered
and functioning

Score
(out of
100)
0

50

25 one-fourth of
the districts
covered and
functioning
0- No districts
covered/although
DMHP exists, not
functioning
100- present, fully
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100- present, fully
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent

Rehabilitation
services

At all levels

Vocational training, day


care, longstay facilities in
govt sector/ppp

Specialised
services

Whether existing, level of


functionality, present at
different levels of care

Human
Resources

Services for
substance
use
disorders,
old age,
mental
retardation,
child
psychiatry,
community
services,
forensic
services
(exclude
DMHP staff
here)

Adequacy of
psychiatrists/clinical
psychologists/psychiatric
social
workers/psychiatric
nurses or mental health
trained nurses

100 fully
adequate
75 moderately
adequate
50 somewhat
adequate
25- inadequate
0 grossly
inadequate

25

Financing for
mental health

State level

Existence of separate
budget for mental
health/mental health
activities

10% -separate
budget, fully
adequate
75 separate
budget,
moderately

25

157

Governance
and Policy

State
Mental
Health
Authority
and other
authorities

Separate Mental Health


Nodal Officer
Functioning Mental
Health Authority
Nodal persons for mental
health in SHRC/Legal
Services
Authority/Others
State Mental Health
Rules
State Mental Health
Programme
Range of medications
Regular supply and
dispensing
Standard procurement
arrangements

Availability of
psychiatric
medication

At every
level

Affirmative
action for
persons with
mental illness

At every
level

Disability assessment
Pension
Travel concession
Health insurance
Special assistance
Educational benefits
Job reservation

10

Treatment
Gap

Overall

Approximate number of
persons with mental
158

adequate
50 separate
budget,
somewhat
adequate
25 no separate
budget, but some
financial
resources
available annually
0 no separate
budget/marginal
financial resource
allocation
100 Existing,
fully functional
75- Existing,
mostly functional
50- Existing,
somewhat
functional
25- Partial
0 Non existent

100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100 no
treatment gap

25

NR

25

illness approximate
numbers totally receiving
treatment in the state

Total Score (out of 1000)


Average Score (%)

75 25%
treatment gap
50 -50%
treatment gap
25 -75%
treatment gap
0- 100%
treatment gap
150
15%

An emphasis on how to develop a multi-sectoral partnership with other ministries/depts and


extend the purview of mental health care beyond the health sector and the role of state
governments and NHRC to catalyse this process.

RECOMMENDATIONS:
The state needs to provide more complete information on all its facilities for mental
health. Although the trained mental health nurses are relatively higher here than in
other places, the rest of the mental health professionals are very few. The functioning
of the DMHP is unclear. Since training facilities do not exist within the UT, a detailed
plan on how to expand mental health services at all levels and develop human
resources is a very important need. There is a need to develop supportive
interventions for psychological crisis and for persons with suicidal ideation.

159

DAMAN AND DIU


SECTION 1. STATE LEVEL REPORT
2. GENERAL INFORMATION REGARDING THE STATE (U.T. of Daman & Diu)
a. Area- Daman 72 sq.kms, Diu 40 sq.kms; total 112 sq kms
b. No of districts- 2
c. Population, age distribution (as per census 2011) 243247
d. Gender distribution pop(male)-150301, pop(female)-92946
e. Life expectancy at birth male and female: Males:, Females:
f. Per capita State Government expenditure on health:
g. Any health indicators for the state: Crude Birth Rate ; Crude Death Rate; Infant
Mortality Rate; Sex Ratio
h. Completeness/quality of information provided: Deficient Very little
information is provided.
3. MENTAL ILLNESS BURDEN/ INFORMATION REGARDING MENTAL ILLNESS
N
(prevalence)
2.1. Total number of persons with
mental illness (all ICD categories)
2.2. Broad categories
2.2.a Severe mental disorders
(BPAD, psychosis)
2.2.b Common mental disorders
2.2.c Substance use disorders
(alcohol and other drugs)
2.2.d Mental Retardation

N
(treatment
seeking)

Source of
information

700

NA

2.3. No of Males with mental health


problems
2.4. No of females with mental
health problems
2.5. No of children with mental
health problems
2.6. No of elderly with mental health
problems
2.7. No of homeless mentally ill
persons

COMMENT: This has been calculated based on the OPD registrations at the Manochikitsa
Kendra PHC, Kachigam, as 7.8% of the attendees.

160

3. MENTAL HEALTH SERVICES IN THE STATE:


3.1.Organization of Services (description of number of psychiatric hospitals, medical
college depts, district hospitals)
N/N
3.1.a No of district
general hospitals with
separate department of
psychiatry
3.1.b No of medical
colleges with department
of psychiatry
3.1.c No of district
general hospitals
providing psychiatric care
3.1.d No of District
Mental Health
Programmes in the State

No with dept/facility
Total No of units

% coverage

NIL

Manochikitsa
Kendra PHC,
Kachigam

1
N

3.1.e No of government
psychiatric hospitals
3.1.f No of private
psychiatric hospitals
3.1.g Total No of
psychiatric hospitals in
the state
3.1.h No of NGOs
providing mental health
care

0
NA
NA

COMMENT: Mental health services are provided through the Manochikitsa Kendra in
Kachigam.
1.1.
INPATIENT SERVICES
DESCRIPTION:
Psychiatric
hospitals
(Govt) N=0

Psychiatric
hospitals
(Private)
N=0

3.2.a. Total I.npatient


sanctioned/available
beds
3.2.b No of male
beds
3.2.c. No of female

General
Hospitals

District
Hospitals

10

161

NGOs

Total

10

beds
3.2.d. No of beds for
children
3.2.e. No of beds for
elderly
3.2.f. No of beds for
substance use
disorders
3.2.g. No of beds for
forensic psychiatry
3.2.h. Occupancy (%)
3.2.i. No of
admissions during
previous year
3.2.j. No of
discharges during
previous year
3.2.k. Average
duration of inpatient
stay in days mean
3.2.l. Average
duration of inpatient
stay in days median
3.2.m. No of closed
wards
3.2.n. No of closed
ward beds
3.2.o. No of open
wards
3.2.p. No of open
ward beds
3.2.q. No of paid
wards
3.2.r.No of paid beds
3.2.s.No of
admissions through
courts
3.2.t. No of deaths in
the last year
3.2.u. No of suicides
in the last year

COMMENT:

162

1.2.

OUTPATIENT SERVICES

3.3.a. No of new OP
registrations in the
previous year
3.3.b. No of
emergency
attendees in the
previous year
3.3.c Total no of OP
follow-up in the
previous year

Govt.
Psychiatric
hospitals
N=
25

Private
Psychiatric
hospitals
N=

General
Hospitals

District
Hospitals

NGOs

N=

N=

N=

Total

COMMENT: The number of OPD registrations is extremely small.


2. REHABILITATION FOR PERSONS WITH MENTAL ILLNESS
2.1.
Government residential rehabilitation/longstay facilities : 0
2.2.
Government day care/outdoor rehabilitation facilities: No and description:0
2.3.
Government run half-way homes: No and description. If none, plans to establish
and details:0
2.4.
NGO participation in the half way homes:Nil
2.5.
Longstay rehabilitation facilities: 0
3. MENTAL HEALTH CARE IN OTHER COMMUNITY FACILITIES
State Level, in the Govt Sector

5.1. No of shelter homes, observation homes,


special homes and childrens homes
5.2. No of counsellors trained in mental health in
the above institutions
5.3. No of protection homes for destitute women
5.4. No of counsellors trained in mental health in
the above institutions
5.5. No of old age homes
5.6. No of counsellors trained in mental health in
the above institutions
5.7. No of Central Jails and District Jails in the State
5.8. No of counsellors trained in mental health in

163

NIL
1
NIL
2
NIL

the above institutions


5.9.No of counsellors trained in mental health in
the above institutions

NR

Helplines for Mental Health: NA


COMMENT: There are no organised rehabilitation facilities for persons with mental illness.
The state facilities do not have any trained mental health professionals.
4. MENTAL HEALTH HUMAN RESOURCES
Mental Health Care Professionals

6.1. No of
Psychiatrists
6.2. No of Clinical
Psychologists
6.3. No of
Psychiatric Social
Workers
6.4. No of nurses
trained in mental
health
6.5. No of trained
counselors

Government
Sector medical
colleges/hospitals
1

Psychiatric
medical
colleges
NA

Private
Practice

Total

NA

NIL

NA

NA

01

NA

NA

01

NIL

NA

NIL

NIL

NA

COMMENT: There is 1 psychiatrist, 1 clinical psychologist and 1 psychiatric social worker in


the entire UT.
7. MENTAL HEALTH HUMAN RESOURCE DEVELOPMENT
7.1. Degree/Diploma Courses
In Entire state, Annual No of
Seats in
MD Psychiatry
DNB Psychiatry
Diploma in Psychiatry
PhD Clinical Psychology
MPhil Clinical Psychology
PhD Psychiatric Social Work
MPhil Psychiatric Social Work

Institutions where the Programme is offered

NA
NA
NA
NONE
NONE
NA
NA
164

PhD Psychiatric Nursing


MSc Psychiatric Nursing
BSc Psychiatric Nursing
Basic Diploma in Psychiatric
Nursing (DPN)

NONE
NONE
NONE
NONE

COMMENT: No postgraduate training facilities are available in mental health.


7.2. Other training in mental health
7.2.a. Details of Undergraduate MBBS training in psychiatry: Details NR
7.2.b. Details of in-service training for Govt medical officers (No trained, duration)---NONE,
No plans
7.2.c. Any other training courses in mental health offered by the state
None
8. GOVERNANCE:
8.1. Nodal Authority and responsibilities : NR
8.2. Presence of a State Mental Health Plan:None
8.3. Enactment of State Mental Health Rules: Not specified
8.4. Oversight of policies and Programmes related to mental health: None
8.5. Specific oversight of the DMHP programme.Only functional in 1 District
8.6. Attempts towards integration of mental health care into general health care, NCD
management etc.: Not evident
8.7. Examples of commitment to develop mental health services (high level involvement,
budgeting, networking: Not evident
8.8. Examples of inter-sectoral collaboration to improve mental health services : None evident
8.9. Attempts towards mental health promotion : None evident
COMMENT: Strengths and weaknesses
Very little activity in the area of mental health.
9. FINANCING
165

9.1. Sources of financing of different categories: Not specified


9.2 Budget provision from State and Centre in INR (for different facilities if required): NR
9.3. Mental Health Expenditure as proportion of Total Health Expenditure in State: NR
(If available % spending on Health in the State may also be provided)
10. ANY OTHER SIGNIFICANT INFORMATION NR
11. INNOVATIONS NR
12. OVERALL SUMMARY OF STATE LEVEL MENTAL HEALTH SERVICES
Services are confined to those provided by the Manochikitsa Kendra.

SECTION 2
2.1. PSYCHIATRIC INSTITUTIONS
No psychiatric institutions
SECTION 3
3. General Hospital Departments of Psychiatry and District Hospital Departments
Further details not provided.
SECTION 4
No NGOs working in the area of mental health.
4.8. SUMMARY AND RECOMMENDATIONS FOR SECTION 4
Very little information to report.

166

SECTION 5
DISTRICT MENTAL HEALTH PROGRAMME (information in the prescribed format is not
available)

5.1. A brief description of the location of the DMHP, when it started, total population covered:
0NE DISTRICT WHERE DMHP HAS BEEN INITIATED AND BEING IMPLEMENTED
5.2. A summary of annual registrations old and new, treatment outcomes in terms of those on
regular treatment and those dropped out, with diagnostic categories if provided. Would be
useful to know what kind of clientele is serviced under the DMHP NR
5.3. Frequency of home visits carried out by the HW/ANM; numbers covered and for what
diagnostic categories, no of admissions facilitated: NR

167

5.4. Kinds of essential drugs available, number dispensed, number of patients receiving
medication under the DMHP in a month: NR
5.5. Duration of untreated mental illness for different diagnostic categories if provided: NR
5.6. Monitoring of the DMHP by the concerned officer /impressions and trouble-shooting
(mention if there is a committee and its composition): NR
5.7. IEC activities of the DMHP: NR
5.8. Training calendar of the DMHP (doctors, health workers, nurses, pharmacists, school
teachers/Anganwadi workers (whether any training conducted): NR
5.9. Activities to sensitize the gram panchayats: NR
5.10. Special Rapporteurs report on the activities of the DMHP, its reach, areas of good
performance, areas of poor performance, barriers for effective service delivery, measures to
streamline functioning, funding flow and barriers thereof: The Programme has been
discontinued.
5.11. Inspection Committees observations: Not visited as there is no psychiatric hospital.
5.12. SUMMARY OBSERVATIONS OF DMHP AND RECOMMENDATIONS:
The details are so scanty and the report is that the Programme has been discontinued.
SECTION 6
6. SUMMARY OF MENTAL HEALTH CARE INDICATORS IN ____DAMAN & DIU_ (name of state)
6.1. Availability of mental health facilities

Mental health outpatient


facilities in the state
Day treatment facilities
Psychiatric beds in general
hospitals
Community residential facilities
Beds/places in community
residential facilities
Psychiatric hospitals
Beds in psychiatric hospitals

Total No of
facilities/beds
1

Rate per 100,000


population
0.4

10

4.0

168

6.2. Access to Care


Rate per 100,000
population

Females %

Persons treated in mental


health outpatient facilities
Persons treated in mental
health day care facilities
General hospital admissions
Community residential facilities
Persons staying in community
residential facilities at the end
of the year
Admissions to mental hospitals

No information provided on outpatient attendance.


6.3. Information Systems

Persons with mental


disorders treated in
primary health care
Interventions delivered
in primary health care
for persons with
mental disorders
Persons treated in
mental health
outpatient facilities
Contacts in mental
health day treatment
facilities
Admissions in general
hospitals with
psychiatric beds
Admissions in mental
hospitals
Days spent in mental
hospitals
Admissions in
community residential
facilities

Data on No of
persons/activities
collected and reported
YES/NO
N

Data on age and


gender are collected
and reported
YES/NO
N

Data on patients
diagnosis are collected
and reported
YES/NO
N

169

6.4. Human Resources at the State Level


Health professionals working
in the mental health sector
Rate per 100,000
Psychiatrists
Medical doctors not specialised
in psychiatry
Clinical Psychologists
Psychiatric Social Workers
Psychiatric Nurses
Occupational therapists
Other health workers

Training of health
professionals in educational
institutions
Rate per 100,000
0.4

1
1

0.4
0.4

6.5. INFORMAL HUMAN RESOURCES (Family and User Associations)


Present in the state
No of members
Participation in the
formulation/implementation of
policy/plan/legislation

User
N
N
N

Family
N
N
N

6.6. MEDICINES
Type of Medication
All psychotropic medication
Mood stabilisers
Antipsychotics
Anxiolytics
Antidepressants
Anti-craving medication/ Substitution
treatments

Availability
Not recorded
Not recorded
Not recorded
Not recorded
Not recorded
Not recorded

SECTION 7
1. STATE MENTAL HEALTH REPORT CARD
SUMMARY OF SECTIONS 1-7.
Summary of areas where state has achieved good progress/little progress/no progress
There has been some increase of psychiatrists, but human resources are grossly deficient. The
details of functioning of the mental hospital in Sendari, Bilaspur are not complete. The DMHP
is functioning under one-third of districts and even these details are not available. Although
170

there are 5 government medical colleges, no PG Programmes have been initiated. Only two
centres have provided information on patient patterns.
MENTAL HEALTH REPORT CARD (needs to be revised after all the information is obtained)
Area

Focus

Parameters

Mental Health
Services
(Secondary
and Tertiary)

Medical
College
Depts,
General
Hospitals,
Specialised
psychiatric
hospitals

Adequacy of inpatient
beds
Functional Departments
Functional OP services

Primary
Health Care
mental health
services

District
Mental
Health
Programme

% of functional DMHPs

Rehabilitation
services

At all levels

Vocational training, day


care, longstay facilities in
govt sector/ppp

171

Rating

100- present, fully


satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100 All districts
covered; fully
satisfactory
75 majority of
districts covered
and functioning
50 half the
districts covered
and functioning
25 one-fourth of
the districts
covered and
functioning
0- No districts
covered/although
DMHP exists, not
functioning
100- present, fully
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent

Score
(out of
100)
0

Specialised
services

Services for
substance
use
disorders,
old age,
mental
retardation,
child
psychiatry,
community
services,
forensic
services
(exclude
DMHP staff
here)

Whether existing, level of


functionality, present at
different levels of care

100- present, fully


satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent

Human
Resources

Adequacy of
psychiatrists/clinical
psychologists/psychiatric
social
workers/psychiatric
nurses or mental health
trained nurses

100 fully
adequate
75 moderately
adequate
50 somewhat
adequate
25- inadequate
0 grossly
inadequate

25

Financing for
mental health

State level

Existence of separate
budget for mental
health/mental health
activities

Governance
and Policy

State
Mental
Health
Authority
and other
authorities

Separate Mental Health


Nodal Officer
Functioning Mental
Health Authority
Nodal persons for mental
health in SHRC/Legal
Services
Authority/Others

10% -separate
budget, fully
adequate
75 separate
budget, moderately
adequate
50 separate
budget, somewhat
adequate
25 no separate
budget, but some
financial resources
available annually
0 no separate
budget/marginal
financial resource
allocation
100 Existing, fully
functional
75- Existing, mostly
functional
50- Existing,
somewhat
functional
25- Partial

172

25

State Mental Health


Rules
State Mental Health
Programme
Range of medications
Regular supply and
dispensing
Standard procurement
arrangements

Availability of
psychiatric
medication

At every
level

Affirmative
action for
persons with
mental illness

At every
level

Disability assessment
Pension
Travel concession
Health insurance
Special assistance
Educational benefits
Job reservation

10

Treatment
Gap

Overall

Approximate number of
persons with mental
illness approximate
numbers totally receiving
treatment in the state

Total Score (out of 1000)


Average Score (%)

0 Non existent

100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25 Unsatisfactory
0- Not available at
any level
100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25 Unsatisfactory
0- Not available at
any level
100 no treatment
gap
75 25% treatment
gap
50 -50% treatment
gap
25 -75% treatment
gap
0- 100% treatment
gap

25

25

75
7.5

RECOMMENDATIONS:
The state needs to provide more complete information on all its facilities for mental
health. The UT is under-resourced as far as mental health professionals are concerned
and there are no within UT facilities for its enhancement. The UT needs to plan on
how it will enhance human resources by deputing its staff for training. Apart from the
10 bed general hospital facility, no other mental health services seem to exist. Even
the one DMHP appears non-functional.
There is an urgent need for a comprehensive mental health plan with strategies and
targets to be achieved in a time-bound manner.

173

NCT OF DELHI
SECTION 1. STATE LEVEL REPORT
1. GENERAL INFORMATION REGARDING THE STATE
1.1. Area: 1483 sq. km
1.2. No of districts: 11
1.3. Population, age distribution (as per census 2011): 167.87 lakhs
0-14 Years: 29% (48.69 lakhs)
15-59 Years: 65.3% (109.11 lakhs)
>or=60 Years: 5.7% (9.56 lakhs )
1.4. Gender distribution: Male=8987326 (53.6%); Females=7800615(46.4%)
1.5. Life expectancy at birth male and female: Male = 70.0 years, Female= 96.2 years
(Estimation of life expectation at birth for the smaller States of India, 2000. International
Institute of Population Sciences)
1.6. Per capita State Government expenditure on health:1207 in 2009-10 (A report by
National Institute of Public Finance and Policy)
1.7. Any health indicators for the state (life expectancy, etc)
1.8. Completeness/quality of information provided: Mostly Complete
2. MENTAL ILLNESS BURDEN/ INFORMATION REGARDING MENTAL ILLNESS
N
(prevalence)

2.1. Total number of persons with


mental illness (all ICD categories)

8.34 lakhs*

7%*

2.5. No of children with mental


health problems**
2.7. No of homeless mentally ill
persons

3.15 lakhs *

6.46%*

26666

33.3%

N
%
Source of
(treatment
information
seeking)
1.4 lakhs
0.84% New

registration
in Psychiatry
OPD across
all facilities
in Delhi in
2013

174

Derived
using
estimates
from
survey
from
Ashray

Adhikar
Abhiyan

COMMENT: * actual data not available. Estimated on the basis of various meta-analysis of
epidemiological studies in India
**Derived using estimates from article by Malhotra S et al

3. MENTAL HEALTH SERVICES IN THE STATE:


3.1. Organization of Services (description of number of psychiatric hospitals, medical college
depts, district hospitals)

N/N
3.1.a No of district
general hospitals with
separate department of
psychiatry
3.1.b No of medical
colleges with department
of psychiatry
3.1.c No of district
general hospitals
providing psychiatric care
3.1.d No of District
Mental Health
Programmes in the State

No with dept/facility
Total No of units

% coverage

3/24

18%*

8/8

100%

13/33

39% *

5/11

45%*

N
3.1.e No of government
psychiatric hospitals
3.1.f No of private
psychiatric hospitals
3.1.g Total No of
psychiatric hospitals in
the state
3.1.h No of NGOs
providing mental health
care

1
22
23

14

COMMENT: Being a very small state, travelling from one corner to the other does not take
more than two hours and location of DMHP clinics have been kept in mind the geographical
coverage. No one has to travel more than 5 kilometres to access psychiatric care.
175

3.2. INPATIENT SERVICES


DESCRIPTION:

Psychiatric
hospitals
(Govt) N=1
3.2.a. Total Inpatient
sanctioned/available
beds
3.2.b No of male beds
3.2.c. No of female
beds
3.2.d. No of beds for
children
3.2.e. No of beds for
elderly
3.2.f. No of beds for
substance use
disorders
3.2.g. No of beds for
forensic psychiatry
3.2.h. Occupancy (%)
3.2.i. No of admissions
during previous year
3.2.j. No of discharges
during previous year
3.2.k. Average
duration of inpatient
stay in days mean
3.2.l. Average
duration of inpatient
stay in days median
3.2.m. No of closed
wards
3.2.n. No of closed
ward beds
3.2.o. No of open
wards
3.2.p. No of open
ward beds
3.2.q. No of paid
wards
3.2.r.No of paid beds
3.2.s.No of admissions

270

Psychiatric
hospitals
(Private)
N=24
375

General
Hospitals
N=5

District
Hospitals
N=0

NGOs
N=0

Total

170

815

140
110
10
40

40
87.7%
1923

2728

1862
39 days

11
210
5
70
1
5
276
176

through courts
3.2.t. No of deaths in
the last year
3.2.u. No of suicides in
the last year

4
0

3.3. OUTPATIENT SERVICES

3.3.a. No of new OP
registrations in the
previous year
3.3.b. No of
emergency
attendees in the
previous year
3.3.c Total no of OP
follow-up in the
previous year

Govt.
Psychiatric
hospitals
N=
33939

Private
Psychiatric
hospitals
N=
15808

General
Hospitals

District
Hospitals

NGOs

Total

N=
71936

N=
17972

N=
-

139655

19312

896

1350

184

21742

204131

51133

292698

53694

601556

4. REHABILITATION FOR PERSONS WITH MENTAL ILLNESS


4.1. Government residential rehabilitation/long stay facilities : None at present(*See 4.3)
4.2. Government day care/outdoor rehabilitation facilities: 1 day care centre at IHBAS
4.3. Government run half-way homes: None at present. However, Network of Long Stay
Homes and Half way Homes (LSH/HWH) is being planned for the State of Delhi. 7 of such
LSH/HWH are to be started soon. 5 LSH/HWH are planned to be under administrative
control of Department of Social Welfare. The buildings have been constructed and
administrative and monitoring mechanism for such rehabilitation homes is under
deliberation. 2 LSH/HWH are planned to be constructed at IHBAS for which approval o f
Layout plan is MCD and DDA is in process.
4.4. NGO participation in the half way homes:
4.5. Long stay rehabilitation facilities: No and description; NGO participation:
5. MENTAL HEALTH CARE IN OTHER COMMUNITY FACILITIES
State Level, in the Govt Sector

5.1. No of shelter homes, observation homes,


special homes and childrens homes
5.2. No of counsellors trained in mental health in
the above institutions

177

5.3. No of protection homes for destitute women


5.4. No of counsellors trained in mental health in
the above institutions
5.5. No of old age homes
5.6. No of counsellors trained in mental health in
the above institutions
5.7. No of Central Jails and District Jails in the State
5.8. No of counsellors trained in mental health in
the above institutions

1
0
2
0
2
0

Comment: It is not specified if the personnel in the community facilities are trained in mental
health.
Helplines for Mental Health
Suicide Helpline by NGOs- Sanjivini, Sumaitri and Snehi
Disha (Pre-Exam Helpline for students, parents and Teachers run by NGO Snehi)
Hopeline ( A Pre-and Post Exam Helpline for students and parents run by NGO Snehi)
6. MENTAL HEALTH HUMAN RESOURCES
Mental Health Care Professionals

6.1. No of
Psychiatrists
6.2. No of Clinical
Psychologists
6.3. No of
Psychiatric Social
Workers
6.4. No of nurses
trained in mental
health
6.5. No of trained
counselors

Government
Sector medical
colleges/hospitals

Private
medical
colleges

134

Private
Total
Psychiatric
Hospitals/Nursing
Homes
61
196

16

56

72

19

17

36

22

24

COMMENT:
There is no sanctioned post of Psychiatric Social Worker or Clinical Psychologist in any District
Hospital apart from Medical Colleges/Teaching Institutes.

178

7. MENTAL HEALTH HUMAN RESOURCE DEVELOPMENT


7.1. Degree/Diploma Courses
In Entire state, Annual No of
Seats in
MD Psychiatry
DNB Psychiatry
Diploma in Psychiatry
PhD Clinical Psychology
MPhil Clinical Psychology
PhD Psychiatric Social Work
MPhil Psychiatric Social Work
PhD Psychiatric Nursing
MSc Psychiatric Nursing
BSc Psychiatric Nursing
Basic Diploma in Psychiatric
Nursing (DPN)

Institutions where the Programme is offered

22
5
0
3
17
0
0
0
0
0
0

IHBAS, AIIMS, MAMC, LHMC, RML


Sir Ganga Ram Hospital, Base Hospital
AIIMS
IHBAS

Comment: The UT has several centres offering post-graduate training. However, training in
psychiatric social work and psychiatric nursing is completely deficient.
7.2. Other training in mental health
IHBAS conducts training of General Practioners in Private Sector and Medical and
Paramedical Staff from Delhi Health Services, Municipal Corporations, Central Armed Police
Forces.
7.2.a. Details of Undergraduate MBBS training in psychiatry
Name of medical college
No of hours of
theory

Duration of
psychiatry
posting during
UG

Duration of
psychiatry
posting during
internship

10 hours

15 days

15 days

179

Qualifying
Examination
includes
competency
evaluation in
psychiatry
No skill testing.
Only a single
question in
Medicine Theory
Examination

7.2.b. Details of in-service training for Govt medical officers (No trained, duration)
Nearly 200 Medical Officers have been imparted a 3 day training at IHBAS so far. IHBAS has
designed its own GP Training Module to suit the local needs.
7.2.c. Any other training courses in mental health offered by the state
Different levels of Medical & ParaMedical Staff are provided training in Mental Health across
different sectors/agencies in Delhi by IHBAS:
a.
b.
c.
d.

School Health Programme of MCD


Central Armed Police Forces (Paramilitary)
Counsellors in Observational Homes
Asha Kiran (A Government Run Home for persons with Mental Retardation)

8. GOVERNANCE:
8.1. Nodal Authority and responsibilities:
Name

Contact details

Ms. Madhu Garg, Special


Secretary, Health & Family
Welfare, GNCTD

9th Floor, A Wing, Delhi Secretariat, Delhi

1.

Medical Education

2.

State Medical and


Health Department.

Dr. S. K. Sharma Director,


Directorate of Health
Services GNCTD

Social Welfare
Department

Ms. A Madhavi,
Dy.Director
(Disability)

3.

4.

State Mental Health


Authority

5.

District Legal
Services Authority

DHS Office, Karkardooma, Delhi


Department of Social Welfare, GNCT of
Delhi, Delhi gate, New Delhi
(Ph.23724493; 23713612)

Dr Nimesh G Desai, Member


Secretary, SMHA & Director,
IHBAS

Sh. Dharmesh Sharma,


Member Secretary, DSLSA

180

Director Office, Institute of Human


Behaviour and Allied Sciences, Dilshad
Garden, Delhi-95 (Ph: 011-22112136)

Central Office, Pre-Fab Building, Patiala


House Court,
New Delhi-110001

8.2. Presence of a State Mental Health Plan: SMHA, Delhi & IHBAS with active collaboration of
all stakeholders across all agencies has on multiple occasions in the form of Public Seminars
and Stakeholders consultative meet discussed and deliberated the themes cutting across
various aspects of the Mental Health Services Network and various strategies of inter-sectoral
coordination & linkage at different levels. Based on this, the draft Delhi Mental Health Plan
has also been prepared by SMHA, Delhi which is now in the process of final stages of
deliberations with the Policymakers under Department of Health.
8.3. Enactment of State Mental Health Rules: The model State Mental Health Rules, 1990 under
Mental Health Act, 1987 have been officially adopted by State Mental Health Authority in 1999.
The SMHA, Delhi in consultation with professional organizations like DPS, IAPP and Judicial
bodies have also developed the draft guidelines for various categories of Mental Health services
facilities regarding minimum standards and is being proposed to be included in State Mental
Health Rules.
8.4. Oversight of policies and Programmes related to mental health:
a. Department of Health has a dedicated nodal officer of the rank of Special Secretary
for Mental Health
b. SMHA, Delhi with its technical secretariat at IHBAS plays active role in Promoting
Awareness about Mental Health and active initiative for Policy issues pertaining to
Mental Health.
c. IHBAS as the nodal agency for implementation of Mental Health Programme in Delhi
has also initiated many community based outreach initiatives for vulnerable population
with active collaboration with NGOs, Users and Carers organizations and Quasi Judicial
Bodies like DSLSA.
8.5. Specific oversight of the DMHP programme.
DMHP is functional in 5 Districts and practically covers entire geographical area of Delhi.
Continuous supply of medications is being insured. However, due to frequent changes in
directives regarding staffing and resulting litigation, recruitment has been suffering. However,
essential clinical services are being ensured by the Nodal Agency (IHBAS). Training has also been
suffering because of non-availability of funds.
8.6. Attempts towards integration of mental health care into general health care, NCD
management etc.
The presence of Department of Psychiatry in various Medical Colleges, non-teaching Hospitals,
and large Multi-specialty Private Hospitals ensures Psychiatric Care in general health setting.
181

Besides, DMHP has been strategically located in General Hospitals/Dispensaries to achieve


integration with general health care. The designated Psychiatric Hospital-IHBAS also has
liasoning with neighbouring General Hospitals.
8.7. Examples of commitment to develop mental health services
The budget for lone Psychiatric Hospital has been steadily increasing over time. Also, DMHP has
been rescued several times by approval of loans by State Government in event of delay/nonrelease of funds by Government of India.
8.8. Examples of inter-sectoral collaboration to improve mental health services (including PPP
intitiatives)
Mobile Court for issuing Reception Orders and treatment orders has been functioning at Jama
Masjid with help from DSLSA and NGOs.
There is active collaboration between Health and Social Welfare Departments for regular
review of Mental Health Services in various shelter homes, women homes and Juvenile Homes.
8.9. Attempts towards mental health promotion
There are regular public sensitization and awareness Activities in the form of Mental Health
Awareness Week and Brain Awareness Week every year. Apart from this, several Stakeholders'
consultative meetings have been organized.
9. FINANCING
9.1. Sources of financing of different categories
Government of India finances Department of Psychiatry in its Medical Colleges and other
Hospitals, and also finances 3 out of 5 DMHPs. It has also agreed to support IHBAS as a Center
of Excellence under its manpower development Scheme in Mental Health.
State Government is financing the only public sector Psychiatric Hospital-IHBAS and Psychiatry
Departments in its Medical Colleges and other Hospitals. It has also taken over 2 DMHPs in the
State.
Municipal Corporation is financing one of Medical College with its Psychiatry Department.
Besides, Employee State Insurance Scheme Hospitals are financed as per statutory
arrangement.
Private Psychiatric Hospitals are largely financed by out-of-pocket expenses by public.

182

9.2 Budget provision from State and Centre in INR (for different facilities if required): Per
capita Health expenditure (this is different from budget allocated to health department) by
State & Centre is 1207 and 58 respectively for year 2010-11. There is no separate budgeting
for Mental Health. However, there is line item of Outreach Services for Homeless Mentally Ill
persons under the overall plan outlay of IHBAS in 12 th Five Year Plan.
9.3. Mental Health Expenditure as proportion of Total Health Expenditure in State: NA
10. ANY OTHER SIGNIFICANT INFORMATION
Writ Petition (WPC 6698/2007) Pratibha Chopra Vs Union of India has ensured that several
long-stay homes for recovered mentally ill persons are in final stages of being materialized. The
order in this Writ Petition had directives to start mental health services across various agencies
with the predominant focus on having minimum accessible mental health services to the
various categories of vulnerable population.
An Insurance scheme is under consideration by State Government and Pension Scheme for
persons disabled by Mental Illness is already in place.
11. INNOVATIONS
SMHA, Delhi and IHBAS have constantly been trying to evolve the innovative Programmes
based on the community care model on the principle of continuum of care. These few
Programmes highlights are given below:
Mobile Court on the street in collaboration with DSLSA for facilitating treatment and care of
severely mentally ill persons on the street has been set-up for first time in India.
Mental Health Outreach Programme for Homeless at Jama Masjid is being run since 2000 in
collaboration with NGO and is providing treatment for chemical dependence and Common
Mental Disorders on the streets of Old Delhi area.
Mobile Mental Health Service (MMHU) provides pre-hospitalization services for home-bound
and homeless mentally ill.
Hospital based innovations: IHBAS has a Psychiatric Intensive Care Unit (PICU) which is one of
its kinds in entire North-India.
IHBAS also has a Mother and Child Care Unit (MCU) which provides in-patients care to mothers
with Severe Mental Illness without separating their children from them during their
hospitalization.

183

SECTION 2
2.1. PSYCHIATRIC INSTITUTIONS
There is only one Public Sector Psychiatric Institute named Institute of Human Behaviour and
Allied Sciences situated near the North-Eastern border of Delhi.
Domains
Infrastructure

Amenities and facilities

Status in 2008*
New Buildings, State-of-the-art
infrastructure, Separate waiting
halls and toilets, Dharamshala
Specialty Clinics

Financial arrangements

Not reviewed

Diet

Herbal Garden, Effluent


Treatment Plan, Biomedical
Waste management, Budget
allocation 50/day per patient.

Investigations and treatment


Staff and training
Supportive services
Recreation/Occupational
therapy/Rehabilitation

Not reviewed
Not reviewed
Not reviewed
Day care activity scheduling,
vocational training, Indoor and
outdoor games, TV, Radio,
Computer, Library
Not reviewed

Networking with other agencies

Developments since 2008


New Emergency Block,
Renovation of Old Psychiatry
Blocks is in progress.
Child and Adolescent Psychiatry
Ward and Mother and Child
Care Unit have been
established
Financed by Government of
Delhi. Centre of Excellence is
being financed by Govt. of
India.
Dining arrangement with table
and chairs with large screen
TVs. Amount spent on food
items translates into 53.50 per
bed per day. 3075 Calories per
day are being provided.

Regular Picnics

Active networking with


Department of Social Welfare,
DSLSA, Women & Child
Development, Asha Kiran,Nari
Niketan. Training is being
provided to Medical Officers
from Central Armed Police
Forces and MCD.

*Reference: Nagaraja D & Murthy P. Mental Health Care and Human Rights. National Human
Rights Commission. 2008

184

SERVICES
i. Outpatient: A separate OPD Block with waiting halls with toilets and drinking water is
present. Annual OPD registration is nearly 2.5 lakhs and continues to be steadily growing
despite availability of several GHPUs in this region, indicating patient preferance. Several
specialty clinics: Child and Adolescent Psychiatry, Mental Retardation, De-addiction, Marital and
Psychosexual, Tobacco Cessation.
ii. Inpatient: In-patient facilities have been further upgraded with renovation of wards. There
has been an increase in number of admission through Reception Orders because of
sensitization of Police and Judicial Officers about plight of homeless mentally ill. The list of
medications available for in-patients is very large with several relatively high cost and newer
medications with improved efficacy and lesser side effects being made available. Number of
ECTs administered is very low considering the bed strength and occupancy. All ECTs are
modified and Anaesthetist is always available. The Dining Facility with Tables and Chairs and TV
screens is one of its kinds in any Psychiatric Institute.
Diagnostic categories seen in Rank Order:
Rank
Order
1
2
3
4
5

Out-Patient

In-Patient

Depressive disorders (12.8%)


Other psychotic disorders (10.3%)
Alcohol and drug abuse disorders (9.7%)
Other anxiety disorders (6.1%)
Schizophrenia (4.9%)

Schizophrenia (24.6%)
Bipolar mood disorder (19.9%)
Alcohol and drug abuse disorders (17.5%)
Other psychotic disorders (12.5%)
Children with psychiatric illnesses (3.6%)

iii. DIAGNOSTICS AND THERAPEUTICS

Investigations: Most of the common investigations and many advanced Investigations


are available in-house. There are state-of the-art laboratories in the Diagnostic Block
and many other tertiary care Public Hospitals avail the advanced laboratory services like
immune-histo-chemistry.
Therapeutic facilities: Apart from Medications, high emphasis on Psycho-social care is
given for improved treatment outcomes. Average length of stay is around a month.
Improvements in rehabilitation: More than 90 % of the patients are discharged with
family members. The Institute works on the principle of Prevention of
Institutionalization.

iv. ENGAGEMENT:

185

Attempts to involve families of persons with mental illness: Families are educated about
patients illness and are involved in decision making regarding treatment.
Disability certification and number of certificates issued in the previous year: IHBAS
issues disability certificates for Mental Illnesses, Mental retardation, and Neurological
Disabilities. 2030 disability certificates were issued last year.

v. ADMINISTRATIVE

Annual number of adverse events: 27 complaints were received last year and none was
of level 3 (major) or level 4 (Critical/serious nature) as per documented categorisation
standards.
Mechanisms for redressal of patient complaints: All complaints are examined as per
Hospital Policy framed under NABH standards and there is an elaborate mechanism for
grievance redressal in place.

vi. COMMUNITY OUTREACH AND NETWORKING

Community Programmes: IHBAS is the Nodal Centre for implementation of DMHP in


Delhi. Besides this, an outreach clinic for Homeless Mentally Ill is being run on streets of
Jama Masjid area for more than a decade.
Networking with external agencies: IHBAS has active collaboration with various NGOs,
Users and Carers Groups, and Various Government Agencies including Quasi-Judicial
bodies to address various aspects related to mental health.
Public mental health education: Mental Health Awareness Week and Brain Awareness
week are two major public awareness Programmes organized by IHBAS. Besides this,
there are numerous other awareness ativities.

vii. TRAINING

Post-graduate training IHBAS has MD Psychiatry, DM Neurology and M. Phil Clinical


Psychology Courses. M. Phil Psychiatric Social Work and Dip. Psychiatric Nursing is
planned.
Any other training Programmes: Provides internship/observership/training
opportunities to Graduate/Post-graduate students in Psychology, Social Work, and Postgraduate Psychiatry Students from GHPUs and Medical Officers and Paramedical staff
from State Health Services, Municipalities, Central armed Police Forces and General
Practitioners.

vii. RESEARCH:

186

IHBAS has numerous research publications and some important contributions are in
the area of Suicide Behaviour, Disaster Mental Health and Urban Mental Health
Module.

viii. ANY OTHER SALIENT CONTRIBUTIONS OF THE HOSPITAL/INSTITUTE: Prevention of


Institutionalization model of care
ix. Any monitoring of hospital: A Board of Visitors visits IHBAS every month and oversees the
issues related to Mental Health Act, 1987. Overall administration is monitored by Department
of Health of GNCTD. It has been visited by NHRC team/ Rapporteurs from time to time.
x. Special Rapporteurs observation:
Excerpts from NHRC Rapporteur (Mrs. S Jalja) report are:
IHBAS is a tertiary level mental health care Institution providing integrated Neuropsychiatric
Services and is also involved in teaching and training in the field of mental health and
neurosciences. It is also the nodal centre for implementation of NMHP/DMHP in the NCT of
Delhi and is one of the resource centres for the 2 Programmes. It has active collaboration with
NGOs and has initiated a number of community based mental care Programmes including
Mobile Mental Health unit (MMHU) and community base outreach services. Besides, it
functions as Secretariat of State Mental Health Authority of NCT of Delhi. The institute is NABH
accredited and is following the Out-Patient care based model for treatment, with minimum
hospitalization rate (less than 1%), low period of stay and high discharge rates of homeless
mentally ill. Care is taken by the Institute in preventing institutionalization.
It is a NABH accredited Institution, therefore, the quality assurance is not a problem. ..... Dr.
Desai and his team have been able to provide a vision on mental care and run the institution
based on modern approaches to mental health care and up-gradation of technology in the labs.
I also visited the different Departments and the patient care units. As mentioned the institute
follows the policy of minimum institutionalization and maximum community care. The patients,
both male and female, were in good condition. The wards were spacious and airy. Facilities like
drinking water, sanitation were seen provided to them. The wards were kept clean and
hygienic. Those patients who were fit were allowed freedom to move around within the wards,
which I think is a good step. I spoke to some of the patients and family members. They said they
had no complaints.
xi. Any other observations (including Inspection Committee Reports): Inspection Committee led
by Sh Anshu Prakash, Joint Secretary, Government of India, found the physical state of affairs at
IHBAS satisfactory.
187

IHBAS, NCT, New Delhi:


1. Rehabilitation of longstay patients
2. Number of vacant positions, particularly those created under COE scheme, to be filled
3. Geriatric ward waiting to be started

xii. Summary and Recommendations from SECTION 2:


Areas of positive change
NABH Accreditation for patient safety and
quality of care.
Increased bed strenghth
Child and Adolescent Psychiatry Ward
Center for Excellence under Manpower
Development Scheme of Government of India
MD Psychiatry seats have been increased from
2 to 4

Areas of poor progress


Research
Manpower shortage

SECTION 3
3. General Hospital Departments of Psychiatry and District Hospital Departments
Psychiatric OPD Services
GHPU/District Hospitals
S. No.

Name

New
registrations

Old
follow
ups

Waitin
g hall

Toilets

Separate
interview
rooms

Drinking
water

Canteen

OPD lab
services

OPD
rehab
services

Educational
materials

Teaching-Private
1

1
2
3
4
5

6
7

Hamd 1263
646
ard
Institu
te
Teaching Government
AIIMS 14921
40321
MAMC 4333
52809
& GB
Pant
UCMS
& GTB
RML
VMMC
&
Safdurj
ung

LHMC
NDMC
& Hindu
Rao

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes
Yes

Yes
Yes

Yes
Yes

Yes
Yes

Yes
Yes

Yes
Yes

Yes
Yes

Yes
No

6643

10921

No

No

No

Yes

Yes

Yes

No

No

23390
8249

115360

24987

Yes
Yes

Yes
Yes

Yes
Yes

Yes
Yes

Yes
Yes

Yes
Yes

Yes
Yes

Yes
Yes

40 per day
(Approx)

150

Yes

Yes

Yes

Yes

No

No

No

Yes

2400
(Approx)

3200

Yes

Yes

No

Yes

Yes

No

Yes

No

per day
Approx
Approx

188

Army
Hospital

8
GovtTeaching
Total
Teaching
Total

17319

71936

292598

73199

293244

Yes

Yes

Yes

Yes

Yes

Yes

No

Yes

Non- Teaching GHPU/District Hospitals


S.
No.
1

2
3
4
5
6
7
8
9

Name

New
registrations

Old
follow
ups

Waiting
hall

Toilets

Separate
interview
rooms

Drinking
water

Canteen

OPD lab
services

OPD
rehab
services

Educational
materials

Madan
Mohan
Malviya
Lal Bahadur
Shastri
Baba Saheb
Ambedkar
Deen Dayal
Upadhyay
Composite
Hospital
ESI Okhla
Central Jail
Hospital
ESI
Basaidarapur
ESI Jhilmil

NA

NA

Yes

Yes

Yes

Yes

Yes

No

No

No

Yes

Yes

No

Yes

Yes

No

No

No

5762

18947

Yes

Yes

Yes

Yes

No

Yes

No

Yes

NA

12000

No

No

Yes

Yes

Yes

Yes

Yes

Yes

116

NA

Yes

Yes

Yes

Yes

Yes

No

No

Yes

1469
3873

NA
5127

Yes
Yes

Yes
Yes

No
Yes

Yes
Yes

Yes
Yes

Yes
Yes

Yes
No

Yes
No

3585

8367

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

3167
17972

9253

Yes

Yes

Yes

Yes

Yes

ALL

Approx

53694

Psychiatric In-Patient Services


GHPU/District Hospitals
S. No.

Private
Teaching
1
Govt
Teaching
1
2
3
4
5

Name

Total Beds

Beds
occupied on
st
1 April

Average
Duration
of Stay

Total
admissions

Hamdard
Institute

AIIMS
MAMC & GB
Pant
UCMS & GTB
RML
VMMC &
Safdurjung

32
36

32
27

21 days
21 days

269
294

0
42
0

0
21
0

0
21 days
0

0
547
0

189

6
7
8

LHMC
NDMC &
Hindu Rao
Army Base
Hospital

GovtTeaching
Total
Teaching
Total

60
0

50
0

21 days
0

NA
0

55

55

16 days

NA

170

130

1110

170

130

1110

Average
Duration
of Stay
0

Total
admissions

Non- Teaching GHPU/District Hospitals


S. No.

Name

Total Beds

Madan
Mohan
Malviya
Lal Bahadur
Shastri
Baba Saheb
Ambedkar
Deen Dayal
Upadhyay
Composite
Hospital
ESI Okhla
Central Jail
Hospital
ESI
Basaidarapur
ESI Jhilmil

Beds
occupied on
st
1 April
0

0
0

0
0

0
0

0
0

2
3
4
5
6
7
8
9
10
Total

Emergency Services
GHPU/District Hospitals
S. No.
Private
Teaching
1

Name

Availability

Total
Number

Hamdard
Institute

No

Govt
Teaching

190

AIIMS

Yes

MAMC & GB
Pant
UCMS & GTB
RML
VMMC &
Safdurjung
LHMC
NDMC &
Hindu Rao
Army base
Hospital

Yes

1350
(approx)
-

No
Yes
Yes

Yes
No

Yes

1-2/day
(approx)
1350

3
4
5
6
7
8
GovtTeaching
Total
Teaching
Total

1350

Non- Teaching GHPU/District Hospitals


S. No.

Name

Availability

Madan
Mohan
Malviya
Lal Bahadur
Shastri
Baba Saheb
Ambedkar
Deen Dayal
Upadhyay
Composite
Hospital
ESI Okhla
Central Jail
Hospital
ESI
Basaidarapur
ESI Jhilmil

No

Total
Number
-

No

No

No

Yes

No
Yes

148

Yes

36

2
3
4
5
6
7
8
9
10
Total

184

191

Mental Health Manpower


GHPU/District Hospitals
S. No.

Private
Teaching
1
Govt
Teaching
1
2
3
4
5
6
7
8

Name

Qualified
Psychiatris
ts

General
Medical
Officer

Clinical
Psychologist

PSW/MSW

Traines
Psychiatric
Nurse

General
Nurse

Hamdard
Institute

AIIMS
MAMC & GB
Pant
UCMS &
GTB
RML
VMMC &
Safdurjung
LHMC
NDMC &
Hindu Rao
Army Base
Hospital

36
11

0
1

5
-

5
1

0
-

43
13

13
8

0
0

2
-

2
-

0
-

19
2

6
3

0
-

0
-

88

87

89

87

General
Nurse

GovtTeaching
Total
Teaching
Total

Non- Teaching GHPU/District Hospitals


S. No.

Name

Qualified
Psychiatrists

Madan
Mohan
Malviya
Lal Bahadur
Shastri
Baba Saheb
Ambedkar
Deen Dayal
Upadhyay
Composite
Hospital
ESI Okhla
Central Jail
Hospital

2
3
4
5
6
7

Clinical
Psychologist

PSW/MSW

General
Medical
Officer
-

Traines
Psychiatric
Nurse
-

1
3

192

8
9
10
11

Total

ESI
Basaidarapur
ESI Jhilmil
ESI Rohini
Chacha
Nehru Bal
Chikitsalaya

13

10

3.2. Areas (distribution throughout the states): The GHPUs are distributes throughout the state
in different areas.
3.5. Diagnostic categories in rank order that present in the outpatient- Depressive disorders,
alcohol and drug abuse disorders, Schizophrenia, Bipolar mood disorders, Obsessive compulsive
disorders
3.8. Extent of family involvement- Family members stay with the patient and are usually
involved in decision making regarding treatment
3.12. Psychotropic medication availability/free/cost- All govt. GHPUs provide psychotropics
from all major groups free of cost
3.13. ECTs- all ECTs are Modified ECTs.
3.14. Observations of extent to which counselling and psychotherapy are provided- varies
across different GHPus
3.15. Whether disability certification is available (if available numbers certified/year)- Some of
the GHPUs provide disability certificate
3.16. Extent and nature of community involvement- most of the large GHPUs have some
involvement in awareness activities
3.17. Whether engagement with the DMHP and extent- none
3.18. Nature and partnership with NGOs for networking- some of the GHPUs have collaboration
with NGOs
3.19. Presence of PG training- whether adequately distributed throughout the state- Psychiatry
post-graduation in many places. Deficiency of pg training in psychiatric social work and
psychiatric nursing.
3.20. Nature of public mental health material prepared and distributed/ activities to educatemost of the GHPUs have posters/pamphlets and organise various awareness camps.
193

3.21. Areas of research, sources of funding and major findings- there have been innumerable
research areas and varied sources of funding
3.22. Whether monitored and by whom. What were the observations?- there is no formal
monitoring by NHRC or any board of visitor (MC/GHPU)
3.23. Special Rapporteurs observations- not assessed (MC/GHPU)
3.24. Inspection Committees observations- not assessed (MC/GHPU)

3.25. SUMMARY AND RECOMMENDATIONS WITH RESPECT TO SECTION 3:


The services available are well-documented. This allows a critical appraisal of what exists and
what needs to be improved. Emergency services and post-graduate training in psychiatric social
work and psychiatric nursing are the areas that are deficient.
SECTION 4
4. NGOS WORKING IN MENTAL HEALTH:
S.No. Name of NGO
1. SUMAITRI
VOLUNTARY
ORGANISATION

Location
1, Aradhana Hostel
Cplx, Bhagwan DAS
Ln, Mandi House, Delhi
110001

2. SANJIVINI SOCIETY
A - 6,
FOR MENTAL HEALTH, Satsang Vihar,
Qutab Institutional
Area, South Delhi, New
Delhi, Delhi, India

Main Work
Suicide
prevention and
crisis
intervention

Clientele
Depressed and
suicidal

Depressed,
distressed, suicidal,
recovering mentally ill

3. SAARTHAK
(campaigns for the
rights of mentally ill.)

A-1/266,
Safdarjung Enclave,
New Delhi-110029.

Crisis
intervention,
Rehabilitation,
Community
outreach
Programmes,
Training in
counselling skills
Awareness and
advocacy about
mental illness

4. Manas
Mental Health and
Social Service

S-62, Okhla Industrial


Area Phase II,
New Delhi-110020
India.

OPD services
and community
outreach
Programmes

5. ROSHINI

K-4-d, Malviya Nagar,

Awareness,

194

Psychiatrically ill
persons, general
public and policy
makers
Mentally ill persons in
shelter homes

family members of

New Delhi -110017

6. SNEHI

B-347, Vasant Kunj


Enclave, New Delhi110070

7. NAMI

563 Sunehri Bagh


Sector-13, Rohini
Delhi-85

8. AANCHAL Charitable
Trust

F-16, Naveen Shahdara,


Behind Shyam Lal
College
Pocket-7 & 8, Jasola
Vihar, New Delhi110025

9. ACTION FOR AUTISM

10. ASHRAY ADHIKAR


ABHIYAN

11. MNGO

S-442, 2nd
Floor, School Block,
Near Bawa Palace,
Shakarpur
Delhi -110092
St. Stephen Hospital
Tis Hazari
Delhi

12. IGSSS

28, Institutional Area,


Lodhi Road, New Delhi03

13. THE EARTH SAVIOURS


FOUNDATION

34, Green Avenue


Road, Near D Block
Church,
Vasant Kunj, New
Delhi-110070 INDIA
195

support for
family members
of persons with
mental illness
Promoting
positive mental
health,
prevention of
suicide, training
people as
mental health
professionals, ,
providing
counselling
through
helplines
Counselling,
social assistance,
residential care,
day care,
training
Special
education
Rehabilitation
and special
education

persons with mental


illness

Students, parents,
teachers

Recovering/recovered
mentally ill persons

Children with
intellectual
disabilities
Persons with autism

Community
outreach clinics,
shelter home

Homeless mentally ill

Residential care,
rehabilitation,
legal and social
assistance
Awareness
about mental
illness, medical
illnesses and
substance use
Accommodation,
counselling,
medical care,
rehabilitation

Homeless mentally ill

Homeless and poor

Destitutes and old


age persons

4.5. Details of any training carried out by the NGO- SARTHAK provides Short training, Diploma,
certificate courses, Ashray Adhikar Abhiyan provides screening of SMI/de addiction training to
case managers, SNEHI provides counselling and mental health care skills training.
4.6. Networking activities of the NGO- Most of the NGOs have active collaboration with IHBAS
and department of social welfare
4.7. Salient contributions of the NGO- first line support services for homeless mentally ill
persons, helpline services, day care and rehabilitation, support for family members, prevention
of suicide.
4.8. Special Rapporteurs observations of NGOs- Not assessed
4.9. Inspection Committees observations of NGOs- Not assessed
SECTION 5
5. DISTRICT MENTAL HEALTH PROGRAMME
5.1. A brief description of the location of the DMHP
IHBAS is the nodal agency for implementation of DMHP in Delhi. The DMHP started in the year
2000. Currently it is being implemented in five out of eleven districts in Delhi. The geographical
location and schedule of the Clinics are provided below.
5.2. A summary of annual registrations old and new, treatment outcomes in terms of those on
regular treatment and those dropped out, with diagnostic categories if provided.
DMHP Location

Old Registrations
(Annual)

New
Registrations
(Annual)

Drop-Outs (of
New
Registrations)

288

Regular
Treatment (Of
New
Registrations)
124

South
(Chattarpur)
North-West
( Jehangirpuri)
South-West
(Dwarka)
West
(Moti-Nagar)
North (Timarpur)

5051
9700

683

409

204

4451

430

125

265

4208

625

230

279

2289

268

88

40

122

Common diagnoses in rank order are: Common Mental Disorders (31%), Psychosis (12%),
Substance Use Disorders (12%), Child & Adolescent Disorders (5%), Epilepsy (4%).
196

Delhi Government Dispensary


Timarpur
Monday, Thursday & Friday
09:30AM to 12.30PM

OPD Days:
Timings:

Babu Jagjeewan Ram Memorial Hospital


Jahangirpuri
OPD Days: Wednesday & Friday
Timings:
09:30AM to 01:00PM

Acharya Shri Bhikshu Government Hospital

Moti Nagar
OPD Days: Wednesday, Thursday &
Saturday
Timings:
09:30AM to 01:00PM

Delhi Government Dispensary


Sector12, Dwarka
Wednesday, Friday &
Saturday
Timings:
10.00AM to 01:00PM
OPD Days:

IHBAS
Delhi Government Dispensary
Chattarpur
OPD Days: Monday, Thursday & Saturday
Timings:
10.00AM to 01:00PM

5.3. Frequency of home visits carried out by the HW/ANM; numbers covered and for what
diagnostic categories, no of admissions facilitated: Nil
5.4. Kinds of essential drugs available, number dispensed, number of patients receiving
medication under the DMHP in a month: Near all major psychotropic classes are available for
free dispensing, round the year. Medication list includes many other newer medications apart
from those mentioned in NMHP list of essential psychotropics to be made available at DMHPs.
5.5. Duration of untreated mental illness for different diagnostic categories if provided:
5.6. Monitoring of the DMHP by the concerned officer /impressions and trouble-shooting
(mention if there is a committee and its composition): There are Supervising and Coordinating
Faculty for each DMHP and overall monitoring is done by a committee of Heads of Departments
of Psychiatry, Psychiatric Social Work and Clinical Psychology and by State Nodal Officer.
5.7. IEC activities of the DMHP: Monthly awareness Programmes in respective clinics alongwith
community contact Programme in respective districts in collaboration with NGOs and local

197

community leaders. However, in recent times, due to significant shortage of staff, it is not being
done on regular basis.
A regular State-wide Mental Health awareness Week is being organized in collaboration with
IHBAS & SMHA in the month of October on the eve of World Mental Health Day.
5.8. Training calendar of the DMHP (doctors, health workers, nurses, pharmacists, school
teachers/Anganwadi workers (whether any training conducted): As per modified activities,
training of Medical Officers is being done at IHBAS in centralized manner and till now
approximately 200 Medical Officers have been trained.
5.9. Activities to sensitize the gram panchayats: Not applicable to Delhi. However, sensitization
of Policymakers, Judicial Officers is done on regular basis under the aegis of SMHA, Delhi.
5.10. Special Rapporteurs report on the activities of the DMHP, its reach, areas of good
performance, areas of poor performance, barriers for effective service delivery, measures to
streamline functioning, funding flow and barriers thereof.
...Overall implementation of the Programme is satisfactory....
...If the DMHP is to be a success, there ought to be proper delegation and decentralization of
powers to the Outreach Clinics.....
...Shortage of Manpower is a serious problem faced by all outreach clinics...
....funding under the programme is highly erratic.......unless corrective measures are taken,
the utilization of funds under NMHP/DMHP will continue to remain a problem...
No posts of Research Officer has been created under DMHP.......action-research would be
more suited, as the learning from research is feed back into action.
...The NGO s needs to be fully engaged into all activities relating to mental health care....
..The treatment could be narrowed with greater community participation, removal of
constraints in field visits by the staff, timely funding for training and sensitization,
involvement of voluntary agencies and Institutions.
5.11. Inspection Committees observations
No visit to DMHP has taken place.
5.12. SUMMARY OBSERVATIONS OF DMHP AND RECOMMENDATIONS:

198

Currently, the activities of DMHP under 5 districts are implemented fully and following
activities are being undertaken by each DMHP:
a. Clinical Mental Health Services
b. IEC activities
c. Training
The problems faced are:
a.
b.
c.
d.

The delay in approval and process of release of funds.


The shortage of Manpower.
Infrastructure of the Clinics need to be upgraded.
The fund utilization norms are very restrictive and there is no flexibility permitted for
implementing agency.

There is proposal to implement DMHP in all districts in 12 th Five Year Plan in phase-wise
manner.
SECTION 6
6. SUMMARY OF MENTAL HEALTH CARE INDICATORS IN Delhi
6.1. Availability of mental health facilities

Mental health outpatient


facilities in the state
Day treatment facilities
Psychiatric beds in general
hospitals
Community residential facilities
Beds/places in community
residential facilities
Psychiatric hospitals
Beds in psychiatric hospitals

Total No of
facilities/beds
41

Rate per 100,000


population
0.22

1
170

0.005
0.91

0
0

0
0

1(govt.)+22(pvt.)
645

0.12
3.45

6.2. Access to Care

Persons treated in mental


health outpatient facilities
Persons treated in mental
health day care facilities
General hospital admissions
199

Rate per 100,000


population
746.81
0.11
5.93

Community residential facilities


Persons staying in community
residential facilities at the end
of the year
Admissions to mental hospitals

0
0

10.28

6.3. Information Systems

Persons with mental


disorders treated in
primary health care
Interventions delivered
in primary health care
for persons with
mental disorders
Persons treated in
mental health
outpatient facilities
Contacts in mental
health day treatment
facilities
Admissions in general
hospitals with
psychiatric beds
Admissions in mental
hospitals
Days spent in mental
hospitals
Admissions in
community residential
facilities

Data on No of
persons/activities
collected and reported
YES/NO
No

Data on age and


gender are collected
and reported
YES/NO
No

Data on patients
diagnosis are collected
and reported
YES/NO
No

Yes

No

No

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

Yes

NA

NA

NA

6.4. Human Resources at the State Level

Psychiatrists
Clinical Psychologists
Psychiatric Social Workers
Psychiatric Nurses

Health professionals working


in the mental health sector
Rate per 100,000
1.13
0.43
0.21
0.14

200

6.5. INFORMAL HUMAN RESOURCES (Family and User Associations)

Present in the state


No of members
Participation in the
formulation/implementation of
policy/plan/legislation

User

Family

Yes
NA
Have participated in various
stakeholders consultative
meetings

Yes
NA
Have participated in various
stakeholders consultative
meetings

6.6. MEDICINES
Type of Medication

Availability

All psychotropic medication


Mood stabilisers
Antipsychotics
Anxiolytics
Antidepressants
Anti-craving medication/ Substitution
treatments

Widely available
Widely available
Widely available
Widely available
Available at few centres

7.MENTAL HEALTH REPORT CARD


SUMMARY OF SECTIONS 1-7.
The information from Delhi has been systematically collected across all the sectors. This is an
example that it is possible to collate such information in every state. The highlights are a good
understanding of the problem to be addressed, special populations that need attention; a
serious attempt to capture the reach of mental health services through medical
colleges/GHPUs/Dt hospitals; information on the private hospitals and NGOs.
Good practices include setting up of helplines, mobile courts, help for the homeless mentally ill,
improvements at IHBAS including NABH accreditation, wide availability of psychotropic
medication.
Delhi is one of the few that has a mental health plan.

MENTAL HEALTH REPORT CARD (needs to be revised after all the information is obtained)
Area

Mental Health

Focus

Medical

Parameters

Adequacy of inpatient
201

Rating

100- present, fully

Score
(out of
100)
75

Services
(Secondary
and Tertiary)

College
Depts,
General
Hospitals,
Specialised
psychiatric
hospitals

beds
Functional Departments
Functional OP services

Primary
Health Care
mental health
services

District
Mental
Health
Programme

% of functional DMHPs

Rehabilitation
services

At all levels

Vocational training, day


care, longstay facilities in
govt sector/ppp

Specialised
services

Services for
substance
use
disorders,
old age,
mental
retardation,
child
psychiatry,
community

Whether existing, level of


functionality, present at
different levels of care

202

satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100 All districts
covered; fully
satisfactory
75 majority of
districts covered
and functioning
50 half the
districts covered
and functioning
25 one-fourth of
the districts
covered and
functioning
0- No districts
covered/although
DMHP exists, not
functioning
100- present, fully
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100- present, fully
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory

50

25

25

Human
Resources

Financing for
mental health

services,
forensic
services
(exclude
DMHP staff
here)

0- absent

Adequacy of
psychiatrists/clinical
psychologists/psychiatric
social
workers/psychiatric
nurses or mental health
trained nurses

100 fully
adequate
75 moderately
adequate
50 somewhat
adequate
25- inadequate
0 grossly
inadequate

50

State level

Existence of separate
budget for mental
health/mental health
activities

50

Governance
and Policy

State
Mental
Health
Authority
and other
authorities

Availability of
psychiatric
medication

At every
level

Separate Mental Health


Nodal Officer
Functioning Mental
Health Authority
Nodal persons for mental
health in SHRC/Legal
Services
Authority/Others
State Mental Health
Rules
State Mental Health
Programme
Range of medications
Regular supply and
dispensing

10% -separate
budget, fully
adequate
75 separate
budget,
moderately
adequate
50 separate
budget,
somewhat
adequate
25 no separate
budget, but some
financial
resources
available annually
0 no separate
budget/marginal
financial resource
allocation
100 Existing,
fully functional
75- Existing,
mostly functional
50- Existing,
somewhat
functional
25- Partial
0 Non existent

100- Fully
satisfactory
75- Mostly

50

203

75

Standard procurement
arrangements

Affirmative
action for
persons with
mental illness

At every
level

Disability assessment
Pension
Travel concession
Health insurance
Special assistance
Educational benefits
Job reservation

10

Treatment
Gap

Overall

Approximate number of
persons with mental
illness approximate
numbers totally receiving
treatment in the state

Total Score (out of 1000)


Average Score (%)

satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100 no
treatment gap
75 25%
treatment gap
50 -50%
treatment gap
25 -75%
treatment gap
0- 100%
treatment gap

50

25

475
47.5

RECOMMENDATIONS:
Delhi has made many important strides in developing mental health services,
particularly for the marginalised populations. There have been multiple funding
mechanisms. Human resources are relatively better, although PG training in
psychiatric social work and psychiatric nursing needs serious attention. There are still
problems with the DMHP with respect to human resources and funds. UG training
needs strengthening.
While the Mental Health Plan has been prepared, it needs to be monitored to ensure a
time-bound implementation.

204

GOA
SECTION 1. STATE LEVEL REPORT
1.1. GENERAL INFORMATION REGARDING THE STATE
1.2. Area- 3702 sq.kms
1.3. No of districts- 2
1.4. Population, age distribution (as per census 2011) 1458545
1.5. Gender distribution pop(male)- 739140, pop(female) 719405
1.6. Life expectancy at birth male and female: Males: Females:
1.7. Per capita State Government expenditure on health:
1.8. Any health indicators for the state:
1.9. Completeness/quality of information provided: Partially complete-several areas
of information not provided.
2. MENTAL ILLNESS BURDEN/ INFORMATION REGARDING MENTAL ILLNESS
N
(prevalence)
2.1. Total number of persons with
mental illness (all ICD categories)

3241

2.2. Broad categories


2.2.a Severe mental disorders
(BPAD, psychosis)
2.2.b Common mental disorders
2.2.c Substance use disorders
(alcohol and other drugs)
2.2.d Mental Retardation
2.3. No of Males with mental health
problems
2.4. No of females with mental
health problems
2.5. No of children with mental
health problems
2.6. No of elderly with mental health
problems
2.7. No of homeless mentally ill
persons

N
(treatment
seeking)
1547
(Inpatients),
45443 -OPD
patients
525
1317
722
80

--------NA
12
56
No record

NA

205

Source of
information
1)Hospicio
hospital, Margao
2) North District
Hospital, Mapusa

COMMENT: Information provided on mental illness in the state is only with respect to the
numbers seeking treatment. An estimate of persons in need of treatment in the state is
important to determine treatment gaps.
3. MENTAL HEALTH SERVICES IN THE STATE:
3.1. Organization of Services (description of number of psychiatric hospitals, medical
college depts, district hospitals)

N/N
3.1.a No of district
general hospitals with
separate department of
psychiatry
3.1.b No of medical
colleges with department
of psychiatry
3.1.c No of district
general hospitals
providing psychiatric care
3.1.d No of District
Mental Health
Programmes in the State

3.1.e No of government
psychiatric hospitals
3.1.f No of private
psychiatric hospitals
3.1.g Total No of
psychiatric hospitals in
the state
3.1.h No of NGOs
providing mental health
care

No with dept/facility
Total No of units

% coverage

1 (South Goa)

COMMENT: The information from facilities outside the two mentioned above is grossly
deficient.

206

3.2.
INPATIENT SERVICES
DESCRIPTION:
Psychiatric
hospitals
(Govt)
3.2.a. Total I.npatient
sanctioned/available
beds
3.2.b No of male
beds
3.2.c. No of female
beds
3.2.d. No of beds for
children
3.2.e. No of beds for
elderly
3.2.f. No of beds for
substance use
disorders
3.2.g. No of beds for
forensic psychiatry
3.2.h. Occupancy (%)
3.2.i. No of
admissions during
previous year
3.2.j. No of
discharges during
previous year
3.2.k. Average
duration of inpatient
stay in days mean
3.2.l. Average
duration of inpatient
stay in days median
3.2.m. No of closed
wards
3.2.n. No of closed
ward beds
3.2.o. No of open
wards
3.2.p. No of open
ward beds
3.2.q. No of paid
wards
3.2.r.No of paid beds

Psychiatric
hospitals
(Private)
N=0

184+6

General
Hospitals
N=5

District
Hospitals
N=2

NGOs
N=

Total

190

104
80

1108+439

1547

NA

7
140

207

3.2.s.No of
admissions through
courts
3.2.t. No of deaths in
the last year
3.2.u. No of suicides
in the last year

257

4
0

COMMENT: There a still a considerable number of admissions that come through the courts.

3.3.

OUTPATIENT SERVICES
Govt.
Psychiatric
hospitals
N=

3.3.a. No of new OP
registrations in the
previous year
3.3.b. No of
emergency
attendees in the
previous year
3.3.c Total no of OP
follow-up in the
previous year

Private
Psychiatric
hospitals
N=

General
Hospitals

District
Hospitals

NGOs

N=

N=

N=

Total

3713
3713
377

41730

COMMENT: Information from other sectors needs to be obtained systematically.


4. REHABILITATION FOR PERSONS WITH MENTAL ILLNESS
4.1. Government residential rehabilitation/longstay facilities : Yes
4.2. Government day care/outdoor rehabilitation facilities: No and description: 0
4.3. Government run half-way homes: No and description. If none, plans to establish
and details: 0
4.4. NGO participation in the half way homes: No
4.5.
Longstay rehabilitation facilities: 0

208

5. MENTAL HEALTH CARE IN OTHER COMMUNITY FACILITIES


State Level, in the Govt Sector

5.1. No of shelter homes, observation homes,


special homes and childrens homes

Shelter homes for


children and
women , Apna
Ghar for juvenile
children
2

5.2. No of counsellors trained in mental health in


the above institutions
5.3. No of protection homes for destitute women
5.4. No of counsellors trained in mental health in
the above institutions
5.5. No of old age homes

5.6. No of counsellors trained in mental health in


the above institutions
5.7. No of Central Jails and District Jails in the State
5.8. No of counsellors trained in mental health in
the above institutions
5.9.No of counsellors trained in mental health in
the above institutions

NIL
Old age homes
inder Provedorea
North and South
Goa
NIL
3
Psychiatrist
posted once a
month
NA

Helplines for Mental Health: 1097 for women, 2252525 for suicide prevention
COMMENT: A few of the community facilities have staff trained in mental health.
6. MENTAL HEALTH HUMAN RESOURCES
Mental Health Care Professionals

6.1. No of
Psychiatrists
6.2. No of Clinical
Psychologists
6.3. No of
Psychiatric Social
Workers
6.4. No of nurses

Government
Psychiatric
Sector medical
medical
colleges/hospitals colleges

Private
Practice

Total

16+4

NA

20

NA

05

01+01

NA

02

NA

60

54+6

NIL
209

trained in mental
health
6.5. No of trained
counselors

NIL

NIL

NA

COMMENT: The non-government information is lacking.


7. MENTAL HEALTH HUMAN RESOURCE DEVELOPMENT
7.1. Degree/Diploma Courses
In Entire state, Annual No of
Seats in

Institutions where the Programme is offered

MD Psychiatry

Institute of Psychiatry & Human Behavior,


Bambolim Goa

DNB Psychiatry
Diploma in Psychiatry

Nil
2

PhD Clinical Psychology


MPhil Clinical Psychology
PhD Psychiatric Social Work
MPhil Psychiatric Social Work
PhD Psychiatric Nursing
MSc Psychiatric Nursing
BSc Psychiatric Nursing
Basic Diploma in Psychiatric
Nursing (DPN)

NONE
NONE
Nil
Nil
Nil
Nil
Nil
Nil

Institute of Psychiatry & Human Behavior,


Bambolim Goa

COMMENT: Apart from psychiatry, there is no post-graduate training in any of the other
disciplines. No details of psychiatry UG training at the Goa Medical College is mentioned.
7.2. Other training in mental health
7.2.a. Details of Undergraduate MBBS training in psychiatry: Details NR
7.2.b. Details of in-service training for Govt medical officers (No trained, duration)---105
Medical officers from Directorate of Health Services trained by Institute of Psychiatry &
Human Behavior, Bambolim, Goa
7.2.c. Any other training courses in mental health offered by the state
None

210

8. GOVERNANCE:
8.1. Nodal Authority and responsibilities : Dr Prashant Natekar
8.2. Presence of a State Mental Health Plan: None
8.3. Enactment of State Mental Health Rules: Not specified
8.4. Oversight of policies and Programmes related to mental health: None
8.5. Specific oversight of the DMHP programme. Nil
8.6. Attempts towards integration of mental health care into general health care, NCD
management etc.: Not evident
8.7. Examples of commitment to develop mental health services (high level involvement,
budgeting, networking: Not evident
8.8. Examples of inter-sectoral collaboration to improve mental health services : None evident
8.9. Attempts towards mental health promotion : None evident
COMMENT: Strengths and weaknesses
It is unclear whether it is a deficiency in documentation or whether the states mental health
services outside of the IPHB, Margao and Mapusa.
9. FINANCING
9.1. Sources of financing of different categories : Not specified
9.2 Budget provision from State and Centre in INR (for different facilities if required): NR
9.3. Mental Health Expenditure as proportion of Total Health Expenditure in State: NR
(If available % spending on Health in the State may also be provided)
10. ANY OTHER SIGNIFICANT INFORMATION
11. INNOVATIONS
12. OVERALL SUMMARY OF STATE LEVEL MENTAL HEALTH SERVICES
Difficult to comment on because of lacunae in information.

211

SECTION 2
2.1. PSYCHIATRIC INSTITUTIONS
Name and a para on status in 2008 (refer to NHRC book Mental Health Care and Human
Rights)
North District Hospital, Goa
Domains
Infrastructure

Amenities and facilities

Financial arrangements
Diet
Investigations and treatment

Staff and training

Supportive services

Status
A separate OPD block has
been constructed with
dedicated emergency
services
working 24 hours, facilities
for visiting relatives
to stay, a waiting hall for
patients,
toilets for patients
and relatives, drinking
water,
canteen services, OPD
lab services.
Patient toilet ratio is 6.9:1.
There is 24 hour running
water with fans and
coolers. There are separate
interview rooms available.
OPD lab services are
available.
Rs. 90/- per patient per day
2000 calories per day per
patient
Basic biochemistry and
pathology tests available in
the lab
There are currently 20
psychiatrists,
105 GMOs, 1
PSW, and 54 trained
psychiatric
nurses and 4 CPs.
Extension clinics are run on

212

Tuesdays at 7 places
The report states that IP
rehabilitation services are
available

Recreation/Occupational
therapy/Rehabilitation
Networking with other
agencies
SERVICES
i. Outpatient: available

ii. Inpatient (improvement in in-patient facilities; any increase in open compared to closed ward
admissions; further reduction in court admissions; improvement particularly in the care of
women, children and elderly; use of disposables needles and syringes; no re-use of shaving
blades; any illness outbreaks and how contained; availability of psychotropic medication
including free medicines; use of ECTs including direct ECT): available.
Diagnostic categories seen:
iii. DIAGNOSTICS AND THERAPEUTICS

Investigations: all drugs and investigations available free of cost


Therapeutic facilities: all drugs and investigations available free of cost
Improvements in rehabilitation:

iv. ENGAGEMENT:

Attempts to involve families of persons with mental illness:evident


Disability certification and number of certificates issued in the previous year:

v. ADMINISTRATIVE

Annual number of adverse events: 0


Mechanisms for redressal of patient complaints: not evident

vi. COMMUNITY OUTREACH AND NETWORKING

Community Programmes: NA
Networking with external agencies: 3 NGOs
Public mental health education:

213

vii. TRAINING

Post-graduate training new Programmes, enhancement of seats and measures to


maintain/improve quality of training: 5 MD Psychiatry seats
Any other training Programmes:

vii. RESEARCH:

Research (areas, funding agencies, findings),

viii. ANY OTHER SALIENT CONTRIBUTIONS OF THE HOSPITAL/INSTITUTE:


ix. Any monitoring of hospital (internal or external)- By State Mental Health Authority.
x. Special Rapporteurs observation: Utilisation certificates are not been promptly sent.
xi. Any other observations (including Inspection Committee Reports): Parts of hospital require
urgent repair. MD seats can be enhanced in view of good number of faculties available.
Adverse events are routinely recorded (48 last year). The IC report records 2 visits by the
SHRC.
Enquiry by the Goa Human Rights Commission (Proceeding No 20/2012)
This enquiry was in response to media reports in a local newspaper Herald under the caption:
Its a mad scene at IPHB; IPHB lacks infrastructure to help calm tense nerves; 3) Plights of
patients at IPHB unending even after cure. The Commission issued notices to the Chief
Secretary, Govt of Goa, Secretary Health, Govt of Goa and the Dean, Goa Medical College. The
Commission also visited the IPHB on 13/05/2013 to ascertain the factual position. The
Commission noted the inordinate delay in filling up vacancies, the delay in creation of post of a
full-time director, and the lack of basic infrastructure though the State Govt was making an
effort to provide necessary basic infrastructure. The Committee made a set of 8
recommendations:
1.
2.
3.
4.
5.
6.

Filling up of post of director


Filling up of all vacant posts
Providing of all basic infrastructure for the inmates
Establishing of a day-care centre
Shifting of fully recovered patients to a safe environment
Utilization of the large area available for recreational activities
214

7. Growing of trees in the campus to make it environment friendly


8. Sincere efforts to maintain cleanliness
Two year later, there is still no director. The Dean of the GMC functions as director. Many of
the vacant posts appear, however, to have been filled. The IPHB is in the process of applying
under the Scheme A of the Central Govt for support as a Centre of Excellence. To overcome the
human resource shortage, the IPHB has taken 6 Assistant Lecturers on contract.

xii. Summary and Recommendations from SECTION 2:


Areas of positive change
Some positive changes in the IPHB
compared to earlier

Areas of poor progress


Lack of adequate long-term rehabilitation
for longstay patients
Vacancies of all positions, particularly
psychiatric social work and psychiatric
nursing
SECTION 3

3. General Hospital Departments of Psychiatry and District Hospital Departments


The broad outline for this section:
3.1. Names of GH/DH and their location.
Name
North District Hospital
Hoapicio hospital

location
Mapusa, Goa
Maragao, Goa

3.2. Areas (distribution throughout the states): Well distributed through out the state
3.3. Whether separate funding and adequacy: Funding available for Hospicio Hospital
3.4. Whether OP/IP and emergency services available: OPD and emergency services available
at both, inpatient available for only North District Hospital.
3.5. Diagnostic categories in rank order that present in the outpatient: mostly common mental
disorders. In the District hospital Northern Goa, all the 573 annual admissions in the previous year
were for addiction treatment. Government Sector services inadequate for the size and population of
the state.
215

3.6. Adequacy of OP facilities: adequate


3.7. Inpatient occupancy, free and paying beds, average cost of inpatient stay per week; rank
order of diagnostic categories: highly variable
3.8. Extent of family involvement- all
3.9. Measures to protect rights including complaint redressal: not apparent
3.10. Any networking: 3 NGOs involved
3.11. Staffing details and any shortages/vacancies: shortage at most places
3.12. Psychotropic medication availability/free/cost: available free in government hospitals
3.13. ECTs (Nos given across the facilities or average/No of direct ): available at few
3.14. Observations of extent to which counselling and psychotherapy are provided: variable
practise
3.15. Whether disability certification is available (if available numbers certified/year): available
at few centres
3.16. Extent and nature of community involvement: good
3.17. Whether engagement with the DMHP and extent:
3.18. Nature and partnership with NGOs for networking: yes
3.19. Presence of PG training- whether adequately distributed throughout the state: 2 MD
Psychiatry seats is available at Institute of Psychiatry and Human Behaviour, Bambolim, Goa.
3.20. Nature of public mental health material prepared and distributed/ activities to educate
3.21. Areas of research, sources of funding and major findings: IPHB is a teaching, training and
research Institute and there are plans to upgrade in the near future.
3.22. Whether monitored and by whom: None
3.23. Special Rapporteurs observations: Not relevant
3.24. Inspection Committees observations: Not relevant
3.25. SUMMARY AND RECOMMENDATIONS WITH RESPECT TO SECTION 3:

216

(Overall impressions about the mental health service delivery through the General and District
Hospitals).
It will be possible to comment only when comprehensive information is made available.
SECTION 4
4. NGOS WORKING IN MENTAL HEALTH:
4.1. A brief description of the NGO and its location: Sangath centre, Bardez, Goa
4.2. Nature of work carried out by the NGO in the domains mentioned and details of each:
Counselling and home-based Programmes
4.3. Description of clientele seen by the NGO and number of persons who use the services in
the previous year: Patient care services and rehabilitation
4.4. Research details: Research on Developmental and behavioural problems in children and
adolescents, common mental disorders, alcohol use disorders funded by national,
international and local funding agencies
4.5. Details of any training carried out by the NGO- Annual short course on leadership in
Mental Health. Many workshops are also being conducted with regard to mental health
training.
4.6. Networking activities of the NGO
4.7. Salient contributions of the NGO- Psychosocial interventions for a range of mental health
problems, school health programmes and interventions for children development and
behavioural problems
4.8. Special Rapporteurs observations- Not relevant
4.9. Inspection Committees observations-Not relevant
4.1. A brief description of the NGO and its location: COOJ Mental Health Foundation, Bastora,
Goa
4.2. Nature of work carried out by the NGO in the domains mentioned and details of each:
Awareness/education
4.3. Description of clientele seen by the NGO and number of persons who use the services in
the previous year: Counselling, legal and social assistance
4.4. Research details: no
217

4.5. Details of any training carried out by the NGO- Students on job training for 1-2 months and
vocational training for persons with mental illnesses.
4.6. Networking activities of the NGO
4.7. Salient contributions of the NGO4.8. Special Rapporteurs observations- Not relevant
4.9. Inspection Committees observations- Not relevant
4.1. A brief description of the NGO and its location: Sethu cente, Porvorim Goa
4.2. Nature of work carried out by the NGO in the domains mentioned and details of each:
Advocacy, awareness/education
4.3. Description of clientele seen by the NGO and number of persons who use the services in
the previous year
4.4. Research details: NR
4.5. Details of any training carried out by the NGO- Professionals and care givers of children
4.6. Networking activities of the NGO
4.7. Salient contributions of the NGO- training on sexuality issues conducted for people with
special needs
4.8. Special Rapporteurs observations- Not relevant
4.9. Inspection Committees observations-Not relevant
SUMMARY AND RECOMMENDATIONS FOR SECTION 4
There are a few NGOs working in Goa. However, there is no mention of mechanisms of
GO/NGO collaboration to address local mental health care needs.

218

SECTION 5
7. DISTRICT MENTAL HEALTH PROGRAMME ( information in the prescribed format is not
available)

5.1. A brief description of the location of the DMHP, when it started, total population covered:
south Goa, started in 2001
5.2. A summary of annual registrations old and new, treatment outcomes in terms of those on
regular treatment and those dropped out, with diagnostic categories if provided.
5.3. Frequency of home visits carried out by the HW/ANM; numbers covered and for what
diagnostic categories, no of admissions facilitated:
5.4. Kinds of essential drugs available, number dispensed, number of patients receiving
medication under the DMHP in a month:
219

5.5. Duration of untreated mental illness for different diagnostic categories if provided:
5.6. Monitoring of the DMHP by the concerned officer /impressions and trouble-shooting
(mention if there is a committee and its composition):
5.7. IEC activities of the DMHP:
5.8. Training calendar of the DMHP (doctors, health workers, nurses, pharmacists, school
teachers/Anganwadi workers (whether any training conducted): no training
5.9. Activities to sensitize the gram panchayats
5.10. Special Rapporteurs report on the activities of the DMHP, its reach, areas of good
performance, areas of poor performance, barriers for effective service delivery, measures to
streamline functioning, funding flow and barriers thereof:
5.11. Inspection Committees observations: Not relevant
5.12. SUMMARY OBSERVATIONS OF DMHP AND RECOMMENDATIONS:
The details of the DMHP are inadequate.
SECTION 6
6. SUMMARY OF MENTAL HEALTH CARE INDICATORS IN Goa
6.1. Availability of mental health facilities

Mental health outpatient


facilities in the state
Day treatment facilities
Psychiatric beds in general
hospitals
Community residential facilities
Beds/places in community
residential facilities
Psychiatric hospitals
Beds in psychiatric hospitals

Total No of
facilities/beds
3

Rate per 100,000


population
0.21

0
10*
0
0
1
190

0.07
13.02

Rate per 100,000


population
255

Females %

6.2. Access to Care*

Persons treated in mental


health outpatient facilities

220

Persons treated in mental


health day care facilities
General hospital admissions
Community residential facilities
Persons staying in community
residential facilities at the end
of the year
Admissions to mental hospitals

0
0

106

*incomplete
6.3. Information Systems

Persons with mental


disorders treated in
primary health care
Interventions delivered
in primary health care
for persons with
mental disorders
Persons treated in
mental health
outpatient facilities
Contacts in mental
health day treatment
facilities
Admissions in general
hospitals with
psychiatric beds
Admissions in mental
hospitals
Days spent in mental
hospitals
Admissions in
community residential
facilities

Data on No of
persons/activities
collected and reported
YES/NO
N

Data on age and


gender are collected
and reported
YES/NO
N

Data on patients
diagnosis are collected
and reported
YES/NO
N

221

6.4. Human Resources at the State Level


Health professionals working
in the mental health sector
Rate per 100,000
Psychiatrists
Medical doctors not specialised
in psychiatry
Clinical Psychologists
Psychiatric Social Workers
Psychiatric Nurses
Occupational therapists
Other health workers

0.10
NA
0.012
0.0088
NA
NA
NA

Training of health
professionals in educational
institutions
Rate per 100,000
0.035

0.038

6.5. INFORMAL HUMAN RESOURCES (Family and User Associations)


Present in the state
No of members
Participation in the
formulation/implementation of
policy/plan/legislation

User
N
N
N

Family
N
N
N

6.6. MEDICINES
Type of Medication
All psychotropic medication
Mood stabilisers
Antipsychotics
Anxiolytics
Antidepressants
Anti-craving medication/ Substitution
treatments

Availability
Available
Available
Available
Available
Available at few centres

7. STATE MENTAL HEALTH REPORT CARD


SUMMARY OF SECTIONS 1-7.
Summary of areas where state has achieved good progress/little progress/no progress
The figures for mental health personnel is incomplete, however it is clear that human
resources are grossly deficient. Some improvements have occurred at the IPHB. Without
more detailed information about the district hospitals/DMHP/other sectors, it is difficult to
accurately summarise the areas of progress.
222

MENTAL HEALTH REPORT CARD (needs to be revised after all the information is obtained)
Area

Focus

Parameters

Mental Health
Services
(Secondary
and Tertiary)

Medical
College
Depts,
General
Hospitals,
Specialised
psychiatric
hospitals

Adequacy of inpatient
beds
Functional Departments
Functional OP services

Primary
Health Care
mental health
services

District
Mental
Health
Programme

% of functional DMHPs

Rehabilitation
services

At all levels

Vocational training, day


care, longstay facilities in
govt sector/ppp

Specialised
services

Services for
substance
use
disorders,

Whether existing, level of


functionality, present at
different levels of care
223

Rating

100- present, fully


satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100 All districts
covered; fully
satisfactory
75 majority of
districts covered
and functioning
50 half the
districts covered
and functioning
25 one-fourth of
the districts
covered and
functioning
0- No districts
covered/although
DMHP exists, not
functioning
100- present, fully
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100- present, fully
satisfactory
75- present,
reasonably

Score
(out of
100)
50

50

25

25

Human
Resources

Financing for
mental health

Governance
and Policy

old age,
mental
retardation,
child
psychiatry,
community
services,
forensic
services
(exclude
DMHP staff
here)

satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent

Adequacy of
psychiatrists/clinical
psychologists/psychiatric
social
workers/psychiatric
nurses or mental health
trained nurses

100 fully
adequate
75 moderately
adequate
50 somewhat
adequate
25- inadequate
0 grossly
inadequate

25

State level

Existence of separate
budget for mental
health/mental health
activities

25

State
Mental
Health
Authority
and other
authorities

Separate Mental Health


Nodal Officer
Functioning Mental
Health Authority
Nodal persons for mental
health in SHRC/Legal
Services
Authority/Others
State Mental Health

10% -separate
budget, fully
adequate
75 separate
budget,
moderately
adequate
50 separate
budget,
somewhat
adequate
25 no separate
budget, but some
financial
resources
available annually
0 no separate
budget/marginal
financial resource
allocation
100 Existing,
fully functional
75- Existing,
mostly functional
50- Existing,
somewhat
functional
25- Partial
0 Non existent

224

25

Rules
State Mental Health
Programme
Range of medications
Regular supply and
dispensing
Standard procurement
arrangements

Availability of
psychiatric
medication

At every
level

Affirmative
action for
persons with
mental illness

At every
level

Disability assessment
Pension
Travel concession
Health insurance
Special assistance
Educational benefits
Job reservation

10

Treatment
Gap

Overall

Approximate number of
persons with mental
illness approximate
numbers totally receiving
treatment in the state

Total Score (out of 1000)


Average Score (%)

100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100 no
treatment gap
75 25%
treatment gap
50 -50%
treatment gap
25 -75%
treatment gap
0- 100%
treatment gap

25

25

275
27.5

RECOMMENDATIONS: A more detailed documentation is first required, for a proper


assessment of the problems and the responses required. The State requires to make a
detailed time-bound mental health plan and focus on the development of adequate human
resources, strengthening of the DMHP and primary health care. The deficiency of psychiatric
social workers and psychiatric nurses is particularly striking. GO/NGO collaboration can be
strengthened.

225

GUJARAT
SECTION 1. STATE LEVEL REPORT
8. GENERAL INFORMATION REGARDING THE STATE
8.1. Area: 196,204 km2
8.2. No of districts: 29
8.3. Population, age distribution (as per census 2011): 603lakhs
0-9 years
10-19 years
20-44 years
45-79 years
80 years and above

11296168
(18.7%)
12015205
(19.9%)
24036773
(39.8%)
12303640
(20.4%)
549062
(0.9%)

8.4. Gender distribution: Male: 52.1%


Female: 47.9%
8.5. Life expectancy at birth male and female: Male63.1; Female 64.1
8.6. Per capita State Government expenditure on health: 368 (2009-10)
8.7. Any health indicators for the state
Crude Death Rate:6.6
Crude Birth Rate:21.1
Infant Mortality:38
Sex Ratio: 919
8.8. Completeness/quality of information provided: Mostly Complete
9. MENTAL ILLNESS BURDEN/ INFORMATION REGARDING MENTAL ILLNESS
N
(prevalence)
2.1. Total number of persons
with mental illness (all ICD
categories)

28,00000

4.64%

226

N
%
Source of information
(treatment
seeking)
372398
0.62% Mental Health Mission
Report 2003

2.2. Broad categories


2.2.a Severe mental
disorders (BPAD, psychosis)
2.2.b Common mental
disorders
2.2.c Substance use disorders
(alcohol and other drugs)
2.2.d Mental Retardation
2.3. No of Males with mental
health problems
2.4. No of females with
mental health problems
2.5. No of children with
mental health problems
2.6. No of elderly with mental
health problems
2.7. No of homeless mentally
ill persons

Patients treated in
govt.
hospitals/departments
of psychiatry medical
college
department/general
hospital psychiatry
unit in 2013

85780
158935
35784
4563

56954

0.2%

23589

0.01%

6784

1.23%

NR

COMMENT: 0.62% of total population is under psychiatric treatment from various


Government Hospitals. Apart from this, many are expected to be on treatment from DMHP
and from Private Sources.
10. MENTAL HEALTH SERVICES IN THE STATE:
10.1.
Organization of Services (description of number of psychiatric hospitals, medical
college depts, district hospitals)

3.1.a No of district
general hospitals with
separate department of
psychiatry
3.1.b No of medical
colleges with department
of psychiatry
3.1.c No of district
general hospitals
providing psychiatric care
3.1.d No of District
Mental Health
Programmes in the State

N/N No with dept/facility


Total No of units
14/29

% coverage

19/19

100%

14/29

48%

8/29

27%

N
3.1.e No of government
psychiatric hospitals

227

48%

3.1.f No of private
psychiatric hospitals
3.1.g Total No of
psychiatric hospitals in
the state
3.1.h No of NGOs
providing mental health
care

64
68

COMMENT: Nearly half of the districts offer psychiatric care. All medical colleges have
departments of psychiatry.
10.2.
INPATIENT SERVICES
DESCRIPTION:

3.2.a. Total Inpatient


sanctioned/available
beds

Psychiatric
hospitals
(Private) N=
683

Psychiatric
hospitals
(Govt) N=
280

District
Hospitals
N=
300
(Medical
Colleges)

NGOs
N=

Total

40

1303

General
Hospitals

District
Hospitals

NGOs

N=

N=

N=

COMMENT:.

10.3.

OUTPATIENT SERVICES

3.3.a. No of new OP
registrations in the
previous year
3.3.b. No of
emergency
attendees in the
previous year
3.3.c Total no of OP
follow-up in the
previous year

Govt.
Psychiatric
hospitals
N=
17085

Private
Psychiatric
hospitals
N=

Total

*341700

129045

*2580900

*Estimates (Not part of affidavit information. See Comment below)

228

COMMENT: As per WHO-AIMS 2006 report only 5% of OPD data (mostly from Psychiatric
Hospitals) across Gujarat is transmitted to Health Department. Hence, actual OPD attendance
across all facilities combined should be around 20 times of listed figure.
11. REHABILITATION FOR PERSONS WITH MENTAL ILLNESS
11.1.
Government residential rehabilitation/longstay facilities : No and description:NA
11.2.
Government day care/outdoor rehabilitation facilities: No and description:4
11.3.
Government run half-way homes: No and description. If none, plans to establish
and details:Nil, no plans listed
11.4.
NGO participation in the half way homes:Nil
11.5.
Longstay rehabilitation facilities: NGOs Ashadeep Foundation (Junagadh) &
AtmaVishwas Vidyalaya (Valsad) are running long term centres.
12. MENTAL HEALTH CARE IN OTHER COMMUNITY FACILITIES
State Level, in the Govt Sector

5.1. No of shelter homes, observation homes,


special homes and childrens homes
5.2. No of counsellors trained in mental health in
the above institutions
5.3. No of protection homes for destitute women
5.4. No of counsellors trained in mental health in
the above institutions
5.5. No of old age homes
5.6. No of counsellors trained in mental health in
the above institutions
5.7. No of Central Jails and District Jails in the State
5.8. No of counsellors trained in mental health in
the above institutions
5.9.No of counsellors trained in mental health in
the above institutions

23
10
14
7
10
NA
4+22
NA
NA

Helplines for Mental Health: Aadhaar Helpline for mental health at Ahmedabad and Vadodara
9722100101/200
Saath Suicide prevention at Ahmedabad - 1098
COMMENT: Number of Counsellors is hugely deficient. Long stay facilities need to created.
Mental health services in jails needs to be properly organised.
229

13. MENTAL HEALTH HUMAN RESOURCES


Mental Health Care Professionals

6.1. No of
Psychiatrists
6.2. No of Clinical
Psychologists
6.3. No of
Psychiatric Social
Workers
6.4. No of nurses
trained in mental
health
6.5. No of trained
counselors

Government
Sector medical
colleges/hospitals
52

Private
medical
colleges
17

Private
Practice

Total

200

269

11

12

15

393

399

18

NA

18

COMMENT:
As per WHO-AIMS 2006 report, there were 210 Psychiatrists in Gujarat, mostly in private clinics.
The affidavit states 269 as the total number of psychiatrists presently.
7. MENTAL HEALTH HUMAN RESOURCE DEVELOPMENT
7.1. Degree/Diploma Courses
In Entire state, Annual No of
Seats in

Institutions where the Programme is offered

MD Psychiatry

23

B J Medical College, Ahmedabad; CU Shah Medical


College, Surendra Nagar; Government Medical
College, Bhavnagar; Government Medical College,
Surat; Medical College, Baroda; MP Shah Medical
College,Jamnagar; Pandit Deendayal Upadhyay
Medical College, Rajkot; SBKS Medical Instt. &
Research Centre, Vadodara; Smt. N.H.L.Municipal
Medical College, Ahmedabad

DNB Psychiatry
Diploma in Psychiatry
PhD Clinical Psychology
MPhil Clinical Psychology
PhD Psychiatric Social Work
MPhil Psychiatric Social Work
PhD Psychiatric Nursing

11
3
12
Nil
Nil
NA
230

MSc Psychiatric Nursing


BSc Psychiatric Nursing
Basic Diploma in Psychiatric
Nursing (DPN)

15
20

COMMENT: Data for Medical Courses updated from MCI website.


7.2. Other training in mental health
7.2.a. Details of Undergraduate MBBS training in psychiatry: Details not provided
7.2.b. Details of in-service training for Govt medical officers: 20 per annum, 2 weeks training *
7.2.c. Any other training courses in mental health offered by the state
30 nurses are trained per annum for 10 days.
Training of Health workers: 90 HW for 7 days
School Teachers: 150 for 4 days
8. GOVERNANCE:
8.1. Nodal Authority and responsibilities :

Nodal
Authority

Nodal Officers with


responsibility for mental
health care in the State
Health Services
Medical Education

1
2

State Medical and Health


Department
Social Welfare Department

3
4
5

State Mental Health


Authority
District Legal Services
Authority

Name

Contact details

Addl. Director Medical


Education
Addl. Director Medical
Services

5, Dr. Jivraj Mehta Bhavan,


Gandhinagar
14, Dr. Jivraj Mehta Bhavan,
Gandhinagar
16, Dr. Jivraj Mehta Bhavan,
Gandhinagar
5, Dr. Jivraj Mehta Bhavan,
Gandhinagar
High Court, Gujarat

Director - Social Defense


Member Secretary
Member Secretary-Legal
Service Authority

8.2. Presence of a State Mental Health Plan: No


8.3. Enactment of State Mental Health Rules: Yes

231

8.4. Oversight of policies and Programmes related to mental health:


Taluka Mental Health Programme
Thirteen Grant-in-aid Hospitals from 13 talukas of Gujarat were identified to provide aid under
a Taluka Mental Health Programme in line of District Mental Health Programme (DMHP).
Rupees 5 lakhs per annum are being given to each participating institution to upgrade their
OPD and Information Education &Communication (IEC) services, as well as support for
medication. Five additional Grant-in-aid hospitals were added as part of the programme.
Initiative in Public Sector
Following programmes were initiated in public sector hospitals which include 1 Hospital for
Mental Health ,Ahmedabad and 4 Medical Colleges.

Suicide prevention programme at all 6 Medical Colleges, with Surat as the nodal
centre

BJ Medical College were awarded 3 projects:

o Child Mental Health


o Adolescent Mental Health
o IEC
o Psychological first Aid
8.5. Specific oversight of the DMHP programme. Has been implemented in 8 districts. 4 more
districts are proposed. Inconsistency of funds from GoI is cited as area of difficulty.
8.6. Attempts towards integration of mental health care into general health care, NCD
management etc.: Taluka Mental Health Programme
8.7. Examples of commitment to develop mental health services : There are several innovative
Programmes like Dava & Dua, Taluka Mental Health, community based initiatives.
8.8. Examples of inter-sectoral collaboration to improve mental health services (including PPP
intitiatives): 8 NGOs have been selected to continue support and upscale community based
mental health activities.

Organization

District

Intervention Area

Ahmedabad
Ahmedabad
Womens Action
Group (AWAG)
Trust for Reaching the Panch Mahal

Domestic Violence
School Mental Health and
Adolescent
Tribal Population
232

Unreached (TRU)
Vikas Jyot Trust (VJT)
Baroda Citizen
Council (BCC)
Ashadeep Foundation

BAIF Foundation

Blind People
Association (BPA)

Vadodara
Vadodara
Junagadh
Porbander

Dang
Bharuch
Surant
Surendranagar
Kheda
Jamnagar
Navsari
Anand

Traditional Healers
Street Children
Urban Slum Population
Family Members
Rural Population
Rehabilitation for both urban and
rural
Day care Centre
Traditional Healers
Service Delivery
Rural Population
Disability
Community Based Rehabilitation

8.9. Attempts towards mental health promotion: None


COMMENT: There is a vibrant co-ordination with the NGO sector.
Strengths:
Several innovative schemes.
Mental health programmem by States own funds-Taluka Mental health Programme.
Weaknesses:
Less than half of districts covered under DMHP+TMHP
Total beds appear inadequate
Government Sector Services: inadequate for size and population of State.
9. FINANCING
9.1. Sources of financing of different categories: NR
9.2 Budget provision from State and Centre in INR : NR
9.3. Mental Health Expenditure as proportion of Total Health Expenditure in State: 3% as per
WHO-AIMS 2006 report. 90 % of this is on Psychiatric Hospitals.
10. ANY OTHER SIGNIFICANT INFORMATION

233

11. INNOVATIONS
Dawa & Dua Programme
Community Programme
Several Projects associated with Medical Colleges
12. OVERALL SUMMARY OF STATE LEVEL MENTAL HEALTH SERVICES

The constant effort to improve mental health services is commendable. There are good
public-private partnership.The State has may innovations in mental health care.
SECTION 2
2.1. PSYCHIATRIC INSTITUTIONS
Hospital for Mental Health, Bhuj (Information filled from Inspection Commitee Report)
Domains

Status in 2008

Infrastructure
Amenities and facilities

New facility
16 bedded with occupancy of
34. Proposed to be 30 bedded.

Financial arrangements

41.41 lakhs (enhanced


budget)

Diet
Investigations and treatment

25.21/day
ECTs

Staff and training

Only 1 Psychiatrist and 1 PSW.


Recruitment planned.

ECTs are given at nearby


District Hospital in view of
Anaesthetists availability
Resident Medical Officer Post
is vacant since Dec 2010. PSW
filled on contract basis. No
Psychiatrist/Clinical
Psychologist.

One carpenter. Provision of


computer training

TV hall with seating capacity of


12-15

Supportive services
Recreation/Occupational
therapy/Rehabilitation
Networking with other agencies

Developments since 2008


Remains 16 bedded.
Occupancy increased to 54.
Proposed to be 60 bedded
now.
2.5 crores sanctioned by State
Government for upgradation
to 60 bedded.

SERVICES
i. Outpatient: Available without Psychiatrist/Clinical Psychiologist.

234

ii. Inpatient: Admissions several times the sanctioned capacity. ECTs are provided at District
Hospital.
iii. DIAGNOSTICS AND THERAPEUTICS

Investigations: None available (Done at District Hospital)


Therapeutic facilities: Antidepressants and anticonvulsants are irregularly available
Improvements in rehabilitation: None apparent from Inspection Commitee report

v. ADMINISTRATIVE

Annual number of adverse events: 2


Mechanisms for redressal of patient complaints: Present

vi. COMMUNITY OUTREACH AND NETWORKING

Community Programmes: Outreach Services at Mandvi Sub-District Hospital

x. Special Rapporteurs observation: Not visited


Areas of positive change

Areas of poor progress

TV Hall
Sanction of Budget for upgradation

The measures proposed in 2008 are not yet


implemented in 2015.
Overcrowding.
No Psychioatrist/Clinical Psychologist. There is
only one contractual PSW in name of Mental
Health Professionals
Irregular supply of medications.
ECTs carried outside
No investigations available.

Hospital for Mental Health, Jamnagar


Domains

Status in 2008

Developments since 2008

Infrastructure

Occupation Therapy Building


2004
Rehabilitation Complex 2008
Kitchen renovation and new
auditorium underway
Open Ward
Involuntary admissions
minimum
43.79 lakh
2500 Cal/day
28/day

Basic structure good, but


Maintenance inadequate

Amenities and facilities

Financial arrangements
Diet

235

Investigations and treatment


Staff and training
Supportive services
Recreation/Occupational
therapy/Rehabilitation
Networking with other agencies

Adequate drug supply


Inadequate
Separate MRD
Present

No ECT in last 2 years

NGOs working

2 community outreach every


month

No disability certification

SERVICES
i. Outpatient: Available
ii. Inpatient: long duration of in-patient stay (85 days). Bed Occupancy nearly 50%.
iii. DIAGNOSTICS AND THERAPEUTICS

Investigations: available
Therapeutic facilities: medicines regularly available, no ECT in last 2 years

v. ADMINISTRATIVE

Annual number of adverse events: 0

vi. COMMUNITY OUTREACH AND NETWORKING

Community Programmes: 2 outreach every month


Networking with external agencies: Yes
Public mental health education: Yes

vii. TRAINING

Post-graduate training None

ix. Any monitoring of hospital -None


x. Special Rapporteurs observation: not visited
xi. Any other observations: Overall awareness of rights of patients amongst the staff and
members need to be improved. Inadequacy of staff.
xii. Summary and Recommendations from SECTION 2:
Areas of positive change
Areas of poor progress
Good basic structure

Poor maintenance
No Psychiatrist & No administrative officer.
Other staff also short.
Poor awareness about Human Rights amongst
staff

236

Hospital for Mental Health, Ahmadabad


Domains

Status in 2008

Developments since 2008

Infrastructure

New Building
Short stay ward
Open ward added
Emergency non-functional
194 lakhs

Maintained, CoE added

Amenities and facilities


Financial arrangements
Diet
Investigations and treatment
Staff and training

Supportive services

Recreation/Occupational
therapy/Rehabilitation
Networking with other agencies

33.8/day; 2500-3000 cal


Commendable restoration of
patients
No trained Psychiatric Nurses

Self-help group
Computerisation under
process
Good

Preventive maintenance
followed
Amount under CoE has not
been audited
NABH accredited now
No faculty in Psychiatry/PSW
under CoE
2 of 4 Psychiatrists are parttime
Adequate

Good

Rogi Kalyan samiti has powers


for repair and maintenance of
all patient related services

SERVICES
i. Outpatient: Available
ii. Inpatient: Proportion of voluntary admissions gone up
Diagnostic categories seen:
iii. DIAGNOSTICS AND THERAPEUTICS

Investigations: Available
Therapeutic facilities: Available
Improvements in rehabilitation: good

iv. ENGAGEMENT:

Attempts to involve families of persons with mental illness: Commendable


Disability certification: Exists

237

v. ADMINISTRATIVE

Annual number of adverse events: 0


Mechanisms for redressal of patient complaints: Rogi Kalyan Samiti for maintenance

vi. COMMUNITY OUTREACH AND NETWORKING

Community Programmes: 7 per month


Networking with external agencies: with several NGOs for rescue and rehabilitation

vii. TRAINING

Post-graduate training Clinical Psychology and Psychiatric Nursing

ix. Any monitoring of hospital: By SMHA and by NHRC


x. Special Rapporteurs observation: Utilization certificates for amount already spent has not
been submitted.
xi. Any other observations (including Inspection Committee Reports): Commendable work
xii. Summary and Recommendations from SECTION 2:
Areas of positive change
NABH Accreditation
Outreach Programmes
Comprehensive treatment and
rehabilitation facilities
Centre of Excellence Scheme
Hospital for Mental Health, Vadodara

Areas of poor progress


No teaching Faculty in Psychiatry,
psychiatric social work
Out of 4 Psychiatrists, 2 are part-time

Domains

Status in 2008

Developments since 2008

Infrastructure

New OPD under construction


Ward renovation under
process.
OPD facilities upgraded
211.18 lakhs

Constructed

Amenities and facilities


Financial arrangements

Diet
Investigations and treatment
Staff and training

As per norms
Medicines adequate, ECT
suspended
No CP, PSW, Psychiatric Nurses

238

Good
Funds under Manpower
Scheme B not released since
2009
NABH Accredited
Out of 4 Psychiatrists, 2 are on
contract. 2 Social workers are
on contract. Selected for
scheme B of Manpower

development in 2009, but no


grants released till 2015. No
courses at present, but
proposed
Supportive services
Recreation/Occupational
therapy/Rehabilitation
Networking with other agencies

Books and newspapers,


Separate MRD
Half-Way home, Day care
centre, OT

SERVICES
i. Outpatient: Available
ii. Inpatient: Available
iii. DIAGNOSTICS AND THERAPEUTICS

Investigations: Available
Therapeutic facilities: Available

v. ADMINISTRATIVE

Annual number of adverse events: 0


Mechanisms for redressal of patient complaints: Rogi Kalyan Samiti

vi. COMMUNITY OUTREACH AND NETWORKING

Community Programmes: Present


Networking with external agencies: Several NGOs

vii. TRAINING

Post-graduate training None, under process

ix. Any monitoring of hospital (internal or external)- By NHRC


x. Special Rapporteurs observation: Should be selected as Centre of Excellence. The funds
sanctioned under Scheme B to be released immediately (delayed)
xi. Any other observations (including Inspection Committee Reports): Good progress

239

xii. Summary and Recommendations from SECTION 2:


Areas of positive change

Areas of poor progress

Quality of care

Teaching and Manpower development scheme

SECTION 3
3. General Hospital Departments of Psychiatry and District Hospital Departments
The broad outline for this section: Although relevant Appendixes have not been provided, an
attempt to provide summary of Facilities available with medical Colleges is made on the basis of
additional information received from SMHA, Member Secretary.
3.1. Names of GH/DH and their location.
Name
B.J. Medical College
Government Medical College
P.D.U Medical College
Government Medical College
M.P.SHAH Medical College
S.S.G Medical College

Location
Ahmedabad
Surat
Rajkot
Bhavnagar
Jamnagar
Vadodara

3.2. Areas: All Medical College Departments are spread throughout the State, except for Kutch
District which is very large and the Psychiatric Hospital in Bhuj (Kutch District) also lacks in all
areas of Mental Health Service Delivery.
3.3. Whether separate funding and adequacy: No separate accounting of funds for Psychiatry
Department.
3.4. Whether OP/IP and emergency services available: OPD and IPD is available in all.
3.9. Measures to protect rights including complaint redressal: Measures are taken to protect
Human Rights as per SMHA, Member Secretary.
3.11. Staffing details and any shortages/vacancies: All Psychiatry Departments in Medical
Colleges are short in Staff.
3.12. Psychotropic medication availability/free/cost: Available
3.13. ECTs (Nos given across the facilities or average/No of direct ) : Available
3.14. Observations of extent to which counselling and psychotherapy are provided: Provided
240

3.15. Whether disability certification is available : Available


3.16. Extent and nature of community involvement: None reported
3.17. Whether engagement with the DMHP and extent: None reported
3.18. Nature and partnership with NGOs for networking: None reported
3.19. Presence of PG training- whether adequately distributed throughout the state: 2 to 4 MD
Seats in each
3.23. Special Rapporteurs observations: Not visited
3.24. Inspection Committees observations: Not visited
3.25. SUMMARY AND RECOMMENDATIONS WITH RESPECT TO SECTION 3:
Except for Kutch Region, most areas have access to GHPUs. There is urgent requirement of more
beds in specialized areas like Mother and Child Care, Geriatric Psychiatry etc alongwith faculty.
SECTION 4
4. NGOS WORKING IN MENTAL HEALTH:
8 NGOs have been selected to continue support and upscale community based mental health
activities.
Organization

District

Intervention Area

Ahmedabad
Womens Action
Group (AWAG)
Trust for Reaching the
Unreached (TRU)
Vikas Jyot Trust (VJT)
Baroda Citizen
Council (BCC)
Ashadeep Foundation

Ahmedabad

BAIF Foundation

Dang
Bharuch
Surant
Surendranagar
Kheda
Jamnagar
Navsari
Anand

Domestic Violence
School Mental Health and
Adolescent
Tribal Population
Traditional Healers
Street Children
Urban Slum Population
Family Members
Rural Population
Rehabilitation for both urban and
rural
Day care Centre
Traditional Healers
Service Delivery

Blind People
Association (BPA)

Panch Mahal
Vadodara
Vadodara
Junagadh
Porbander

241

Rural Population
Disability
Community Based Rehabilitation

4.8. SUMMARY AND RECOMMENDATIONS FOR SECTION 4


Apart from these NGOs listed in the Affidavit, there are some more NGOs working with
Psychiatric Hospitals and providing rescue and rehabilitation services. More association with
GHPUs is also required.
SECTION 5
5. DISTRICT MENTAL HEALTH PROGRAMME (Information not available in appropriate
format)

5.1. A brief description of the location of the DMHP, when it started, total population covered:
DMHP
Navsari
Surendranagar
Porbander
Junagadh

Started
98-99
2005-6
2006-7
2006-7

Population Covered
1329672
1756268
585449
2743082

242

Banaskantha
Dang
Amreli
Godhara

2007-8
2006-7
2005-6
2005-6

3120506
228291
1514190
2390776

5.6. Monitoring of the DMHP by the concerned officer /impressions and trouble-shooting: The
reported problems are:

Funds partially released (Funds are being released from State Budget at present to
keep programme running). In most DMHPs funding stopped after First Installment.

5.7. IEC activities of the DMHP: Being Done


5.8. Training calendar of the DMHP: Medical Officers, Health Workers and Nurses
5.9. Activities to sensitize the gram panchayats. Done
5.10. Special Rapporteurs report: Funding is problematic. Infrastructure and services are
good.
5.11. Inspection Committees observations: Not relevant
5.12. SUMMARY OBSERVATIONS OF DMHP AND RECOMMENDATIONS:
Despite funding being not available from GoI, State government has kept the Programme
running from its own funds. One Medical College/Psychiatric Hospital and one NGO are
identified for support in each DMHP. However, coverage needs to be increased.
SECTION 6
6. SUMMARY OF MENTAL HEALTH CARE INDICATORS IN GUJARAT
6.1. Availability of mental health facilities

Mental health outpatient


facilities in the state
Day treatment facilities
Psychiatric beds in general
hospitals
Community residential facilities
Beds/places in community
residential facilities
Psychiatric hospitals
Beds in psychiatric hospitals

Total No of
facilities/beds
202 (WHO-AIMS
Report)
4
340

Rate per 100,000


population
0.33

0
0

0
0

4
683

0.007
1.13

243

0.007
0.56

6.2. Access to Care

Persons treated in mental


health outpatient facilities
Persons treated in mental
health day care facilities
General hospital admissions
Community residential facilities
Persons staying in community
residential facilities at the end
of the year
Admissions to mental hospitals

Rate per 100,000


population
341700

Females %

7.17

6.3. Information Systems

Persons with mental


disorders treated in
primary health care
Interventions delivered
in primary health care
for persons with
mental disorders
Persons treated in
mental health
outpatient facilities
Contacts in mental
health day treatment
facilities
Admissions in general
hospitals with
psychiatric beds
Admissions in mental
hospitals
Days spent in mental
hospitals
Admissions in
community residential
facilities

Data on No of
persons/activities
collected and reported
YES/NO
N

Data on age and


gender are collected
and reported
YES/NO
N

Data on patients
diagnosis are collected
and reported
YES/NO
N

*The above is as per affidavit information supplied. WHO-AIMS 2006 report differs.
244

6.4. Human Resources at the State Level


Health professionals working
in the mental health sector
Rate per 100,000
Psychiatrists
Medical doctors not specialised
in psychiatry
Clinical Psychologists
Psychiatric Social Workers
Psychiatric Nurses
Occupational therapists
Other health workers

269

Training of health
professionals in educational
institutions
Rate per 100,000
0.44

11
15
393

0.02
0.02
0.65

18

0.03

6.5. INFORMAL HUMAN RESOURCES (Family and User Associations)

Present in the state


No of members
Participation in the
formulation/implementation of
policy/plan/legislation

User
Yes

Family
Yes

6.6. MEDICINES
Type of Medication
All psychotropic medication
Mood stabilisers
Antipsychotics
Anxiolytics
Antidepressants
Anti-craving medication/ Substitution
treatments

Available
Irregularly available at some places
Irregularly available at some places
Irregularly available at some places
Irregularly available at some places
Irregularly available at some places
Irregularly available at some places

7.MENTAL HEALTH REPORT CARD (needs to be revised after all the information is obtained)
Area

Mental Health
Services
(Secondary
and Tertiary)

Focus

Medical
College
Depts,
General

Parameters

Adequacy of inpatient
beds
Functional Departments
Functional OP services
245

Rating

100- present, fully


satisfactory
75- present,
reasonably

Score
(out of
100)
50

Hospitals,
Specialised
psychiatric
hospitals

Primary
Health Care
mental health
services

District
Mental
Health
Programme

% of functional DMHPs

Rehabilitation
services

At all levels

Vocational training, day


care, longstay facilities in
govt sector/ppp

Specialised
services

Services for
substance
use
disorders,
old age,
mental
retardation,
child
psychiatry,
community
services,
forensic
services

Whether existing, level of


functionality, present at
different levels of care

246

satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100 All districts
covered; fully
satisfactory
75 majority of
districts covered
and functioning
50 half the
districts covered
and functioning
25 one-fourth of
the districts
covered and
functioning
0- No districts
covered/although
DMHP exists, not
functioning
100- present, fully
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100- present, fully
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent

25

25

25

Human
Resources

(exclude
DMHP staff
here)

Adequacy of
psychiatrists/clinical
psychologists/psychiatric
social
workers/psychiatric
nurses or mental health
trained nurses

100 fully
adequate
75 moderately
adequate
50 somewhat
adequate
25- inadequate
0 grossly
inadequate

25

Financing for
mental health

State level

Existence of separate
budget for mental
health/mental health
activities

25

Governance
and Policy

State
Mental
Health
Authority
and other
authorities

Availability of
psychiatric
medication

At every
level

Separate Mental Health


Nodal Officer
Functioning Mental
Health Authority
Nodal persons for mental
health in SHRC/Legal
Services
Authority/Others
State Mental Health
Rules
State Mental Health
Programme
Range of medications
Regular supply and
dispensing
Standard procurement
arrangements

10% -separate
budget, fully
adequate
75 separate
budget,
moderately
adequate
50 separate
budget,
somewhat
adequate
25 no separate
budget, but some
financial
resources
available annually
0 no separate
budget/marginal
financial resource
allocation
100 Existing,
fully functional
75- Existing,
mostly functional
50- Existing,
somewhat
functional
25- Partial
0 Non existent

100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory

50

247

75

Affirmative
action for
persons with
mental illness

At every
level

Disability assessment
Pension
Travel concession
Health insurance
Special assistance
Educational benefits
Job reservation

10

Treatment
Gap

Overall

Approximate number of
persons with mental
illness approximate
numbers totally receiving
treatment in the state

Total Score (out of 1000)


Average Score (%)

25
Unsatisfactory
0- Not available at
any level
100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100 no
treatment gap
75 25%
treatment gap
50 -50%
treatment gap
25 -75%
treatment gap
0- 100%
treatment gap

25

25

350
35

RECOMMENDATIONS: The State of Gujarat has made much progress in the area of mental
health service development. The focus on Taluka Mental Health is commendable. The WHOAIMS project has helped to consolidate services, but also reveals the lacunae in information
gathering and a more realistic understanding of service delivery. The State must make a
concerted effort to match the resources and the treatment gap. It can be a model to many
other states. However, even here, human resource shortages, poor expansion of DMHP,
irregular supply of medication continue to be problems. The State provides a good example
of PPP engagement.

248

HARYANA
SECTION 1. STATE LEVEL REPORT
1. GENERAL INFORMATION REGARDING THE STATE
1.1 Area - 44000 s.q. k.m
1.2 No of districts 21
1.3 Population, age distribution (as per census 2011) - 25351462 Census 2011
1.4 Gender distribution Males- 13494734 ; females -118567728
1.5 Life expectancy at birth 66.2 years
1.6 Per capita State Government expenditure on health: 403 in 2009-10
1.7 Any health indicators for the state
1.8 Crude Birth rate:21.3
1.9 Crude Death rate:6.3
1.10
Infant Mortality rate: 41
1.11
Sex ratio:877
1.12
Completeness/quality of information provided: Deficient
If deficient, areas of deficiency: report awaited for many vital pieces of information
8. MENTAL ILLNESS BURDEN/ INFORMATION REGARDING MENTAL ILLNESS
N
(prevalence)
2.1. Total number of persons with
mental illness (all ICD categories)
2.2. Broad categories
2.2.a Severe mental disorders
(BPAD, psychosis)
2.2.b Common mental disorders
2.2.c Substance use disorders
(alcohol and other drugs)
2.2.d Mental Retardation
2.3. No of Males with mental health
problems
2.4. No of females with mental
health problems
2.5. No of children with mental
health problems
2.6. No of elderly with mental health
problems
2.7. No of homeless mentally ill
persons

1774602

16191*

30070*

5893*

249

N
(treatment
seeking)

Source of
information

COMMENT:
*Census 2011 has been cited as Source. However, figures in Census 2011 are for
disabled population and not for mentally ill.
9. MENTAL HEALTH SERVICES IN THE STATE:
9.1. Organization of Services (description of number of psychiatric hospitals, medical
college depts, district hospitals)

3.1.a No of district
general hospitals with
separate department of
psychiatry
3.1.b No of medical
colleges with department
of psychiatry
3.1.c No of district
general hospitals
providing psychiatric care
3.1.d No of District
Mental Health
Programmes in the State

N/N No with
dept/facility
Total No of units

% coverage

11/21

52%

No information

11/21

52%

3/21

14%

N
3.1.e No of government
psychiatric hospitals
3.1.f No of private
psychiatric hospitals
3.1.g Total No of
psychiatric hospitals in
the state
3.1.h No of NGOs
providing mental health
care

1
0
1

No information

COMMENT: Absence of knowledge of available infrastructure for treatment of Mentally Ill


persons reflects poorly on States commitment to Mental Health services.

250

9.2.
INPATIENT SERVICES
DESCRIPTION:

Psychiatric
hospitals
(Govt) N=1
3.2.a. Total I.npatient
sanctioned/available
beds
3.2.b No of male
beds
3.2.c. No of female
beds
3.2.d. No of beds for
children
3.2.e. No of beds for
elderly
3.2.f. No of beds for
substance use
disorders
3.2.g. No of beds for
forensic psychiatry
3.2.h. Occupancy (%)
3.2.i. No of
admissions during
previous year
3.2.j. No of
discharges during
previous year
3.2.k. Average
duration of inpatient
stay in days mean
3.2.l. Average
duration of inpatient
stay in days median
3.2.m. No of closed
wards
3.2.n. No of closed
ward beds
3.2.o. No of open
wards
3.2.p. No of open
ward beds
3.2.q. No of paid

Psychiatric
hospitals
(Private)
N=0

40

General
Hospitals
N=

District
Hospitals
N=11
86

NGOs
N=

Total

126

20
20
0
0
0

0
2.5%
57

47

1821 day

15 day

2
10
2
30
0
251

wards
3.2.r.No of paid beds
3.2.s.No of
admissions through
courts
3.2.t. No of deaths in
the last year
3.2.u. No of suicides
in the last year

0
2

0
0

COMMENT:
Total available Psychiatry bed strength is very low for the population of State. The
Psychiatric Hospital is being underutilized.
Excerpt from NHRC Spl Rapporteur Report ....there were hardly any indoor patients.
The policy appears to restrict hospital admissions. But this should not mean that serious
and difficult cases do not need admission, at least for brief periods.
9.3.

OUTPATIENT SERVICES
Govt.
Psychiatric
hospitals
N=1

3.3.a. No of new OP
registrations in the
previous year
3.3.b. No of
emergency
attendees in the
previous year

3.3.c Total no of OP
follow-up in the
previous year

Private
Psychiatric
hospitals
N=0

General
Hospitals

District
Hospitals

NGOs

N=

N=12

N=0

Total

4719

1,37,390

1,42,109

Written In
liason with
PGIMS
Rohtak. No
numbers
provided
8946

370

370

74,676*

83622

*The number appears small as many entities have not provided data regarding followup patients.
COMMENT:
Bipolar Disorder and Schizophrenia predominates the admissions in Psychiatric Hospital.
In Outpatient and district hospital it is predominantly common mental disorders.

252

10. REHABILITATION FOR PERSONS WITH MENTAL ILLNESS


10.1. Government residential rehabilitation/longstay facilities : The list provides 40
names, but these are De-addiction cum rehabilitation centres.
10.2. Government day care/outdoor rehabilitation facilities: 0
10.3. Government run half-way homes: No and no plans to establish any
10.4. NGO participation in the half way homes:NA
10.5. Longstay rehabilitation facilities:0
11. MENTAL HEALTH CARE IN OTHER COMMUNITY FACILITIES
State Level, in the Govt Sector

5.1. No of shelter homes, observation homes,


special homes and childrens homes
5.2. No of counsellors trained in mental health in
the above institutions
5.3. No of protection homes for destitute women
5.4. No of counsellors trained in mental health in
the above institutions
5.5. No of old age homes

5.6. No of counsellors trained in mental health in


the above institutions
5.7. No of Central Jails and District Jails in the State
5.8. No of counsellors trained in mental health in
the above institutions

0
0

1 (Govt.) + 6
(NGO)

19
0

Helplines for Mental Health: NA


COMMENT: Social welfare infrastructure as such is lacking. Mental Health is on the
backburner.
12. MENTAL HEALTH HUMAN RESOURCES
Mental Health Care Professionals
Government
Private
Sector medical
medical
colleges/hospitals colleges
6.1. No of
Psychiatrists
6.2. No of Clinical

12
0
253

Private
Practice

Total

Psychologists
6.3. No of
Psychiatric Social
Workers
6.4. No of nurses
trained in mental
health
6.5. No of trained
counselors

COMMENT: There is a huge deficiency of mental health human resources in the State.
7. MENTAL HEALTH HUMAN RESOURCE DEVELOPMENT
7.1. Degree/Diploma Courses
In Entire state, Annual No of
Seats in

Institutions where the Programme is offered

MD Psychiatry
DNB Psychiatry
Diploma in Psychiatry
PhD Clinical Psychology
MPhil Clinical Psychology
PhD Psychiatric Social Work
MPhil Psychiatric Social Work
PhD Psychiatric Nursing
MSc Psychiatric Nursing
BSc Psychiatric Nursing
Basic Diploma in Psychiatric
Nursing (DPN)

PGIMS (Rohtak)

PGIMS (Rohtak)

COMMENT: More seats are expected under Centre for Excellence Scheme at Rohtak.
7.2. Other training in mental health: none
7.2.a. Details of Undergraduate MBBS training in psychiatry: Written NA, but there are
Medical colleges with MBBS Course in the State.
7.2.b. Details of in-service training for Govt medical officers (No trained, duration)
None, but planned for 2015.
7.2.c. Any other training courses in mental health offered by the state
None
254

8. GOVERNANCE:
8.1. Nodal Authority and responsibilities :
State Medical & Health Department: Dr Vishwaneet Singh, deputy Director, Mental Health, O/O
DGHS, Haryana, Panchkula
State Mental Health authority: Dr Vishwaneet Singh, Convener SMHA, O/O DGHS, Haryana,
Panchkula
8.2. Presence of a State Mental Health Plan: None
8.3. Enactment of State Mental Health Rules: No
8.4. Oversight of policies and Programmes related to mental health: None
8.5. Specific oversight of the DMHP programme. Implemented in only 3 districts and planned in
other 5.
8.6. Attempts towards integration of mental health care into general health care, NCD
management etc.: None
8.7. Examples of commitment to develop mental health services (high level involvement,
budgeting, networking: none
8.8. Examples of inter-sectoral collaboration to improve mental health services (including PPP
intitiatives): none
8.9. Attempts towards mental health promotion :None
COMMENT: The State Mental Health Institute has come into existence, but as pointed out by
NHRC Special Rapporteur, it is not being utilized optimally.
12. OVERALL SUMMARY OF STATE LEVEL MENTAL HEALTH SERVICES
There is only one namesake Psychiatric Institute in entire State which is not sufficient for entire
population of the state. It appears that destitute mentally ill persons are not receiving mental
health care. Number of PG seats in various Mental Health courses is too low and needs to be
increased.

255

SECTION 2
2.1. PSYCHIATRIC INSTITUTIONS
State Institute of Mental Health (Rajya Mansik Swasthya Sansthan), Pt. BD Sharma, PGIMS,
Rohtak
Domains

Status in 2008

Infrastructure

The Chief Minister of Haryana


laid the foundation stone on
26th November 2007 and the
expected date of completion is
25th May 2009. The male open
ward will have 30 beds. The
male closed ward will have 20
beds. The female open ward
will have 20 beds and the
female closed ward will have 10
beds. There are provisions for
day care, a rehabilitation
unit, an administrative block
and an OPD block. The OPD will
have spacious well-ventilated
waiting halls with adequate
sitting arrangements, drinking
water and separate toilet
facilities for men and women.
There will be an ECT room, a
recovery room, and a separate
records room. Open wards
are on the ground floor. Access
to first floor is by lift, ramp and
staircase.
There are 4 activity rooms
located alongside each ward for
multidisciplinary
meetings, seminars, group
discussions, counseling,
academic activities and
recreational facilities.

Amenities and facilities


Financial arrangements
Diet

Developments since 2008

250 lakhs for 2014-15


The report states that there will
be two separate dining rooms
for men and women and a
modern kitchen as
well as canteen. The institute
256

Investigations and treatment

Staff and training

Supportive services
Recreation/Occupational
therapy/Rehabilitation

has also kept the post of a


dietician.
The report talks about
appointment of ECT, ECG and
lab technicians and the setting
up of an ECT room with A/C
facilities for anaesthesia and
emergency management, but
does not give details of the
other investigation facilities
that will be made available to
patients.
Since the hospital is still under
construction the report
proposes the following staffing
patterns. One senior professorcum-director, one senior
professor-cum-medical
superintendent, 6 medical
teachers, 4 psychiatric social
workers and 4 clinical
psychologists, 5 medical
officers, 3 occupational
therapists, 30 nurses, one lab
technician, an ECT technician
and an ECG technician as well
as several other administrative
staff. The institute also plans
for visiting non-psychiatry
consultants in the disciplines of
Medicine, Orthopaedics and
Obstetrics and Gynaecology.
The report mentions a day-care
centre, which will have
occupational therapy units with
facilities for yoga,
pranayama and recreational
facilities.

Networking with other agencies

SERVICES
i. Outpatient: Exists
ii. Inpatient: Services exist, but very low utilization.

257

Emergency services not


available

Not only the sanctioned


posts are lower in number
than committed in earlier
NHRC review, all are not
filled. No teaching post exist.

Diagnostic categories seen: Bipolar Disorder and Schizophrenia/other psychotic disorders


predominate admissions.
iii. DIAGNOSTICS AND THERAPEUTICS

Investigations: Exist
Therapeutic facilities: Medications are provided. For ECT, dependent on neighbouring
Medical College.
Improvements in rehabilitation: Exists

iv. ENGAGEMENT:

Attempts to involve families of persons with mental illness: 100% acceptance by families
Disability certification and number of certificates issued in the previous year: No board

v. ADMINISTRATIVE

Annual number of adverse events: 0


Mechanisms for redressal of patient complaints: Not enumerated.

vi. COMMUNITY OUTREACH AND NETWORKING

Community Programmes: None


Networking with external agencies: None
Public mental health education: None

vii. TRAINING

None

vii. RESEARCH:

None

viii. ANY OTHER SALIENT CONTRIBUTIONS OF THE HOSPITAL/INSTITUTE:


ix. Any monitoring of hospital (internal or external)- None
x. Special Rapporteurs observation: The institute has a staff strength of 42 of which 33 are in
place. The staff comprises of 03 Psychiatrists, 01 Medical Officer, 02 Psychiatric social Workers,
01 Clinical Psychologist, 01 Dietician, 02 Occupational therapists. The vacant posts include that
of Deputy Medical Superintendent, one Psychiatrist (out of two) and a Clinical Psychologist (out
of two). The HOD, Dept. of Psychiatry, PGIMS, is the ex-officio CEO and an Asst. Professor from
the Dept. of Psychiatry is acting as Deputy Medical Superintendent. The post of Medical
258

Superintendent has not yet been created. The hospital is dependent on PGIMS for MRI/X-ray
and other radiographic facilities.
The CEO stated that from 2011 to 2015 outdoor services have been provided to 36180 patients
of which 22329 are follow up cases and 13851 are new cases. The psycho-sexual clinic has
handled 7560 cases in the same period of which 3640 are follow-up cases and 3920 are new
cases. Further, the Clinical Psychology Unit has conducted 6546 assessment and therapy
sessions from 2011 to 2015; the Psychiatric Social work Unit has conducted 5698 assessment
and therapy sessions between 2011 and 2015. Various activities are taken up by the
Occupational Therapy Unit. 7936 patients have been provided with medicines in the period
between March 2014 and February, 2015.
It was, however, seen that there were hardly any indoor patients. The policy appears to restrict
hospital admissions. But this should not mean that serious and difficult cases do not need
admission, at least for brief periods.
The institute is facing many problems. It was reported that no activity was taken up in the
period 2010-14. The impression one gets is that the institute is functioning at a sub-optimal
level as the facilities at the sprawling institute are not being put to use. There appears to be lack
clarity on the part of the authorities on the status of the institute. Dr. Rajiv Gupta, ex-officio
CEO is of view that the institute ought to be brought under the management of the Psychiatric
Department of the PGIMS and that NMHP and DMHP programmes should be under one
umbrella. It is, however, seen from the minutes of the meeting held on 17-1-2014 under the
chairmanship of the Principal Secretary Health that a decision was taken to the effect that SIMH
would continue to be managed by the University of Health Sciences on behalf of the State
Government. This appears to have confused the matter further. It is not clear how a state level
institute could be under the control of the University.
In the above said meeting that it was also decided that the University would delegate
appropriate administrative powers to the CEO. Apparently no such delegation of powers has
taken place so far, whereas, the State Government in its affidavit before the Supreme Court
had claimed that the institute has been empowered with adequate administrative and financial
powers. The CEO has been emphasizing in the status report on the institute as well as in the
letters addressed to the higher authorities that the institute was facing problems due to lack of
clarity in its administrative set up and in the absence of delegation adequate administrative and
financial powers. The issue needs to be resolved quickly by the State Government.
There should be no doubt that the Institute ought to have an independent Director. It would be
appropriate for him to report to the DGHS/Health Secretary in all administrative and financial
matters. Affiliation with the University should facilitate it to function as a teaching- cumtraining institution. Close coordination with the PGIMS would benefit both. The Govt. of
Haryana could study the model of the Institute of Behavioral and Allied Sciences (IHBAS), New
Delhi or other similar state-level institutions and decide on the model to be followed in the case
259

of SIMH.
In the first instance an independent Director-someone of eminence and vision- ought to be
appointed without any further delay. Regular Superintendent and Deputy Superintendent of
the hospital need to be appointed quickly. Along with the appointment of an independent
Director, autonomy and efficiency ought to be brought to the functioning of the institute by
proper delegation and decentralization.
xi. Any other observations (including Inspection Committee Reports): Not inspected
xii. Summary and Recommendations from SECTION 2:
Areas of positive change

Areas of poor progress

Has been established

Nearly 25% vacancy in sanctioned strength,


which itself is much lower than earlier proposed.
Not being utilised adequately and has very poor
bed occupancy. Dependent on neighbouring
Institute for many day-to-day needs like ECT,
emergency services etc.

SECTION 3
3. General Hospital Departments of Psychiatry and District Hospital Departments
The broad outline for this section:
3.1. Names of GH/DH and their location.
Name

Location

General Hospital, Panchkula


General Hospital, Ambala City
Mukand Lal General hospital
General Hospital, Gurgaon
SIGMS General Hospital
LNJP Hospital
KCGMCH
BSSGH
General Hospital, Sirsa
Maharaja Agarsain General Hospital
BK Hospital

Sector 6, Panchkula
Ambala City
YamunaNagar
Gurgaon
Kaithal
Kurukshetra
Karnal
GT Road, Panipat
Sirsa
Hissar
Faridabad

3.2. Areas (distribution throughout the states): Well distributed


3.3. Whether separate funding and adequacy: Not specified
260

3.4. Whether OP/IP and emergency services available: Available in most


3.5. Diagnostic categories in rank order that present in the outpatient: Common Mental
Disorders most common
3.6. Adequacy of OP facilities: Adequate
3.7. Inpatient Available at some places only
3.8. Extent of family involvement: Good
3.9. Measures to protect rights including complaint redressal: Not specified
3.10. Any networking: None
3.11. Staffing details and any shortages/vacancies: Most places have Psychiatrists available.
However, other Mental Health Professionals are available only at few places.
3.12. Psychotropic medication availability/free/cost: Available free
3.13. ECTs (Nos given across the facilities or average/No of direct ): Not being provided at
most places
3.14. Observations of extent to which counselling and psychotherapy are provided: Variable
3.15. Whether disability certification is available (if available numbers certified/year): Available
at many places. Together more than thousand certificates are issued per year.
3.16. Extent and nature of community involvement: Poor
3.17. Whether engagement with the DMHP and extent: None
3.18. Nature and partnership with NGOs for networking: None
3.19. Presence of PG training- whether adequately distributed throughout the state: None
3.20. Nature of public mental health material prepared and distributed/ activities to educate:
None
3.21. Areas of research, sources of funding and major findings: None
3.22. Whether monitored and by whom. What were the observations? : None
3.23. Special Rapporteurs observations: Covered under DMHP Section
3.24. Inspection Committees observations: None
261

3.25. SUMMARY AND RECOMMENDATIONS WITH RESPECT TO SECTION 3:


There is a strong network of District Hospitals present with Psychiatrists available at most
places. This can be taken advantage of in extending in-patient and Emergency Services which
are non-existent for vast areas.
SECTION 4
4. NGOS WORKING IN MENTAL HEALTH: No information provided on affidavit.
4.8. Special Rapporteurs observations: There is reference to NGO named Sambandh which
provides rehabilitation support to patients at SIMH.
4.9. Inspection Committees observations: None
4.8. SUMMARY AND RECOMMENDATIONS FOR SECTION 4
There is need to rope in NGOs in DMHP and General Hospitals to extend the scope of services
being provided.
SECTION 5
DISTRICT MENTAL HEALTH PROGRAMME
5.1. A brief description of the location of the DMHP, when it started, total population covered:
District
Hisar
Gurgaon
Kurukshetra

Year
Started

Population
Covered

1999

934038

New
Registrations
503*
179*
14**

Old
Registrations
12428*
7848*
1043**

*7 month data
** 28 days data
5.2. A summary of annual registrations old and new, treatment outcomes in terms of those on
regular treatment and those dropped out, with diagnostic categories if provided: At
Kurukshetra, Mental Retardation comprises more than 80% of all registration(these numbers
are however very small and therefore cannot be interpreted); whereas at other places it is
Depression and other Neurosis which comprise bulk of services.

262

2.

5.3. Frequency of home visits carried out by the HW/ANM; numbers covered and for what
diagnostic categories, no of admissions facilitated:Only being carried out at Kurukshetra
District.
5.4. Kinds of essential drugs available, number dispensed, number of patients receiving
medication under the DMHP in a month: Most of essential Psychotropics are available.
5.5. Duration of untreated mental illness for different diagnostic categories if provided: Data
seems unreliable (Very short for MR)
5.6. Monitoring of the DMHP by the concerned officer /impressions and trouble-shooting
(mention if there is a committee and its composition): Good to satisfactory on all counts
263

5.7. IEC activities of the DMHP: Not specified


5.8. Training calendar of the DMHP (doctors, health workers, nurses, pharmacists, school
teachers/Anganwadi workers (whether any training conducted): Only mentioned for DMHP
Gurgoan. Mostly ASHA workers (98) and 15 Doctors.
5.9. Activities to sensitize the gram panchayats: None
5.10. Special Rapporteurs report on the activities of the DMHP:
There is still ambiguity regarding agency that should coordinate all the programmes under
NMHP/DMHP. In the initial period up to 2010, PGIMS functioned as the coordinating
institution, since all programmes were concentrated in and around Rohtak. Now the
programmes are being coordinated by the Health Education wing of the office of the
DGHS/DGMER. It is understood that a Deputy Director in DGHS is managing the DMHP
without proper staff support. He is still struggling to reconcile the progress reports and
utilization of funds so far allocated. If the programmes are to be handled by the office of the
DGHS/DGMER, there is need to strengthen the administrative set up on top priority......
Decentralization and delegation
It is seen that the management of NMHP/DMHP is highly centralized. All powers are vested
with the State Govt. /DGHS. In fact, funds from GOI /GOH are/were received and managed
centrally by PGIMS so far. On my visit to the mental health units in the three districts, I found
that not even contingency funds are sanctioned to them. If the DMHP is to be a success, there
ought to be adequate delegation and decentralization of powers to the field units. Each of the
local units ought to be empowered to implement the programme in their respective areas
under a well qualified project Officer. The role of DGHS/Coordinating institution ought to be
limited to coverall coordination of the project, technical guidance and supervision......
Infrastructure
As mentioned the mental health care units under DMHP in the three districts are located in
General/Civil Hospital run by Haryana Government. There is hardly any furniture or amenities
for the staff and the patients. A well kept and patient- friendly set up befitting a modem
mental health clinic needs to be provided for in each of these units. In the case of the COE
and other programmes the infrastructure is available; but without manpower to run them.

Human Resources

Experts have pointed out that the chief challenge for Haryana is the development of Human
264

resources for the State mental health care programme. The state has reportedly less than
50% of mental health professionals as compared to the neighbouring state of Punjab.
Shortage of manpower, especially posts of key functionaries including Psychiatrists, is a
serious problem .The Psychiatrists working in DHMP are from the State service where the
pay- scales is higher. Many of the Psychiatrists are attracted by the higher pay and better
working conditions in the private sector. This reality has to be factored into the programme
by the GOI.
The staff posted in the clinics brought to my notice irregular payment of their salary, low pay
and anomaly in the pay scales. Due to these problems the programme is not therefore able to
attract sufficient number of Psychiatrists and mental health professionals. I was told that
many of them who were earlier with the units have left the programme. Unless the full
complement of staff work as a team, it would be difficult to achieve the goals-both short
term and long-term under the programme. Apparently no manpower planning for running
the programme has been made by the State Government. Otherwise, it would be a long time
to have adequate trained specialist human resources in the state. As a measure to build up
district level mental health team, a programme of short term training of about 3 months
ought to be taken up.. The State Government ought to take care of the manpower problem
well before the programme is extended to other districts.

5.11. Inspection Committees observations: None


5.12. SUMMARY OBSERVATIONS OF DMHP AND RECOMMENDATIONS:
All districts should be covered. The gaps identified by NHRC Special rapporteur need to be
rectified.
SECTION 6
6. SUMMARY OF MENTAL HEALTH CARE INDICATORS IN Haryana
6.1. Availability of mental health facilities

Mental health outpatient


facilities in the state
Day treatment facilities
Psychiatric beds in general
hospitals
Community residential facilities
Beds/places in community

Total No of
facilities/beds

Rate per 100,000


population

15

0.06

0
86

0
0.34

0
0

0
0
265

residential facilities
Psychiatric hospitals
Beds in psychiatric hospitals

1
40

0.004
0.16

Rate per 100,000


population
561

Females %

6.2. Access to Care

Persons treated in mental


health outpatient facilities
Persons treated in mental
health day care facilities
General hospital admissions
Community residential facilities
Persons staying in community
residential facilities at the end
of the year
Admissions to mental hospitals

0
0
0

0.22

6.3. Information Systems

Persons with mental


disorders treated in
primary health care
Interventions delivered
in primary health care
for persons with
mental disorders
Persons treated in
mental health
outpatient facilities
Contacts in mental
health day treatment
facilities
Admissions in general
hospitals with
psychiatric beds
Admissions in mental
hospitals
Days spent in mental
hospitals
Admissions in
community residential
facilities

Data on No of
persons/activities
collected and reported
YES/NO
N

Data on age and


gender are collected
and reported
YES/NO
N

Data on patients
diagnosis are collected
and reported
YES/NO
N

266

6.4. Human Resources at the State Level


Health professionals working
in the mental health sector
Rate per 100,000
Psychiatrists
Medical doctors not specialised
in psychiatry
Clinical Psychologists
Psychiatric Social Workers
Psychiatric Nurses
Occupational therapists
Other health workers

0.05

Training of health
professionals in educational
institutions
Rate per 100,000
0.024

0.004

6.5. INFORMAL HUMAN RESOURCES (Family and User Associations)

Present in the state


No of members
Participation in the
formulation/implementation of
policy/plan/legislation

User
NA

Family
NA

6.6. MEDICINES
Type of Medication
All psychotropic medication
Mood stabilisers
Antipsychotics
Anxiolytics
Antidepressants
Anti-craving medication/ Substitution
treatments

Availability
Available free
Available free
Available free
Available free
Not available

267

MENTAL HEALTH REPORT CARD (needs to be revised after all the information is obtained)
Area

Focus

Parameters

Mental Health
Services
(Secondary
and Tertiary)

Medical
College
Depts,
General
Hospitals,
Specialised
psychiatric
hospitals

Adequacy of inpatient
beds
Functional Departments
Functional OP services

Primary
Health Care
mental health
services

District
Mental
Health
Programme

% of functional DMHPs

Rehabilitation
services

At all levels

Vocational training, day


care, longstay facilities in
govt sector/ppp

Specialised
services

Services for
substance
use
disorders,

Whether existing, level of


functionality, present at
different levels of care
268

Rating

100- present, fully


satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100 All districts
covered; fully
satisfactory
75 majority of
districts covered
and functioning
50 half the
districts covered
and functioning
25 one-fourth of
the districts
covered and
functioning
0- No districts
covered/although
DMHP exists, not
functioning
100- present, fully
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100- present, fully
satisfactory
75- present,
reasonably

Score
(out of
100)
25

12.5

12.5

12.5

Human
Resources

Financing for
mental health

Governance
and Policy

old age,
mental
retardation,
child
psychiatry,
community
services,
forensic
services
(exclude
DMHP staff
here)

satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent

Adequacy of
psychiatrists/clinical
psychologists/psychiatric
social
workers/psychiatric
nurses or mental health
trained nurses

100 fully
adequate
75 moderately
adequate
50 somewhat
adequate
25- inadequate
0 grossly
inadequate

12.5

State level

Existence of separate
budget for mental
health/mental health
activities

12.5

State
Mental
Health
Authority
and other
authorities

Separate Mental Health


Nodal Officer
Functioning Mental
Health Authority
Nodal persons for mental
health in SHRC/Legal
Services
Authority/Others
State Mental Health

10% -separate
budget, fully
adequate
75 separate
budget,
moderately
adequate
50 separate
budget,
somewhat
adequate
25 no separate
budget, but some
financial
resources
available annually
0 no separate
budget/marginal
financial resource
allocation
100 Existing,
fully functional
75- Existing,
mostly functional
50- Existing,
somewhat
functional
25- Partial
0 Non existent

269

12.5

Rules
State Mental Health
Programme
Range of medications
Regular supply and
dispensing
Standard procurement
arrangements

Availability of
psychiatric
medication

At every
level

Affirmative
action for
persons with
mental illness

At every
level

Disability assessment
Pension
Travel concession
Health insurance
Special assistance
Educational benefits
Job reservation

10

Treatment
Gap

Overall

Approximate number of
persons with mental
illness approximate
numbers totally receiving
treatment in the state

Total Score (out of 1000)


Average Score (%)

100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100 no
treatment gap
75 25%
treatment gap
50 -50%
treatment gap
25 -75%
treatment gap
0- 100%
treatment gap

25

12.5

137.5
13.8

RECOMMENDATIONS:
The affidavit from Haryana is hugely deficient in its recording. There are 6 medical colleges in
Haryana (Rohtak and Ambala), but no information is provided. Details about other locations
is also scarce. It is commendable that more than half the districts are providing psychiatric
care (52%), although DMHP coverage is only 14%. The psychiatric hospital is running suboptimally. Details of community care of special populations is not provided. There are a large
number of jails where no mental health services are provided. There is much confusion in
terms of the administrative structure of the DMHP.
270

The first thing required is the governance and identification of nodal persons responsible.
Then the information available needs to be updated and the problem/resource
available/gaps must be identified.
A time bound mental health plan must be developed.
The State/Centre and other agencies should come together to identify methods to enhance
human resources and oversight of the programme.

271

HIMACHAL PRADESH
SECTION 1. STATE LEVEL REPORT
7. GENERAL INFORMATION REGARDING THE STATE
7.1.
Area 55673 sq km
7.2.
No of districts 12
7.3.
Population, age distribution (as per census 2011) : 6864602
0-9 years

1136161

10-19 years

1279685

20-44 years

2742909

45-79 years

1588947

80 years and above

7.4.

106737

Gender distribution
Male

3481873

Female

3382729

7.5.
Life expectancy at birth male and female : Male= 67.7 Years; Female=72.4 years
7.6.
Per capita State Government expenditure on health: 906 (Year 2010)
7.7.
Any health indicators for the state (life expectancy, etc)
Birth rate: 16.5
Death rate: 6.7
7.8.
Completeness/quality of information provided: Mostly Complete
8. MENTAL ILLNESS BURDEN/ INFORMATION REGARDING MENTAL ILLNESS
N
(prevalence)
2.1. Total number of persons with
mental illness (all ICD categories)

480522

272

N
%
(treatment
seeking)
23229
0.33

Source of
information

2.2. Broad categories


2.2.a Severe mental disorders
(BPAD, psychosis)
2.2.b Common mental disorders
2.2.c Substance use disorders
(alcohol and other drugs)
2.2.d Mental Retardation

868
7022
7516
1033

2.3. No of Males with mental health


problems
2.4. No of females with mental
health problems
2.5. No of children with mental
health problems
2.6. No of elderly with mental health
problems
2.7. No of homeless mentally ill
persons

5607
438
743
2

COMMENT: The number of persons seeking treatment is very low as compared to other
States. If it is assumed that prevalence of mental disorders is nearly equal, this may be
because of lack of treatment facilities.

9. MENTAL HEALTH SERVICES IN THE STATE:


9.1.
Organization of Services (description of number of psychiatric hospitals, medical
college depts, district hospitals)

N/N

No with dept/facility
Total No of units

% coverage

3.1.a No of district
general hospitals with
separate department of
psychiatry
3.1.b No of medical
colleges with department
of psychiatry
3.1.c No of district
general hospitals
providing psychiatric care
3.1.d No of District
Mental Health
Programmes in the State

16.6%

25%

12

100%

16.6%

3.1.e No of government

273

psychiatric hospitals
3.1.f No of private
psychiatric hospitals
3.1.g Total No of
psychiatric hospitals in
the state
3.1.h No of NGOs
providing mental health
care

3
4

13

COMMENT: Since the terrain is difficult for travel, more number of geographically spread out
facilities are required.
9.2.
INPATIENT SERVICES
DESCRIPTION:

Psychiatric
hospitals
(Govt) N=1
3.2.a. Total Inpatient
sanctioned/available
beds
3.2.b No of male
beds
3.2.c. No of female
beds
3.2.d. No of beds for
children
3.2.e. No of beds for
elderly
3.2.f. No of beds for
substance use
disorders
3.2.g. No of beds for
forensic psychiatry
3.2.h. Occupancy (%)
3.2.i. No of
admissions during
previous year
3.2.j. No of
discharges during
previous year
3.2.k. Average

62

Psychiatric
hospitals
(Private)
N=3
30

General
Hospitals
N=

District
Hospitals
N=12

NGOs
N=13

Total

123

31
31

20

20

73

31

10

11

51

no

Nil

no

Nil

no

Nil

no

Nil

62.9
114

73.3
796

388

0
0

73

796

1-2yrs

7days

274

1292

duration of inpatient
stay in days mean
3.2.l. Average
duration of inpatient
stay in days median
3.2.m. No of closed
wards
3.2.n. No of closed
ward beds
3.2.o. No of open
wards
3.2.p. No of open
ward beds
3.2.q. No of paid
wards
3.2.r.No of paid beds
3.2.s.No of
admissions through
courts
3.2.t. No of deaths in
the last year
3.2.u. No of suicides
in the last year

6months

Nil

Nil

Nil

Nil

Nil

41

Nil
Nil

0
0

Nil

Nil

COMMENT: Himachal Pradesh is one of few States where Private Psychiatric Hospitals account
for nearly two-thirds of all psychiatric admissions. It is apparent that State Psychiatric Hospital
is predominantly a long stay facility (average length of stay is more than 20 times that of private
hospitals). This also highlights the need to have better psychiatric facilities in the government
sector at the GHPU/district level. Also it needs to be re-examined if the information has been
collected from all GHPUs.

9.3.

OUTPATIENT SERVICES

3.3.a. No of new OP
registrations in the
previous year
3.3.b. No of
emergency
attendees in the
previous year

Govt.
Psychiatric
hospitals
N=1
260

Private
Psychiatric
hospitals
N=3
2182+
970=3192

General
Hospitals

District
Hospitals

NGOs

Total

N=12
2393

N=

N=
-

5845

173

179

275

3.3.c Total no of OP
follow-up in the
previous year

718

16410

5293

22421

COMMENT:
Private Psychiatric Hospitals are seeing more patients in OPD than Govt Psychiatric
Hospitals (unless the figures for the latter are incomplete). Also General Hospitals are
registering more new patients than Private Psychiatric Hospitals, but the follow-up is
only one-third as compared to latter. The quality of services offered need to be
examined.
10. REHABILITATION FOR PERSONS WITH MENTAL ILLNESS
10.1.
Government residential rehabilitation/longstay facilities : No and description:
1. Himachal Hospital of Mental and Rehabilitation Centre,Shimla
10.2.
Government day care/outdoor rehabilitation facilities: No and description:
12 district hospitals
10.3.
Government run half-way homes: No and description. If none, plans to establish
and details:
0
10.4.
NGO participation in the half way homes: none
1.1.
Longstay rehabilitation facilities: No and description; NGO participation:
Red cross society, Kangra
Comment: There appears to be some misunderstanding in terms of purpose of the government
psychiatric hospital, which has been virtually transformed into a long stay facility.

2. MENTAL HEALTH CARE IN OTHER COMMUNITY FACILITIES


State Level, in the Govt Sector
5.1. No of shelter homes, observation homes,
special homes and childrens homes

N
22 Children
homes, 1 shelter
home at Shimla
run by NGO, 2 in
children home at
Hamirpur & Una

5.2. No of counsellors trained in mental health in


the above institutions
5.3. No of protection homes for destitute women

276

5.4. No of counsellors trained in mental health in


the above institutions
5.5. No of old age homes
5.6. No of counsellors trained in mental health in
the above institutions
5.7. No of Central Jails and District Jails in the State
5.8. No of counsellors trained in mental health in
the above institutions
5.9.No of counsellors trained in mental health in
the above institutions

0
12
-

Helplines for Mental Health:


NGO Child Line helpline. No.1098
COMMENT: There is non-existence of any sort of mental health service in community facilities.
3. MENTAL HEALTH HUMAN RESOURCES
Mental Health Care Professionals

6.1. No of
Psychiatrists
6.2. No of Clinical
Psychologists
6.3. No of
Psychiatric Social
Workers
6.4. No of nurses
trained in mental
health
6.5. No of trained
counselors

Government
Sector medical
colleges/hospitals
(include district
general hospital
information also)
7

Psychiatric
medical
colleges

Private
Practice

Total

12

12

13

12

14

45

47

COMMENT: The manpower is grossly inadequate.

277

7. MENTAL HEALTH HUMAN RESOURCE DEVELOPMENT


7.1. Degree/Diploma Courses
In Entire state, Annual No of
Seats in

MD Psychiatry
DNB Psychiatry
Diploma in Psychiatry
PhD Clinical Psychology
MPhil Clinical Psychology
PhD Psychiatric Social Work
MPhil Psychiatric Social Work
PhD Psychiatric Nursing
MSc Psychiatric Nursing
BSc Psychiatric Nursing
Basic Diploma in Psychiatric
Nursing (DPN)

3
0
0
0
0
0
0
0
0
0
0

Institutions where the Programme is offered

COMMENT: There is need to initiate Courses at all levels. State Mental Health Institute may
be transformed to cater to this need.
7.2. Other training in mental health
7.2.a. Details of Undergraduate MBBS training in psychiatry
Name of medical
college

No of hours of
theory

Duration of
psychiatry
posting during
UG

Duration of
psychiatry
posting during
internship

IGMC Shimla
Dr RPGMC, Tanda

20
20

2weeks
2weeks

2weeks
2weeks

Qualifying
Examination
includes
competency
evaluation in
psychiatry

COMMENT:
7.2.b. Details of in-service training for Govt medical officers (No trained, duration)
Yes, 230
7.2.c. Any other training courses in mental health offered by the state
In psychiatric Nursing

278

8. GOVERNANCE:
8.1. Nodal Authority and responsibilities :
Director Medical Education and Research- 0177-2620733
Director Health Services HP 0177-2621424
Director Social Welfare 0177-2622041
8.2. Presence of a State Mental Health Plan: None
8.3. Enactment of State Mental Health Rules: None
8.4. Oversight of policies and Programmes related to mental health: No specific Programme or
policy
8.5. Specific oversight of the DMHP programme. Only one out of 12 Districts have running
DMHP Programme. DMHP in Bilaspur had been stopped after 5 year of central support.
Despite covering the most populous district (Kangra) accounting for nearly a fourth of States
population, less than 500 persons are able to utilize DMHP services in a year. Only 4 drugs are
supplied through DMHP.
If the numbers of training sessions are correctly filled, it may be one of the best performing
DMHP for training more than 7 thousand personnel.
8.6. Attempts towards integration of mental health care into general health care, NCD
management etc. : None apparent
8.7. Examples of commitment to develop mental health services (high level involvement,
budgeting, networking: None apparent
8.8. Examples of inter-sectoral collaboration to improve mental health services (including PPP
initiatives): None apparent
8.9. Attempts towards mental health promotion: None apparent
COMMENT: Strengths and weaknesses
There is absence of any stated policy towards mental health. The purposes and differences
between a Psychiatric Hospital and Rehabilitation services needs to be understood at higher
levels of Governance. DMHP data indicates that the model being implemented elsewhere is
not cost-effective even in the most populous district and some other model may be better
suited for difficult terrains with sparse population.
279

9. FINANCING
9.1. Sources of financing of different categories : Mostly out-of-pocket indicated by high
dependence on Private Psychiatric Institutions.
9.2 Budget provision from State and Centre in INR (for different facilities if required): NA
9.3. Mental Health Expenditure as proportion of Total Health Expenditure in State: NA

10. ANY OTHER SIGNIFICANT INFORMATION (e.g. litigation, insurance schemes for persons
with mental illness, pension and other assistance, job reservations)
Case No 37-IV/2104 State vs Pullaya Chamba
State vs Rocky disposed on 23-9-2014, Shimla

11. INNOVATIONS
12. OVERALL SUMMARY OF STATE LEVEL MENTAL HEALTH SERVICES
As suggested by NHRC Special Rapporteur, the Psychiatric Hospital requires up gradation in
terms of adequate staff and various recreational and rehabilitataional services. The DMHP
needs to be revived in Bilaspur and a complete revamp of strategy is required.
SECTION 2
2.1. PSYCHIATRIC INSTITUTIONS
Himachal Hospital of Mental Health and Rehabilitation, Shimla
62 bed psychiatric unit (50+12 rehab). Has a geriatric ward. No academic activities. Average
inpatient staty is 275 days. Has received regular visits from the SMHA (7) and SHRC (1). All
medications are available. Liaison with the Indian Red Cross Society and Prayas Foundation.
Domains

Status in 2008

Developments since 2008

Infrastructure

A newly constructed fourstoried building with proper


planning was started in 2004.
The ground floor consists of a
central heating plant with a
control room, a kitchen and a
store room. The first floor is

Facilities for visitors stay are


not available.

280

the OPD complex with toilets,


a recreation room and an
occupational therapy room.
There are a total of 50
inpatient beds.
Amenities and facilities
Financial arrangements
Diet

Investigations and treatment

Staff and training

Supportive services
Recreation/Occupational
therapy/Rehabilitation

Not been calculated as per


calorie requirement. The
budget allocation for food per
patient per day is Rs 27.40.
Separate dining facilities are
available.
No ECT services are available.
No community outreach
activities are conducted. There
is no board for disability
certification. The hospital does
not have any facilities for
investigation according to its
report. Free medicines
are available
There are three GMOs, 4
general nurses, 6 ward
attenders, one cook and one
pharmacist. There are no
psychiatrists, clinical
psychologists, psychiatric
social workers or trained
nurses. There are no visiting
non-psychiatry consultants.
The medical superintendent of
the Centre is not a psychiatrist
The report states that
recreational facilities are
available but details are not
provided. There are no inpatient rehabilitation
services

Networking with other agencies


The report state that there is a
need to post a psychiatrist
along with essential post of
paramedical and other staff.

281

Total budget nearly 3.25


Crores
Mess services are outsourced

No Clinical Psychologist, PSW


or trained Nurse. Only 1
Psychiatrist deputed from
another Institute is the sole
Mental Health professional.

SERVICES
i. Outpatient:
ii. Inpatient: ECT not available.
Diagnostic categories seen: Schizophenia followed by Mental retardation
iii. DIAGNOSTICS AND THERAPEUTICS

Investigations: outsourced
Therapeutic facilities: Free drugs
Improvements in rehabilitation: No Professional available

iv. ENGAGEMENT:

Attempts to involve families of persons with mental illness: 95% are taken back by
family. However, average length of stay does not reflect that.
Disability certification and number of certificates issued in the previous year: Only 2
certificates in a year.

v. ADMINISTRATIVE

Annual number of adverse events: 10


Mechanisms for redressal of patient complaints: Counselling

vi. COMMUNITY OUTREACH AND NETWORKING

Community Programmes: Yes, 5/month. Only 9 patients reached till now. Must have
been very taxing for the single Mental Health Professional as highlighted by NHRC
Special Raporteur.
Networking with external agencies: Red Cros Society for Substance Users
Public mental health education: Available

vii. TRAINING

Post-graduate training : None


Any other training Programmes: None

vii. RESEARCH: Nil


viii. ANY OTHER SALIENT CONTRIBUTIONS OF THE HOSPITAL/INSTITUTE:Nil
ix. Any monitoring of hospital (internal or external)- None
282

x. Special Rapporteurs observation: There is no arrangement for proper lighting. The


Rehabiliatational Beds are defunct. There is absence of support staff and shortage of Mental
Health Professionals.
xi. Any other observations (including Inspection Committee Reports): The IC reports find that
there is adequate space, clean toilets, water supply and ventilation.
xii. Summary and Recommendations from SECTION 2:
Areas of positive change

Areas of poor progress

Psychiatric Hospital is functional

Manpower
Recreational and Rehab Services
Training and research

SECTION 3
3. General Hospital Departments of Psychiatry and District Hospital Departments
The broad outline for this section:
3.1. Names of GH/DH and their location.
S. No. Name

Inpatient Outpatient Emergency

1
2
3
4

Y
N
N
Y

Y
Y
Y
Y

Y
N
N
Y

Y
Y

N
N

N
Y

Y
N

N
N

N
Y

N
N
N

N
N
N

N
N
N

5
6
7

8
9
10
11
12

RH Bilaspur
RH Chamba
RH Hamirpur
Zonal Hospital
Dharamshala
RH Rekong
Pass
RH Kullu
RH Keylong
Lahaul and
Spiti
ZH Mandi
DDUZH
Shimla
Sirmaur
RH Solan
UNA

3.5. Diagnostic categories in rank order that present in the outpatientAlcohol and drug abuse disorder most common
283

3.6. Adequacy of OP facilities- Inadequate


3.7. Inpatient occupancy, free and paying beds, average cost of inpatient stay per week; rank
order of diagnostic categories
Details not available
3.8. Extent of family involvement- Some
3.9. Measures to protect rights including complaint redressal- No complaints reported
3.10. Any networking: None
3.11. Staffing details and any shortages/vacancies
12 psychiatrists, 12 Cl. Psychologist, 12 PSW, 45 psychiatric nurse/ trained general nurse.
3.12. Psychotropic medication availability/free/cost- Varies across hospitals
3.13. ECTs (Nos given across the facilities or average/No of direct ) NO ECT given
3.14. Observations of extent to which counselling and psychotherapy are provided- Provided to
some
3.15. Whether disability certification is available (if available numbers certified/year) 754
3.16. Extent and nature of community involvement- variable
3.17. Whether engagement with the DMHP and extent- ZH Mandi, ZH Dharamshala, RH
Bilaspur
3.18. Nature and partnership with NGOs for networking- in some hospitals
3.19. Presence of PG training- whether adequately distributed throughout the state- Only 3 MD
Psychiatry Seats.
3.20. Nature of public mental health material prepared and distributed/ activities to educateHoarding, banners, pamphlets in ZH Dharamshala
3.21. Areas of research, sources of funding and major findings- NIL
3.22. Whether monitored and by whom. What were the observations? No monitoring
3.23. Special Rapporteurs observations: There is lack of networking with NGOs. The
opportunities for upgradation under NMHP are not being availed.

284

3.24. Inspection Committees observations: MC/GH Not visited


3.25. SUMMARY AND RECOMMENDATIONS WITH RESPECT TO SECTION 3:
The Medical Colleges can serve as resource centres for DMHP and Training facilities. NHRC
Special Rapporteurs assessment of ground situation is that MOs posted in PHC/CHC are not
trained to treat Mental Illnesses despite the large number of trained MOs claimed in State
Affidavit.
SECTION 4
4. NGOS WORKING IN MENTAL HEALTH:
S.No. Name of NGO

Location

Aastha

Sirmour

Prem Ashram

Una

DCPU

Chamba

4
5
6

Red Cross Society


CORD
Chil line Helpline

Dharamshala
Dharamshala
Dharamshala

7
8

Uddan
Sahyog Bal Shravan
Viklang Kalyan Samiti
Jagriti research and
rehabilitation society

New Shimla
Mandi

Main Work
Formal
education,
health related
education,
daily living
skills,
physiotherapy,
health check
up
Disability
awareness
sessions,
counselling
behaviour
modification
for child
disability
Counselling,
rehabilitation,
Self help
groups,
awareness, IEC,
appliances to
MR, Alcohol
Anonymous
Not mentioned
Social
assistance,
schooling

Mandi

285

Clientele
Not mentioned

Not mentioned

Rape victims,
children
Children, substance
addiction,

Not mentioned
Not mentioned

10
11

12

13

for special children


Savera research and
rehabilitation centre
Divya jyoti research
and rehabilitation
society
Sakar Society for
differently abled
persons
Gyan Shiksha Samiti
Bhangrotu

special
children, home
based services,
rehabilitation.

Mandi
Mandi

Sunder nagar, Mandi

Mandi

4.4. Research details


DCPU- ICPS, JJ Act, POCSO
4.5. Details of any training carried out by the NGO
DCPU carries out training of stakeholders.
4.6. Networking activities of the NGO
4.7. Salient contributions of the NGO
4.8. Special Rapporteurs observations
4.9. Inspection Committees observations
4.8. SUMMARY AND RECOMMENDATIONS FOR SECTION 4
NHRC Special Rapporteur has pointed out that some NGOs are receiving aid from
Government for rehabilitation purposes. These NGOs should be identified and a networking
between government Agencies and NGOs is required for best outcome.

286

SECTION 5
5. DISTRICT MENTAL HEALTH PROGRAMME

5.1. A brief description of the location of the DMHP, when it started, total population covered:
2 DMHP- Kangra and Bilaspur

DMHP

Old
New Home Admission Drugs available
cases cases visits facilitated

Kangra

282

180

25

Diazepam,
Fluoxetine,
Risperidone

287

Patients
Training activities
on
regular
treatment
251
Of doctors, health
workers, nurses,
pharmacist,
school teachers,
aanganwadi

Bilaspur 0

26

Phenobarbitone 0

workers, gram
panchayat
Of doctors, health
workers, nurses,
pharmacist

5.10. Special Rapporteurs report: The Bilaspur DMHP has not been taken up by State after
end of Central funding and is nearly non-functional. There is no Staff recruited under DMHP
in Kangra.
5.11. Inspection Committees observations: DMHP not visited. However, in the report, it is
mentioned that de-addiction centres are running in all 12 districts. These are conceptualised
under the Adolescent Health Programme. Each centre is manned by a psychiatric counsellor
and medical social worker, all trained at NIMHANS. Medical officers have also been trained at
NIMHANS.
5.12. SUMMARY OBSERVATIONS OF DMHP AND RECOMMENDATIONS:
As discussed in previous sections, there is need for complete revamp of DMHP. In view of
difficult terrain and sparse population, a model of reimbursement of cost incurred in availing
treatment of Mental Illnesses may be more cost-effective than having a DMHP with very low
number of actual beneficiaries.
SECTION 6
6. SUMMARY OF MENTAL HEALTH CARE INDICATORS IN HIMACHAL PRADESH
6.1. Availability of mental health facilities
Total No of
facilities/beds
Mental health outpatient
facilities in the state
Day treatment facilities
Psychiatric beds in general
hospitals
Community residential facilities
Beds/places in community
residential facilities
Psychiatric hospitals
Beds in psychiatric hospitals

Rate per 100,000


population

31

0.19

4
62

0.05
0.90

288

6.2. Access to Care

Persons treated in mental


health outpatient facilities
Persons treated in mental
health day care facilities
General hospital admissions
Community residential facilities
Persons staying in community
residential facilities at the end
of the year
Admissions to mental hospitals

Rate per
100,000
population

Females %

297.62

13.25

6.3. Information Systems

Persons with mental


disorders treated in
primary health care
Interventions delivered
in primary health care
for persons with
mental disorders
Persons treated in
mental health
outpatient facilities
Contacts in mental
health day treatment
facilities
Admissions in general
hospitals with
psychiatric beds
Admissions in mental
hospitals
Days spent in mental
hospitals
Admissions in
community residential
facilities

Data on No of
persons/activities
collected and reported
YES/NO
-

Data on age and


gender are collected
and reported
YES/NO
-

Data on patients
diagnosis are collected
and reported
YES/NO
-

yes

partial

yes

yes

na

289

6.4. Human Resources at the State Level


Health professionals working
in the mental health sector
Rate per 100,000
Psychiatrists
Medical doctors not specialised
in psychiatry
Clinical Psychologists
Psychiatric Social Workers
Psychiatric Nurses
Occupational therapists
Other health workers

12
13
14
47
-

Training of health
professionals in educational
institutions
Rate per 100,000
0.17

0.18
0.20
0.68

6.5. INFORMAL HUMAN RESOURCES (Family and User Associations)

Present in the state


No of members
Participation in the
formulation/implementation of
policy/plan/legislation

User
No

Family
No

6.6. MEDICINES
Type of Medication
All psychotropic medication
Mood stabilisers
Antipsychotics
Anxiolytics
Antidepressants
Anti-craving medication/ Substitution
treatments

Availability
Not available
Available
Available
Available
Not available

MENTAL HEALTH REPORT CARD (needs to be revised after all the information is obtained)
Area

Mental Health
Services
(Secondary
and Tertiary)

Focus

Medical
College
Depts,
General

Parameters

Adequacy of inpatient
beds
Functional Departments
Functional OP services
290

Rating

100- present, fully


satisfactory
75- present,
reasonably

Score
(out of
100)
50

Hospitals,
Specialised
psychiatric
hospitals

Primary
Health Care
mental health
services

District
Mental
Health
Programme

% of functional DMHPs

Rehabilitation
services

At all levels

Vocational training, day


care, longstay facilities in
govt sector/ppp

Specialised
services

Services for
substance
use
disorders,
old age,
mental
retardation,
child
psychiatry,
community
services,
forensic
services

Whether existing, level of


functionality, present at
different levels of care

291

satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100 All districts
covered; fully
satisfactory
75 majority of
districts covered
and functioning
50 half the
districts covered
and functioning
25 one-fourth of
the districts
covered and
functioning
0- No districts
covered/although
DMHP exists, not
functioning
100- present, fully
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100- present, fully
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent

25

25

25

Human
Resources

(exclude
DMHP staff
here)

Adequacy of
psychiatrists/clinical
psychologists/psychiatric
social
workers/psychiatric
nurses or mental health
trained nurses

100 fully
adequate
75 moderately
adequate
50 somewhat
adequate
25- inadequate
0 grossly
inadequate

25

Financing for
mental health

State level

Existence of separate
budget for mental
health/mental health
activities

25

Governance
and Policy

State
Mental
Health
Authority
and other
authorities

Availability of
psychiatric
medication

At every
level

Separate Mental Health


Nodal Officer
Functioning Mental
Health Authority
Nodal persons for mental
health in SHRC/Legal
Services
Authority/Others
State Mental Health
Rules
State Mental Health
Programme
Range of medications
Regular supply and
dispensing
Standard procurement
arrangements

10% -separate
budget, fully
adequate
75 separate
budget,
moderately
adequate
50 separate
budget,
somewhat
adequate
25 no separate
budget, but some
financial
resources
available annually
0 no separate
budget/marginal
financial resource
allocation
100 Existing,
fully functional
75- Existing,
mostly functional
50- Existing,
somewhat
functional
25- Partial
0 Non existent

100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory

25

292

50

Affirmative
action for
persons with
mental illness

At every
level

Disability assessment
Pension
Travel concession
Health insurance
Special assistance
Educational benefits
Job reservation

10

Treatment
Gap

Overall

Approximate number of
persons with mental
illness approximate
numbers totally receiving
treatment in the state

Total Score (out of 1000)


Average Score (%)

25
Unsatisfactory
0- Not available at
any level
100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100 no
treatment gap
75 25%
treatment gap
50 -50%
treatment gap
25 -75%
treatment gap
0- 100%
treatment gap

25

25

300
30

RECOMMENDATIONS: The State has been making efforts to increase all mental health human
resources and develop mental health services, particularly for addiction at the district level. It
has invested in staff training. However, there is a disproportionate growth of the government
facilities compared to the private facilities. As mentioned in the IC report, it is necessary to
increase PG seats at IGMC (A PG corse is to be started at Dr RPGMC Tanda), sanctioning of
clinical psychologist post at the medical colleges, raising of HHMHR to the status of a state
level facility, implementation of NMHP in all districts, long-term rehabilitation initiatives by
the Social Welfare Department and strengthened rehabilitation.

293

JAMMU AND KASHMIR

SECTION 1. STATE LEVEL REPORT


1. GENERAL INFORMATION REGARDING THE STATE
1.2. Area- 222236 sq km
1.3. No of districts- Jammu-10 Kashmir-10, (Ladakh not mentioned in affidavit, but
has 2 districts)
1.4. Population, age distribution (as per census 2011)- 12541302
Age0-9 years
10-19 years
20-44 years
45-79 years
80 years and above

2826587
(22.5%)
2651315
(21.1%)
4725968
(37.7%)
2195173
(17.5%)
126870
(1.0%)

1.5.
1.6.

Gender distribution male- 6640662 (52.9%)Female- 5900640 (47.1%)


Life expectancy at birth male and female: 65 Years for Males, 67 Years for
females
1.7. Per capita State Government expenditure on health:930 (Year 2009-10)
1.8. Any health indicators for the state
Crude Birth Rate: 17.5
Crude Death Rate: 5.3
Infant Mortality Rate: 37
Sex Ratio:889
1.9. Completeness/quality of information provided: Deficient (Most of the
information is from NHRC Special Rapporteurs report)
If deficient, areas of deficiency: Information is only for JAMMU Division

294

2. MENTAL ILLNESS BURDEN/ INFORMATION REGARDING MENTAL ILLNESS


N
(prevalence)
2.1. Total number of persons with
mental illness (all ICD categories)

877891

N
(treatment
seeking)

Source of
information

7*

*As no data is provided, estimated as per estimates from various epidemiological metaanalyses done in India.
80, 000 people visited various Mental Health Professionals in Kashmir Valley during 2005-06
and three-fourths were diagnosed with serious psychological problems as per survey by State
Mental Health Society. (Source: NHRC Special Rapporteurs report).
COMMENT: Various studies cited by NHRC Special Rappoteur indicate that Psychiatric
Morbidity may be more in J & K compared to rest of India and estimates based on metaanalysis may not be applicable.
3. MENTAL HEALTH SERVICES IN THE STATE:
3.2. Organization of Services (description of number of psychiatric hospitals, medical
college depts, district hospitals)

N/N

No with dept/facility
Total No of units

% coverage

3.1.a No of district
general hospitals with
separate department of
psychiatry
3.1.b No of medical
colleges with department
of psychiatry
3.1.c No of district
general hospitals
providing psychiatric care
3.1.d No of District
Mental Health
Programmes in the State

4/22

18%

4/4&

100%

4/22

18%

4 (+2 partial)

18% (+9%)

3.1.e No of government
psychiatric hospitals
3.1.f No of private
psychiatric hospitals
3.1.g Total No of
psychiatric hospitals in

0
2

295

the state
3.1.h No of NGOs
providing mental health
care

1*

&

Medical Council of India website

*As per NHRC Special Rapporteurs report


COMMENT: Ladakh Division which accounts for nearly half of the area in actual
administrative control of Govt. has no resources at all.
3.3.
INPATIENT SERVICES
DESCRIPTION:

3.2.a. Total
I.npatient
sanctioned/available
beds
3.2.b No of male
beds
3.2.c. No of female
beds

Psychiatric
hospitals
(Govt) N=
120(Jammu)
100
(Shrinagar)

Psychiatric
hospitals
(Private) N=
0

General
Hospitals
N=
0

District
Hospitals
N=
0

70 +70

50+30

NGOs
N=

Total

COMMENT: Very low bed occupancy observed by NHRC Special rapporteur in Psychiatric
hospitals.
3.4.

OUTPATIENT SERVICES

3.3.a. No of new OP
registrations in the
previous year
3.3.b. No of
emergency
attendees in the
previous year
3.3.c Total no of OP
follow-up in the
previous year

Govt.
Private
Psychiatric
Psychiatric
hospitals
hospitals
N=
N=
4859
(Jammu)+14978
(Shrinagar)
4-5 daily in
Jammu

General
Hospitals

District
Hospitals

NGOs

N=
9641

N=

N=

24554+23952

9793

296

Total

COMMENT:
Despite 3 times new OPD registrations in Shrinagar, the total follow-ups appear to be
similar. It may be because of differences in nature of psychiatric disorders.

4. REHABILITATION FOR PERSONS WITH MENTAL ILLNESS


4.2.
4.3.
4.4.
4.5.
4.6.

Government residential rehabilitation/longstay facilities : No and description: nil


Government day care/outdoor rehabilitation facilities: No and description: nil
Government run half-way homes: No and description. If none, plans to establish
and details: not applicable
NGO participation in the half way homes: not applicable
Longstay rehabilitation facilities: No and description; NGO participation: not
applicable

5. MENTAL HEALTH CARE IN OTHER COMMUNITY FACILITIES


State Level, in the Govt Sector

5.1. No of shelter homes, observation homes,


special homes and childrens homes
5.2. No of counsellors trained in mental health in
the above institutions
5.3. No of protection homes for destitute women
5.4. No of counsellors trained in mental health in
the above institutions
5.5. No of old age homes
5.6. No of counsellors trained in mental health in
the above institutions
5.7. No of Central Jails and District Jails in the State

5.8. No of counsellors trained in mental health in


the above institutions
5.9.No of counsellors trained in mental health in
the above institutions

Helplines for Mental Health: NONE

297

0
1
0
1
0
1 central, 7
district
0
0

6. MENTAL HEALTH HUMAN RESOURCES


Mental Health Care Professionals

6.1. No of
Psychiatrists
6.2. No of Clinical
Psychologists
6.3. No of
Psychiatric Social
Workers
6.4. No of nurses
trained in mental
health
6.5. No of trained
counselors

Government
Sector medical
colleges/hospitals
15

Private
medical
colleges
NA

Private
Practice

NA

NA

NA

NA

NA

NA

NA

NA

NA

Total

NA

4 trained Programme Officers in DMHP


COMMENT:
Special Rapporteurs report mentions that manpower is significantly short. Instances of
selected candidates not being provided joining letters are worth highlighting for the State
administrations introspection.
7. MENTAL HEALTH HUMAN RESOURCE DEVELOPMENT
7.1. Degree/Diploma Courses- INFORMATION NOT PROVIDED
In Entire state, Annual No of
Seats in
MD Psychiatry
DNB Psychiatry
Diploma in Psychiatry
PhD Clinical Psychology
MPhil Clinical Psychology
PhD Psychiatric Social Work
MPhil Psychiatric Social Work
PhD Psychiatric Nursing
MSc Psychiatric Nursing
BSc Psychiatric Nursing
Basic Diploma in Psychiatric
Nursing (DPN)

Institutions where the Programme is offered

GMC, Shrinagar

GMC, Shrinagar

298

COMMENT:
There was no information supplied through affidavit. The Medical Council of India website
displays only 3 MD Psychiatry seats.
NHRC Special Rapporteur reports that there is proposal of a Centre of excellence being
established which should offer different courses.
7.2. Other training in mental health: Medical officers are being
7.2.a. Details of Undergraduate MBBS training in psychiatry: INFORMATION NOT PROVIDED.
There are 4 Medical colleges in The State (2 in Jammu, 2 in Shrinagar) as Medical council Of
India
7.2.b. Details of in-service training for Govt medical officers (No trained, duration)
INFORMATION NOT PROVIDED. Medical Officers are provided 3 months training at NIMHANS
as per NHRC Special Rapporteur
7.2.c. Any other training courses in mental health offered by the state INFORMATION NOT
PROVIDED
8. GOVERNANCE:
8.1. Nodal Authority and responsibilities : No information provided by State on affidavit.
State mental Health Authority exists on paper. Remains non-functional and no license has
evber been issued. Facilities in private sector remain unlicensed, if exist. (NHRC Special
Rapporteur)
8.2. Presence of a State Mental Health Plan: None
8.3. Enactment of State Mental Health Rules: Not reported
8.4. Oversight of policies and Programmes related to mental health
The Jammu and Kashmir Legal Services Authority Scheme, 2010 provides legal services to the
mentally ill persons and persons with mental disabilities. (Source: DLSA website)
8.5. Specific oversight of the DMHP programme.
Fully implemented in Jammu, Udhampur, Kathua, and Rajouri. State claims partial
implementation in Doda and Samba. Non-availability of staff and medicines is the main
problem. Source: NHRC Special Rappoteurs report)

299

8.6. Attempts towards integration of mental health care into general health care, NCD
management etc.: None
8.7. Examples of commitment to develop mental health services: None
8.8. Examples of inter-sectoral collaboration to improve mental health services: None
8.9. Attempts towards mental health promotion: None
COMMENT: Strengths and weaknesses
State Mental Health Authority needs to be activated. The manpower shortage has been
accentuated by long recruitment processes and lack of training facilities within the State.

9. FINANCING
9.1. Sources of financing of different categories: State government is financing Healthcare.
Government of India is providing funds for NMHP.
9.2 Budget provision from State and Centre in INR : NA
9.3. Mental Health Expenditure as proportion of Total Health Expenditure in State: NA
10. ANY OTHER SIGNIFICANT INFORMATION (e.g. litigation, insurance schemes for persons
with mental illness, pension and other assistance, job reservations) no litigation
11. INNOVATIONS: None
12. OVERALL SUMMARY OF STATE LEVEL MENTAL HEALTH SERVICES
There is need for equitable distribution of Mental Sercvices within the State. Ladakh has been
deprived of any kind of Mental Health Service (Even the 2 districts in Ladakh Division are not
counted in the affidavit submitted by State!). DMHP also needs to be scaled up and initiated
in Kashmir Valley. The Centre of Excellence Scheme related work needs to be expedited to
address manpower shortage.

300

SECTION 2
2.1. PSYCHIATRIC INSTITUTIONS
No information provided on affidavit. The information entered is from NHRC Special
Rapporteurs report.
Name and a para on status in 2008 (refer to NHRC book Mental Health Care and Human
Rights)
Government District Psychiatric Hospital, Jammu
Domains
Infrastructure

Status in 2008
Adequate

Amenities and facilities


Financial arrangements

No canteen services
127.4 lakh (2004-05)

Diet
Investigations and treatment
Staff and training
Supportive services
Recreation/Occupational
therapy/Rehabilitation
Networking with other agencies

Not mentioned
Adequate
Inadequate. DNB Course
Adequate
No rehabilitation services

Developments since 2008


Fully airconditioned new
building. Shifted to Resham
nagar colony now. (Not
complete yet)
Adequate
35.58 lakh (plan)+318.00
lakhs (non-plan)
55/day/patient
No training
Adequate
Occupational therapist has
retired.

SERVICES
i. Outpatient: Avaialable with a special Deaddiction Clinic with Opiod Substitution Therapy
ii. New Building had improved facilities.
Diagnostic categories seen:
iii. DIAGNOSTICS AND THERAPEUTICS

Investigations: No mention
Therapeutic facilities: Drugs are free of cost. ECT is not being given now.
Improvements in rehabilitation: Deterioration because of retirement of sole
Occupatiional Therapist.

iv. ENGAGEMENT:

Attempts to involve families of persons with mental illness: Involved


301

Disability certification and number of certificates issued in the previous year: No


certification board

v. ADMINISTRATIVE

Annual number of adverse events: None


Mechanisms for redressal of patient complaints: Not mentioned

vi. COMMUNITY OUTREACH AND NETWORKING

Community Programmes: Not mentioned


Networking with external agencies: 3 NGOs involved
Public mental health education: Not mentioned

vii. TRAINING

Post-graduate training DNB course mentioned in 2008 report appears to have been
discontinued.
Any other training Programmes: MBBS students are provided training

vii. RESEARCH: Nil


x. Special Rapporteurs observation: Everything in this section is from her observations
xi. Any other observations (including Inspection Committee Reports):
xii. Summary and Recommendations from SECTION 2:
Areas of positive change

Areas of poor progress

New air-conditioned building

Post-graduate course stopped. Rehabilitation


services suffering

Name and a para on status in 2008 (refer to NHRC book Mental Health Care and Human
Rights)
Government Psychiatric Diseases Hospital, Rainbari, Shrinagar
Domains

Status in 2008

Developments since 2008

Infrastructure
Amenities and facilities
Financial arrangements

Adequate
Adequate
Not mentioned

Diet

Adequate

Adequate
Adequate
Plan (22.28 lakh), Non-plan
(460.69 lakhs)
Kitchen and dining hall
damaged
302

Investigations and treatment


Staff and training

Adequate
No Psychiatric social Worker,
Occupational therapist

Supportive services
Recreation/Occupational
therapy/Rehabilitation
Networking with other agencies

Adequate
No rehabilitation services

No occupational therapist
(retired)
3 MD Psychiatry saets
4 MPhil (Clinical Psychology)
seats
No drivers/vehicles
Games available. No
occupational therapist
Outreach programme

SERVICES
i.
ii.

Outpatient: Available with a special Deaddiction, Geriatric and Children Clinic


New Building had improved facilities.

iii. DIAGNOSTICS AND THERAPEUTICS

Investigations: No mention
Therapeutic facilities: Drugs are free of cost. ECT is not being given now.
Improvements in rehabilitation: Deterioration because of retirement of sole
Occupatiional Therapist.

iv. ENGAGEMENT:

Attempts to involve families of persons with mental illness: Involved


Disability certification and number of certificates issued in the previous year: No
certification board

v. ADMINISTRATIVE

Annual number of adverse events: None


Mechanisms for redressal of patient complaints: Not mentioned

vi. COMMUNITY OUTREACH AND NETWORKING

Community Programmes: Camps with NGOorganized (Average 100 patients)


Networking with external agencies: 1 NGOs involved
Public mental health education: School Programme

vii. TRAINING

Post-graduate training MD Psychiatry and MPhil Clinical Psychology. The only seats
available for entire State

303

vii. RESEARCH: Nil


x. Special Rapporteurs observation: Everything in this section is from her observations
xi. Any other observations (including Inspection Committee Reports):Diet needs to be
monitored and improved. Furniture is inadequate (PDH Jammu).
PDH Shrinagar- satisfactory arrangements for care and treatment. Need to set up measures for
continuing care/rehabilitation, particularly for destitute. Suggestion to colour code the linen.
xii. Summary and Recommendations from SECTION 2:
Areas of positive change

Areas of poor progress

Post-Graduate Corses

Vehicles and Drivers


Funds for latest drugs
Recruitment
Vocational Rehabilitation

SECTION 3
3. General Hospital Departments of Psychiatry and District Hospital Departments
The broad outline for this section:
3.1. Names of GH/DH and their location.
Govt Hospital Gandhi Nagar Jammu
Govt Hospital Sarwal Jammu
Govt District Hospital Udhampur
Govt District Hospital Kathua
Govt District Hospital Rajouri
3.2. Areas (distribution throughout the states): Only in Jammu Division, none in Kashmir/Ladhak
3.3. Whether separate funding and adequacy:
3.4. Whether OP/IP and emergency services available

Only Outpatient available

3.5. Diagnostic categories in rank order that present in the outpatient Not available
3.6. Adequacy of OP facilities - adequate
3.7. Inpatient occupancy, free and paying beds, average cost of inpatient stay per week; rank
order of diagnostic categories Not available
304

3.8. Extent of family involvement- Involved


3.9. Measures to protect rights including complaint redressal- No patient complaint reported
3.10. Any networking- No
3.11. Staffing details and any shortages/vacancies- 1 psychiatrist, 2 psychologists, 1 Social
worker
3.12. Psychotropic medication availability/free/cost- limited stock avaialble
3.13. ECTs- NO
3.14. Observations of extent to which counselling and psychotherapy are provided- Not
apparent
3.15. Whether disability certification is available (if available numbers certified/year)- yes, 151
3.16. Extent and nature of community involvement- none
3.17. Whether engagement with the DMHP and extent- provide help to Mental health units
3.18. Nature and partnership with NGOs for networking- no
3.19. Presence of PG training- whether adequately distributed throughout the stateinformation not provided
3.20. Nature of public mental health material prepared and distributed/ activities to educateIEC activities
3.21. Areas of research, sources of funding and major findings- NA
3.22. Whether monitored and by whom. No report
3.23. Special Rapporteurs observations: Lack of manpower, crammed rooms, limited IEC
facilities, No in-patient facilities, shortage of medicines
3.24. Inspection Committees observations: Not inspected
3.25. SUMMARY AND RECOMMENDATIONS WITH RESPECT TO SECTION 3:
The facilities for Psychiatric Services in General Hospitals is a result of DMHP in Jammu.
However, facilities are not adequate because of manpower and medicine shortage. No facilities
exist in Ladakh/Kashmir divisions.

305

SECTION 4
4. NGOS WORKING IN MENTAL HEALTH: INFORMATION NOT PROVIDED ON AFFIDAVIT
Special rapporteurs report has references to some NGO activity:
a.
b.
c.
d.
e.

Mother Theresa Home for Dying and Destitutes


Jeevan Dhara
Choti Theresa
Action Aid in Mental Health
MSF (Medicine Sans Frontiers)

4.8. SUMMARY AND RECOMMENDATIONS FOR SECTION 4


NGOs are providing counselling services or aid Psychiatric Hospitals in organizing Outreach
Camps.
Formal documentation of work being done by them is required.
SECTION 5
5.DISTRICT MENTAL HEALTH PROGRAMME INFORMATION NOT PROVIDED In AFFIDAVIT as
per format.

306

5.1. A brief description of the location of the DMHP, when it started, total population covered:
DMHP Location
Government District
General Hospital,
Sarwal
Government Hospital,
GandhiNagar
District Hospital,
Udhampur
RamNagar
SubDivisional Hospital
PHC Ghordi
District Jail
Government District
Hospital, Rajouri
Government District
Hospital, Kathua
JLNM District Hospital
Aga Said Memorial
Govt. District Hospital

District
Jammu

Started
2010

Udhampur

2010

Rajouri

2011

Kathua

2010

Population covered

Shrinagar
Budgam

5.2. A summary of annual registrations old and new, treatment outcomes in terms of those on
regular treatment and those dropped out, with diagnostic categories if provided.
Variable patient load from more than 50 a day to 3-4 a day across locations.
5.3. Frequency of home visits carried out by the HW/ANM; numbers covered and for what
diagnostic categories, no of admissions facilitated: No home visits
5.4. Kinds of essential drugs available, number dispensed, number of patients receiving
medication under the DMHP in a month: In most DMHPs, medicines are not available (not
supplied for 2 years in cases, to exhausted in some place)
5.5. Duration of untreated mental illness for different diagnostic categories if provided: NA
5.6. Monitoring of the DMHP by the concerned officer /impressions and trouble-shooting:
Probably none
5.7. IEC activities of the DMHP: None
5.8. Training calendar of the DMHP (doctors, health workers, nurses, pharmacists, school
teachers/Anganwadi workers (whether any training conducted): Only few doctors have been
trained at NIMHANS
307

5.9. Activities to sensitize the gram panchayats: None


5.10. Special Rapporteurs report on the activities of the DMHP: DMHP is functional in only 4
Districts in Jammu region. No in-patient facility exists. There is shortage of Manpower and
Medicines.
5.11. Inspection Committees observations: Not inspected
5.12. SUMMARY OBSERVATIONS OF DMHP AND RECOMMENDATIONS:
Need to scale-up activities significantly.
Uninterrupted supply of medications needs to be ensured.
In-patient facilities need to be initiated.
Training and IEC needs to be initiated. (Psychiatric Diseases Hospitals in Jammu, and in
Shrinagar with 7 Psychiatric Faculty each can be made Resource Institutions)
SECTION 6
7. SUMMARY OF MENTAL HEALTH CARE INDICATORS IN Jammu & Kashmir

6.1. Availability of mental health facilities

Mental health outpatient


facilities in the state
Day treatment facilities
Psychiatric beds in general
hospitals
Community residential facilities
Beds/places in community
residential facilities
Psychiatric hospitals
Beds in psychiatric hospitals

Total No of
facilities/beds
12

Rate per 100,000


population
0.096

0
0

0
0

0
0

0
0

2
220

0.016
1.76

Rate per 100,000


population
640 *

Females %

6.2. Access to Care

Persons treated in mental


health outpatient facilities

308

Persons treated in mental


health day care facilities
General hospital admissions
Community residential facilities
Persons staying in community
residential facilities at the end
of the year
Admissions to mental hospitals

0
0
0
0

5.76

*Approximation based on data of field visits mentioned in NHRC Special Rapporteur


6.3. Information Systems

Persons with mental


disorders treated in
primary health care
Interventions delivered
in primary health care
for persons with
mental disorders
Persons treated in
mental health
outpatient facilities
Contacts in mental
health day treatment
facilities
Admissions in general
hospitals with
psychiatric beds
Admissions in mental
hospitals
Days spent in mental
hospitals
Admissions in
community residential
facilities

Data on No of
persons/activities
collected and reported
YES/NO
No

Data on age and


gender are collected
and reported
YES/NO
No

Data on patients
diagnosis are collected
and reported
YES/NO
No

No

No

No

No

No

No

No

No

No

No

No

No

No

No

No

No

No

No

No

No

No

309

6.4. Human Resources at the State Level


Health professionals working
in the mental health sector
Rate per 100,000
Psychiatrists
Medical doctors not specialised
in psychiatry
Clinical Psychologists
Psychiatric Social Workers
Psychiatric Nurses
Occupational therapists
Other health workers

0.12

0.064
0.016

Training of health
professionals in educational
institutions
Rate per 100,000
0.024

0.032

6.5. INFORMAL HUMAN RESOURCES (Family and User Associations)


Present in the state
No of members
Participation in the
formulation/implementation of
policy/plan/legislation

User
No information
No information
No information

Family
No information
No information
No information

6.6. MEDICINES
Type of Medication

Availability

All psychotropic medication


Mood stabilisers
Antipsychotics
Anxiolytics
Antidepressants
Anti-craving medication/ Substitution
treatments

Usually Not available


Usually Not available
Usually Not available
Usually Not available
Usually Not available
Available in Psychiatric Diseases Hospitals
only

MENTAL HEALTH REPORT CARD (needs to be revised after all the information is obtained)
Area
1

Mental Health
Services
(Secondary
and Tertiary)

Focus
Medical
College
Depts,
General

Parameters
Adequacy of inpatient
beds
Functional Departments
Functional OP services
310

Rating

Score (out
of 100)
100- present, fully 25 (no
satisfactory
information)
75- present,
reasonably

Hospitals,
Specialised
psychiatric
hospitals

Primary
Health Care
mental health
services

District
Mental
Health
Programme

% of functional DMHPs

Rehabilitation
services

At all levels

Vocational training, day


care, longstay facilities in
govt sector/ppp

Specialised
services

Services for
substance
use
disorders,
old age,
mental
retardation,
child
psychiatry,
community
services,
forensic
services

Whether existing, level


of functionality, present
at different levels of care

311

satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100 All districts 12.5
covered; fully
satisfactory
75 majority of
districts covered
and functioning
50 half the
districts covered
and functioning
25 one-fourth
of the districts
covered and
functioning
0- No districts
covered/although
DMHP exists, not
functioning
100- present, fully 12.5
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100- present, fully 25
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent

Human
Resources

(exclude
DMHP staff
here)

Adequacy of
psychiatrists/clinical
psychologists/psychiatric
social
workers/psychiatric
nurses or mental health
trained nurses

100 fully
adequate
75 moderately
adequate
50 somewhat
adequate
25- inadequate
0 grossly
inadequate

25

Financing for
mental health

State level

Existence of separate
budget for mental
health/mental health
activities

25

Governance
and Policy

State
Mental
Health
Authority
and other
authorities

Availability of
psychiatric
medication

At every
level

Separate Mental Health


Nodal Officer
Functioning Mental
Health Authority
Nodal persons for mental
health in SHRC/Legal
Services
Authority/Others
State Mental Health
Rules
State Mental Health
Programme
Range of medications
Regular supply and
dispensing
Standard procurement
arrangements

10% -separate
budget, fully
adequate
75 separate
budget,
moderately
adequate
50 separate
budget,
somewhat
adequate
25 no separate
budget, but some
financial
resources
available annually
0 no separate
budget/marginal
financial resource
allocation
100 Existing,
fully functional
75- Existing,
mostly functional
50- Existing,
somewhat
functional
25- Partial
0 Non existent

100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory

25

312

12.5

Affirmative
action for
persons with
mental illness

At every
level

Disability assessment
Pension
Travel concession
Health insurance
Special assistance
Educational benefits
Job reservation

10

Treatment
Gap

Overall

Approximate number of
persons with mental
illness approximate
numbers totally receiving
treatment in the state

Total Score (out of 1000)


Average Score (%)

25
Unsatisfactory
0- Not available at
any level
100- Fully
12.5
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100 no
12.5
treatment gap
75 25%
treatment gap
50 -50%
treatment gap
25 -75%
treatment gap
0- 100%
treatment gap
187.5
18.8

RECOMMENDATIONS: Information is provided only for Jammu and not for Kashmir and
Ladakh regions. Information is scanty in affidavit and based mainly on Special Rapporteurs
Report. DMHP coverage is still poor and human resources and medication are still major
problems. The biggest problem is a lack of governance with the State Mental Health
Authority in place. PG training is greatly deficient.
J and K needs a large human resource, good mental health programme governance, and lots
to be done. This is a state which needs urgent attention, filling up of deficient information, a
proper plan and implementation.

313

JHARKHAND

SECTION 1. STATE LEVEL REPORT


13. GENERAL INFORMATION REGARDING THE STATE (Jharkhand)
13.1. Area
79716 Sq.Kms.
13.2. No of districts
24 (As per Census 2011)
13.3. Population, age distribution (as per census 2011) Total Population 32966238
Distribution by
Age 0 14 Years : 33.5%
15 59 Years : 59.9%
13.4. Gender distribution
Males : 16931688
Females : 16034550
13.5. Life expectancy at birth male and female
N.A.
13.6. Per capita State Government expenditure on health
N.A.
13.7. Any health indicators for the state (life expectancy, etc) N.A.
13.8. Completeness/quality of information provided: Complete/Partially
Complete/Deficient
If deficient, areas of deficiency: Lack of information in many areas
14. MENTAL ILLNESS BURDEN/ INFORMATION REGARDING MENTAL ILLNESS
N
(prevalence)
2.1. Total number of persons with
mental illness (all ICD categories)
2.2. Broad categories
2.2.a Severe mental disorders
(BPAD, psychosis)
2.2.b Common mental disorders
2.2.c Substance use disorders
(alcohol and other drugs)
2.2.d Mental Retardation

2.62

Yet to be
studied

2.3. No of Males with mental health


problems
2.4. No of females with mental
health problems
2.5. No of children with mental
health problems
314

N
(treatment
seeking)

Source of
information
Census of
India 2011

2.6. No of elderly with mental health


problems
2.7. No of homeless mentally ill
persons

COMMENT: Has not provided any estimation of the extent of mental health problems in the
state.

15. MENTAL HEALTH SERVICES IN THE STATE:


15.1. Organization of Services (description of number of psychiatric hospitals, medical
college depts, district hospitals)

N/N

No with dept/facility
Total No of units

3.1.a No of district general


hospitals with separate
department of psychiatry

NIL

3.1.b No of medical colleges with


department of psychiatry

3.1.c No of district general


hospitals providing psychiatric
care
3.1.d No of District Mental Health
Programmes in the State

4 (Under DMHP)

% coverage

N
3.1.e No of government
psychiatric hospitals
3.1.f No of private psychiatric
hospitals
3.1.g Total No of psychiatric
hospitals in the state

3.1.h No of NGOs providing


mental health care

N.A.
3

COMMENT: As per the affidavit, only 3 of medical colleges have a department of psychiatry.
Information from the private sector is not available. DMHP is implemented in 4/24 districts.
There are very few NGOs.

315

15.2. INPATIENT SERVICES


DESCRIPTION:
Psychiatric
hospitals
(RINPAS)
(Govt) N=
3.2.a. Total I.npatient Santioned
sanctioned/available Beds 600
beds
Available
Beds 580
3.2.b No of male
382
beds
(As on 1st
April, 2014)
3.2.c. No of female
198
beds
(As on 1st
April, 2014)
3.2.d. No of beds for Details not
children
available
3.2.e. No of beds for Details not
elderly
available
3.2.f. No of beds for
Details not
substance use
available
disorders
3.2.g. No of beds for Details not
forensic psychiatry
available
3.2.h. Occupancy (%) 96
3.2.i. No of
2458
admissions during
previous year
3.2.j. No of
2358
discharges during
previous year
3.2.k. Average
55.78 days
duration of inpatient
stay in days mean
3.2.l. Average
N.A.
duration of inpatient
stay in days median
3.2.m. No of closed
Nil
wards
3.2.n. No of closed
Nil
ward beds
3.2.o. No of open
11
wards
3.2.p. No of open
600
ward beds

Psychiatric
hospitals
(Private) N=

General
Hospitals
N=

District
Hospitals
N=

NGOs
N=

Total

316

3.2.q. No of paid
wards
3.2.r.No of paid beds
3.2.s.No of
admissions through
courts
3.2.t. No of deaths in
the last year
3.2.u. No of suicides
in the last year

1
2
100

4
Nil

COMMENT: The duration of inpatient stay is relatively longer in RINPAS compared to other
psychiatric institutions. Information from CIP and other large private institutions have not been
provided.

15.3. OUTPATIENT SERVICES

3.3.a. No of new OP
registrations in the
previous year
3.3.b. No of
emergency
attendees in the
previous year
3.3.c Total no of OP
follow-up in the
previous year

Govt.
Psychiatric
hospitals
N=
13114

Private
Psychiatric
hospitals
N=

General
Hospitals

District
Hospitals

NGOs

N=

N=

N=

Total

N.A.

80563

COMMENT:
*common diagnostic categories in rank order in each of the different facilities

16. REHABILITATION FOR PERSONS WITH MENTAL ILLNESS


16.1. Government residential rehabilitation/longstay facilities : No and description: Nil
16.2. Government day care/outdoor rehabilitation facilities: No and description: Nil
317

16.3. Government run half-way homes: No and description. If none, plans to establish
and details: Two half way homes (Males & Females) 50 bedded are underway at
RINPAS
16.4. NGO participation in the half way homes: Nil
16.5. Longstay rehabilitation facilities: No and description; NGO participation: Nil
17. MENTAL HEALTH CARE IN OTHER COMMUNITY FACILITIES
State Level, in the Govt Sector

5.1. No of shelter homes, observation homes, special homes and


childrens homes
5.2. No of counsellors trained in mental health in the above
institutions
5.3. No of protection homes for destitute women
5.4. No of counsellors trained in mental health in the above
institutions
5.5. No of old age homes
5.6. No of counsellors trained in mental health in the above
institutions
5.7. No of Central Jails and District Jails in the State
5.8. No of counsellors trained in mental health in the above
institutions
5.9.No of counsellors trained in mental health in the above
institutions

Detailed information is
not available

Helplines for Mental Health: (Nature of helpline, who runs it, for whom, any information on
its utilization) Yes, Umang Help Line is available at RINPAS.
COMMENT:
18. MENTAL HEALTH HUMAN RESOURCES
Mental Health Care Professionals

6.1. No of
Psychiatrists
6.2. No of Clinical
Psychologists
6.3. No of Psychiatric
Social Workers
6.4. No of nurses
trained in mental
health
6.5. No of trained
counselors

Government Sector
medical
colleges/hospitals
18

Psychiatric
medical colleges

9
14
10

N.A.

318

Private
Practice

Total

COMMENT: The information on mental health professional resources outside RINPAS has not
been documented.
7. MENTAL HEALTH HUMAN RESOURCE DEVELOPMENT
7.1. Degree/Diploma Courses
In Entire state, Annual No of N
Institutions where the Programme is offered
Seats in
MD Psychiatry
1
RINPAS
DNB Psychiatry
Nil
RINPAS
Diploma in Psychiatry
1
RINPAS
PhD Clinical Psychology
4
RINPAS
MPhil Clinical Psychology
12
RINPAS
PhD Psychiatric Social Work
4
RINPAS
MPhil Psychiatric Social
12
RINPAS
Work
PhD Psychiatric Nursing
Nil
MSc Psychiatric Nursing
Nil
BSc Psychiatric Nursing
Nil
Basic Diploma in Psychiatric
6
RINPAS
Nursing (DPN)
COMMENT: No information on training outside RINPAS.
7.2. Other training in mental health 7.2.a. Details of Undergraduate MBBS training in psychiatry
Name of medical
college

No of hours of
theory

Duration of
psychiatry
posting during
UG

Duration of
psychiatry
posting during
internship

Qualifying
Examination
includes
competency
evaluation in
psychiatry

COMMENT: Posting of all three Medical Colleges students of the state in Psychiatry
department for undergraduate MBBS psychiatry training.
* If many medical colleges and all uniform UG training, mention the number of colleges and the
details of UG training
7.2.b. Details of in-service training for Govt medical officers (No trained, duration) : 38
319

*If not trained, plans to train and timeline


7.2.c. Any other training courses in mental health offered by the state : Information is not
available.
* Describe the type of course/duration/participants
8. GOVERNANCE:
8.1. Nodal Authority and responsibilities : Nodal Officers with responsibilities for mental
health care in the state health services are
1. Medical Education

: Mr. Naveen Kumar

2. State Medical & Health Department

: Mr. Naveen Kumar

3. State Mental Health Authority

: Director, RINPAS

4. District Legal Services Authority

: JHALSA

8.2. Presence of a State Mental Health Plan: NR


8.3. Enactment of State Mental Health Rules: NR
8.4. Oversight of policies and Programmes related to mental health
8.5. Specific oversight of the DMHP programme. Brief description of districts where fully
implemented, where partially implemented and details of reasons for incomplete
implementation. Also mention here a brief summary of availability of medicines and
psychosocial care for patients with mental illness. No. Of district Mental Health Programme
(DMHP) in the state = 4
No. Of districts in which DMHP has been implemented = 4
No. Of district in which DMHP has been fully implemented = 4
The additional number of districts in which state proposes to implement the district mental
health Programme during the next five years beginning (2015-16) = 2 (Hazaribagh, Deoghar)
8.6. Attempts towards integration of mental health care into general health care, NCD
management etc.
8.7. Examples of commitment to develop mental health services (high level involvement,
budgeting, networking

320

8.8. Examples of inter-sectoral collaboration to improve mental health services (including PPP
intitiatives) Mental Health Services are provided in the Central Jail, Ranchi, Gumla,
Daltonganj, Chaibasa and in probation and observation homes, Ranchi.
8.9. Attempts towards mental health promotion (e.g. SMHA Karnataka had organised regular
phone in Programmes related to mental health and mental disorders. Public responses were
evaluated and were very encouraging)
COMMENT: Strengths and weaknesses

9. FINANCING
9.1. Sources of financing of different categories : (RINPAS) Funds (Plan) Rs. 15,00,00,000.00
Funds Non Plan Rs. 26,22,31,722.00. Other sources of funding Rs. 6,09, 19,200.00 (Due from
Govt. of Bihar).
9.2 Budget provision from State and Centre in INR (for different facilities if required)
9.3. Mental Health Expenditure as proportion of Total Health Expenditure in State
(If available % spending on Health in the State may also be provided)
10. ANY OTHER SIGNIFICANT INFORMATION (e.g. litigation, insurance schemes for persons
with mental illness, pension and other assistance, job reservations)
Here a few lines can be mentioned on mental health professional bodies at the state level (e.g.
State Branch of the Indian Psychiatric Society) and their activities. This may be useful to discuss
in the recommendations how such bodies can be leveraged to improve different aspects of
mental health care in the state.
11. INNOVATIONS
In the COMMENTS, the observations of the Special Rapporteur or the high level committees
visit to the states may be incorporated
12. OVERALL SUMMARY OF STATE LEVEL MENTAL HEALTH SERVICES : Total population of state
of Jharkhand is 32966238. Total no. Of districts in the state are 24. Approximate no. Of persons
with mental illness is 2.62 %. There is one state run psychiatric hospital in the state i.e. RINPAS.
There is need to develop the psychiatric services at the district hospitals. Total no. Of medical
colleges in the state which have a separate department of psychiatry is three. Mental Health
services are provided in the Central Jail, Ranchi, Gumla, Daltonganj, Chaibasa and in probation
321

and observation homes. As per recommendation of special rapporteur, NHRC, there is need of
modernization of vocational Programmes in RINPAS, RMCH and central Jail and there should be
a human right cell in each hospital related to mental health. The mentally ill persons should be
provided equitable, accessible and affordable care at both institutional and community levels
by developing community linkages. Innovative methods for mental care for promoting illness,
prevention, treatment and rehabilitation at state level are not documented.
There is no mention of the other mental health resources in the state (Davis Institute of
Neuropsychiatry, Ranchi, Departments of Psychiatry at RIMS Ranchi, PMCH Dhanbad, MGMCH
Jamshedpur.

SECTION 2
2.1. PSYCHIATRIC INSTITUTIONS : RINPAS, Kanke, Ranchi
Name and a para on status in 2008 (refer to NHRC book Mental Health Care and Human
Rights)
Domains
Infrastructure

Amenities and facilities

Financial arrangements
Diet
Investigations and treatment
Staff and training
Supportive services
Recreation/Occupational
therapy/Rehabilitation

Status in 2008
Several renovation of Wards
were undertaken, new
administrative block,
community hall and OPD
hall were constructed.
Convention centre is
proposed.
Drug de-addiction centre is
functioning since 2005,
Toilet, Drinking water and
canteen facilities are
available.

Developments since 2008


Renovation of wards has
been completed, new OPD
building is ready to use for
patients.

Proposal for mechanised


kitchen is being prepared.

CT scan machine is being


installed.
Yoga therapy is being done There is improvement in the
in each ward. T.V. and occupation therapy and
Newpapers
in
regional rehabilitation for the
322

Networking with other


agencies
SERVICES

languages are available in patients. This has been also


each ward.
documented in the report of
special rapporteur of NHRC.
There is active involvement
with NGO - Sanjeevani

i. Outpatient: There is Separate outpatient block constructed. There are facilities for visiting
relatives to stay, waiting hall for patients, separate interview rooms for patients, drinking water
and canteen services. Also in OPD block, there are provisions of OPD lab services, OPD
rehabilitation services, specialized children, geriatric, forensic services and specialized deaddiction services.
ii. Inpatient : There are separate dining facilities, interview rooms available to speak to patients
and there are facilities for adequate care for women patients. Disposable needles and syringes
are use in the hospital.
Diagnostic categories seen:
iii. DIAGNOSTICS AND THERAPEUTICS

Investigations: Haematology, Serology, Biochemistry, Urine Test, Ophthalmoscopy,


Biometry, EEG, ECG, X-ray, CT Scan, Psychological Testing.
Therapeutic facilities:
Improvements in rehabilitation:

iv. ENGAGEMENT:

Attempts to involve families of persons with mental illness:


Disability certification and number of certificates issued in the previous year: Disability
certification is done. No. Of certificates issued in previous year 949.

v. ADMINISTRATIVE

Annual number of adverse events: N.A.


Mechanisms for redressal of patient complaints: N.A.

vi. COMMUNITY OUTREACH AND NETWORKING

Community Programmes: Yes, No. Of Community Outreach activities per month = 4,


No. Of patients covered through outreach Programmes 33292.
Networking with external agencies: No

323

Public mental health education: IEC Material (booklets) in awareness Programme and
community outreach Programme, helpline for telecounseling

vii. TRAINING

Post-graduate training new Programmes, enhancement of seats and measures to


maintain/improve quality of training: Post-graduate training is provided to M.D., DPM,
Clinical Psychology, Psychiatric Social work, Psychiatry Nursing students.
Any other training Programmes: MBBS students, Nursing students, Clinical Psychology
and Psychiatric Social Worker, Field Placement of M.Phil, Diploma and P.G. students.

vii. RESEARCH:

Research (areas, funding agencies, findings), : Institutional Projects, Ph.D. and M.D.
Thesis, M.Phil and DPM dissertation research papers.

viii. ANY OTHER SALIENT CONTRIBUTIONS OF THE HOSPITAL/INSTITUTE:


ix. Any monitoring of hospital (internal or external)- details : Monitoring is done by NHRC and
SHRC. No. Of visits by NHRC and SHRC in last two years is two.
x. Special Rapporteurs observation: Prof. S. Narayan, Date of Visit : 5th to 7th Feb., 2015. The
observations are as following
OPD status :

There were long ques at both the registration counter as well as at the medicine
distribution counter :
The OPD space was not clean and some cracks were found in the walls and floor.

Occupational Therapy & Rehabilitation Unit :

The main trades running in the male section of the OT and Rehabilitation centre were
Tailoring; Painting; Welding (gas & Electric); Black Smith; Caning; Weaving; Book
binding; Printing (digital); Paper bag & Envelope making; Carpentry; Soap (Cake &
Detergent); Canteen; Bakery; Computer Training.
The mail trades female section were Tailoring; Knitting and Embroidery; Basket making;
Agarbatti making; Shawl making; Mushroom cultivation; Vegetable cultivation; Paper
Bag; Jute bag making; Pitonji Mala; Canteen.

Staff status

The RINPAS is autonomous but there is no rule for recruitment, service condition etc.
324

The majority of the vacant teaching and non teaching sanctioned posts affects the
working of the hospital.
The mental hospital had no dietician;
There is no Radiologist in the RINPAS

xi. Any other observations (including Inspection Committee Reports): Infrastructure is


adequate. Vocational workshops are impressive. There are no separate geriatric facilities. Drug
availability is satisfactory. There are many destitute patients. There are many staff
vacancies.There has been regular monitoring. There have been no complaints.
xii. Summary and Recommendations from SECTION 2:
The information about Central Institute of Psychiatry as well as some of the old private
facilities in Jharkand have not been included in the affidavit. This makes state-level planning
difficult.
At the CIP, as per the IC Report, the inpatient facility consists of 643 beds (421 male, 222
female). It has a 50-bed childrens ward, no geriatric ward, a 60 bed deaddiction centre, a 50
bed rehabilitation unit, a 16 bed emergency facility. There are staff vacancies in psychiatry.
Daily average OPD attendance is 211 and 14387 patients were newly registered in the
previous year, and 45223 follow-ups were registered. There were 4150 admissions. Mean
duration of inpatient stay is 33 days. CIP had 12 patients with duration of stay more than 1
year and 60 patients (33 male and 27 female) staying more than 5 years. CIP has acive
outeach services, with extension clinics at Bokaro, Hazaribagh and other places, has
programmes for child mental health and has a total of 7 outreach programmes. Drug
availability is good. 402 patients received modified ECTs. Medical co-morbitity among
patients is frequent. There is a grievance redressal system in place as well as incident
recording. The CIP is providing training in OST, substance use disorder management and short
term training in epilepsy management. Two NGOs collaborate with the institute. Last year
funding was Rs 45 crores (19.5 c revenue, 25.5 c capital).
The IC recommended that long-stay patients be rehabilitated with the help of the Jharkand
State Legal Services Authority, NGOs and respective local authorities.

325

SECTION 3
3. General Hospital Departments of Psychiatry and District Hospital Departments
The broad outline for this section:
3.1. Names of GH/DH and their location. Ranchi Institute of Medical Sciences (RIMS) and
District Hospital of Ranchi. There is no psychiatry department in Ranchi District Hospital.
(If there are many, this could be done in a tabular column).
The following areas may be mentioned as a summary of all the units; where needed , examples
could be made of a specific dept to highlight both positives and negatives.
3.2. Areas (distribution throughout the states): N.A.
3.3. Whether separate funding and adequacy: N.A.
3.4. Whether OP/IP and emergency services available : Only OPD services are available, the
daily turn out of patients at OPD is only 3 to 4 patients. There is no indoor patient facility.
3.5. Diagnostic categories in rank order that present in the outpatient : N.A.
3.6. Adequacy of OP facilities : N.A.
3.7. Inpatient occupancy, free and paying beds, average cost of inpatient stay per week; rank
order of diagnostic categories : N.A.
3.8. Extent of family involvement : N.A.
3.9. Measures to protect rights including complaint redressal : N.A.
3.10. Any networking : N.A.
3.11. Staffing details and any shortages/vacancies : N.A.
3.12. Psychotropic medication availability/free/cost : N.A.
3.13. ECTs (Nos given across the facilities or average/No of direct )
3.14. Observations of extent to which counselling and psychotherapy are provided : N.A.
3.15. Whether disability certification is available (if available numbers certified/year) : N.A.
3.16. Extent and nature of community involvement : N.A.
326

3.17. Whether engagement with the DMHP and extent : N.A.


3.18. Nature and partnership with NGOs for networking : N.A.
3.19. Presence of PG training- whether adequately distributed throughout the state : N.A.
3.20. Nature of public mental health material prepared and distributed/ activities to educate :
N.A.
3.21. Areas of research, sources of funding and major findings : N.A.
3.22. Whether monitored and by whom. What were the observations? : N.A.
3.23. Special Rapporteurs observations : N.A.
3.24. Inspection Committees observations : N.A.
3.25. SUMMARY AND RECOMMENDATIONS WITH RESPECT TO SECTION 3:
(Overall impressions about the mental health service delivery through the General and District
Hospitals).
Deficient information
SECTION 4
4. NGOS WORKING IN MENTAL HEALTH:
4.1. A brief description of the NGO and its location : Navbharat, Jagriti Kendra and Sanjeevani
Gram Trust, Help in identification and follow-up of patients at DMHP community outreach
clinics.
4.2. Nature of work carried out by the NGO in the domains mentioned and details of each : N.A.
4.3. Description of clientele seen by the NGO and number of persons who use the services in
the previous year : N.A.
4.4. Research details : N.A.
4.5. Details of any training carried out by the NGO : N.A.
4.6. Networking activities of the NGO : N.A.
4.7. Salient contributions of the NGO : N.A.
4.8. Special Rapporteurs observations : N.A.
327

4.9. Inspection Committees observations : N.A.


4.8. SUMMARY AND RECOMMENDATIONS FOR SECTION
SECTION 5
5.DISTRICT MENTAL HEALTH PROGRAMME
5.1. A brief description of the location of the DMHP, when it started, total population covered:
DMHP is functioning in four districts of Jharkhand namely Dumka, Jamshedpur, Daltonganj,
Gumla districts. DMHP Programme is operational in three districts namely Dumka, Daltonganj
and Gumla. In Dumka district, DMHP is operational since year 2005 06 and in districts
Daltonganj and Gumla it is operational since year 2008-09. The Programme is operational in the
districts with its full manpower strength and has been conducting the activities such as
awareness camps, IEC campaigns, training of medical and paramedical staffs. All the activities in
the state have been conducted in collaboration with NGO. State Govt. has started one new
DMHP in Jamshedpur district for which Programme implementation and support staff has been
recruited by the state government.
5.2. A summary of annual registrations old and new, treatment outcomes in terms of those on
regular treatment and those dropped out, with diagnostic categories if provided. Would be
useful to know what kind of clientele is serviced under the DMHP:
5.3. Frequency of home visits carried out by the HW/ANM; numbers covered and for what
diagnostic categories, no of admissions facilitated:
5.4. Kinds of essential drugs available, number dispensed, number of patients receiving
medication under the DMHP in a month: No. Of patients receiving medications under the
DMHP in a month
District

No. Of patients

Dumka

46

Jameshdpur

98

Daltonganj

86

Gumla

17

5.5. Duration of untreated mental illness for different diagnostic categories if provided:
5.6. Monitoring of the DMHP by the concerned officer /impressions and trouble-shooting
(mention if there is a committee and its composition):
328

5.7. IEC activities of the DMHP:


5.8. Training calendar of the DMHP (doctors, health workers, nurses, pharmacists, school
teachers/Anganwadi workers (whether any training conducted):
5.9. Activities to sensitize the gram panchayats
5.10. Special Rapporteurs report on the activities of the DMHP, its reach, areas of good
performance, areas of poor performance, barriers for effective service delivery, measures to
streamline functioning, funding flow and barriers thereof.
5.11. Inspection Committees observations
5.12. SUMMARY OBSERVATIONS OF DMHP AND RECOMMENDATIONS: This institute is the
nodal point for District Mental Health Programme. The DMHP is being run in following
Districts :
District

Started in the year

Dumka

Feb. 2006

Gumla

April 2009

Daltonganj

April 2009

Jamshedpur

May 2011

Centres are running satisfactorily. Services are mainly related to patient care and
training of Doctors, Nurses, Teachers, Gram Pradhan, Sahia, Aanganbari Sevika, Students and
family members of patients.
Medicine is provided free of cost at all the centres. Psychiatrists and Senior Residents of
RINPAS alongwith other team members are involved in various community outreach
Programmes in Hazaribagh, Saraikela, Khunti and Johna. RINPAS is the nodal institute for
implementation of DMHP and OPD services under DMHP has started at Sardar Hospitals in
Dumka, Gumla, Daltonganj and Jamshedpur. There are also visits of Doctors in Central Jail of
Ranchi, Hazaribagh and Khunti.

329

330

SECTION 6
6. SUMMARY OF MENTAL HEALTH CARE INDICATORS IN JHARKHAND (name of state)
6.1. Availability of mental health facilities

Mental health outpatient


facilities in the state
Day treatment facilities
Psychiatric beds in general
hospitals
Community residential facilities
Beds/places in community
residential facilities
Psychiatric hospitals
Beds in psychiatric hospitals

Total No of
facilities/beds
10

Rate per 100,000


population
0.329

0.823

3
*

0.004
1.469

*does not include a count of beds outside RINPAS


6.2. Access to Care
Rate per 100,000
population
Persons treated in mental
health outpatient facilities
Persons treated in mental
health day care facilities
General hospital admissions
Community residential facilities
Persons staying in community
residential facilities at the end
of the year
Admissions to mental hospitals

Females %

14.52

6.3. Information Systems

Persons with mental


disorders treated in
primary health care
Interventions delivered
in primary health care

Data on No of
persons/activities
collected and reported
YES/NO
No

Data on age and


gender are collected
and reported
YES/NO
No

Data on patients
diagnosis are collected
and reported
YES/NO
No

No

No

No

331

for persons with


mental disorders
Persons treated in
mental health
outpatient facilities
Contacts in mental
health day treatment
facilities
Admissions in general
hospitals with
psychiatric beds
Admissions in mental
hospitals
Days spent in mental
hospitals
Admissions in
community residential
facilities

No

No

No

No

No

No

No

No

No

Yes

Yes

Yes

Yes

Yes

Yes

No

No

No

6.4. Human Resources at the State Level


Health professionals working
in the mental health sector
Rate per 100,000
Psychiatrists
Medical doctors not specialised
in psychiatry
Clinical Psychologists
Psychiatric Social Workers
Psychiatric Nurses
Occupational therapists
Other health workers

0.301

0.047
0.033
0.166

Training of health
professionals in educational
institutions
Rate per 100,000
0.0364
2.893
0.010
0.003
0.016

6.5. INFORMAL HUMAN RESOURCES (Family and User Associations)

Present in the state


No of members
Participation in the
formulation/implementation of
policy/plan/legislation

User
Yes

Family
Yes

Not routinely

Not routinely

332

6.6. MEDICINES
Type of Medication

Expenditure at State level per year and per


100,000 population (inINR)

All psychotropic medication


Mood stabilisers
Antipsychotics
Anxiolytics
Antidepressants
Anti-craving medication/ Substitution
treatments

SECTION 7
19. STATE MENTAL HEALTH REPORT CARD

MENTAL HEALTH REPORT CARD (needs to be revised after all the information is obtained)particulary relevant to Jharkand as information is largely confined to RINPAS
Area

Focus

Parameters

Mental Health
Services
(Secondary
and Tertiary)

Medical
College
Depts,
General
Hospitals,
Specialised
psychiatric
hospitals

Adequacy of inpatient
beds
Functional Departments
Functional OP services

Primary
Health Care
mental health
services

District
Mental
Health
Programme

% of functional DMHPs

333

Rating

100- present, fully


satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100 All districts
covered; fully
satisfactory
75 majority of
districts covered
and functioning
50 half the
districts covered
and functioning
25 one-fourth of
the districts
covered and

Score
(out of
100)
25

12.5

functioning
0- No districts
covered/although
DMHP exists, not
functioning
100- present, fully
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100- present, fully
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent

Rehabilitation
services

At all levels

Vocational training, day


care, longstay facilities in
govt sector/ppp

Specialised
services

Whether existing, level of


functionality, present at
different levels of care

Human
Resources

Services for
substance
use
disorders,
old age,
mental
retardation,
child
psychiatry,
community
services,
forensic
services
(exclude
DMHP staff
here)

Adequacy of
psychiatrists/clinical
psychologists/psychiatric
social
workers/psychiatric
nurses or mental health
trained nurses

100 fully
adequate
75 moderately
adequate
50 somewhat
adequate
25- inadequate
0 grossly
inadequate

25

Financing for
mental health

State level

Existence of separate
budget for mental
health/mental health
activities

10% -separate
budget, fully
adequate
75 separate
budget,
moderately
adequate
50 separate
budget,

25

334

12.5

25

Governance
and Policy

State
Mental
Health
Authority
and other
authorities

Separate Mental Health


Nodal Officer
Functioning Mental
Health Authority
Nodal persons for mental
health in SHRC/Legal
Services
Authority/Others
State Mental Health
Rules
State Mental Health
Programme
Range of medications
Regular supply and
dispensing
Standard procurement
arrangements

Availability of
psychiatric
medication

At every
level

Affirmative
action for
persons with
mental illness

At every
level

Disability assessment
Pension
Travel concession
Health insurance
Special assistance
Educational benefits
Job reservation

10

Treatment
Gap

Overall

Approximate number of
persons with mental
illness approximate
numbers totally receiving
treatment in the state
335

somewhat
adequate
25 no separate
budget, but some
financial
resources
available annually
0 no separate
budget/marginal
financial resource
allocation
100 Existing,
fully functional
75- Existing,
mostly functional
50- Existing,
somewhat
functional
25- Partial
0 Non existent

100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100 no
treatment gap
75 25%
treatment gap
50 -50%

25

25

25

25

treatment gap
25 -75%
treatment gap
0- 100%
treatment gap
Total Score (out of 1000)
Average Score (%)

225
22.5

It is possible that the mental health report for Jharkand will improve if the information is more
comprehensive.
RECOMMENDATIONS: Since information outside of RINPAS has not been compiled, it is very
difficult to be able to assess the adequacy of resources.
The State Government should first comprehensively compile the information of government
and private psychiatric facilities.
It has the advantage of 2 large institutions which should work collaboratively to plan and
execute mental health services for the state. For this there is a need for a higher authority to
which all these institutions are accountable to and work with.

336

KARNATAKA
SECTION 1. STATE LEVEL REPORT
20. GENERAL INFORMATION REGARDING THE STATE
20.1. Area: 191791 sq kms
20.2. No of districts: 30
20.3. Population, age distribution (as per census 2011) 6,10,95297
20.4. Gender distribution:Males: 30,966,657; Females: 30,128,640 968:1000; Children
(0-6 years) 11.7%
20.5. Life expectancy at birth male and female: Male: 62.43; Female:66.44 (2004)
20.6. Per capita State Government expenditure on health: Less than 1% of GDP
20.7. Any health indicators for the state: Infant mortality rate at 38 and maternal
mortality ratio at 178 (SRS 2007-2009) are both lower than the national average (40
and 178 respectively), Literacy rate at 75.6% is higher than the national (74.04%).
20.8. Completeness/quality of information provided: Complete/Partially
Complete/Deficient
Deficient information. Apart from DIMHANS (state) and NIMHANS (central), there are 76
private psychiatric facilities in the state (as per the list provided from the Karnataka State
Mental Authority). There are also 47 medical colleges with Departments of Psychiatry.
However, the state affidavit does not contain the information from these facilities.
The information is also deficient in the area of DMHP details.
An effort was made to collect the information from all possible sources.
21. MENTAL ILLNESS BURDEN/ INFORMATION REGARDING MENTAL ILLNESS

2.1. Total number of persons


with mental illness (all ICD
categories)

N
%
(prevalence)
85533330
Calculated
by state at
14%*
See
explanation
below

337

N (treatment
%
Source of
seeking)
information
592996
0.69% As per
(collated
information
information
provided by
from 2
state
psychiatric
(calculated as
institutes, 32 Dt
1% psychosis,
Hospital/Medical
10% minor
Colleges and
mental
DMHP
disorder and
3% alcohol
abuse)

2.2. Broad categories


2.2.a Severe mental disorders
(BPAD, psychosis)
2.2.b Common mental
disorders
2.2.c Substance use disorders
(alcohol and other drugs)
2.2.d Mental Retardation

No information
available as per
categories

2.3. No of Males with mental


health problems
2.4. No of females with mental
health problems
2.5. No of children with
mental health problems
2.6. No of elderly with mental
health problems
2.7. No of homeless mentally
ill persons

See comment

COMMENT: The state has calculated the number of persons with having some kind of mental
disorder at 14% of the population. This is higher than what has been thrown up in national
epidemiological surveys, which suggest rates of 58-73/1000. A recent pilot study carried out in
NIMHANS in Kolar district suggests adult weighted prevalence at 8.84% and child mental health
morbidity at 3.4%). Nevertheless the numbers receiving treatment annually as per the state
level information reveals the huge treatment gap in the government sector.
A survey by a consortium of NGOs in Bangalore in 2010 estimates that there are 17,141
homeless persons. 2 It is well known that rates of mental illness are higher among those in
destitute homes and those who are homeless.
22. MENTAL HEALTH SERVICES IN THE STATE:
22.1. Organization of Services (description of number of psychiatric hospitals, medical
college depts, district hospitals) The state has listed that the sources of information
for state level mental health care in the government sector is provided through
specialised institutes (namely the National Institute of Mental Health and Neuro
Sciences, NIMHANS, Bangalore, a central govt institution and the Dharwad Institute
of Mental Health and Neuro Sciences (DIMHANS), a state govt institution; 32 general
hospitals and medical colleges and 12 DMHPs

http://www.thehindu.com/news/cities/bangalore/what-have-we-done-for-the-homeless-pretty-muchnothing/article2731238.ece

338

District

Population

Name of
facility

Licensed
private
institutions

No of private
psychiatrists

Bangalore

9,621,551

38

86

2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30

Belgaum
Mysore
Tumkur
Gulbarga
Bellary
Bijapur
DK
Davangere
Raichur
Bagalkot
Dharwad
Mandya
Hassan
Shimoga
Bidar
Chitradurga
Haveri
Kolar
UK
Koppal
Chikkaballapura
Udupi
Yadgir
Chikkamagalur
Ramanagara
Gadag
Chamrajnagar
Bangalore rural
Kodagu

4,779,661
3,001,127
2,678,980
2,566,326
2,452,595
2,177,331
2,089,649
1,945,497
1,928,812
1,889,752
1,847,023
1,805,769
1,776,421
1,752,753
1,703,300
1,659,456
1,597,668
1,536,401
1,437,169
1,389,920
1,255,104
1,177,361
1,174,271
1,137,961
1,082,636
1,064,570
1,020,791
990,923
554,519

12MC, 1
PH
2MC
2 MC
3MC
3MC
MC
2MC
8MC
2MC
2MC
MC
2MC, 1 PH
MC
MC
2MC
MC
MC

2
13
3
2
3
1
9
1
2

7
7
3
3
2
1
27
4
1
4
7

MC

1
2
5

2
6
1
2
1

1
5
1

MC

No of
psychiatrists
in govt
service
(DH/Psych
facilities)
48
3

3
1
1
1

14

3
1
1
1
1
1
1
1
1
1
1
1
1
1

*MC-medical college; PH-psychiatric hospital


As already mentioned, no information has been provided about the private psychiatric
facilities, although there are 84 registered facilities listed by the KSMHA Information from
medical college departments of psychiatry has also not been obtained

339

The list of the 170 private psychiatrists provided in the appendix of the state report
appears outdated, as a couple of the psychiatrists mentioned in the list are now
deceased. The number of psychiatrists listed in government service is 87.
In terms of psychologists working in the government sector, 34 are in Bangalore (1 each
in Davangere, Chikkaballapur, Ramnagagar, Tumkur, Chamararajnagar, Kodagu,
Chikkamagalur, Udupi, DK, Gulbarga, Koppal, Yadgiri, Bijapur, Bagalkot, Gadag and
Haveri. There are 7 psychologists in Dharwad (DIMHANS).
Psychiatric Social Workers
There are a total of 36 psychiatric social workers in Bangalore (33 at NIMHANS), one each
in 20 other districts. Districts that do not have any mental health professionals as per the
States submission include Bangalore (R), Mandya and Bidar. No psychologist or
psychiatric social workers are posted at Raichur, Bellary and Karwar. Shimoga and
Mysore have one psychiatric social worker but no psychologist. NIMHANS has 49
psychiatric nurses.

N/N
3.1.a No of district
general hospitals with
separate department of
psychiatry
3.1.b No of medical
colleges with department
of psychiatry
3.1.c No of district
general hospitals
providing psychiatric care
3.1.d No of District
Mental Health
Programmes in the State

No with dept/facility
Total No of units

30/30

100

47/47

100

30/30

100

12/30

40%

N
3.1.e No of government
psychiatric hospitals
3.1.f No of private

% coverage

2
82
340

psychiatric hospitals
3.1.g Total No of
psychiatric hospitals in
the state
3.1.h No of NGOs
providing mental health
care

84

COMMENT: The lacunae in the above information will be supplemented by the information
provided by the KSMHA.
22.2. INPATIENT SERVICES
DESCRIPTION: The two major psychiatric facilities have filled up 2 different proforma,
and thus parameters cannot be captured for both. Where information is available for
both, they are combined. Where only available for one, the name is specified.

3.2.a. Total Inpatient


sanctioned/available
beds
3.2.b No of male
beds
3.2.c. No of female
beds
3.2.d. No of beds for
children
3.2.e. No of beds for
elderly
3.2.f. No of beds for
substance use
disorders
3.2.g. No of beds for
forensic psychiatry
3.2.h. Occupancy (%)
3.2.i. No of
admissions during
previous year
3.2.j. No of

Psychiatric
hospitals
(Govt) N=2
(DIMHANS
& NIMHANS
894

Psychiatric
hospitals
(Private) N=

No info
available

General
Hospitals
N=

District
Hospitals
N=

Being
collated

386
245
20 +40
20 +10
20 +77

8
(NIMHANS)
57% (
DIMHANS)
2152+6204
8356
2088
341

NGOs
N=

Total

discharges during
previous year

3.2.k. Average
duration of inpatient
stay in days mean
3.2.l. Average
duration of inpatient
stay in days median
3.2.m. No of closed
wards
3.2.n. No of closed
ward beds
3.2.o. No of open
wards
3.2.p. No of open
ward beds
3.2.q. No of paid
wards
3.2.r.No of paid beds
3.2.s.No of
admissions through
courts
3.2.t. No of deaths in
the last year
3.2.u. No of suicides
in the last year

discharges
as against
2152
admissions
(DIMHANS)
30 days
(NIMHANS)

30 days
(NIMHANS)

7
200
17
160+
17
12+97
2152
(DIMHANS)
12
0

For DIMHANS, appendix 1 has been sent by the State Govt, for NIMHANS appendix 2 has
been sent, which does not cover the same parameters.
COMMENT: At NIMHANS, inpatient beds are separately designated for children, elderly,
substance abuse and forensic psychiatry. A separate inpatient emergency observation ward has
also been created, with 18 beds. DIMHANS has also started inpatient facilities for children,
elderly and substance use disorders.
Facilities
At DIMHANS, the self-report states that there is adequate water supply, fans/coolers are
available and patient toilet ratio is 5:1. There are separate dining facilities, interview rooms.
Women receive adequate care during their menstruation. There is no compulsory shaving of
the head. Disposable needles and syringes are used throughout the hospital. Shaving blades are
not reused. Dinner is still served very early (6 pm) with a very long gap between dinner and
breakfast (9 am).
342

There are few admissions through the courts in the previous year (53).
However, there are still compulsory uniforms.
The dietary allocation at DIMHANS is Rs 47 per day (3000 kcals).
Longstay: Across the two institutions, 55 patients had an inpatient stay exceeding 5 years (14
and 41 respectively at DIMHANS and NIMHANS and a total of 9 had duration of stay over a
year. While at DIMHANS, there was no expressed problem of patients not having families to
accept them, the report from NIMHANS mentions that there are 50 patients who do not have
families.
There have been no outbreaks of infectious disease in the last year.

Treatment
Twenty three drugs are available at DIMHANS, including a variety of antipsychotics,
antidepressants, mood stabilisers, anti-convulsants, benzodiazepines. Long-acting injectable
antipsychotics are also available. All classes of drugs are available at NIMHANS
ECT services are provided at DIMHANS, with an anaesthetist being available all the time. During
the last year, 698 persons have received ECTs. At NIMHANS , 752 patients received ECTs during
the last year.
At DIMHANS, all patients receive counselling and psychotherapy is provided when required.
Families are all educated and counselling, and the hospital involves the patient in treatment
decisions. No complaints regarding patient care have been received, and patients and families
have provided positive feedback about care received. NIMHANS provides comprehensive
services.
Records
DIMHANS has a separate medical records and case files are retrieved within 5-10 minutes.
Administrative Issues
At DIMHANS, the medical superintendent is a psychiatrist. There has been no litigation with
regard to any infringement of human rights. There is a functioning board of visitors which
meets once a month. Disability certification is done and 272 certificates were issued in the last
year.

343

NIMHANS has received visits from both NHRC and SHRC, as well as the SMHA. They have
recognised NIMHANS as a model institution.
Research is only just starting at DIMHANS.
Community outreach and partnerships
DIMHANS is about to start a community outreach Programme and is going to be the nodal
agency for the DMHP in Dharwad district.
Partnerships
DIMHANS has partnerships with the Karnataka Legal Aid Services and the CROMP Rehabilitation
Centre.

No suicides were reported from either of the psychiatric institutions.


*mention common diagnostic categories in rank order in each of the different facilities
(to see if each facility has a different pattern of self seeking and have tried to develop
services based on that)
22.3. OUTPATIENT SERVICES*

3.3.a. No of new OP
registrations in the
previous year
3.3.b. No of
emergency
attendees in the
previous year
3.3.c Total no of OP
follow-up in the
previous year

Govt.
Psychiatric
hospitals
N=2
6718

Private
Psychiatric
hospitals
N=
Not
provided

369

94542

COMMENT:

344

General
Hospitals

District
Hospitals

NGOs

N=
Not
provided

N=
Being
collated

N=

Total

The information pertaining to the two government psychiatric hospitals only have been
provided. This is still at variance with the information obtained during the Inspection
committee visits (where the information was verified).
23. REHABILITATION FOR PERSONS WITH MENTAL ILLNESS
23.1. Government residential rehabilitation/longstay facilities : No and description:2
longstay facilities
23.2. Government day care/outdoor rehabilitation facilities: No and description: 13
23.3. Government run half-way homes: No and description. If none, plans to establish
and details:2
23.4. NGO participation in the half way homes: Manasadhara 13
23.5. Longstay rehabilitation facilities: No and description; NGO participation:
24. MENTAL HEALTH CARE IN OTHER COMMUNITY FACILITIES
State Level, in the Govt Sector
5.1. No of shelter homes, observation homes,
special homes and childrens homes
5.2. No of counsellors trained in mental health in
the above institutions
5.3. No of protection homes for destitute women
5.4. No of counsellors trained in mental health in
the above institutions
5.5. No of old age homes
5.6. No of counsellors trained in mental health in
the above institutions
5.7. No of Central Jails and District Jails in the State
5.8. No of counsellors trained in mental health in
the above institutions

N
43
29
18
29
27
54
102
Position of
psychiatrist at
Central Prison
and Belgaum
vacant

5.9.No of counsellors trained in mental health in


the above institutions

Helplines for Mental Health: (Nature of helpline, who runs it, for whom, any information on
its utilization)
104 Arogyavani 24*7 100 lines
108- Toll free ambulance

345

1056 Toll free control room at Directorate of Health and FW.


09449000739- ambulance to shift persons with mental illness from home to hospital (only
in Bangalore)
COMMENT:
25. MENTAL HEALTH HUMAN RESOURCES
Mental Health Care Professionals

6.1. No of
Psychiatrists
6.2. No of Clinical
Psychologists
6.3. No of
Psychiatric Social
Workers
6.4. No of nurses
trained in mental
health
6.5. No of trained
counselors

Government
Psychiatrists
Sector medical
in medical
colleges/hospitals colleges
87

Private
Practice

Total

170

257

57
56

49+

NR

NR

COMMENT: There is a very active private sector. However, the activities within the academic
institutions have not been captured.
*Specifically describe the sanctioned strengths of staff at the District General Hospital and
Medical Colleges and whether the posts have been filled. Please note that the mental health
staff numbers are already reflected in the first column of human resources above. The others
(record keeper, community nurse/case manager, case registry assistant can be mentioned here).
Here, the idea is to highlight whether the District GH staff unit is complete and functioning.
7. MENTAL HEALTH HUMAN RESOURCE DEVELOPMENT
7.1. Degree/Diploma Courses
In Entire state, Annual No of
Seats in
MD Psychiatry
DNB Psychiatry
Diploma in Psychiatry

Institutions where the Programme is offered

73
6
21

Multiple

346

PhD Clinical Psychology


MPhil Clinical Psychology
PhD Psychiatric Social Work
MPhil Psychiatric Social Work
PhD Psychiatric Nursing
MSc Psychiatric Nursing
BSc Psychiatric Nursing
Basic Diploma in Psychiatric
Nursing (DPN)

4
29
4
29
1
8
65
20

NIMHANS
NIMHANS, Manipal
NIMHANS, Manipal
NIMHANS, Bangalore Nursing College
NIMHANS, DIMHANS

COMMENT:
*Any pending proposals for creation of degree/diploma courses or seat enhancement. Name of
authority, No of seats, Status of the same.
Also mention here any other courses being conducted to increase mental health human
resources at a basic level (any certificate courses etc) or specialised level (DM/Post doctoral
fellowships etc)
7.2. Other training in mental health
Medical officers in the DMHP are being trained for 3 days (so far 2283 trained). Other
paramedical staff receive 1 day training (so far 8086 are trained)
7.2.a. Details of Undergraduate MBBS training in psychiatry
Regulated by the Rajiv Gandhi University of Health Sciences except in autonomous
institutions.
Name of medical
college

No of hours of
theory

Duration of
psychiatry
posting during
UG

Duration of
psychiatry
posting during
internship

All medical
colleges

26 hours

15 days

15 days

347

Qualifying
Examination
includes
competency
evaluation in
psychiatry
There is a
compulsory
question in
medicine paper 3.
This is usually a
short note for 4-5
marks. A move to
enhance it to 25
marks and
combine with a

similar allocation
to dermatology is
reportedly
underway.

COMMENT: Theory classes are lower than that stipulated by the MCI.
This information has been asked for and will be provided
* If many medical colleges and all uniform UG training, mention the number of colleges and the
details of UG training
This ought to have been obtained from all the medical college departments of psychiatry.
7.2.b. Details of in-service training for Govt medical officers (No trained, duration)
So far, 624 medical officers have been imparted training in mental health.
But no regular training provided per annum.
State planning to train as per DMHP in 12 districts.
So far, no government nurses trained in mental health. Intend to start under DMHP.
Other training:
1 day training for paramedical staff
3 day training for medical officers
1 year training for medical officers was being offered at NIMHANS
MSc psychosocial rehabilitation training at RFS Bangalore
*If not trained, plans to train and timeline
7.2.c. Any other training courses in mental health offered by the state
* Describe the type of course/duration/participants
8. GOVERNANCE:
8.1. Nodal Authority and responsibilities : State Mental Health Authority
8.2. Presence of a State Mental Health Plan: Yes, 2003
8.3. Enactment of State Mental Health Rules: 2008

348

8.4. Oversight of policies and Programmes related to mental health:


One major driving force in Karnataka to develop psychiatric services was the proactive role
taken by the High Court of Karnataka which asked for a plan of action in its order of 18 July
2002. Dr R Sreenivas Murthy was invited to advise the state mental health authority to develop
an action plan. A draft plan was submitted on 8.2.2003, and was accepted for implementation
in 2003.
Recognising the importance of mental health Programme in the State, a decision to carry out an
evaluation was taken in July 2008.
KSMHA
The agency is active in the area of licensing. However, the process has been left to the district
authorities (DC) and the mental health facilities in other parts of the state. The report
advocates the following:
Regular communication of guidelines and orders with all mental health facilities
-Direction follow up of licencing by the KSMHA staff
-Review of the rules regarding the appointment of Board of Visitors
-Authority for issue of licence
-Bringing drug dependence centres under the MH licencing
DIMHANS
The report observes dramatic changes at DIMHANS following a visit by the NHRC team (from
NIHAS) in the 1990s direct monitoring from the Honourable court. Positive changes have been
noted in the following:

Better outpatient services


More open wards
Improved human resources
However, the inter-disciplinary functioning is inadequate.

DMHPs
Initially, DMHPs had been started in 4 districts- Chamarajnagar, Shimoga, Gulbarga and Karwar
with support of the Govt of India. In 2008, the observations were as follows:

The training of the doctors and health workers have been carried out mainly by the
professionals from Bangalore;
The local level staff have not been adequately used to train the PHC personnel
349

The adequacy of the mental health care and the effectiveness of the mental health care by
the PHC team is extremely limited
The minimal care that is occurring in the DMHP seems to be a reflection of the incomplete
training, lack of a full time Programme officer, etc
There has been almost no limited technical guidance and monitoring of the district mental
health Programme(as reflected in the extremely inadequate record maintenance, few
patients registered, lack of follow up of drop outs, etc).
The availability of essential psychiatric medicines is the only positive aspect of the DMHP.
The public mental health education activities are minimal or absent.
The inadequacy of record keeping is most striking.
The district hospital is providing only OPD care, with limited admissions, as no specific ward
is available for psychiatric admissions;
There is urgent need for the revision of the PHC level records, along with its
computerization for easy analysis and feedback to the user community;
Appointment of a full time Programme officer is a priority;
There is greater need for development of the responsibilities of the psychologist/social
worker.
There is greater need for support, supervision on a monthly basis/nurse in the DMHP team;
Specific measures to fully utilize the private psychiatrists has to be developed and
implemented.

The 2003-2008 review summary findings:


1. Training of all the general health personnel in essentials of mental health care, so that
following the training they can survey the general population, organise camps and provide
care to the ill persons and their families; PARTIALLY COMPLETED
2. A time bound Programme to train required number of psychiatrists, clinical psychologists,
psychiatric social workers, psychiatric nurses and rehabilitation professionals; PARTIALLY
COMPLETED
3. Creation of District Mental Health Teams to support and support the community mental
health care Programmes; PARTIALLY COMPLETED
4. Karnataka Institute of Mental Health to be made into an autonomous Institute; NOT
COMPLETED
5. Strengthening of the Departments of Psychiatry of the 4 Government medical colleges and
enhancing the training in psychiatry for medical undergraduates to two months and making
psychiatry an examination subject in final year; PARTIALLY COMPLETED
6. Short term plan to train professionals for mental health care through focussed courses to
doctors, psychologists, social workers, nurses; PARTIALLY COMPLETED
7. Specific schemes to support the families to acquire the skills of caring, form self-help groups
and financial support as appropriate to the most needy; NOT INITIATED
350

8. Funding support for voluntary organisations to take up wide range of community based
mental health care activities like setting up of day care centres, half-way homes and longstay homes; NOT INITIATED
9. Involvement of the private mental health professionals and organisations in the state
Programme; NOT INITIATED
10. Public mental health education on a regular and continuous basis; NOT INITIATED
11. Mechanism for the licensing of all mental health facilities based on agreed upon standards
for different types of mental health facilities; COMPLETED
12. Formation of Board of Visitors in all of the mental health facilities; COMPLETED
13. Appointment of a full-time Joint Director(Mental Health) to support the Programme along
with monitoring and evaluation; COMPLETED
14. Enhanced funding for mental health care, gradually to at least 10% of the total health
budget; PROVIDED BUT UNUTILISED
15. Development of a coordinating mechanism between the departments of health, welfare,
education, labour and employment and law and justice to meet the variety of mental health
initiatives UNDER KSMHA SINCE 2008, and
16. An annual mechanism to review the needs of the persons with mental disorders, mental
health of the community and progress in implementation of the mental health Programmes
in the State. NOT UNDERTAKEN.
The Honourable High Court of Karnataka has continued to pursue the developments or lack of
developments in the area through a series of orders since 2010. Areas of enquiry have been the
following:
1. Composition of a psychiatric unit in a district hospital
2. Ensuring appointment of a psychiatrist to all the districts
3. Opening of clinics in all districts and equipping with necessary drugs
The High Court of Karnataka continues to monitor these efforts.
8.5. Specific oversight of the DMHP programme. Brief description of districts where fully
implemented, where partially implemented and details of reasons for incomplete
implementation. Also mention here a brief summary of availability of medicines and
psychosocial care for patients with mental illness.
Detailed information on the 12 DMHPs not provided.
8.6. Attempts towards integration of mental health care into general health care, NCD
management etc.
Happening as a pilot in Kolar district through a NIMHANS GOK initiative.

351

8.7. Examples of commitment to develop mental health services (high level involvement,
budgeting, networking
8.8. Examples of inter-sectoral collaboration to improve mental health services (including PPP
intitiatives)
Some attempts include:

Tirthahalli Mental HealthProject


Basic Needs project to empower persons with mental disorders and their
families.
Siddalghatta community mental health project (RFS)
The Karuna Trust initiative for mental health training in 25 PHCs. The preliminary
experience suggested very low levels of identification.

8.9. Attempts towards mental health promotion (e.g. SMHA Karnataka had organised regular
phone in Programmes related to mental health and mental disorders. Public responses were
evaluated and were very encouraging)
According to the Karnataka review report, three psychiatrists in the state have played an
important role in public health education, Dr CR Chandrashekar, Dr Ashok Pai and Dr Shridhar.
The KSHMA has been running a TV Programme called Hello Gelayare successfully for 3 years.
The family group ACMI has also developed health education material.
The Karnataka State Legal Services Authority has been conducting mental health awareness in
most districts of the state.
COMMENT: Strengths and weaknesses (see later)
9. FINANCING
9.1. Sources of financing of different categories
9.2 Budget provision from State and Centre in INR (for different facilities if required)
DMHP (Central functions) Rs 9 crores (12 DMHPs)
Remaining DMHPs being funded by State
Rs 50 lakhs to SMHA under NRHM (2008-09 and 2009-10)
9.3. Mental Health Expenditure as proportion of Total Health Expenditure in State
(If available % spending on Health in the State may also be provided)
352

Health Budget through DOHFW and Medical Education: 5421 crores (2013-2014)
DOHFW health spending: Rs 207723 (2008-09)
10. ANY OTHER SIGNIFICANT INFORMATION (e.g. litigation, insurance schemes for persons
with mental illness, pension and other assistance, job reservations)
Here a few lines can be mentioned on mental health professional bodies at the state level (e.g.
State Branch of the Indian Psychiatric Society) and their activities. This may be useful to discuss
in the recommendations how such bodies can be leveraged to improve different aspects of
mental health care in the state.
11. INNOVATIONS
Mansadhara: rehabilitation centres opened at all districts for people recovering from
severe mental disorders.
Free ambulance services with the help of Rotary since 2009 in Bangalore. 750 persons
availed it so far.
Manochintana Programme on FM Radio since 6.3. 2010.
Doordarshan live telecast of phone in Programmes. 175 Programmes since August 2009
Super Tuesday Mental Health Clinic at all PHCs.
12. OVERALL SUMMARY OF STATE LEVEL MENTAL HEALTH SERVICES
Summary of action points in directions of Honble High Court of Karnataka

Creation of psychiatric units in all the district hospitals with, professional team with
infrastructure (Psychiatrist , Psychologist and Psychiatric social worker).
To recruit and posts Psychiatrist, Psychologist and Psychiatric social worker to all these
units.
For distribution of drugs from these units.
To appoint duly qualified person as Director to DIMHANS, Dharwad
To start PG course in DIMHANS, Dharwad (MD psychiatry and DPN started at KIMS
Hubli.)
To create awareness about mental health to general public in all districts (conducted at
26 districts).
Judgment dated 2.2.2015 gives summary about the background of this writ petition of
other important judgment.

353

Karnataka State Mental health Taskforce: First state to set up an advisory body.
1. To propagate the concept of positive mental health through
psycho education.
2. To dispel the myths and superstition pertaining to mental health
amongst the general population regarding mental illness.
3. To educate people to identify primary mental health symptoms,
differentiate psychosis and neurosis for early referral to
mental health professional.
4. To have a comprehensive mental health service Programme
a psychiatrist, clinical psychologist, psychiatric social worker
and psychiatric nurses in all the district hospitals.
5. To inspect and monitor existing mental health facilities.
6. To start schools for the residential care of the mentally
retarded children in each district with approximate 50 inmates.
Components:
Manasadhara
Manochaitanya Super Tuesday
Teachers as counsellors
Sex education in high schools
Suicide prevention helplines at the district levels

SECTION 2
2.1. PSYCHIATRIC INSTITUTIONS
DIMHANS
Name and a para on status in 2008 (refer to NHRC book Mental Health Care and Human
Rights)
Domains
Infrastructure

Status in 2008

Developments since 2008


New hostel building under
construction for students
MD course expected to start in
2016. Plans to start MPhil. 6
MSc Nursing since Oct 2015.
20 bed deaddiction centre
20 bed childrens ward

Amenities and facilities


Financial arrangements
354

Diet
Investigations and treatment
Staff and training
Supportive services
Recreation/Occupational
therapy/Rehabilitation
Networking with other agencies

There has been a reduction in the working number of beds (375 sanctioned/212 working)- the
reason for the same is not mentioned.

SERVICES
i. Outpatient: DIMHANS-277 daily, 6708 new patients, 94553 follow-up
ii. Inpatient 2152 admissions; 1-2 weeks duration of stay.
Diagnostic categories seen:
iii. DIAGNOSTICS AND THERAPEUTICS

Investigations: Yes
Therapeutic facilities: Yes
Improvements in rehabilitation:Yes

iv. ENGAGEMENT:

Attempts to involve families of persons with mental illness: Yes


Disability certification and number of certificates issued in the previous year:Yes

v. ADMINISTRATIVE

Annual number of adverse events: Few instances of minor incidents


Mechanisms for redressal of patient complaints: In place

vi. COMMUNITY OUTREACH AND NETWORKING

Community Programmes:Outreach at Navalgud Taluka Hospital


Networking with external agencies: With 9 organisations in Hubli, Dharwad, Koppal,
Karwar and Bangalore.
Public mental health education:Yes

355

vii. TRAINING

Post-graduate training new Programmes, enhancement of seats and measures to


maintain/improve quality of training: (MD Psychiatry initiated, MPhil Clinical Psychology
and MSc Nursing initiated.
Any other training Programmes: BSc, MSc Nursing, MSW and psychology students

vii. RESEARCH:

Research (areas, funding agencies, findings)

viii. ANY OTHER SALIENT CONTRIBUTIONS OF THE HOSPITAL/INSTITUTE:


ix. Any monitoring of hospital (internal or external)- details Nodal agency for 10 districts in
North Karnataka.
x. Special Rapporteurs observation:
The Special Rapporteur Shri KS Chalam visited NIMHANS, Victoria Hospital, KIMH Dharwad
along with the Director, Dept of Health and Family Welfare Dr HC Ramesh and Dr Gunde Rao,
the nodal officer for mental health.
While the particulars from NIMHANS have been provided, the information refers to the entire
institute and not only the mental health facilities. He comments that the facilities are excellent,
nurses seem to be well trained for the purpose and are able to relate themselves to the patients.
Even patients with criminal record are also allowed to move freely within the rooms allotted to
them with police guard.
The Rapporteur feels that the real problem of mentally ill persons is that of rehabilitation.
Though some of them (patients) appealed to me to get them relieved, the doctors and nurses
narrated stories how none of their relatives are willing to take them home.
It is my considered opinion that majority of the inmates are from poor socio-economic
background and it would be a burden for the family to provide succour to them even if they are
cured. This needs to be deliberated by the national bodies to find out solutions for their
rehabilitation as it has been done for HIV/AIDS etc.
Victoria Hospital:
The special rapporteur visited the hospital with Dr Prakash I/C HOD. He observed that the
facilities of teaching and clinical observation had improved. A special wing with modern
facilities for op and consultancy, PG facility had been developed. The doctors and PGs were
happy with the facilities.
356

KIMH, Dharwad
The Rapporteur had an interaction with the Director, KIMS, Dharwad and has opined that things
had substantially improved at Dharwad after the appointment of Dr D Nagaraja as Director. 125
new posts had been sanctioned by the government.There had been an enquiry against an
officer regarding the misappropriation of funds to the tune of Rs 80 lakhs, and a chargesheet
was soon to be filed.
The Rapporteur was informed of a scheme in the Karnataka Government for Rehabilitation.
xi. Any other observations (including Inspection Committee Reports): The Institute has
considerable capacity, but the operational beds are much less. There is a separate Childrens
ward and a 20 bed de-addiction ward, but there were no patients. Drugs were sufficient. The IC
observed that there were no teaching courses for Clinical Psychology and Psychiatric Social
Work. The IC observed that a modern kitchen, laundry and rehabilitation section was to
become operational shortly. The IC observed that in the female wards, hair was cropped, and
advised that this not be done routinely. The hospital has old records and was advised to
preserve the same for historical value. The overall conditions including sanitation and hygiene
were satisfactory.
xii. Summary and Recommendations from SECTION 2: Several improvements have been made
at DIMHANS, but the reasons for reduction in beds is unclear, particularly as this facility is the
only specialised psychiatric hospital in the northern region.
NIMHANS
The IC noted that NIMHANS is a Central Govt Institute administered as an autonomous
organisation and has sufficient financial resources under both plan and non-plan. It is a leader
in the field of mental health services in the country and has been made an Institute of national
importance. In addition to post-graduate programmes, a DM in Addiction and Child Psychiatry,
PDFs in many topics such as geriatric, addiction, schizophrenia, community, emergency,
obsessive compulsive disorder and rehabilitation have been started. There is spcialised tertiary
care through a 519 bed facility with specialised treatment for geriatric, child and de-addiction
facilities, a mother-baby unit. The hospital is well supported by other departments. There was
an unfortunate incident in te prison ward which the IC visited, leading to the death of a
prisoner, for which an inquest is underway. NIMHANS has a number of longstay, who have
nowhere else to go. The Committee was satisfied regarding the physical state of affairs at
NIMHANS.

357

SECTION 3
7. General Hospital Departments of Psychiatry and District Hospital Departments
Information is very deficient. Complete information has been asked for and is awaited.
(However, this was not provided despite reminders)
The broad outline for this section:
3.1. Names of GH/DH and their location.
(If there are many, this could be done in a tabular column).
The following areas may be mentioned as a summary of all the units; where needed , examples
could be made of a specific dept to highlight both positives and negatives.
3.2. Areas (distribution throughout the states):
3.3. Whether separate funding and adequacy:
Victoria Hospital : Grant of Rs3450000 during 2006-13
3.4. Whether OP/IP and emergency services available
3.5. Diagnostic categories in rank order that present in the outpatient
3.6. Adequacy of OP facilities
3.7. Inpatient occupancy, free and paying beds, average cost of inpatient stay per week; rank
order of diagnostic categories
3.8. Extent of family involvement
3.9. Measures to protect rights including complaint redressal
3.10. Any networking
3.11. Staffing details and any shortages/vacancies
3.12. Psychotropic medication availability/free/cost
3.13. ECTs (Nos given across the facilities or average/No of direct )
3.14. Observations of extent to which counselling and psychotherapy are provided
3.15. Whether disability certification is available (if available numbers certified/year)
3.16. Extent and nature of community involvement
358

3.17. Whether engagement with the DMHP and extent


3.18. Nature and partnership with NGOs for networking
3.19. Presence of PG training- whether adequately distributed throughout the state
3.20. Nature of public mental health material prepared and distributed/ activities to educate
3.21. Areas of research, sources of funding and major findings
3.22. Whether monitored and by whom. What were the observations?
3.23. Special Rapporteurs observations: Not relevant
3.24. Inspection Committees observations: Not relevant
3.25. SUMMARY AND RECOMMENDATIONS WITH RESPECT TO SECTION 3:
(Overall impressions about the mental health service delivery through the General and District
Hospitals). This information is lacking

SECTION 4
8. NGOS WORKING IN MENTAL HEALTH:
This information is very deficient in the submitted affidavit.
Karnataka is the first state which had a carer group (AMEND). There are several NGOS
working in the area of mental health in the State including Basic Needs, Karuna Trust,
Poirada,CCDC, AV Baliga Trust, Roots, Promise Foundation, RFS, MPA, Banjara
Academy,Chittadama, Prasanna Counseling Centre, Narendra Foundation, VGKK and others.
4.1. A brief description of the NGO and its location
4.2. Nature of work carried out by the NGO in the domains mentioned and details of each
4.3. Description of clientele seen by the NGO and number of persons who use the services in
the previous year
4.4. Research details
4.5. Details of any training carried out by the NGO
4.6. Networking activities of the NGO
4.7. Salient contributions of the NGO
359

4.8. Special Rapporteurs observations


4.9. Inspection Committees observations
4.8. SUMMARY AND RECOMMENDATIONS FOR SECTION 4
The work of the NGOs in India and collaborative efforts must be properly documented.

SECTION 5
5.DISTRICT MENTAL HEALTH PROGRAMME

5.1. A brief description of the location of the DMHP, when it started, total population covered:
There are supposedly 12 districts with DMHP (of a total of 30 districts) with central funds of Rs
9 crores.

360

5.2. A summary of annual registrations old and new, treatment outcomes in terms of those on
regular treatment and those dropped out, with diagnostic categories if provided. Would be
useful to know what kind of clientele is serviced under the DMHP:
5.3. Frequency of home visits carried out by the HW/ANM; numbers covered and for what
diagnostic categories, no of admissions facilitated: NR
5.4. Kinds of essential drugs available, number dispensed, number of patients receiving
medication under the DMHP in a month: NR
5.5. Duration of untreated mental illness for different diagnostic categories if provided: NR
5.6. Monitoring of the DMHP by the concerned officer /impressions and trouble-shooting
(mention if there is a committee and its composition): NR
5.7. IEC activities of the DMHP: NR
5.8. Training calendar of the DMHP (doctors, health workers, nurses, pharmacists, school
teachers/Anganwadi workers (whether any training conducted): NR
5.9. Activities to sensitize the gram panchayats NR
5.10. Special Rapporteurs report on the activities of the DMHP, its reach, areas of good
performance, areas of poor performance, barriers for effective service delivery, measures to
streamline functioning, funding flow and barriers thereof- Not specific to DMHP
5.11. Inspection Committees observations- Not evaluated
5.12. SUMMARY OBSERVATIONS OF DMHP AND RECOMMENDATIONS:
Considering that Karnataka was the birthplace of the DMHP, it is important to see how the
DMHP is doing in Karnataka, especially as it is quite vibrant in the neighbouring states. Sadly,
apart from the UCs and SOEs, no tangible information has been provided.
SECTION 6
6. SUMMARY OF MENTAL HEALTH CARE INDICATORS IN KARNATAKA
6.1. Availability of mental health facilities

Mental health outpatient


facilities in the state
Day treatment facilities

Total No of
facilities/beds
133

Rate per 100,000


population
0.22

13

0.02
361

Psychiatric beds in general


hospitals
Community residential facilities
Beds/places in community
residential facilities
Psychiatric hospitals
Beds in psychiatric hospitals

NR
2
NR
2
894

0.003
1.5

Rate per 100,000


population
Not calculated as
data grossly
deficient

Females %

6.2. Access to Care

Persons treated in mental


health outpatient facilities
Persons treated in mental
health day care facilities
General hospital admissions
Community residential facilities
Persons staying in community
residential facilities at the end
of the year
Admissions to mental hospitals

NA

13.7

6.3. Information Systems: Not documented*


Data on No of
persons/activities
collected and reported
YES/NO

Data on age and


gender are collected
and reported
YES/NO

Persons with mental


disorders treated in
primary health care
Interventions delivered
in primary health care
for persons with
mental disorders
Persons treated in
mental health
outpatient facilities
Contacts in mental
362

Data on patients
diagnosis are collected
and reported
YES/NO

health day treatment


facilities
Admissions in general
hospitals with
psychiatric beds
Admissions in mental
Y
Y
Y
hospitals
Days spent in mental
Y
Y
Y
hospitals
Admissions in
community residential
facilities
*Most of the parameters are recorded as No as this information is not routinely collected and could not
be made available even on the direction of the Honble Supreme Court.

6.4. Human Resources at the State Level- Will be entered after all information is received.

Psychiatrists
Medical doctors not specialised
in psychiatry
Clinical Psychologists
Psychiatric Social Workers
Psychiatric Nurses
Occupational therapists
Other health workers

Health professionals working in


the mental health sector
Rate per 100,000
0.42

Training of health professionals


in educational institutions
Rate per 100,000

0.09
0.09
0.08

6.5. INFORMAL HUMAN RESOURCES (Family and User Associations)


Present in the state
No of members
Participation in the
formulation/implementation of
policy/plan/legislation

User
ACMI

Family
AMEND

6.6. MEDICINES
Type of Medication

Expenditure at State level per year and per


100,000 population (inINR)

All psychotropic medication


Mood stabilisers
Antipsychotics
363

Anxiolytics
Antidepressants
Anti-craving medication/ Substitution
treatments

SECTION 7
26. STATE MENTAL HEALTH REPORT CARD
SUMMARY OF SECTIONS 1-7.
Summary of areas where state has achieved good progress/little progress/no progress
Areas of positive change
Mental health services have improved in all
sectors
The High Court intervention in 2003 has
yielded many dividends
The State has undertaken many
programmes-notable are the mental health
awareness and special clinics.
Attempts to place a psychiatrist in each
district

Areas of poor progress


Despite all the interventions, there has
been no mechanism of mental health
problem and human resource surveillance
on a regular basis
There are a lot of lacunae in the reporting
Mental health trained human resource in
community settings is quite deficient
Despite the NIMHANS report on prisons,
there is no systematic mental health care in
prison settings.
Lack of data mining is the most important lacuna.

STATE MENTAL HEALTH REPORT CARD


MENTAL HEALTH REPORT CARD (needs to be revised after all the information is obtained)
Area

Focus

Parameters

Mental Health
Services
(Secondary
and Tertiary)

Medical
College
Depts,
General
Hospitals,
Specialised
psychiatric
hospitals

Adequacy of inpatient
beds
Functional Departments
Functional OP services

Primary
Health Care

District
Mental

% of functional DMHPs
364

Rating

100- present, fully


satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100 All districts
covered; fully

Score
(out of
100)
50

25

mental health
services

Health
Programme

Rehabilitation
services

At all levels

Vocational training, day


care, longstay facilities in
govt sector/ppp

Specialised
services

Whether existing, level of


functionality, present at
different levels of care

Human
Resources

Services for
substance
use
disorders,
old age,
mental
retardation,
child
psychiatry,
community
services,
forensic
services
(exclude
DMHP staff
here)

Adequacy of
psychiatrists/clinical
psychologists/psychiatric
social
workers/psychiatric
nurses or mental health
trained nurses

365

satisfactory
75 majority of
districts covered
and functioning
50 half the
districts covered
and functioning
25 one-fourth of
the districts
covered and
functioning
0- No districts
covered/although
DMHP exists, not
functioning
100- present, fully
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100- present, fully
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent

100 fully
adequate
75 moderately
adequate
50 somewhat
adequate
25- inadequate
0 grossly
inadequate

25

25

25

Financing for
mental health

State level

Existence of separate
budget for mental
health/mental health
activities

Governance
and Policy

State
Mental
Health
Authority
and other
authorities

Availability of
psychiatric
medication

At every
level

Separate Mental Health


Nodal Officer
Functioning Mental
Health Authority
Nodal persons for mental
health in SHRC/Legal
Services
Authority/Others
State Mental Health
Rules
State Mental Health
Programme
Range of medications
Regular supply and
dispensing
Standard procurement
arrangements

Affirmative
action for
persons with
mental illness

At every
level

Disability assessment
Pension
Travel concession
Health insurance
Special assistance
366

10% -separate
budget, fully
adequate
75 separate
budget,
moderately
adequate
50 separate
budget,
somewhat
adequate
25 no separate
budget, but some
financial
resources
available annually
0 no separate
budget/marginal
financial resource
allocation
100 Existing,
fully functional
75- Existing,
mostly functional
50- Existing,
somewhat
functional
25- Partial
0 Non existent

25

100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat

50

50

25

Educational benefits
Job reservation

10

Treatment
Gap

Overall

Approximate number of
persons with mental
illness approximate
numbers totally receiving
treatment in the state

satisfactory
25
Unsatisfactory
0- Not available at
any level
100 no
treatment gap
75 25%
treatment gap
50 -50%
treatment gap
25 -75%
treatment gap
0- 100%
treatment gap

Total Score (out of 1000)


Average Score (%)
If all the information is properly obtained, it is likely that the report card will improve.

25

325
32.5

RECOMMENDATIONS:
Very little factual information was obtained from the affidavit. The first step would be to obtain
all the information and for the state to prepare a comprehensive report. The help of NIMHANS
may be obtained in this regard. It is also necessary for the State to plan high-level oversight and
engagement in this exercise. The High Court intervention more than a decade ago provided the
impetus. To maintain the momentum, there needs to be this high level engagement in the
preparation of a mental health plan with specific objectives and deliverables in a time-bound
manner. Karnataka has diverse programmes in mental health, which can serve as models to
other states.

367

KERALA
SECTION 1.
1. GENERAL INFORMATION REGARDING THE STATE
1.1. Area: 38863 sq kms
1.2. No of districts: 14
1.3. Population, age distribution (as per census 2011) 33406061
1.4. Gender distribution: 1084:1000; Children (0-6 years) 959 Females/1000
Males
1.5. Life expectancy at birth male and female: Male:72 ; Female:75 (01-2006)
1.6. Per capita State Government expenditure on health: Not provided
1.7. Any health indicators for the state: Infant mortality rate at 12 and
maternal mortality ratio at 66 (SRS 2007-2009) are both lower than the
national average (40 and 178 respectively), Literacy rate at 95% is higher
than the national (74.04%).
Health Development indicators- Kerala & India 2009
Health Indicators
Birth rate (per 1,000 population)
Death rate (per 1,000 population)
Infant mortality rate (per 1,000 population)
Maternal mortality ratio (per lakh live births) * 2009
Total Fertility rate (per woman)
Couple Protection rate (%)
Life at birth (Male)
Life at birth (Female)
Life at birth (Average)

Kerala
14.60
6.60
6.70
40
1.70
62.30
71.40
76.30
74.00

India
22.80
7.40
44.00
301
2.90
52
62.60
64.20
63.50

The Extent of Mental Health Problems in Kerala State as per Kerala State Mental Health
Authority
Population in Kerala State (2001 Census )
Prevalence of Psychiatry disorders (10%-WHO Report 2001)
Prevalence of severe psychiatric disorders (20/1000 Population)
Neurosis and Psychosomatic disorders (20-30/1000 Population)
Mental Retardation (0-1% of all children up to 6 years)

368

3,33,87,677
31,83,862
6,36,772
6,36,772 9,55,159
18,267 - 36,535

a. Completeness/quality of information provided: Partially Complete


If deficient, areas of deficiency:
Deficient information. There is no detailed information on private psychiatric facilities in the
state (as per the list provided from the Kerala Government). There are 29 medical colleges,
however only 14 medical colleges have Departments of Psychiatry.
The information is also deficient in the area of DMHP details.

2. MENTAL ILLNESS BURDEN/ INFORMATION REGARDING MENTAL ILLNESS


N
(prevalence)
2.1. Total number of persons with
mental illness (all ICD categories)

2380000

N
(treatment
seeking)
Calculated Not
by state
provided
at 7%*

2.2. Broad categories


2.2.a Severe mental disorders
(BPAD, psychosis)
2.2.b Common mental disorders
2.2.c Substance use disorders
(alcohol and other drugs)
2.2.d Mental Retardation

No
information
available as
per
categories

2.3. No of Males with mental health


problems
2.4. No of females with mental
health problems
2.5. No of children with mental
health problems
2.6. No of elderly with mental health
problems
2.7. No of homeless mentally ill
persons

Not
provided
Not
provided
Not
provided
Not
provided
Not
provided

Source of
information
As per
information
provided by
state

3. MENTAL HEALTH SERVICES IN THE STATE:

Organization of Services (description of number of psychiatric hospitals, medical college depts,


district hospitals) Kerala, the southernmost state of India, has attracted international attention
for its outstanding achievements in population health despite its economic backwardness.
369

Kerala has achieved improvements in health development indicators, comparable to those of


many developed countries, even though the state's per capita income is low in comparison to
them. There are over 2,700 government medical institutions in the state, with 330 beds per
100,000 population, the highest in the country . The state has listed that the sources of
information for state level health care in the government sector is provided through specialised
institutes namely Mental Health Centres at three districts namely Thiruvananthapuram, Calicut
and Thrissur. Kerala also has 29 Medical colleges among which only 14 have departments of
psychiatry. Additionally, 14 district hospitals have psychiatric services and only 7 districts have
active DMHPs.
District

No of Health Care Institutions Number of beds

Alappuzha
Ernakulam
Idukki
Kannur
Kasaragod
Kollam
Kottayam
Kozhikode
Malappuram
Palakkad
Pathanamthitta
Thiruvananthapuram
Thrissur
Wayanad
Total

343
676
194
392
209
704
440
342
327
316
310
1011
602
127
5,993

8,835
21,819
4,096
5,149
2,107
12,530
9,323
9,034
5,030
4,925
5,096
73,410
19,891
2,307
183,552

General health care system in Kerala


Medical Colleges
Psychiatric hospitals
District hospitals
General hospitals
Taluk headquarters hospitals
Community health centres
Primary health centres
Govt dispensaries
Govt rural dispensaries
Subcentres

26
3
16
18
81
105
944
239
310
5094

*MC-medical college; PH-psychiatric hospital

370

As already mentioned, no information has been provided about the private psychiatric
facilities. There are a total of 19 psychiatric social workers, 22 psychologists and 233
trained nurses in Kerala as per the States submission.

N/N

No with dept/facility
Total No of units

% coverage

3.1.a No of district
general hospitals with
separate department of
psychiatry
3.1.b No of medical
colleges with department
of psychiatry
3.1.c No of district
general hospitals
providing psychiatric care
3.1.d No of District
Mental Health
Programmes in the State

14/14

100

14/29

50

14/14

100

7/14

50

3.1.e No of government
psychiatric hospitals
3.1.f No of private
psychiatric hospitals
3.1.g Total No of
psychiatric hospitals in
the state
3.1.h No of NGOs
providing mental health
care

Information not provided


Incomplete

Incomplete (only provided for Thrissur-14


NGOs)

a. INPATIENT SERVICES
DESCRIPTION: The three major psychiatric facilities have filled up 2 different proforma,
and thus parameters cannot be compared between the three.

Psychiatric
hospitals
(Govt) N=3
3.2.a. Total Inpatient
sanctioned/available
beds
3.2.b No of male

1342

Psychiatric
hospitals
(Private)
N=16
Not
available

849
371

General
Hospitals
N=

District
Hospitals
N=

NGOs
N=

Total

216

156

Not
1724
available

beds
3.2.c. No of female
beds
3.2.d. No of beds for
children
3.2.e. No of beds for
elderly
3.2.f. No of beds for
substance use
disorders
3.2.g. No of beds for
forensic psychiatry
3.2.h. Occupancy (%)
3.2.i. No of
admissions during
previous year
3.2.j. No of
discharges during
previous year
3.2.k. Average
duration of inpatient
stay in days mean
3.2.l. Average
duration of inpatient
stay in days median
3.2.m. No of closed
wards
3.2.n. No of closed
ward beds
3.2.o. No of open
wards
3.2.p. No of open
ward beds
3.2.q. No of paid
wards
3.2.r.No of paid beds
3.2.s.No of
admissions through
courts
3.2.t. No of deaths in
the last year
3.2.u. No of suicides
in the last year

483

79

689

157

30

372

Facilities
At the mental hospitals of Kerala state, the self-report states that there is adequate water
supply and fans are available . There are separate dining facilities, interview rooms. Women
receive adequate care during their menstruation. There is no compulsory shaving of the head.
However, there are still compulsory uniforms.
The dietary allocation at at these centres vary between Rs 60 and 90 per patient per day (3500
Kcal per day).
Long stay: As per data given by Trivandrum hospital, 35 patients have stayed for more than 5
years, In Thrissur, 42 patient had stayed for more than 5 years. However, there is no
information from Calicut.There have been no outbreaks of infectious disease in the last year.
Treatment
14 drugs are available at Thiruvananthapuram, including a variety of antipsychotics,
antidepressants, mood stabilisers, anti-convulsants and benzodiazepines. 32 drugs are available
in Thrissur (including parenteral and oral drugs.
ECT services are provided only in Trivandrum (54 patients in the past year) with an anaesthetist
being available all the time while Thrissur does not have ECT services. At all hospitals, the
reports claim that they are providing counselling and psychotherapy as and when required.
Psychoeducation is provided to all families. No major complaints regarding patient care have
been received, and patients and families have provided positive feedback about care received.
Records
Trivandrum and Thrissur hospitals do have separate medical records and case files are retrieved
within a couple of minutes.
Administrative Issues
Both Trivandrum and Thrissur hospital do NOT have a psychiatrist as a medical
superintendent.
There has been no litigation with regard to any infringement of human rights. There is a
functioning board of visitors happening once in two months. Disability certification is done in
both the centres (n=702 including both hospitals)
Involvement of active research is been claimed from all the three mental health centres. 7
publications from Thiruvananthapuram in the past 5 years, while Thrissur has come up with 36
publications in the past 5 years and Kozhikode has 18 publications.
373

Community outreach and partnerships


Trivandrum, Kozhikode and Thrissur Mental Hospital are already have community outreach
Programme. Kozhikode community outreach Programme runs in three districts on the model
of DMHP.
Partnerships

b. OUTPATIENT SERVICES*

3.3.a. No of new OP
registrations in the
previous year
3.3.b. No of
emergency
attendees in the
previous year
3.3.c Total no of OP
follow-up in the
previous year

Govt.
Psychiatric
hospitals
N=3
6980

Private
Psychiatric
hospitals
N=17
Not
available

General
Hospitals

District
Hospitals

NGOs

N=37

N=7

N=5
Not
available

5295

Not
available

Not
available

97321

Not
available

Not
available

Total

COMMENT:
*common diagnostic categories in rank order in each of the different facilities
4. REHABILITATION FOR PERSONS WITH MENTAL ILLNESS
a. Government residential rehabilitation/longstay facilities : No and description: 8
longstay facilities (6 Ashabhavans under social justice departments)
b. Government day care/outdoor rehabilitation facilities: No and description:
outdoor rehabilitation is present in only one institution: 22
c. Government run half-way homes: No and description. If none, plans to establish
and details:NIL
d. NGO participation in the half way homes: Information not available
e. Long stay rehabilitation facilities: No and description;
f. NGO participation: Information not available

374

5. MENTAL HEALTH CARE IN OTHER COMMUNITY FACILITIES


State Level, in the Govt Sector

5.1. No of shelter homes, observation homes,


special homes and childrens homes
5.2. No of counsellors trained in mental health in
the above institutions
5.3. No of protection homes for destitute women
5.4. No of counsellors trained in mental health in
the above institutions
5.5. No of old age homes
5.6. No of counsellors trained in mental health in
the above institutions
5.7. No of
Central Jails and
District Jails in the State
5.8. No of counsellors trained in mental health in
the above institutions
5.9.No of counsellors trained in mental health in
the above institutions

24

20

14

3
11

Helplines for Mental Health: (Nature of helpline, who runs it, for whom, any information on
its utilization)
1056 - DISHA Direct Intervention system for health awareness 24*7
1098- Child help line
COMMENT:
6. MENTAL HEALTH HUMAN RESOURCES
Mental Health Care Professionals

6.1. No of
Psychiatrists
6.2. No of Clinical
Psychologists
6.3. No of
Psychiatric Social
Workers
6.4. No of nurses
trained in mental

Government
Sector medical
colleges/hospitals
71

Psychiatry in
medical
colleges
42

17

22

15

19

233

Private
Practice

Total

Not available

113

233

375

health
6.5. No of trained
counselors

NR

COMMENT:
7. MENTAL HEALTH HUMAN RESOURCE DEVELOPMENT
7.1. Degree/Diploma Courses
P G Centres in Psychiatry
MD Seat in Psychiatry in Govt. Medical Colleges
DPM Seats in Psychiatry in Govt. Medical Colleges
MD Seat in Psychiatry in Pvt. Medical Colleges
DPM Seat in Psychiatry in Pvt. Medical Colleges
DNB (Psychiatry)

13
5
16
6
4

The affidavit does not record the numbers of annual Clinical Psychology and Psychiatric Social Work
seats. However, there are courses for Nursing recorded- 1 PhD, 153 MSc Nursing and 15 DPN seats

COMMENT:
*Any pending proposals for creation of degree/diploma courses or seat enhancement. Name of
authority, No of seats, Status of the same.
Also mention here any other courses being conducted to increase mental health human
resources at a basic level (any certificate courses etc) or specialised level (DM/Post doctoral
fellowships etc)
7.2. Other training in mental health
Medical officers in the DMHP are being trained for 3 days (so far 2283 trained). Other
paramedical staff receive 1 day training (so far 8086 are trained)
7.2.a. Details of Undergraduate MBBS training in psychiatry

Name of medical
college

No of hours of
theory

Duration of
psychiatry
posting during
UG

376

Duration of
psychiatry
posting during
internship

Qualifying
Examination
includes
competency
evaluation in
psychiatry

All medical
colleges
COMMENT:

This information has been asked for and will be provided


* If many medical colleges and all uniform UG training, mention the number of colleges and the
details of UG training
This ought to have been obtained from all the medical college departments of psychiatry.
7.2.b. Details of in-service training for Govt medical officers (No trained, duration)
So far, 200 medical officers have been imparted training in mental health for 5days. But no
regular training provided per annum. So far, 3029 government nurses have been trained in
mental health for one day.
MSc psychosocial rehabilitation training at RFS Bangalore
*If not trained, plans to train and timeline
7.2.c. Any other training courses in mental health offered by the state
* Describe the type of course/duration/participants
8. GOVERNANCE:
8.1. Nodal Authority and responsibilities : Kerala State Mental Health Authority
8.2. Presence of a State Mental Health policy: Yes
8.3. Enactment of State Mental Health Rules: 2012
8.4. Oversight of policies and Programmes related to mental health: Kerala State Mental Health
Authority
Kerala State Mental Health Authority
Kerala State Mental Health Authority is the statutory body constituted by Government of Kerala
in accordance with section 4 of the Mental Health Act 1987. It was formed in November 1993
as per the notification No(P) 122 / 93 Health and Family Welfare Department dated 1/11/1993
by the advice of the Government of India. Office is situated in a separate building adjacent to
the office of the District Medical Officer, Thiruvananthapuram.

377

It is functioning under the superintendence, direction and control of the State Government. The
Authority is empowered with
1. Regulation, development and co-ordination with respect of Mental Health Services under the
State Government and all other matters which, under this Act, are the concern of the State
Government or any officer or authority subordinate to the State Government
2. Supervise the psychiatric hospital and psychiatric nursing homes and other Mental Health
Service Agencies (including places in which mentally ill persons may be kept or detained) under
the control of the State Government
3. Advise the State Government on all matters relating to mental health
4. Discharge such other function with respect to matters relating to mental health as the State
Government may require
DMHPs
Initially, DMHPs had been started in 8 districts with support of the Govt of India. The extension
of the DMHP to all the 14 districts in the state will be done jointly by the NRHM under its
Community Mental Health Programme and by the state government. As of now, eight districts
in the state, Kasargod, Kannur, Kozhikode, Wayanad, Malappuram, Idukki, Thrissur and
Thiruvananthapuram, are under the DMHP Programme. It will be extended to Ernakulam,
Palakkad, Alappuzha, Pathanamthitta, Kottayam and Kollam. The NRHM will fund the
implementation of the Programme in Ernakulam, Palakkad, Pathanamthitta and Kottayam.

The minimal to moderate care that is occurring in the DMHP seems to be a reflection of the
minimal resources, incomplete training and non-availability of continuous handholding of
the PHC doctors
There has been almost no limited technical guidance and monitoring of the district mental
health Programme(as reflected in the extremely inadequate record maintenance, few
patients registered, lack of follow up of drop outs, etc)
Non-interrupting availability of essential psychiatric medicines is the only positive aspect of
the DMHP.
The inadequacy of record keeping is most striking.
The majority district hospital is providing only OPD care, with limited admissions, as no
specific ward is available for psychiatric admissions;
There is urgent need for the revision of the PHC level records, along with its
computerization for easy analysis and feedback to the user community;
There is greater need for development of the responsibilities of the psychologist/social
worker.
There is greater need for support, supervision on a monthly basis/nurse in the DMHP team;
378

Specific measures to fully utilize the private psychiatrists has to be developed and
implemented.
The summary of DMHP findings:
17. Training of all the general health personnel in essentials of mental health care, so that
following the training they can survey the general population, organise camps and provide
care to the ill persons and their families; PARTIALLY COMPLETED
18. A time bound Programme to train required number of psychiatrists, clinical psychologists,
psychiatric social workers, psychiatric nurses and rehabilitation professionals; PARTIALLY
COMPLETED
19. Creation of District Mental Health Teams to support and support the community mental
health care Programmes; PARTIALLY COMPLETED
20. Strengthening of the Departments of Psychiatry of the 4 Government medical colleges and
enhancing the training in psychiatry for medical undergraduates to two months and making
psychiatry an examination subject in final year; PARTIALLY COMPLETED
21. Short term plan to train professionals for mental health care through focussed courses to
doctors, psychologists, social workers, nurses; PARTIALLY COMPLETED
22. Specific schemes to support the families to acquire the skills of caring, form self-help groups
and financial support as appropriate to the most needy; INITIATED IN MINIMAL WAY
23. Funding support for voluntary organisations to take up wide range of community based
mental health care activities like setting up of day care centres, half-way homes and longstay homes; NOT INITIATED
24. Involvement of the private mental health professionals and organisations in the state
Programme; NOT INITIATED
25. Public mental health education on a regular and continuous basis; NOT INITIATED
26. Mechanism for the licensing of all mental health facilities based on agreed upon standards
for different types of mental health facilities; COMPLETED
27. State Mental Health Rules; MADE
8.5. Specific oversight of the DMHP programme. Brief description of districts where fully
implemented, where partially implemented and details of reasons for incomplete
implementation. Also mention here a brief summary of availability of medicines and
psychosocial care for patients with mental illness.
Kerala implemented DMHP comprehensively only in five districts as per the rapporteur report.
They are Kannur, Wayanad, Idukki, Thrissur and Thiruvananthapuram.
The available report also says that in the remaining 7districts (Ernakulam, Kasargod, Kozhikode,
Malappuram, Palakkad, Pathanamthitta and Kottayam) have initiated community mental health
programme under NHRM. This community mental health programme is similar to DMHP,
however it is not comprehensive. Hence, partial implementation of mental health services.

379

8.6. Attempts towards integration of mental health care into general health care, NCD
management etc.
Partial integration of mental health care into general health care.

8.7.

Examples of commitment to develop mental health services (high level involvement,


budgeting, networking

The Thiruvananthapuram DMHP report is encouraging with respect to achieving the goals of
the programme. However, detailed report from other districts are not present.
8.8. Examples of inter-sectoral collaboration to improve mental health services (including PPP
intitiatives)
Some attempts include:
Details not available
8.9. Attempts towards mental health
The Kerala State Legal Services Authority has been conducting mental health awareness in most
districts of the state.
COMMENT: Strengths and weaknesses (see later)
9. FINANCING
9.1. Sources of financing of different categories
Not available
9.2 Budget provision from State and Centre in INR (for different facilities if required)

380

9.3. Mental Health Expenditure as proportion of Total Health Expenditure in State


NOT available
10. ANY OTHER SIGNIFICANT INFORMATION (e.g. litigation, insurance schemes for persons
with mental illness, pension and other assistance, job reservations)
NOT available
11. INNOVATIONS
The available report also says that in the remaining 7districts (Ernakulam, Kasargod, Kozhikode,
Malappuram, Palakkad, Pathanamthitta and Kottayam) have initiated community mental health
programme under NHRM. This community mental health programme is similar to DMHP,
however it is not comprehensive. Hence, partial implementation of mental health services.
The state has successfully diverted the general physical health budget from NHRM to
community mental health for the first time in the history of INDIA.
In the COMMENTS, the observations of the Special Rapporteur or the high level committees
visit to the states may be incorporated
12. OVERALL SUMMARY OF STATE LEVEL MENTAL HEALTH SERVICES
Has attempted to provide sustainable mental health services to the community and to
integrate these with Health services.
Early detection of patients within the community itself.
381

To see that, patients and their relatives do not have to travel long distance to go to
hospitals or nursing homes in the cities.
To take pressure off the mental hospitals and Medical colleges.
To reduce the stigma attached towards mental illness through change of attitude
and public education.
To treat and rehabilitate mental patients discharged from the mental hospital within
the community
SECTION 2
2.1. PSYCHIATRIC INSTITUTIONS
Name and a para on status in 2008 (refer to NHRC book Mental Health Care and Human
Rights)
Domains
Infrastructure

Status in 2008

Developments since 2008


New de-addiction ward
20 seclusion ward
Old buildings are tiled
30KVA new generator
CCTV For Male Forensic
Psychiatry
Public Addressing System In
Wards
Power Laundry

Amenities and facilities

Financial arrangements
Diet
Investigations and treatment

Two semi-auto analysers &


Li analyser purchased
Created posts
Psychiatry -17

Staff and training


Supportive services
Recreation/Occupational
therapy/Rehabilitation

Cable Tv
Remuneration
Cultivation
Film show

Networking with other


agencies
Have not added numbers to the domains in case team members wish other areas to be added
382

For facilities that were not reviewed earlier, a brief description of when the facility was started,
and details under the heads indicated above and below may be provided.
A few lines may be added on whether any changes/ specialised services have been initiated in
the following areas:
SERVICES : As per Rapporteur Shri Shyam Sundar observations there have been no new changes
seen. He also notes that the hospital has made some micro-achievements in terms of
infrastructure. However, the situation has become bad to worse in terms of continuous supply
of medications and overcrowding
i. Outpatient:
ii. Inpatient
Diagnostic categories seen:
iii. DIAGNOSTICS AND THERAPEUTICS

Investigations:
Therapeutic facilities:
Improvements in rehabilitation:

iv. ENGAGEMENT:

Attempts to involve families of persons with mental illness:


Disability certification and number of certificates issued in the previous year:

v. ADMINISTRATIVE

Annual number of adverse events:


Mechanisms for redressal of patient complaints:

vi. COMMUNITY OUTREACH AND NETWORKING

Community Programmes:
Networking with external agencies:
Public mental health education:

vii. TRAINING

Post-graduate training new Programmes, enhancement of seats and measures to


maintain/improve quality of training:
Any other training Programmes:
383

vii. RESEARCH:

Research (areas, funding agencies, findings),

viii. ANY OTHER SALIENT CONTRIBUTIONS OF THE HOSPITAL/INSTITUTE:


ix. Any monitoring of hospital (internal or external)- details
x. Special Rapporteurs observation:
Report of the Special Rapporteur:
The Special Rapporteur Shri Shyam Sundar all the three government psychiatric institutes. As
per his observations there have been micro-achievements in terms of infrastructure. However,
the situation has become bad to worse in terms of
a) Regular continuous supply of medications
b) Overcrowding
xi. Any other observations (including Inspection Committee Reports):
GMHC Kozhikode- The IC (visit led by Shri KB Agarwal on 22 July 2015) has reported that the
physical state of the hospital is good. The general hygienic conditions are just satisfactory and
a great deal of improvement is required in this regard. There are only 2 part-time sweepers
for the whole campus. The DHS assured to augment this arrangement. In some wards,
patients were lying on the floor on mats. Cleanliness was only average. There are cells still.
They are not properly illuminated and dark. The isolation cells are still used, without proper
partition. The latrines here have no privacy or partition. This impinges upon dignity
emanating from the dignity to privacy. Certain wards are overcrowded. There are many
patients fit for discharge but destitute. Of 123 such patients, 50 are from other states. The IC
recommended that this be updgraded to a centre of excellence with modern psychiatric
wards, facilities for modern interventions and rehabilitation.
The IC visited the GHMC Thrissur on 21 July 2015. It observed the need for more human
resources to improve individualised care. It recommends the need for a modern surveillance
system as the wards are distributed. It records that the female wards are overcrowded, which
leads to physical abuse of one patient by another. The IC was informed that plans for repair
of the pavilions was underway. The IC recommended that vacancies should be filled. There is
384

concern about patients from outside Kerala, whose rehabilitation is challenging. The Centre
was found to have good liaison with NGOs.There are 2 day care centres functioning nearby.
The IC reviewed the functioning of 21 rehabilitation units. Diet was satisfactory. The IC
recommended that GHMC Thrissur be upgraded to a COE. It also recommended an identity
card system to enable the follow-up of patients, which can then become part of an e-health
record.
MHC Thiruvanthapuram-The IC was appreciative of the facilities, including rehabilitation.
They were satisfied with the overall facilities and functioning. They advised its upgradation as
a Centre of Excellence and improvement of the wards with more single rooms, further
modifications of the behaviour intensive units, more facilities for rehabilitation and training,
and more human resources.
xii. Summary and Recommendations from SECTION 2:
Areas of positive change
Greater focus on rehabilitation
Some changes in infrastructure
PG training and academic inputs at MHC
Thiruvanthapuram makes a positive
difference

Areas of poor progress


Overcrowding
Cells still exist despite so many earlier
recommendations
Scope for improving hygiene and living
conditions
SECTION 3

9. General Hospital Departments of Psychiatry and District Hospital Departments


Information is deficient.
The information has not been consolidated. Forms have been returned for DH Kozhencherry,
DH Kottayam, DH EKM, DH Idukki, DH Thrissur, GH Kalpatta, and DH Kasargod. However, the
information in this section is deficient.
3.1.
Emergency
OP new cases
IP

DH
Kozhencherry
1497
1345
274

DH
Kottayam
652
1131
65

DH EKM

15
410

67
90

322
1074

8675
11741
97

Diagnosis
Organic
Schizophrenia

DH
Idukki
NR
NR
NR
NR

385

DH
Thrissur
No
NR
NR-90%
alcohol
No nos
but
mainly

GH
Kalpatta
NR
NR

DH
Kasargod
NR
NR
425

No
details

No details

BPAD
Other psychotic
OCD
Other anxiety
Depression
Alcohol and
drugs
Personality
Children

300
37
62
163
175
183
30
27

147

Not adequate
Not adequate

Adequate
Adequate

Not adequate
Adequate
Adequate
Not adequate

Adequate
Not adeq
Adequate

Psychiatrist
Clinical Psych
PSW
Psy Nurse
Gen Nurse

1
1
1

1
1

Medications
Psychotherapy
Disability
certification
ECTs
Community
involvement
NGO
involvement
DMHP
involvement
Monitoring

NR

651
153

23

Facilities
Toilets
Interview
rooms
Drinking water
Canteen
Lab services
Rehab services
Education
material

2868
2099
555
1405
1741
1407
270
3508
NR

common
mental
disorders

NR

NR

NR

NR

1
1

3
2
1
13

NR
To all
Yes

NR
Yes

NR
NR
Yes

NR
NR

Yes

NR
To some
Yes

NR
NR
NR

No
NR

No
No

Yes
Yes

No
No

No
No

No
No

NR
NR

NR

NR

NR

No

No

No

NR

NR

NR

Yes

No

No

No

NR

NR

NR

NR

No

No

No

NR

Staff details

3.25. SUMMARY AND RECOMMENDATIONS WITH RESPECT TO SECTION 3:


(Overall impressions about the mental health service delivery through the General and District
Hospitals).
The information provided is incomplete both in content of the individual form and the coverage
across hospitals. No information from GH/MCs has been obtained.

386

However, where information is provided, many inferences can be made. Both severe mental
disorders and common mental disorders are seen in the DH. Ernakulam DH is particularly busy
and sees a large number of outpatients. It is also involved with the DMHP.

SECTION 4
10. NGOS WORKING IN MENTAL HEALTH:
This information is deficient in the submitted affidavit.
There is a list of 13 NGOs in Thrissur (Society for Occupational Therapy and Rehabilitation,
Divyahridayashrayam, Carisma Bhavan, Snehalayam, Gagultha Ashram, St Marys Mercy
Home, St Josephs Mental Bhavan, Majlis Park, Nazreth Care and Support Centre, St Annes
Convent, Assoication of Mentally Handicapped Adults, PSC Exam Coaching Centre and
Rotary Club) and Abhayam Koppam in Palakkad.
There is a list of 15 NGOs in Thiruvananthapuram all of whom are involved in IEC, awareness
and rehabilitation. They include: Gandhi Bhavan, Pathanamthitta, Navanirman Kendra,
Tpuram, Sneha Bhavan, TPuram, Santi Mandiram, TPuram, Karunyatheertham, Kollam Dt,
Akasparavakal, TPuram, SICK, TPuram, Santhi Bhavana, TPuram, Sadhana, TPuram, Child
Line, TPuram, Carehome, TPuram, Amma Charitable Society, TPuram, Snehatheeram,
Kollam Dt, Providence Home, TPuram and Mother Theresa Centre, Poovar.
There are likely to be many more NGOs in the State of Kerala in other areas apart from
Thrissur and Thiruvanthapuram.

4.1. A brief description of the NGO and its location


4.2. Nature of work carried out by the NGO in the domains mentioned and details of each
4.3. Description of clientele seen by the NGO and number of persons who use the services in
the previous year
4.4. Research details
4.5. Details of any training carried out by the NGO
4.6. Networking activities of the NGO
4.7. Salient contributions of the NGO
4.8. Special Rapporteurs observations: Not relevant
387

4.9. Inspection Committees observations: Not relevant


4.8. SUMMARY AND RECOMMENDATIONS FOR SECTION 4
These details must be collated so that a directory of NGOs working in mental health may be
collated.
SECTION 5
5.DISTRICT MENTAL HEALTH PROGRAMME

The DMHP information is not in the specified format. However, a few common details can be
consolidated from the filled up affidavits
DMHP

TPuram
Kollam

New
cases 1
month
126

Old
cases
526

No on
regular
followup
625

NR

NR

NR
388

Drugs

Activities Training

Available Good
Available Good

Active
Active

Alappuzah
Idukki
Thrissur
Wayanad
Kannur
Kottayam
Ernakulam
Palakkad
Malappuram
Kozhikode
Kasargod
Pathamthitta

793
30
538
18
378
41

12640
4114
12976
3495
12672
1355

775
376
NR
NR
NR
695

Available
Irregular
Available
Available
Irregular
Available

Good
Good
Good
Variable
Good
Good

Active
Active
Active
Active
Active
Active

NR

NR

NR
NR
NR
NR

NR
NR

NR
NR

NR
NR

76
2160
10
3588
NR
3065
28
6567
1300
Not recorded as per proforma

Irregular Variable
Available Good

Active
Active

NR

NR

NR

5.10. Special Rapporteurs report on the activities of the DMHP, its reach, areas of good
performance, areas of poor performance, barriers for effective service delivery, measures to
streamline functioning, funding flow and barriers thereof: The special Rapporteur Dr
Shamasunder has been following up on the status of Kerala.
5.11. Inspection Committees observations: Not undertaken
5.12. SUMMARY OBSERVATIONS OF DMHP AND RECOMMENDATIONS:
Kerala has been running successful community programmes, but the information is not
complete or encompassing these gaps in information make it very difficult to make a
comprehensive assessment. Nevertheless, it is evident that the programmes at Alappuzah,
Kannur and Thrissur have been fairly active in terms of registering persons with mental
illness. They are also active in training activities. Monitoring is done regularly. A few are
complain of some deficiency in the interaction between the doctor and other team members
and the medical management by the doctor.
SECTION 6
6. SUMMARY OF MENTAL HEALTH CARE INDICATORS IN KERALA
6.1. Availability of mental health facilities

Mental health outpatient


facilities in the state
Day treatment facilities
Psychiatric beds in general
hospitals

Total No of
facilities/beds
31

Rate per 100,000


population
0.09

NOT available
NOT available

389

Community residential facilities


(includes shelter homes,
observation homes, juvenile
home, destitute, old age,
orphanage, rehab, long stay
home etc )
Beds/places in community
residential facilities
Psychiatric hospitals
Beds in psychiatric hospitals
Government (1548)
Private (estimated)1539

80

0.24

NOT available
3

0.009

9.2

6.2. Access to Care: NOT available

Persons treated in mental


health outpatient facilities
Persons treated in mental
health day care facilities
General hospital admissions
Community residential facilities
Persons staying in community
residential facilities at the end
of the year
Admissions to mental hospitals

Rate per 100,000


population
Not complete

Females %

NR
Not complete
NR
NR

22.5

6.3. Information Systems: NOT available


Data on No of
persons/activities
collected and reported
YES/NO

Data on age and


gender are collected
and reported
YES/NO

Persons with mental


disorders treated in
primary health care
Interventions delivered
in primary health care
for persons with
mental disorders
Persons treated in
mental health
outpatient facilities
Contacts in mental
390

Data on patients
diagnosis are collected
and reported
YES/NO

health day treatment


facilities
Admissions in general
hospitals with
psychiatric beds
Admissions in mental
hospitals
Days spent in mental
hospitals
Admissions in
community residential
facilities

6.4. Human Resources at the State LevelHealth professionals working


in the mental health sector
Rate per 100,000
Psychiatrists
Medical doctors not
specialised in psychiatry
Clinical Psychologists
Psychiatric Social Workers
Psychiatric Nurses (general
nurses undergone training in
psychiatry)
Occupational therapists
Other health workers

Training of health
professionals in educational
institutions
Rate per 100,000

0.34

0.07
0.06
0.7

NOT available
NOT available

6.5. INFORMAL HUMAN RESOURCES (Family and User Associations): NOT available
User

Family

Present in the state


No of members
Participation in the
formulation/implementation
of policy/plan/legislation

391

6.6. MEDICINES: NOT available


Type of Medication

Expenditure at State level per year and per


100,000 population (inINR)

All psychotropic medication


Mood stabilisers
Antipsychotics
Anxiolytics
Antidepressants
Anti-craving medication/ Substitution
treatments
SECTION 7
7. STATE MENTAL HEALTH REPORT CARD
SUMMARY OF SECTIONS 1-7.
Summary of areas where state has achieved good progress/little progress/no progress
Kerala has been one of the trendsetters in community mental health services. The DMHP has
run successfully where it has been initiated. Every district hospital offers psychiatric services.
It is somewhat surprising that only 50% of the medical colleges in Kerala have a department
of psychiatry.The hospitals in Kozhikode and Thrissur are still overcrowded and need
improvements, which have not occurred to the desired level, despite several past
recommendations. Human resource shortages are evident. Unforunately, the data from
medical colleges has not been collated, as comprehensive information from other sources.
The information from the private sector is also lacking.
A comprehensive picture is necessary for Kerala to develop a progressive mental health plan
and formulate strategies to improve mental health care at all levels.
MENTAL HEALTH REPORT CARD
Area

Mental Health
Services
(Secondary
and Tertiary)

Focus

Medical
College
Depts,
General
Hospitals,
Specialised
psychiatric

Parameters

Adequacy of inpatient
beds
Functional Departments
Functional OP services

392

Rating

100- present, fully


satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat

Score
(out of
100)
25

hospitals

Primary
Health Care
mental health
services

District
Mental
Health
Programme

% of functional DMHPs

Rehabilitation
services

At all levels

Vocational training, day


care, longstay facilities in
govt sector/ppp

Specialised
services

Whether existing, level of


functionality, present at
different levels of care

Human
Resources

Services for
substance
use
disorders,
old age,
mental
retardation,
child
psychiatry,
community
services,
forensic
services
(exclude
DMHP staff
here)

Adequacy of
psychiatrists/clinical
psychologists/psychiatric
393

satisfactory
25 present,
unsatisfactory
0- absent
100 All districts
covered; fully
satisfactory
75 majority of
districts covered
and functioning
50 half the
districts covered
and functioning
25 one-fourth of
the districts
covered and
functioning
0- No districts
covered/although
DMHP exists, not
functioning
100- present, fully
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100- present, fully
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent

100 fully
adequate
75 moderately

50

50

25

25

social
workers/psychiatric
nurses or mental health
trained nurses

adequate
50 somewhat
adequate
25- inadequate
0 grossly
inadequate
10% -separate
budget, fully
adequate
75 separate
budget,
moderately
adequate
50 separate
budget,
somewhat
adequate
25 no separate
budget, but some
financial
resources
available annually
0 no separate
budget/marginal
financial resource
allocation
100 Existing,
fully functional
75- Existing,
mostly functional
50- Existing,
somewhat
functional
25- Partial
0 Non existent

50

100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at

50

Financing for
mental health

State level

Existence of separate
budget for mental
health/mental health
activities

Governance
and Policy

State
Mental
Health
Authority
and other
authorities

Availability of
psychiatric
medication

At every
level

Separate Mental Health


Nodal Officer
Functioning Mental
Health Authority
Nodal persons for mental
health in SHRC/Legal
Services
Authority/Others
State Mental Health
Rules
State Mental Health
Programme
Range of medications
Regular supply and
dispensing
Standard procurement
arrangements

394

50

Affirmative
action for
persons with
mental illness

At every
level

Disability assessment
Pension
Travel concession
Health insurance
Special assistance
Educational benefits
Job reservation

10

Treatment
Gap

Overall

Approximate number of
persons with mental
illness approximate
numbers totally receiving
treatment in the state

Total Score (out of 1000)


Average Score (%)

any level
100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100 no
treatment gap
75 25%
treatment gap
50 -50%
treatment gap
25 -75%
treatment gap
0- 100%
treatment gap

25

25

375
37.5

RECOMMENDATIONS:
A consolidated report with information from the medical colleges, GHPUs and districts with
annual figures.
Preparation of a mental health plan
Kerala can be a model for other states on the development and monitoring of the DMHP once it
consolidates the findings across the DMHPs, including their reach in terms of patients and
training.
All medical colleges must have departments of psychiatry. Develop trained human resources
continues to be a need.

395

LAKSHADWEEP
SECTION 1. STATE LEVEL REPORT
8. GENERAL INFORMATION REGARDING THE STATE
8.2. Area: 32 sq. kms
8.3. No of districts: 1
8.4. Population, age distribution (as per census 2011): Total= 64473
0-9 years

10459

10-19 years

11622

20-44 years

27230

45-79 years

14566

80 years and above

8.5.
8.6.
8.7.
8.8.

481

Gender distribution: Males=33123; Females=31350(Sex ratio:946)


Life expectancy at birth male and female: NA
Per capita State Government expenditure on health:NA
Any health indicators for the state (life expectancy, etc):

Crude Birth Rate: 14.8


Crude Death Rate:6.3
Infant Mortality Rate :24
Sex Ratio Completeness/quality of information provided: Mostly Complete/Partially
Complete/Deficient
If deficient, areas of deficiency:
9. MENTAL ILLNESS BURDEN/ INFORMATION REGARDING MENTAL ILLNESS
N
(prevalence)
2.1. Total number of persons with 4500(as per
mental illness (all ICD categories) Estimated
prevalence
of 7%)

396

N
(treatment
seeking)
197(as per
affidavit)

Source of
information

2.2. Broad categories


2.2.a Severe mental disorders
(BPAD, psychosis)
2.2.b Common mental disorders
2.2.c Substance use disorders
(alcohol and other drugs)
2.2.d Mental Retardation

11
186

2.3. No of Males with mental


NA
health problems
2.4. No of females with mental
NA
health problems
2.5. No of children with mental
NA
health problems
2.6. No of elderly with mental
NA
health problems
2.7. No of homeless mentally ill
NA
persons
COMMENT: Despite the small number of persons likely to need services, a large treatment
gap is still evident.

10. MENTAL HEALTH SERVICES IN THE STATE:


10.2. Organization of Services (description of number of psychiatric hospitals, medical
college depts, district hospitals)

N/N

No with dept/facility
Total No of units

% coverage

3.1.a No of district
general hospitals with
separate department of
psychiatry
3.1.b No of medical
colleges with department
of psychiatry
3.1.c No of district
general hospitals
providing psychiatric care
3.1.d No of District
Mental Health
Programmes in the State

3.1.e No of government

N
397

psychiatric hospitals
3.1.f No of private
psychiatric hospitals
3.1.g Total No of
psychiatric hospitals in
the state
3.1.h No of NGOs
providing mental health
care

0
0

COMMENT: There is no Psychiatric Hospital in the entire State. Also there is no Government
Sector Medical college. Since the terrain is hilly with difficulty in transport, only one hospital
being proposed for the post of contractual psychiatrist at Rajiv Gandhi Hospital , Agatti under
PPP mode cannot cater to entire population. No NGO has been listed to be working in mental
health by the Government.

10.3. INPATIENT SERVICES


DESCRIPTION:

3.2.a. Total I.npatient


sanctioned/available
beds
3.2.b No of male beds
3.2.c. No of female
beds
3.2.d. No of beds for
children
3.2.e. No of beds for
elderly
3.2.f. No of beds for
substance use
disorders
3.2.g. No of beds for
forensic psychiatry
3.2.h. Occupancy (%)
3.2.i. No of admissions
during previous year
3.2.j. No of discharges
during previous year

Psychiatric
hospitals
(Govt) N=
0

Psychiatric
hospitals
(Private) N=
0

General
Hospitals
N=
0

District
Hospitals
N=
0

NGOs
N=

Total

0
0

0
0

0
0

0
0

0
0

0
0

0
0

0
0

0
0

0
0

0
0

0
0

398

3.2.k. Average
duration of inpatient
stay in days mean
3.2.l. Average
duration of inpatient
stay in days median
3.2.m. No of closed
wards
3.2.n. No of closed
ward beds
3.2.o. No of open
wards
3.2.p. No of open
ward beds
3.2.q. No of paid
wards
3.2.r.No of paid beds
3.2.s.No of admissions
through courts
3.2.t. No of deaths in
the last year
3.2.u. No of suicides in
the last year

0
0

0
0

0
0

0
0

0
0

0
0

COMMENT: Presently no inpatient services.

10.4. OUTPATIENT SERVICES


Govt.
Psychiatric
hospitals
N=
0

3.3.a. No of new
OP registrations in
the previous year
3.3.b. No of
0
emergency
attendees in the
previous year
3.3.c Total no of OP 0
follow-up in the
previous year

Private
Psychiatric
hospitals
N=
0

General
Hospitals

District
Hospitals

NGOs

Total

N=
0

N=
0

N=
0

399

COMMENT: No data has been provided in terms of emergency and follow-up


11. REHABILITATION FOR PERSONS WITH MENTAL ILLNESS
11.2. Government residential rehabilitation/longstay facilities : No and description: 0
11.3. Government day care/outdoor rehabilitation facilities: No and description: 0
11.4. Government run half-way homes: No and description. If none, plans to establish
and details: 0, NO Plan
11.5. NGO participation in the half way homes:NA
11.6. Longstay rehabilitation facilities: No and description; NGO participation: 0
12. MENTAL HEALTH CARE IN OTHER COMMUNITY FACILITIES
State Level, in the Govt Sector
5.1. No of shelter homes, observation homes,
special homes and childrens homes
5.2. No of counsellors trained in mental
health in the above institutions
5.3. No of protection homes for destitute
women
5.4. No of counsellors trained in mental
health in the above institutions
5.5. No of old age homes
5.6. No of counsellors trained in mental
health in the above institutions
5.7. No of Central Jails and District Jails in the
State
5.8. No of counsellors trained in mental
health in the above institutions
5.9.No of counsellors trained in mental health
in the above institutions

N
0
0
0
0
0
0
0
0
0

Helplines for Mental Health: (Nature of helpline, who runs it, for whom, any information on
its utilization)
COMMENT: There is no record of any community level services. It may be assumed that there
are no counsellors or other professionals trained in mental health.

400

13. MENTAL HEALTH HUMAN RESOURCES


Mental Health Care Professionals
Government
Psychiatric
Sector medical
medical
colleges/hospitals colleges

6.1. No of
Psychiatrists
6.2. No of Clinical
Psychologists
6.3. No of
Psychiatric Social
Workers
6.4. No of nurses
trained in mental
health
6.5. No of trained
counselors

Private
Practice
(Licensed
Nursing
Homes)
0

Total

7. MENTAL HEALTH HUMAN RESOURCE DEVELOPMENT


7.1. Degree/Diploma Courses
In Entire state, Annual No of
Seats in
MD Psychiatry
DNB Psychiatry
Diploma in Psychiatry
PhD Clinical Psychology
MPhil Clinical Psychology
PhD Psychiatric Social Work
MPhil Psychiatric Social Work
PhD Psychiatric Nursing
MSc Psychiatric Nursing
BSc Psychiatric Nursing
Basic Diploma in Psychiatric
Nursing (DPN)

Institutions where the Programme is offered

0
0
0
0
0
0
0
0
0
0
0

COMMENT: There are no in-house facilities for training mental health professionals, nor any
proper plan of deputation of staff to develop human recourses.
7.2. Other training in mental health
401

7.2.a. Details of Undergraduate MBBS training in psychiatry: None


7.2.b. Details of in-service training for Govt medical officers :0
7.2.c. Any other training courses in mental health offered by the state :0
8. GOVERNANCE:
8.1. Nodal Authority and responsibilities : NOT clearly mentioned
8.2. Presence of a State Mental Health Plan: No
8.3. Enactment of State Mental Health Rules: NR
8.4. Oversight of policies and Programmes related to mental health: NR
8.5. Specific oversight of the DMHP programme. NR
8.6. Attempts towards integration of mental health care into general health care, NCD
management etc. NR
8.7. Examples of commitment to develop mental health services (high level involvement,
budgeting, networking NR
8.8. Examples of inter-sectoral collaboration to improve mental health services (including PPP
intitiatives) NR
8.9. Attempts towards mental health promotion NR
COMMENT: Strengths and weaknesses
No encouraging signs of any activity in the area of mental health evident.
9. FINANCING
9.1. Sources of financing of different categories : NR
9.2 Budget provision from State and Centre in INR (for different facilities if required): NR
9.3. Mental Health Expenditure as proportion of Total Health Expenditure in State: NR
(If available % spending on Health in the State may also be provided)
10. ANY OTHER SIGNIFICANT INFORMATION
None

402

11. INNOVATIONS
None
12. OVERALL SUMMARY OF STATE LEVEL MENTAL HEALTH SERVICE
The UT of Lakshadweep is a group of 36 islands scattered with difficult terrain in Arabian sea
with a Population of 65000. There is no medical college in the UT, no psychiatric
hospital/Nursing Home in Govt. Sector/Private sector. No DMHP Programme is currently
being implemented in the UT.
There are three General Hospitals with only Indira Gandhi Hospital,Kavaratti is only providing
Limited specialized clinical services .Though, the primary health care system is good with
currently 3 CHC,4PHC, 14 Sub centres & 2 First Aid centres with overall health indicators are
better than national indicators.
There are no sanctioned post of Mental health professional in the UT. The psychiatric cases
are being managed by the GDMO and cases are referred to Physician at IG Hospital,Kavaratti
as and when required. Two senior doctors have been trained in mental health from NIMHANS
& are posted at Kavaratti who provides specialized consultation regardind metal illness
whenever required. The cases who are not manageable there are Referred to Govt. Mental
Hospital at Trichur & Calicut(Kerala). The UT has an MOU with the State of Kerala in this
regard.Once the treatment is completed, they are taken back.
Govt. Scheme for Providing financial assistance to Psychiatric patients of Lakshadweep
The objective of the scheme is to provide Medical Assistance to the poor patients evacuated
from the Islands to the mainland with approval of the Director of Medical & Health Services,
Lakshadweep.The patients referred to the mainland by arranging special sortie of Helicopter
with escorts have to purchase air tickets and also to spend a lot of money for their stay at
mainland and for various investigations and treatment. As per the existing scheme, the
treatment charges from Govt. Hospital at mainland for a patient whose annual income per year
is below Rs.12000/- (BPL). The transportation charges for such patients and the escorts
recommended by the treating Medical Officer and treatment charges at mainland,
investigation, laboratory charges etc are to be reimbursed to the poor patients of Lakshadweep
Islands.
(Source: Official website of Lakshadweep)
Proposed:
1.
2.

1 post of psychiatrist at Rajiv Gandhi Hospital at Agatti Island under PPP mode.
DMHP being implemented in 1 district in 2015-16 (as per the Affidavit)
403

SECTION 2
2.1. PSYCHIATRIC INSTITUTIONS
None
SECTION 3
3. General Hospital Departments of Psychiatry and District Hospital Departments
None
3.25. SUMMARY AND RECOMMENDATIONS WITH RESPECT TO SECTION 3:
SECTION 4
4. NGOS WORKING IN MENTAL HEALTH:
None
SECTION 5
5. DISTRICT MENTAL HEALTH PROGRAMME
None. Proposal as above.

404

SECTION 6
6. SUMMARY OF MENTAL HEALTH CARE INDICATORS IN Lakshwadeep)
6.1. Availability of mental health facilities

Mental health outpatient


facilities in the state
Day treatment facilities
Psychiatric beds in general
hospitals
Community residential facilities
Beds/places in community
residential facilities
Psychiatric hospitals
Beds in psychiatric hospitals

Total No of
facilities/beds
0

Rate per 100,000


population
0

0
0

0
0

0
0

0
0

0
0

0
0

Rate per 100,000


population
305.6

Females %

6.2. Access to Care

Persons treated in mental


health outpatient facilities
Persons treated in mental
health day care facilities
General hospital admissions
Community residential facilities
Persons staying in community
residential facilities at the end
of the year
Admissions to mental hospitals

0
0
0
0

6.3. Information Systems


None

405

6.4. Human Resources at the State Level


Health professionals working
in the mental health sector
Rate per 100,000
Psychiatrists
Medical doctors not specialised
in psychiatry
Clinical Psychologists
Psychiatric Social Workers
Psychiatric Nurses
Occupational therapists
Other health workers

0
0

Training of health
professionals in educational
institutions
Rate per 100,000
0
0

0
0
0
0
0

0
0
0
0
0

6.5. INFORMAL HUMAN RESOURCES (Family and User Associations)


Present in the state
No of members
Participation in the
formulation/implementation of
policy/plan/legislation

User
0
0
0

Family
0
0
0

6.6. MEDICINES
Type of Medication
All psychotropic medication
Mood stabilisers
Antipsychotics
Anxiolytics
Antidepressants
Anti-craving medication/ Substitution
treatments

Expenditure at State level per year and per


100,000 population (inINR)
0
0
0
0
0
0

406

SECTION 7
14. STATE MENTAL HEALTH REPORT CARD
SUMMARY OF SECTIONS 1-7.
Summary of areas where state has achieved good progress/little progress/no progress
There is some outpatient care. Patients requiring hospitalisation or more intensive care are
sent to Kerala.There is as yet no attempt to develop human resources.
Area

Focus

Parameters

Mental Health
Services
(Secondary
and Tertiary)

Medical
College
Depts,
General
Hospitals,
Specialised
psychiatric
hospitals

Adequacy of inpatient
beds
Functional Departments
Functional OP services

Primary
Health Care
mental health
services

District
Mental
Health
Programme

% of functional DMHPs

Rehabilitation
services

At all levels

Vocational training, day


care, longstay facilities in
govt sector/ppp

407

Rating

100- present, fully


satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100 All districts
covered; fully
satisfactory
75 majority of
districts covered
and functioning
50 half the
districts covered
and functioning
25 one-fourth of
the districts
covered and
functioning
0- No districts
covered/although
DMHP exists, not
functioning
100- present, fully
satisfactory
75- present,
reasonably
satisfactory

Score
(out of
100)
12.5

Specialised
services

Human
Resources

Financing for
mental health

50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100- present, fully
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent

Services for
substance
use
disorders,
old age,
mental
retardation,
child
psychiatry,
community
services,
forensic
services
(exclude
DMHP staff
here)

Whether existing, level of


functionality, present at
different levels of care

Adequacy of
psychiatrists/clinical
psychologists/psychiatric
social
workers/psychiatric
nurses or mental health
trained nurses

100 fully
adequate
75 moderately
adequate
50 somewhat
adequate
25- inadequate
0 grossly
inadequate

12.5

State level

Existence of separate
budget for mental
health/mental health
activities

10% -separate
budget, fully
adequate
75 separate
budget,
moderately
adequate
50 separate
budget,
somewhat
adequate
25 no separate
budget, but some
financial
resources
available annually
0 no separate
budget/marginal
financial resource

12.5

408

Governance
and Policy

State
Mental
Health
Authority
and other
authorities

Separate Mental Health


Nodal Officer
Functioning Mental
Health Authority
Nodal persons for mental
health in SHRC/Legal
Services
Authority/Others
State Mental Health
Rules
State Mental Health
Programme
Range of medications
Regular supply and
dispensing
Standard procurement
arrangements

Availability of
psychiatric
medication

At every
level

Affirmative
action for
persons with
mental illness

At every
level

Disability assessment
Pension
Travel concession
Health insurance
Special assistance
Educational benefits
Job reservation

10

Treatment
Gap

Overall

Approximate number of
persons with mental
illness approximate
numbers totally receiving
treatment in the state

Total Score (out of 1000)


Average Score (%)

allocation
100 Existing,
fully functional
75- Existing,
mostly functional
50- Existing,
somewhat
functional
25- Partial
0 Non existent

100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100 no
treatment gap
75 25%
treatment gap
50 -50%
treatment gap
25 -75%
treatment gap
0- 100%
treatment gap

12.5

50
0.5

409

Recommendations:
There is a need for Lakshadweep to have mental health governance in place to plan mental
health services for the UT. It is time for the UT to develop its mental health human and health
delivery resource, as it is needs to deliver mental health resources to many more than it
presently it. As the numbers requiring mental health services increases, it would be necessary
to have trained human resource than depend entirely on another state.

410

MADHYA PRADESH
SECTION 1. STATE LEVEL REPORT
1. GENERAL INFORMATION REGARDING THE STATE
a. Area: 308000 sq kms
b. No of districts: 51
c. Population, age distribution (as per census 2011): 72597565
d. Gender distribution: Males: 37612920; Females: 34984645
e. Life expectancy at birth male and female: Males: 59.19; Females: 58.01 (both
below the national average
f. Per capita State Government expenditure on health: Not provided
g. Any health indicators for the state
Indicator

MP

India

Infant Mortality Rate (SRS 2013)

54

40

Maternal Mortality Rate (SRS 2010-12)

230 178

Total Fertility Rate (SRS 2012)

2.9

Sex Ratio (Census 2011)

930 940

2.4

The Extent of Mental Health Problems in Madhya Pradesh State: The affidavit states that
no epidemiological study is available in the state of MP to know the persons with mental
illnesses

h. Completeness/quality of information provided: Partially Complete


If deficient, areas of deficiency: Full information on the prevalence of psychiatric disorders in
the state. The information is also deficient in the area of DMHP details.

2. MENTAL ILLNESS BURDEN/ INFORMATION REGARDING MENTAL ILLNESS:


NOT PROVIDED IN THE AFFIDAVIT
However, going by the available national epidemiological figures, the numbers are as
follows, approximate persons with psychiatric disorders: 50,00,000

411

3. MENTAL HEALTH SERVICES IN THE STATE:


Organization of Services (description of number of psychiatric hospitals, medical college depts,
district hospitals) Madhya Pradesh, a state in India is one of her large states hosting about a 7 %
of the countrys population. As regards the mental health services, there are two mental
hospitals in Gwalior and Indore. Also, the state has 5 state government medical colleges and an
All India Institute of Medical Sciences in Bhopal. All have the departments of Psychiatry.
Additionally, 5 district hospitals (Rathlam, Guna, Barwani, Jabalpur and Bhopal) have psychiatric
facilities. None of the other 46 districts have any sort of psychiatric facilities run by the
state/central government.
INPATIENT SERVICES

DESCRIPTION: The following table gives details of the in-patient services of the psychiatric
institutes as well as the GHPUs of Madhya Pradesh.

3.2.a. Total Inpatient


sanctioned/available
beds

Psychiatric
hospitals
(Govt)
2
350

Psychiatric
hospitals
(Private) N=

MC
General
N=14 Hospitals
N=
300
(including
GHPUs in
govt sector
and
district
hospitals)

3.2.b No of male beds


3.2.c. No of female
beds
3.2.d. No of beds for
children
3.2.e. No of beds for
elderly
3.2.f. No of beds for
substance use
disorders
3.2.g. No of beds for
forensic psychiatry
3.2.h. Occupancy (%)
3.2.i. No of admissions
during previous year
3.2.j. No of discharges
412

District
Hospitals
N=5

NGOs
N=

Total

during previous year


3.2.k. Average
duration of inpatient
stay in days mean
3.2.l. Average
duration of inpatient
stay in days median
3.2.m. No of closed
wards
3.2.n. No of closed
ward beds
3.2.o. No of open
wards
3.2.p. No of open
ward beds
3.2.q. No of paid
wards
3.2.r.No of paid beds
3.2.s.No of admissions
through courts
3.2.t. No of deaths in
the last year
3.2.u. No of suicides
in the last year

Facilities
Psychiatric Institutions:
Both institutions have adequate facilities in terms of dedicated emergency services, facilities
for visiting relatives, waiting hall for patients, toilets, separate interview rooms, drinking
water and canteen services. Also, OP lab and rehab facilities are also available.
Longstay: 48 patients had inpatient stay for more than a year in Gwalior and 59 in Indore
mental hospital.
Treatment
According to the affidavit, 25 psychotropics are available free of cost throughout the year in
both mental hospitals.
ECT services are provided only in Gwalior. All ECTs are modified here. 300 patients received
ECTs in the previous year here.
413

However, MH Indore does not have any ECT facilities.


At both hospitals, counselling and psychoeducation is being provided as and when required.
Psychoeducation is provided to all families. No major complaints regarding patient care have
been received, and patients and families have provided positive feedback about care received.
Additionally, both hospitals are involved in some form of community outreach activities. Two
institutes have taken up the supervising and monitoring of the DMHP as well. One institute are
liaising with local NGOs in order to rehabilitate the wandering mentally ill.
Records
Both hospitals have dedicated medical records sections and the average time taken to retreive
files vary between 15-30 minutes
Administrative Issues: Indore mental hospital has psychiatrist as Medical superintendent, while
Gwalior does not have psychiatrist as medical superintent.

a. OUTPATIENT SERVICES*
Govt.
Psychiatric
hospitals
N=2
3.3.a. No of new OP
registrations in the
previous year

10000

3.3.b. No of
emergency
attendees in the
previous year

2500

Private
Psychiatric
hospitals
N=

General
Hospitals

District
Hospitals

NGOs

N=

N=

N=

120000
(including
district
hospitals
and private
GHPUs)
7000
(including
GHPUs,
District
hospitals
and private
GHPUs
113000
(including
GHPUs,
District
hospitals
and private
GHPUs)

3.3.c Total no of OP
follow-up in the
previous year

414

Total

COMMENT: The denominator is not clear, i.e. the total number of general hospitals.
Information from private facilities are not availablw.

4. REHABILITATION FOR PERSONS WITH MENTAL ILLNESS


a. Government residential rehabilitation/longstay facilities : ONE
b. Government day care/outdoor rehabilitation facilities: No and description: NONE
at present
c. Government run half-way homes: No and description. If none, plans to establish
and details: TWO
d. NGO participation in the half way homes:NO
e. Longstay rehabilitation facilities: No and description; NGO participation: NO
5. MENTAL HEALTH CARE IN OTHER COMMUNITY FACILITIES
State Level, in the Govt Sector
5.1. No of shelter homes, observation homes,
special homes and childrens homes
5.2. No of counsellors trained in mental
health in the above institutions
5.3. No of protection homes for destitute
women
5.4. No of counsellors trained in mental
health in the above institutions
5.5. No of old age homes

5.6. No of counsellors trained in mental


health in the above institutions
5.7. No of Central Jails and District Jails in the
State
5.8. No of counsellors trained in mental
health in the above institutions

415

N
21
4
31
NONE
67 (all run by
NGOs, none by
the
government)
NONE
11 central jails
and 33 district
jails
NONE

Helplines for Mental Health: (Nature of helpline, who runs it, for whom, any information on
its utilization)

Helpline for the problems of disabled since 2008. (number: 1800-233-4397). Located
at NGO Arushi, Bhopal, Approximately, 157400 benefited
Helpline no 1090 is being run by the police dept for problems related to violence
against women
Helpline no 1098 is being run by ministry of women and child welfare for children
Helpline no 1091 is being run by the ministry of women and child welfare for family
counseling centre

COMMENT: There are a very large number of community institutions which need counsellors
trained in mental health. Prisons also require mental health inputs.
6. MENTAL HEALTH HUMAN RESOURCES
Mental Health Care Professionals

6.1. No of
Psychiatrists

Government
Sector medical
colleges/hospitals
37

6.2. No of Clinical
Psychologists

6.3. No of
Psychiatric Social
Workers

6.4. No of nurses
trained in mental
health
6.5. No of trained
counselors

85

Private
medical
colleges
25 (including
private
medical
colleges and
private
practice)
7 (including
private
medical
colleges and
private
practice)
9 (including
private
medical
colleges and
private
practice)
50

NIL

416

Private
Practice

Total

COMMENT: The human resources seem to be equally distributed between the government
and private facilities. MP appears to have this distribution even for other mental health
professionals other than psychiatrists, which has not been noticed in too many other states.
7. MENTAL HEALTH HUMAN RESOURCE DEVELOPMENT
7.1. Degree/Diploma Courses
P G Centres in Psychiatry
MD Seat in Psychiatry in Medical Colleges
DPM Seats in Psychiatry in Govt. Medical Colleges
MD Seat in Psychiatry in Pvt. Medical Colleges
DPM Seat in Psychiatry in Pvt. Medical Colleges
DNB (Psychiatry)

9
0
0
0
0

COMMENT: Considering there are 2 government psychiatric institutions and many medical
colleges, training in mental health specialties is very limited.
7.2. Other training in mental health
training medical oficers in psychiatry is ongoing in collaboration with NIMHANS, Bangalore
7.2.a. Details of Undergraduate MBBS training in psychiatry
Name of medical
college

No of hours of
theory

Duration of
psychiatry
posting during
UG

Duration of
psychiatry
posting during
internship

All medical
colleges

25 hours

15 days

15 days

Qualifying
Examination
includes
competency
evaluation in
psychiatry

COMMENT: Training is less than what is prescribed by the MCI. Does not mention if there is
competency evaluation in psychiatry.
The affidavit notes that This information has been asked for and will be provided.
7.2.b. Details of in-service training for Govt medical officers (No trained, duration)
NO DETAILS available
*If not trained, plans to train and timeline

417

7.2.c. Any other training courses in mental health offered by the state
NR
8. GOVERNANCE:
8.1. Nodal Authority and responsibilities :
1. Medical education: Dr RN Sahu, Prof and HOD of Psychiatry, Gandhi Medical College,
Bhopal, 0755-4050410
2. State Medical and Health Department: Dr Pramod Chandra, Deputy Director, NCD,
Directorate of Health and Family Welfare, Satpuda Bhawan, Bhopal; 0755-2527120
3. Social Welfare Department: Director,Social justice and disability welfare, Bhopal
0755-2550895
4. State Mental Authority: Dr RN Sahu; Prof and HOD of Psychiatry, Gandhi Medical
College, Bhopal, 0755-4050410

8.2. Presence of a State Mental Health Plan: NO


8.3. Enactment of State Mental Health Rules: NO
8.4. Oversight of policies and Programmes related to mental health: NO
8.5. Specific oversight of the DMHP programme.
DMHP has been initiated only partially in 3 districts. Lack of manpower and lack of funds are
cited as reasons for incomplete implementation of DMHP
8.6. Attempts towards integration of mental health care into general health care, NCD
management etc.
NO
8.7. Examples of commitment to develop mental health services (high level involvement,
budgeting, networking: NR
8.8. Examples of inter-sectoral collaboration to improve mental health services (including PPP
intitiatives)
NONE
418

8.9. Attempts towards mental health promotion: NONE


COMMENT: Strengths and weaknesses (see later)
9. FINANCING
9.1. Sources of financing of different categories
9.2 Budget provision from State and Centre in INR (for different facilities if required)
The two mental hospitals are getting grants from the Directorate of Medical Education of the
State Government. Also, these two institutes got one time grant-in aid from the Union Health
Ministry during 2005-06. This money has been utilised for infrastructure development. The
government medical colleges and district hospitals get only state government grants. DMHP
funds utilization has not been optimal.
9.3. Mental Health Expenditure as proportion of Total Health Expenditure in State: NR
10. ANY OTHER SIGNIFICANT INFORMATION (e.g. litigation, insurance schemes for persons
with mental illness, pension and other assistance, job reservations) NR
11. INNOVATIONS
NONE
12. OVERALL SUMMARY OF STATE LEVEL MENTAL HEALTH SERVICES

Indore mental hospital is a very old hospital founded in 1917.


Very low resources and mental health services
Even the DMHP is not functioning fully in any of the districts
Private institutes have seen more number of psychiatry cases in the previous year
Obviously, treatment gap remains huge

SECTION 2
2.1. PSYCHIATRIC INSTITUTIONS
Name and a para on status in 2008 (refer to NHRC book Mental Health Care and Human
Rights)
Domains
Infrastructure
Amenities and facilities

Status in 2008

Developments since 2008


155 beds
5 beds allotted for
419

emergencies
10 for de-addiction
5 for children
Rights of patients are
displayed
Fans, coolers, drinking water
available and adequate
The hospital is undr the
administrative charge of the
Dean MGM Medical College,
Indore

Financial arrangements

Diet
Investigations and treatment

Lab available. All


psychotropics regularly
available.
MD psychiatry coure has
been started at MH Indore
(2 seats). But there is no
separate academic block.
PGs are accommodated in
the MGM Medical College
Hostel.
There are no sanctioned
faculty posts in Clinical
Psychology, PSW and
Psychiatric Nursing. There
are 2 sanctioed posts of
clinical psychologist (none
working) 4 PSW (3 working)

Staff and training

Supportive services
Recreation/Occupational
therapy/Rehabilitation
Networking with other
agencies

2 units of rehabilitation
have been set up
Camps are conducted
regularly

SERVICES
i. Outpatient: Averages 114/day. There were 3684 registrations during the previous year, 30626
follow-ups.

420

ii. Inpatient: 155 beds. There were 574 admissions in the previous year. Mean duration of stay
is 11.2 days. There are 17 patients with stay between 1-5 years adn 45 more than 5 years. There
are 58 destitute patients. There were 3 deaths due to medical causes..
Diagnostic categories seen: all ICD 10 categories
iii. DIAGNOSTICS AND THERAPEUTICS

Investigations: all common blood and urine investigations and X-ray facilities are
available.
Therapeutic facilities: both inpatient and outpatient facilities are available. Psychotropic
medications are made available free of cost throughout the year.
ECT services have been suspended because of lack of anaesthetist.
Improvements in rehabilitation:

iv. ENGAGEMENT:

Attempts to involve families of persons with mental illness: almost always, families are
involved in patient care.
Disability certification and number of certificates issued in the previous year: Available,
but very few issued. While 450 persons with mental retardation received certificates in
the past year, only about 25 with mental illnesses received certificates in the past one
year

v. ADMINISTRATIVE

Annual number of adverse events: None


Mechanisms for redressal of patient complaints: May I help you window to receive
complaints.

vi. COMMUNITY OUTREACH AND NETWORKING

Community Programmes: very few


Networking with external agencies: very less
Public mental health education: Some form of public mental health education is going
on.

vii. TRAINING

Post-graduate training new Programmes, enhancement of seats and measures to


maintain/improve quality of training: PG training for doctors are available only at MH

421

Indore Also, other courses such as clinical psychology, social work and nursing training
needs immediate attention
Any other training Programmes:

vii. RESEARCH:

Research (areas, funding agencies, findings): NONE that is noteworthy

viii. ANY OTHER SALIENT CONTRIBUTIONS OF THE HOSPITAL/INSTITUTE:


ix. Any monitoring of hospital (internal or external)- One visit by NHRC (Prof Narayan); No visits
by SMHA/CHMA.
x. Special Rapporteurs observation: NOT AVAILABLE
xi. Any other observations (including Inspection Committee Reports): The IC (led by Shri Manoj
Jhalani) emphasized the need for filling up of the sanctioned posts; anaesthesia services to be
resumed to facilitate ECTs, Operationalisation of day care centre and half way home; PG
teaching in all mental health disciplines; Upgradation of Professor post to Professor Director for
more autonomous function of the hospital; Implementation of the DMHP in western MP under
supervision of the MH Indore; greater responsiblitiy on the family to care for the patients;
creation of rehabilitation for destitute patients by the Social Justice Department.
xii. Summary and Recommendations from SECTION 2: MH Indore
Areas of positive change
PG training
Specialised services
Some improvements in infrastructure
Short-term training for nurses
3 NGOs involved with the hospital (Seva
Dham, Ujjain, Parmanand hospital, Indore,
Aarogyam Abhyas Mandal, Indore

Areas of poor progress


Inadequate human resources
Lack of adequate networking and
collaboration for placement of longstay;
Poor community engagement thought there
is a proposal to initiate a DMHP

Gwalior Manasik Arogyashala

Domains
Infrastructure
Amenities and facilities

Status in 2008

Developments since 2008


212 beds (204 functioning)
4 beds allotted for geriatric
psychiatry
10 for de-addiction
422

5 for children
Rights of patients are
displayed
Fans, coolers, drinking water
available and adequate
State of art ECT facility
Grant-in-aid to imrpve the
wards, furniture, ECT
equipment (213 lakhs)
Adequate
Lab available. All
psychotropics regularly
available.
Nursing staff recruited by
Vyapam (25 additional)

Financial arrangements

Diet
Investigations and treatment

Staff and training


Supportive services
Recreation/Occupational
therapy/Rehabilitation
Networking with other
agencies

2 units of rehabilitation
have been set up
Outreach activities are
conducted regularly

SERVICES
i. Outpatient: Averages 95/day. There were 6667 registrations during the previous year, 27915
follow-ups.
ii. Inpatient: 204 beds. There were 1943 admissions in the previous year. Mean duration of stay
is 270 days. There are 84 patients with stay between 1-5 years and 34 more than 5 years. There
are 85 destitute patients. There were 9 deaths in the previous year.
Diagnostic categories seen: all ICD 10 categories: NR
iii. DIAGNOSTICS AND THERAPEUTICS

Investigations: all common blood and urine investigations and X-ray facilities are
available.
Therapeutic facilities: both inpatient and outpatient facilities are available. Psychotropic
medications are made available free of cost throughout the year.
ECT services are provided. 303 patients received ECTs in the previous year
Improvements in rehabilitation: 2 independent units

iv. ENGAGEMENT:
423

Attempts to involve families of persons with mental illness: almost always, families are
involved in patient care.
Disability certification and number of certificates issued in the previous year: Available.

v. ADMINISTRATIVE
Annual number of adverse events: 11, violence leading to injury. All attended.
Mechanisms for redressal of patient complaints: Present
vi. COMMUNITY OUTREACH AND NETWORKING
Community Programmes: No involvement with the DMHP. But GMA conducts regular
community activities.
Networking with external agencies: Collaboration with Red Cross Society, Child Help
Line, Life Line.
Public mental health education: Some form of public mental health education is going
on.
vii. TRAINING

Post-graduate training new Programmes, enhancement of seats and measures to


maintain/improve quality of training: No significant training activities.
Any other training Programmes: Nil

vii. RESEARCH:

Research (areas, funding agencies, findings): NONE that is noteworthy

viii. ANY OTHER SALIENT CONTRIBUTIONS OF THE HOSPITAL/INSTITUTE:


ix. Any monitoring of hospital (internal or external)- The NHRC has regularly visited teh GMA in
2003, 2004, 2007 (Shri Chaman Lal); 2008, 2009, 2010, 2011 (Dr Laxmidhar Mishra) and 2015
(Prof S Narayan)
x. Special Rapporteurs observation: xi. Any other observations (including Inspection Committee Reports): The IC (led by Shri Manoj
Jhalani) emphasized the need for post graduate training programmes to be initiated at GMA;
provisions to make families accept the family member following treatment of mental illness;
community camps for awareness, re-engagement of GMA with DMHP, upgradation of ECT
facility; distribution of food in stainless steel trolleys and proposal for funding for rehabilitation
through PIP to NHM.
xii. Summary and Recommendations from SECTION 2: MH Indore
424

Areas of positive change


Some improvements in infrastructure
NGO involvement has begun
ECT facilities have been improved

Areas of poor progress


Inadequate human resources
No initiation of PG training
No engagement with DMHP

SECTION 3
11. General Hospital Departments of Psychiatry and District Hospital Departments
The broad outline for this section:
3.1. Names of GH/DH and their location.
(If there are many, this could be done in a tabular column).
Name of the facility

Location

Hamidiya Hospital

Department of Psychiatry, Hamidiya Hospital and


Gandhi Medical College, Royal Market, Bhopal,
462001
Dept of Psych
Rewa

MGM Medical College, Indore


Department of Psychiatry, SS
Medical College
Dept of Psychiatry, Gajra Raja Veer Sawarkar Marg, Lashkar, Gwalior
Medical College
NSCB Medical College, Nagpur
Road, Jabalpur
Bundelkhand Medical College; Shivaji Ward Tili Road
Dept of Psychiatry
Dept of Psychiatry, People's
People's Hospital, By-pass Road, Bhanper,
Hospital
Bhopal, 462037
Dept of Psychiatry, LN Medical LN Medical College and JK Hospital, JK Town,
College
Kolar Raod, Bhopal 462042
Shri Aurobindo Medical
Indore-Ujjain State Highway, Near MR-10
College and Post graduate
Crossing, Sanwer Road, Indore-453555; Ph no:
Institute
0731-4231000; Fax: 0731-4231010
Index Medical College Hospital and Research Centre, Indore
Chirayu Medical College and
Bhopal-Indore Highway, near Bhairavgarh Bhopal
Hospital, Bhopal
RD Gardi Medical College and Agar Road, Surasa, Ujjain 456006
425

GHPU/Dt
Hospital
GHPU

GHPU
GHPU
GHPU
GHPU
GHPU
GHPU
GHPU
GHPU

GHPU
GHPU
GHPU

CR Gardi Hospital
AIIMS, Bhopal
Bhopal Memorial Hospital and
Research Centre; Psychiatric
unit in a tertiary care centre
Seth Govind Das District
Hospital
JP Hospital
Dist Hospital Barwani
District Hospital Guna
District Hospital Ratlam
District Hospital Sehore
MG District Hospital, Dewas

Saket Nagar, Bhopal 462024


Department of Psychiatry, Bhopal Memorial
Hospital and Research Centre, ICMR, Govt of
India, Raisen Bypass Road, Karond, Bhopal:
462038
Seth Goving Das Distric Hospital (Victoria
Hospital) Jabalpur
Bhopal
Bharwani
Near Shastri Park, AB Road,
Jail Road, Ratlam, CMHO Office
AB Road, Dewas, MP

GHPU
GHPU

Dt hospital
Dist
Hospital
Dt hospital
Dt Hospital
Dt Hospital
Dt Hospital
Dt Hospital

But no details of patient numbers and characteristics are provided.


3.2. Areas (distribution throughout the states): Yes, distributed throughout the state
3.3. Whether separate funding and adequacy:
No separate funding for psychiatry, funding agency, health and medical education
departments of the state government. Bhopal Cancer Memorial Hospital is being funded by
ICMR, NewDelhi.
3.4. Whether OP/IP and emergency services available: Yes, available in most of them.
3.5. Diagnostic categories in rank order that present in the outpatient: all ICD-10 categories
3.6. Adequacy of OP facilities: most of them seem adequate.
3.7. Inpatient occupancy, free and paying beds, average cost of inpatient stay per week; rank
order of diagnostic categories: mostly severe mental disorders; occupancy is about 90%
3.8. Extent of family involvement: Nearly always
3.9. Measures to protect rights including complaint redressal: Not adequate
3.10. Any networking: Very poor
3.11. Staffing details and any shortages/vacancies: Severe shortage of manpower
3.12. Psychotropic medication availability/free/cost: Yes, available
426

3.13. ECTs (Nos given across the facilities or average/No of direct ): About 1000 overall; Direct
ECT is prevalent in many institutes
3.14. Observations of extent to which counselling and psychotherapy are provided: Counselling
all the time, psychotherapy some times
3.15. Whether disability certification is available (if available numbers certified/year): Yes;
about 5000
3.16. Extent and nature of community involvement: Some institutes. Camps, rural health
training centre, jail hospitals,
3.17. Whether engagement with the DMHP and extent: Barring one or two, none of the other
are involved
3.18. Nature and partnership with NGOs for networking: Not noteworthy
3.19. Presence of PG training- whether adequately distributed throughout the state: Not
adequate at all; less than 10 MD psychiatry per year; practically nil training in other mental
health specialties.
3.20. Nature of public mental health material prepared and distributed/ activities to educate
3.21. Areas of research, sources of funding and major findings: NONE that is noteworthy
3.22. Whether monitored and by whom. What were the observations? No
3.23. Special Rapporteurs observations: Not relevant
3.24. Inspection Committees observations: Not relevant
3.25. SUMMARY AND RECOMMENDATIONS WITH RESPECT TO SECTION 3:

Patients who are able to come to the institutes are getting services. However, this is
awfully inadequate to bridge the huge treatment gap. Moreover, there seems to be no
effort on the part of the govt to scale up service delivery mechanisms in the state. PG
training is very inadequate.

427

SECTION 4
12. NGOS WORKING IN MENTAL HEALTH:
4.1. A brief description of the NGO and its location: details of only two NGOs are given.
Samarpan Mahila Vikas Kendra, Jabalpur and Late Shri CK Sakpal Memorial Psychosocial
rehab centre, Barwani
4.2. Nature of work carried out by the NGO in the domains mentioned and details of each:
Counseling, legal assistance, social assistance, advocacy, awareness in the community, health
camps, ICTC linkage etc.
4.3. Description of clientele seen by the NGO and number of persons who use the services in
the previous year: No other details are provided
4.4. Research details
4.5. Details of any training carried out by the NGO
4.6. Networking activities of the NGO
4.7. Salient contributions of the NGO
4.8. Special Rapporteurs observations
4.9. Inspection Committees observations
4.8. SUMMARY AND RECOMMENDATIONS FOR SECTION 4
While it is encouraging that there are a few NGOs and that the psychiatric hospitals have also
started engaging them, this needs to be a stronger movement to ensure comprehensive care
for persons with mental illness.

428

SECTION 5
4. DISTRICT MENTAL HEALTH PROGRAMME

5 districts are supposed to be covered of the 51 (less than 10%) (Shivpuri, Dewas, Sehore,
Mandla, Satna)- but no further details are provided.
5.1. A brief description of the location of the DMHP, when it started, total population covered:
5.2. A summary of annual registrations old and new, treatment outcomes in terms of those on
regular treatment and those dropped out, with diagnostic categories if provided. Would be
useful to know what kind of clientele is serviced under the DMHP:
5.3. Frequency of home visits carried out by the HW/ANM; numbers covered and for what
diagnostic categories, no of admissions facilitated:
5.4. Kinds of essential drugs available, number dispensed, number of patients receiving
medication under the DMHP in a month:
5.5. Duration of untreated mental illness for different diagnostic categories if provided:

429

5.6. Monitoring of the DMHP by the concerned officer /impressions and troubleshooting(mention if there is a committee and its composition):
5.7. IEC activities of the DMHP:
5.8.Training calendar of the DMHP (doctors, health workers, nurses, pharmacists, school
teachers/Anganwadi workers (whether any training conducted):
5.9. Activities to sensitize the gram panchayats
5.10. Special Rapporteurs report on the activities of the DMHP, its reach, areas of good
performance, areas of poor performance, barriers for effective service delivery, measures to
streamline functioning, funding flow and barriers thereof.
5.11. Inspection Committees observations: None
5.12. SUMMARY OBSERVATIONS OF DMHP AND RECOMMENDATIONS:
INFORMATION EXTREMELY INADEQUATE TO MEANINGFULLY COMMENT

SECTION 6
6. SUMMARY OF MENTAL HEALTH CARE INDICATORS IN MADHYA PRADESH
6.1. Availability of mental health facilities

Mental health outpatient


facilities in the state

Day treatment facilities


Psychiatric beds in general
hospitals
Community residential facilities
Beds/places in community
residential facilities
Psychiatric hospitals
Beds in psychiatric hospitals

Total No of
facilities/beds
21 psychiatric
facilities overall
apart from
DMHP facilities
in 3 districts
1
NR

Rate per 100,000


population
0.03

NR
NR
2
359

0.003
0.49

6.2. Access to Care

430

Persons treated in mental


health outpatient facilities
Persons treated in mental
health day care facilities
General hospital admissions
Community residential facilities
Persons staying in community
residential facilities at the end
of the year
Admissions to mental hospitals
(2517)

Rate per 100,000


population
Not complete

Females %

NR
Not complete
NR

3.5

6.3. Information Systems: Inadequate information to respond


Data on No of
persons/activities
collected and reported
YES/NO

Data on age and


gender are collected
and reported
YES/NO

Data on patients
diagnosis are collected
and reported
YES/NO

Persons with mental


disorders treated in
primary health care
Interventions delivered
in primary health care
for persons with
mental disorders
Persons treated in
mental health
outpatient facilities
Contacts in mental
health day treatment
facilities
Admissions in general
hospitals with
psychiatric beds
Admissions in mental
hospitals
Days spent in mental
hospitals
Admissions in
community residential
facilities

6.4. Human Resources at the State Level- Will be entered after all information is received.
431

Psychiatrists
Medical doctors not specialised
in psychiatry
Clinical Psychologists
Psychiatric Social Workers
Psychiatric Nurses
Occupational therapists

Health professionals working


in the mental health sector
Rate per 100,000
0.09

Training of health professionals in


educational institutions
Rate per 100,000

0.02
0.02
0.19

Other health workers

6.5.INFORMAL HUMAN RESOURCES (Family and User Associations)


Present in the state
No of members
Participation in the
formulation/implementation of
policy/plan/legislation

User
No

Family
No

6.6. MEDICINES
Type of Medication
All psychotropic medication
Mood stabilisers
Antipsychotics
Anxiolytics
Antidepressants
Anti-craving medication/ Substitution
treatments

Expenditure at State level per year and per


100,000 population (in INR)
No details provided

432

SECTION 7
7. STATE MENTAL HEALTH REPORT CARD
SUMMARY OF SECTIONS 1-7.
Summary of areas where state has achieved good progress/little progress/no progress
Some improvements have occurred in the psychiatric institutions. It is notable that MH
Indore has initiated a post-graduate training programme in psychiatry. However, given the
large population and the lack of human resources, developing human resources is the first
and biggest challenge for the State. The DMHP has been operational in less than 10%. It is
encouraging that there are a few NGOs working in the area of mental health.
MENTAL HEALTH REPORT CARD(needs to be revised after all the information is obtained)
Area

Focus

Parameters

Mental Health
Services
(Secondary
and Tertiary)

Medical
College
Depts,
General
Hospitals,
Specialised
psychiatric
hospitals

Adequacy of inpatient
beds
Functional Departments
Functional OP services

Primary
Health Care
mental health
services

District
Mental
Health
Programme

% of functional DMHPs

Rehabilitation
services

At all levels

Vocational training, day


care, longstay facilities in
govt sector/ppp
433

Rating
100- present, fully
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100 All districts
covered; fully
satisfactory
75 majority of
districts covered
and functioning
50 half the
districts covered
and functioning
25 one-fourth of
the districts
covered and
functioning
0- No districts
covered/although
DMHP exists, not
functioning
100- present, fully
satisfactory
75- present,

Score (out
of 100)
25

12.5

12.5

Specialised
services

Human
Resources

Financing for
mental health

Services for
substance
use
disorders,
old age,
mental
retardation,
child
psychiatry,
community
services,
forensic
services
(exclude
DMHP staff
here)

Whether existing, level of


functionality, present at
different levels of care

State level

Existence of separate
budget for mental
health/mental health
activities

Adequacy of
psychiatrists/clinical
psychologists/psychiatric
social
workers/psychiatric
nurses or mental health
trained nurses

434

reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100- present, fully
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent

100 fully
adequate
75 moderately
adequate
50 somewhat
adequate
25- inadequate
0 grossly
inadequate
10% -separate
budget, fully
adequate
75 separate
budget,
moderately
adequate
50 separate
budget,
somewhat
adequate
25 no separate
budget, but some
financial
resources
available annually
0 no separate

12.5

12.5

12.5

Governance
and Policy

State
Mental
Health
Authority
and other
authorities

Separate Mental Health


Nodal Officer
Functioning Mental
Health Authority
Nodal persons for mental
health in SHRC/Legal
Services
Authority/Others
State Mental Health
Rules
State Mental Health
Programme
Range of medications
Regular supply and
dispensing
Standard procurement
arrangements

Availability of
psychiatric
medication

At every
level

Affirmative
action for
persons with
mental illness

At every
level

Disability assessment
Pension
Travel concession
Health insurance
Special assistance
Educational benefits
Job reservation

10

Treatment
Gap

Overall

Approximate number of
persons with mental
illness approximate
numbers totally receiving
treatment in the state

Total Score (out of 1000)


Average Score (%)

budget/marginal
financial resource
allocation
100 Existing,
fully functional
75- Existing,
mostly functional
50- Existing,
somewhat
functional
25- Partial
0 Non existent

100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100 no
treatment gap
75 25%
treatment gap
50 -50%
treatment gap
25 -75%
treatment gap
0- 100%
treatment gap

25

25

25

12.5

175
17.5
435

RECOMMENDATIONS:
Governance at a very high level, strategic planning , resource mobilisation and regular
monitoring are very important to improve the situation of mental health care in Bhopal. There
is a great paucity of human resources. The various institutions particularly medical colleges and
psychiatric institutions should be capitalised for improving the human resource ratios. This is
particularly important in the government sector, as it is evident that a lot of the treatment
delivery is shifting to the private sector. It is upon the State Government with the help of the
Centre to provide mental health care to its citizens.

436

MAHARASHTRA
SECTION 1. STATE LEVEL REPORT
8. GENERAL INFORMATION REGARDING THE STATE
a. Area: 118809 sq kms
b. No of districts: 36
c. Population, age distribution (as per census 2011): 112374333
d. Gender distribution: Males: 58243056; Females: 54131277
e. Life expectancy at birth male and female: Males: 67.9; Females: 71.9.
f. Per capita State Government expenditure on health: Not provided
g. Any health indicators for the state
Indicator
Decadal Growth (%) (Census
2011)
Infant Mortality Rate (SRS 2013)
Maternal Mortality Rate (SRS
2010-12)
Total Fertility Rate (SRS 2012)

Maharashtra India
15.99

17.64

24

40

87

178

1.8

2.4

The Extent of Mental Health Problems in Maharashtra State: Source of information from
the Medical Information Systems of the 4 regional mental hospitals and 12 DMHP
centres of the state(for the year 2013-2014)
Total Outpatients
Total inpatients
Total suicides

179950
9667
16622

h. Completeness/quality of information provided: Partially Complete


If deficient, areas of deficiency: Full information on the prevalence of psychiatric disorders in
the state. The information is also deficient in the area of DMHP details. Although individual
forms have been returned from many of the private psychiatric hospitals, these are
incomplete and have not been collated into a consolidated state level response.

437

9. MENTAL ILLNESS BURDEN/ INFORMATION REGARDING MENTAL ILLNESS:


NOT PROVIDED IN THE AFFIDAVIT
However, going by the available national epidemiological figures, the numbers are as
follows
Total persons with psychiatric disorders: 65,00,000
Total persons with severe mental disorders: 16,85,000
Total persons with common mental disorders: 23,26,000
Total persons with substance dependence: 8,00,000
10. MENTAL HEALTH SERVICES IN THE STATE:
Organization of Services (description of number of psychiatric hospitals, medical college depts,
district hospitals) Maharashtra, a south western state of India is one of her large states hosting
about a 10% of the countrys population. As regards the mental health services, there are four
Regional Mental Hospitals in Pune (Yerawada), Thane, Nagpur and Rathnagiri. Additionally,
the Maharashtra Institute of Mental Health functions in the campus of BJ Medical College,
Pune. State government affidavit gives information about the departments of psychiatry
(general hospital psychiatric units) in 15 state owned medical colleges in Maharashtra. They
are located in the following places: Yavatmal, Ambaajogai, Aurangabad, Kolhapur, Sangli in
Miraj, Latur, Nagpur (two government medical college in Nagpur), Dhule, Solapur, Mumbai,
Nanded, Thane, Pune and Akola. However, there is no information on many prominent
government medical institutes of Maharashtra such as (a) Armed Forces Medical College,
Pune, (b) Dr. R.N. Cooper Municipal Medical College & General Hospital, Mumbai, (c)
Government Medical College, Chandrapur, (d) Lokmanya Tilak Municipal Medical College, Sion,
Mumbai, (e) Seth GS Medical College, Mumbai and (f) Topiwala National Medical College,
Mumbai. There are a total of 44 medical colleges in Maharashtra. Altogether, there are 48
medical colleges teaching MBBS in Maharashtra.
When it comes to the district hospital psychiatry units, though the affidavit states that all 23
district hospitals contains a separate departments of psychiatry, it contains information of
only 12 district hospitals. Also, notably, 86 sub-district hospitals of the state do not have any
psychiatric facility.
a. INPATIENT SERVICES
DESCRIPTION:The following table gives details of the in-patient services of the
psychiatric institutes as well as the GHPUs of Maharashtra.

438

Psychiatric
hospitals
(Govt) N=4
3.2.a. Total Inpatient
sanctioned/available
beds
3.2.b No of male
beds
3.2.c. No of female
beds
3.2.d. No of beds for
children
3.2.e. No of beds for
elderly
3.2.f. No of beds for
substance use
disorders
3.2.g. No of beds for
forensic psychiatry
3.2.h. Occupancy (%)
3.2.i. No of
admissions during
previous year

3.2.j. No of
discharges during
previous year
3.2.k. Average
duration of inpatient
stay in days mean

5695

2639
(details of
Rathnagiri
mental
hospital is
absent in
affidavit)

Psychiatric
hospitals
(Private)
N=103
2065

MCs
N=18

General
Hospitals
N=

District
Hospitals
N=

310

100

NGOs
N=

Total

8170

Not able to calculate as details have not been given in the affidavit
1839 (this
Not
35 (this also
also is
mentioned
is
incomplete
in
incomplete
as many
affidavit,
as many
hospitals
but from
hospitals
data is
adding
data is
absent)
individual
absent)
hospitals
20683
admissions
occur per
year in the
pvt
hospitals

10 days to 3
months
(again,
details not
complete)

10 days
(incomplet
e data)

3.2.l. Average
duration of inpatient
stay in days median
3.2.m. No of closed

10 days
(incomplete
data)

439

wards
3.2.n. No of closed
ward beds
3.2.o. No of open
wards
3.2.p. No of open
ward beds
3.2.q. No of paid
wards
3.2.r.No of paid beds
3.2.s.No of
admissions through
courts
3.2.t. No of deaths in
the last year
3.2.u. No of suicides
in the last year

5065

Data not
available

Data not
available

2224

Data not
available

Data not
available

11 (data
incomplete)

Data not
available

Data not
available

Complete
data not
available

Complete
data not
available

Complete
data not
available

Since the information provided in the state level questionnaire affidavit is very limited, other
aspects and comparisons cannot be described or undertaken.
Facilities
Psychiatric Institutions:
Only one out of five psychiatric institutions have separate facilities for relatives.
All five institutes have adequate drinking water facilities, OPD laboratory services, OP and IP
rehabilitation facilities.
Various vocational training services that are available as follows: tailoring, carpentry, weaving,
screen printing, file making, greeting card, drawing, painting, metting, embroidery, imitation
jewellery, artificial flowers, envelops, etc.
Four out of five have: separate OPD block and 24 hour emergency services, waiting hall for
patients, adequate toilet facilities; most of them do not have specialised services for children,
geriatric, deaddiction or forensic patients.
None of them have canteen facilities.
Three institutes have educational materials for patients.
Four out of five institutes have separate medical records for psychiatry patients.
440

Users are involved most of the times in treatment decisions in all these hospitals.
Patient rights are displayed in the wards at three institutes.
There were neither any complaints about the services nor any positive feedback about the
patient care.
Longstay: Data on the number of long stay patients in psychiatric institutes are given by only
two institutes out of five. A total of 700 patients had stayed for more than a year inside those
hospitals in the year previous to the affidavit submission. No other information specific to the
longstay of patients are provided in the affidavit
Treatment
According to the affidavit, 47 psychotropic drugs are available free of cost throughout the year
in all these 5 psychiatric institutes including antipsychotics, antidepressants, mood stabilizers,
sedatives and antiepileptic medications
ECT services are provided in all the five institutes. Overall, about 12,500 modified ECT sessions
were given in the previous year. None of the patients received unmodified ECTs in the past year
in these institutes. All 5 institutes have anesthetists available all the time for ECT services.
At all hospitals, counselling and psychoeducation is being provided as and when required.
Psychoeducation is provided to all families. No major complaints regarding patient care have
been received, and patients and families have provided positive feedback about care received.
Additionally, all 5 hospitals are involved in some form of community outreach activities. Two
institutes have taken up the supervising and monitoring of the DMHP as well. One institute are
liaising with local NGOs in order to rehabilitate the wandering mentally ill.
Records
All the hospitals have dedicated medical records sections and the average time taken to
retreive files vary between 15-30 minutes

441

Administrative Issues: In two out of 4 institutes, MS is a psychiatrist. There has been 1 visit by
the SHRC to one of the institutes in the previous year.
No suicides were reported from any of the psychiatric institutions.

b. OUTPATIENT SERVICES*
Govt.
Psychiatric
hospitals
N=2
6718

Private
Psychiatric
hospitals
N=103
137000

3.3.b. No of
emergency
attendees in the
previous year

369

13000

3.3.c Total no of OP
follow-up in the
previous year

94542*

678729

3.3.a. No of new OP
registrations in the
previous year

General
Hospitals

District
Hospitals

NGOs

N=26
107395
(both
GHPUs and
District
hospitals
put
together)
9033 (both
GHPUs and
District
hospitals
put
together)
185722
(both
GHPUs and
District
hospitals
put
together)

N=

N=

Total

251113

COMMENT: While there are a larger number of outpatient registrations in the private sector,
this averages 1330 patients per private facility, 4130 in the general hospitals whereas the
government facility averages about 3259.
It must be noted that the OP registrations recorded in the affidavit is only for 2 of the 4
regional hospitals. The number of OP registrations for all the 4 (mentioned in the IC Report)
totals 9336. Similarly the follow-ups across the 5 government facilities is 150157. Average
follow-up is higher in the MC/GHPU and the government psychiatric facilities.

442

11. REHABILITATION FOR PERSONS WITH MENTAL ILLNESS


a. Government residential rehabilitation/longstay facilities : NONE
b. Government day care/outdoor rehabilitation facilities: No and description:One
(PUNE)
c. Government run half-way homes: No and description. If none, plans to establish
and details:NONE
d. NGO participation in the half way homes:NOT AVAILABLE
e. Longstay rehabilitation facilities: No and description; NGO participation:
In the IC report it is mentioned that Day Care Centres are available at the RMH Nagpur, BJ
Medical College, Pune, Chaitanya Centre for Psychological Help Pune, Nityanand Rehab and
ResinMHC, Pune, Shanti Nursing Home, Aurangabad. Long term residential centres are run by
TISS Mumbai, Chaitanya MHC and Nityanand MHC.

12. MENTAL HEALTH CARE IN OTHER COMMUNITY FACILITIES


State Level, in the Govt Sector
5.1. No of shelter homes, observation homes,
special homes and childrens homes
5.2. No of counsellors trained in mental
health in the above institutions
5.3. No of protection homes for destitute
women
5.4. No of counsellors trained in mental
health in the above institutions
5.5. No of old age homes
5.6. No of counsellors trained in mental
health in the above institutions
5.7. No of Central Jails and District Jails in the
State
5.8. No of counsellors trained in mental
health in the above institutions
5.9.No of counsellors trained in mental health
in the above institutions

N
60
NONE
20
NONE
19
NONE
38
NONE
NONE

Helplines for Mental Health: (Nature of helpline, who runs it, for whom, any information on
its utilization)

443

Government has set up a state level mental health helpline in PUNE for the following
purposes: Suicide prevention, addiction and domestic violence. 1098 is the helpline for
adolescent mental health problems.
COMMENT: There are a huge number of facilities in the community, but none of the
counsellors running these services are trained in mental health.
13. MENTAL HEALTH HUMAN RESOURCES
Mental Health Care Professionals
Government
Psychiatric
Sector medical
medical
colleges/hospitals colleges
210

6.1. No of
Psychiatrists
6.2. No of
1
Clinical
Psychologists
6.3. No of
75
Psychiatric Social
Workers
6.4. No of nurses 156
trained in mental
health
6.5. No of
trained
counselors

Private
Practice

Total

NA

COMMENT: There are practically no clinical psychologists in the medical colleges and general
hospitals.
7. MENTAL HEALTH HUMAN RESOURCE DEVELOPMENT
7.1. Degree/Diploma Courses
P G Centres in Psychiatry
MD Seat in Psychiatry in Govt. Medical Colleges
6
DPM Seats in Psychiatry in Govt. Medical Colleges 4
MD Seat in Psychiatry in Pvt. Medical Colleges
NA
DPM Seat in Psychiatry in Pvt. Medical Colleges
NA
DNB (Psychiatry)
NA

444

COMMENT: For such a large state, with so 48 medical colleges, the PG seats are extremely
few. For such a large state, it is not fathomable why PG training has not been increased to
augment human resources.
7.2. Other training in mental health
Medical officers in the DMHP are being trained for 3 days(so far 120 trained). Other
paramedical staff received 1 day training (so far 50 are trained) in the past one year
7.2.a. Details of Undergraduate MBBS training in psychiatry
Name of
medical college

No of hours of
theory

Duration of
psychiatry
posting during
UG

Duration of
psychiatry
posting during
internship

Qualifying
Examination
includes
competency
evaluation in
psychiatry

All medical
25 hours
15 days
15 days
colleges
COMMENT: This is still sub-optimal when compared to the MCI prescribed guidelines.
7.2.b. Details of in-service training for Govt medical officers (No trained, duration)
NO DETAILS available
7.2.c. Any other training courses in mental health offered by the state
8. GOVERNANCE:
8.1. Nodal Authority and responsibilities : Additional Director, Mental Health, Directorate of
Health Services
8.2. Presence of a State Mental Health Plan: NO
8.3. Enactment of State Mental Health Rules: NO
8.4. Oversight of policies and Programmes related to mental health: NR
8.5. Specific oversight of the DMHP programme. NR
DMHP has been initiated fully in 12 districts. However, detailed information on the 12
DMHPs not provided.
8.6. Attempts towards integration of mental health care into general health care, NCD
management etc.
445

NO
8.7. Examples of commitment to develop mental health services (high level involvement,
budgeting, networking
8.8. Examples of inter-sectoral collaboration to improve mental health services (including PPP
intitiatives)
NONE
8.9. Attempts towards mental health promotion NONE
COMMENT: Strengths and weaknesses (see later)
9. FINANCING
9.1. Sources of financing of different categories
9.2 Budget provision from State and Centre in INR (for different facilities if required)
The state of Maharashtra has received funding from the Government of India for renovations
of the regional mental hospitals (all four). However, the utilization is 100% only in two
centres. Also, major part of the funds has gone for repair and renovation work. Work towards
manpower development and improvement of patient care facilities are conspicuous by their
absence. In addition, the affidavit contains details of GOI grant for 6 DMHPs. Most of them
have shown 100% utilization of the money. Money for upgradation of Maharashtra Institute
of Mental Health has shown the poorest utilization. Here, apart from the library, nothing else
seems to have changed. The % utilization is just 0.11%. As regards the state govt funding, the
medical colleges (n=13) have got funds ranging from 17,00,000 till 35,00,000/- for mental
health the previous year. Almost all the colleges have utilized the funds towards
infrastructure development rather than manpower improvement. However, the utilization
has been 100% in nearly all the medical colleges.

9.3. Mental Health Expenditure as proportion of Total Health Expenditure in State


NR
10. ANY OTHER SIGNIFICANT INFORMATION (e.g. litigation, insurance schemes for persons
with mental illness, pension and other assistance, job reservations)
11. INNOVATIONS

446

NONE
12. OVERALL SUMMARY OF STATE LEVEL MENTAL HEALTH SERVICES
Maharashtra is one state which has seen a booming private sector in the mental health
sector. However, the government sector though has services, needs a lot of improvement,
especially in human resource development. There seem to be no problems with regards to
the availability of psychotropic medications.

SECTION 2
2.1. PSYCHIATRIC INSTITUTIONS
Name and a para on status in 2008 (refer to NHRC book Mental Health Care and Human
Rights)
Domains

Infrastructure
Amenities and facilities
Financial arrangements
Diet
Investigations and
treatment
Staff and training
Supportive services
Recreation/Occupational
therapy/Rehabilitation
Networking with other
agencies

Developments since 2008


RMH Yerawada
RMH Thane
RMH
RMH Nagpur
Pune
Ratnagiri
Overall, these facilities have improved in the past 10 years. For
example, specialised services have started in certain psychiatric
institutions (Geriatric, OP Rehab in RMH Pune), dedicated
emergency services, waiting hall, drinking water facilities, OP
lab services etc. However, the most striking thing about these
mental hospitals is the dearth of manpower. Still a number of
vacancies are present, particularly of psychiatrists. Number of
allotted vacancies pertaining to psychologists, social workers
and nurses are woefully inadequate. Further, despite having
close to 3000 beds, none of these institutes have PG training
facilities.

SERVICES
i. Outpatient:
ii. Inpatient (improvement in in-patient facilities; any increase in open compared to closed ward
admissions; further reduction in court admissions; improvement particularly in the care of
women, children and elderly; use of disposables needles and syringes; no re-use of shaving
blades; any illness outbreaks and how contained; availability of psychotropic medication
447

including free medicines; use of ECTs including direct ECT): On paper, these seem to be
adequate across 4 institutions.
Diagnostic categories seen: All ICD-10 categories.
iii. DIAGNOSTICS AND THERAPEUTICS

Investigations:
Therapeutic facilities:
Improvements in rehabilitation:

iv. ENGAGEMENT:

Attempts to involve families of persons with mental illness:


Disability certification and number of certificates issued in the previous year:

v. ADMINISTRATIVE

Annual number of adverse events:


Mechanisms for redressal of patient complaints:

vi. COMMUNITY OUTREACH AND NETWORKING

Community Programmes: Yes, community outreach programme such as visiting jails,


association with local DMHPs etc is ocurring
Networking with external agencies: Yes, some networking with local NGOs (for example,
NEPTUNE NGO in collaboration with Thane mental hospital provides care to wandering
mentally ill. The INCENSE programme is a programme aimed at rehabilitating patients in
the RMH Yeravada, though not mentioned in the affidavit.
Public mental health education: all these institutions provide some public mental health
education by way of banners, posters, fixtures etc. No other details are available

vii. TRAINING: NO PG training

Post-graduate training new Programmes, enhancement of seats and measures to


maintain/improve quality of training:
Any other training Programmes: Yes, nurses, paramedical staff and medical officers,
periodic training is occurring.

vii. RESEARCH: NONE

Research (areas, funding agencies, findings),

448

viii. ANY OTHER SALIENT CONTRIBUTIONS OF THE HOSPITAL/INSTITUTE:


ix. Any monitoring of hospital (internal or external)- details
x. Special Rapporteurs observation:
xi. Any other observations (including Inspection Committee Reports):
Infrastructure like roads, buildings, sewage lines very old and need repair
Adequate funds required to building maintenance, maintenance of vacant spaces and toilet
repairs
Shortage of continuous water supply
Poor condition of toilets and bathrooms
In geriatric ward, commode not available for elderly patients
Bed strength for females is less
There are some vacancies of staff
Sanctioned posts of medical officers and nurses not as per norms
No provision of appointment of contractual staff
Diet is appropriate. Linen provision is satisfactory
Medicines are avialbe
Open land is unused, except in Nagpur where there is farming and garden activities
Compound walls are in disrepair
OPD is well functioning
No family ward are functioning in Thane, Pune and Nagpur
Huge number of long stay. Many patients requested for discharge.
Occupational therapy functioning in Pune, Thane and Nagpur but not in Ratnagiri.

Recommendations by the IC included:


Need for half way homes to be established by the Social Justice Department and run by
competent NGIs
Overall modernisation
Development of human resources by starting PG courses
Creation of new posts
Expansion of DMHP
Facilitate collaboration with civil society and NGOs
OT units to be upgraded
Family units to be established
Regular psycho-education programmes
An increase in female beds in Ratnagiri and Napur (decrease in male beds)
Installation of CCTV to monitor
GB to be chaired by Guardian Minister
RKS to review complaints and recommendations from Visitors Committee regularly
Regular revision of user charges
Proper marketing of products made by rehabilitation
Constitution of State Mental Health Authority at the earliest.
xii. Summary and Recommendations from SECTION 2:
449

The hospitals at Yerawada Pune and Thane have huge number of outpatients, few staff, high
number of longstay patients, many destitute patients. There is regular oversight by the
hospital authority, Rogi Kayan Samiti and Visitors Committee. Many problems continue
because of high numbers and low staffing. It is not clear whether existing staff are well
trained and sensitive to the patient needs. There is high medical morbidity. RMH Yerwada
has an NGO Parivartan involved in rehabilitation and TISS is involved with Thane to provide
rehabilitation under the Tarasha Project. RMH Ratnagiri is a smaller hospital but duration of
inpatient stay is also long here. It has linkages with an NGO Maher for rehabilitation of
women patients.
Comparison of patients seen across hospitals

No of beds
No of admissions per
year
No of outpatient
registrations
No of follow-ups

Psychiatric Hospitals
Govt (5)

Psychiatric Hospitals
Pvt (103)

Medical Colleges
(18)

5695
6577

2065
20683

410
1874

9336

137000

107395

150157

678729

185722

Although the total number of patients seen in the private psychiatric hospitals is larger the
average number seen in higher in the government hospitals.
SECTION 3
13. General Hospital Departments of Psychiatry and District Hospital Departments
Information is very deficient.
3.1. Names of GH/DH and their location. GHPUs are located across the state. Totally
information is present for 15 medical colleges. They are: Yavatmal, Ambaajogai, Aurangabad,
Akola, Kolhaapur, Sangli & Miraj, Latur, Nagpur (information is present for two govt medical
colleges in Nagpur), Dhule, Solapur, Mumbai, Nanded, Thane and Pune. However, apart from
the Grant Medical College, none of the other government medical colleges in Mumbai does get
mention in the report. For example, SION hospital, KEM hospital etc. coming to district
hospitals, psychiatry facilities are present only in those 12 districts where DMHPs are running.
3.2. Areas (distribution throughout the states): distributed throughout the state
3.3. Whether separate funding and adequacy: no separate funding is available for these. Some
of them have got one time grant in aid under NMHP during the year 2006-07
3.4. Whether OP/IP and emergency services available: yes, apart from one district hospital, all
other facilities have emergency services available.

450

3.5. Diagnostic categories in rank order that present in the outpatient: all ICD 10 categories are
being seen
3.6. Adequacy of OP facilities: yes, they all have separate outpatient departments. Most of
them have half of adequate facilities such as waiting halls, toilets, separate interview rooms,
drinking water facilities, canteen facilities, OPD and OP rehab facilities. Educational facilities are
inadequate in the majority. Also, most of them do not have special clinics
3.7. Inpatient occupancy, free and paying beds, average cost of inpatient stay per week; rank
order of diagnostic categories: The inpatient beds range between 10 and 60. Average duration
of in patient stay is about 10 days. Average cost of in patient stay range between 140 per week
to Rs350 per week.
3.8. Extent of family involvement: nearly always involved
3.9. Measures to protect rights including complaint redressal: most of them dont have the
patient rights displayed
3.10. Any networking: majority of them DO NOT have any networking
3.11. Staffing details and any shortages/vacancies: these are manned by psychiatrists, general
duty medical officers, clinical psychologists, psychiatric social workers and nurses. However,
there seem to be inadequate number of mental health professionals particularly psychologists
and social workers
3.12. Psychotropic medication availability/free/cost: yes, a variety of them are available free of
cost.
3.13. ECTs (Nos given across the facilities or average/No of direct ): YES, about 7000 given in
the previous year across these facilities. From among these, about 60 are direct ECTs
3.14. Observations of extent to which counselling and psychotherapy are provided: Psychoeducation is provided to all, psychotherapy is provided to some
3.15. Whether disability certification is available (if available numbers certified/year): Yes,
medical board exists in all these facilities: about 10,000 disability certificates are issued in the
previous year.
3.16. Extent and nature of community involvement: some outreach occurring in half of these
facilities.
3.17. Whether engagement with the DMHP and extent: as mentioned earlier, the district
hospitals contain psychiatric facilities only in those where DMHP is running.
451

3.18. Nature and partnership with NGOs for networking: very few. Details mentioned above in
summary
3.19. Presence of PG training- whether adequately distributed throughout the state: only four
of the medical colleges have psychiatry PG training facilities. None of these centres offer PG
training in other mental health disciplines such as psychology or social work.
3.20. Nature of public mental health material prepared and distributed/ activities to educate:
Yes, all of these are engaged in some form of mental health awareness building in the form
of: pamphlets, programmes in television, public lectures, banners etc.
3.21. Areas of research, sources of funding and major findings: None to be noted
3.22. Whether monitored and by whom. What were the observations? Most of them
monitored by state govt. two are being monitored by the High Court.
3.23. Special Rapporteurs observations:
3.24. Inspection Committees observations:
3.25. SUMMARY AND RECOMMENDATIONS WITH RESPECT TO SECTION 3:
(Overall impressions about the mental health service delivery through the General and District
Hospitals). There appear to be basic levels of service provision. Inadequate human resources, ,
no PG training facilities, no extension of district level facilities to non DMHP districts are
evident.
SECTION 4
14. NGOS WORKING IN MENTAL HEALTH:
4.1. A brief description of the NGO and its location: Information is provided for 14 NGOs in the
area of mental health in Maharashtra. They are located in Miraj, Sangli, Raigadh, Mumbai,
Thane, Bandra, Ratnagiri, Nagpur, Wardha, Satara, Latur and Pune
4.2. Nature of work carried out by the NGO in the domains mentioned and details of each: most
of them provide counselling and assistance. Some of them provide residential care for
homeless mentally ill. Many of them carry out awareness enhancing activities
4.3. Description of clientele seen by the NGO and number of persons who use the services in
the previous year
4.4. Research details: NONE

452

4.5. Details of any training carried out by the NGO:


4.6. Networking activities of the NGO: Few of them have networking with medical colleges
4.7. Salient contributions of the NGO: NONE that is striking
4.8. Special Rapporteurs observations: 4.9. Inspection Committees observations: 4.8. SUMMARY AND RECOMMENDATIONS FOR SECTION 4
There is scope for greater NGO presence and collaboration in this state.

SECTION 5
5. DISTRICT MENTAL HEALTH PROGRAMME:

453

DMHP is present in 12 districts. They are: Amaravathi, Ahmednagar, Alibagh-Raigadh,


Bhandara, Buldhana, Gadchiroli, Jalgaon, Nashik, Osmanabad, Parbhani, Satara and Wardha .
None of the other 24 districts have psychiatric facilities at the district level.

5.1. A brief description of the location of the DMHP, when it started, total population covered:
5.2. A summary of annual registrations old and new, treatment outcomes in terms of those on
regular treatment and those dropped out, with diagnostic categories if provided. Would be
useful to know what kind of clientele is serviced under the DMHP:
5.3. Frequency of home visits carried out by the HW/ANM; numbers covered and for what
diagnostic categories, no of admissions facilitated:
5.4. Kinds of essential drugs available, number dispensed, number of patients receiving
medication under the DMHP in a month:
5.5. Duration of untreated mental illness for different diagnostic categories if provided:
5.6. Monitoring of the DMHP by the concerned officer /impressions and troubleshooting(mention if there is a committee and its composition):
5.7. IEC activities of the DMHP:
5.8.Training calendar of the DMHP (doctors, health workers, nurses, pharmacists, school
teachers/Anganwadi workers (whether any training conducted):
5.9. Activities to sensitize the gram panchayats
5.10. Special Rapporteurs report on the activities of the DMHP, its reach, areas of good
performance, areas of poor performance, barriers for effective service delivery, measures to
streamline functioning, funding flow and barriers thereof.
5.11. Inspection Committees observations5.12. SUMMARY OBSERVATIONS OF DMHP AND RECOMMENDATIONS:
Details about the functioning of the DMHP are inadequate.

454

SECTION 6
6. SUMMARY OF MENTAL HEALTH CARE INDICATORS IN MAHARASHTRA
6.1. Availability of mental health facilities

Mental health outpatient


facilities in the state
Day treatment facilities
Psychiatric beds in general
hospitals
Community residential
facilities
Beds/places in community
residential facilities
Psychiatric hospitals
Beds in psychiatric hospitals

Total No of
facilities/beds
31

Rate per 100,000


population
0.03

156*

3000

2.7
Overall 2.8 BEDS PER
100000 population

Rate per
100,000
population
130.5

Females %

*incomplete
6.2. Access to Care

Persons treated in mental


health outpatient facilities
Persons treated in mental
health day care facilities
General hospital admissions
Community residential
facilities
Persons staying in
community residential
facilities at the end of the
year
Admissions to mental
hospitals

22.8

455

6.3. Information Systems: NO INFORMATION AVAILABLE


Data on No of
persons/activities
collected and reported
YES/NO

Data on age and


gender are collected
and reported
YES/NO

Data on patients
diagnosis are collected
and reported
YES/NO

Persons with mental


disorders treated in
primary health care
Interventions delivered
in primary health care
for persons with
mental disorders
Persons treated in
mental health
outpatient facilities
Contacts in mental
health day treatment
facilities
Admissions in general
hospitals with
psychiatric beds
Admissions in mental
hospitals
Days spent in mental
hospitals
Admissions in
community residential
facilities

6.4. Human Resources at the State LevelHealth professionals working


in the mental health sector
Rate per 100,000
Psychiatrists
Medical doctors not specialised
in psychiatry
Clinical Psychologists (1)*
Psychiatric Social Workers
Psychiatric Nurses
Occupational therapists
Other health workers

0.18

0.07
0.14

*To be verified

456

Training of health
professionals in educational
institutions
Rate per 100,000

6.5.INFORMAL HUMAN RESOURCES (Family and User Associations)


Present in the state
No of members
Participation in the
formulation/implementation of
policy/plan/legislation

User
ACMI

Family

6.6. MEDICINES: NO INFORMATION AVAILABLE


Type of Medication

Expenditure at State level per year and per


100,000 population (inINR)

All psychotropic medication


Mood stabilisers
Antipsychotics
Anxiolytics
Antidepressants
Anti-craving medication/ Substitution
treatments

SECTION 7
14. STATE MENTAL HEALTH REPORT CARD
SUMMARY OF SECTIONS 1-7.
Summary of areas where state has achieved good progress/little progress/no progress
Several recommendations have been made to improve the mental hospitals in Maharashtra.
Despite these recommendations, and the orders of the High Court, the changes in the hospitals
has been minor and many problems prevail. It has been noticed in many states that improving
human resources, academic training, NGO involvement and a co-ordinated plan help in the
positive transformation of the hospitals. The state needs to apply its efforts in this direction.
Despite so many medical colleges, post-graduate training opportunities in the State are
disproportionately small. Concerted efforts to enhance training must be taken.
The private sector in Maharashtra is predominant over other sectors. Mental illnesses are
chronic in nature and out of pocket spending can greatly impoverish families. The scenario in
terms of families looking after persons with mental illness appears to consist of two extremeseither dumping in the mental hospitals or enduring great amounts of personal and financial
hardships (not dissimilar to situations in many other states). The State needs to provide many
457

more open, voluntary and free services for patients with mental illness and facilitate families to
care for these persons through supportive welfare schemes, in addition to treatment. This is
imperative. A plan outlining the proposed enhancement of services that are easily accessible to
patients and their families and its achievement in a time- bound manner is crucial.
MENTAL HEALTH REPORT CARD(needs to be revised after all the information is obtained)
Area

Focus

Parameters

Mental Health
Services
(Secondary
and Tertiary)

Medical
College
Depts,
General
Hospitals,
Specialised
psychiatric
hospitals

Adequacy of inpatient
beds
Functional Departments
Functional OP services

Primary
Health Care
mental health
services

District
Mental
Health
Programme

% of functional DMHPs

Rehabilitation
services

At all levels

Vocational training, day


care, longstay facilities in
govt sector/ppp

458

Rating

100- present, fully


satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100 All districts
covered; fully
satisfactory
75 majority of
districts covered
and functioning
50 half the
districts covered
and functioning
25 one-fourth of
the districts
covered and
functioning
0- No districts
covered/although
DMHP exists, not
functioning
100- present, fully
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,

Score
(out of
100)
25
(mostly
in
private)

25

12.5

Specialised
services

Human
Resources

unsatisfactory
0- absent
100- present, fully
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent

Services for
substance
use
disorders,
old age,
mental
retardation,
child
psychiatry,
community
services,
forensic
services
(exclude
DMHP staff
here)

Whether existing, level of


functionality, present at
different levels of care

Adequacy of
psychiatrists/clinical
psychologists/psychiatric
social
workers/psychiatric
nurses or mental health
trained nurses

100 fully
adequate
75 moderately
adequate
50 somewhat
adequate
25- inadequate
0 grossly
inadequate

12.5

Financing for
mental health

State level

Existence of separate
budget for mental
health/mental health
activities

12.5

Governance
and Policy

State
Mental
Health

Separate Mental Health


Nodal Officer
Functioning Mental

10% -separate
budget, fully
adequate
75 separate
budget,
moderately
adequate
50 separate
budget,
somewhat
adequate
25 no separate
budget, but some
financial
resources
available annually
0 no separate
budget/marginal
financial resource
allocation
100 Existing,
fully functional
75- Existing,

459

12.5

25

Authority
and other
authorities

Health Authority
Nodal persons for mental
health in SHRC/Legal
Services
Authority/Others
State Mental Health
Rules
State Mental Health
Programme
Range of medications
Regular supply and
dispensing
Standard procurement
arrangements

Availability of
psychiatric
medication

At every
level

Affirmative
action for
persons with
mental illness

At every
level

Disability assessment
Pension
Travel concession
Health insurance
Special assistance
Educational benefits
Job reservation

10

Treatment
Gap

Overall

Approximate number of
persons with mental
illness approximate
numbers totally receiving
treatment in the state

Total Score (out of 1000)


Average Score (%)

mostly functional
50- Existing,
somewhat
functional
25- Partial
0 Non existent

100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100 no
treatment gap
75 25%
treatment gap
50 -50%
treatment gap
25 -75%
treatment gap
0- 100%
treatment gap

25

25

12.5

187.5
18.8

460

MANIPUR
SECTION 1. STATE LEVEL REPORT
1. GENERAL INFORMATION REGARDING THE STATE (Manipur)
a. Area
22327 Sq.Mtr.
b. No of districts
c. Population, age distribution (as per census 2011)
d. Gender distribution

9
2321756
Male 13,69764
Female - 1351992

e. Life expectancy at birth male and female


f. Per capita State Government expenditure on health
g. Any health indicators for the state (life expectancy, etc)

N.A.
N.A.
N.A.

h. Completeness/quality of information provided: Complete/Partially


Complete/Deficient
If deficient, areas of deficiency: Estimation of mental illness is based on persons
seeking treatment and not on existing numbers. Some of the other information is not
complete.
2. MENTAL ILLNESS BURDEN/ INFORMATION REGARDING MENTAL ILLNESS
N
(prevalence)
2.1. Total number of
persons with mental
illness (all ICD categories)
2.2. Broad categories
2.2.a Severe mental
disorders (BPAD,
psychosis)
2.2.b Common mental
disorders
2.2.c Substance use
disorders (alcohol and
other drugs)
2.2.d Mental Retardation

24051 (Source of
Information
RIMS, DMHP
Report)
1,231

2,350
1,032

202
461

N
(treatment
seeking)

Source of
information

2.3. No of Males with


mental health problems
2.4. No of females with
mental health problems
2.5. No of children with
mental health problems
2.6. No of elderly with
mental health problems
2.7. No of homeless
mentally ill persons

N.A.
539
391
371
N.A.

COMMENT: The State has provided information about the treatment referrals and not really
estimated the number of persons with mental illness.
3. MENTAL HEALTH SERVICES IN THE STATE:
Organization of Services (description of number of psychiatric hospitals, medical college depts,
district hospitals)
N/N
3.1.a No of district general
hospitals with separate
department of psychiatry

3.1.b No of medical colleges with


department of psychiatry

3.1.c No of district general


hospitals providing psychiatric
care
3.1.d No of District Mental Health
Programmes in the State

No with dept/facility
Total No of units

% coverage

N
3.1.e No of government
psychiatric hospitals
3.1.f No of private psychiatric
hospitals

N.A.
N.A.

462

3.1.g Total No of psychiatric


hospitals in the state

N.A.

3.1.h No of NGOs providing


mental health care

69

COMMENT: More than half the districts are covered by the DMHP. There is a large NGO
presence.
a. INPATIENT SERVICES
DESCRIPTION:
Psychiatric
hospitals
(Govt)

3.2.a. Total Inpatient


sanctioned/available
beds
3.2.b No of male beds
3.2.c. No of female beds
3.2.d. No of beds for
children
3.2.e. No of beds for
elderly
3.2.f. No of beds for
substance use disorders
3.2.g. No of beds for
forensic psychiatry
3.2.h. Occupancy (%)
3.2.i. No of admissions
during previous year
3.2.j. No of discharges
during previous year
3.2.k. Average duration
of inpatient stay in days
mean
3.2.l. Average duration

Psychiatric
hospitals
(Private) N=

General Hospitals

District
Hospitals
N=9

NGOs
N=69

Total

Jawarlal
Nehru
Institute of
Medical
Sciences,
Imphal, East
District
10

Regional
Institute of
Medical
Sciences, (RIMS
Hospital)
Imphal, West
Dist.
30

06
04
NR

NR
NR
NR

NR

NR

NR

20

NR

NR

NR
NR

95%
509

NR

NR

10-14 days

14-15 DAYS

NR

NR

463

NR

of inpatient stay in days


median
3.2.m. No of closed
wards
3.2.n. No of closed ward
beds
3.2.o. No of open wards
3.2.p. No of open ward
beds
3.2.q. No of paid wards
3.2.r.No of paid beds
3.2.s.No of admissions
through courts
3.2.t. No of deaths in
the last year
3.2.u. No of suicides in
the last year

NR

NR

NR

NR

NR
NR

3
50

NR
NR
NR

Nil
Nil
Nil

NR

NR

NR

NR

COMMENT: The inpatient facilities are restricted to the JNIMS Imphal and RIMS Hospital.
Much of the information is not documented.
b. OUTPATIENT SERVICES
Psychiatric
hospitals
(Govt)

3.3.a. No of
new OP
registrations in
the previous
year
3.3.b. No of
emergency
attendees in
the previous
year

Private
Psychiatric
hospitals
N=

General Hospitals
Jawarlal
Nehru
Institute of
Medical
Sciences,
Imphal, East
District
NR

Regional
Institute of
Medical
Sciences,
(RIMS
Hospital)
Imphal, West
Dist.
9650

NR

1460

464

District
Hospitals
N=

NGOs Total
N=

3.3.c Total no
of OP followup in the
previous year

NR

6825

COMMENT: Information not available from JNIMS.


4. REHABILITATION FOR PERSONS WITH MENTAL ILLNESS
a. Government residential rehabilitation/longstay facilities : No and description:
NIL
b. Government day care/outdoor rehabilitation facilities: No and description: NIL
c. Government run half-way homes: No and description. If none, plans to establish
and details NIL
d. NGO participation in the half way homes: 2
e. Longstay rehabilitation facilities: No and description; NGO participation:
Protection and rehabilitation homes 11 (Information from Social Welfare
Departments)
5. MENTAL HEALTH CARE IN OTHER COMMUNITY FACILITIES
State Level, in the Govt Sector
5.1. No of shelter homes, observation homes, special homes and
childrens homes
5.2. No of counsellors trained in mental health in the above
institutions
5.3. No of protection homes for destitute women
5.4. No of counsellors trained in mental health in the above
institutions
5.5. No of old age homes
5.6. No of counsellors trained in mental health in the above
institutions
5.7. No of Central Jails and District Jails in the State
5.8. No of counsellors trained in mental health in the above
institutions
5.9.No of counsellors trained in mental health in the above
institutions

N
2, 4, 11 and 19
NR
18
NR
36
N.A.
2 Central Jail (Functional, 2
district jail (Non-functional)
and 1 sub-jail (Not-functional)
NR
NR

Helplines for Mental Health: There is no record of helplines.


COMMENT: There are many community facilities but it is not clear if there are trained
counsellors in these facilities. Similarly it is not recorded if prisons have mental health care.

465

6. MENTAL HEALTH HUMAN RESOURCES


Mental Health Care Professionals
Government Sector
medical
colleges/hospitals
6.1. No of Psychiatrists

15

6.2. No of Clinical
Psychologists
6.3. No of Psychiatric Social
Workers
6.4. No of nurses trained in
mental health
6.5. No of trained counselors
6.6. Record Keeper
6.7. Case Registry Assistant

12

Psychiatric
Hospital

Private
Practice

Total

14
17
NR
NR
NR

COMMENT: Most of the mental health human resources are in the government sector.
7. MENTAL HEALTH HUMAN RESOURCE DEVELOPMENT
7.1. Degree/Diploma Courses
In Entire state, Annual No of
Seats in
MD Psychiatry
DNB Psychiatry
Diploma in Psychiatry
PhD Clinical Psychology
MPhil Clinical Psychology

Institutions where the Programme is offered

3 per year

Regional Institute of Medical Sciences Hospital,


Imphal West

7 per year

Regional Institute of Medical Sciences Hospital,


Imphal West

PhD Psychiatric Social Work


MPhil Psychiatric Social Work
PhD Psychiatric Nursing
MSc Psychiatric Nursing
BSc Psychiatric Nursing
Basic Diploma in Psychiatric
Nursing (DPN)

COMMENT: No. Of PGs posted for 15 days or more M.D. (Medicines PGs, Interns 15 days).
7.2. Other training in mental health : HIV / IDU counselling for trainers of OST.

466

7.2.a. Details of Undergraduate MBBS training in psychiatry


Name of medical
college

No of hours of
theory

Duration of
Duration of
Qualifying
psychiatry posting psychiatry posting Examination
during UG
during internship includes
competency
evaluation in
psychiatry

COMMENT: Details of MBBS teaching of psychiatry have not been provided.


7.2.b. Details of in-service training for Govt medical officers (No trained, duration) : 350
7.2.c. Any other training courses in mental health offered by the state : 362
8. GOVERNANCE:
8.1. Nodal Authority and responsibilities : Medical Education : Thingom Joychandra Singh,
SMHA Dr. Marry Haobam
8.2. Presence of a State Mental Health Plan: NR
8.3. Enactment of State Mental Health Rules: NR
8.4. Oversight of policies and Programmes related to mental health : NR
8.5. Specific oversight of the DMHP programme: NR
No. Of district in which DMHP has been implemented = 5, No. Of districts in which it has been
fully implemented = 5,
8.6. Attempts towards integration of mental health care into general health care, NCD
management etc.: NR
8.7. Examples of commitment to develop mental health services (high level involvement,
budgeting, networking: NR
8.8. Examples of inter-sectoral collaboration to improve mental health services (including PPP
intitiatives) : NR
8.9. Attempts towards mental health promotion: NR
COMMENT: Strengths and weaknesses

467

A nodal authority is in existence. It would be important to have representation from social welfare
and legal services.

9. FINANCING
9.1. Sources of financing of different categories NR
9.2 Budget provision from State and Centre in INR (for different facilities if required)
9.3. Mental Health Expenditure as proportion of Total Health Expenditure in State
(If available % spending on Health in the State may also be provided)
10. ANY OTHER SIGNIFICANT INFORMATION (e.g. litigation, insurance schemes for persons
with mental illness, pension and other assistance, job reservations)
11. INNOVATIONS: NR
12. OVERALL SUMMARY OF STATE LEVEL MENTAL HEALTH SERVICES :
There have been efforts to enhance human resources. Local training is very important. It is
important to examine whether training in psychiatric social work and psychiatric nursing can
also be initiated.
SECTION 2
2.1.

PSYCHIATRIC INSTITUTIONS
There are no psychiatric hospitals in Manipur either in the government or private
sector.
SECTION 3

3. General Hospital Departments of Psychiatry and District Hospital Departments


The broad outline for this section:
3.1. Names of GH/DH and their location. : Regional Institute of Medical Sciences Hospital,
Imphal West, Pin-795004, Jawaharlal Institute of Medical Sciences, Porompat, Imphal East
District
3.2. Areas (distribution throughout the states): NR
3.3. Whether separate funding and adequacy: NR
3.4. Whether OP/IP and emergency services available : OPD, IP and Emergency Services are
available.
468

3.5. Diagnostic categories in rank order that present in the outpatient


3.6. Adequacy of OP facilities : Waiting Halls, Toilets, Separate Interview Rooms, Drinking
Water, Canteen Services, OPD Lab services are adequate.
3.7. Inpatient occupancy, free and paying beds, average cost of inpatient stay per week; rank
order of diagnostic categories Occupancy 95%.
The breakup as per ICD 10 is as follows (RIMS, Imphal West)
Organic Psychiatric Disorders
Schizophrenia
Bipolar Mood Disorder
Other Psychotic Disorders
Obsessive Compulsive Disorder
Other anxiety Disorders
Depressive Disorders
Adjustment Disorders
Alcohol and drug Abuse Disorders
Personality Disorders
Children with Psychiatric illness

54
100
200
3
47
20
82
3

3.8. Extent of family involvement : Always involved


3.9. Measures to protect rights including complaint redressal : Rights of patients are displayed
in wards.
3.10. Any networking : Yes Networking with SAO, MNP Plus, WAFD-NGOs
3.11. Staffing details and any shortages/vacancies :
Qualified psychiatrists
General Medical Officers
Clinical Psychologists
Psychiatric / Medical Social Workers
Trained Psychiatric Nurses
General Nurses
Other (Specify)

4
4
4
-

3.12. Psychotropic medication availability/free/cost : Free of Cost available


3.13. ECTs (Nos given across the facilities or average/No of direct ) : N.A.
3.14. Observations of extent to which counselling and psychotherapy are provided : Provided
to all
469

3.15. Whether disability certification is available (if available numbers certified/year) : Yes, 40
certificate per year.
3.16. Extent and nature of community involvement : occasional camps are organized free
related to Mental Health Awareness.
3.17. Whether engagement with the DMHP and extent : Nil
3.18. Nature and partnership with NGOs for networking : 1. Women action for development of
psycho-social. 2. Rural Education and action for change. 3 SASO, 4. MNP Centre for Mental
Hygiene, 5. Existance.
3.19. Presence of PG training- whether adequately distributed throughout the state : Yes
MD 3 per year and M.Phil 7 per year.
3.20. Nature of public mental health material prepared and distributed/ activities to educate :
Nil
3.21. Areas of research, sources of funding and major findings : Nil
3.22. Whether monitored and by whom. What were the observations? : Monitoring is being
done by State Government.
3.23. Special Rapporteurs observations
3.24. Inspection Committees observations
3.25. SUMMARY AND RECOMMENDATIONS WITH RESPECT TO SECTION 3:
A majority of psychiatric disorders presenting to RIMS are psychotic disorders
including schizophrenia and bipolar mood disorders. Common mental disorders and
adjustment disorders are also frequently diagnosed.
Information is not provided for the JNIMS.
SECTION 4
4. NGOS WORKING IN MENTAL HEALTH:
4.1. A brief description of the NGO and its location : 1. Centre of Mental Hygiene,
CHANGANGEI, Airport Road, Imphal, Manipur, 2. Integrated rehabilitative centre of addicts,
3. Ibomal Institute for Mentally retarded children, 4 Half way home for treated and controlled
mentally ill persons, 5. Rehabilitation Centre for older persons suffering from dementia.

470

4.2. Nature of work carried out by the NGO in the domains mentioned and details of each :
Counselling, Social Assistance, Residential Care, Rehabilitation, After Care, Home based
Programmes, Awareness Generation Activities, In the Field of Drugs abuse, Mental
Retardation and Mental illness.
4.3. Description of clientele seen by the NGO and number of persons who use the services in
the previous year : Drug de-addiction centre 800, Institute for mental retardation 110, Half
way homes for mentally ill 75, Rehabilitation Centre for older persons of dementia - 10
4.4. Research details : NR
4.5. Details of any training carried out by the NGO : NR
4.6. Networking activities of the NGO : Hospital such as RIMS, JNIMS
4.7. Salient contributions of the NGO : Day Care, Rehabilitation Centre for older persons with
dementia, Half way home, Home based care for special children.
4.8. Special Rapporteurs observations :
4.9. Inspection Committees observations :
4.8. SUMMARY AND RECOMMENDATIONS FOR SECTION 4
General hospital psychiatry appears to be the mainstay of psychiatric care in Manipur.

471

SECTION 5
6. DISTRICT MENTAL HEALTH PROGRAMME

5.1. A brief description of the location of the DMHP, when it started, total population covered:
DMHP, Imphal West, Imphal East, Chaura Chandpur, Chandel, Thoubal.
5.2. A summary of annual registrations old and new, treatment outcomes in terms of those on
regular treatment and those dropped out, with diagnostic categories if provided.
Sr.No.
1.
2.
3.
4.
5

Annual Registration Old


New Cases
No. Of patients of regular treatment
First Contact drop out
Recovered patients

Imphal
West
2015
119
1358
91
1491

472

Imphal
East
1013
83
692
78
710

Chaura
Chandpur
N.A.
168
1558
N.A.
N.A.

Chandel

Thoubal

450
29
211
87
71

1952
55
918
50
1253

5.3. Frequency of home visits carried out by the HW/ANM; numbers covered and for what
diagnostic categories, no of admissions facilitated: Details are not available.
5.4. Kinds of essential drugs available, number dispensed, number of patients receiving
medication under the DMHP in a month:

Sr.No.

DMHP Districts

1.

Chaura Chandpur

2.

Chaura Chandpur

3.

Chaura Chandpur

4.

Chaura Chandpur

5.

Chaura Chandpur

6.

DMHP, Chandel

7.

DMHP, Chandel

8.

DMHP, Chandel

9.

DMHP, Chandel

10.

DMHP, Chandel

No. Of
Patients
Number
Receiving medication
Dispensed
under DMHP in a
month

Essential
Drugs
Olanzepine
(10mg.)
Sertraline
(50 mg.)
Risperdone
(2 mg.)
Sodium Valproate
(200mg.)
Oxcarbamazepine
(300 mg.)
Chlorpromazine
(100 mg.)
Risperdone
(2 mg.)
Phenobarbitone
(60 mg.)
Eptoin
(100 mg.)
Imipramine
(75 m.gm.)

800

8
22

550

12

550

12

500

10

400 Strips

56

400 strips

48

820 strips

87

450 strips

51

250 strips

42

5.5. Duration of untreated mental illness for different diagnostic categories if provided: NR
5.6. Monitoring of the DMHP by the concerned officer /impressions and trouble-shooting
(mention if there is a committee and its composition): NR
5.7. IEC activities of the DMHP: NR
5.8. Training calendar of the DMHP (doctors, health workers, nurses, pharmacists, school
teachers/Anganwadi workers (whether any training conducted):
S.No. Training (No. Attended)
1.
2.
3.

Training of Doctors
Training of Health Workers
Training of Nurses

Imphal Imphal
West
East
62
58
47
60
30
45
473

Chaura
Chandpur
20
N.A.
40

Chandel

Thoubal

40
N.A.
45

60
50
32

4.
5.
6.

Training of Pharmacist
Training of Teachers
Anganwadi Worker

20
N.A.
N.A.

17
N.A.
N.A.

N.A.
40
40

06
56
65

5.9. Activities to sensitize the gram panchayats: NR


5.10. Special Rapporteurs report : 5.11. Inspection Committees observations:5.12. SUMMARY OBSERVATIONS OF DMHP AND RECOMMENDATIONS:
Manipur is one of th few states which has provided detailed information on its DMHP.
SECTION 6
6. SUMMARY OF MENTAL HEALTH CARE INDICATORS IN MANIPUR (name of state)
6.1. Availability of mental health facilities

Mental health outpatient facilities in


the state

Total No of
facilities/beds

Rate per 100,000 population

0.329

40

0.823

Day treatment facilities


Psychiatric beds in general hospitals
Community residential facilities
Beds/places in community residential
facilities
Psychiatric hospitals

0.004

Beds in psychiatric hospitals

1.469

6.2. Access to Care


Rate per 100,000
population
Persons treated in mental health
outpatient facilities
Persons treated in mental health day
care facilities

474

Females %

20
N.A.
N.A.

General hospital admissions

14.52

Community residential facilities


Persons staying in community
residential facilities at the end of the
year
Admissions to mental hospitals

6.3. Information Systems: Complete information not provided

Persons with mental


disorders treated in
primary health care
Interventions delivered
in primary health care
for persons with
mental disorders
Persons treated in
mental health
outpatient facilities
Contacts in mental
health day treatment
facilities
Admissions in general
hospitals with
psychiatric beds
Admissions in mental
hospitals
Days spent in mental
hospitals
Admissions in
community residential
facilities

Data on No of
persons/activities
collected and reported
YES/NO

Data on age and


gender are collected
and reported
YES/NO

Data on patients
diagnosis are collected
and reported
YES/NO

Yes

Yes

Yes

Yes

Yes

Yes

No

No

No

475

6.4. Human Resources at the State Level

Psychiatrists

Health professionals working


in the mental health sector
Rate per 100,000

Training of health professionals


in educational institutions
Rate per 100,000

0.301

0.0364

Medical doctors not specialised


in psychiatry

2.893

Clinical Psychologists

0.047

0.010

Psychiatric Social Workers

0.033

0.003

Psychiatric Nurses

0.166

0.016

Occupational therapists
Other health workers

6.5. INFORMAL HUMAN RESOURCES (Family and User Associations)


Present in the state
No of members
Participation in the
formulation/implementation of
policy/plan/legislation

User
Yes

Family
Yes

Not routinely

Not routinely

6.6. MEDICINES
Type of Medication

Expenditure at State level per year and per


100,000 population (inINR)

All psychotropic medication


Mood stabilisers
Antipsychotics
Anxiolytics
Antidepressants
Anti-craving medication/ Substitution
treatments

476

SECTION 7
7. STATE MENTAL HEALTH REPORT CARD
SUMMARY OF SECTIONS 1-7.
Summary of areas where state has achieved good progress/little progress/no progress

The state has made a concerted effort to provide comprehensive information of the
facilities and human resources. Areas of positive strides is the development of
psychiatric services in 5 of the 9 districts, increase in the multidisciplinary human
resource and the presence of post-graduate training in psychiatry and clinical
psychology. The NGO presence is reasonable. If there can be more effort in the
comprehensive collection of information and a time-bound mental health plan with
regular support, the State can improve many of its indicators in mental health. Human
resources in the other mental health sectors need to be increased and training of
professionals working in community facilities in mental health may be undertaken.

MENTAL HEALTH REPORT CARD


Area

Focus

Parameters

Rating

Mental
Health
Services
(Secondary
and Tertiary)

Medical
College
Depts,
General
Hospitals,
Specialised
psychiatric
hospitals

Adequacy of inpatient
beds
Functional Departments
Functional OP services

Primary
Health Care
mental health
services

District
% of functional DMHPs
Mental
Health
Programme

100- present,
fully satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100 All districts
covered; fully
satisfactory
75 majority of
districts covered
and functioning
50 half the

477

Score
(out of
100)
25

50

districts covered
and functioning
25 one-fourth
of the districts
covered and
functioning
0- No districts
covered/although
DMHP exists, not
functioning
Rehabilitation At all levels Vocational training, day 100- present,
25
services
care, longstay facilities
fully satisfactory
in govt sector/ppp
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
Specialised
Services for Whether existing, level
100- present,
0
services
substance
of functionality, present fully satisfactory
use
at different levels of care 75- present,
disorders,
reasonably
old age,
satisfactory
mental
50 present,
retardation,
somewhat
child
satisfactory
psychiatry,
25 present,
community
unsatisfactory
services,
0- absent
forensic
services
Human
(exclude
Adequacy of
100 fully
25
Resources
DMHP staff psychiatrists/clinical
adequate
here)
psychologists/psychiatric 75 moderately
social
adequate
workers/psychiatric
50 somewhat
nurses or mental health adequate
trained nurses
25- inadequate
0 grossly
inadequate
478

Financing for State level


mental health

Existence of separate
budget for mental
health/mental health
activities

Governance
and Policy

State
Mental
Health
Authority
and other
authorities

Availability of
psychiatric
medication

At every
level

Separate Mental Health


Nodal Officer
Functioning Mental
Health Authority
Nodal persons for
mental health in
SHRC/Legal Services
Authority/Others
State Mental Health
Rules
State Mental Health
Programme
Range of medications
Regular supply and
dispensing
Standard procurement
arrangements

Affirmative
action for

At every
level

Disability assessment
Pension
479

10% -separate
25
budget, fully
adequate
75 separate
budget,
moderately
adequate
50 separate
budget,
somewhat
adequate
25 no separate
budget, but some
financial
resources
available annually
0 no separate
budget/marginal
financial resource
allocation
100 Existing,
25
fully functional
75- Existing,
mostly functional
50- Existing,
somewhat
functional
25- Partial
0 Non existent

100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available
at any level
100- Fully
satisfactory

75

25

persons with
mental illness

10

Treatment
Gap

Travel concession
Health insurance
Special assistance
Educational benefits
Job reservation

Overall

Approximate number of
persons with mental
illness approximate
numbers totally
receiving treatment in
the state

75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available
at any level
100 no
treatment gap
75 25%
treatment gap
50 -50%
treatment gap
25 -75%
treatment gap
0- 100%
treatment gap

25

Total Score (out of 1000)


300
Average Score (%)
30
RECOMMENDATIONS: It is evident that Manipur has been making a concerted effort to
improve its mental health services. However, the ratios are still unsatisfactory and human
resources and beds for mental health care need to be increased. Special services for children,
elderly etc need to be developed. The DMHP need to be expanded. As with the other states,
an assessment of those in need of mental health services and a detailed mental health plan
must be prepared. The state has many NGOs who can be of assistance to provide mental
health care in specialised settings in the community. The nodal authority needs to be
expanded to include other sectors.

480

MEGHALAYA
SECTION 1. STATE LEVEL REPORT
8. GENERAL INFORMATION REGARDING THE STATE (Meghalaya)
a. Area
22429 Sq.Kms.
b. No of districts
7 (As per Census 2011)
c. Population, age distribution (as per census 2011)
Total Population
2966889
Distribution by Age
0 4 Years
= 406154
15 19 Years = 326188
20 34 Years = 725950
35 49 Years = 443271
50 64 Years = 189560
65 79 Years = 72317
Above 80 Years = 15877

d.
e.
f.
g.
h.

Gender Distribution
Males = 1491832, Females = 1475057
Life expectancy at birth male and female
N.A.
Per capita State Government expenditure on health
N.A.
Any health indicators for the state (life expectancy, etc) N.A.
Completeness/quality of information provided: Mostly Complete/Partially
Complete/Deficient

If deficient, areas of deficiency: Some of the information from the NGOs is not provided
and full information from the DMHP has not been provided.
9. MENTAL ILLNESS BURDEN/ INFORMATION REGARDING MENTAL ILLNESS
N
(prevalence)
2.1. Total number of
persons with mental
illness (all ICD
categories)

2.2. Broad categories


2.2.a Severe mental
disorders (BPAD,
psychosis)

178013 (WHO :
Mental Health
Atlas 2005)

47470

481

N (treatment
seeking)

Source of
information

2.2.b Common mental


disorders
2.2.c Substance use
disorders (alcohol and
other drugs)
2.2.d Mental
Retardation

61414

2.3. No of Males with


mental health problems
2.4. No of females with
mental health problems
2.5. No of children with
mental health problems
2.6. No of elderly with
mental health problems
2.7. No of homeless
mentally ill persons

N.A.

20471

20471

326357
278887
264053
N.A.

COMMENT: The State has calculated mental health morbidity at 6%. This may be revised
when national prevalence figures become available. Until then, this can be used to plan
mental health services in the State.
10. MENTAL HEALTH SERVICES IN THE STATE:
a. Organization of Services (description of number of psychiatric hospitals, medical
college depts, district hospitals)

N/N
3.1.a No of district general
hospitals with separate
department of psychiatry

3.1.b No of medical colleges with


department of psychiatry

Nil

3.1.c No of district general


hospitals providing psychiatric
care
3.1.d No of District Mental Health
Programmes in the State

No with dept/facility
Total No of units

% coverage

482

3.1.e No of government
psychiatric hospitals
3.1.f No of private psychiatric
hospitals
3.1.g Total No of psychiatric
hospitals in the state

3.1.h No of NGOs providing


mental health care

1
2

COMMENT: There are very few specialised psychiatric facilities in the State. There is only 1
NGO.
b. INPATIENT SERVICES
DESCRIPTION:
Psychiatric
hospitals
MIMHANS
(Govt) N=1
3.2.a. Total I.npatient 150
sanctioned/available
beds
3.2.b No of male
100
beds
3.2.c. No of female
50
beds
3.2.d. No of beds for Details not
children
available
3.2.e. No of beds for Details not
elderly
available
3.2.f. No of beds for
Details not
substance use
available
disorders
3.2.g. No of beds for Details not
forensic psychiatry
available
3.2.h. Occupancy (%) 49
3.2.i. No of
1051
admissions during
previous year
3.2.j. No of
329
discharges during
previous year
3.2.k. Average
90 days
duration of inpatient

Psychiatric
hospitals
(Private)
SANKER N=1
80

General
Hospitals
N=

District
Hospitals
N=

NGOs
N=

Total

55
25
5
N.A.
30

N.A.
N.A.
364

364

3 Months

483

stay in days mean


3.2.l. Average
duration of inpatient
stay in days median
3.2.m. No of closed
wards
3.2.n. No of closed
ward beds
3.2.o. No of open
wards
3.2.p. No of open
ward beds
3.2.q. No of paid
wards
3.2.r.No of paid beds
3.2.s.No of
admissions through
courts
3.2.t. No of deaths in
the last year
3.2.u. No of suicides
in the last year

n.a.

3 Months

Nil

150

Nil

Nil

11

Nil

11

Nil

Nil

Nil
60

Nil
Nil

Nil

Nil

COMMENT: Psychiatric facilities exist in only 2 districts.


c. OUTPATIENT SERVICES

3.3.a. No of new OP
registrations in the
previous year
3.3.b. No of
emergency
attendees in the
previous year
3.3.c Total no of OP
follow-up in the
previous year

Govt.
Psychiatric
MIMHANS
hospitals
N=1

Private
Psychiatric
hospitals
SANKER
N=1

970

1731

469

N.A.

10569

20711

484

General
Hospitals

District
Hospitals

NGOs

N=2 (Jovai
Civil
Hospital,
Tura Civil
Hospital)
129 & 1092

N=

N=

Total

COMMENT: Both the psychiatric hospitals appear to be quite active. Two civil hospital
registrations are mentioned. Not clear if there are others. At the Tura Civil hospital, psychotic
disorders and alcohol and drug abuse disorders form a significant proportion of the
registrations.
11. REHABILITATION FOR PERSONS WITH MENTAL ILLNESS
a. Government residential rehabilitation/longstay facilities : No and description: 1
b. Government day care/outdoor rehabilitation facilities: No and description: 3
c. Government run half-way homes: No and description. If none, plans to establish
and details: N.A.
d. NGO participation in the half way homes: 1
e. Longstay rehabilitation facilities: No and description; NGO participation:
Children Home (Run by Govt. = 20, Run by NGO = 64)
12. MENTAL HEALTH CARE IN OTHER COMMUNITY FACILITIES
State Level, in the Govt Sector
5.1. No of shelter homes, observation homes, special homes
and childrens homes
5.2. No of counsellors trained in mental health in the above
institutions
5.3. No of protection homes for destitute women
5.4. No of counsellors trained in mental health in the above
institutions
5.5. No of old age homes
5.6. No of counsellors trained in mental health in the above
institutions
5.7. No of Central Jails and District Jails in the State
5.8. No of counsellors trained in mental health in the above
institutions
5.9.No of counsellors trained in mental health in the above
institutions
Helplines for Mental Health: NR

N
24
Nil
Nil
Nil
Nil
Nil
4 (District Jail)
Nil
Nil

COMMENT: There are a huge number of childrens homes run by NGOs. The reason for such a
large number needs to be ascertained. It is important that the counsellors in these homes are
trained by NGOs. Mental health services need to be provided in prisons and other
correctional settings.

485

13. MENTAL HEALTH HUMAN RESOURCES


Mental Health Care Professionals
Government Sector
medical
colleges/hospitals
6.1. No of
Psychiatrists
6.2. No of Clinical
Psychologists
6.3. No of Psychiatric
Social Workers
6.4. No of nurses
trained in mental
health
6.5. No of trained
counselors

Psychiatric
medical colleges

Private
Practice

Total

6
4
5
26

Nil

COMMENT: The mental health human resources are short in the State. Some attempt has been
made to train nurses in mental health. There is one medical college in Shillong- the North
Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, but it is not mentioned
whether it has a department of psychiatry.
7. MENTAL HEALTH HUMAN RESOURCE DEVELOPMENT
7.1. Degree/Diploma Courses : N.A.
In Entire state, Annual No of
Seats in
MD Psychiatry
DNB Psychiatry
Diploma in Psychiatry
PhD Clinical Psychology
MPhil Clinical Psychology
PhD Psychiatric Social Work
MPhil Psychiatric Social Work
PhD Psychiatric Nursing
MSc Psychiatric Nursing
BSc Psychiatric Nursing
Basic Diploma in Psychiatric
Nursing (DPN)

Institutions where the Programme is offered

SANKER, Mawlai, Meghalaya

COMMENT: No post graduate training in psychiatry and other mental health speciality except
for MPhil PSW is available in the State.
486

PGs posted for 15days or more = 105 (SANKER, MAWLAI, MEGHALAYA).


7.2. Other training in mental health
7.2.a. Details of Undergraduate MBBS training in psychiatry : Nil
Name of medical
college

No of hours of
theory

Duration of
psychiatry
posting during
UG

Duration of
psychiatry
posting during
internship

Qualifying
Examination
includes
competency
evaluation in
psychiatry

COMMENT: Not mentioned if there is UG training in the NEIGRH in Shillong.


7.2.b. Details of in-service training for Govt medical officers (No trained, duration) : NR
*If not trained, plans to train and timeline
7.2.c. Any other training courses in mental health offered by the state : Information is not
available.
* Describe the type of course/duration/participants
8. GOVERNANCE:
8.1. Nodal Authority and responsibilities : Nodal Officers with responsibilities for mental
health care in the state health services are
1. State Mental Health Authority

: Dr. B. Shohkhlet (State Mental Health Authority


Office, MIMHANS)

8.2. Presence of a State Mental Health Plan: NR


8.3. Enactment of State Mental Health Rules: NR
8.4. Oversight of policies and Programmes related to mental health: NR
8.5. Specific oversight of the DMHP programme: NR
8.6. Attempts towards integration of mental health care into general health care, NCD
management etc: NR
8.7. Examples of commitment to develop mental health services (high level involvement,
budgeting, networking: NR

487

8.8. Examples of inter-sectoral collaboration to improve mental health services (including PPP
intitiatives) : NR
8.9. Attempts towards mental health promotion : NR
COMMENT: Strengths and weaknesses
There has been some attempt to enhance mental health human resources, particularly mental
health nurses. However, facilities and human resources are quite short
9. FINANCING
9.1. Sources of financing of different categories : MIMHANS Plan (Amount in Rs. 19050000,
Non Plan Rs. 20450000)
9.2 Budget provision from State and Centre in INR (for different facilities if required): NR
9.3. Mental Health Expenditure as proportion of Total Health Expenditure in State: NR
(If available % spending on Health in the State may also be provided)
10. ANY OTHER SIGNIFICANT INFORMATION (e.g. litigation, insurance schemes for persons
with mental illness, pension and other assistance, job reservations): NR
11. INNOVATIONS: NR
12. OVERALL SUMMARY OF STATE LEVEL MENTAL HEALTH SERVICES : Services are mainly
provided through the MIMHANS and one private psychiatric facility. Only 2 districts have
DMHP and there is only 1 NGO working in mental health.
SECTION 2
2.1. PSYCHIATRIC INSTITUTIONS
The Meghalaya Institute was established in October 1998. It has 150 beds, 100 for men and
50 for women. There are limited recreational facilities. There are 3 psychiatrists and 3
medical officers and 23 nurses. There is no academic involvement. Mean duration of stay is
90 days. There are 13 patients with stay more than 5 years and 23 with duration of stay
between one to 5 years.The hospital has no linkages with institutions providing community
care. It has no laboratory facilities. It does not carry out outreach. All medications are
available. No ECT facilities are provided. Counseling and recreation are available. There are
no specialised services. Rights of patients are not displayed. There is no record of adverse
events and no grievance redressal mechanism. There have been 2 visits by the NHRC (Shri
Anil Pradhan on 27 May 2013 and 11 Feb2015. There was one visit by the SMHA on 25
488

October 2014. This hospital is not involved with the DMHP. The hospital received regular
grant-in-aid.
Domains
Infrastructure
Amenities and facilities
Financial arrangements
Diet
Investigations and treatment
Staff and training
Supportive services
Recreation/Occupational
therapy/Rehabilitation
Networking with other agencies

Status in 2008
Not mentioned

Developments since 2008


The comments of the IC
indicate a need for
improvement in many areas

SERVICES
i. Outpatient:
ii. Inpatient:
Diagnostic categories seen:
iii. DIAGNOSTICS AND THERAPEUTICS

Investigations: No
Therapeutic facilities: Medication; counseling
Improvements in rehabilitation:No significant improvement

iv. ENGAGEMENT:

Attempts to involve families of persons with mental illness:


Disability certification and number of certificates issued in the previous year: v.
ADMINISTRATIVE
Annual number of adverse events: Mechanisms for redressal of patient complaints: Nil

vi. COMMUNITY OUTREACH AND NETWORKING

Community Programmes: Nil


Networking with external agencies: Nil
Public mental health education: No

vii. TRAINING

Post-graduate training new Programmes, enhancement of seats and measures to


maintain/improve quality of training: No PG training
489

Any other training Programmes:

vii. RESEARCH:

Research (areas, funding agencies, findings), : nil

viii. ANY OTHER SALIENT CONTRIBUTIONS OF THE HOSPITAL/INSTITUTE:


ix. Any monitoring of hospital (internal or external)- details Visit by NHRC and SHRC
x. Special Rapporteurs observation
xi. Any other observations (including Inspection Committee Reports): The IC visited MIMHANS
on 20 July 2015. It suggested the setting up of a legal care support system for the patients in
consultation with the Meghalaya State Legal Services Authority. It recommended putting up
signages of the rights of patients. It emphasized the need of maintaining mental health
records properly. The IC noted that there was a space crunch in the hospital which needed to
be improved. Facilities for mentally ill prisoners also required to be improved. Community
services also needed to be improved with the help of NGOs and the legal service authority.
The bathrooms and kitchens also required regular maintenance. Welfare of destitute patients
needed greater attention.
xii. Summary and Recommendations from SECTION 2:
Areas of positive change

Areas of poor progress


Rehabilitation
Patient facilities
Community services and networking
SECTION 3

3. General Hospital Departments of Psychiatry and District Hospital Departments


The broad outline for this section:
3.1. Names of GH/DH and their location. JOWAI Civil Hospital, West Jainta Hills, Meghayala,
Tura Civil Hospital, West Garo Hills, Meghalaya.
(If there are many, this could be done in a tabular column).
The following areas may be mentioned as a summary of all the units; where needed , examples
could be made of a specific dept to highlight both positives and negatives.
3.2. Areas (distribution throughout the states): N.R.
3.3. Whether separate funding and adequacy: N.R.
490

3.4. Whether OP/IP and emergency services available : OPD services are available
3.5. Diagnostic categories in rank order that present in the outpatient : Broad ICD Categories
(Jowai Civil Hospital, Meghalaya)
1. Severe Mental Disorder

- 20

2. Common Mental Disorder

- 15

3. Alcohol and Drug Abuse

- 40

4. Mental Retardation

- 39

5. Geriatrics with Mental Health Problem - 05


6. Women with Mental Health Problem

- 10

(Broad ICD Categories, Tura Civil Hospital, Meghalaya)


1. Organic Psychiatric Disorder

- 30

2. Schizophrenia

- 271

3. Bipolar affective disorder

- 82

4. Other Psychotic Disorder

- 355

5. Other Anxiety Disorder

- 66

6. Depressive Disorder

- 67

7. Alcohol and Drug Abuse Disorder

- 152

8. Children with Psychiatric Disorder

- 69

3.6. Adequacy of OP facilities : In OPD Waiting Halls, Toilet, Separate Interview Rooms,
Drinking Water Facilities are adequate.
3.7. Inpatient occupancy, free and paying beds, average cost of inpatient stay per week; rank
order of diagnostic categories : Average cost of in patient stay = 60,000/Overall no. Of admissions in previous years the breakup is as given below
1. Organic Psychiatric Disorder

- 04

2. Schizophrenia

- 19

3. Bipolar affective disorder

- 03

4. Other Psychotic Disorder

- 17

5. OCD

- 01

6. Other Anxiety Disorder

- 03
491

7. Depression

- 04

8. Adjustment Disorder

- 04

9. Alcohol and Drug Abuse Disorder

- 27

3.8. Extent of family involvement : Extent of Family Involvement in Treatment Decisions :


Always involved.
3.9. Measures to protect rights including complaint redressal : N.A.
3.10. Any networking : N.A.
3.11. Staffing details and any shortages/vacancies : Qualified Psychiatrist = 1, General Medical
Officer = 1, Clinical Psychologist = 1, Psychiatric Social Worker = 5, General Nurse = 1
3.12. Psychotropic medication availability/free/cost : Medicines are available free of cost.
3.13. ECTs (Nos given across the facilities or average/No of direct ) : N.A.
3.14. Observations of extent to which counselling and psychotherapy are provided : Psycho
Education / Counselling Provided to all, Psychotherapy Provided to some.
3.15. Whether disability certification is available (if available numbers certified/year) : Yes, 52
per year.
3.16. Extent and nature of community involvement : No
3.17. Whether engagement with the DMHP and extent : Training of Medical Officers, Staff
Nurses, MPW, Asha Workers are being conducted.
3.18. Nature and partnership with NGOs for networking : Yes, Bethany Society, West Garo
Hills, Tura, Meghalaya
3.19. Presence of PG training- whether adequately distributed throughout the state : No
3.20. Nature of public mental health material prepared and distributed/ activities to educate :
Slide Power Point presentation, local language, T.V. Mental Health Talks.
3.21. Areas of research, sources of funding and major findings : N.A.
3.22. Whether monitored and by whom. What were the observations? : N.A.
3.23. Special Rapporteurs observations : N.A.
3.24. Inspection Committees observations : N.A.

492

3.25. SUMMARY AND RECOMMENDATIONS WITH RESPECT TO SECTION 3:


SECTION 4
4. NGOS WORKING IN MENTAL HEALTH:
4.1. A brief description of the NGO and its location : NR
4.2. Nature of work carried out by the NGO in the domains mentioned and details of each : NR.
4.3. Description of clientele seen by the NGO and number of persons who use the services in
the previous year : NR
4.4. Research details : NR
4.5. Details of any training carried out by the NGO : NR
4.6. Networking activities of the NGO : NR
4.7. Salient contributions of the NGO : NR
4.8. Special Rapporteurs observations : NR
4.9. Inspection Committees observations : NR
4.8. SUMMARY AND RECOMMENDATIONS FOR SECTION
There are very few NGOs in Meghalaya working in mental health.

SECTION 5
5.DISTRICT MENTAL HEALTH PROGRAMME
5.1. A brief description of the location of the DMHP, when it started, total population covered:
West Jaintia Hills. Total population covered = 927826. Total sub centres in PHC/PHU = 78
5.2. A summary of annual registrations old and new, treatment outcomes in terms of those on
regular treatment and those dropped out, with diagnostic categories if provided. Would be
useful to know what kind of clientele is serviced under the DMHP: Total No. Of Cases Registered
= 530, No. Of Patients on regular treatment = 266, No. Of Patients recovered = 109.

493

5.3. Frequency of home visits carried out by the HW/ANM; numbers covered and for what
diagnostic categories, no of admissions facilitated: Total No. Of Visits by the HW/ANM to
educate and motivate the patients = Depressive disorders = 6, Epilepsy 2, Mental
Retardation 2, Substance abuse 165. Admissions of patients in IPD = 120, in OPD = 152.
5.4. Kinds of essential drugs available, number dispensed, number of patients receiving
medication under the DMHP in a month:
5.5. Duration of untreated mental illness for different diagnostic categories if provided:
5.6. Monitoring of the DMHP by the concerned officer /impressions and trouble-shooting
(mention if there is a committee and its composition):
5.7. IEC activities of the DMHP: Yes, IEC activities are being conducted by district mental
health society, West Jaintia Hills, Jowai, Meghalaya
5.8. Training calendar of the DMHP (doctors, health workers, nurses, pharmacists, school
teachers/Anganwadi workers (whether any training conducted):
5.9. Activities to sensitize the gram panchayats
5.10. Special Rapporteurs report on the activities of the DMHP:
5.11. Inspection Committees observations:494

5.12. SUMMARY OBSERVATIONS OF DMHP AND RECOMMENDATIONS:


The DMHP is functioning in only 2 districts and need to be expanded.
SECTION 6
6. SUMMARY OF MENTAL HEALTH CARE INDICATORS IN MEGHALAYA (name of state)
6.1. Availability of mental health facilities
Total No of
facilities/beds
Mental health outpatient facilities
in the state
Day treatment facilities
Psychiatric beds in general
hospitals
Community residential facilities
Beds/places in community
residential facilities
Psychiatric hospitals
Beds in psychiatric hospitals
6.2. Access to Care

0.82

0.004
1.47

Rate per 100,000


population
Persons treated in mental
health outpatient facilities
Persons treated in mental
health day care facilities
General hospital admissions
Community residential facilities
Persons staying in community
residential facilities at the end
of the year
Admissions to mental hospitals

Rate per 100,000


population
0.33

Females %

14.52

6.3. Information Systems


Data on No of
persons/activities
collected and reported
YES/NO

Data on age and


gender are collected
and reported
YES/NO

Persons with mental


disorders treated in
495

Data on patients
diagnosis are collected
and reported
YES/NO

primary health care


Interventions delivered
in primary health care
for persons with
mental disorders
Persons treated in
mental health
outpatient facilities
Contacts in mental
health day treatment
facilities
Admissions in general
hospitals with
psychiatric beds
Admissions in mental
hospitals
Days spent in mental
hospitals
Admissions in
community residential
facilities

Yes

Yes

Yes

Yes

Yes

Yes

No

No

No

6.4. Human Resources at the State Level


Health professionals working
in the mental health sector
Rate per 100,000
Psychiatrists
Medical doctors not specialised
in psychiatry
Clinical Psychologists
Psychiatric Social Workers
Psychiatric Nurses
Occupational therapists
Other health workers

0.301

0.047
0.033
0.166

Training of health
professionals in educational
institutions
Rate per 100,000
0.04
2.9
0.01
0.003
0.016

6.5. INFORMAL HUMAN RESOURCES (Family and User Associations)


Present in the state
No of members
Participation in the
formulation/implementation of
policy/plan/legislation

User
Yes

Family
Yes

Not routinely

Not routinely

496

6.6. MEDICINES
Type of Medication

Expenditure at State level per year and per


100,000 population (inINR)

All psychotropic medication


Mood stabilisers
Antipsychotics
1Anxiolytics
Antidepressants
Anti-craving medication/ Substitution
treatments

SECTION 7
1. STATE MENTAL HEALTH REPORT CARD
SUMMARY OF SECTIONS 1-7.
Summary of areas where state has achieved good progress/little progress/no progress

The State has one psychiatric hospital, a private hospital and psychiatric services
through 2 civil hospitals are mentioned. The NGO presence in mental health is very
small. The human resources in all specialities is inadequate. All mental health services
are also inadequate. There needs to be a lot of improvement in MIMHANS.

MENTAL HEALTH REPORT CARD


Area

Mental Health
Services
(Secondary
and Tertiary)

Focus

Medical
College
Depts,
General
Hospitals,
Specialised
psychiatric
hospitals

Parameters

Adequacy of inpatient
beds
Functional Departments
Functional OP services

497

Rating

100- present, fully


satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent

Score
(out of
100)
25

Primary
Health Care
mental health
services

District
Mental
Health
Programme

% of functional DMHPs

Rehabilitation
services

At all levels

Vocational training, day


care, longstay facilities in
govt sector/ppp

Specialised
services

Whether existing, level of


functionality, present at
different levels of care

Human
Resources

Services for
substance
use
disorders,
old age,
mental
retardation,
child
psychiatry,
community
services,
forensic
services
(exclude
DMHP staff
here)

Adequacy of
psychiatrists/clinical
psychologists/psychiatric
social
workers/psychiatric
nurses or mental health
trained nurses
498

100 All districts


covered; fully
satisfactory
75 majority of
districts covered
and functioning
50 half the
districts covered
and functioning
25 one-fourth of
the districts
covered and
functioning
0- No districts
covered/although
DMHP exists, not
functioning
100- present, fully
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100- present, fully
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent

25

100 fully
adequate
75 moderately
adequate
50 somewhat
adequate
25- inadequate

25

12.5

0 grossly
inadequate
6

Financing for
mental health

State level

Existence of separate
budget for mental
health/mental health
activities

Governance
and Policy

State
Mental
Health
Authority
and other
authorities

Availability of
psychiatric
medication

At every
level

Separate Mental Health


Nodal Officer
Functioning Mental
Health Authority
Nodal persons for mental
health in SHRC/Legal
Services
Authority/Others
State Mental Health
Rules
State Mental Health
Programme
Range of medications
Regular supply and
dispensing
Standard procurement
arrangements

Affirmative
action for
persons with

At every
level

Disability assessment
Pension
Travel concession
499

10% -separate
budget, fully
adequate
75 separate
budget,
moderately
adequate
50 separate
budget,
somewhat
adequate
25 no separate
budget, but some
financial
resources
available annually
0 no separate
budget/marginal
financial resource
allocation
100 Existing,
fully functional
75- Existing,
mostly functional
50- Existing,
somewhat
functional
25- Partial
0 Non existent

25

100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100- Fully
satisfactory
75- Mostly

50

25

25

mental illness

10

Treatment
Gap

Health insurance
Special assistance
Educational benefits
Job reservation

Overall

Approximate number of
persons with mental
illness approximate
numbers totally receiving
treatment in the state

Total Score (out of 1000)


Average Score (%)
RECOMMENDATIONS

satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100 no
treatment gap
75 25%
treatment gap
50 -50%
treatment gap
25 -75%
treatment gap
0- 100%
treatment gap

12.5

225
22.5

The State needs to prepare a comprehensive action plan to expand mental health services and augment
human resources. The psychiatric hospital needs improvement. Rehabilitation facilities and affirmative
action for persons with mental illness is very critical. NGOs need to be encouraged to work in the area of
mental health. Training professionals working in the various homes (particularly childrens homes which
seem many in number) in mental health is important.

500

MIZORAM
SECTION 1. STATE LEVEL REPORT
2. GENERAL INFORMATION REGARDING THE STATE (Mizoram)
a. Area
21081 Sq.Km.
b. No of districts
c. Population, age distribution (as per census 2011)

8
1091014 (Census 2011)

d. Gender distribution
e.
f.
g.
h.

Males 5,52,339
Females 5,38,675
Life expectancy at birth male and female
N.A.
Per capita State Government expenditure on health
N.A.
Any health indicators for the state (life expectancy, etc) N.A.
Completeness/quality of information provided: Complete/Partially
Complete/Deficient

If deficient, areas of deficiency: Estimation of mentally ill, information on mental


health services.
3. MENTAL ILLNESS BURDEN/ INFORMATION REGARDING MENTAL ILLNESS
N
(prevalence)
2.1. Total number of
persons with mental
illness (all ICD categories)
2.2. Broad categories
2.2.a Severe mental
disorders (BPAD,
psychosis)
2.2.b Common mental
disorders
2.2.c Substance use
disorders (alcohol and
other drugs)
2.2.d Mental Retardation
2.3. No of Males with
mental health problems
2.4. No of females with

4619 (Data from


Kulikawn & Civil
Hospital,
Aizawal)
N.A.

NR
NR
501

N
(treatment
seeking)

Source of
information

mental health problems


2.5. No of children with
mental health problems
2.6. No of elderly with
mental health problems
2.7. No of homeless
mentally ill persons

NR
NR
NR

COMMENT: The number of patients seen in two facilities is provided as the number needing
care in Mizoram. There is no mention of the homeless persons with mental illness and annual
number of suicides in the state.
4. MENTAL HEALTH SERVICES IN THE STATE:
Organization of Services (description of number of psychiatric hospitals, medical college depts,
district hospitals)
N/N
3.1.a No of district general
hospitals with separate
department of psychiatry

3.1.b No of medical colleges with


department of psychiatry

Nil

3.1.c No of district general


hospitals providing psychiatric
care
3.1.d No of District Mental Health
Programmes in the State

3.1.e No of government
psychiatric hospitals
3.1.f No of private psychiatric
hospitals
3.1.g Total No of psychiatric
hospitals in the state

Nil

3.1.h No of NGOs providing


mental health care

10

No with dept/facility
Total No of units

Nil
Nil

502

% coverage

COMMENT: There are no psychiatric facilities. There are only 2 districts that offer mental
health services.
a. INPATIENT SERVICES
DESCRIPTION: No details are provided for the general hospitals.
Psychiatric hospitals (Govt) ()

3.2.a. Total Inpatient


sanctioned/available
beds
3.2.b No of male
beds
3.2.c. No of female
beds
3.2.d. No of beds for
children
3.2.e. No of beds for
elderly
3.2.f. No of beds for
substance use
disorders
3.2.g. No of beds for
forensic psychiatry
3.2.h. Occupancy (%)
3.2.i. No of
admissions during
previous year
3.2.j. No of
discharges during
previous year
3.2.k. Average
duration of inpatient
stay in days mean
3.2.l. Average
duration of inpatient
stay in days median
3.2.m. No of closed
wards
3.2.n. No of closed
ward beds
3.2.o. No of open
wards
3.2.p. No of open

Psychiatric
hospitals
(Private)
N=

General
Hospital
N=

District
Hospitals
N=

NGOs
N=

Total

503

ward beds
3.2.q. No of paid
wards
3.2.r.No of paid beds
3.2.s.No of
admissions through
courts
3.2.t. No of deaths in
the last year
3.2.u. No of suicides
in the last year

COMMENT: No information on outpatient care is provided.


b. OUTPATIENT SERVICES
Govt.
Psychiatric
hospitals
N=
3.3.a. No of new OP
registrations in the
previous year
3.3.b. No of
emergency attendees
in the previous year

NR

3.3.c Total no of OP
follow-up in the
previous year

NR

Private
Psychiatric
hospitals
N=

General
Hospitals
N=

District
Hospitals
N=

NGOs

Total

N=

NR

COMMENT: The affidavit is deficient in patient related information in any facility.


5. REHABILITATION FOR PERSONS WITH MENTAL ILLNESS
a. Government residential rehabilitation/longstay facilities : No and description: NR
b. Government day care/outdoor rehabilitation facilities: No and description: NR
c. Government run half-way homes: No and description. If none, plans to establish
and details NR
d. NGO participation in the half way homes: NR
e. Longstay rehabilitation facilities: No and description; NGO participation: Details
are not available

504

6. MENTAL HEALTH CARE IN OTHER COMMUNITY FACILITIES


State Level, in the Govt Sector
5.1. No of shelter homes, observation homes, special homes and
childrens homes
5.2. No of counsellors trained in mental health in the above
institutions
5.3. No of protection homes for destitute women
5.4. No of counsellors trained in mental health in the above
institutions
5.5. No of old age homes
5.6. No of counsellors trained in mental health in the above
institutions
5.7. No of Central Jails and District Jails in the State
5.8. No of counsellors trained in mental health in the above
institutions
5.9.No of counsellors trained in mental health in the above
institutions

Detailed information is
not available

Helplines for Mental Health:


COMMENT: Hardly any information has been recorded in the affidavit.
7. MENTAL HEALTH HUMAN RESOURCES
Mental Health Care Professionals

6.1. No of
Psychiatrists
6.2. No of Clinical
Psychologists
6.3. No of Psychiatric
Social Workers
6.4. No of nurses
trained in mental
health
6.5. No of trained
counselors
6.6. Record Keeper
6.7. Case Registry
Assistant

Government Sector
medical
colleges/hospitals

Psychiatric
Hospital

Private
Practice
(Private
Sector)

NR

NR

NR

NR
NR

NR
NR

NR
NR

505

Total

COMMENT: The number of mental health professionals in Mizoram is slightly better than in
the neighbouring states.
7. MENTAL HEALTH HUMAN RESOURCE DEVELOPMENT
7.1. Degree/Diploma Courses
In Entire state, Annual No of
Seats in
MD Psychiatry
DNB Psychiatry
Diploma in Psychiatry
PhD Clinical Psychology
MPhil Clinical Psychology
PhD Psychiatric Social Work
MPhil Psychiatric Social Work
PhD Psychiatric Nursing
MSc Psychiatric Nursing
BSc Psychiatric Nursing
Basic Diploma in Psychiatric
Nursing (DPN)

Institutions where the Programme is offered

COMMENT: No PG psychiatry courses.


7.2. Other training in mental health : Except for Psychiatry Social Work M.Phil & Ph.D. which
are available in Mizoram University, Other courses training are not available. The state dont
have Medical College.
7.2.a. Details of Undergraduate MBBS training in psychiatry
Name of medical
college

No of hours of
theory

Duration of
psychiatry
posting during
UG

Duration of
psychiatry
posting during
internship

Qualifying
Examination
includes
competency
evaluation in
psychiatry

COMMENT: No medical college.


7.2.b. Details of in-service training for Govt medical officers (No trained, duration) : On an
average 15 20 Medical Officers are trained in Mental Health and duration of training is 3
days.

506

7.2.c. Any other training courses in mental health offered by the state : The Govt. plans to
train the staff nurses in psychiatry nursing in near future. The duration of training is planned
to be 3 days.
8. GOVERNANCE:
8.1. Nodal Authority and responsibilities : 1. Medical Education - Dr. Robert L. Khawlhring
2. State Medical and Health Department - Dr. Robert L. Khawlhring
3. Social Welfare Department Pu Vanlalnghaka Zote
4. State Mental Health Authority Dr. C. Lalhrekima
8.2. Presence of a State Mental Health Plan: NR
8.3. Enactment of State Mental Health Rules: NR
8.4. Oversight of policies and Programmes related to mental health : NR
8.5. Specific oversight of the DMHP programme. NR
8.6. Attempts towards integration of mental health care into general health care, NCD
management etc. NR
8.7. Examples of commitment to develop mental health services (high level involvement,
budgeting, networking NR
8.8. Examples of inter-sectoral collaboration to improve mental health services (including PPP
intitiatives) NR
8.9. Attempts towards mental health promotion NR
COMMENT: Strengths and weaknesses
In the absence of adequate information, it is not possible to comment on strengths and
weaknesses.
9. FINANCING
9.1. Sources of financing of different categories NR
9.2 Budget provision from State and Centre in INR (for different facilities if required) NR
9.3. Mental Health Expenditure as proportion of Total Health Expenditure in State NR

507

(If available % spending on Health in the State may also be provided)


10. ANY OTHER SIGNIFICANT INFORMATION (e.g. litigation, insurance schemes for persons
with mental illness, pension and other assistance, job reservations) NR
11. INNOVATIONS
NR
12. OVERALL SUMMARY OF STATE LEVEL MENTAL HEALTH SERVICES :
Information on the extent and delivery of mental health services in Mizoram is inadequate.
SECTION 2
2.1. PSYCHIATRIC INSTITUTIONS ( Not relevant as none exist in the state)
SECTION 3
3. General Hospital Departments of Psychiatry and District Hospital Departments
The broad outline for this section:
3.1. Names of GH/DH and their location. : Two civil hospitals mentioned earlier, but
information is not detailed in this section.
(If there are many, this could be done in a tabular column).
The following areas may be mentioned as a summary of all the units; where needed , examples
could be made of a specific dept to highlight both positives and negatives.
3.2. Areas (distribution throughout the states):
3.3. Whether separate funding and adequacy: NR.
3.4. Whether OP/IP and emergency services available : NR
3.5. Diagnostic categories in rank order that present in the outpatient NR
3.6. Adequacy of OP facilities : NR
3.7. Inpatient occupancy, free and paying beds, average cost of inpatient stay per week; rank
order of diagnostic categories NR
3.8. Extent of family involvement : NR
3.9. Measures to protect rights including complaint redressal : 3.10. Any networking : NR
508

3.11. Staffing details and any shortages/vacancies : NR


3.12. Psychotropic medication availability/free/cost : NR
3.13. ECTs (Nos given across the facilities or average/No of direct ) NR
3.14. Observations of extent to which counselling and psychotherapy are provided : NR
3.15. Whether disability certification is available (if available numbers certified/year) : NR
3.16. Extent and nature of community involvement : NR
3.17. Whether engagement with the DMHP and extent : NR
3.18. Nature and partnership with NGOs for networking : NR
3.19. Presence of PG training- whether adequately distributed throughout the state : NR
3.20. Nature of public mental health material prepared and distributed/ activities to educate :
NR

3.21. Areas of research, sources of funding and major findings : NR


3.22. Whether monitored and by whom. What were the observations? : NR
3.23. Special Rapporteurs observations 3.24. Inspection Committees observations 3.25. SUMMARY AND RECOMMENDATIONS WITH RESPECT TO SECTION 3:
Lack of information
SECTION 4
4. NGOS WORKING IN MENTAL HEALTH:
4.1. A brief description of the NGO and its location : NGOs providing Mental Health Care
including de-addition Centres and Homes in state of Mizoram are as follows :1. Chhawndawlna In, Grace Society, Lunglei.
2. Damna In, Zuangtui
3. Rescue Centre, Kawmzawl Lunglei.
4. Rescue Centre, Sihphir
509

5. Social Guidance Agency, Aizawal


6. Synod Rescue Home, Durtlang
7. TNT Centre, Zuangtui
8. TNT Centre, Kolasib
9. TNT Centre, Harangchalkawl, Lunglei
10. Volunteers for Community Health (VOLCOMH)
4.2. Nature of work carried out by the NGO in the domains mentioned and details of each : NR
4.3. Description of clientele seen by the NGO and number of persons who use the services in
the previous year : Majority of persons suffering from the substance abuse problem and HIV
illnesses have used the services provided by NGOs.
4.4. Research details : NR
4.5. Details of any training carried out by the NGO : 1. Awareness programmes on HIV / AIDS,
relapse prevention. 2. Drug Awareness Programmes using the youth group. 3. Teaching /
Education to both parents, care givers and to clients. 4. Domestic Violence Education, 5.
Suicide Prevention, 6. Legal Awareness Programmes.
4.6. Networking activities of the NGO : Liaison with Department of Psychiatry, Civil Hospital,
Govt. of Mizoram for Networking activities of NGO, (VOLCOMH)
4.7. Salient contributions of the NGO : A. Sensitize and creating Awareness among family of
Mentally ill persons about Mental Health Legislation. B. Families of Mentally ill persons and
society are made aware about the Nodal Departments, Various benefits and facilities
provided by Government. C. Sensitize families of mentally ill persons and other NGOs how to
approach the above stated departments of seeking government support to improve their
lives.
4.8. Special Rapporteurs observations : 4.9. Inspection Committees observations : 4.8. SUMMARY AND RECOMMENDATIONS FOR SECTION 4
There appear to be a number of NGOs in the State which are active in the area of mental
health. However, it is unclear as to what are the various benefits and facilities provided by
the Government. Most of the NGOs work in the area of drug abuse.
510

SECTION 5
5. DISTRICT MENTAL HEALTH PROGRAMME
5.1. A brief description of the location of the DMHP, when it started, total population covered:
No. Of districts in which DMHP has been implemented :
a.
b.

No. Of Districts in which it has been fully implemented 2 (CHAMPHAI & SAIHA)
No. Of Districts in which it has been partially implemented 2 (AIZWAL &LUNGLEI)

5.2. A summary of annual registrations old and new, treatment outcomes in terms of those on
regular treatment and those dropped out, with diagnostic categories if provided. Would be
useful to know what kind of clientele is serviced under the DMHP: Total no. Of patients
registered in the month of November December, 2014 = 21 + 18 = 39.
Total no. Of patients on regular treatment in the month of November December, 2014 = 19
+ 15 = 34.
511

5.3. Frequency of home visits carried out by the HW/ANM; numbers covered and for what
diagnostic categories, no of admissions facilitated: Nil
5.4. Kinds of essential drugs available, number dispensed, number of patients receiving
medication under the DMHP in a month: Nil
5.5. Duration of untreated mental illness for different diagnostic categories if provided:
5.6. Monitoring of the DMHP by the concerned officer /impressions and trouble-shooting
(mention if there is a committee and its composition):
5.7. IEC activities of the DMHP: NR
5.8. Training calendar of the DMHP (doctors, health workers, nurses, pharmacists, school
teachers/Anganwadi workers (whether any training conducted):
5.9. Activities to sensitize the gram panchayats NR
5.10. Special Rapporteurs report on the activities of the DMHP: 5.11. Inspection Committees observations:- NR
5.12. SUMMARY OBSERVATIONS OF DMHP AND RECOMMENDATIONS: The state proposes to
implement DMHP in Lawngtla Serchhip Kolasib apart from the existing four districts in 2015
2016 and MAMAIT and AZAWAL East in the year 2016-2017 (For the purposes of Health
Services Aizawal District has been divided to East and West. Their by covering the whole state
of Mizoram by 2017.
SECTION 6
6. SUMMARY OF MENTAL HEALTH CARE INDICATORS IN Mizoram (name of state)
6.1. Availability of mental health facilities
Total No of
facilities/beds
Mental health outpatient facilities in
the state
Day treatment facilities
Psychiatric beds in general hospitals
Community residential facilities
Beds/places in community residential
facilities

512

Rate per 100,000 population

Psychiatric hospitals
Beds in psychiatric hospitals

6.2. Access to Care


Rate per 100,000
population

Females %

Persons treated in mental health


outpatient facilities
Persons treated in mental health day
care facilities
General hospital admissions
Community residential facilities
Persons staying in community
residential facilities at the end of the
year
Admissions to mental hospitals

6.3. Information Systems

Persons with mental


disorders treated in
primary health care
Interventions delivered
in primary health care
for persons with
mental disorders
Persons treated in
mental health
outpatient facilities
Contacts in mental
health day treatment
facilities
Admissions in general
hospitals with
psychiatric beds
Admissions in mental
hospitals

Data on No of
persons/activities
collected and reported
YES/NO

Data on age and


gender are collected
and reported
YES/NO

Data on patients
diagnosis are collected
and reported
YES/NO

Yes

Yes

Yes

513

Days spent in mental


hospitals
Admissions in
community residential
facilities

Yes

Yes

Yes

No

No

No

6.4. Human Resources at the State Level


Health professionals working
in the mental health sector
Rate per 100,000
Psychiatrists

Training of health professionals


in educational institutions
Rate per 100,000

0.37

Medical doctors not specialised


in psychiatry
Clinical Psychologists

0.37

Psychiatric Social Workers

0.37

Psychiatric Nurses

0.37

Occupational therapists
Other health workers

6.5. INFORMAL HUMAN RESOURCES (Family and User Associations)


User

Family

Present in the state


No of members
Participation in the
formulation/implementation of
policy/plan/legislation

6.6. MEDICINES
Type of Medication

Expenditure at State level per year and per


100,000 population (inINR)

All psychotropic medication


Mood stabilisers
Antipsychotics
Anxiolytics
Antidepressants
Anti-craving medication/ Substitution
treatments
514

SECTION 7
8. STATE MENTAL HEALTH REPORT CARD
SUMMARY OF SECTIONS 1-7.
Summary of areas where state has achieved good progress/little progress/no progress
The information provided by the State of Mizoram is very deficient and in order for a proper
self-assessment of its services, the State needs to fill up these gaps. TheNGO presence can be
capitalised.
MENTAL HEALTH REPORT CARD
Area

Focus

Parameters

Mental Health
Services
(Secondary
and Tertiary)

Medical
College
Depts,
General
Hospitals,
Specialised
psychiatric
hospitals

Adequacy of inpatient
beds
Functional Departments
Functional OP services

Primary
Health Care
mental health
services

District
Mental
Health
Programme

% of functional DMHPs

Rehabilitation

At all levels

Vocational training, day


515

Rating

Score (out
of 100)
100- present, fully 25
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100 All districts 50
covered; fully
satisfactory
75 majority of
districts covered
and functioning
50 half the
districts covered
and functioning
25 one-fourth
of the districts
covered and
functioning
0- No districts
covered/although
DMHP exists, not
functioning
100- present, fully 25

services

Specialised
services

Human
Resources

Financing for
mental health

care, longstay facilities in


govt sector/ppp

satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100- present, fully 25
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent

Services for
substance
use
disorders,
old age,
mental
retardation,
child
psychiatry,
community
services,
forensic
services
(exclude
DMHP staff
here)

Whether existing, level


of functionality, present
at different levels of care

Adequacy of
psychiatrists/clinical
psychologists/psychiatric
social
workers/psychiatric
nurses or mental health
trained nurses

100 fully
adequate
75 moderately
adequate
50 somewhat
adequate
25- inadequate
0 grossly
inadequate

25

State level

Existence of separate
budget for mental
health/mental health
activities

10% -separate
budget, fully
adequate
75 separate
budget,
moderately
adequate
50 separate
budget,
somewhat
adequate
25 no separate
budget, but some
financial
resources

25

516

Governance
and Policy

State
Mental
Health
Authority
and other
authorities

Separate Mental Health


Nodal Officer
Functioning Mental
Health Authority
Nodal persons for mental
health in SHRC/Legal
Services
Authority/Others
State Mental Health
Rules
State Mental Health
Programme
Range of medications
Regular supply and
dispensing
Standard procurement
arrangements

Availability of
psychiatric
medication

At every
level

Affirmative
action for
persons with
mental illness

At every
level

Disability assessment
Pension
Travel concession
Health insurance
Special assistance
Educational benefits
Job reservation

10

Treatment
Gap

Overall

Approximate number of
persons with mental
illness approximate
numbers totally receiving
treatment in the state

517

available annually
0 no separate
budget/marginal
financial resource
allocation
100 Existing,
fully functional
75- Existing,
mostly functional
50- Existing,
somewhat
functional
25- Partial
0 Non existent

100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100 no
treatment gap
75 25%
treatment gap
50 -50%
treatment gap
25 -75%
treatment gap
0- 100%
treatment gap

25

0 (no
information)

25 (no
information)

25

Total Score (out of 1000)


Average Score (%)

225
22.5

RECOMMENDATIONS:
The first step is for Mizoram to fill up the gaps in the information available on mental health
services in the State including preparing an estimate of the persons with mental illness
requiring help. For this a better understanding of the mental health care indicators is essential.
The State Mental Health Plan should look at human resource enhancement and the
development of specialized psychiatric care in the State.

518

NAGALAND
SECTION 1. STATE LEVEL REPORT
1. GENERAL INFORMATION REGARDING THE STATE (Nagaland)
a. Area
16579 Sq.Kms.
b. No of districts
11 (As per Census 2011)
c. Population, age distribution (as per census 2011) Total Population 1980602
d. Gender distribution
Male : Female ratio = 1000 : 931
e. Life expectancy at birth male and female
NR
f. Per capita State Government expenditure on health
NR.
g. Any health indicators for the state (life expectancy, etc) NR
Completeness/quality of information provided: Complete/Partially
Complete/Deficient
If deficient, areas of deficiency: Information on estimation of persons with mental
illness and care available at the secondary level is deficient.
2. MENTAL ILLNESS BURDEN/ INFORMATION REGARDING MENTAL ILLNESS
N
(prevalence)
2.1. Total number of persons with
mental illness (all ICD categories)
2.2. Broad categories
2.2.a Severe mental disorders
(BPAD, psychosis)
2.2.b Common mental disorders
2.2.c Substance use disorders
(alcohol and other drugs)
2.2.d Mental Retardation

N
(treatment
seeking)

NR

2.3. No of Males with mental


health problems
2.4. No of females with mental
health problems
2.5. No of children with mental
health problems
2.6. No of elderly with mental
health problems
519

Source of
information

2.7. No of homeless mentally ill


persons
COMMENT: No information has been provided on the number of persons in the State with
mental health morbidity requiring help.
3. MENTAL HEALTH SERVICES IN THE STATE:
a. Organization of Services (description of number of psychiatric hospitals, medical
college depts, district hospitals)
N/N
3.1.a No of district general
hospitals with separate
department of psychiatry

3.1.b No of medical colleges with


department of psychiatry

Nil

3.1.c No of district general


hospitals providing psychiatric
care
3.1.d No of District Mental Health
Programmes in the State

3.1.e No of government
psychiatric hospitals
3.1.f No of private psychiatric
hospitals
3.1.g Total No of psychiatric
hospitals in the state

3.1.h No of NGOs providing


mental health care

Nil

No with dept/facility
Total No of units

% coverage

Nil
1

COMMENT: There is one government psychiatric facility. Only one district has a DMHP
running. Psychiatric services are reported in only one general hospital. There are no NGOs
providing mental health care. There are no private psychiatric facilities.

520

b. INPATIENT SERVICES
DESCRIPTION:

3.2.a. Total Inpatient


sanctioned/available
beds
3.2.b No of male
beds
3.2.c. No of female
beds
3.2.d. No of beds for
children
3.2.e. No of beds for
elderly
3.2.f. No of beds for
substance use
disorders
3.2.g. No of beds for
forensic psychiatry
3.2.h. Occupancy (%)
3.2.i. No of
admissions during
previous year
3.2.j. No of
discharges during
previous year
3.2.k. Average
duration of inpatient
stay in days mean
3.2.l. Average
duration of inpatient
stay in days median
3.2.m. No of closed
wards
3.2.n. No of closed
ward beds
3.2.o. No of open
wards
3.2.p. No of open
ward beds
3.2.q. No of paid
wards
3.2.r.No of paid beds
3.2.s.No of

Psychiatric
hospitals
(Govt) N=1
25

Psychiatric
hospitals
(Private) N=

General
Hospitals
N=

District
Hospitals
N=

NGOs
N=0

Total

25

15
10
Details not
available
Details not
available
Details not
available
Details not
available
56
N.A.

N.A.

23 days

19 days

Nil
Nil
2
25
2
2
3
521

admissions through
courts
3.2.t. No of deaths in
the last year
3.2.u. No of suicides
in the last year

Nil
Nil

COMMENT: According to the affidavit, there are only 25 inpatient beds for the treatment of
mental disorders in the entire State.

c. OUTPATIENT SERVICES

3.3.a. No of new OP
registrations in the
previous year
3.3.b. No of
emergency
attendees in the
previous year
3.3.c Total no of OP
follow-up in the
previous year

Govt.
Psychiatric
hospitals
N=
294

Private
Psychiatric
hospitals
N=

General
Hospitals

District
Hospitals

NGOs

N=

N=

N=

Total

294

92

718

COMMENT: Details of outpatient services outside of the psychiatric hospital have not been
provided.
4. REHABILITATION FOR PERSONS WITH MENTAL ILLNESS
a. Government residential rehabilitation/longstay facilities : No and description: Nil
b. Government day care/outdoor rehabilitation facilities: No and description: Nil
c. Government run half-way homes: No and description. If none, plans to establish
and details: Nil
d. NGO participation in the half way homes: Nil
e. Longstay rehabilitation facilities: No and description; NGO participation: Nil

522

5. MENTAL HEALTH CARE IN OTHER COMMUNITY FACILITIES

State Level, in the Govt Sector


5.1. No of shelter homes, observation homes, special homes and
childrens homes
5.2. No of counsellors trained in mental health in the above
institutions
5.3. No of protection homes for destitute women
5.4. No of counsellors trained in mental health in the above
institutions
5.5. No of old age homes
5.6. No of counsellors trained in mental health in the above
institutions
5.7. No of Central Jails and District Jails in the State
5.8. No of counsellors trained in mental health in the above
institutions
5.9.No of counsellors trained in mental health in the above
institutions

N
NR
NR
NR
NR
NR
NR
4
Nil
Nil

Helplines for Mental Health: (Nature of helpline, who runs it, for whom, any information on
its utilization) Nil
COMMENT: Details of community facilities have not been provided. There are no trained
counsellors providing mental health care in the prisons.
6. MENTAL HEALTH HUMAN RESOURCES
Mental Health Care Professionals
Government Sector
medical
colleges/hospitals
6.1. No of
Psychiatrists
6.2. No of Clinical
Psychologists
6.3. No of Psychiatric
Social Workers
6.4. No of nurses
trained in mental
health
6.5. No of trained
counselors

Psychiatric
medical colleges

6
1 (On Contract)
Nil
4

N.A.

523

Private
Practice

Total

COMMENT: There are very few mental health professionals.


7. MENTAL HEALTH HUMAN RESOURCE DEVELOPMENT
7.1. Degree/Diploma Courses : N.A.
In Entire state, Annual No of
Seats in
MD Psychiatry
DNB Psychiatry
Diploma in Psychiatry
PhD Clinical Psychology
MPhil Clinical Psychology
PhD Psychiatric Social Work
MPhil Psychiatric Social Work
PhD Psychiatric Nursing
MSc Psychiatric Nursing
BSc Psychiatric Nursing
Basic Diploma in Psychiatric
Nursing (DPN)

Institutions where the Programme is offered

COMMENT: There is no medical college in the State.


7.2. Other training in mental health
7.2.a. Details of Undergraduate MBBS training in psychiatry
Name of medical
college

No of hours of
theory

Duration of
psychiatry
posting during
UG

Duration of
psychiatry
posting during
internship

Qualifying
Examination
includes
competency
evaluation in
psychiatry

COMMENT: No. Of U.G./Interns posted for 15 days or more in psychiatry department = 11.
Since there is no medical college listed on the MCI website, it is unclear where the
UGs/interns are from.
7.2.b. Details of in-service training for Govt medical officers (No trained, duration) : NR
*If not trained, plans to train and timeline
7.2.c. Any other training courses in mental health offered by the state : Information is not
available. NR
* Describe the type of course/duration/participants
524

8. GOVERNANCE:
8.1. Nodal Authority and responsibilities : Nodal Officers with responsibilities for mental
health care in the state health services are:
1. State Medical & Health Department

: Dr. Leamnyei (Ph. : 8974633971)

8.2. Presence of a State Mental Health Plan: NR


8.3. Enactment of State Mental Health Rules: NR
8.4. Oversight of policies and Programmes related to mental health: NR
8.5. Specific oversight of the DMHP programme: NR
8.6. Attempts towards integration of mental health care into general health care, NCD
management etc. NR
8.7. Examples of commitment to develop mental health services (high level involvement,
budgeting, networking NR
8.8. Examples of inter-sectoral collaboration to improve mental health services (including PPP
intitiatives) NR
8.9. Attempts towards mental health promotion: NR
COMMENT: Strengths and weaknesses
A significant part of mental health services appear to be carried out by the SMHI, although its
inpatient bed capacity is small, occupancy rather low and the number of patients seen is rather
small.
9. FINANCING
9.1. Sources of financing of different categories : State Mental Health Institute Kohima : Non
plan funds [(Amount in Rs. 1,58,54,100.00 (Salary Head)]
9.2 Budget provision from State and Centre in INR (for different facilities if required)
9.3. Mental Health Expenditure as proportion of Total Health Expenditure in State
(If available % spending on Health in the State may also be provided)
10. ANY OTHER SIGNIFICANT INFORMATION (e.g. litigation, insurance schemes for persons
with mental illness, pension and other assistance, job reservations): NR
525

11. INNOVATIONS
NR

12. OVERALL SUMMARY OF STATE LEVEL MENTAL HEALTH SERVICES :


Limited psychiatric services are provided through the SMHI Kohima and one district mental
health programme. Most mental health human resource specialties have limited
professionals. There is no medical college. There are no specialised services.
SECTION 2
2.1. PSYCHIATRIC INSTITUTIONS : Mental Hospital, Kohima
Name and a para on status in 2008 (refer to NHRC book Mental Health Care and Human
Rights)
Domains
Infrastructure

Status in 2008
A new OPD complex as well
as one medical officers
quarter is under
construction through grant
in aid from Govt. of India.

Amenities and facilities

Neat and well maintained.


No rehabilitation facilities
No special services
No MRD
No ECT
Through Director Health and
Family Welfare

Financial arrangements
Diet
Investigations and treatment

Staff and training

Developments since 2008


Sufficient open space as
well as covered areas.

There are 2 psychiatrist and


1 medical officer. The
institute request for
creation of new posts like
Clinical Psychologist,
Occupational Therapist, and
grade four staff.

Supportive services
Recreation/Occupational

Only psychological testing


Antipsychotics are
irregularly available and the
reset not available
1 Clinical Psychologist, 4
medical officers

Nil
Nil
526

therapy/Rehabilitation
Networking with other
agencies
SERVICES

Nil

i. Outpatient: 294 new registrations (IC report)


ii. Inpatient: 123
Diagnostic categories seen:
iii. DIAGNOSTICS AND THERAPEUTICS

Investigations: Only psychological testing


Therapeutic facilities: Improvements in rehabilitation:Nil

iv. ENGAGEMENT:

Attempts to involve families of persons with mental illness: NR


Disability certification and number of certificates issued in the previous year: v.
ADMINISTRATIVE NR
Annual number of adverse events: Mechanisms for redressal of patient complaints: NR

vi. COMMUNITY OUTREACH AND NETWORKING

Community Programmes: NR
Networking with external agencies: NR
Public mental health education: NR

vii. TRAINING

Post-graduate training new Programmes, enhancement of seats and measures to


maintain/improve quality of training: N.A.

Any other training Programmes: GNM, B.Sc. Nursing Students two weeks training for each
student (Theory + Case Demonstration) Mental health training is provided for Post Basic BSc
Nursing students and General Nursing Students from the Christian Institute of Health Sciences
and Research. Nursing trainees are also posted from DH Dimapur, Naga Hospital Authority
Kohima and IMDH Mokochung.MSc, MA and BA Psychology students, MSW students,
Diploma in counselling students are also posted to the SMHI Kohmia. The MH is also involved
in training of DMHP staff.

527

vii. RESEARCH: NR

Research (areas, funding agencies, findings), :

viii. ANY OTHER SALIENT CONTRIBUTIONS OF THE HOSPITAL/INSTITUTE:


ix. Any monitoring of hospital (internal or external)- details
x. Special Rapporteurs observation xi. Any other observations (including Inspection Committee Reports): The IC visited the hospital
on 20 July 2015. It observed that the space was adequate and well maintained and that
patients were generally satisfied. Most of the longstay patients (11 out of 13 were women).
In this hospital, it was noted that the female inpatient number was relatively larger when
compared to the total number (in comparison with other hospitals). Absence of anaesthetist
has prevented ECT administration although other facilities are available. Drugs are not
regularly available. No legal services are available. The SLSA Nagaland member-secretary was
appraised and asked to make para-legal volunteers avaialable.
xii. Summary and Recommendations from SECTION 2:
Areas of positive change
Areas are clean and well maintained

Areas of poor progress


No specialised services
No post graduate academic activity
Inadequate multidisiciplinary staff
Inadequate rehabilitation facilities
SECTION 3

3. General Hospital Departments of Psychiatry and District Hospital Departments


The broad outline for this section:
3.1. Names of GH/DH and their location. Non Functional
(If there are many, this could be done in a tabular column).
The following areas may be mentioned as a summary of all the units; where needed , examples
could be made of a specific dept to highlight both positives and negatives.
3.2. Areas (distribution throughout the states): NR
3.3. Whether separate funding and adequacy: NR

528

3.4. Whether OP/IP and emergency services available


3.5. Diagnostic categories in rank order that present in the outpatient : NR
3.6. Adequacy of OP facilities : NR
3.7. Inpatient occupancy, free and paying beds, average cost of inpatient stay per week; rank
order of diagnostic categories : NR
3.8. Extent of family involvement : NR
3.9. Measures to protect rights including complaint redressal : NR
3.10. Any networking : NR
3.11. Staffing details and any shortages/vacancies : NR
3.12. Psychotropic medication availability/free/cost : NR
3.13. ECTs (Nos given across the facilities or average/No of direct ) NR
3.14. Observations of extent to which counselling and psychotherapy are provided : NR
3.15. Whether disability certification is available (if available numbers certified/year) : NR
3.16. Extent and nature of community involvement : NR
3.17. Whether engagement with the DMHP and extent : NR
3.18. Nature and partnership with NGOs for networking : NR
3.19. Presence of PG training- whether adequately distributed throughout the state : NR
3.20. Nature of public mental health material prepared and distributed/ activities to educate :
NR
3.21. Areas of research, sources of funding and major findings : NR
3.22. Whether monitored and by whom. What were the observations? : NR
3.23. Special Rapporteurs observations : NR
3.24. Inspection Committees observations : NR
3.25. SUMMARY AND RECOMMENDATIONS WITH RESPECT TO SECTION 3: Very little
information has been provided regarding the mental health services in secondary care.

529

SECTION 4
4. NGOS WORKING IN MENTAL HEALTH: There appear to be no NGOs working in the area of
mental health.
4.1. A brief description of the NGO and its location : N.A.
4.2. Nature of work carried out by the NGO in the domains mentioned and details of each : N.A.
4.3. Description of clientele seen by the NGO and number of persons who use the services in
the previous year : N.A.
4.4. Research details : N.A.
4.5. Details of any training carried out by the NGO : N.A.
4.6. Networking activities of the NGO : N.A.
4.7. Salient contributions of the NGO : N.A.
4.8. Special Rapporteurs observations : N.A.
4.9. Inspection Committees observations : N.A.
4.8. SUMMARY AND RECOMMENDATIONS FOR SECTION
None available.
SECTION 5
5. DISTRICT MENTAL HEALTH PROGRAMME

5.1. A brief description of the location of the DMHP, when it started, total population covered:
One DMHP is listed, but no further information has been provided.
5.2. A summary of annual registrations old and new, treatment outcomes in terms of those on
regular treatment and those dropped out, with diagnostic categories if provided.
5.3. Frequency of home visits carried out by the HW/ANM; numbers covered and for what
diagnostic categories, no of admissions facilitated: NR

530

5.4. Kinds of essential drugs available, number dispensed, number of patients receiving
medication under the DMHP in a month: NR
5.5. Duration of untreated mental illness for different diagnostic categories if provided: NR
5.6. Monitoring of the DMHP by the concerned officer /impressions and trouble-shooting
(mention if there is a committee and its composition): NR
5.7. IEC activities of the DMHP: NR
5.8. Training calendar of the DMHP (doctors, health workers, nurses, pharmacists, school
teachers/Anganwadi workers (whether any training conducted): NR
5.9. Activities to sensitize the gram panchayats NR
5.10. Special Rapporteurs report on the activities of the DMHP: -

531

5.11. Inspection Committees observations 5.12. SUMMARY OBSERVATIONS OF DMHP AND RECOMMENDATIONS:
No information available.
SECTION 6
6. SUMMARY OF MENTAL HEALTH CARE INDICATORS IN NAGALAND
6.1. Availability of mental health facilities
Total No of
facilities/beds
Mental health outpatient
facilities in the state
Day treatment facilities
Psychiatric beds in general
hospitals
Community residential facilities
Beds/places in community
residential facilities
Psychiatric hospitals
Beds in psychiatric hospitals

Rate per 100,000


population
0.329

0.823

0.004
1.469

6.2. Access to Care


Rate per 100,000
population
Persons treated in mental
health outpatient facilities
Persons treated in mental
health day care facilities
General hospital admissions
Community residential facilities
Persons staying in community
residential facilities at the end
of the year
Admissions to mental hospitals

14.52

532

Females %

6.3. Information Systems

Persons with mental


disorders treated in
primary health care
Interventions delivered
in primary health care
for persons with
mental disorders
Persons treated in
mental health
outpatient facilities
Contacts in mental
health day treatment
facilities
Admissions in general
hospitals with
psychiatric beds
Admissions in mental
hospitals
Days spent in mental
hospitals
Admissions in
community residential
facilities

Data on No of
persons/activities
collected and reported
YES/NO

Data on age and


gender are collected
and reported
YES/NO

Data on patients
diagnosis are collected
and reported
YES/NO

Yes

Yes

Yes

Yes

Yes

Yes

No

No

No

6.4. Human Resources at the State Level


Health professionals working
in the mental health sector
Rate per 100,000
Psychiatrists
Medical doctors not specialised
in psychiatry
Clinical Psychologists
Psychiatric Social Workers
Psychiatric Nurses
Occupational therapists
Other health workers

0.301

0.047
0.033
0.166

Training of health
professionals in educational
institutions
Rate per 100,000
0.0364
2.893
0.010
0.003
0.016

533

6.5. INFORMAL HUMAN RESOURCES (Family and User Associations)


User

Family

Present in the state


No of members
Participation in the
formulation/implementation of
policy/plan/legislation

6.6. MEDICINES
Type of Medication

Expenditure at State level per year and per


100,000 population (inINR)

All psychotropic medication


Mood stabilisers
Antipsychotics
Anxiolytics
Antidepressants
Anti-craving medication/ Substitution
treatments

SECTION 7
7. STATE MENTAL HEALTH REPORT CARD
SUMMARY OF SECTIONS 1-7.
Summary of areas where state has achieved good progress/little progress/no progress
Psychiatric services appear to be poorly developed outside the state mental health Institute.
The hilly terrain poses challenges as in other parts of NE India. No training, no specialised
services are available. The DMHP services are available in only one of the 11 districts but no
further details are provided. No legal aid is available to patients. Many women with mental
illness in the hospital are destitute.

534

MENTAL HEALTH REPORT CARD


Area

Focus

Parameters

Mental
Health
Services
(Secondary
and Tertiary)

Medical
College
Depts,
General
Hospitals,
Specialised
psychiatric
hospitals

Adequacy of inpatient
beds
Functional Departments
Functional OP services

Primary
Health Care
mental health
services

District
% of functional DMHPs
Mental
Health
Programme

Rehabilitation At all levels


services

Vocational training, day


care, longstay facilities
in govt sector/ppp

535

Rating

Score
(out of
100)
12.5

100- present,
fully satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100 All districts 12.5
covered; fully
satisfactory
75 majority of
districts covered
and functioning
50 half the
districts covered
and functioning
25 one-fourth
of the districts
covered and
functioning
0- No districts
covered/although
DMHP exists, not
functioning
100- present,
12.5
fully satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,

unsatisfactory
0- absent
Services for Whether existing, level
100- present,
substance
of functionality, present fully satisfactory
use
at different levels of care 75- present,
disorders,
reasonably
old age,
satisfactory
mental
50 present,
retardation,
somewhat
child
satisfactory
psychiatry,
25 present,
community
unsatisfactory
services,
0- absent
forensic
services
(exclude
Adequacy of
100 fully
DMHP staff psychiatrists/clinical
adequate
here)
psychologists/psychiatric 75 moderately
social
adequate
workers/psychiatric
50 somewhat
nurses or mental health adequate
trained nurses
25- inadequate
0 grossly
inadequate

Specialised
services

Human
Resources

Financing for State level


mental health

Existence of separate
budget for mental
health/mental health
activities

536

12.5

25

10% -separate
25
budget, fully
adequate
75 separate
budget,
moderately
adequate
50 separate
budget,
somewhat
adequate
25 no separate
budget, but some
financial
resources
available annually
0 no separate
budget/marginal
financial resource

Governance
and Policy

State
Mental
Health
Authority
and other
authorities

Separate Mental Health


Nodal Officer
Functioning Mental
Health Authority
Nodal persons for
mental health in
SHRC/Legal Services
Authority/Others
State Mental Health
Rules
State Mental Health
Programme
Range of medications
Regular supply and
dispensing
Standard procurement
arrangements

Availability of
psychiatric
medication

At every
level

Affirmative
action for
persons with
mental illness

At every
level

Disability assessment
Pension
Travel concession
Health insurance
Special assistance
Educational benefits
Job reservation

10

Treatment
Gap

Overall

Approximate number of
persons with mental
illness approximate
numbers totally
receiving treatment in
the state

537

allocation
100 Existing,
fully functional
75- Existing,
mostly functional
50- Existing,
somewhat
functional
25- Partial
0 Non existent

100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available
at any level
100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available
at any level
100 no
treatment gap
75 25%
treatment gap
50 -50%
treatment gap
25 -75%
treatment gap
0- 100%
treatment gap

25

12.5

12.5

12.5

Total Score (out of 1000)


Average Score (%)

162.5
16.25

RECOMMENDATIONS: The Health Intelligence Bureau needs to be involved in providing


estimates of persons with mental illness. State needs to draw up a comprehensive mental
health service plan. It has submitted a plan for upgradation of the state run Mental Hospital
to the Government of India. However, given the geographical challenges, the plan will have
to be comprehensive and look at mechanisms of providing care nearer to the people.

538

ODISHA
SECTION 1. STATE LEVEL REPORT
1. GENERAL INFORMATION REGARDING THE STATE
a. Area: 155,707 sq kms
b. No of districts: 30
c. Population, age distribution (as per census 2011): 41974218
d. Gender distribution: Males: 21221136; Females: 20762082
e. Life expectancy at birtH: 59.6 YEARS, well below the national average.
f. Per capita State Government expenditure on health: Not provided
g. Any health indicators for the state
Indicator

Orissa

India

Infant Mortality Rate ( SRS 2013)

51

40

Maternal Mortality Rate (SRS 2010-12)

235

178

Total Fertility Rate (SRS 2012)

2.1

2.4

Sex Ratio (Census 2011)

978

940

The Extent of Mental Health Problems in Odisha State: Source of information from
mental health institute and DMHP running in 8 districts: 55,000
h. Completeness/quality of information provided: Deficient
If deficient, areas of deficiency: NO information related to DMHPs. All forms related to
DMHPs are left blank. No details of patients seen in medical colleges, general and district
hospitals

539

MENTAL ILLNESS BURDEN/ INFORMATION REGARDING MENTAL ILLNESS:


NOT PROVIDED IN THE AFFIDAVIT
However, going by the available national epidemiological figures, the numbers are as
follows
Total persons with psychiatric disorders: 28,00,000
Total persons with severe mental disorders: 2,00,000
Total persons with common mental disorders: 23,26,000
Total persons with substance dependence: 4,00,000
2. MENTAL HEALTH SERVICES IN THE STATE:
Organization of Services
Odisha, an eastern state of India has only one psychiatric institute, named the Mental Health
Institute in SCB Medical College, Cuttack. There is no information on GHPUs at all in the
affidavit. Only few district hospitals have psychiatric facilities. the number of beds is only 160.
out of which, 120 is in the mental health institute and the remaining 40 are in the district
hospitals. There are 9 districts with Depts of Psychiatry and 13 which provide psychiatric
services.
a. INPATIENT SERVICES
DESCRIPTION:The following table gives details of the in-patient services of the
psychiatric institutes as well as the GHPUs of Odisha.

Psychiatric
hospitals
(Govt) N=1
3.2.a. Total Inpatient
sanctioned/available
beds
3.2.b No of male
beds
3.2.c. No of female
beds
3.2.d. No of beds for
children
3.2.e. No of beds for
elderly
3.2.f. No of beds for

Psychiatric
hospitals
(Private) N=

120

General
Hospitals
N=

District
Hospitals
N=13
40

540

NGOs
N=

Total

160

substance use
disorders
3.2.g. No of beds for
forensic psychiatry
3.2.h. Occupancy (%)
3.2.i. No of
admissions during
previous year
3.2.j. No of
discharges during
previous year
3.2.k. Average
duration of inpatient
stay in days mean
3.2.l. Average
duration of inpatient
stay in days median
3.2.m. No of closed
wards

Not able to calculate as details have not been given in the affidavit
100%
50%

2 weeks

2 weeks

3.2.n. No of closed
ward beds
3.2.o. No of open
wards
3.2.p. No of open
ward beds
3.2.q. No of paid
wards
3.2.r.No of paid beds
3.2.s.No of
admissions through
courts
3.2.t. No of deaths in
the last year

NR

Data not
available

Data not
available

NR

Data not
available

Data not
available

NR

Data not
available

Data not
available

3.2.u. No of suicides
in the last year

Complete
data not
available

Complete
data not
available

Complete
data not
available

Treatment
Some important psychotropics are available free of cost in district hospitals and the
mental health institute. Beyond this, no information is available
Records: NR

541

Administrative Issues: not available


b. OUTPATIENT SERVICES*

3.3.a. No of new
OP registrations in
the previous year
3.3.b. No of
emergency
attendees in the
previous year
3.3.c Total no of OP
follow-up in the
previous year

Govt.
Psychiatric
hospitals
N=2
11000

Private
Psychiatric
hospitals
N=

General
Hospitals

District
Hospitals

NGOs

N=

N=
6000

N=

Total

17000

COMMENT: Incomplete information. There are 8 medical colleges in Odisha. It is not


mentioned how many have departments of psychiatry and the outpatient and inpatient load
of these facilities.
3. REHABILITATION FOR PERSONS WITH MENTAL ILLNESS
a. Government residential rehabilitation/longstay facilities : NONE
b. Government day care/outdoor rehabilitation facilities: No and description: NONE
c. Government run half-way homes: No and description. If none, plans to establish
and details: NONE
d. NGO participation in the half way homes: NOT AVAILABLE
e. Longstay rehabilitation facilities: No and description; NGO participation: 6 of
them are being run with the help of NGOs
4. MENTAL HEALTH CARE IN OTHER COMMUNITY FACILITIES
State Level, in the Govt Sector

5.1. No of shelter homes, observation homes,


special homes and childrens homes
5.2. No of counsellors trained in mental health in
the above institutions
5.3. No of protection homes for destitute women
5.4. No of counsellors trained in mental health in

542

0
6 (run by NGOs)

the above institutions


5.5. No of old age homes
5.6. No of counsellors trained in mental health in
the above institutions
5.7. No of Central Jails and District Jails in the State
5.8. No of counsellors trained in mental health in
the above institutions
5.9.No of counsellors trained in mental health in
the above institutions

0
0
5 central jails and
2 district jails
0
0

Helplines for Mental Health: (Nature of helpline, who runs it, for whom, any information on
its utilization): NIL
COMMENT: It is surprising that community facilities are listed as not existing. There are
no trained counsellors providing mental health care in jails.
5. MENTAL HEALTH HUMAN RESOURCES
Mental Health Care Professionals

6.1. No of
Psychiatrists
6.2. No of Clinical
Psychologists
6.3. No of
Psychiatric Social
Workers
6.4. No of nurses
trained in mental
health
6.5. No of trained
counselors

Government
Psychiatric
Sector medical
medical
colleges/hospitals colleges
25

Private
Practice

Total

NA

8
1

COMMENT: Only one psychiatric social worker is listed for the entire state. All the other
mental health resources are also deficient.

543

7. MENTAL HEALTH HUMAN RESOURCE DEVELOPMENT


7.1. Degree/Diploma Courses
P G Centres in Psychiatry
MD Seat in Psychiatry in Govt. Medical Colleges
5
DPM Seats in Psychiatry in Govt. Medical Colleges
0
MD Seat in Psychiatry in Pvt. Medical Colleges
NA
DPM Seat in Psychiatry in Pvt. Medical Colleges
NA
DNB (Psychiatry)
0

COMMENT: There are only 5 PG seats available in the entire State.


7.2. Other training in mental health
400 staff of DMHP were trained in the previous year. No other information is available.
7.2.a. Details of Undergraduate MBBS training in psychiatry
Name of medical
college

No of hours of
theory

Duration of
psychiatry
posting during
UG

Duration of
psychiatry
posting during
internship

All medical
colleges
COMMENT:

25 hours

15 days

15 days

Qualifying
Examination
includes
competency
evaluation in
psychiatry

This information has been asked for and will be provided


The details of the medical colleges have not been provided.
7.2.b. Details of in-service training for Govt medical officers (No trained, duration)
NO DETAILS available
*If not trained, plans to train and timeline
7.2.c. Any other training courses in mental health offered by the state
NR

544

8. GOVERNANCE:
8.1. Nodal Authority and responsibilities : Additional Director, Mental Health, Directorate of
Health Services
8.2. Presence of a State Mental Health Plan: NO
8.3. Enactment of State Mental Health Rules: NO
8.4. Oversight of policies and Programmes related to mental health: NR
8.5. Specific oversight of the DMHP programme. Brief description of districts where fully
implemented, where partially implemented and details of reasons for incomplete
implementation. Also mention here a brief summary of availability of medicines and
psychosocial care for patients with mental illness.
DMHP has been initiated fully in 12 districts. However, NO information about DMHP is
available.
8.6. Attempts towards integration of mental health care into general health care, NCD
management etc.
NO
8.7. Examples of commitment to develop mental health services (high level involvement,
budgeting, networking
NR
8.8. Examples of inter-sectoral collaboration to improve mental health services (including PPP
intitiatives)
NONE
8.9. Attempts towards mental health promotion (e.g. SMHA Karnataka had organised regular
phone in Programmes related to mental health and mental disorders. Public responses were
evaluated and were very encouraging)
NONE
COMMENT: Strengths and weaknesses (see later)
9. FINANCING
9.1. Sources of financing of different categories NR
545

9.2 Budget provision from State and Centre in INR (for different facilities if required) NR
9.3. Mental Health Expenditure as proportion of Total Health Expenditure in State NR
(If available % spending on Health in the State may also be provided)
10. ANY OTHER SIGNIFICANT INFORMATION (e.g. litigation, insurance schemes for persons
with mental illness, pension and other assistance, job reservations) NR
11. INNOVATIONS
NONE
12. OVERALL SUMMARY OF STATE LEVEL MENTAL HEALTH SERVICES

Odisha is quite deficient with regard to the mental health services. The facilities are
quite rudimentary.
SECTION 2

2.1. PSYCHIATRIC INSTITUTIONS


The Mental Health Institute (SCB Cuttuck) has initiated various steps to improve the
infrastructure and the manpower. However, the report also mentions that the process is just
initiated. None of them have yet become functional.
Domains
Infrastructure

Status in 2008

Developments since 2008


Childrens ward has been
established. There is a 15
bed de-addiction centre and
5 bed rehab. There are plans
for a geriatric ward,
adolescent ward, forensic
ward and a liaison
psychiatry ward.
Plans for further
improvement
Grant in aid from state. COE
in 2014-15

Amenities and facilities


Financial arrangements
Diet
Investigations and treatment
Staff and training
Supportive services
Recreation/Occupational

Yes
Improved
Yes
546

therapy/Rehabilitation
Networking with other
agencies

Nodal centre for the 8


DMHPs

SERVICES
i. Outpatient:10700 new registrations and 34743 follow-ups
ii. Inpatient NO previous data to compare. Adequate details are not mentioned in the affidavit.
As per IC report, bed strength is 120. 3252 admissions occurred last year. The duration of stay is
10-15 days and there are a total of 3 patients with inpatient stay more than 1 year. There were
20 deaths last year. There are 30 destitute patients. Medical co-morbidity is very high.
Diagnostic categories seen: All ICD-10 categories.
iii. DIAGNOSTICS AND THERAPEUTICS

Investigations: Available
Therapeutic facilities: Medication, ECTs, Counseling,
Improvements in rehabilitation: No

iv. ENGAGEMENT:

Attempts to involve families of persons with mental illness:NR


Disability certification and number of certificates issued in the previous year: No
medical board exists.

v. ADMINISTRATIVE

Annual number of adverse events: Nil


Mechanisms for redressal of patient complaints: NR

vi. COMMUNITY OUTREACH AND NETWORKING

Community Programmes: NONE


Networking with external agencies: NONE
Public mental health education: NONE

vii. TRAINING: only 5 PG seats in psychiatry

Post-graduate training new Programmes, enhancement of seats and measures to


maintain/improve quality of training:
Any other training Programmes: NO
547

vii. RESEARCH: NONE

Research (areas, funding agencies, findings),

viii. ANY OTHER SALIENT CONTRIBUTIONS OF THE HOSPITAL/INSTITUTE:


ix. Any monitoring of hospital (internal or external)- details One visit by NHRC/SHRC.
x. Special Rapporteurs observation: - Shri D Sarangi visited the MHI, Cuttuck. He observed
that the grants had been fully utilized. There was a lack of sleeping facility for attendants.
Food was being cooked in an improvised shed. There were gaping staff vacancies. There was
no computerisation of records. A COE was under development. The Clinical Psychology
Department was functional, but the Dept of Psychiatric Social Work was not yet fuctional.
The library had been well equipped.
Of the other two medical colleges in the State, MKCG Medical College, Behrampur, had not
received an upgradation grant. VSS Medical College had received a grant for upgradation of
its psychiatric wing.
xi. Any other observations (including Inspection Committee Reports): The IC visited the hospital
on 1 june 2015. There was some overcrowding wth 30 patients being accommodated on the
floor. There was overcrowding in the outpatient as well. It is expected that the COE would
overcome these problems. It was observed that no steps had been taken to enhance human
resources without which no improvement would be possible. It was advised that human
resources should be increased on a war footing. An active collaboration was advised with
many of the universities in Odisha like Utkal University, Ravenshaw University and so on. The
IC highlighted the need for the Social Welfare Department and Legal Services Authority along
with the Dept of Health and the NMHP to work out a suitable rehabilitation programme for
the destitute patients along with credible NGOs. The IC also recommended increase in diet,
enhancing of teaching faculty, training in PSW courses.
xii. Summary and Recommendations from SECTION 2:
Areas of positive change
Institute enhanced to COE
Many new specialty beds
Free legal aid

Areas of poor progress


Diet still inadequate
No rehabilitation facilities
Lack of mental health specialists
No disability certification

548

SECTION 3
15. General Hospital Departments of Psychiatry and District Hospital Departments
Information is very deficient.
The broad outline for this section:
3.1.
3.2. Areas (distribution throughout the states): Distributed throughout the state
3.3. Whether separate funding and adequacy: No separate funding is available for these. Some
of them have got one time grant in aid under NMHP during the year 2006-07
3.4. Whether OP/IP and emergency services available: Yes, apart from one district hospital, all
other facilities have emergency services available.
3.5. Diagnostic categories in rank order that present in the outpatient: All ICD 10 categories are
being seen.
3.6. Adequacy of OP facilities: Yes, they all have separate outpatient departments. Most of
them have half of facilities such as waiting halls, toilets, separate interview rooms, drinking
water facilities, canteen facilities, OPD and OP rehab facilities. Educational facilities are
inadequate in the majority. Also, most of them do not have special clinics.
3.7. Inpatient occupancy, free and paying beds, average cost of inpatient stay per week; rank
order of diagnostic categories:
3.8. Extent of family involvement: Nearly always involved.
3.9. Measures to protect rights including complaint redressal: Most of them do not have the
patient rights displayed.
3.10. Any networking: Majority of them DO NOT have any networking.
3.11. Staffing details and any shortages/vacancies: These are manned by psychiatrists, general
duty medical officers, clinical psychologists, psychiatric social workers and nurses. However,
there seem to be inadequate number of mental health professionals particularly
psychologists and social workers.
3.12. Psychotropic medication availability/free/cost: Yes, a variety of them are available free of
cost.
549

3.13. ECTs (Nos given across the facilities or average/No of direct ):


3.14. Observations of extent to which counselling and psychotherapy are provided: Psychoeducation is provided to all, psychotherapy is provided to some.
3.15. Whether disability certification is available (if available numbers certified/year): 3.16. Extent and nature of community involvement: Some outreach occurring in half of these
facilities.
3.17. Whether engagement with the DMHP and extent: As mentioned earlier, the district
hospitals contain psychiatric facilities only in those where DMHP is running.
3.18. Nature and partnership with NGOs for networking: Very few. Details mentioned above in
summary
3.19. Presence of PG training- whether adequately distributed throughout the state: NO,
grossly inadequate.
3.20. Nature of public mental health material prepared and distributed/ activities to educate:
NO information is available.
3.21. Areas of research, sources of funding and major findings: None to be noted.
3.22. Whether monitored and by whom. What were the observations? Other facilities not
visited.
3.23. Special Rapporteurs observations: 3.24. Inspection Committees observations: 3.25. SUMMARY AND RECOMMENDATIONS WITH RESPECT TO SECTION 3:
Some of the general hospitals and district hospitals appear to be active. However, the
information is not comprehensive and complete.

550

SECTION 4
16. NGOS WORKING IN MENTAL HEALTH: The IC report mentions Mission Ashra, Basundara
and Janani.
4.1. A brief description of the NGO and its location: NR
4.2. Nature of work carried out by the NGO in the domains mentioned and details of each:
4.3. Description of clientele seen by the NGO and number of persons who use the services in
the previous year
4.4. Research details: NONE
4.5. Details of any training carried out by the NGO:
4.6. Networking activities of the NGO: Few of them have networking with medical colleges
4.7. Salient contributions of the NGO: NONE that is striking
4.8. Special Rapporteurs observations: 4.9. Inspection Committees observations: 4.8. SUMMARY AND RECOMMENDATIONS FOR SECTION 4: There appear to be hardly any
NGOs working in the area of mental health in the State.
SECTION 5
5. DISTRICT MENTAL HEALTH PROGRAMME: as already mentioned above, DMHP is present in
12 districts and their description is NOT present in the affidavit
5.1. A brief description of the location of the DMHP, when it started, total population covered:
5.2. A summary of annual registrations old and new, treatment outcomes in terms of those on
regular treatment and those dropped out, with diagnostic categories if provided. Would be
useful to know what kind of clientele is serviced under the DMHP:
5.3. Frequency of home visits carried out by the HW/ANM; numbers covered and for what
diagnostic categories, no of admissions facilitated:
5.4. Kinds of essential drugs available, number dispensed, number of patients receiving
medication under the DMHP in a month:
551

5.5. Duration of untreated mental illness for different diagnostic categories if provided:

5.6. Monitoring of the DMHP by the concerned officer /impressions and troubleshooting(mention if there is a committee and its composition):
5.7. IEC activities of the DMHP:
5.8.Training calendar of the DMHP (doctors, health workers, nurses, pharmacists, school
teachers/Anganwadi workers (whether any training conducted):
5.9. Activities to sensitize the gram panchayats
5.10. Special Rapporteurs report on the activities of the DMHP: This was reviewed by Shri
Damodar Sarangi. He noted that in most cases, a DMHP structural unit was provided, but there
were no staff. The few psychiatrists who were available in the state had many grievances- not
declared as specialists, with the requisite entitlements, lack of opportunities for medical
officers to pursue PG in psychiatry as seats are few, rapid staff turnover, authority who recruits
(CDMO or other) not clear. He advised the DMHP must not stop once the central government
withdraws; that contractual staff may be considered; better availability of medicines may be
ensured; equipment bought under the DMHP be properly used; IEC activities be expanded;
records be computerised; expenditure be streamlined; fund diversion be prevented.
552

5.11. Inspection Committees observations 5.12. SUMMARY OBSERVATIONS OF DMHP AND RECOMMENDATIONS: Details not provided.
SECTION 6
6. SUMMARY OF MENTAL HEALTH CARE INDICATORS
6.1. Availability of mental health facilities

Mental health outpatient


facilities in the state
Day treatment facilities
Psychiatric beds in general
hospitals
Community residential
facilities
Beds/places in community
residential facilities
Psychiatric hospitals
Beds in psychiatric hospitals

Total No of
facilities/beds

Rate per 100,000


population

160

0.4 per 100000

Rate per
100,000
population

Females %

6.2. Access to Care

Persons treated in mental


health outpatient facilities
Persons treated in mental
health day care facilities
General hospital admissions
Community residential
facilities
Persons staying in
community residential
facilities at the end of the
year
Admissions to mental
hospitals

7.8

553

6.3. Information Systems: NO INFORMATION AVAILABLE

Persons with mental


disorders treated in
primary health care
Interventions delivered
in primary health care
for persons with mental
disorders
Persons treated in
mental health outpatient
facilities
Contacts in mental
health day treatment
facilities
Admissions in general
hospitals with psychiatric
beds
Admissions in mental
hospitals
Days spent in mental
hospitals
Admissions in
community residential
facilities

Data on No of
persons/activities
collected and
reported YES/NO

Data on age and


gender are collected
and reported
YES/NO

Data on patients
diagnosis are
collected and
reported
YES/NO

YES

YES

YES

YES

YES

YES

6.4. Human Resources at the State Level-

Psychiatrists
Medical doctors not

Health professionals
working in the mental
health sector
Rate per 100,000
0.06

554

Training of health
professionals in educational
institutions
Rate per 100,000

specialised in psychiatry
Clinical Psychologists
Psychiatric Social Workers
Psychiatric Nurses
Occupational therapists
Other health workers

0.02
0.002
0.01

6.5.INFORMAL HUMAN RESOURCES (Family and User Associations)


User

Family

Present in the state


No of members
Participation in the
formulation/implementation
of policy/plan/legislation
6.6. MEDICINES: NO INFORMATION AVAILABLE
Type of Medication

Expenditure at State level per year and per


100,000 population (inINR)

All psychotropic medication


Mood stabilisers
Antipsychotics
Anxiolytics
Antidepressants
Anti-craving medication/ Substitution
treatments
SECTION 7
6. STATE MENTAL HEALTH REPORT CARD
SUMMARY OF SECTIONS 1-7.
Summary of areas where state has achieved good progress/little progress/no progress
Main problem Lack of data mining
Areas of good progress
Attempt to place a psychiatrist in each district
Efforts to expand DMHP
Mental health care at PHC level
Areas of poor progress:
Shortage of human resources
555

Lack of rehabilitation facilities


Lack of engagement of non-health sectors
Inadequate post graduate seats in psychiatry despite many medical colleges.
MENTAL HEALTH REPORT CARD
Area

Focus

Parameters

Mental Health
Services
(Secondary
and Tertiary)

Medical
College
Depts,
General
Hospitals,
Specialised
psychiatric
hospitals

Adequacy of inpatient
beds
Functional Departments
Functional OP services

Primary
Health Care
mental health
services

District
Mental
Health
Programme

% of functional DMHPs

Rehabilitation
services

At all levels

Vocational training, day


care, longstay facilities in
govt sector/ppp

556

Rating

100- present, fully


satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100 All districts
covered; fully
satisfactory
75 majority of
districts covered
and functioning
50 half the
districts covered
and functioning
25 one-fourth of
the districts
covered and
functioning
0- No districts
covered/although
DMHP exists, not
functioning
100- present, fully
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory

Score
(out of
100)
32.5

25

12.5

Specialised
services

Human
Resources

0- absent
100- present, fully
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent

Services for
substance
use
disorders,
old age,
mental
retardation,
child
psychiatry,
community
services,
forensic
services
(exclude
DMHP staff
here)

Whether existing, level of


functionality, present at
different levels of care

Adequacy of
psychiatrists/clinical
psychologists/psychiatric
social
workers/psychiatric
nurses or mental health
trained nurses

100 fully
adequate
75 moderately
adequate
50 somewhat
adequate
25- inadequate
0 grossly
inadequate

25

Financing for
mental health

State level

Existence of separate
budget for mental
health/mental health
activities

25

Governance
and Policy

State
Mental
Health
Authority

Separate Mental Health


Nodal Officer
Functioning Mental
Health Authority

10% -separate
budget, fully
adequate
75 separate
budget,
moderately
adequate
50 separate
budget,
somewhat
adequate
25 no separate
budget, but some
financial
resources
available annually
0 no separate
budget/marginal
financial resource
allocation
100 Existing,
fully functional
75- Existing,
mostly functional

557

12.5

25

and other
authorities

Nodal persons for mental


health in SHRC/Legal
Services
Authority/Others
State Mental Health
Rules
State Mental Health
Programme
Range of medications
Regular supply and
dispensing
Standard procurement
arrangements

Availability of
psychiatric
medication

At every
level

Affirmative
action for
persons with
mental illness

At every
level

Disability assessment
Pension
Travel concession
Health insurance
Special assistance
Educational benefits
Job reservation

10

Treatment
Gap

Overall

Approximate number of
persons with mental
illness approximate
numbers totally receiving
treatment in the state

Total Score (out of 1000)


Average Score (%)

50- Existing,
somewhat
functional
25- Partial
0 Non existent

100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100 no
treatment gap
75 25%
treatment gap
50 -50%
treatment gap
25 -75%
treatment gap
0- 100%
treatment gap

50

12.5

25

250
25%

RECOMMENDATIONS: The State of Odisha has been making attempts to improve psychiatric
care at the district level. A more comprehensive picture can develop if the complete
information on the patients being seen in the medical colleges, district hospitals and in the
DMHP can be obtained. Rehabilitation, affirmative action for persons with mental illness, the
engagement of non-health sectors and a time bound action plan to improve mental health
care in the State are essential steps.
558

PUDUCHERRY
SECTION 1. STATE LEVEL REPORT
1. GENERAL INFORMATION REGARDING THE STATE (information as per submitted
questionnaire)
a. Area: 492 sq kms
b. No of districts: 4 Pondicherry, Karaikal, Mahe and Yanam. The districts are
distant from each other (Pondicherry-Karaikal 134 kms; Pondicherry-Mahe 608
kms; Pondicherry- Yanam 819 kms.
c. Population, age distribution (as per census 2011) 12,44,464 ; Male:6,10,485;
Female:6,33,979 ; Children (0-6 years) 1,32,858
d. Gender distribution: 1037 females: 1000 males
e. Life expectancy at birth male and female: 62 and 64 years respectively
f. Per capita State Government expenditure on health: Rs 1016 (as on 31.3.2012)
g. Any health indicators for the state: Infant mortality rate at birth (19) is lower
than the national average (40) as is the maternal mortality rate (35 in 2009 as
compared to the national average of 212 for the same year). Literacy rate at
85.5% is higher than the national (74.04%).
h. Completeness/quality of information provided: Complete/Partially
Complete/Deficient
If deficient, areas of deficiency:
The information is deficient in terms of Appendix 2 (medical colleges and all
hospitals). Separate annexures are provided only for JIPMER, IGGGHPGI,GH Karaikal,
Vinayaka Mission Medical College and Hospital, Karaikal. The information is also deficient in
the area of DMHP details as per Appendix 4.
Basis of Information:

The information is based on the affidavit submitted by Shri G Ragesh


Chandra, Secretary Health , Govt of Puducherry on 28 August 2013.
Affidavit along with questionnaires submitted by Shri Candavelou,
Commissioner cum Secretary, Health Dept, Govt of Puducherry dated 19
January 2015 (the information provided in this affidavit has primarily been
used for this report, particularly when the figures are at variance with the
earlier information)
Rapporteur notes submitted by Dr KR Shyamsundar dated 31 July 2015.

559

2. MENTAL ILLNESS BURDEN/ INFORMATION REGARDING MENTAL ILLNESS


Numbers seeking treatment have been obtained from the MRD of District
Hospitals/JIPMER/Govt and Private Medical College Hospitals in the UT of Puducherry.
The source for annual suicides is the Director of Crime Records Bureau, Puducherry.
N
(prevalence)
2.1. Total number of persons
with mental illness (all ICD
categories)
2.2. Broad categories
2.2.a Severe mental disorders
(BPAD, psychosis)
2.2.b Common mental disorders
2.2.c Substance use disorders
(alcohol and other drugs)
2.2.d Mental Retardation

Not
provided

N
(treatment
seeking)
1,21,549*

38,227
33,709

Source of
information

Affidavit (MRD of Dt
Hospital/JIPMER/Govt
and Private Medical
College Hospitals in
the UT of Puducherry)

30,782
6,224

2.3. No of Males with mental


health problems
2.4. No of females with mental
health problems
2.5. No of children with mental
health problems
2.6. No of elderly with mental
health problems
2.7. No of homeless mentally ill
persons
Annual Number of suicides

21,918
3,530
6,330
Nil
497 (2014)

*refers to total visits and not to individual patients


COMMENT: Calculating that 7% of the population would have a mental disorder, it places the
number at 87113. In Puducherry, the numbers mentioned as being under care exceed this
number. This could be explained by several factors that this count includes not just new
registrations but total patient visits. Also Puducherry caters to many patients from Tamil
Nadu, thus increasing the numbers seen. Calculating that 3.5% of the child population is likely
to have a mental health problem, the number of children between 0-6 years in need of
attention would stand at 4650. Since there is no data on the number of older children and
adolescents, the number of such children in need of mental health services cannot be
calculated. Puducherry is an unusual state in that it has no homeless mentally ill. Whether
there are no homelessly mentally ill at all, or whether they are not counted remains to be
ascertained.
560

MENTAL HEALTH SERVICES IN THE STATE:


a. Organization of Services (description of number of psychiatric hospitals, medical
college depts, district hospitals)
The Union territory of Puduchery has 2 government general hospitals, two Government
Medical Colleges, i.e. Indira Gandhi Government Medical College and Research
Institute, funded by the Govt of Puducherry and the Central Govt Institute- the
Jawaharlal Nehru Institute of Post-Graduate Medical Education and Research (JIPMER).
There are additionally 7 private medical colleges also providing mental health care.
Two district hospitals in Puducherry and Karaikal have separate department of
psychiatry.
General
Hospitals/
District
Hospitals
providing
psychiatric
care
Indira
Gandhi
Govt
General
Hospital
and PGI,
Puducherry
Govt
General
Hospital
Karaikal

Medical
Colleges/Institutes

No of
psychiatrists
in govt
service
(DH/Psych
facilities)

JIPMER, Puducherry
(Govt)

15
(IGGGH 3
GH KKL 1
JIPMER 9
IGMCRI 2)

Indira Gandhi Medical


College and Research
Institute, Puducherry
(Govt)
Aarupadai Veedu
Medical College
Hospitals, Puducherry
(Pvt)
Mahatma Gandhi
Medical College and
Research Institute,
Puducherry(Pvt)
Pondicherry Institute of
Medical Sciences,
Puducherry(Pvt)
Shri Lakshmi Narayana
Institute of Medical
Sciences, Puduchery(Pvt)
Shri Manakula
561

No of
psychiatrists
in private
medical
colleges

33

Vinaynagar Medical
College and Hospital,
Kalitheerthalkuppam(Pvt)
Shri Venkateshwara
5
Medical College Hospital
and RC, Purucherry(Pvt)
Vinayaka Missions
4
Medical College,
Karaikal(Pvt)

Coverage of psychiatric care

3.1.a No of district
general hospitals with
separate department
of psychiatry
3.1.b No of medical
colleges with
department of
psychiatry
3.1.c No of district
general hospitals
providing psychiatric
care
3.1.d No of District
Mental Health
Programmes in the
State
3.1.e No of
government
psychiatric hospitals
3.1.f No of private
psychiatric hospitals
3.1.g Total No of
psychiatric hospitals in
the state
3.1.h No of NGOs
providing mental
health care

N/N No with
dept/facility
Total No of
units
2/4

% coverage

9/9

100

2/4

50%

2/4

50%

50%

NIL

NIL
NIL

None providing mental health care

Mahe and Yanam do not have a district mental health Programme. Their populations are
small (41,934 and 55,616) but they are both located very far from Puducherry.

562

b. INPATIENT SERVICES
DESCRIPTION:
There are no government or private psychiatric hospitals functioning in Puducherry.
The break up of beds in the different locations is not provided. However, the first
affidavit states that there are 85 beds in the government sector and 70 beds in the
private medical colleges for inpatient psychiatric treatment (total 155).
This information is provided for 2 general hospitals in the government sector.
General
District
Hospitals/MC Hospitals

NGOs

Total

Comment

3.2.a. Total Inpatient


sanctioned/available
beds

JIPMER-30
IGGGH-8

85 (not
indicated
where
the other
beds are)

JIPMERBed
occupancy
as on 1
April 2014
was 27

3.2.b No of male
beds
3.2.c. No of female
beds
3.2.d. No of beds for
children
3.2.e. No of beds for
elderly
3.2.f. No of beds for
substance use
disorders
3.2.g. No of beds for
forensic psychiatry
3.2.h. Occupancy (%)
3.2.i. No of
admissions during
previous year
3.2.j. No of
discharges during
previous year
3.2.k. Average
duration of inpatient
stay in days mean
3.2.l. Average
duration of inpatient
stay in days median

JIPMER-14
IGGGH-4
JIPMER-13
IGGGH-4
JIPMER-2

DH
Karaikal-10

57780

Karaikal-38

563

3.2.m. No of closed
wards
3.2.n. No of closed
ward beds
3.2.o. No of open
wards
3.2.p. No of open
ward beds
3.2.q. No of paid
wards
3.2.r.No of paid beds
3.2.s.No of
admissions through
courts
3.2.t. No of deaths in
the last year
3.2.u. No of suicides
in the last year

JIPMER-NA
JIPMER-29
JIPMER -1
JIPMER -1

COMMENT: JIPMER has 1 special ward bed of the total of 30 inpatient beds and 2 beds for
children. There are no other inpatient specialty wards at JIPMER.
Diagnostic break-up of inpatients in previous year as per information provided

Bipolar Mood disorder


Schizophrenia
Organic psychotic disorders
Other psychotic disorders
Alcohol and Drug abuse
disorders
Depressive disorders
Obsessive Compulsive
disorders
Other anxiety disorders
Adjustment disorders
Personality disorders
Children with psychiatric
illness

JIPMER
126
144
11
88
72
54
4
5
9
4
2

564

At JIPMER, the mean duration of inpatient stay is 19.4 days and the median duration of stay
is 18 days. The major admissions are for psychotic and mood disorders followed by substance
use disorders.
Patient/Care giver involvement:
At JIPMER, it is mentioned that all families are educated and counselled and that patients are
always involved in treatment decisions. However, rights of patients are not displayed in the
wards.
No complaints have been received from patients regarding their care. Positive feedback has
been received particularly for the crisis intervention clinic and the de-addiction clinic.
Facilities: Treatment: Records: Available
Administrative Issues: Research: is only just starting.
Partnerships: -

c. OUTPATIENT SERVICES*
General Hospitals
N= 3
JIPMER-5214
IGGGH-2323

3.3.a. No of new
OP registrations in
the previous year
3.3.b. No of
JIPMER- 750
emergency
attendees in the
previous year
3.3.c Total no of OP JIPMER- 50561
follow-up in the
IGGGH-39633
previous year
565

District
Hospitals
N=2
Karaikal11001
Karaikal-18

Karaikal9302

Total

COMMENT: The report states that the average outpatient is 470 (presumably per day across
the facilities- this does not specify old or new). It states that 40% of attendees in the
Government General Hospital and 80% of the attendees to JIPMER for mental health care are
from the neighbouring states, particularly the neighbouring districts of Tamil Nadu.
JIPMER, broad categories of follow-ups seen in the previous year include dementia, alcohol
and nicotine use disorders, schizophrenia and other psychotic disorders, bipolar mood
disorders, depression, anxiety disorders, obsessive compulsive disorder, Dhat syndrome,
sexual dysfunction, personality disorder, mental retardation, childhood developmental
disorders, ADHD, conduct disorder and childhood emotional disorder.
At JIPMER, special clinics include a Child Guidance Clinic twice weekly, and a weekly once
clinic for each of the following: De-addiction clinic, Crisis Intervention Clinic, Psychosomatic
Disorder Clinic, Memory Clinic, Marital and Psychosexual Clinic and Perinatal Clinic.
Adequacy of Outpatient Services
At JIPMER, it is documented that there are adequate interview rooms to see patients;
drinking water, OPD lab and rehab services are adequate and there is available educational
material for all patients.
However, the waiting hall and toilet facilities at JIPMER are documented as being inadequate.
3. REHABILITATION FOR PERSONS WITH MENTAL ILLNESS
According to the report, there are no government residential rehabilitation centres or
long stay facilities. There are no government day care or outdoor rehabilitation
facilities. The Government does not run any half way homes.
a. NGO participation in the half way homes:
b. Longstay rehabilitation facilities: No and description; NGO participation:

566

Networking :
At JIPMER, there is a liaison with NGOs including Fraternal Life Service Home (FLSH), Ousteri
(for halfway home care). The latter provides free treatment and patients are brought for
regular follow-up visits to JIPMER.

4. MENTAL HEALTH CARE IN OTHER COMMUNITY FACILITIES


State Level, in the Govt Sector

5.1. No of shelter homes, observation homes,


special homes and childrens homes

44
(36 in Puducherry
7 in Karaikal
1 in Yanam)

5.2. No of counsellors trained in mental health in


the above institutions
5.3. No of protection homes for destitute women

No details
provided
11
(Puducherry 9
Karaikal 2)
Not mentioned

5.4. No of counsellors trained in mental health in


the above institutions
5.5. No of old age homes

5.6. No of counsellors trained in mental health in


the above institutions
5.7. No of Central Jails and District Jails in the State

5.8. No of counsellors trained in mental health in


the above institutions

6
(Government 3
NGO run 3)
Not mentioned
4
(Puducherry
Central Prison
Karaikal special
sub jail
Mahe sub jail
Yanam sub jail)
No professionals
trained in mental
health

Most of the childrens homes are concentrated in Puducherry.


Helplines for Mental Health: The state has help lines for persons who attempt suicide,
have addiction, women subjected to domestic violence, adolescent mental health
problems etc.

567

DMHP
Figures are mentioned only for the Puducherry district- about 47388 annual new
registrations.
COMMENT:
5. MENTAL HEALTH HUMAN RESOURCES
Mental Health Care Professionals
Government
Sector medical
colleges/hospitals
15

Private
medical
colleges
33

2
(JIPMER 2)

11

2
(IGGGH1
JIPMER 1)

10
(AVMC,
MGMCRI,
PIMS,
SMVMC 1
each and
SLIMS,
SVMCH and
VMMC 2
each)

12

6.4. No of nurses 3
trained in mental (IGGGH 1
health
JIPMER 1
IGMC&RI 1)

19
(VMMC 2
PIMS,SLIMS
& SVMCH -3
each
AVMC 4)

22

6.5. No of
trained
counselors

3
(SLIMS,
SVMCH and
VMMC 1
each)

6.1. No of
Psychiatrists
6.2. No of
Clinical
Psychologists
6.3. No of
Psychiatric Social
Workers

Nil

568

Private
Practice

Total

48

COMMENT:
JIPMER has a multi-disciplinary team of 9 psychiatrists (5 faculty and 4 senior residents), 2
clinical psychologists, 1 psychiatric social worker, 1 trained psychiatric nurse and 4 general
nurses, 1 occupational therapist, 1 lab technician, 3 office staff and 1 security guard.
The Health Secretary of Puducherry Shri Ragesh Chandra has indicated in his affidavit that
there are sufficient number of medical resource personnel in the existing facilities to meet
the needs of persons with mental disorders. He says in the last three years (prior to 2013),
only 5 patients were referred to a higher institution of mental health at Chennai for
admission and further management. Hence there is no need to establish a separate mental
hospital in this Union Territory. The Secretary Health, further adds that separate wards,
adequate beds and necessary funds have been allocated and that there is no administrative
or financial constraints in delivery of mental health care services.
At the District General Hospitals where there is a Department of Psychiatry (2 Districts), there
are a total of 6 sanctioned posts (4 Programme Officer/Psychiatrist, 1 PSW (NRHM), 1 CP, 1
Psychiatric Nurse). There are no sanctioned posts of Record Keeper, Community Nurse, Case
Registry Assistant.
There is a separate financial outlay of Rs 3,98,000 for the above posts.
Of the psychiatrists posts in the government hospitals, only 1 out of 16 is vacant.
It is not clear how the other two districts (Mahe and Yanam) are being served with respect to
mental health care.
7. MENTAL HEALTH HUMAN RESOURCE DEVELOPMENT
7.1. Degree/Diploma Courses
In Entire state, Annual No of
Seats in
MD Psychiatry

DNB Psychiatry

Nil

Institutions where the Programme is


offered/Other comments
JIPMER 3
Private Medical Colleges 6

569

Diploma in Psychiatry
PhD Clinical Psychology

Nil
12

MPhil Clinical Psychology

Nil

PhD Psychiatric Social Work


MPhil Psychiatric Social
Work
PhD Psychiatric Nursing
MSc Psychiatric Nursing
BSc Psychiatric Nursing

Nil
Nil

Basic Diploma in Psychiatric


Nursing (DPN)
COMMENT:

Nil

Under the Pondicherry University, 12 PhD


Psychology seats
Under the Pondicherry University, there are 66
PG seats in Psychology (not clear if MPhil or
MA)
Under the Pondicherry University, there are
110 MSW seats
JIPMER (2014-15)
JIPMER 5; MTIPGHS &RI 2
All BSc Nursing (general) students receive
mandatory training in their third year including
theory classes, out-patient and clinical ward
postings

2
5
Nil

He also adds that mental health awareness is being carried out in regional languages and
materials are available for dissemination among the masses.
7.2. Other training in mental health
7.2.a. Details of Undergraduate MBBS training in psychiatry
Name of medical
college

No of hours of
theory

Duration of
psychiatry
posting during
UG

All medical
colleges

Nil according to proforma

Duration of
psychiatry
posting during
internship

Qualifying
Examination
includes
competency
evaluation in
psychiatry

COMMENT:
It is reported that there is no undergraduate training in mental health (including lectures,
posting and internship rotation). This is surprising considering the presence of 9 medical
colleges, including JIPMER, with functioning departments of psychiatry.
7.2.b. Details of in-service training for Govt medical officers (No trained, duration)
570

As per the affidavit of the Health Secretary (2013), JIPMER offers MD (Psychiatry) training and
Mother Theresa Post Graduate and Research Institute of Health Sciences, Puducherry run by
the Govt of Puducherry offers MSc Nursing. He further adds that medical officers are deputed
for training in mental health at NIMHANS and mental health services are imparted in a multidisciplinary team.
However, in the affidavit dated 19 January 2015, it is mentioned that there are no inservice
training Programmes for government medical officers or for government nurses in mental
health. There is a mention that a training of trainers Programme is planned through
NIMHANS.
7.2.c. Any other training courses in mental health offered by the state 8. GOVERNANCE:
8.1. Nodal Authority and responsibilities : Various nodal authorities have been identified by
the Govt of Puducherry for assignment of responsibility for mental health care. These include:
a. Director of Medical Education
b. Director, State Medical and Health Department
c. Director, Social Welfare Department
d. Programme Officer, Social Welfare Department
e. Programme Officer, State Mental Health Authority
f. Member Secretary, District Legal Services Authority
8.2. Presence of a State Mental Health Plan: NR
8.3. Enactment of State Mental Health Rules: NR
8.4. Oversight of policies and Programmes related to mental health: NR
8.5. Specific oversight of the DMHP programme. NR
8.6. Attempts towards integration of mental health care into general health care, NCD
management etc. NR

571

8.7. Examples of commitment to develop mental health services (high level involvement,
budgeting, networking NR
8.8. Examples of inter-sectoral collaboration to improve mental health services (including PPP
intitiatives) NR
8.9. Attempts towards mental health promotion NR
COMMENT: Strengths and weaknesses (see later)
9. FINANCING
9.1. Sources of financing of different categories
The IGGGH receives financial support from the state budget and NRHM funds (for DMHP)
9.2 Budget provision from State and Centre in INR (for different facilities if required)
9.3. Mental Health Expenditure as proportion of Total Health Expenditure in State
According to the affidavit submitted by the Health Secretary, the necessary funds have been
allocated for maintenance and improvement of the physical infrastructure and there is no
administrative or financial constraints in delivery of mental health care services.
(If available % spending on Health in the State may also be provided)
10. ANY OTHER SIGNIFICANT INFORMATION (e.g. litigation, insurance schemes for persons
with mental illness, pension and other assistance, job reservations)
There are no cases relating to mental health in the state.
There are no plans to expand the District Mental Health Programme beyond the two districts
of Puducherry and Karaikal.
11. INNOVATIONS
In the COMMENTS, the observations of the Special Rapporteur or the high level committees
visit to the states may be incorporated
12. OVERALL SUMMARY OF STATE LEVEL MENTAL HEALTH SERVICES
The UT of Puducherry has organised services for mental health in a reasonably
systematic manner, without having a government psychiatric facility. Services have
572

been made available for children. Facilities are present in both the government and
private sector. The coverage at district levels is 50%. Outpatients are active in all the
facilities. Some facilities in JIPMER require improvement. Rehabilitation is an area that
requires improvement. There is a need to train counsellors working in community
institutions in mental health. Compared to psychiatrists, the numbers of other mental
health professionals is relatively low.

SECTION 2
2.1. PSYCHIATRIC INSTITUTIONS
As per the report of Shri Ragesh Chandra, Secretary Health, in the previous three years, only 5
patients were referred to the higher institution of Mental Health at Chennai for admission
and further management. Hence, there is no need to establish a separate mental hospital in
this Union Territory.

SECTION 3
17. General Hospital Departments of Psychiatry and District Hospital Departments

The broad outline for this section:


3.1. Names of GH/DH and their location.
1. Jawaharlal Institute of Post Graduate Medical Education and Research, Puducherry
2. Indira Gandhi Govt General Hospital and PGI, Puducherry
3. Govt General Hospital Karaikal

(If there are many, this could be done in a tabular column).


The following areas may be mentioned as a summary of all the units; where needed , examples
could be made of a specific dept to highlight both positives and negatives.
3.2. Areas (distribution throughout the states):
573

JIPMER and IGGGH&PGI are in Puducherry and GGH is in Karaikal


3.3. Whether separate funding and adequacy:
This question was asked specific to the psychiatric unit.
JIPMER is a centrally funded institute. The questionnaire from JIPMER says that the details of
funding for the psychiatric unit are currently not available.
IGGGHPGI Puducherry received an allocation of 116.92 lakhs, which was received and
deemed adequate. Part of this came from the State Budget (Rs 60 lakhs) and part from the
NRHM funds (Rs 56.92 lakhs).
GGH Karaikal received an allocation of Rs 30 lakhs, which was received and deemed
adequate.
3.4. Whether OP/IP and emergency services available
Both OP and IP services are available at all the three facilities.

Total No of emergency
attendees during the
previous year
Organic Psychiatric
Disorders
Schizophrenia
Other psychotic
disorders
Bipolar mood disorders
Obsessive compulsive
disorder
Other anxiety disorders
Depressive disorders
Adjustment disorders
Alcohol and drug abuse
disorders
Personality disorders
Children with psychiatric
illnesses

JIPMER

IGGHPGI

GGH Karaikal

750

1715

18

68 (9%)

154

127 (17%)
82 (11%)

285
189

3
2

173 (23%)
Nil

394
Nil

4
Nil

29 (4%)
61 (8%)
67 (9%)
121 (16%)

69
137
154
297

1
1

14 (2%)
8 (1%)

34
Nil

Nil

574

Vinayaka
Mission MCH
4

3.5. Diagnostic categories in rank order that present in the outpatient


JIPMER

IGGHPGI*

GGH Karaikal

5214

2323 (new cases)


39633 (Follow-up)

11001 (new
cases)
9302 (Follow- up)

Dementia

2789 (org
disorders)

21 (org
disorders)

Alcohol and drug


use disorders
Nicotine use
disorder
Schizophrenia
Other psychotic
disorders
Bipolar disorder
Obsessive
Compulsive
disorders
Anxiety disorders
Depressive
disorders
Adjustment
disorder
Dissociative
disorder
Sexual
dysfunction
Personality
disorder
Mental
Retardation
Children with
psychiatric
disorders

11036

8558

750

19760
3821

596
2347

320
96

8084
7702

876
556

430
90

382
174

956
5915

124
550

37

50

Total No of new
outpatient
registrations in
the previous year
Broad ICD
categories

Vinayaka
Mission MCH
1647 (new
cases)
953 (Follow-up)

No numbers, only
break-up provided

976

467

31

169

*totals do not add up

575

3.6. Adequacy of OP facilities


JIPMER
It is reported that the waiting hall and toilets are not adequate, but that they are
under renovation. The waiting rooms are adequate, facilities for drinking water,
canteen, OPD lab services, rehab services are adequate. There are educational
materials provided to patients and families. JIPMER runs 7 special clinics (A Child
Guidance Clinic twice weekly, De-addiction, Crisis intervention, Psychosomatic
Disorder Clinic, Memory Clinic, Marital and psychosexual clinic and perinatal clinic
once a week)
In IGGGHPGI, it is reported that the waiting hall, toilets, interview rooms, drinking
water and OPD lab services and educational materials are adequate. But canteen
services are not adequate. OPD rehabilitation services are also not perceived to be
adequate. There are no special clinics
3.7. Inpatient occupancy, free and paying beds, average cost of inpatient stay per week;
rank order of diagnostic categories
No of allotted beds
No of beds occupied as
on 1 April 2014
No of beds free
No of beds paying
Average duration of
inpatient stay (Mean)
Average duration of
inpatient stay (Median)
Average cost of
inpatient stay

JIPMER
30 (M=14; F=13,
Spl=1; Child=2)
27

IGGGHPGI
8 (M=4; F=4)

GGH Karaikal
4 (M=2; F=2)

29
1

8
-

19.4 days

18 days

Free except 1

All free

All free

Admissions during the last year and diagnostic breakup

Total Number of
inpatient
admissions
Organic
psychiatric

JIPMER

IGGGHPGI

GGH
Karaikal

519

Details not
provided

38

11

576

Vinayaka
Mission
MCH

disorders
Schizophrenia
Other psychotic
disorders
Bipolar mood
disorders
Obsessive
compulsive
disorder
Other anxiety
disorders
Depressive
disorders
Adjustment
disorders
Alcohol and drug
abuse disorders
Personality
disorders
Children with
psychiatric
illnesses

144
88

3
5

7
5

126

12

29

54

10

72

12

154

3.8.Extent of family involvement


At JIPMER, all families are educated and counselled. The consumers are involved in
the treatment decisions at all times
At IGGGHPGI, it is reported that all families are educated and counselled. No patient
complaints have been received.
At the GH Karaikal, it is reported that all families are educated and counseled.
However, they are not actively involved in decisions regarding treatment. No
complaints have been received regarding care.
At the private Vinayaka Mission MCH, the report mentions that some of the families
are educated and counselled and sometimes involved in treatment planning.
3.9. Measures to protect rights including complaint redressal
At JIPMER, the rights of patients are not displayed. At IGGGHPGI and GH Karaikal, rights
of patients are displayed in the wards. These are also displayed in the Vinayaka Mission
MCH.
3.10. Any networking
577

At IGGGHPGI, GH Karaikal and Vinayaka Mission MCH, there is no networking with NGOs.
3.11. Staffing details and any shortages/vacancies
At IGGGHPGI, there are 3 qualified psychiatrists, 1 general medical officer, 1 PSW (NMHP
staff), 1 trained psychiatric nurse, 1 general nurse and 5 other staff.
At the Vinayaka Mission MCH, there are 4 qualified psychiatrists, 3 general medical officers, 1
psychologist, 2 psychiatric/medical social workers and 5 trained psychiatric nurses.
3.12. Psychotropic medication availability/free/cost
At JIPMER, all common psychotropic medications are available.
At IGGGHPGI, all common psychotropics are available. Even drugs like mirtazapine,
olanzapine, clozapine, multiple types of benzodiazepines are also available.
3.13. ECTs (Nos given across the facilities or average/No of direct )
At JIPMER, 370 ECTs were given in the last year, all modified.
At IGGGHPGI, no ECTs were given in the previous year.
3.14. Observations of extent to which counselling and psychotherapy are provided
At JIPMER, it is mentioned that all patients receive psychoeducation and counselling.
Psychotherapy is provided to some. The report from IGGGHPGI is similar.
3.15. Whether disability certification is available (if available numbers certified/year)
At JIPMER, there is a board for disability certification, and 50 certificates were issued in the
last year. At IGGGHPGI, there is a board and 174 certificates have been issued.
3.16. Extent and nature of community involvement
JIPMER has community outreach services once a week at the rural health centre,
Ramanathapuram. It conducts 4 community outreach activities each month and covers about
250 patients in its outreach.
At IGGGHPGI, there is no community outreach, but it is running the DMHP
578

3.17. Whether engagement with the DMHP and extent


JIPMER has no involvement in the DMHP.
The IGGGHPGI is involved in the DMHP and the Programme implementation is through State
and NRHM Funds.
3.18. Nature and partnership with NGOs for networking
At IGGGHPGI, there is no NGO involvement
3.19. Presence of PG training- whether adequately distributed throughout the state
At JIPMER, there are 3 MD psychiatry seats per year. There are no post graduate Programmes
in psychology, psychiatric social work or psychiatric nursing. Post graduates (DM students)
from Neurology and Clinical Pharmacology have psychiatric postings. At the undergraduate
level, VI semester MBBS students have a mandatory posting. During internship also, there is a
mandatory posting.
At IGGGHPGI, there are no postgraduate psychiatric training. Nor are there any courses for
other mental health specialties. However, DNB students are posted for one month and
students of psychiatric social work and psychology are posted to psychiatry for observation.
47 interns underwent posting.
3.20. Nature of public mental health material prepared and distributed/ activities to educate
The staff at JIPMER and at IGGGHPGI conducts awareness Programmes for World Mental
Health Day and participates in English and Tamil Programmes on the TV and Radio.
There is no telemedicine facility at JIPMER or IGGGHPGI.
3.21. Areas of research, sources of funding and major findings
No major research has been undertaken in any of the departments
3.22. Whether monitored and by whom. What were the observations?
There has been no monitoring visits to JIPMER either by the State Govt, High Court, NHRC or
other bodies to JIPMER.
579

The NHM provides funds and supervises the DMHP run out of the IGGGHPGI.
3.23. Special Rapporteurs observations
The report of Dr KR Shyamsundar, special rapporteur, who visited GH, JIPMER and Indira
Gandhi Hospital (private) can be summarised as follows:

Patients admitted for mental illness in both the government and inpatient facilities
are not kept for more than one month

In the GH Pondicherry (8 bed ward) neatness was found wanting, the walls were
shabby, the taps and toilets leaky. But family members were satisfied with the
psychiatric care. There was a heavy rush to procure medications (it being a Monday
and a drug distribution day)

Shortage of psychiatrists and other staff was a major problem expressed by Dr Balan,
senior psychiatrist and other staff. While the state has calculated that 1.22 lakh
patients are currently receiving treatment, there are only 48 psychiatrists providing
this treatment. This means a ratio of 1 psychiatrist to 2500 psychiatric patients
(including outpatient) and 1 psychiatrist for a 25,917 population. While this is
relatively better than many other states, the rapporteur notes that many patients
from the state of Tamil Nadu (particularly the districts of Cuddalore, Villupuram,
Nagapattinam and Thanjavur) also seek psychiatric care in Puducherry. The local
psychiatrists in their interaction with the rapporteur, have indicated a shortage of
psychiatrists, clinical psychologists, psychiatric social workers, psychiatric nurses as
well as general nurses trained in mental health and counsellors.

3.24. Inspection Committees observations: Nil


3.25. SUMMARY AND RECOMMENDATIONS WITH RESPECT TO SECTION 3:
Relative to other states and UTs, Puducherry has made a concerted effort to develop
psychiatric facilities in the general and district hospitals. Efforts have been made develop
training although the human resources are still adequate. Some of the amenities need to be
improved. Medication is fairly adequate. Rehabilitation needs to be improved.
580

SECTION 4
18. NGOS WORKING IN MENTAL HEALTH: Not mentioned
4.1. A brief description of the NGO and its location
4.2. Nature of work carried out by the NGO in the domains mentioned and details of each
4.3. Description of clientele seen by the NGO and number of persons who use the services in
the previous year
4.4. Research details
4.5. Details of any training carried out by the NGO
4.6. Networking activities of the NGO
4.7. Salient contributions of the NGO
4.8. Special Rapporteurs observations
4.9. Inspection Committees observations
4.8. SUMMARY AND RECOMMENDATIONS FOR SECTION 4
No details available.
SECTION 5
DISTRICT MENTAL HEALTH PROGRAMME
5.1. A brief description of the location of the DMHP, when it started, total population covered:
The DMHP is running in 2 districts, but no details have been provided.
5.2. A summary of annual registrations old and new, treatment outcomes in terms of those on
regular treatment and those dropped out, with diagnostic categories if provided. Would be
useful to know what kind of clientele is serviced under the DMHP:
5.3. Frequency of home visits carried out by the HW/ANM; numbers covered and for what
diagnostic categories, no of admissions facilitated:
5.4. Kinds of essential drugs available, number dispensed, number of patients receiving
medication under the DMHP in a month:

581

5.5. Duration of untreated mental illness for different diagnostic categories if provided:

5.6. Monitoring of the DMHP by the concerned officer /impressions and trouble-shooting
(mention if there is a committee and its composition):
5.7. IEC activities of the DMHP:
5.8. Training calendar of the DMHP (doctors, health workers, nurses, pharmacists, school
teachers/Anganwadi workers (whether any training conducted):
5.9. Activities to sensitize the gram panchayats
5.10. Special Rapporteurs report on the activities of the DMHP: 5.11. Inspection Committees observations:5.12. SUMMARY OBSERVATIONS OF DMHP AND RECOMMENDATIONS:
Adequate details of the DMHP have not been provided.

582

SECTION 6
6. SUMMARY OF MENTAL HEALTH CARE INDICATORS IN PUDUCHERRY
6.1. Availability of mental health facilities

Mental health outpatient


facilities in the state
Day treatment facilities
Psychiatric beds in general
hospitals
Community residential facilities
Beds/places in community
residential facilities
Psychiatric hospitals
Beds in psychiatric hospitals

Total No of
facilities/beds

Rate per 100,000


population

155

12.5

Rate per 100,000


population

Females %

6.2. Access to Care

Persons treated in mental


health outpatient facilities
Persons treated in mental
health day care facilities
General hospital admissions
Community residential facilities
Persons staying in community
residential facilities at the end
of the year
Admissions to mental hospitals

6.3. Information Systems:


Data on No of
persons/activities
collected and reported

Data on age and


gender are collected
and reported

583

Data on patients
diagnosis are collected
and reported

YES/NO
Persons with mental
disorders treated in
primary health care
Interventions delivered
in primary health care
for persons with
mental disorders
Persons treated in
mental health
outpatient facilities
Contacts in mental
health day treatment
facilities
Admissions in general
hospitals with
psychiatric beds
Admissions in mental
hospitals
Days spent in mental
hospitals
Admissions in
community residential
facilities

YES/NO

YES/NO

YES

YES

YES

Not applicable

Not applicable

Not applicable

6.4. Human Resources at the State Level- Will be entered after all information is received.
Health professionals working
in the mental health sector
Rate per 100,000
Psychiatrists
Medical doctors not specialised
in psychiatry
Clinical Psychologists
Psychiatric Social Workers
Psychiatric Nurses
Occupational therapists
Other health workers

Training of health
professionals in educational
institutions
Rate per 100,000

3.9

0.9
0.9
0
Nil in mental health
Nil

6.5. INFORMAL HUMAN RESOURCES (Family and User Associations)


User

Family

Present in the state


No of members
584

Participation in the
formulation/implementation of
policy/plan/legislation

6.6. MEDICINES
Type of Medication

Expenditure at State level per year and per


100,000 population (inINR)

All psychotropic medication


Mood stabilisers
Antipsychotics
Anxiolytics
Antidepressants
Anti-craving medication/ Substitution
treatments

SECTION 7
6. STATE MENTAL HEALTH REPORT CARD
SUMMARY OF SECTIONS 1-7.
Summary of areas where state has achieved good progress/little progress/no progress
Areas of good progress are in development of mental health services in different general
hospital settings, locally available post-graduate courses in psychiatry. Areas of poor progress
are in the development of other mental health human resources, rehabilitation and adequate
number of NGOs.
MENTAL HEALTH REPORT CARD (needs to be revised after all the information is obtained)
Area

Mental Health
Services
(Secondary
and Tertiary)

Focus

Medical
College
Depts,
General
Hospitals,
Specialised
psychiatric

Parameters

Adequacy of inpatient
beds
Functional Departments
Functional OP services

585

Rating

100- present, fully


satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat

Score
(out of
100)
50

hospitals

Primary
Health Care
mental health
services

District
Mental
Health
Programme

% of functional DMHPs

Rehabilitation
services

At all levels

Vocational training, day


care, longstay facilities in
govt sector/ppp

Specialised
services

Whether existing, level of


functionality, present at
different levels of care

Human
Resources

Services for
substance
use
disorders,
old age,
mental
retardation,
child
psychiatry,
community
services,
forensic
services
(exclude
DMHP staff
here)

Adequacy of
psychiatrists/clinical
psychologists/psychiatric
586

satisfactory
25 present,
unsatisfactory
0- absent
100 All districts
covered; fully
satisfactory
75 majority of
districts covered
and functioning
50 half the
districts covered
and functioning
25 one-fourth of
the districts
covered and
functioning
0- No districts
covered/although
DMHP exists, not
functioning
100- present, fully
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100- present, fully
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent

100 fully
adequate
75 moderately

50

25

25

32.5

social
workers/psychiatric
nurses or mental health
trained nurses

Financing for
mental health

State level

Existence of separate
budget for mental
health/mental health
activities

Governance
and Policy

State
Mental
Health
Authority
and other
authorities

Availability of
psychiatric
medication

At every
level

Separate Mental Health


Nodal Officer
Functioning Mental
Health Authority
Nodal persons for mental
health in SHRC/Legal
Services
Authority/Others
State Mental Health
Rules
State Mental Health
Programme
Range of medications
Regular supply and
dispensing
Standard procurement
arrangements

587

adequate
50 somewhat
adequate
25- inadequate
0 grossly
inadequate
10% -separate
budget, fully
adequate
75 separate
budget,
moderately
adequate
50 separate
budget,
somewhat
adequate
25 no separate
budget, but some
financial
resources
available annually
0 no separate
budget/marginal
financial resource
allocation
100 Existing,
fully functional
75- Existing,
mostly functional
50- Existing,
somewhat
functional
25- Partial
0 Non existent

100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level

25

50

50

Affirmative
action for
persons with
mental illness

At every
level

Disability assessment
Pension
Travel concession
Health insurance
Special assistance
Educational benefits
Job reservation

10

Treatment
Gap

Overall

Approximate number of
persons with mental
illness approximate
numbers totally receiving
treatment in the state

Total Score (out of 1000)


Average Score (%)

100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100 no
treatment gap
75 25%
treatment gap
50 -50%
treatment gap
25 -75%
treatment gap
0- 100%
treatment gap

32.5

50

400
40%

RECOMMENDATIONS:
Puducherry needs to make a comprehensive mental health action plan engaging all the
sectors. It already has a broad-based nodal authority. Time-bound planning, inter-sectoral coordination, improving of human resources and greater focus on primary care and enhance
mental health service delivery in the UT.

588

PUNJAB
SECTION 1. STATE LEVEL REPORT
7. GENERAL INFORMATION REGARDING THE STATE OF PUNJAB
a. Area- 50,362 km2
b. No of districts- 22
c. Population, age distribution (as per census 2011): Total 27704236
0-9 : 4501548
10-19: 5401085
20-44: 11134576
45-79: 6285106
More than 80 : 379501
d. Gender distribution
0-6: 846
Overall: 893
e. Life expectancy at birth male and female
Male-69.78
Female-72.00
f. Per capita State Government expenditure on health
g. Any health indicators for the state (life expectancy, etc)
Total population (In crore) (Census 2011)
2.77
Infant Mortality Rate (SRS 2013)
26
Maternal Mortality Rate (SRS 2010-12)
155
Total Fertility Rate (SRS 2012)
1.7
Crude Birth Rate ( SRS 2013)
15.7
Crude Death Rate ( SRS 2013)
6.7
Natural growth rate (SRS 2013)
9
Sex Ratio (Census 2011)
893
Child Sex Ratio (Census 2011)
846
Total Literacy Rate (%) (Census 2011) 76.68 74.04
Male Literacy Rate (%) (Census 2011) 81.48 82.14
Female Literacy Rate (%) (Census 2011)
71.34 65.46
h. Completeness/quality of information provided: Partially Complete
If deficient, areas of deficiency: Data for States Psychiatric Hospital has not been
provided.

589

8. MENTAL ILLNESS BURDEN/ INFORMATION REGARDING MENTAL ILLNESS


N
(prevalence)
2.1. Total number of persons with
mental illness (all ICD categories)

1939296*

N
(treatment
seeking)

Source of
information

7*

COMMENT:
*Estimated burden on basis of epidemiological meta-analyses in absence of any actual data.
9. MENTAL HEALTH SERVICES IN THE STATE:
a. Organization of Services (description of number of psychiatric hospitals, medical
college depts, district hospitals)

N/N
3.1.a No of district
general hospitals with
separate department of
psychiatry
3.1.b No of medical
colleges with department
of psychiatry
3.1.c No of district
general hospitals
providing psychiatric care
3.1.d No of District
Mental Health
Programmes in the State

No with dept/facility
Total No of units

% coverage

14/22

63.7%

10 govt (41/41)
31 pvt

100%

14/22

63.7%

3/22

13.6%

N
3.1.e No of government
psychiatric hospitals
3.1.f No of private
psychiatric hospitals
3.1.g Total No of
psychiatric hospitals in
the state
3.1.h No of NGOs
providing mental health
care

1
7
8

COMMENT: The numbers look deficient vis a vis the population in almost every area, except
coverage of Medical Colleges with Department of Psychiatry.
590

b. INPATIENT SERVICES
DESCRIPTION:

Psychiatric
hospitals
(Govt) N=1
3.2.a. Total I.npatient
sanctioned/available
beds

330**

Psychiatric
hospitals
(Private)
N=7
88

General
Hospitals
N=

District
Hospitals
N=22

83

NGOs
N=

Total

501

COMMENT: *Data about medical colleges is lacking.


**Not provided in affidavit. Figures from Inspection Committee Report incorporated.

c. OUTPATIENT SERVICES

3.3.a. No of new OP
registrations in the
previous year
3.3.b. No of
emergency
attendees in the
previous year
3.3.c Total no of OP
follow-up in the
previous year

Govt.
Psychiatric
hospitals
N=1
12506a

27071a

Private
Psychiatric
hospitals
N=
17252

*General
Hospitals

*District
Hospitals

NGOs

N=

N=
89853

N=

Total

119611

151

630

781

6602**

82332**

116005**

COMMENT:
a

Not provided in affidavit. Figures from Inspection Committee Report incorporated.


*Data is difficult to be separated into General Hospitals and District hospitals and figures
under District Hospital reflect both combined.
** Figures appear lower than new registrations because most of Hospitals have not
report data.

591

10. REHABILITATION FOR PERSONS WITH MENTAL ILLNESS


a. Government residential rehabilitation/longstay facilities : No and description:17
b. Government day care/outdoor rehabilitation facilities: No and description: 0
c. Government run half-way homes: No and description. If none, plans to establish
and details: NIL
d. NGO participation in the half way homes:
e. Longstay rehabilitation facilities: No and description; NGO participation: NIL
As per the IC report, the Punjab government has established 22 rehabilitation centres in the
state (? For drug de-addiction).
11. MENTAL HEALTH CARE IN OTHER COMMUNITY FACILITIES
State Level, in the Govt Sector
5.1. No of shelter homes, observation homes,
special homes and childrens homes
5.2. No of counsellors trained in mental
health in the above institutions
5.3. No of protection homes for destitute
women
5.4. No of counsellors trained in mental
health in the above institutions
5.5. No of old age homes
5.6. No of counsellors trained in mental
health in the above institutions
5.7. No of Central Jails and District Jails in the
State
5.8. No of counsellors trained in mental
health in the above institutions
5.9.No of counsellors trained in mental health
in the above institutions

N
15
0
1
0

Helplines for Mental Health: 104 Medical helpline


COMMENT: Mental Health Care in community facilities appears non-existent

592

12. MENTAL HEALTH HUMAN RESOURCES


Mental Health Care Professionals

6.1. No of
Psychiatrists
6.2. No of Clinical
Psychologists
6.3. No of
Psychiatric Social
Workers
6.4. No of nurses
trained in mental
health
6.5. No of trained
counselors

COMMENT:

Government
Psychiatric
Sector medical
medical
colleges/hospitals colleges
31

Private
Practice

Total

31

12

12

24

24

12

12

28

28

While there are relatively more mental health professionals in the State

compared to other states, human resources for mental health relative to the population are
very low.
7. MENTAL HEALTH HUMAN RESOURCE DEVELOPMENT
7.1. Degree/Diploma Courses
In Entire state, Annual No of
Seats in

Institutions where the Programme is offered

MD Psychiatry

11

Government Medical Colleges-Amritsar, Faridkot


& Patiala; Dayanand Medical College, Ludhiana

DNB Psychiatry
Diploma in Psychiatry
PhD Clinical Psychology
MPhil Clinical Psychology
PhD Psychiatric Social Work
MPhil Psychiatric Social Work
PhD Psychiatric Nursing
MSc Psychiatric Nursing
BSc Psychiatric Nursing
Basic Diploma in Psychiatric
Nursing (DPN)

9
0
0
0
0
0
0
5
0
0

593

COMMENT: Less than 10% of Medical Colleges are offering Post-Graduation in Psychiatry.
There is huge scope of increasing PG seats in Medical colleges. Training in other mental health
specialties is grossly inadequate.
7.2. Other training in mental health: 2 day training for GDMOs
7.2.a. Details of Undergraduate MBBS training in psychiatry: No data provided
7.2.b. Details of in-service training for Govt medical officers (No trained, duration)
2 day training; nearly 258 trained till date.
7.2.c. Any other training courses in mental health offered by the state
None
8. GOVERNANCE:
8.1. Nodal Authority and responsibilities : Dr Sukhwinder Kaur (State Programme Officer:
01722602128)
8.2. Presence of a State Mental Health Plan: None
8.3. Enactment of State Mental Health Rules: No information
8.4. Oversight of policies and Programmes related to mental health:
8.5. Specific oversight of the DMHP programme. Only implemented in 3 districts. Is reported to
have been fully implemented. Planned in 10 more districts.
COMMENT: Amritsar Mental Hospital had pioneered in community involvement in Mental
Health care. However, the current scenario appears to be not so good. The fact that State has
been unable to provide sought information in many areas quoting report awaited from
other govt. agencies speaks about the coordination between various Govt. Departments.
12. OVERALL SUMMARY OF STATE LEVEL MENTAL HEALTH SERVICES
There is requirement of both Out-Patient and In-patient services to be extended. The
presence of approximately 2 Medical Colleges in each district can be utilized to extend these
services and also for introducing PG courses in Mental Health.

594

SECTION 2
2.1. PSYCHIATRIC INSTITUTIONS
No information provided on affidavit. Data from Inspection Committee Report has been
utilised in this section.
Name and a para on status in 2008 (refer to NHRC book Mental Health Care and Human
Rights)
Institute of Mental Health, Amritsar
Domains

Status in 2008

Infrastructure

The Punjab Government


transferred the administrative
control of the hospital to
Punjab Health Systems
Corporation in the year 2000.
A new building has come up
with all the amenities and
become operational
since 2003.
The old Mental hospital has
been demolished and the
surplus handed over to the
government and the loan
repaid to the government

Developments since
2008
Geriatric ward
Forensic Ward

The hospital reports that


the geysers meant to heat
up the water were installed
by the Construction Agency
in a defective condition.
However all the geysers
were serviced and
repaired. Patients now
have hot water facility in
the winter months

Amenities and facilities

Financial arrangements
Diet

The new kitchen


complex uses
gas as fuel and
meets all standards
of hygiene.
The patients are
provided bed tea,
breakfast,
595

lunch, evening
tea and dinner
with food meeting
nutritional
standards. Kheer
is served twice a week with
daily
lunch including a
seasonal fruit.

Investigations and treatment


Staff and training

Supportive services
Recreation/Occupational
therapy/Rehabilitation
Networking with other
agencies
SERVICES

No teaching post has been


filled. Staff appears to be
inadequate for number of
beds. There are 4 DNB
seats per year; however
the quality of training with
only 4 Medical Officers
with PG in Psychiatry
remains questionable.

IMPROVED

Partial

i. Outpatient: available
ii. Inpatient: available. There are 17 deaths reported in a year and medical comorbidity has
been listed to be nil. There is need to review data collection process. According to the report
submitted to the IC, there are 237 patients with stay greater than one year and 178 with a
stay more than 5 years. 44 of them are destitute.
iii. DIAGNOSTICS AND THERAPEUTICS

Investigations: available
Therapeutic facilities: Rehabiltational facilities are partially available. Medications in
the hospital are adequate.
Improvements in rehabilitation: Some improvement

vii. TRAINING

Post-graduate training 4 DNB Seats/annum

596

ix. Any monitoring of hospital (internal or external)- 3 visits by Principal secretary Health and 5
visits by Director, PHSC in 2 years.
Notices were received from the NHRC regarding two inpatient deaths. The replies were sent
to these notices.
xii. Summary and Recommendations from SECTION 2:
Areas of positive change
Areas of poor progress
High standards of cleanliness and sanitation Staff needs to be strengthened
Rehabilitation needs to be strengthened
Good kitchen services
IC Report- The IC was satisfied with the cleanliness and maintenance of the hospital. Kitchen
services were hygienic. The IC recommended the shifting of recovered destitute patients to
more suitable accommodation. Records were noted to be wll maintained, but it was
recommended that they be digitised. Food was of good quality. Toilets were well maintained.
There were recreational facilities for patients. TVs were provided but not working in 2 of the
wards.
SECTION 3
3. General Hospital Departments of Psychiatry and District Hospital Departments
The broad outline for this section:
3.1. Names of GH/DH and their location.
S. No
1
2
3
4
5
6
7
8
9
10
11
12
13
14

Name
Civil Hospital
District Hospital
Civil Hospital
Civil Hospital
Civil Hospital
Civil Hospital
Rajindra Hospital
Civil Hospital
District Hospital
Civil Hospital
Civil Hospital
Civil Hospital
Civil Hospital
Civil Hospital

Location
Amritsar
Firozpur citry
Hoshiarpur
Moga
Nagar
Pathankot
Patiala
Rajeshpura
Taran taran
Malout
Balachaur
Abohar
Barnala
Faridkot
597

3.2. Areas (distribution throughout the states): Well distributed.


3.3. Whether separate funding and adequacy: Psychiatry Departments not funded separately
3.4. Whether OP/IP and emergency services available: Highly variable.
3.5. Diagnostic categories in rank order that present in the outpatient
3.6. Adequacy of OP facilities: Highly variable
3.7. Inpatient occupancy, free and paying beds, average cost of inpatient stay per week; rank
order of diagnostic categories: Highly variable
3.12. Psychotropic medication: Available at some places
3.13. ECTs :Wherever exists, it is Modified. High variability in usage.
3.14. Observations of extent to which counselling and psychotherapy are provided
3.15. Whether disability certification is available : Available at some places
3.16. Extent and nature of community involvement: Highly variable
3.17. Whether engagement with the DMHP and extent: Some places
3.18. Nature and partnership with NGOs for networking
3.19. Presence of PG training- whether adequately distributed throughout the state: Only 3
centres have PG in Psychiatry.
3.25. SUMMARY AND RECOMMENDATIONS WITH RESPECT TO SECTION 3:
There is huge variability not only in terms of existence of Psychiatry Services, but also
utilization rates. In some hospitals, only 2 emergency cases had been seen in a year; and in
others more than hundred. In-patient admissions also show such inconsistency across
settings.
OPD services show more consistency. Being availed in good numbers, wherever existing.
It appears that only 5-6 of these hospitals have dependable Mental Health Services.

598

SECTION 4
4. NGOS WORKING IN MENTAL HEALTH:
8 NGOs have been said to be working on Mental Health, but no further information is
available. One NGO-Red Cross Deaddiction has been named in affidavit. Pingalwada society
has been said to be providing community mental health care in Amritsar.
4.8. SUMMARY AND RECOMMENDATIONS FOR SECTION 4
The detailed information on NGOs needs to be captured by State.
SECTION 5
5. DISTRICT MENTAL HEALTH PROGRAMME
5.1. A brief description of the location of the DMHP, when it started, total population covered:
Is said to be fully implemented in 3 districts and proposed in 10 more districts. No further
information has been provided.

599

SECTION 6
6. SUMMARY OF MENTAL HEALTH CARE INDICATORS IN Punjab
6.1. Availability of mental health facilities

Mental health outpatient


facilities in the state
Day treatment facilities
Psychiatric beds in general
hospitals
Community residential facilities
Beds/places in community
residential facilities
Psychiatric hospitals
Beds in psychiatric hospitals

Total No of
facilities/beds
89

Rate per 100,000


population
0.32

83

0.30

16

0.06

8
418

0.03
1.50

Rate per 100,000


population
212.03

Females %

6.2. Access to Care

Persons treated in mental


health outpatient facilities
Persons treated in mental
health day care facilities
General hospital admissions
Community residential facilities
Persons staying in community
residential facilities at the end
of the year
Admissions to mental hospitals

4.31
-

0.38

6.3. Information Systems

Persons with mental


disorders treated in
primary health care
Interventions delivered
in primary health care

Data on No of
persons/activities
collected and reported
YES/NO
Y

Data on age and


gender are collected
and reported
YES/NO
Y

Data on patients
diagnosis are collected
and reported
YES/NO
Y

600

for persons with


mental disorders
Persons treated in
mental health
outpatient facilities
Contacts in mental
health day treatment
facilities
Admissions in general
hospitals with
psychiatric beds
Admissions in mental
hospitals
Days spent in mental
hospitals
Admissions in
community residential
facilities

6.4. Human Resources at the State Level


Health professionals working
in the mental health sector
Rate per 100,000
Psychiatrists
Medical doctors not specialised
in psychiatry
Clinical Psychologists
Psychiatric Social Workers
Psychiatric Nurses
Occupational therapists
Other health workers

0.11

Training of health
professionals in educational
institutions
Rate per 100,000
0.06

0.01
0.08
-

0
0
0.014

6.5. INFORMAL HUMAN RESOURCES (Family and User Associations) No Information


6.6. MEDICINES
Type of Medication
All psychotropic medication
Mood stabilisers
Antipsychotics
Anxiolytics
Antidepressants
Anti-craving medication/ Substitution
treatments

Availability
Variable across facilities
Variable across facilities
Variable across facilities
Variable across facilities
Variable across facilities

601

SECTION 7
1. STATE MENTAL HEALTH REPORT CARD
SUMMARY OF SECTIONS 1-7.
Summary of areas where state has achieved good progress/little progress/no progress
MENTAL HEALTH REPORT CARD (needs to be revised after all the information is obtained)
Area

Focus

Parameters

Mental Health
Services
(Secondary
and Tertiary)

Medical
College
Depts,
General
Hospitals,
Specialised
psychiatric
hospitals

Adequacy of inpatient
beds
Functional Departments
Functional OP services

Primary
Health Care
mental health
services

District
Mental
Health
Programme

% of functional DMHPs

Rehabilitation
services

At all levels

Vocational training, day


care, longstay facilities in
govt sector/ppp

602

Rating

100- present, fully


satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100 All districts
covered; fully
satisfactory
75 majority of
districts covered
and functioning
50 half the
districts covered
and functioning
25 one-fourth of
the districts
covered and
functioning
0- No districts
covered/although
DMHP exists, not
functioning
100- present, fully
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat

Score
(out of
100)
50

12.5

25

Specialised
services

Services for
substance
use
disorders,
old age,
mental
retardation,
child
psychiatry,
community
services,
forensic
services
(exclude
DMHP staff
here)

Whether existing, level of


functionality, present at
different levels of care

Human
Resources

Financing for
mental health

State level

Existence of separate
budget for mental
health/mental health
activities

Governance
and Policy

State
Mental

Separate Mental Health


Nodal Officer

Adequacy of
psychiatrists/clinical
psychologists/psychiatric
social
workers/psychiatric
nurses or mental health
trained nurses

603

satisfactory
25 present,
unsatisfactory
0- absent
100- present, fully
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent

100 fully
adequate
75 moderately
adequate
50 somewhat
adequate
25- inadequate
0 grossly
inadequate
10% -separate
budget, fully
adequate
75 separate
budget,
moderately
adequate
50 separate
budget,
somewhat
adequate
25 no separate
budget, but some
financial
resources
available annually
0 no separate
budget/marginal
financial resource
allocation
100 Existing,
fully functional

25

25

25

25

Health
Authority
and other
authorities

Functioning Mental
Health Authority
Nodal persons for mental
health in SHRC/Legal
Services
Authority/Others
State Mental Health
Rules
State Mental Health
Programme
Range of medications
Regular supply and
dispensing
Standard procurement
arrangements

Availability of
psychiatric
medication

At every
level

Affirmative
action for
persons with
mental illness

At every
level

Disability assessment
Pension
Travel concession
Health insurance
Special assistance
Educational benefits
Job reservation

10

Treatment
Gap

Overall

Approximate number of
persons with mental
illness approximate
numbers totally receiving
treatment in the state

Total Score (out of 1000)


Average Score (%)

75- Existing,
mostly functional
50- Existing,
somewhat
functional
25- Partial
0 Non existent

100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100 no
treatment gap
75 25%
treatment gap
50 -50%
treatment gap
25 -75%
treatment gap
0- 100%
treatment gap

25

25

25

262.5
26.3%

604

RECOMMENDATIONS:
The State of Punjab needs to prepare a systematic mental health plan based on the
estimation of mental health problems in the State. Although there are a large number of
medical colleges, and all have departments, the number of post graduate training seats is
extremely low. All mental health human resources need to be increased. While drug
rehabilitation has received attention, the same has not occurred for mental health problems.
DMHP has been fully implemented in only 3 districts and needs to expand to 19 more
districts. All this will not be possible without a coherent, supervised, time bound action plan.

605

RAJASTHAN
SECTION 1. STATE LEVEL REPORT
2. GENERAL INFORMATION REGARDING THE STATE (RAJASTHAN)
a. Area- 342239 sq.kms
b. No of districts- 33
c. Population, age distribution (as per census 2011) 68548437
d. Gender distribution pop(male)-35550997, pop(female)-32997440
e. Life expectancy at birth male and female: Males:61.5, Females:62.3
f. Per capita State Government expenditure on health:302 (2009-10)
g. Any health indicators for the state: Crude Birth Rate25.6; Crude Death Rate6.5;
Infant Mortality Rate47; Sex Ratio926
h. Completeness/quality of information provided: Partially Complete
3. MENTAL ILLNESS BURDEN/ INFORMATION REGARDING MENTAL ILLNESS
N
(prevalence)
2.1. Total number of persons with
mental illness (all ICD categories)

4798390

7%

2.2. Broad categories


2.2.a Severe mental disorders
(BPAD, psychosis)
2.2.b Common mental disorders
2.2.c Substance use disorders
(alcohol and other drugs)
2.2.d Mental Retardation
2.3. No of Males with mental health
problems
2.4. No of females with mental
health problems
2.5. No of children with mental
health problems
2.6. No of elderly with mental health
problems
2.7. No of homeless mentally ill
persons

N
%
(treatment
seeking)
250880
0.36%

Source of
information
Compiled
from various
hospitals.

104659
99220
17799

--------79763
20901
8301
No record

COMMENT:
Nearly 5% of estimated mentally ill persons are under treatment from facilities reporting
data. This may improve if all the information on psychiatric services is consolidated.
606

4. MENTAL HEALTH SERVICES IN THE STATE:


a. Organization of Services (description of number of psychiatric hospitals, medical
college depts, district hospitals)

N/N
3.1.a No of district
general hospitals with
separate department of
psychiatry
3.1.b No of medical
colleges with department
of psychiatry
3.1.c No of district
general hospitals
providing psychiatric care
3.1.d No of District
Mental Health
Programmes in the State

No with dept/facility
Total No of units
7/33

12 medical colleges in the


state and 10 medical
colleges have separate
Department of Psychiatry

% coverage
21%

83.3%

15%
05
3.03%
1/33
N

3.1.e No of government
psychiatric hospitals
3.1.f No of private
psychiatric hospitals
3.1.g Total No of
psychiatric hospitals in
the state
3.1.h No of NGOs
providing mental health
care

02
NA
NA

YES

COMMENT: DMHP exists in only one state. It is not clear why only 5 district hospitals are
providing psychiatric care when 7 have departments of psychiatry.

607

b. INPATIENT SERVICES
DESCRIPTION:

Psychiatric
hospitals
(Govt) N=2

Psychiatric
hospitals
(Private)
N=0

3.2.a. Total I.npatient 395


sanctioned/available
beds
3.2.b No of male
beds
3.2.c. No of female
beds
3.2.d. No of beds for
children
3.2.e. No of beds for
elderly
3.2.f. No of beds for
substance use
disorders
3.2.g. No of beds for
forensic psychiatry
3.2.h. Occupancy (%)
3.2.i. No of
admissions during
previous year
3.2.j. No of
discharges during
previous year
3.2.k. Average
duration of inpatient
stay in days mean
3.2.l. Average
duration of inpatient
stay in days median
3.2.m. No of closed
wards
3.2.n. No of closed
ward beds
3.2.o. No of open
wards
3.2.p. No of open
ward beds

General
Hospitals
N=5

District
Hospitals
N=

NGOs
N=

Total

143

608

3.2.q. No of paid
wards
3.2.r.No of paid beds
3.2.s.No of
admissions through
courts
3.2.t. No of deaths in
the last year
3.2.u. No of suicides
in the last year

COMMENT:
The number of beds available are too low for the population of the State.
c. OUTPATIENT SERVICES

3.3.a. No of new OP
registrations in the
previous year
3.3.b. No of
emergency
attendees in the
previous year
3.3.c Total no of OP
follow-up in the
previous year

Govt.
Psychiatric
hospitals
N=
79427

Private
Psychiatric
hospitals
N=

General
Hospitals

District
Hospitals

NGOs

N=

N=

N=

Total

95484

COMMENT: Information not comprehensively gathered.


*common diagnostic categories in rank order in each of the different facilities
5. REHABILITATION FOR PERSONS WITH MENTAL ILLNESS
a. Government residential rehabilitation/longstay facilities : 0
b. Government day care/outdoor rehabilitation facilities: No and description:0
c. Government run half-way homes: No and description. If none, plans to establish
and details:0
d. NGO participation in the half way homes:Nil
e. Longstay rehabilitation facilities: 0
There are hardly any facilities for rehabilitation.
609

6. MENTAL HEALTH CARE IN OTHER COMMUNITY FACILITIES


State Level, in the Govt Sector
5.1. No of shelter homes, observation homes,
special homes and childrens homes
5.2. No of counsellors trained in mental health in
the above institutions
5.3. No of protection homes for destitute women
5.4. No of counsellors trained in mental health in
the above institutions
5.5. No of old age homes
5.6. No of counsellors trained in mental health in
the above institutions
5.7. No of Central Jails and District Jails in the State
5.8. No of counsellors trained in mental health in
the above institutions
5.9.No of counsellors trained in mental health in
the above institutions

N
0
NIL

NIL
NIL
NIL
36

NA

Helplines for Mental Health: 222216 Helpline in Jalore District


COMMENT: It is of concern that no community facilities are documented which care for
children, elderly and destitute women in the community. No mental health services are
provided in the prisons.
7. MENTAL HEALTH HUMAN RESOURCES
Mental Health Care Professionals

6.1. No of
Psychiatrists
6.2. No of Clinical
Psychologists
6.3. No of
Psychiatric Social
Workers
6.4. No of nurses
trained in mental
health
6.5. No of trained
counselors

Government
Sector medical
colleges/hospitals)
55 (govt hospital
and govt medical
colleges)
07 on contact

Private
Practice

Total

NA

71

NA

08

NA

06

NIL

Psychiatric
medical
colleges
16 in private
medical
college
01 in private
medical
college
05 in private
medical
college
NIL

NIL

NIL

NA

01

610

NA

COMMENT: The lack of mental health nurses is striking. Although the number of psychiatrists
is relatively better than in other states, other health professionals are very few in number.
7. MENTAL HEALTH HUMAN RESOURCE DEVELOPMENT
7.1. Degree/Diploma Courses
In Entire state, Annual No of
Seats in
MD Psychiatry

Institutions where the Programme is offered

24

Dr SN Medical College, Jodhpur, Geetanjali Medical


College & Hospital,Udaipur; Government Medical
College, Kota; Jawaharlal Nehru Medical College,
Ajmer; Mahatma Gandhi Medical College and
Hospital, Jaipur; National Institute of Medical
Science & Research, Jaipur; R N T Medical College,
Udaipu; Sardar Patel Medical College, Bikaner; SMS
Medical College, Jaipur

DNB Psychiatry
Diploma in Psychiatry
PhD Clinical Psychology
MPhil Clinical Psychology
PhD Psychiatric Social Work
MPhil Psychiatric Social Work
PhD Psychiatric Nursing
MSc Psychiatric Nursing

NA
NA
NONE
NONE
NA
NA
NONE
26

BSc Psychiatric Nursing


Basic Diploma in Psychiatric
Nursing (DPN)

NONE
NONE

Upchar College of nursing, Jaipur


Jaipur Hospital college of nursing
Govt College of Nursing, Jaipur
Govt College of Nursing, Bikaner
Institute of Medical technology and Nursing
education
Anapurna Medical Training Institute, Sikar

COMMENT: PG training is present for psychiatry and for MSc PsychiatricNursing.


*Bikaner and Jhalawar Medical College (details not available).
7.2. Other training in mental health
7.2.a. Details of Undergraduate MBBS training in psychiatry: Details NA
7.2.b. Details of in-service training for Govt medical officers (No trained, duration)---NONE,
No plans
611

7.2.c. Any other training courses in mental health offered by the state
None
8. GOVERNANCE:
8.1. Nodal Authority and responsibilities : Dr Pradeep Sharma, 09314623284;
pradeeprameshwar@gmail.com
8.2. Presence of a State Mental Health Plan:None
8.3. Enactment of State Mental Health Rules: Not specified
8.4. Oversight of policies and Programmes related to mental health: None
8.5. Specific oversight of the DMHP programme. Only functional in 1 District (only partially)
8.6. Attempts towards integration of mental health care into general health care, NCD
management etc.: Not evident
8.7. Examples of commitment to develop mental health services (high level involvement,
budgeting, networking: Not evident
8.8. Examples of inter-sectoral collaboration to improve mental health services : None evident
8.9. Attempts towards mental health promotion : None evident
COMMENT: Strengths and weaknesses
Although the total number of Beds and OPD facilities for Mental Health are low, There are
many Medical Colleges in the State which can be upgraded to expand not only patient care
related infrastructure but also the teaching and training. Apart from this, these Medical
Colleges can be helpful in DMHP administration, guidance and training.
9. FINANCING
9.1. Sources of financing of different categories : Not specified
9.2 Budget provision from State and Centre in INR (for different facilities if required): NA
9.3. Mental Health Expenditure as proportion of Total Health Expenditure in State: NA
(If available % spending on Health in the State may also be provided)

612

10. ANY OTHER SIGNIFICANT INFORMATION


There are 8 cases related to Mental Illness pending with State Human Right Commission.
11. INNOVATIONS
State is striving for two NIMHANS like institutes.
11. OVERALL SUMMARY OF STATE LEVEL MENTAL HEALTH SERVICES
Psychiatric services are provided through the 2 government psychiatric hospitals and 10
medical college departments of psychiatry. There is only 1 DMHP. Comprehensive
information has not been gathered regarding psychiatric care through the general and
district hospitals. NGO participation is low. Seats exist for training in psychiatry and MSc
psychiatric nursing, but not for other mental health specialties.
SECTION 2
2.1. PSYCHIATRIC INSTITUTIONS
Mental Hospital, Jaipur
Domains
Infrastructure

Status in 2008
A separate OPD block has
been constructed with
dedicated emergency services
working 24 hours, facilities
for visiting relatives
to stay, a waiting hall for
patients, toilets for patients
and relatives, drinking water,
canteen services, OPD, lab
services.
There is a separate
children's ward with specialised
children's services.
The report mentions
that Rs 2.65 crore has been
received from the National
Mental Health Programme for
upgradation of the hospital for
construction of Family
Psychiatry Ward, dining halls,
hostels for trainees and repairs.
There are new library rooms
613

Developments since 2008


There has been modernisation
and renovation of wards, OPD,
kitchen, and hostels. Inspection
committee has observed
damaged portions in the
hospital requiring repair.

Amenities and facilities

with full time staff.


The report places the current
patient to toilet ratio at 1:8.
There is 24 hour running
water with fans and coolers.
Separate dining facility is under
construction. The report does
not address the suggestion for
better laundry facilities and
hot water facility for winter.
Intercom facility is available
in all rooms wards, OPD
and administrative block.
There is a separate unit for
forensic services with 14
beds

Financial arrangements
Diet

Investigations and treatment

Details of laboratory
investigation
services provided
in the hospital are not
mentioned
in the report.

Staff and training

There are currently 12


psychiatrists,
6 GMOs, 1
PSW, and no trained psychiatric
nurses or CPs.
However there is one CP
working on contract basis
There is 1 occupational
therapist, 1 lab technician,
61 general nurses and 62
ward attenders and peons.

Supportive services
Recreation/Occupational
therapy/Rehabilitation

The report states that IP


rehabilitation services are
available

Networking with other agencies

614

Equipments in the kitchen are


new and adequate, setting is
clean and hygienic.
All medications in essential
drug list are available free of
cost. Laboratory setup is
modern.

There are vacant posts of


clinical psychologist and
psychiatric social workers.

SERVICES
i. Outpatient: Available
ii. Inpatient (improvement in in-patient facilities; any increase in open compared to closed ward
admissions; further reduction in court admissions; improvement particularly in the care of
women, children and elderly; use of disposables needles and syringes; no re-use of shaving
blades; any illness outbreaks and how contained; availability of psychotropic medication
including free medicines; use of ECTs including direct ECT): Modified ECT available.
Diagnostic categories seen:
iii. DIAGNOSTICS AND THERAPEUTICS

Investigations: All drugs and investigations available free of cost


Therapeutic facilities: All drugs and investigations available free of cost
Improvements in rehabilitation:

iv. ENGAGEMENT:

Attempts to involve families of persons with mental illness:Disability certification and number of certificates issued in the previous year:-

v. ADMINISTRATIVE

Annual number of adverse events: 0


Mechanisms for redressal of patient complaints: Not evident

vi. COMMUNITY OUTREACH AND NETWORKING

Community Programmes: 6 DMHP planned from next year.


Networking with external agencies: 3 NGOs
Public mental health education:

vii. TRAINING

Post-graduate training New Programmes, enhancement of seats and measures to


maintain/improve quality of training: 5 MD Psychiatry seats
Any other training Programmes:

vii. RESEARCH:

Research (areas, funding agencies, findings),

615

viii. ANY OTHER SALIENT CONTRIBUTIONS OF THE HOSPITAL/INSTITUTE:


ix. Any monitoring of hospital (internal or external)- By State Mental Health Authority.
x. Special Rapporteurs observation: utilisation certificates are not been promptly sent.
xi. Any other observations (including Inspection Committee Reports): Parts of hospital require
urgent repair. MD seats can be enhanced in view of good number of faculties available.
xii. Summary and Recommendations from SECTION 2:
Areas of positive change
New infrastructure has been created

Areas of poor progress


No teaching post in psychiatric social work,
clinical psychology, psychiatric nursing has
been filled. There are no PG courses except
psychiatry.

Dr. SN Medical College and Psychiatric centre. Mathuradas mathur hospital, Jodhpur
This hospital was not evaluated in 2008 by NHRC.
SERVICES
i. Outpatient: available
ii. Inpatient: MECTs available
Diagnostic categories seen:
iii. DIAGNOSTICS AND THERAPEUTICS

Investigations: Available
Therapeutic facilities: Available
Improvements in rehabilitation:

iv. ENGAGEMENT:

Attempts to involve families of persons with mental illness:


Disability certification and number of certificates issued in the previous year:

v. ADMINISTRATIVE

Annual number of adverse events: 0


Mechanisms for redressal of patient complaints: Not evident
616

vi. COMMUNITY OUTREACH AND NETWORKING

Community Programmes: None


Networking with external agencies: None
Public mental health education: Done

vii. TRAINING

Post-graduate training New Programmes, enhancement of seats and measures to


maintain/improve quality of training: 1 MD psychiatry
Any other training Programmes: Internship for psychology trainees.

vii. RESEARCH:

Research (areas, funding agencies, findings),

viii. ANY OTHER SALIENT CONTRIBUTIONS OF THE HOSPITAL/INSTITUTE:


ix. Any monitoring of hospital (internal or external)- None
x. Special Rapporteurs observation: Mr Ajay Kumar recommended better building
maintenance.
xi. Any other observations (including Inspection Committee Reports): The IC (headed by Shri
Sunil Sharma JS, Ministry of Health and Family Welfare) visited the Psychiatric Centre, Jaipur on
20 June 2015. It observed that there was adequate space, medications are available, there are
supportive lab facilities, the kitchen is hygienic, linen is clean and adequate. The committee
recommended the better maintenance of buildings, increase in rehabilitation and setting up of
half way homes and day care centres with the help of the Department of Social Welfare and
NGOs, deputation of psychiatrists from here to IMH Chennai to observe some of the services
there, enhancing of PG seats, setting up of a legal aid cell, filling up of the posts of clinical
psychologist and psychiatric social worker, awareness programmes on mental illness,
engagement of families.
xii. Summary and Recommendations from SECTION 2:
Areas of positive change
Proposed to be developed as NIMHANS.

Areas of poor progress


There has not been any monitoring of the
hospital in the past. There is no manpower in
disciplines other than psychiatry.

617

SECTION 3
3. General Hospital Departments of Psychiatry and District Hospital Departments
The broad outline for this section:
3.1. Names of GH/DH and their location.
Name

location

R.N.T Medical College and Hospital


Geetanjali Medical and Hospital
TCS Memorial Psychiatric Hospital
Sehag General Hospital
Sanjeevani Hospital
Garg Hospital
General Hospital
Government Medical College and Associate
Group of Hospital
New Medical College and Hospital
Aiims
Sardar Patel Medical College
JLN Medical College and Associate Group of
Hospital
Mahatma Gandhi Medical College
General Hospital
SRG Hospital and Jhalawar Medical College

Udaipur
Udaipur
Ganganagar
Ganganagar
Ganganagar
Ganganagar
Sawai madhopur
Kota
Kota
Jodhpur
Bikaner
Ajmer
Jaipur
Jalone
Jhalawar

3.2. Areas (distribution throughout the states): Well distributed through out the state
3.3. Whether separate funding and adequacy: No separate funding for psychiatry
3.4. Whether OP/IP and emergency services available: OPD available at most places, inpatient
and emergency at few.
3.5. Diagnostic categories in rank order that present in the outpatient: Mostly common mental
disorder
3.6. Adequacy of OP facilities: Adequate
3.7. Inpatient occupancy, free and paying beds, average cost of inpatient stay per week; rank
order of diagnostic categories: Highly variable
3.8. Extent of family involvement
3.9. Measures to protect rights including complaint redressal: Not apparent
618

3.10. Any networking: None


3.11. Staffing details and any shortages/vacancies: Shortage at most places
3.12. Psychotropic medication availability/free/cost: Available free in government hospitals
3.13. ECTs (Nos given across the facilities or average/No of direct ): Available at few centres
3.14. Observations of extent to which counselling and psychotherapy are provided: Variable
practice
3.15. Whether disability certification is available (if available numbers certified/year): Available
at few centres
3.16. Extent and nature of community involvement: Poor
3.17. Whether engagement with the DMHP and extent: Only in Sikar
3.18. Nature and partnership with NGOs for networking: None
3.19. Presence of PG training- whether adequately distributed throughout the state: MD
Psychiatry course is available at 9 centres, however number of seats are low
3.20. Nature of public mental health material prepared and distributed/ activities to educate
3.21. Areas of research, sources of funding and major findings: Mainly PG thesis and
presentations.
3.22. Whether monitored and by whom: None
3.23. Special Rapporteurs observations: Few centres visited where grants for manpower
development were given. Shortage of manpower and inadequacy of funds observed at Jaipur,
Kota.
3.24. Inspection Committees observations: 3.25. SUMMARY AND RECOMMENDATIONS WITH RESPECT TO SECTION 3:
(Overall impressions about the mental health service delivery through the General and District
Hospitals).
1. Plan of strengthening the Department of Psychiatry in Ajmer, Bikaner, Kota, Udaipur and
Jhalawar.

619

2. Jaipur and Jodhpur Medical college ant to expand their department of psychiatry into
National Institute of Mental Health and Neurosciences and Centre of Excellence.
3. The State proposes to upgrade the teaching, training and research institutes such as
Bikaner and Jhalawar Medical colleges in the next 5 years
4. They propose the conversion of their Psychiatric Centre, Jaipur associated with SMS
Medical college , and Psychiatric Centre ,Jodhpur associated with the Jodhpur Medical
College into an autonomous institution in the next 5 years.
All the above proposals are need to be monitored carefully.
SECTION 4
4. NGOS WORKING IN MENTAL HEALTH:
4.1. A brief description of the NGO and its location: TC Sidana Charitable Society,
Shriganganagr
4.2. Nature of work carried out by the NGO in the domains mentioned and details of each:
rehabilitation
4.3. Description of clientele seen by the NGO and number of persons who use the services in
the previous year: patient care services and rehabilitation
4.4. Research details:
4.5. Details of any training carried out by the NGO
4.6. Networking activities of the NGO
4.7. Salient contributions of the NGO
4.8. Special Rapporteurs observations
4.9. Inspection Committees observations
4.8. SUMMARY AND RECOMMENDATIONS FOR SECTION 4
Many more NGOs to be associated with government sector psychiatric facilities.

620

SECTION 5
5.DISTRICT MENTAL HEALTH PROGRAMME ( information in the prescribed format is not
available)

5.1. A brief description of the location of the DMHP, when it started, total population covered:
0NE DISTRICT (SIKAR) WHERE DMHP HAS BEEN INITIATED AND BEING FULLY IMPLEMENTED
5.2. A summary of annual registrations old and new, treatment outcomes in terms of those on
regular treatment and those dropped out, with diagnostic categories if provided. Would be
useful to know what kind of clientele is serviced under the DMHP: approximately 10,000 new
patients and 13,000 old patients.
5.3. Frequency of home visits carried out by the HW/ANM; numbers covered and for what
diagnostic categories, no of admissions facilitated:
5.4. Kinds of essential drugs available, number dispensed, number of patients receiving
medication under the DMHP in a month:
5.5. Duration of untreated mental illness for different diagnostic categories if provided:
621

5.6. Monitoring of the DMHP by the concerned officer /impressions and trouble-shooting
(mention if there is a committee and its composition):
5.7. IEC activities of the DMHP:
5.8. Training calendar of the DMHP (doctors, health workers, nurses, pharmacists, school
teachers/Anganwadi workers (whether any training conducted):
5.9. Activities to sensitize the gram panchayats
5.10. Special Rapporteurs report on the activities of the DMHP, its reach, areas of good
performance, areas of poor performance, barriers for effective service delivery, measures to
streamline functioning, funding flow and barriers thereof: the Programme has been
discontinued
5.11. Inspection Committees observations 5.12. SUMMARY OBSERVATIONS OF DMHP AND RECOMMENDATIONS: only 1 district had
DMHP which is also being discontinued. There is urgent need to look into the administration
of DMHP in the state.
SECTION 6
6. SUMMARY OF MENTAL HEALTH CARE INDICATORS IN RAJASTHAN
6.1. Availability of mental health facilities

Mental health outpatient


facilities in the state
Day treatment facilities
Psychiatric beds in general
hospitals
Community residential facilities
Beds/places in community
residential facilities
Psychiatric hospitals
Beds in psychiatric hospitals

Total No of
facilities/beds
17

Rate per 100,000


population
0.024

0
143

0.21

0
0
2
395

0.003
0.58

622

6.2. Access to Care

Persons treated in mental


health outpatient facilities
Persons treated in mental
health day care facilities
General hospital admissions
Community residential facilities
Persons staying in community
residential facilities at the end
of the year
Admissions to mental hospitals

Rate per 100,000


population
115.9

Females %

0
0

6.35

6.3. Information Systems

Persons with mental


disorders treated in
primary health care
Interventions delivered
in primary health care
for persons with
mental disorders
Persons treated in
mental health
outpatient facilities
Contacts in mental
health day treatment
facilities
Admissions in general
hospitals with
psychiatric beds
Admissions in mental
hospitals
Days spent in mental
hospitals
Admissions in
community residential
facilities

Data on No of
persons/activities
collected and reported
YES/NO
N

Data on age and


gender are collected
and reported
YES/NO
N

Data on patients
diagnosis are collected
and reported
YES/NO
N

623

6.4. Human Resources at the State Level


Health professionals working
in the mental health sector
Rate per 100,000
Psychiatrists
Medical doctors not specialised
in psychiatry
Clinical Psychologists
Psychiatric Social Workers
Psychiatric Nurses
Occupational therapists
Other health workers

0.10
NA

Training of health
professionals in educational
institutions
Rate per 100,000
0.035

0.012
0.009
NA
NA
NA

6.5. INFORMAL HUMAN RESOURCES (Family and User Associations)


Present in the state
No of members
Participation in the
formulation/implementation of
policy/plan/legislation

User
N
N
N

Family
N
N
N

6.6. MEDICINES
Type of Medication
All psychotropic medication
Mood stabilisers
Antipsychotics
Anxiolytics
Antidepressants
Anti-craving medication/ Substitution
treatments

Availability
Available
Available
Available
Available
Available at few centres

MENTAL HEALTH REPORT CARD


Area

Mental Health
Services
(Secondary
and Tertiary)

Focus

Medical
College
Depts,
General

Parameters

Adequacy of inpatient
beds
Functional Departments
Functional OP services
624

Rating

100- present, fully


satisfactory
75- present,
reasonably

Score
(out of
100)
50

Hospitals,
Specialised
psychiatric
hospitals

Primary
Health Care
mental health
services

District
Mental
Health
Programme

% of functional DMHPs

Rehabilitation
services

At all levels

Vocational training, day


care, longstay facilities in
govt sector/ppp

Specialised
services

Services for
substance
use
disorders,
old age,
mental
retardation,
child
psychiatry,
community
services,
forensic
services

Whether existing, level of


functionality, present at
different levels of care

625

satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100 All districts
covered; fully
satisfactory
75 majority of
districts covered
and functioning
50 half the
districts covered
and functioning
25 one-fourth of
the districts
covered and
functioning
0- No districts
covered/although
DMHP exists, not
functioning
100- present, fully
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100- present, fully
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent

25

25

25

Human
Resources

(exclude
DMHP staff
here)

Adequacy of
psychiatrists/clinical
psychologists/psychiatric
social
workers/psychiatric
nurses or mental health
trained nurses

100 fully
adequate
75 moderately
adequate
50 somewhat
adequate
25- inadequate
0 grossly
inadequate

25

Financing for
mental health

State level

Existence of separate
budget for mental
health/mental health
activities

25

Governance
and Policy

State
Mental
Health
Authority
and other
authorities

Availability of
psychiatric
medication

At every
level

Separate Mental Health


Nodal Officer
Functioning Mental
Health Authority
Nodal persons for mental
health in SHRC/Legal
Services
Authority/Others
State Mental Health
Rules
State Mental Health
Programme
Range of medications
Regular supply and
dispensing
Standard procurement
arrangements

10% -separate
budget, fully
adequate
75 separate
budget,
moderately
adequate
50 separate
budget,
somewhat
adequate
25 no separate
budget, but some
financial
resources
available annually
0 no separate
budget/marginal
financial resource
allocation
100 Existing,
fully functional
75- Existing,
mostly functional
50- Existing,
somewhat
functional
25- Partial
0 Non existent

100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory

50

626

25

Affirmative
action for
persons with
mental illness

At every
level

Disability assessment
Pension
Travel concession
Health insurance
Special assistance
Educational benefits
Job reservation

10

Treatment
Gap

Overall

Approximate number of
persons with mental
illness approximate
numbers totally receiving
treatment in the state

Total Score (out of 1000)


Average Score (%)

25
Unsatisfactory
0- Not available at
any level
100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100 no
treatment gap
75 25%
treatment gap
50 -50%
treatment gap
25 -75%
treatment gap
0- 100%
treatment gap

25

25

300
30%

RECOMMENDATIONS: The State of Rajasthan has been making plans to improve psychiatric
facilities and human resources, but it is advisable to make both short and long-term plans and
monitor their implementation. There is a need of a consolidation of the services available and
their coverage; identification and remediation of gaps in service in a time bound manner.

627

SIKKIM
SECTION 1. STATE LEVEL REPORT
1. GENERAL INFORMATION REGARDING THE STATE
1.1. Area: 7096 sq. kms
1.2. No of districts: 4
1.3. Population, age distribution (as per census 2011): Total= 610755

1.4.
1.5.
1.6.
1.7.

0-9 years=99014
10-19 years=133860
20-44 years=264340
45-79 years=107545
80and above=4642
Gender distribution: Males=323070; Females=287507
Life expectancy at birth male and female: Not available.
Per capita State Government expenditure on health:1899 (Third highest in India)
Any health indicators for the state:

Crude Birth Rate 17.1


Crude Birth Rate 5.2
Infant Mortality Rate 22
Sex Ratio 889
Completeness/quality of information provided: Mostly Complete/Partially Complete/Deficient
If deficient, areas of deficiency:
2. MENTAL ILLNESS BURDEN/ INFORMATION REGARDING MENTAL ILLNESS
N
(prevalence)
2.1. Total number of persons with
mental illness (all ICD categories)
2.2. Broad categories
2.2.a Severe mental disorders
(BPAD, psychosis)
2.2.b Common mental disorders
2.2.c Substance use disorders
(alcohol and other drugs)
2.2.d Mental Retardation

42700

2.3. No of Males with mental health


problems
628

N
(treatment
seeking)

Source of
information

2.4. No of females with mental


health problems
2.5. No of children with mental
health problems
2.6. No of elderly with mental health
problems
2.7. No of homeless mentally ill
persons

COMMENT: No figures available. Estimated from agreed figure of 7%.


3. MENTAL HEALTH SERVICES IN THE STATE:
3.1. Organization of Services (description of number of psychiatric hospitals, medical college
depts, district hospitals)
N/N

No with dept/facility
Total No of units

% coverage

3.1.a No of district
general hospitals with
separate department of
psychiatry
3.1.b No of medical
colleges with department
of psychiatry
3.1.c No of district
general hospitals
providing psychiatric care
3.1.d No of District
Mental Health
Programmes in the State

1/4

25%

1/1

100%

3/4

75%

4/4

100%

3.1.e No of government
psychiatric hospitals
3.1.f No of private
psychiatric hospitals
3.1.g Total No of
psychiatric hospitals in
the state
3.1.h No of NGOs
providing mental health
care

0
0

COMMENT: There is no Psychiatric Hospital in the entire State. Also there is no Government
Sector Medical college. Since the terrain is hilly with difficulty in transport, only one district
having Department of Psychiatry cannot cater to entire population. No NGO has been listed
to be working in mental health by the Government.
629

3.2. INPATIENT SERVICES


DESCRIPTION:

Psychiatric
hospitals
(Govt) N=

Psychiatric
hospitals
(Private) N=

3.2.a. Total I.npatient


sanctioned/available
beds
3.2.b No of male beds
3.2.c. No of female
beds
3.2.d. No of beds for
children
3.2.e. No of beds for
elderly
3.2.f. No of beds for
substance use
disorders
3.2.g. No of beds for
forensic psychiatry
3.2.h. Occupancy (%)
3.2.i. No of admissions
during previous year
3.2.j. No of discharges
during previous year
3.2.k. Average
duration of inpatient
stay in days mean
3.2.l. Average
duration of inpatient
stay in days median
3.2.m. No of closed
wards
3.2.n. No of closed
ward beds
3.2.o. No of open
wards
3.2.p. No of open
ward beds
3.2.q. No of paid
wards
3.2.r.No of paid beds
3.2.s.No of admissions
through courts

General
Hospitals
N=

District
Hospitals
N=
20

NGOs
N=

Total

10
10

140%
187 (in
2014)

Range (Min
5-6 Max 30)

630

3.2.t. No of deaths in
the last year
3.2.u. No of suicides in
the last year

3.3. OUTPATIENT SERVICES


Govt.
Psychiatric
hospitals
N=

Private
Psychiatric
hospitals
N=

General
Hospitals

District
Hospitals

NGOs

N=

N=
3752

N=

3.3.a. No of new OP
registrations in the
previous year
3.3.b. No of
emergency
attendees in the
previous year
3.3.c Total no of OP
follow-up in the
previous year

Total

72

4. REHABILITATION FOR PERSONS WITH MENTAL ILLNESS


4.1. Government residential rehabilitation/longstay facilities : No and description: 0
4.2. Government day care/outdoor rehabilitation facilities: No and description: 0
4.3. Government run half-way homes: No and description. If none, plans to establish and
details: 0, NO Plan
4.4. NGO participation in the half way homes:NA
4.5. Longstay rehabilitation facilities: No and description; NGO participation: 0
5. MENTAL HEALTH CARE IN OTHER COMMUNITY FACILITIES
State Level, in the Govt Sector
5.1. No of shelter homes, observation homes,
special homes and childrens homes
5.2. No of counsellors trained in mental
health in the above institutions
5.3. No of protection homes for destitute
women
5.4. No of counsellors trained in mental
health in the above institutions
5.5. No of old age homes
5.6. No of counsellors trained in mental
health in the above institutions
631

N
1
0
0

1
0

5.7. No of Central Jails and District Jails in the


State
5.8. No of counsellors trained in mental
health in the above institutions

2
Weekly visit by
Psychiatrist

Helplines for Mental Health: STNM, Department of Psychiatry helpline (18003453225).


Covers entire state. Up gradation to Crisis Intervention Centre proposed on PPP mode.
6. MENTAL HEALTH HUMAN RESOURCES
Mental Health Care Professionals
Government
Psychiatric
Sector medical
medical
colleges/hospitals colleges

6.1. No of
Psychiatrists
6.2. No of Clinical
Psychologists
6.3. No of
Psychiatric Social
Workers
6.4. No of nurses
trained in mental
health
6.5. No of trained
counselors

Private
Practice
(Licensed
Nursing
Homes)

Total

11

7. MENTAL HEALTH HUMAN RESOURCE DEVELOPMENT


7.1. Degree/Diploma Courses
In Entire state, Annual No of
Seats in
MD Psychiatry
DNB Psychiatry
Diploma in Psychiatry
PhD Clinical Psychology
MPhil Clinical Psychology
PhD Psychiatric Social Work
MPhil Psychiatric Social Work
PhD Psychiatric Nursing
MSc Psychiatric Nursing

Institutions where the Programme is offered

2
0
0
0
0
0
0
0
0

Private Medical college (Sikkim Manipal)

632

BSc Psychiatric Nursing


Basic Diploma in Psychiatric
Nursing (DPN)

0
0

COMMENT:
No pending proposal
7.2. Other training in mental health
One day training for MPHW
7.2.a. Details of Undergraduate MBBS training in psychiatry
COMMENT: Written Nil, needs to be verified
7.2.b. Details of in-service training for Govt medical officers (No trained, duration)
12 Medical officers receive 3 day training per year
7.2.c. Any other training courses in mental health offered by the state
8. GOVERNANCE:
8.1. Nodal Authority and responsibilities :
Medical Education: Dr JK Topagay, additional Director
State Mental Health Authority: Dr PM Pradhan, Director
8.2. Presence of a State Mental Health Plan: None
8.3. Enactment of State Mental Health Rules: No information
8.4. Oversight of policies and Programmes related to mental health: None
8.5. Specific oversight of the DMHP programme. Implemented in all districts. Availability of
medications is a big issue to be addressed. Utilization very low in some districts.
8.6. Attempts towards integration of mental health care into general health care, NCD
management etc.: None
8.7. Examples of commitment to develop mental health services : None
8.8. Examples of inter-sectoral collaboration to improve mental health services (including PPP
intitiatives): None
633

8.9. Attempts towards mental health promotion: None apparent


COMMENT: Strengths and weaknesses: Although implemented in all districts, DMHP needs
special attention. A Psychiatric hospital is required, but not even under consideration.
9. FINANCING
9.1. Sources of financing of different categories:
Private Medical College being self financed. DMHP as per scheme.
Govt. Department of Psychiatry in one of the district hospital is financed by State
Government.
9.2 Budget provision from State and Centre in INR (for different facilities if required): No
information specific to mental health
9.3. Mental Health Expenditure as proportion of Total Health Expenditure in State: Not
available
10. ANY OTHER SIGNIFICANT INFORMATION
Suo-Moto PIL in High Court
There is a stringent act called "Sikkim Anti-Drug act, 2006" aimed to control drug use.
11. INNOVATIONS
12. OVERALL SUMMARY OF STATE LEVEL MENTAL HEALTH SERVICES
Sikkim has very good health infrastructure. However, Mental Health requires further
strengthening particularly Psychiatric Hospital needs to be established/designated. Also PG
training in Mental Health needs to be initiated.
SECTION 2
2.1. PSYCHIATRIC INSTITUTIONS
None
SECTION 3
3. General Hospital Departments of Psychiatry and District Hospital Departments
The broad outline for this section:

634

3.1. Names of GH/DH and their location.


Sir Thuthop Namgyal Memorial Hospital, Gangtok, East Sikkim
3.2. Areas (distribution throughout the states): Gangtok, East Sikkim
3.3. Whether separate funding and adequacy: No separate funding for Psychiatry
3.4. Whether OP/IP and emergency services available:Yes
3.5. Diagnostic categories in rank order that present in the outpatient: Organic Psychiatric
Disorders,Schizophrenia, Bipolar Mood Disorders, Depressive disorders, Substance use
disorders
3.6. Adequacy of OP facilities: Adequate
3.7. Inpatient occupancy, free and paying beds, average cost of inpatient stay per week; rank
order of diagnostic categories
Total beds 20, Bed occupancy 140%, All free beds
Diagnoses: Alcohol & Drug use disorders, Schizophrenia & other psychotic disorders, Biploar
Disorder, Depressive Disorders
3.8. Extent of family involvement: All families educated and counselled. Sometimes involved
in Decision making
3.9. Measures to protect rights including complaint redressal: None
3.10. Any networking: No
3.11. Staffing details and any shortages/vacancies: Psychiatrists 3, Clinical Psychologists 1,
Trained Nurse: 1 (No Psychiatric Social Worker)
3.12. Psychotropic medication availability/free/cost: List does not have any mood stabilizer, all
free
3.13. ECTs (Nos given across the facilities or average/No of direct ): None
3.14. Observations of extent to which counselling and psychotherapy are provided: Claimed to
be provided to all. However, staffing pattern seems inadequate to support this claim.
3.15. Whether disability certification is available (if available numbers certified/year): Yes, 121
3.16. Extent and nature of community involvement: Nil
635

3.17. Whether engagement with the DMHP and extent: All 4 districts
3.18. Nature and partnership with NGOs for networking: None
3.19. Presence of PG training- whether adequately distributed throughout the state: Only 2
seats in Private Medical college
3.20. Nature of public mental health material prepared and distributed/ activities to educate:
Posters
3.21. Areas of research, sources of funding and major findings: Psychological Autopsy of
Suicidal deaths
3.22. Whether monitored and by whom. What were the observations?
3.23. Special Rapporteurs observations3.24. Inspection Committees observations3.25. SUMMARY AND RECOMMENDATIONS WITH RESPECT TO SECTION 3:
Only one Hospital may not be sufficient forentire State. PG training in Mental Health needs to
be initiated.
SECTION 4
NGOS WORKING IN MENTAL HEALTH:
(None reported in Affidavit, however, references of state financing 2 NGO found in a PIL. Also
report by Dr Satish Rasaily ,Singtam Distrirct Hospital ,Sikkim, East also states that 6 NGOs
are involved in Drug Abuse Control work.)
4.1. A brief description of the NGO and its location
4.2. Nature of work carried out by the NGO in the domains mentioned and details of each
4.3. Description of clientele seen by the NGO and number of persons who use the services in
the previous year
4.4. Research details
4.5. Details of any training carried out by the NGO
4.6. Networking activities of the NGO
4.7. Salient contributions of the NGO
636

4.8. Special Rapporteurs observations


4.9. Inspection Committees observations
4.8. SUMMARY AND RECOMMENDATIONS FOR SECTION 4
There is a need to document the work of the NGOs involved in mental health and to enhance
the same to work in different parts of the States.
SECTION 5
5.DISTRICT MENTAL HEALTH PROGRAMME

637

5.1. A brief description of the location of the DMHP, when it started, total population covered:
S. No
1
2
3
4

Location
District Hospital, East
Sikkim
North Sikkim
South Sikkim
District Hospital
Gyalshing, West
Sikkim

Start Date
August 2011

Population covered
281293

December 2012
September 2013

42028
21892
142000

5.2. A summary of annual registrations old and new, treatment outcomes in terms of those on
regular treatment and those dropped out, with diagnostic categories if provided. Would be
useful to know what kind of clientele is serviced under the DMHP:
Total new registrations (All combined): 58
Old Registrations:1601
Regular treatment : less than half
First contact dropout: nearly one-third
Irregular: One-fourth
Diagnosis: Neurosis: more than half, Psychosis: less than 10%, Substance use disorders:
second highest
5.3. Frequency of home visits carried out by the HW/ANM; numbers covered and for what
diagnostic categories, no of admissions facilitated: None in East & West, More than half of all
registrations in North, Some in South
Admissions faciliated in West (mostly Substance use) and South (Mostly epilepsy)
5.4. Kinds of essential drugs available, number dispensed, number of patients receiving
medication under the DMHP in a month:
No antidepressant in East Sikkim, South Sikkim. Only chlorpromazine amongst antipsychotics.
North & West Sikim have drugs for nearly all common indications.
5.5. Duration of untreated mental illness for different diagnostic categories if provided: Less
than 1 month for most categories in East, more than 2 years in North, West and South,

638

5.6. Monitoring of the DMHP by the concerned officer /impressions and trouble-shooting
(mention if there is a committee and its composition): Irregular & erratic funding and
manpower problems identified
5.7. IEC activities of the DMHP: Good to satisfactory
5.8. Training calendar of the DMHP (doctors, health workers, nurses, pharmacists, school
teachers/Anganwadi workers) (whether any training conducted): Regular training but no
refresher training
5.9. Activities to sensitize the gram panchayats: Done
5.10. Special Rapporteurs report on the activities of the DMHP, its reach, areas of good
performance, areas of poor performance, barriers for effective service delivery, measures to
streamline functioning, funding flow and barriers thereof.5.11. Inspection Committees observations5.12. SUMMARY OBSERVATIONS OF DMHP AND RECOMMENDATIONS:
Sikkim has a functioning DMHP in all districts. Underutilisation is a concern and factors apart
from the geographical terrain need to be determined. Drug supply is erratic. Attempts to
improve the functioning are occurring.
SECTION 6
6. SUMMARY OF MENTAL HEALTH CARE INDICATORS IN SIKKIM
6.1. Availability of mental health facilities

Mental health outpatient


facilities in the state
Day treatment facilities
Psychiatric beds in general
hospitals
Community residential facilities
Beds/places in community
residential facilities
Psychiatric hospitals
Beds in psychiatric hospitals

Total No of
facilities/beds
5 (Including
DMHP)

Rate per 100,000


population
0.8

20

0
0
0
0

639

6.2. Access to Care

Persons treated in mental


health outpatient facilities
Persons treated in mental
health day care facilities
General hospital admissions
Community residential facilities
Persons staying in community
residential facilities at the end
of the year
Admissions to mental hospitals

Rate per 100,000


population
620

Females %
NA

0
43
0
0

6.3. Information Systems

Persons with mental


disorders treated in
primary health care
Interventions delivered
in primary health care
for persons with
mental disorders
Persons treated in
mental health
outpatient facilities
Contacts in mental
health day treatment
facilities
Admissions in general
hospitals with
psychiatric beds
Admissions in mental
hospitals
Days spent in mental
hospitals
Admissions in
community residential
facilities

Data on No of
persons/activities
collected and reported
YES/NO
No

Data on age and


gender are collected
and reported
YES/NO
No

Data on patients
diagnosis are collected
and reported
YES/NO
No

No

No

No

Yes

No

Yes

No

No

No

Yes

No

Yes

No

No

No

No

No

No

No

No

No

640

6.4. Human Resources at the State Level


Health professionals working
in the mental health sector
Rate per 100,000
Psychiatrists
Medical doctors not specialised
in psychiatry
Clinical Psychologists
Psychiatric Social Workers
Psychiatric Nurses
Occupational therapists
Other health workers

Training of health
professionals in educational
institutions
Rate per 100,000
0.3

0.18
0
0
0

6.5. INFORMAL HUMAN RESOURCES No information available


6.6. MEDICINES
Type of Medication
All psychotropic medication
Mood stabilisers
Antipsychotics
Anxiolytics
Antidepressants
Anti-craving medication/ Substitution
treatments

Availability
Irregularly available to non-available
Irregularly available to non-available
Irregularly available to non-available
Irregularly available to non-available
Irregularly available to non-available

MENTAL HEALTH REPORT CARD


Area

Focus

Parameters

Mental Health
Services
(Secondary
and Tertiary)

Medical
College
Depts,
General
Hospitals,
Specialised
psychiatric
hospitals

Adequacy of inpatient
beds
Functional Departments
Functional OP services

Primary

District

% of functional DMHPs
641

Rating

100- present, fully


satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100 All districts

Score
(out of
100)
50

75

Health Care
mental health
services

Mental
Health
Programme

Rehabilitation
services

At all levels

Vocational training, day


care, longstay facilities in
govt sector/ppp

Specialised
services

Whether existing, level of


functionality, present at
different levels of care

Human
Resources

Services for
substance
use
disorders,
old age,
mental
retardation,
child
psychiatry,
community
services,
forensic
services
(exclude
DMHP staff
here)

Adequacy of
psychiatrists/clinical
psychologists/psychiatric
social
workers/psychiatric
nurses or mental health
trained nurses
642

covered; fully
satisfactory
75 majority of
districts covered
and functioning
50 half the
districts covered
and functioning
25 one-fourth of
the districts
covered and
functioning
0- No districts
covered/although
DMHP exists, not
functioning
100- present, fully
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100- present, fully
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent

100 fully
adequate
75 moderately
adequate
50 somewhat
adequate
25- inadequate
0 grossly

25

25

25

inadequate

Financing for
mental health

State level

Existence of separate
budget for mental
health/mental health
activities

Governance
and Policy

State
Mental
Health
Authority
and other
authorities

Availability of
psychiatric
medication

At every
level

Separate Mental Health


Nodal Officer
Functioning Mental
Health Authority
Nodal persons for mental
health in SHRC/Legal
Services
Authority/Others
State Mental Health
Rules
State Mental Health
Programme
Range of medications
Regular supply and
dispensing
Standard procurement
arrangements

Affirmative
action for
persons with
mental illness

At every
level

Disability assessment
Pension
Travel concession
Health insurance
643

10% -separate
budget, fully
adequate
75 separate
budget,
moderately
adequate
50 separate
budget,
somewhat
adequate
25 no separate
budget, but some
financial
resources
available annually
0 no separate
budget/marginal
financial resource
allocation
100 Existing,
fully functional
75- Existing,
mostly functional
50- Existing,
somewhat
functional
25- Partial
0 Non existent

25

100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100- Fully
satisfactory
75- Mostly
satisfactory

25

50

25

Special assistance
Educational benefits
Job reservation

10

Treatment
Gap

Overall

Approximate number of
persons with mental
illness approximate
numbers totally receiving
treatment in the state

Total Score (out of 1000)


Average Score (%)

50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100 no
treatment gap
75 25%
treatment gap
50 -50%
treatment gap
25 -75%
treatment gap
0- 100%
treatment gap

25

350
35%

RECOMMENDATIONS:
Sikkim needs to prepare a long-term mental health plan to make mental health services more
comprehensive. It has covered all the districts in the DMHP, but reaching the services to the
people poses a big challenge. The services need to be monitored regularly. There is no
specialised psychiatric facility in the State. A comprehensive time-bound mental health plan,
with multi-sectoral engagement, particularly for rehabilitation, enhancement of human
resources in the non-medical mental health specialites and provision of mental health
services in primary care are needed.

644

TAMIL NADU
SECTION 1. STATE LEVEL REPORT
1. GENERAL INFORMATION REGARDING THE STATE
a. Area: 130060 Sq Km
b. No of districts:32
c. Population, age distribution (as per census 2011): 72147030;
d. Gender distribution: 36137975 males; 36009055 females
e. Life expectancy at birth male and female
f. Per capita State Government expenditure on health
g. Any health indicators for the state (life expectancy, etc)
h. Completeness/quality of information provided: Partially Complete
If deficient, areas of deficiency: Patient information from medical colleges and
general/district hospitals is not complete. DMHP details are not complete.
2. MENTAL ILLNESS BURDEN/ INFORMATION REGARDING MENTAL ILLNESS:
There is no clear data base as to the actual number of mentally ill patients in the state,
since no epidemiological survey has been carried out quantifying the number of
mentally ill.
The affidavit mentions the numbers seen in the IMH and 19 Government run medical
colleges. These are as follows:
Serious Mental Disorders (SMD)

29885

Common Mental Disorders (CMD)

43201

Alcohol and drug abuse

15515

Mental Retardation

NA

Geriatric

NA

Annual Suicides in the State

16927 (2012- NCRB)

Number of homeless mentally ill

220

COMMENT: The rappourteurs report states that TN has 5 lakh SMDs, 42 Lakh CMDs,
30 Lakh patients with alcohol use and other drug abuse, 80,000 with MR, 60,000
elderly with mental health problems, 3,80,000 women with mental health problmes
and 50,000 children with mental health problems.
645

3. MENTAL HEALTH SERVICES IN THE STATE:


a. Organization of Services (description of number of psychiatric hospitals, medical
college depts, district hospitals)

N/N
3.1.a No of district
general hospitals with
separate department of
psychiatry
3.1.b No of medical
colleges with department
of psychiatry
3.1.c No of district
general hospitals
providing psychiatric care
3.1.d No of District
Mental Health
Programmes in the State

16

3.1.e No of government
psychiatric hospitals
3.1.f No of private
psychiatric hospitals
3.1.g Total No of
psychiatric hospitals in
the state
3.1.h No of NGOs
providing mental health
care

No with dept/facility
Total No of units

% coverage

42 (Govt 19, private 23)

27

84%

25

78%

50
51

121

COMMENT: TN has a wide network of psychiatric services. There is only one government
facility, but a huge private psychiatry sector. All the medical colleges have departments of
psychiatry. There is an active NGO Sector.
b. INPATIENT SERVICES
DESCRIPTION: The data is too disparate in order to arrive at meaningful description. The State
will have to focus on consolidating the information, so that a comprehensive picture
emerges.

646

c. OUTPATIENT SERVICES: Data incomplete


However, taking into account the number of patients attending the Institute of Mental Health
and the psychiatric wing of the 19 medical colleges (for which information is provided, out of
42) and the district headquarters hospitals through the DMHP, it is estimated that 1038953
patients (new and follow-up visits) have been seen at public mental health services in the
state of Tamil Nadu, during the year 2014.

4. REHABILITATION FOR PERSONS WITH MENTAL ILLNESS: Given in the summary itself
a. Government residential rehabilitation/longstay facilities : No and description:
b. Government day care/outdoor rehabilitation facilities: No and description:
c. Government run half-way homes: No and description. If none, plans to establish
and details:
d. NGO participation in the half way homes:
e. Longstay rehabilitation facilities: No and description; NGO participation:
5. MENTAL HEALTH CARE IN OTHER COMMUNITY FACILITIES: Given in the summary
itself
Helplines for Mental Health: 104; Helpline operated by Tamil Nadu Health System Project in
collaboration with NGOs SNEHA. Suicide prevention helpline 044-24640050; 044-24640060;
COMMENT: Inadequate. But, since there is no benchmark, it could difficult to assess the
relative adequacy.
6. MENTAL HEALTH HUMAN RESOURCES: Given in the summary.

6.1. No of
Psychiatrists
6.2. No of
Clinical
Psychologists

Government
Sector medical
colleges/hospitals
169

Psychiatric
medical
colleges
69

Private
Practice

29

NR

NOT
Recorded

647

Total

238

6.3. No of
74
Psychiatric Social
Workers
6.4. No of nurses 13988
trained in mental
health
6.5. No of
NOT Recorded
trained
counselors

NR

NOT
Recorded

NR

NOT
Recorded

The staff is inadequate with regards to the community nurse, record keeper, case registry
assistant etc. Mental health practioners in the private sector have not been enumerated.
7. MENTAL HEALTH HUMAN RESOURCE DEVELOPMENT:
7.1. Degree/Diploma Courses
In Entire state, Annual No of
Seats in
MD Psychiatry
DNB Psychiatry
Diploma in Psychiatry
PhD Clinical Psychology
MPhil Clinical Psychology
PhD Psychiatric Social Work
MPhil Psychiatric Social
Work
PhD Psychiatric Nursing
MSc Psychiatric Nursing
BSc Psychiatric Nursing
Basic Diploma in Psychiatric
Nursing (DPN)

Institutions where the Programme is offered

43
3
14
NR
20
NR
NR

Details not Recorded


Details not Recorded
Details not Recorded

NIL
3
311
20

Private Sector

Details not Recorded


Details not Recorded
Details not Recorded

COMMENT:
Tamil Nadu is in the process of increasing seats in three medical colleges. Beyond this, there
is no other information available
7.2. Other training in mental health
7.2.a. Details of Undergraduate MBBS training in psychiatry: Given in summary itself

648

7.2.b. Details of in-service training for Govt medical officers (No trained, duration)
1253 have been trained under the DMHP
7.2.c. Any other training courses in mental health offered by the state
Training Paramedical staff under the DMHP
8. GOVERNANCE:
8.1. Nodal Authority and responsibilities : State Mental health authority, Dy Director of
Medical Education (H and D), Chennai; Additional Director of Medical and Rural Health
Services, Chennail, District legal Services Authority, Commissioner for welfare of Differently
abled
8.2. Presence of a State Mental Health Plan: NO
8.3. Enactment of State Mental Health Rules: NO
8.4. Oversight of policies and Programmes related to mental health:
8.5. Specific oversight of the DMHP programme. 25 districts have DMHP fully implemented;
the details are very inadequate to comment further
8.6. Attempts towards integration of mental health care into general health care, NCD
management etc.: NONE
8.7. Examples of commitment to develop mental health services (high level involvement,
budgeting, networking: NONE
8.8. Examples of inter-sectoral collaboration to improve mental health services (including PPP
intitiatives): NONE
8.9. Attempts towards mental health promotion: NONE mentioned
9. FINANCING: The Psychiatric institution and Medical Colleges are adequately funded..
10. ANY OTHER SIGNIFICANT INFORMATION (e.g. litigation, insurance schemes for persons
with mental illness, pension and other assistance, job reservations): NONE
11. INNOVATIONS: NONE mentioned.
In the COMMENTS, the observations of the Special Rapporteur or the high level committees
visit to the states may be incorporated

649

12. OVERALL SUMMARY OF STATE LEVEL MENTAL HEALTH SERVICES


Mental health services in the state: 16 district hospitals having separate dept of psychiatry;
42 medical colleges (govt and private). All these have separate department of psychiatry; The
state has 169 psychiatrists, 29 clinical psychologists and 74 psychiatric social workers in the
govt sector. Also, there are 28 sanctioned programme officers, 16 sanctioned psychiatric
social workers, 16 psychiatric nurses in the state. 13988 nurses have been trained in
psychiatry. 6589 of these trained nurses are posted for psychiatric services. TN offers 43 MD,
3 DNB and 14 DPM seats annually. 20 Mphil Clinical Psychology seats exist. Regarding data on
Mphil in PSW, the affidavit says data awaited. 311 BSc psychiatric nursing seats are offered
each year. 2741 inservice govt medical officers have been training in psychiatry in the year
before submitting the affidavit in the court. 16 Medical colleges provide undergraduate
training in psychiatry. Govt supports 27 NGO run old age homes in the state. TN has one
residential and rehabilitation/long stay facility. Additionally, TN has 33 Govt halfway as well
as long stay homes. TN has a duly constituted State Mental Health authority, but there is no
state mental health plan.
SECTION 2
2.1. PSYCHIATRIC INSTITUTIONS
Name and a para on status in 2008 (refer to NHRC book Mental Health Care and Human
Rights):
Domains
Infrastructure

Status in 2008

Developments since 2008


OPD, IPD and 24 emergency
services; new administrative
block

Amenities and facilities


Financial arrangements
Diet

From State Govt


Provides at the rate of Rs 40
per day

Investigations and treatment


Staff and training
Supportive services
Recreation/Occupational
therapy/Rehabilitation
Networking with other
agencies

Present
Networking with other
agencies present

SERVICES

650

i. Outpatient: 10,599 annual new cases and 1,36,223 follow-up.


ii. Inpatient: Average stay 67 days in closed ward, 12 days in open ward. Large number of
long-stay (733 with a stay more than one year and 551 more than 5 years)
Diagnostic categories seen: All ICD 10 categories
iii. DIAGNOSTICS AND THERAPEUTICS

Investigations: Available
Therapeutic facilities: Available
Improvements in rehabilitation:NONE mentioned. The report to the IC mentions the
presence of a Day Hospital and a long-stay rehabilitation facility at the IMH.

iv. ENGAGEMENT: Referral to nearby medical colleges and DMHP. The IMH is mentioned in
the IC report as the nodal centre for the TN DMHP.

Attempts to involve families of persons with mental illness: Almost always involved
Disability certification and number of certificates issued in the previous year:30

v. ADMINISTRATIVE

Annual number of adverse events: NONE


Mechanisms for redressal of patient complaints: Could not be made out in the affidavit

vi. COMMUNITY OUTREACH AND NETWORKING

Community Programmes: Although the affidavit says yes, there is no mention of


details. The form submitted to the IC mentions that there is an active outreach. The
IMH collaborates with Anbagam for the long-term care of destitute patients and with
Shraddha, an NGO from Maharashtra for rehabilitation of improved patients from
other states admitted by court orders.
Networking with external agencies: NO
Public mental health education: Yes, all India Radio, TV

vii. TRAINING

Post-graduate training NO new Programmes


Any other training Programmes: NONE

vii. RESEARCH:

Research (areas, funding agencies, findings),


651

viii. ANY OTHER SALIENT CONTRIBUTIONS OF THE HOSPITAL/INSTITUTE:


ix. Any monitoring of hospital (internal or external)- details
x. Special Rapporteurs observation: Observations mentioned above; some improvement in
the last visit, but it is difficult to decipher clearly as there is no benchmark.
xi. Any other observations (including Inspection Committee Reports): The IC visited the IMH
Chennai on 12 June 2015. The IC, headed by Shri NB Dhali JS, MOHFW noted that there was
adequate space in the hospital; Rehabilitation facilities were adequate; Medicines were
easily available; ECT use had decreased; Recreational facilities were adequate; Bathroom and
toilets were clean; Visitors Committee was in place; a legal aid centre had been established;
social welfare officers were working in the OPD; OPD was well ventilated; There were no
suicides in the previous year; Academic training was active; Disability pension was a welcome
move.
The IC recommended adequate funds for maintenance and repair; maintenance of heritage
structures; increase in the diet charges; increase in the rehabilitation in view of the long-stay
patients; vacancies to be filled in a time-bound manner;risk allowance to the staff to be
increased to 10% of basic pay; mosquito netting to prevent vector-borne diseases;
sanctioning of one more psychiatry unit as patient number was high and courses in clinical
psychology, psychiatric social work and psychiatric nursing to be initiated.
xii. Summary and Recommendations from SECTION 2:
Areas of positive change
Rehabilitation
Facilities improved

Areas of poor progress

PRIVATE PSYCHIATRIC INSTITUTIONS


A list of 50 institutions which provide mental health services is mentioned in the affidavit.
However, the details of patients seen in the outpatient and inpatient settings, adequacy of
infrastructure and functioning are not provided. Many of these provide care for addiction
related problems.

652

SECTION 3
3. General Hospital Departments of Psychiatry and District Hospital Departments
The broad outline for this section: has 30 medical colleges and 14 district hospitals with
psychiatric services. Majority of them have IP facilities, all have OP Psychiatric facilities. Many of
them have 24 hrs emergency services. Most of them have adequate psychotropic medications
available.. Taluk level hospitals don not contain psychiatric services, except for a few. The
district psychiatrists visit these taluk centres. Manpower could improve to cover first the dist
hospitals. Financing appear to be reasonable.
3.1. Names of GH/DH and their location.
1
2
3
4
5
6
7
8
9

10
11
12
13
14

15

Madras Medical
College, Chennai
Government Stanley
Medical College
Govt Kilpauk Medical
College Hospital
Govt Rajaji Hospital
Madurai
Thanjavur Medical
College
Tirunelveli Medical
College
Chengalpattu Medical
College,
Coimbatore Medical
College Hospital
Govt Dharmapuri
Medical College
Hospital
KAP Vishwanathan
Govt medical College
Vellore Medical College
Kanyakumari Govt
Medical College
Govt Theni Medical
College Hospital
Govt Thoothukudi
Medical College
Hospital
General Thiruvarur

Rajiv Gandhi Govt General Hospital Chennal

GHPU

Govt Stanley Medical College; Chennai-1

GHPU

Poonamallee High Road, Kilpauk, Chennai-10


Dept of Psych; Madurai Medical College,
Madurai, TN

GHPU

Thanjavur, 613004

GHPU

Tirunelveli

GHPU

GST road, Chengalpattu

GHPU

Coimbatore 641018

GHPU

Dharmapuri

GHPU

Tiruchy
Vellore

GHPU
GHPU

Kanyakumari
Govt Theni Medical College and Hospital,
Shanmuganathapuram, K. Vilaku, Theni Dist

GHPU

Thoothukudi
Thiruvarur

GHPU
GHPU
653

GHPU

16

17
18

19

20

Medical College
Hospital
Govt Villupuram
Medical College
Hospital
Govt Sivagangai
Medical College,
Govt Mohan
Kumaramangalam
Medical College
Hospital,
Thiruvannamalai
Medical College,
Thiruvannamalai
IRTMC

Mundiambakkam, Villupurum

GHPU

Sivagangai

GHPU

Salem 636001

GHPU

Thiruvannamalai
Perundurai

GHPU
GHPU

Filled forms have been provided only for 13 of the 20 medical colleges (65%):
Thanjavur Medical College
Govt Rajaji Hospital Madurai
Tirunelveli Medical College
Chengalpattu Medical College,
Coimbatore Medical College Hospital
Govt Dharmapuri Medical College Hospital
Kanyakumari Govt Medical College
Govt Mohan Kumaramangalam Medical College Hospital,
Govt Sivagangai Medical College,
Govt Thoothukudi Medical College Hospital
Mahathma Gandhi Memorial hospital attached to KAPV Govt Medical College
Govt Villupuram Medical College Hospital
Christian Medical College, Dept of Psychiatry (Many details are reportedly given through separate
enclosures; not able to locate them however in the document)

To get a comprehensive picture, it is important to obtain the remaining information.


District Hospitals:
The affidavit lists 27 government district hospitals providing psychiatric care. These include the
DH at Kancheepuram, Nagapattinam, Erode, Tiruchy at Manapari, Ramanathapuram, Theni at
Periyakulam, Thiruvallore, Cuddalore, Virudhanagar, Thiruvarur at Mannargudi, Peramballur,
Namakkal, Kanyakumari at Padmanabhapuram, Madurai at Usilampatti, Tiruppur, Dindigul,
654

Pudukkotai, Karur, Salem at Mettur, Nilgiris, Villuparum at Kallakuruchi, Krishnagiri, Tirunelveli


at Tenkasi, Sivagangai at Karaikudi, Ariyalur and Coimbatore at Tiruppur.
Forms have been returned from 15 of the 27 DH (56%). The State must aim to get the
information from all the districts in order to get a comprehensive information of mental health
services at the District Level, which forms an important location for mental health care.
SECTION 4
4. NGOS WORKING IN MENTAL HEALTH: TN has many NGOs, working in the area of
Mental Health.. however, networking and collaboration between govt and NGOs
needs to improve. At an individual level, the NGOs are doing good work in certain
cities.. they need to percolate throughout the state and the state govt needs to
facilitate the process.
Tamil Nadu lists 121 NGOs as providing mental health services, perhaps one of the
largest and well-organised in the country.
List provided includes the following:
The Banyan/BALM Chennai
SNEHA Chennai
SCARF Chennai
TTK Foundation
Soumanasya Hosp
Miracle Foundation
New Deepam Foundation
Recovery Home Foundation
Rathna Mental Health Center
Asdharikum Annai Care Centre
Valli Care Foundation
Ashram Foundation
Dr Fernandez home for schizophrenia
Sugam Foundation
United Home for adult mentally ill
Manasu
Putholi Health care Nursing Home
Holistic rehabilitation centre
MS Chellamuthu Trust
Navjeevan-YWCA Chennai
AASHA Chennai
Uduvam Karangal Chennai
Oxford Charitable Trust Kanchipuram
Subitcham Madurai
Shantivanam Trust Trichy
Addiction treatment centres
655

Miracle Foundation
St. Josephs Mercy Home
NALAM DRC
Moonshine DRC
Liberty Care Centre
Wisdom Hospital
Vidiyal Foundation
MS De-addiction cum Rehailitation Centre
Many other NGOs not listed.
Detailed forms have been submitted by The Banyan, St Josephs Mercy Home De-Addiction
Centre, Moonshine De-Addiction cum Rehabilitation Centre, Nalam Foundation De-Addiction
Centre, Sowmanasya Hospital, Miracle Foundation, New Deepam Foundation, Wisdom Hospitl
De-Addiction cum Rehabilitation Centre, Vidiyal Foundation De-Addiction Centre, RHF,
Rathna MHC, Aadharikum Annai Care Centre, Valli Care Foundation Trust, MS De-Addiction
cum Rehabilitation centre, Ashram Foundation, Dr Fernandez Home for Schizophrenia, Sugam
Foundation, The United Home for the Adult Mentally Ill, Manasu, Putholi Health Care Nursing
Home, Holistic Rehab Care, MS Chellamuthu Trust and Research Foundation,.

4.1. A brief description of the NGO and its location-see table


4.2. Nature of work carried out by the NGO in the domains mentioned and details of each-see
table
4.3. Description of clientele seen by the NGO and number of persons who use the services in
the previous year-see table
4.4. Research details-see table
4.5. Details of any training carried out by the NGO-see table
4.6. Networking activities of the NGO-see table
4.7. Salient contributions of the NGO-see table
The Banyan/BALM Chennai

Care, training and research in schizophrenia


MH care for homeless, residential care, training,
advocacy and research; lobbying for disability cards with
MSW; night shelter in collaboration with city
corporation, collaboration with Pudhu Vazhu Thittam, a
state govt initiative also focusing on mental health
treatment and prevention, engagement with Puzhal
Central Jail from 2009, Transit care centre for homeless;
long-term care through assisted housing/collaboration
with IMH Chennai, Human Rights Cell, Vocational
training, research projects with Grand Challenges Canada

656

Soumanasya Hosp
Miracle Foundation

New Deepam Foundation


Recovery Home Foundation
Rathna Mental Health Center
Asdharikum Annai Care Centre
Valli Care Foundation
Ashram Foundation
Dr Fernandez home for schizophrenia
Sugam Foundation
United Home for adult mentally ill
Manasu
Putholi Health care Nursing Home
Holistic rehabilitation centre
MS Chellamuthu Trust

Addiction treatment centres


St. Josephs Mercy Home
NALAM DRC
Moonshine DRC
Liberty Care Centre
Wisdom Hospital
Vidiyal Foundation
MS De-addiction cum Rehailitation Centre

(NALAM- well-being approach using community based


workers, exploring alternative living options to
institutionalization); Ratan Tata Trust(alcohol use study);
training and internships; involvement with mental health
policy
Suicide prevention
Alcohol and drug de-addiction, training
Counseling, Rehabilitation
Counseling, legal and social assistance, residential care,
rehabilitation, after care, home based programmes
Counseling, social assistance, residential care,
rehabilitation, aftercare
All aspects except legal assistance and home based
Counseling, residential and aftercare
-doAll aspects
All aspects except home based care
Counseling, residential care, rehabilitation, aftercare
All aspects except legal assistance and home based
Residential care, rehabilitation and aftercare
Counseling, residential care, rehabilitation, home-based
care
All except rehabilitation and home based care
All except legal assistance and home based care
All aspects. Offer services to rural population. Have
created grass root mental health volunteers at the village
level to anchor mental health services. Organize mental
health camps. With MANASA (District Mentally Disabled
Welfare Agency), DMHP and Subitcham (Family
Fellowship for Mentally Retarded and Mentally Ill),
Mental Health Literacy Campaigns, Legal Assistance
through Legal Aid Clinic, Disability certification,
Counseling to juvenile home and vigilance home, social
assistance under MGNREGS and income generation,
short stay, half way and long term care homes,
vocational rehabilitation and community based
rehabilitation, research

Counseling, residential care, rehabilitation, aftercare


-do- and legal and social assistance
Counseling
All aspects
All aspects
All aspects
All aspects

Many other NGOs not listed


SNEHA Chennai
SCARF Chennai
TTK Foundation
Navjeevan-YWCA Chennai
AASHA Chennai
Uduvam Karangal Chennai
Oxford Charitable Trust Kanchipuram

657

Subitcham Madurai
Shantivanam Trust Trichy

4.8. Special Rapporteurs observations: 4.9. Inspection Committees observations: 4.8. SUMMARY AND RECOMMENDATIONS FOR SECTION 4
Tamil Nadu has a considerable number of NGOs working in the area of mental health and
substance abuse. Areas of work include: Care, training and research in schizophrenia, MH care for
homeless, residential care, training advocacy and research; lobbying for disability cards with MSW;
night shelter in collaboration with city corporation, collaboration with Pudhu Vazhu Thittam, a state
govt initiative also focusing on mental health treatment and prevention, engagement with Puzhal
Central Jail from 2009, Transit care centre for homeless; long-term care through assisted
housing/collaboration with IMH Chennai, Human Rights Cell, Vocational training, research projects
training and internships; involvement with mental health policy, Suicide prevention, Alcohol and drug
de-addiction, training, Counseling, Rehabilitation, legal and social assistance, rehabilitation, after care,
home based programmes, grass root mental health volunteers at the village level to anchor mental
health services, mental health camps with MANASA (District Mentally Disabled Welfare Agency),
DMHP and Subitcham (Family Fellowship for Mentally Retarded and Mentally Ill), Mental Health
Literacy Campaigns, counseling to juvenile home and vigilance home, social assistance under
MGNREGS and income generation, short stay, half way and long term care homes, vocational
rehabilitation and community based rehabilitation, research

SECTION 5
5.DISTRICT MENTAL HEALTH PROGRAMME: There is a separate nodal officer is there for the
state. it is successfully running in 25 out of the 32 districts.. Each district under DMHP has
psychiatrist, clinical psychologist and psychiatric social worker.
The DMHP has been implemented in 16 districts (Trichy, Ramanathapuram, Madurai,
Kanyakumari, Theni, Dharmapuri, Erode, Nagapattinam, Kancheepuram, Thiruvallur, Cuddalore,
Perambalur, Virudhanagar, Thiruvarur, Namakkal, Chennai).
Forms have been returned from 26 districts. Questionnaire filled contains either patient data
for 1 month or no data; medication supply adequate.

658

Each district has not consolidated and submitted the district level information
The State has not consolidated all the district information to provide a consolidated report of
DMHP functioning thus allowing a critical appraisal of the adequate functioning of the DMHP in
the State.
5.1. A brief description of the location of the DMHP, when it started, total population covered:
5.2. A summary of annual registrations old and new, treatment outcomes in terms of those on
regular treatment and those dropped out, with diagnostic categories if provided. Would be
useful to know what kind of clientele is serviced under the DMHP:

659

5.3. Frequency of home visits carried out by the HW/ANM; numbers covered and for what
diagnostic categories, no of admissions facilitated:
5.4. Kinds of essential drugs available, number dispensed, number of patients receiving
medication under the DMHP in a month:
5.5. Duration of untreated mental illness for different diagnostic categories if provided:
5.6. Monitoring of the DMHP by the concerned officer /impressions and trouble-shooting
(mention if there is a committee and its composition):
5.7. IEC activities of the DMHP:
5.8. Training calendar of the DMHP (doctors, health workers, nurses, pharmacists, school
teachers/Anganwadi workers (whether any training conducted):
5.9. Activities to sensitize the gram panchayats
5.10. Special Rapporteurs report on the activities of the DMHP, its reach, areas of good
performance, areas of poor performance, barriers for effective service delivery, measures to
streamline functioning, funding flow and barriers thereof.
5.11. Inspection Committees observations
5.12. SUMMARY OBSERVATIONS OF DMHP AND RECOMMENDATIONS:
It is surprising that Tamil Nadu has not provided all the detailed information on its District
Mental Health Programme. In 2013, the Programme underwent external evaluation by the
Centre for Public Health, Dept of Epidemiology, NIMHANS. The Report mentions that in Tamil
Nadu, a majority of the districts have a mental health activity plan and a district level
overseeing committee. Each district has a dedicated budget head for mental health activities.
Outpatient services are reported to be universally available. Inpatient facilities are available
in each district headquarters. Basic psychotropic medications are reported to be available at
district and taluk hospitals and PHCs. Social assistance and welfare measures are undertaken
on a Programme based or need based approach. IEC material is available in the local language
in a majority of districts. External evaluation of the DMHPs has been undertaken in nearly
50% of the districts in the past decade.

660

SECTION 6
6. SUMMARY OF MENTAL HEALTH CARE INDICATORS IN TAMIL NADU
6.1. Availability of mental health facilities:

Mental health outpatient


facilities in the state
Day treatment facilities
Psychiatric beds in general
hospitals

Total No of
facilities/beds
546

Rate per 100,000


population
1.3/100,000 population

Details not
adequate
Details not
adequate

Community residential facilities

Details not
adequate

Beds/places in community
residential facilities

Details not
adequate

Psychiatric hospitals

Details not
adequate

Beds in psychiatric hospitals

Details not
adequate

6.2. Access to Care

Persons treated in mental


health outpatient facilities

Rate per 100,000


population
Details not
adequate

Persons treated in mental


health day care facilities

Details not
adequate

General hospital admissions

Details not
adequate

Community residential facilities

Details not
adequate

Persons staying in community


residential facilities at the end

Details not

661

Females %

of the year

adequate

Admissions to mental hospitals

Details not
adequate

6.3. Information Systems

Persons with mental


disorders treated in
primary health care
Interventions delivered
in primary health care
for persons with
mental disorders
Persons treated in
mental health
outpatient facilities
Contacts in mental
health day treatment
facilities
Admissions in general
hospitals with
psychiatric beds
Admissions in mental
hospitals
Days spent in mental
hospitals
Admissions in
community residential
facilities

Data on No of
persons/activities
collected and reported
YES/NO
Details not adequate

Data on age and


gender are collected
and reported
YES/NO

Data on patients
diagnosis are collected
and reported
YES/NO

Details not adequate

Details not adequate

Details not adequate

Details not adequate

Details not adequate


Details not adequate
Details not adequate

6.4. Human Resources at the State Level


Health professionals working
in the mental health sector
Rate per 100,000
Psychiatrists

0.4 per 100,000 adult


population

662

Training of health
professionals in educational
institutions
Rate per 100,000
Details not adequate

Medical doctors not specialised


in psychiatry
Clinical Psychologists

Details not adequate

Details not adequate

Details not adequate

Details not adequate

Psychiatric Social Workers

Details not adequate

Details not adequate

Psychiatric Nurses

Details not adequate

Details not adequate

Occupational therapists

Details not adequate

Details not adequate

Other health workers

Details not adequate

Details not adequate

6.5. INFORMAL HUMAN RESOURCES (Family and User Associations)


Present in the state

User
Details not adequate

Family
Details not adequate

No of members

Details not adequate

Details not adequate

Participation in the
formulation/implementation of
policy/plan/legislation

Details not adequate

Details not adequate

6.6. MEDICINES
Type of Medication
All psychotropic medication

Expenditure at State level per year and per


100,000 population (inINR)
Details not adequate

Mood stabilisers

Details not adequate

Antipsychotics

Details not adequate

Anxiolytics

Details not adequate

Antidepressants

Details not adequate

Anti-craving medication/ Substitution


treatments

Details not adequate

663

SECTION 7
7. STATE MENTAL HEALTH REPORT CARD
SUMMARY OF SECTIONS 1-7.
Summary of areas where state has achieved good progress/little progress/no progress
Area

Focus

Parameters

Mental Health
Services
(Secondary
and Tertiary)

Medical College
Depts, General
Hospitals,
Specialised
psychiatric
hospitals

Adequacy of
inpatient beds
Functional
Departments
Functional OP
services

Primary Health
Care mental
health services

District Mental
Health Programme

% of functional
DMHPs

Rehabilitation
services

At all levels

Vocational training,
day care, longstay
facilities in govt
sector/ppp

Specialised

Services for

Whether existing,
664

Rating
100- present, fully
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100 All districts
covered; fully
satisfactory
75 majority of
districts covered and
functioning
50 half the districts
covered and
functioning
25 one-fourth of
the districts covered
and functioning
0- No districts
covered/although
DMHP exists, not
functioning
100- present, fully
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100- present, fully

Score (out
of 100)
50

75

25

25

services

substance use
disorders, old age,
mental
retardation, child
psychiatry,
community
services, forensic
services

level of
functionality,
present at different
levels of care

Human
Resources

(exclude DMHP
staff here)

Financing for
mental health

State level

Adequacy of
psychiatrists/clinica
l
psychologists/psyc
hiatric social
workers/psychiatri
c nurses or mental
health trained
nurses
Existence of
separate budget
for mental
health/mental
health activities

Governance
and Policy

State Mental
Health Authority
and other
authorities

Separate Mental
Health Nodal
Officer
Functioning Mental
Health Authority
Nodal persons for
mental health in
SHRC/Legal
Services
Authority/Others
State Mental
Health Rules
665

satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100 fully adequate
75 moderately
adequate
50 somewhat
adequate
25- inadequate
0 grossly
inadequate
10% -separate
budget, fully
adequate
75 separate
budget, moderately
adequate
50 separate
budget, somewhat
adequate
25 no separate
budget, but some
financial resources
available annually
0 no separate
budget/marginal
financial resource
allocation
100 Existing, fully
functional
75- Existing, mostly
functional
50- Existing,
somewhat
functional
25- Partial
0 Non existent

50

50

50

Availability of
psychiatric
medication

At every level

Affirmative
action for
persons with
mental illness

At every level

10

Treatment Gap

Overall

State Mental
Health Programme
Range of
medications
Regular supply and
dispensing
Standard
procurement
arrangements

Disability
assessment
Pension
Travel concession
Health insurance
Special assistance
Educational
benefits
Job reservation
Approximate
number of persons
with mental illness
approximate
numbers totally
receiving
treatment in the
state

Total Score (out of 1000)


Average Score (%)

100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25 Unsatisfactory
0- Not available at
any level
100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25 Unsatisfactory
0- Not available at
any level
100 no treatment
gap
75 25% treatment
gap
50 -50% treatment
gap
25 -75% treatment
gap
0- 100% treatment
gap

75

25

25

450
45.0

RECOMMENDATIONS:
A lot of information has been collected by Tamil Nadu. The State has demonstrated that it is
indeed possible to collect such information. However, as evident, there are basic gaps- there
is no consolidaton of the information of patients seen in the medical colleges/GH/DH; DMHP
patient details are not comprehensive and consolidated; there is no consolidated count of the
psychiatrists available (private sector not mentioned at all), other mental health
professionals. Details of the patients catered to by the large number of private institutions
(numbering 50) has not been obtained.Thus the State must now make an attempt to
consolidate this information and then compare the resources and the needs and on that basis
draw up a comprehensive mental health plan. Despite these lacunae, Tamil Nadu is a State
where there is a lot of activity for mental health occurring in the government sector. As many
of the efforts in Tamil Nadu are worth replicating, it is important for the State to undertake
this effort more comprehensively.
666

TELEGANA
SECTION 1. STATE LEVEL REPORT

1. GENERAL INFORMATION REGARDING THE STATE


1.1. Area: 114840 sq kms
1.2. No of districts: 10
1.3. Population, age distribution (as per census 2011): 3,51,93978
1.4. Gender distribution: Males: Females:
1.5. Life expectancy at birth:
1.6. Per capita State Government expenditure on health:
1.7. Any health indicators for the state
Item

State

India

Infant Mortality Rate ( SRS 2013)

NR

40

Maternal Mortality Rate (SRS 2010-12)

NR

178

Total Fertility Rate (SRS 2012)

NR

2.4

Sex Ratio (Census 2011)

NR

940

The Extent of Mental Health Problems in the State: Source of information from mental
health institute and DMHP running in districts:
1.7.Completeness/quality of information provided: Deficient
If deficient, areas of deficiency: Much of the information is also incomplete in many
areas. NO information related to DMHPs. All forms related to DMHPs are left blank.

667

2. MENTAL ILLNESS BURDEN/ INFORMATION REGARDING MENTAL ILLNESS:


1800000 based on a Minisurvey at Shankarpally.
However, this is likely to be an underestimate.
3. MENTAL HEALTH SERVICES IN THE STATE:
Organization of Services (description of number of psychiatric hospitals, medical college depts,
district hospitals)
The Affidavit is almost entirely based on the information from the IMH Erragadda, Hyderabad.
Medical Colleges with Dept of Psychiatry-11 (Information received from Govt General hospital,
Nizamabad, MGM hospital Warrangal) -2/11 (18%)
District Hospitals with Dept of Psychiatry=5 (Information received from DH, Khammam, DH
Sangareddy, DH Nalgonda, Dh Mahboobnagar, DH Adilabad)
3.1.

INPATIENT SERVICES

DESCRIPTION:The following table gives details of the in-patient services of the


psychiatric institutes as well as the GHPUs of Telengana.

Psychiatric
hospitals
(Govt) N=1
3.2.a. Total
Inpatient
sanctioned/available
beds
3.2.b No of male
beds
3.2.c. No of female
beds
3.2.d. No of beds for
children

3.2.e. No of beds for


elderly
3.2.f. No of beds for
substance use

Psychiatric
hospitals
(Private)
N=

600

General
Hospitals
N=

District
Hospitals
N=5

Incomplete 25
130+

300
300
NA (Ward
available in
Niloufer
Hospital)
NA
20

668

NGOs
N=

Total

disorders
3.2.g. No of beds for
forensic psychiatry
3.2.h. Occupancy
(%)
3.2.i. No of
admissions during
previous year
3.2.j. No of
discharges during
previous year
3.2.k. Average
duration of
inpatient stay in
days mean
3.2.l. Average
duration of
inpatient stay in
days median
3.2.m. No of closed
wards
3.2.n. No of closed
ward beds
3.2.o. No of open
wards
3.2.p. No of open
ward beds
3.2.q. No of paid
wards
3.2.r.No of paid
beds
3.2.s.No of
admissions through
courts
3.2.t. No of deaths
in the last year
3.2.u. No of suicides
in the last year
Facilities

NA

4134

11 days

2
0

Psychiatric Institutions: IMH Erragadda Hyderabad.


GHPUs: Information received only for two.
669

3.2.

OUTPATIENT SERVICES*
Govt.
Psychiatric
hospitals
N=1

Private
Psychiatric
hospitals
N=

3.3.a. No of new
8990
OP registrations in
the previous year
3.3.b. No of
emergency
attendees in the
previous year
3.3.c Total no of OP 126880
follow-up in the
previous year

General
Hospitals

District
Hospitals

NGOs

Mentioned
for 2
2000
1272

Mentioned N=
for 3
2400
1035
2322

Total

1000

4800
10749

500
793
5600

COMMENT: IMH Erragada, Hyderabad has been a teaching institute since 1984.
4. REHABILITATION FOR PERSONS WITH MENTAL ILLNESS
4.1. Government residential rehabilitation/longstay facilities : NONE
4.2. Government day care/outdoor rehabilitation facilities: No and description: NONE
4.3. Government run half-way homes: No and description. If none, plans to establish
and details: NONE
4.4. NGO participation in the half way homes: NOT AVAILABLE
4.5.
Longstay rehabilitation facilities: No and description; NGO participation: 6 of
them are being run with the help of NGOs
An expert committee was set up to advice on the re-integration of patients with their families
and make appropriate arrangements for those who are destitute.
5. MENTAL HEALTH CARE IN OTHER COMMUNITY FACILITIES
State Level, in the Govt Sector
5.1. No of shelter homes, observation homes,
special homes and childrens homes
5.2. No of counsellors trained in mental
health in the above institutions

670

N
NR
NR

5.3. No of protection homes for destitute


women
5.4. No of counsellors trained in mental
health in the above institutions
5.5. No of old age homes

NR
NR
NR

5.6. No of counsellors trained in mental


NR
health in the above institutions
5.7. No of Central Jails and District Jails in the
NR
State
5.8. No of counsellors trained in mental
NR
health in the above institutions
5.9.No of counsellors trained in mental health NR
in the above institutions
Helplines for Mental Health: (Nature of helpline, who runs it, for whom, any information on
its utilization): NIL
COMMENT: According to an earlier affidavit dated 31.1.2014, the Erragada hospital was
providing mental health services to the PHC at Shankarpally, Old age home in Bansilalpet,
Secunderabad, Aaramgarh Home for destitute, Shivaramapally and Central Prison at
Chanchalguda, Hyderabad.
6. MENTAL HEALTH HUMAN RESOURCES
Mental Health Care Professionals
Government
Sector medical
colleges/hospitals
64

6.1. No of
Psychiatrists
6.2. No of
1
Clinical
Psychologists
6.3. No of
0
Psychiatric Social
Workers
6.4. No of nurses 80
trained in mental
health
6.5. No of
0
trained
counselors
3 NGOs providing mental health care.

Psychiatric
medical
colleges
14
5

671

Private
Practice

Total

COMMENT: Information deficient


7. MENTAL HEALTH HUMAN RESOURCE DEVELOPMENT
7.1. Degree/Diploma Courses
P G Centres in Psychiatry
MD Seat in Psychiatry in Govt. Medical Colleges
6 (total)
DPM Seats in Psychiatry in Govt. Medical Colleges 2
MD Seat in Psychiatry in Pvt. Medical Colleges
NA
DPM Seat in Psychiatry in Pvt. Medical Colleges
NA
DNB (Psychiatry)
0
Clinical Psychologists
Nil
PSW
Nil
Nursing
Nil
COMMENT: Very few number of seats for Psychiatry. No post graduate training in other
mental health disciplines.
7.2. Other training in mental health
400 staff of DMHP were trained in the previous year. No other information is available.
7.2.a. Details of Undergraduate MBBS training in psychiatry
Name of
medical college

No of hours of
theory

Duration of
psychiatry
posting during
UG

Duration of
psychiatry
posting during
internship

Qualifying
Examination
includes
competency
evaluation in
psychiatry

All medical
25 hours
15 days
15 days
colleges
COMMENT: Theory hours are lower than what is prescribed by the MCI.
7.2.b. Details of in-service training for Govt medical officers (No trained, duration)
NO DETAILS available
7.2.c. Any other training courses in mental health offered by the state
8. GOVERNANCE:
8.1. Nodal Authority and responsibilities : Additional Director, Mental Health, Directorate of
Health Services
672

8.2. Presence of a State Mental Health Plan: NO


8.3. Enactment of State Mental Health Rules: NO
8.4. Oversight of policies and Programmes related to mental health:
8.5. Specific oversight of the DMHP programme.
DMHP has been initiated fully in 12 districts. However, NO information about DMHP is
available
8.6. Attempts towards integration of mental health care into general health care, NCD
management etc.
NO
8.7. Examples of commitment to develop mental health services (high level involvement,
budgeting, networking
8.8. Examples of inter-sectoral collaboration to improve mental health services (including PPP
intitiatives)
NONE
8.9. Attempts towards mental health promotion
NONE
COMMENT:
Most of the mental health service activities are related to those provided by the IMH,
Hyderabad. The service dimensions of the medical colleges is unclear.
No information has been provided regarding the DMHPs.
9. FINANCING
9.1. Sources of financing of different categories NR
9.2 Budget provision from State and Centre in INR (for different facilities if required) NR
9.3. Mental Health Expenditure as proportion of Total Health Expenditure in State NR
10. ANY OTHER SIGNIFICANT INFORMATION (e.g. litigation, insurance schemes for persons
with mental illness, pension and other assistance, job reservations) Disability certification is
being done at some of the district hospitals.
673

11. INNOVATIONS
NONE
12. OVERALL SUMMARY OF STATE LEVEL MENTAL HEALTH SERVICES
Despite there being several medical colleges, there are few seats in psychiatry and lack of
courses for other mental health disciplines. The State must examine the possibility of
augmenting its mental health human resources. Information on psychiatric service delivery
must be obtained from the medical colleges and private psychiatric facilities in order to plan
services for the future. Rehabilitation requires strengthening. It is heartening to note that in
some district hospitals, disability certification is being routinely done.

SECTION 2
2.1. PSYCHIATRIC INSTITUTIONS- IMH Erragadda, Hyderabad
Domains
Infrastructure

Status in 2008

Amenities and facilities

Financial arrangements

Grant for modernization

Diet
Investigations and treatment
Staff and training

Developments since 2008


A separate prisoners ward
was constructed by
APMSIDC in 2008-2009 with
plinth area of 1110 sq m at
the cost of 2.1 crore.
Adequate amenities are
provided
Rights of patients are
displayed
COE- 2010

Available
Many staff vacancies in
Psychiatry, hardly any
faculty positions in the
other disciplines

Supportive services
Recreation/Occupational
therapy/Rehabilitation
Networking with other
agencies

Recreation present but no


vocational rehabilitation
Outreach present.

674

SERVICES
i. Outpatient: 372 average daily outpatient attendance, 8990 new registrations, 126880 followup
ii. Inpatient 600 beds, 4134 annual admissions; Mean duration of stay 11 days; 19 patients
staying more than 1 year, 2 more than 5 years
Diagnostic categories seen: All ICD-10 categories.
iii. DIAGNOSTICS AND THERAPEUTICS

Investigations: Yes
Therapeutic facilities: Medications available, counselling provided
Improvements in rehabilitation: No

iv. ENGAGEMENT:

Attempts to involve families of persons with mental illness:Disability certification and number of certificates issued in the previous year: -

v. ADMINISTRATIVE

Annual number of adverse events: Nil


Mechanisms for redressal of patient complaints: 30 complaints received in the last year
pertaiing to non-functioning of electrical equipment, water supply problems, food
quality and security related. All resolved.

vi. COMMUNITY OUTREACH AND NETWORKING

Community Programmes: NONE


Networking with external agencies: NONE
Public mental health education: NONE

vii. TRAINING: only 6 PG seats in psychiatry

Post-graduate training new Programmes, enhancement of seats and measures to


maintain/improve quality of training:
Any other training Programmes: NO

vii. RESEARCH: NONE

Research (areas, funding agencies, findings),

675

viii. ANY OTHER SALIENT CONTRIBUTIONS OF THE HOSPITAL/INSTITUTE:


ix. Any monitoring of hospital (internal or external)- Two visits by NHRC. SMHA still not
created.
x. Special Rapporteurs observation: Visited by Dr KS Chalam.He expressed concern about
landgrabbing of the area in which the hospital is located. He also expressed concern regarding
the vacancies. The problems of effective management by the security personnel was also
brought up. The issues with respect to the need for rehabilitation were flagged. Lack of a
compound wall to te premises was brought up. Something needed to be done about the long
distances patients had to walk from one facility to another. Food was sufficient. Furniture
needed reapairs. Some of the toilets were not clean and the outsourcing agencies had not
done the job properly. The Director of the Institute had suggested a separate cadre of
hospital management. The PG programme is run under the Osmania Medical College,
Hyderabad.
xi. Any other observations (including Inspection Committee Reports): None specific
xii. Summary and Recommendations from SECTION 2:
Areas of positive change
Areas of poor progress
Upgradation as COE
Rehabilitation
Modernisation of Dept of Child Psychiatry
Lack of day care facility
at Niloufer Hospital
Lack of NGO participation
Involvement in DMHP (Medak)
SECTION 3
19. General Hospital Departments of Psychiatry and District Hospital Departments
Information is incomplete.
The broad outline for this section:
3.1. Details
3.2. Areas (distribution throughout the states): distributed throughout the state
3.3. Whether separate funding and adequacy: no separate funding is available for these. Some
of them have got one time grant in aid under NMHP during the year 2006-07
3.4. Whether OP/IP and emergency services available: yes, apart from one district hospital, all
other facilities have emergency services available.
3.5. Diagnostic categories in rank order that present in the outpatient: all ICD 10 categories are
being seen
676

3.6. Adequacy of OP facilities: Yes, they all have separate outpatient departments. Most of
them have half of facilities such as waiting halls, toilets, separate interview rooms, drinking
water facilities, canteen facilities, OPD and OP rehab facilities. Educational facilities are
inadequate in the majority. Also, most of them do not have special clinics
3.7. Inpatient occupancy, free and paying beds, average cost of inpatient stay per week; rank
order of diagnostic categories:
3.8. Extent of family involvement: Nearly always involved
3.9. Measures to protect rights including complaint redressal: Most of them do not have the
patient rights displayed
3.10. Any networking: Majority of them DO NOT have any networking
3.11. Staffing details and any shortages/vacancies: These are manned by psychiatrists, general
duty medical officers, clinical psychologists, psychiatric social workers and nurses. However,
there seem to be inadequate number of mental health professionals particularly
psychologists and social workers
3.12. Psychotropic medication availability/free/cost: Yes, a variety of them are available free of
cost.
3.13. ECTs (Nos given across the facilities or average/No of direct ): YES, about 400 given in the
previous year in mental health institute. All of them were modified ECTs.
3.14. Observations of extent to which counselling and psychotherapy are provided: Psychoeducation is provided to all, psychotherapy is provided to some
3.15. Whether disability certification is available (if available numbers certified/year): NO
medical board in mental health institute.
3.16. Extent and nature of community involvement: Some outreach occurring in half of these
facilities.
3.17. Whether engagement with the DMHP and extent: As mentioned earlier, the district
hospitals contain psychiatric facilities only in those where DMHP is running.
3.18. Nature and partnership with NGOs for networking: Very few. Details mentioned above in
summary
3.19. Presence of PG training- whether adequately distributed throughout the state: NO,
grossly inadequate
677

3.20. Nature of public mental health material prepared and distributed/ activities to educate:
NO information is available
3.21. Areas of research, sources of funding and major findings: None to be noted
3.22. Whether monitored and by whom. What were the observations?
3.23. Special Rapporteurs observations: 3.24. Inspection Committees observations: 3.25. SUMMARY AND RECOMMENDATIONS WITH RESPECT TO SECTION 3:
Detailed information about the emergency, outpatient, inpatient facilities and other services
available to patients need to be obtained from ALL medical colleges, GHPUs and district
hospitals.
SECTION 4
20. NGOS WORKING IN MENTAL HEALTH:
4.1. A brief description of the NGO and its location: NO DETAILS
4.2. Nature of work carried out by the NGO in the domains mentioned and details of each:
4.3. Description of clientele seen by the NGO and number of persons who use the services in
the previous year
4.4. Research details:
4.5. Details of any training carried out by the NGO:
4.6. Networking activities of the NGO:
4.7. Salient contributions of the NGO:
4.8. Special Rapporteurs observations: 4.9. Inspection Committees observations: -

678

4.8. SUMMARY AND RECOMMENDATIONS FOR SECTION 4


There is a need to document the presence and work of NGOs. IMH Erragadda mentions that
no NGO is formally involved.

SECTION 5
5. DISTRICT MENTAL HEALTH PROGRAMME: as already mentioned above, DMHP is
present in 12 districts and their description is NOT present in the affidavit. The special
rapporteur report mentions that DMHP is not taken seriously in some places as most
of the doctors and staff are appointed on contract basis and there is discrimination in
pay and work load. Salaries are delayed because of delay in release of grants. There
are two doctors in the scheme- one a well-paid government doctor who does little
work in this scheme and the other who has much work with less pay. The SR report
mentions that it is difficutly to get a trained psychiatrist, especially when one leaves.

679

5.1. A brief description of the location of the DMHP, when it started, total population covered:
5.2. A summary of annual registrations old and new, treatment outcomes in terms of those on
regular treatment and those dropped out, with diagnostic categories if provided. Would be
useful to know what kind of clientele is serviced under the DMHP:
5.3. Frequency of home visits carried out by the HW/ANM; numbers covered and for what
diagnostic categories, no of admissions facilitated:
5.4. Kinds of essential drugs available, number dispensed, number of patients receiving
medication under the DMHP in a month:
5.5. Duration of untreated mental illness for different diagnostic categories if provided:
5.6. Monitoring of the DMHP by the concerned officer /impressions and troubleshooting(mention if there is a committee and its composition):
5.7. IEC activities of the DMHP:
5.8.Training calendar of the DMHP (doctors, health workers, nurses, pharmacists, school
teachers/Anganwadi workers (whether any training conducted):
5.9. Activities to sensitize the gram panchayats
5.10. Special Rapporteurs report on the activities of the DMHP, its reach, areas of good
performance, areas of poor performance, barriers for effective service delivery, measures to
streamline functioning, funding flow and barriers thereof.
5.11. Inspection Committees observations
5.12. SUMMARY OBSERVATIONS OF DMHP AND RECOMMENDATIONS:
There are very few details mentioned about the DMHP to be able to provide a coherent
summary.
SECTION 6
6. SUMMARY OF MENTAL HEALTH CARE INDICATORS
6.1. Availability of mental health facilities
Total No of
facilities/beds
Mental health outpatient
facilities in the state
680

Rate per 100,000


population

Day treatment facilities


Psychiatric beds in general
hospitals
Community residential facilities
Beds/places in community
residential facilities
Psychiatric hospitals
Beds in psychiatric hospitals

160

0.4 per 100000

Rate per 100,000


population

Females %

6.2. Access to Care

Persons treated in mental


health outpatient facilities
Persons treated in mental
health day care facilities
General hospital admissions
Community residential
facilities
Persons staying in
community residential
facilities at the end of the
year
Admissions to mental
hospitals
6.3. Information Systems: NO INFORMATION AVAILABLE
Data on No of
persons/activities
collected and reported
YES/NO

Data on age and


gender are collected
and reported
YES/NO

Persons with mental


disorders treated in
primary health care
Interventions delivered
in primary health care
for persons with
mental disorders
Persons treated in
mental health
outpatient facilities
Contacts in mental
681

Data on patients
diagnosis are collected
and reported
YES/NO

health day treatment


facilities
Admissions in general
hospitals with
psychiatric beds
Admissions in mental
hospitals
Days spent in mental
hospitals
Admissions in
community residential
facilities

YES

YES

YES

YES

6.4. Human Resources at the State LevelHealth professionals working


in the mental health sector
Rate per 100,000
Psychiatrists
Medical doctors not specialised
in psychiatry
Clinical Psychologists
Psychiatric Social Workers
Psychiatric Nurses
Occupational therapists
Other health workers

Training of health
professionals in educational
institutions
Rate per 100,000

0.22

0.02
0.02
0.24

6.5.INFORMAL HUMAN RESOURCES (Family and User Associations) NO INFORMATION


AVAILABLE
User

Family

Present in the state


No of members
Participation in the
formulation/implementation of
policy/plan/legislation

682

6.6. MEDICINES: NO INFORMATION AVAILABLE


Type of Medication

Expenditure at State level per year and per


100,000 population (inINR)

All psychotropic medication


Mood stabilisers
Antipsychotics
Anxiolytics
Antidepressants
Anti-craving medication/ Substitution
treatments

SECTION 7
7. STATE MENTAL HEALTH REPORT CARD
SUMMARY OF SECTIONS 1-7.
Most of the information for the State of Telengana is available for IMH, Erragadda,
Hyderabad. Some attempt has been made to obtain information from the general and district
hospital, but this is incomplete. Information from the DMHP is grossly deficient. Human
resources for mental health are extremely scarce. The State needs to focus on enhancing
these resources and have a more systematic plan for expanding mental health services. There
is no State Mental Health Authority
MENTAL HEALTH REPORT CARD
Area

Focus

Parameters

Rating

Mental
Health
Services
(Secondary
and Tertiary)

Medical
College
Depts,
General
Hospitals,
Specialised
psychiatric
hospitals

Adequacy of inpatient
beds
Functional Departments
Functional OP services

Primary
Health Care

District
Mental

% of functional DMHPs

100- present,
fully satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100 All districts
covered; fully

683

Score
(out of
100)
25

75

mental health Health


services
Programme

satisfactory
75 majority of
districts covered
and functioning
50 half the
districts covered
and functioning
25 one-fourth
of the districts
covered and
functioning
0- No districts
covered/although
DMHP exists, not
functioning
Rehabilitation At all levels Vocational training, day 100- present,
12.5
services
care, longstay facilities
fully satisfactory
in govt sector/ppp
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
Specialised
Services for Whether existing, level
100- present,
25
services
substance
of functionality, present fully satisfactory
use
at different levels of care 75- present,
disorders,
reasonably
old age,
satisfactory
mental
50 present,
retardation,
somewhat
child
satisfactory
psychiatry,
25 present,
community
unsatisfactory
services,
0- absent
forensic
services
Human
(exclude
Adequacy of
100 fully
25
Resources
DMHP staff psychiatrists/clinical
adequate
here)
psychologists/psychiatric 75 moderately
social
adequate
workers/psychiatric
50 somewhat
684

nurses or mental health


trained nurses

adequate
25- inadequate
0 grossly
inadequate
10% -separate
25
budget, fully
adequate
75 separate
budget,
moderately
adequate
50 separate
budget,
somewhat
adequate
25 no separate
budget, but some
financial
resources
available annually
0 no separate
budget/marginal
financial resource
allocation
100 Existing,
12.5
fully functional
75- Existing,
mostly functional
50- Existing,
somewhat
functional
25- Partial
0 Non existent

Financing for State level


mental health

Existence of separate
budget for mental
health/mental health
activities

Governance
and Policy

State
Mental
Health
Authority
and other
authorities

Availability of
psychiatric
medication

At every
level

Separate Mental Health


Nodal Officer
Functioning Mental
Health Authority
Nodal persons for
mental health in
SHRC/Legal Services
Authority/Others
State Mental Health
Rules
State Mental Health
Programme
Range of medications
Regular supply and
dispensing
Standard procurement
arrangements

685

100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25

25

Affirmative
action for
persons with
mental illness

At every
level

Disability assessment
Pension
Travel concession
Health insurance
Special assistance
Educational benefits
Job reservation

10

Treatment
Gap

Overall

Approximate number of
persons with mental
illness approximate
numbers totally
receiving treatment in
the state

Total Score (out of 1000)


Average Score (%)

Unsatisfactory
0- Not available
at any level
100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available
at any level
100 no
treatment gap
75 25%
treatment gap
50 -50%
treatment gap
25 -75%
treatment gap
0- 100%
treatment gap

25

12.5

262.5
26.3

RECOMMENDATIONS:
The State of Telengana needs to collate the information on mental health problems and
responses more systematically. The State Mental Health Authority needs to be in place and
prepare a state mental health plan along with other nodal agencies. The DMHP although
supposedly rolled out in all districts appears to have many deficiencies and needs to be
reviewed in detail. Rehabilitation is grossly lacking and needs to be addressed. NGO
involvement is necessary. A concerted effort to increase human resources must be made
considering there are many medical colleges. Efforts must be made to increase training in
other mental health specialties as well.

686

TRIPURA
SECTION 1. STATE LEVEL REPORT
1. GENERAL INFORMATION REGARDING THE STATE (Tripura)
1.1. Area
NR
1.2. No of districts
NR (8)
1.3. Population, age distribution (as per census 2011) NR (36,71032- 2011 census)
1.4. Gender distribution
NR.
1.5. Life expectancy at birth male and female
NR
1.6. Per capita State Government expenditure on health NR
1.7. Any health indicators for the state (life expectancy, etc) NR
1.8. Completeness/quality of information provided: Complete/Partially
Complete/Deficient
If deficient, areas of deficiency: All areas. Even the basic information about the State
has not been provided.
2. MENTAL ILLNESS BURDEN/ INFORMATION REGARDING MENTAL ILLNESS
N
(prevalence)
2.1. Total number of
persons with mental
illness (all ICD
categories)
2.2. Broad categories
2.2.a Severe mental
disorders (BPAD,
psychosis)
2.2.b Common mental
disorders
2.2.c Substance use
disorders (alcohol and
other drugs)
2.2.d Mental
Retardation

NR

2.3. No of Males with


mental health problems
2.4. No of females with

NR

NR

NR
687

N
(treatment
seeking)

Source of
information

mental health problems


2.5. No of children with
mental health problems
2.6. No of elderly with
mental health problems
2.7. No of homeless
mentally ill persons
COMMENT:

NR
NR
NR

3. MENTAL HEALTH SERVICES IN THE STATE:

Organization of Services (description of number of psychiatric hospitals, medical college depts,


district hospitals)
N/N
3.1.a No of district general
hospitals with separate
department of psychiatry

3.1.b No of medical colleges


with department of psychiatry

NR

3.1.c No of district general


hospitals providing psychiatric
care
3.1.d No of District Mental
Health Programmes in the
State

No with dept/facility
Total No of units

% coverage

NR

N
3.1.e No of government
psychiatric hospitals
3.1.f No of private psychiatric
hospitals
3.1.g Total No of psychiatric
hospitals in the state

3.1.h No of NGOs providing


mental health care

NR

Nil
1

COMMENT: Recording in the State Level Questionnaire affidavit is grossly deficient.

688

a. INPATIENT SERVICES
DESCRIPTION:

Psychiatric hospitals (Govt)


(MODERN PSYCHIATRIC
HOSPITAL, NARSINGARH)

3.2.a. Total
I.npatient
sanctioned/available
beds
3.2.b No of male
beds
3.2.c. No of female
beds
3.2.d. No of beds for
children
3.2.e. No of beds for
elderly
3.2.f. No of beds for
substance use
disorders
3.2.g. No of beds for
forensic psychiatry
3.2.h. Occupancy (%)
3.2.i. No of
admissions during
previous year
3.2.j. No of
discharges during
previous year
3.2.k. Average
duration of inpatient
stay in days mean
3.2.l. Average
duration of inpatient
stay in days median
3.2.m. No of closed
wards
3.2.n. No of closed
ward beds

50

General
Hospitals
N=(GBP
Hospital,
Agartala
30

NR (IC report- 32)

20

NR (IC report- 12)

10

NR (IC report- 6)

NR

NR

NR

NR

NR

NR

NR

NR
NR

57%
271

NR

NR

NR

21 DAYS

NR

21 DAYS

NR

Nil

NR

Nil

689

Psychiatric
hospitals
(Private)
N=

District
Hospitals
N=

NGOs
N=

Total

3.2.o. No of open
wards
3.2.p. No of open
ward beds
3.2.q. No of paid
wards
3.2.r.No of paid beds
3.2.s.No of
admissions through
courts
3.2.t. No of deaths in
the last year
3.2.u. No of suicides
in the last year

NR

NR

30

NR

Nil

NR
NR

Nil
Nil

NR

NR

NR

NR

COMMENT: Very few details are mentioned in state affidavit questionnaire.

b. OUTPATIENT SERVICES
Govt.
Psychiatric
hospitals
N=1
3.3.a. No of new OP
registrations in the
previous year

NR

3.3.b. No of
emergency
attendees in the
previous year

NR

3.3.c Total no of OP
follow-up in the
previous year

NR

Private
Psychiatric
hospitals
N=

General
Hospitals
N=1

District
Hospitals
N=

NGOs

N=

COMMENT: The information in the State Questionnaire affidavit is inadequate.

690

Total

4. REHABILITATION FOR PERSONS WITH MENTAL ILLNESS


a. Government residential rehabilitation/longstay facilities : No and description: NR
Government day care/outdoor rehabilitation facilities: No and description: NR
b. Government run half-way homes: No and description. If none, plans to establish
and details Details are not recorded.
c. NGO participation in the half way homes: Details are not recorded.
d. Longstay rehabilitation facilities: No and description; NGO participation: Details
are not recorded.
5. MENTAL HEALTH CARE IN OTHER COMMUNITY FACILITIES
State Level, in the Govt Sector
5.1. No of shelter homes, observation homes, special homes and
childrens homes
5.2. No of counsellors trained in mental health in the above
institutions
5.3. No of protection homes for destitute women
5.4. No of counsellors trained in mental health in the above
institutions
5.5. No of old age homes
5.6. No of counsellors trained in mental health in the above
institutions
5.7. No of Central Jails and District Jails in the State
5.8. No of counsellors trained in mental health in the above
institutions
5.9.No of counsellors trained in mental health in the above
institutions

Detailed information is
not recorded

Helplines for Mental Health: (Nature of helpline, who runs it, for whom, any information on
its utilization)
COMMENT: Lack of information.

6. MENTAL HEALTH HUMAN RESOURCES


691

Mental Health Care Professionals

6.1. No of
Psychiatrists
6.2. No of Clinical
Psychologists
6.3. No of
Psychiatric Social
Workers
6.4. No of nurses
trained in mental
health
6.5. No of trained
counselors
6.6. Record Keeper
6.7. Case Registry
Assistant

Psychiatric
Hospital
(Modern
Psychiatric
Hospital,
Narsingarh)
3

Government
Private
Sector medical
Practice
colleges/hospitals
(GBP Hospital,
Agartala)

Nil

Nil

Nil

9 (Staff Nurse)

Nil (General
Nurse-6)

Nil

Nil

N.A.
N.A.

N.A.
N.A.

Total

COMMENT: There is some variance with the report submitted to the IC which mentions 17
nurses in The MPH Narsingarh.
7. MENTAL HEALTH HUMAN RESOURCE DEVELOPMENT
7.1. Degree/Diploma Courses
In Entire state, Annual No of
Seats in
MD Psychiatry
DNB Psychiatry
Diploma in Psychiatry
PhD Clinical Psychology
MPhil Clinical Psychology
PhD Psychiatric Social Work
MPhil Psychiatric Social Work
PhD Psychiatric Nursing
MSc Psychiatric Nursing
BSc Psychiatric Nursing
Basic Diploma in Psychiatric
Nursing (DPN)

Institutions where the Programme is offered

1 SEAT / YR.

G.B.P. HOSPITAL, AGARTALA

692

COMMENT: The Modern Psychiatric Hospital, Narsingarh is already functioning as Training


Centre for B.Sc. Nursing, General Nursing, Mid Wifery (GNM) and auxiliary nursing mid wifery
(ANM) courses. It is under active consideration of the State Government to declare this
hospital to be a State Hospital.
7.2. Other training in mental health : NR
7.2.a. Details of Undergraduate MBBS training in psychiatry
Name of
medical college

No of hours of
theory

Duration of
psychiatry
posting during
UG

Duration of
psychiatry
posting during
internship

Qualifying
Examination
includes
competency
evaluation in
psychiatry

COMMENT: No. Of U.G./Interns posted in Psychiatry Department = 90.


7.2.b. Details of in-service training for Govt medical officers (No trained, duration) : NR
7.2.c. Any other training courses in mental health offered by the state : NR
8. GOVERNANCE:
8.1. Nodal Authority and responsibilities : NR
8.2. Presence of a State Mental Health Plan: NR
8.3. Enactment of State Mental Health Rules: NR
8.4. Oversight of policies and Programmes related to mental health : NR
8.5. Specific oversight of the DMHP programme. NR
8.6. Attempts towards integration of mental health care into general health care, NCD
management etc. NR
8.7. Examples of commitment to develop mental health services (high level involvement,
budgeting, networking NR
8.8. Examples of inter-sectoral collaboration to improve mental health services (including PPP
intitiatives) NR
8.9. Attempts towards mental health promotion NR

693

COMMENT: Strengths and weaknesses


Very little information is provided to enable any comments.
9. FINANCING
9.1. Sources of financing of different categories NR
9.2 Budget provision from State and Centre in INR (for different facilities if required) NR
9.3. Mental Health Expenditure as proportion of Total Health Expenditure in State NR
(If available % spending on Health in the State may also be provided)
10. ANY OTHER SIGNIFICANT INFORMATION (e.g. litigation, insurance schemes for persons
with mental illness, pension and other assistance, job reservations) NR
11. INNOVATIONS NR
12. OVERALL SUMMARY OF STATE LEVEL MENTAL HEALTH SERVICES :
Information is extremely deficient.

SECTION 2
2.1. PSYCHIATRIC INSTITUTIONS (Modern Psychiatric Hospital, Narsingarh, Agartala, Tripura)
Domains
Infrastructure

Amenities and facilities

Financial arrangements
Diet
Investigations and treatment
Staff and training

Status in 2008
Developments since 2008
89 bedded hospital which
will come into force in a
phased manner it has
started functioning with 20
beds since 20th July, 2007.
Separate OPD with waiting
hall with separate inpatients
facility, casualty services
with separate staff.

most of the drugs are


Proposal for lab and other
provided free of cost.
facility is under progress,
Three qualified psychiatrist,
one
trained
psychiatry
nurse, 7 general nurse, 12
694

attendant, 2 cooks,
security guards and
sweeping assistant.
Supportive services
Recreation/Occupational
therapy/Rehabilitation

6
6

Recreation services are


available. No rehabilitation
services.

Networking with other


agencies
i. Outpatient: This information is gathered from the IC form- 738 annual new registrations and
3019 follow-up; details of OPD facilities NR
ii. Inpatient: 50 beds (32 male; 12 female; 6 children); 32 destitute patients, same number
staying in the hospital for over a year)
Diagnostic categories seen: NR
iii. DIAGNOSTICS AND THERAPEUTICS :

Investigations: Available
Therapeutic facilities: Most drugs available regularly (antidepressants irregular);
Counseling available; recreation available
Improvements in rehabilitation: No
ENGAGEMENT:
Attempts to involve families of persons with mental illness: NR
Disability certification and number of certificates issued in the previous year: NR

v. ADMINISTRATIVE

Annual number of adverse events: Nil


Mechanisms for redressal of patient complaints:NR

vi. COMMUNITY OUTREACH AND NETWORKING


Community Programmes: Awareness programmes
Networking with external agencies: No
14. Public mental health education: NR
vii. TRAINING

695

Post-graduate training new Programmes, enhancement of seats and measures to


maintain/improve quality of training: No

Any other training Programmes: NR

vii. RESEARCH:

Research (areas, funding agencies, findings) NR


ANY OTHER SALIENT CONTRIBUTIONS OF THE HOSPITAL/INSTITUTE: NR

ix. Any monitoring of hospital (internal or external)- details : 2 visits by SMHA


x. Special Rapporteurs observation: xi. Any other observations (including Inspection Committee Reports): The MPH Agartala was
visited by the IC, headed by Shri KB Agarwal Joint Secretary, MOHFW, on 27 July 2015. The IC
opined that the conditions in the hospital were satisfactory, but that the freshness and
ambience required attention. Certain wards weeere overcrowded. There were 133 patients
although the capacity was 50 beds. 58 patients were fit were discharge but not taken by their
families. 12 patients were from Bangladesh. Recommendations of the IC included
upgradation of the MPH to a COE, setting up of a specialised de-addiction centre, intensive
care facilities, rehabilitation facilities, facilities for patient relatives to stay and viable systems
of stay and social incorporation of neglected patients following their improvement.
xii. Summary and Recommendations from SECTION 2:
Areas of positive change
Medications satisfactory
Reasonably well-maintained

Areas of poor progress


Overcrowding
Lack of specialised services
Lack of rehabilitation
SECTION 3

3. General Hospital Departments of Psychiatry and District Hospital Departments


The broad outline for this section:
3.1. Names of GH/DH and their location. : AGMC and GBP Hospital, Post Office, KUJABAN,
Agartala, Tripura.
(If there are many, this could be done in a tabular column).

696

The following areas may be mentioned as a summary of all the units; where needed , examples
could be made of a specific dept to highlight both positives and negatives.
3.2. Areas (distribution throughout the states):
3.3. Whether separate funding and adequacy: NR.
3.4. Whether OP/IP and emergency services available : OPD, IP and Emergency Services are
available.
3.5. Diagnostic categories in rank order that present in the outpatient Broad ICD categories are
as follows :
Organic Psychiatric Disorders
Schizophrenia
Bipolar Mood Disorder
Other Psychotic Disorders
Obsessive Compulsive Disorder
Other anxiety disorders
Depressive Disorders
Adjustment Disorders
Alcohol and drug Abuse Disorders
Personality Disorders
Children with Psychiatric illnesses
Mental Retardation
Sexual Disorder

4
44
51
22
15
21
45
2
-

3.6. Adequacy of OP facilities : Waiting Halls, Toilets, Separate Interview Rooms, Drinking
Water, Canteen Services, OPD Lab services are adequate.
3.7. Inpatient occupancy, free and paying beds, average cost of inpatient stay per week; rank
order of diagnostic categories No. Of free beds = 30, Occupancy 57%.
The breakup as per ICD 10 is as follows
Organic Psychiatric Disorders
Schizophrenia
Bipolar Mood Disorder
Other Psychotic Disorders
Obsessive Compulsive Disorder
Other anxiety Disorders
Depressive Disorders
Adjustment Disorders

93
63
22
5
15
33
11
697

Alcohol and drug Abuse Disorders


Personality Disorders
Children with Psychiatric illness

27
2

3.8. Extent of family involvement : Always involved


3.9. Measures to protect rights including complaint redressal : Rights of patients are displayed
in wards.
3.10. Any networking : No
3.11. Staffing details and any shortages/vacancies :
Qualified psychiatrists
General Medical Officers
Clinical Psychologists
Psychiatric / Medical Social Workers
Trained Psychiatric Nurses
General Nurses
Other (Specify)

4
Nil
1
6
Clerk 1, Lab. Asstt. 1, Store Keeper - 1

3.12. Psychotropic medication availability/free/cost : Free of Cost available


3.13. ECTs (Nos given across the facilities or average/No of direct ) : Modified ECT given in
previous year 12.
3.14. Observations of extent to which counselling and psychotherapy are provided : Provided
to all
3.15. Whether disability certification is available (if available numbers certified/year) : No
3.16. Extent and nature of community involvement : No
3.17. Whether engagement with the DMHP and extent : No
3.18. Nature and partnership with NGOs for networking : No
3.19. Presence of PG training- whether adequately distributed throughout the state : Yes
MD 1 per year
3.20. Nature of public mental health material prepared and distributed/ activities to educate :
Nil
3.21. Areas of research, sources of funding and major findings : Nil
698

3.22. Whether monitored and by whom. What were the observations? : Monitoring is being
done by State Government.
3.23. Special Rapporteurs observations 3.24. Inspection Committees observations 3.25. SUMMARY AND RECOMMENDATIONS WITH RESPECT TO SECTION 3:
(Overall impressions about the mental health service delivery through the General and District
Hospitals).
The general hospitals information has been furnished. The information from the
district hospitals need to be collected.
SECTION 4
4. NGOS WORKING IN MENTAL HEALTH:
4.1. A brief description of the NGO and its location : No information is available
4.2. Nature of work carried out by the NGO in the domains mentioned and details of each : NR
4.3. Description of clientele seen by the NGO and number of persons who use the services in
the previous year : NR
4.4. Research details : NR
4.5. Details of any training carried out by the NGO : NR
4.6. Networking activities of the NGO : NR
4.7. Salient contributions of the NGO : NR
4.8. Special Rapporteurs observations : NR

4.9. Inspection Committees observations : 4.8. SUMMARY AND RECOMMENDATIONS FOR SECTION 4
Deficient information.

699

SECTION 5
5.DISTRICT MENTAL HEALTH PROGRAMME

5.1. A brief description of the location of the DMHP, when it started, total population covered:
No details information is available. The report to the IC mentions that DMHP west has 10
beds at the MPH Agatala and the hospital is involved in IEC activities in this district.

700

5.2. A summary of annual registrations old and new, treatment outcomes in terms of those on
regular treatment and those dropped out, with diagnostic categories if provided. Would be
useful to know what kind of clientele is serviced under the DMHP:
5.3. Frequency of home visits carried out by the HW/ANM; numbers covered and for what
diagnostic categories, no of admissions facilitated:
5.4. Kinds of essential drugs available, number dispensed, number of patients receiving
medication under the DMHP in a month:
5.5. Duration of untreated mental illness for different diagnostic categories if provided:
5.6. Monitoring of the DMHP by the concerned officer /impressions and trouble-shooting
(mention if there is a committee and its composition):
5.7. IEC activities of the DMHP:
5.8. Training calendar of the DMHP (doctors, health workers, nurses, pharmacists, school
teachers/Anganwadi workers (whether any training conducted):
5.9. Activities to sensitize the gram panchayats
5.10. Special Rapporteurs report on the activities of the DMHP, its reach, areas of good
performance, areas of poor performance, barriers for effective service delivery, measures to
streamline functioning, funding flow and barriers thereof.5.11. Inspection Committees observations 5.12. SUMMARY OBSERVATIONS OF DMHP AND RECOMMENDATIONS:
SECTION 6
6. SUMMARY OF MENTAL HEALTH CARE INDICATORS IN TRIPURA (name of state)
6.1. Availability of mental health facilities
Total No of
facilities/beds
Mental health outpatient facilities
in the state

Rate per 100,000 population


0.329

Day treatment facilities


Psychiatric beds in general hospitals

0.823

701

Community residential facilities


Beds/places in community
residential facilities
Psychiatric hospitals

0.004

Beds in psychiatric hospitals

1.469

6.2. Access to Care


Rate per 100,000
population

Females %

Persons treated in mental health


outpatient facilities
Persons treated in mental health
day care facilities
General hospital admissions
Community residential facilities
Persons staying in community
residential facilities at the end of the
year
Admissions to mental hospitals

14.52

6.3. Information Systems


Data on No of
persons/activities
collected and
reported YES/NO

Data on age and


gender are collected
and reported
YES/NO

Persons with mental


disorders treated in
primary health care
Interventions
delivered in primary
health care for
persons with mental
disorders
702

Data on patients
diagnosis are
collected and
reported
YES/NO

Persons treated in
mental health
outpatient facilities
Contacts in mental
health day treatment
facilities
Admissions in
general hospitals
with psychiatric beds
Admissions in mental Yes
hospitals
Days spent in mental Yes
hospitals
Admissions in
No
community
residential facilities
6.4. Human Resources at the State Level

Yes

Yes

Yes

Yes

No

No

Health professionals working


in the mental health sector
Rate per 100,000
Psychiatrists

0.301

Medical doctors not


specialised in psychiatry

Training of health
professionals in educational
institutions
Rate per 100,000
0.0364
2.893

Clinical Psychologists

0.047

0.010

Psychiatric Social Workers

0.033

0.003

Psychiatric Nurses

0.166

0.016

Occupational therapists
Other health workers

6.5. INFORMAL HUMAN RESOURCES (Family and User Associations)

Present in the state


No of members
Participation in the
formulation/implementation
of policy/plan/legislation

User
Yes

Family
Yes

Not routinely

Not routinely

703

6.6. MEDICINES
Type of Medication

Expenditure at State level per year and per


100,000 population (inINR)

All psychotropic medication


Mood stabilisers
Antipsychotics
Anxiolytics
Antidepressants
Anti-craving medication/ Substitution
treatments

SECTION 7
7. STATE MENTAL HEALTH REPORT CARD
SUMMARY OF SECTIONS 1-7.
Summary of areas where state has achieved good progress/little progress/no progress
The State of Agartala has not provided the basic details of demographics and approximate
number of persons requiring mental health care. Many aspects are not mentioned in the
affidavit. The psychiatric hospital needs to develop specialised care facilities. The activity
within the DMHP and services at the district level need to be ascertained.
MENTAL HEALTH REPORT CARD
Area

Focus

Parameters

Rating

Mental
Health
Services
(Secondary
and Tertiary)

Medical
College
Depts,
General
Hospitals,
Specialised
psychiatric
hospitals

Adequacy of inpatient
beds
Functional Departments
Functional OP services

Primary
Health Care

District
Mental

% of functional DMHPs

100- present,
fully satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100 All districts
covered; fully

704

Score
(out of
100)
50

12.5

mental health Health


services
Programme

satisfactory
75 majority of
districts covered
and functioning
50 half the
districts covered
and functioning
25 one-fourth
of the districts
covered and
functioning
0- No districts
covered/although
DMHP exists, not
functioning
Rehabilitation At all levels Vocational training, day 100- present,
12.5
services
care, longstay facilities
fully satisfactory
in govt sector/ppp
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
Specialised
Services for Whether existing, level
100- present,
12.5
services
substance
of functionality, present fully satisfactory
use
at different levels of care 75- present,
disorders,
reasonably
old age,
satisfactory
mental
50 present,
retardation,
somewhat
child
satisfactory
psychiatry,
25 present,
community
unsatisfactory
services,
0- absent
forensic
services
Human
(exclude
Adequacy of
100 fully
25
Resources
DMHP staff psychiatrists/clinical
adequate
here)
psychologists/psychiatric 75 moderately
social
adequate
workers/psychiatric
50 somewhat
705

nurses or mental health


trained nurses

adequate
25- inadequate
0 grossly
inadequate
10% -separate
25
budget, fully
adequate
75 separate
budget,
moderately
adequate
50 separate
budget,
somewhat
adequate
25 no separate
budget, but some
financial
resources
available annually
0 no separate
budget/marginal
financial resource
allocation
100 Existing,
25
fully functional
75- Existing,
mostly functional
50- Existing,
somewhat
functional
25- Partial
0 Non existent

Financing for State level


mental health

Existence of separate
budget for mental
health/mental health
activities

Governance
and Policy

State
Mental
Health
Authority
and other
authorities

Availability of
psychiatric
medication

At every
level

Separate Mental Health


Nodal Officer
Functioning Mental
Health Authority
Nodal persons for
mental health in
SHRC/Legal Services
Authority/Others
State Mental Health
Rules
State Mental Health
Programme
Range of medications
Regular supply and
dispensing
Standard procurement
arrangements

706

100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25

50

Affirmative
action for
persons with
mental illness

At every
level

Disability assessment
Pension
Travel concession
Health insurance
Special assistance
Educational benefits
Job reservation

10

Treatment
Gap

Overall

Approximate number of
persons with mental
illness approximate
numbers totally
receiving treatment in
the state

Total Score (out of 1000)


Average Score (%)

Unsatisfactory
0- Not available
at any level
100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available
at any level
100 no
treatment gap
75 25%
treatment gap
50 -50%
treatment gap
25 -75%
treatment gap
0- 100%
treatment gap

12.5

12.5

237.5
23.8

RECOMMENDATIONS:
The State of Tripura needs to have a detailed understanding of its problems and responses
and prepare a plan accordingly. There is a need to enhance human resources. There is
potential to increase the training in mental health so that human resource deficiencies may
be addressed. More specialised care facilities as well as primary care facilities need to be
developed.

707

UTTARAKHAND
SECTION 1. STATE LEVEL REPORT
8. GENERAL INFORMATION REGARDING THE STATE (Uttrakhand)
a. Area
53483 Sq.Mtr.
b. No of districts
c. Population, age distribution (as per census 2011)
d. Gender distribution

13
10116752 (Census 2011)
Age distribution

0 4 Years
924864
5 9 Years
1058801
10 14 years 1145343
15 19 Years 1124110
20 24 Years 970068
25 29 Years 810184
30 34 Years 698300
35 39 Years 665500
40 44 Years 566709
45 49 Years 489377
50 54 Year 397158
55 59 Years 318461
60 & above Years 900809
(Census 2011)

e.
f.
g.
h.

Male 5154178
Female - 4962574
Life expectancy at birth male and female
N.A.
Per capita State Government expenditure on health
N.A.
Any health indicators for the state (life expectancy, etc) N.A.
Completeness/quality of information provided: Complete/Partially
Complete/Deficient

If deficient, areas of deficiency: There are several areas not filled out.

708

9. MENTAL ILLNESS BURDEN/ INFORMATION REGARDING MENTAL ILLNESS


N
(prevalence)
2.1. Total number of
persons with mental
illness (all ICD
categories)

2.2. Broad categories


2.2.a Severe mental
disorders (BPAD,
psychosis)
2.2.b Common mental
disorders
2.2.c Substance use
disorders (alcohol and
other drugs)
2.2.d Mental
Retardation

N
(treatment
seeking)

Source of
information

6,07,005
(Estimated from
epidemiological
studies by
Reddy and
Chandrashekhar
1998)
14,515 (CBHI
Report receipt
from Medical
Colleges)
23,835
687

N.A.

2.3. No of Males with


N.A.
mental health problems
2.4. No of females with
N.A.
mental health problems
2.5. No of children with N.A.
mental health problems
2.6. No of elderly with
N.A.
mental health problems
2.7. No of homeless
N.A.
mentally ill persons
COMMENT: The State has made an effort to estimate the number of persons with mental
disorders. However, the information collected through the medical colleges is nowhere
representative of the likely estimate of different kinds of mental disorders.

709

10. MENTAL HEALTH SERVICES IN THE STATE:

Organization of Services (description of number of psychiatric hospitals, medical college depts,


district hospitals)

N/N
3.1.a No of district general
hospitals with separate
department of psychiatry

Nil

3.1.b No of medical colleges


with department of psychiatry

04

3.1.c No of district general


hospitals providing psychiatric
care
3.1.d No of District Mental
Health Programmes in the
State

No with dept/facility
Total No of units

% coverage

N
3.1.e No of government
psychiatric hospitals
3.1.f No of private psychiatric
hospitals
3.1.g Total No of psychiatric
hospitals in the state

3.1.h No of NGOs providing


mental health care

Nil
1

COMMENT: There appear to be few facilities in the government sector providing mental
health care.

710

INPATIENT SERVICES
DESCRIPTION:

3.2.a. Total Inpatient


sanctioned/available
beds
3.2.b No of male beds
3.2.c. No of female
beds
3.2.d. No of beds for
children
3.2.e. No of beds for
elderly
3.2.f. No of beds for
substance use
disorders
3.2.g. No of beds for
forensic psychiatry
3.2.h. Occupancy (%)
3.2.i. No of admissions
during previous year
3.2.j. No of discharges
during previous year
3.2.k. Average
duration of inpatient
stay in days mean
3.2.l. Average duration
of inpatient stay in
days median
3.2.m. No of closed
wards
3.2.n. No of closed
ward beds
3.2.o. No of open
wards
3.2.p. No of open
ward beds
3.2.q. No of paid
wards
3.2.r.No of paid beds
3.2.s.No of admissions

Psychiatric hospitals
(Govt) (State Mental
Health Institute,
Selaque, Dehradun,
Uttrakhand)
30

Psychiatric
hospitals
(Private) N=

General
Hospitals
N=

District
Hospitals
N=

NGOs
N=

Total

NR

15
15

NR
NR

NR

NR

NR

NR

NR

NR

NR

NR

80%
267

NR
NR

261

NR

NR

NR

NR

NR

No

NR

No

NR

NR

26

NR

NR

NR

04
34

NR
NR
711

through courts
3.2.t. No of deaths in
the last year
3.2.u. No of suicides in
the last year

No

NR

No

NR

COMMENT: No information from the general hospitals/medical colleges.


a. OUTPATIENT SERVICES

3.3.a. No of new OP
registrations in the
previous year

Psychiatric
hospitals
(Govt) (State
Mental Health
Institute,
Selaque,
Dehradun,
Uttrakhand)
13662

3.3.b. No of
emergency
attendees in the
previous year

324

3.3.c Total no of OP
follow-up in the
previous year

11972

Private
General
Psychiatric Hospitals
hospitals
N=
N=

District
Hospitals
N=

NGOs
N=

Total

COMMENT: No information from the GH/MC.

11. REHABILITATION FOR PERSONS WITH MENTAL ILLNESS


a. Government residential rehabilitation/longstay facilities : No and description:
NIL
b. Government day care/outdoor rehabilitation facilities: No and description: 1
c. Government run half-way homes: No and description. If none, plans to establish
712

and details Nil, Plan 1 at Haridwar in PPP Model (State Govt. and National Trust)
d. NGO participation in the half way homes: Nil
e. Longstay rehabilitation facilities: No and description; NGO participation: Nil
12. MENTAL HEALTH CARE IN OTHER COMMUNITY FACILITIES
State Level, in the Govt Sector
5.1. No of shelter homes, observation homes, special homes
and childrens homes
5.2. No of counsellors trained in mental health in the above
institutions
5.3. No of protection homes for destitute women
5.4. No of counsellors trained in mental health in the above
institutions
5.5. No of old age homes
5.6. No of counsellors trained in mental health in the above
institutions

N
13, 11, 02, 08
NR
01
NR
02
NR
1 Central Jail, 7 district jail,
sub-district jail 2, Open Jail1
NR

5.7. No of Central Jails and District Jails in the State

5.8. No of counsellors trained in mental health in the above


institutions
5.9.No of counsellors trained in mental health in the above NR
institutions
Helplines for Mental Health: (Nature of helpline, who runs it, for whom, any information on
its utilization)
COMMENT: There are several government run community facilities but they do not seem to
have any mental health trained staff.
13. MENTAL HEALTH HUMAN RESOURCES
Mental Health Care Professionals
Government
Sector medical
colleges/hospitals

6.1. No of
Psychiatrists
6.2. No of Clinical
Psychologists
6.3. No of

Psychiatric
Hospital

Private
Practice

05

07

Nil

03

Nil

04
713

Total

Psychiatric Social
Workers
6.4. No of nurses
trained in mental
health
6.5. No of trained
counselors
6.6. Record Keeper
6.7. Case Registry
Assistant

04

08

Nil

Nil

N.A.
N.A.

N.A.
N.A.

COMMENT:
NR
7. MENTAL HEALTH HUMAN RESOURCE DEVELOPMENT
7.1. Degree/Diploma Courses
In Entire state, Annual No of
Seats in
MD Psychiatry
DNB Psychiatry
Diploma in Psychiatry
PhD Clinical Psychology
MPhil Clinical Psychology
PhD Psychiatric Social Work
MPhil Psychiatric Social
Work
PhD Psychiatric Nursing
MSc Psychiatric Nursing
BSc Psychiatric Nursing
Basic Diploma in Psychiatric
Nursing (DPN)

Institutions where the Programme is offered

COMMENT:
Proposal of SGRR Medical College at Dehradun, Name of Authority with home pending
MCI, No. Of Seats requested 2, Current Status of Proposal Pending at MCI,
7.2. Other training in mental health : HIV / IDU counselling for trainers of OST.

714

7.2.a. Details of Undergraduate MBBS training in psychiatry


Name of
medical college

No of hours of
theory

Duration of
psychiatry
posting during
UG

Duration of
psychiatry
posting during
internship

Qualifying
Examination
includes
competency
evaluation in
psychiatry

COMMENT: Training to Under-graduates in Medical Colleges of States, No. Of UG Lectures


21, Posting 15 days, Internship 15 days (In two months posting in Medicine Departments)
7.2.b. Details of in-service training for Govt medical officers (No trained, duration) : 14
7.2.c. Any other training courses in mental health offered by the state : No. Of Govt. Nurses
who have been imparted training = 4,
8. GOVERNANCE:
8.1. Nodal Authority and responsibilities : 1. Medical Education Dr. R.P. Bhatt 2. State
Medical and Health Department Dr. Suman Arya, 3. Social Welfare Department Mr. Vishnu
Singh Dhanik, 4. SMHA Dr. J.S. Bisht, 5. District Legal Services Authority District Judge in all
districts.
8.2. Presence of a State Mental Health Plan: NR
8.3. Enactment of State Mental Health RulesNR
8.4. Oversight of policies and Programmes related to mental health : NR
8.5. Specific oversight of the DMHP programme. Brief description of districts where fully
implemented, where partially implemented and details of reasons for incomplete
implementation. Also mention here a brief summary of availability of medicines and
psychosocial care for patients with mental illness. No. Of DMHP in the states 7, No. Of
District in which it has been partially implemented 5.
8.6. Attempts towards integration of mental health care into general health care, NCD
management etc. NR
8.7. Examples of commitment to develop mental health services (high level involvement,
budgeting, networking NR
8.8. Examples of inter-sectoral collaboration to improve mental health services (including PPP
intitiatives) NR
715

8.9. Attempts towards mental health promotion


COMMENT: Strengths and weaknesses
There is a broad-based nodal authority.
9. FINANCING
9.1. Sources of financing of different categories State Mental Health Institute, Plan Funds of
amount Rs. 71,45,000.00
9.2 Budget provision from State and Centre in INR (for different facilities if required)
9.3. Mental Health Expenditure as proportion of Total Health Expenditure in State
(If available % spending on Health in the State may also be provided)
10. ANY OTHER SIGNIFICANT INFORMATION (e.g. litigation, insurance schemes for persons
with mental illness, pension and other assistance, job reservations)
11. INNOVATIONS
NR
12. OVERALL SUMMARY OF STATE LEVEL MENTAL HEALTH SERVICES :
Mental health services in the State are provided through 1 government psychiatric facility
and the general hospitals for which information is not available. While there is UG teaching,
an application for PG courses in psychiatry is pending. Human resources are scarce. A broadbased nodal authority for mental health has been formed.
SECTION 2
2.1. PSYCHIATRIC INSTITUTIONS : (State Mental Health Institute, Salaque, Dehradun)
Name and a para on status in 2008 (refer to NHRC book Mental Health Care and Human
Rights)
Domains
Infrastructure
Amenities and facilities

Status in 2008
Founded in 2004

Developments since 2008


OPD services started in
October 2008 and IP
services from Jan 2009.
Yes

Financial arrangements
Diet
716

Investigations and treatment


Staff and training

No academic activity
Only 1 psychiatrist presently
working, along with 2
medical officers. No CP,
PSW sanctioned. 4 staff
nurses

Supportive services
Recreation/Occupational
Recreation yes
therapy/Rehabilitation
Networking with other
No
agencies
i. Outpatient: Waiting Halls, Toilets for patients and relatives, separate interview rooms,
Drinking water facilities are available, No separate speciality services are available for
children, Geriatric patients. No specialized forensic and de-addiction services are there.
ii. Inpatient Medicines are available free of cost. Total number of allotted beds 30 (15 male,
15 female). 263 admissions in previous year.
Diagnostic categories seen:
Organic Psychiatric Disorders
Schizophrenia
Bipolar Mood Disorder
Other Psychotic Disorders
Obsessive Compulsive Disorder
Other anxiety Disorders
Depressive Disorders
Adjustment Disorders
Alcohol and drug Abuse Disorders
Children with Psychiatric Disorders

07
71
77
70
03
15
03

iii. DIAGNOSTICS AND THERAPEUTICS :

Investigations: No
Therapeutic facilities: Medications available. No counseling
Improvements in rehabilitation: Nil
ENGAGEMENT:
Attempts to involve families of persons with mental illness:

Disability certification and number of certificates issued in the previous year: NR

717

v. ADMINISTRATIVE

Annual number of adverse events: Nil


Mechanisms for redressal of patient complaints: Nil

vi. COMMUNITY OUTREACH AND NETWORKING


Community Programmes:
15. Networking with external agencies: No. However, the report mentions that there is
NGO involvement.
16. Public mental health education: No
vii. TRAINING

Post-graduate training new Programmes, enhancement of seats and measures to


maintain/improve quality of training:Nil

Any other training Programmes: Nil

vii. RESEARCH:

Research (areas, funding agencies, findings) Nil


viii. ANY OTHER SALIENT CONTRIBUTIONS OF THE HOSPITAL/INSTITUTE:

ix. Any monitoring of hospital (internal or external)- details : 1 visit by the SMHA.
x. Special Rapporteurs observation:
xi. Any other observations (including Inspection Committee Reports): The IC, headed by Shri
Rakesh Kumar, JS, MOHFW visited the hospital on 1 July 2015. It recommended that the
institute should be completely functional at the earliest, should have a record maintenance
facility, proper internal security, replacement of glass panes with acrylic ones, more
occupational therapy, rehabilitation and residential quarters in the hospital.
xii. Summary and Recommendations from SECTION 2:
Areas of positive change
Psychiatric Hospital functioning
Medicines available

Areas of poor progress


No separate MRD
No rehabilitation
Very few staff in place

718

SECTION 3
3. General Hospital Departments of Psychiatry and District Hospital Departments
The broad outline for this section:
3.1. Names of GH/DH and their location. : Doon Hospital (Govt. District Hospital, Dehradun,
Near Port Road)(If there are many, this could be done in a tabular column).
The following areas may be mentioned as a summary of all the units; where needed , examples
could be made of a specific dept to highlight both positives and negatives.
3.2. Areas (distribution throughout the states): NR
3.3. Whether separate funding and adequacy: No separate funds for psychiatric unit
3.4. Whether OP/IP and emergency services available : emergency and OPD Services are
available.
3.5. Diagnostic categories in rank order that present in the outpatient : Total registration in
OPD 12337,
Organic Psychiatric Disorders
Schizophrenia
Bipolar Mood Disorder
Other Psychotic Disorders
Obsessive compulsive disorder
Depressive Disorders
Other Anxiety Disorder
Adjustment Disorder
Alcohol and drug Abuse Disorders
Personality Disorder
Children with Psychiatric illness

2088
748
868
1196
364
1040
3264
372
820
87
1490

3.6. Adequacy of OP facilities : Waiting Halls, Toilets, Separate Interview Rooms, Drinking
Water, Canteen Services, OPD Lab services are adequate.
3.7. Inpatient occupancy, free and paying beds, average cost of inpatient stay per week; rank
order of diagnostic categories : Total No. Of General Beds 112, Duration of Stay (Mean) 6.22
days, inpatient stay free of cost, overall no. Of admission in previous year - 173
Organic Psychiatric Disorders
Schizophrenia
Bipolar Mood Disorder

12
13
19
719

Other Psychotic Disorders


Obsessive Compulsive Disorder
Other anxiety Disorders
Depressive Disorders
Adjustment Disorders
Alcohol and drug Abuse Disorders
Personality Disorders
Children with Psychiatric illness

29
31
09
51
13

3.8. Extent of family involvement : Always involved


3.9. Measures to protect rights including complaint redressal : N.A.
3.10. Any networking : Yes, Gubbara Early Intervention Centre for Developmental disorders
assessment and management.
3.11. Staffing details and any shortages/vacancies :
Qualified psychiatrists
01
General Medical Officers
03
Clinical Psychologists
01 (Contract basis)
Psychiatric / Medical Social Workers
Trained Psychiatric Nurses
General Nurses
137
Other (Specify)
3.12. Psychotropic medication availability/free/cost : Yes, essential drugs are available free of
cost.
3.13. ECTs (Nos given across the facilities or average/No of direct ) : No
3.14. Observations of extent to which counselling and psychotherapy are provided : Provided
to all
3.15. Whether disability certification is available (if available numbers certified/year) : Yes, 136
3.16. Extent and nature of community involvement : Yes, District Jail Haridwar, Nari Niketan
Dehradun, 1 community outreach activity per month, total patients covered in OPD = 100,
3.17. Whether engagement with the DMHP and extent : N.A.
3.18. Nature and partnership with NGOs for networking : Gubbara, Latika Rai Foundation,
provide assessment and home intervention to patients of developmental disorders, it has
increased awareness and improve management.
3.19. Presence of PG training- whether adequately distributed throughout the state : No
720

3.20. Nature of public mental health material prepared and distributed/ activities to educate :
Yes, Lecturers on awareness in camps, Pamphlets, Posters use for awareness.
3.21. Areas of research, sources of funding and major findings : None
3.22. Whether monitored and by whom. What were the observations? : Yes, Monitoring is
done through PG department of Health and Family Welfare, Uttrakhand.
3.23. Special Rapporteurs observations 3.24. Inspection Committees observations -

3.25. SUMMARY AND RECOMMENDATIONS WITH RESPECT TO SECTION 3:


The Doon Hospital is clearly very active and caters to a variety of psychiatric disorders. It carries
out disability certification. Medications are available and families and patients are counselled.
Similar information must be collected from other general hospitals.

SECTION 4
4. NGOS WORKING IN MENTAL HEALTH:
4.1. A brief description of the NGO and its location : 1. Rapheal Ryder Cheshire International
Centre, Mohini Road and Trans-Rispane Nadi, Dehradun
4.2. Nature of work carried out by the NGO in the domains mentioned and details of each :
Services for persons with intellectual disability : a) Day Care Centre, b) Residential Care, c)
Community Based Rehabilitation, d) Teachers Training Centres
4.3. Description of clientele seen by the NGO and number of persons who use the services in
the previous year : Counselling for over 100 parents, facilitated disability certificates and
disability pension for 50 people, 81 persons with intellectual disability provided residential
care, Rehabilitation Services for 250 children and adults with intellectual disability, home
based Programme for 50 severally disable individual.
4.4. Research details : Short papers on a profile of families of children with mental retardation
attitude of main stream and special teachers ward inclusion of children with special needs.
4.5. Details of any training carried out by the NGO : Special educators, Parents, Primary School
Teachers, Aaganwadi Workers, Health Workers
721

4.6. Networking activities of the NGO : Networking with Selaque Mental Health Authority,
Regular Networking with NGOs, Working in disability Sectors in Uttrakhand (Latika Rai
Foundation, Inspiration, Cheshire Homes, Sragan Spastic Society)
4.7. Salient contributions of the NGO : NR
4.8. Special Rapporteurs observations : NR
4.9. Inspection Committees observations : NR
4.8. SUMMARY AND RECOMMENDATIONS FOR SECTION 4
It must be ascertained whether there is only 1 NGO working in the area of mental health in
the entire state.

SECTION 5
5.DISTRICT MENTAL HEALTH PROGRAMME: NO DETAILED INFORMATION IS AVAILABLE

722

5.1. A brief description of the location of the DMHP, when it started, total population covered:
5.2. A summary of annual registrations old and new, treatment outcomes in terms of those on
regular treatment and those dropped out, with diagnostic categories if provided. Would be
useful to know what kind of clientele is serviced under the DMHP:
5.3. Frequency of home visits carried out by the HW/ANM; numbers covered and for what
diagnostic categories, no of admissions facilitated: Details are not available.
5.4. Kinds of essential drugs available, number dispensed, number of patients receiving
medication under the DMHP in a month:
5.5. Duration of untreated mental illness for different diagnostic categories if provided:
5.6. Monitoring of the DMHP by the concerned officer /impressions and trouble-shooting
(mention if there is a committee and its composition):
5.7. IEC activities of the DMHP:
5.8. Training calendar of the DMHP (doctors, health workers, nurses, pharmacists, school
teachers/Anganwadi workers (whether any training conducted):
5.9. Activities to sensitize the gram panchayats
5.10. Special Rapporteurs report on the activities of the DMHP5.11. Inspection Committees observations 5.12. SUMMARY OBSERVATIONS OF DMHP AND RECOMMENDATIONS:
Since no information is recorde about the DMHP it is not possible to make specific
recommendations regarding the same.

723

SECTION 6
6. SUMMARY OF MENTAL HEALTH CARE INDICATORS IN UTTARAKHAND (name of state)
6.1. Availability of mental health facilities
Total No of
facilities/beds
Mental health outpatient facilities in
the state

Rate per 100,000 population


0.329

Day treatment facilities


Psychiatric beds in general hospitals

0.823

Community residential facilities


Beds/places in community residential
facilities
Psychiatric hospitals

0.004

Beds in psychiatric hospitals

1.469

6.2. Access to Care


Rate per 100,000
population
Persons treated in mental health
outpatient facilities
Persons treated in mental health day
care facilities
General hospital admissions
Community residential facilities
Persons staying in community
residential facilities at the end of the
year
Admissions to mental hospitals

14.52

724

Females %

6.3. Information Systems

Persons with mental


disorders treated in
primary health care
Interventions delivered
in primary health care
for persons with
mental disorders
Persons treated in
mental health
outpatient facilities
Contacts in mental
health day treatment
facilities
Admissions in general
hospitals with
psychiatric beds
Admissions in mental
hospitals
Days spent in mental
hospitals
Admissions in
community residential
facilities

Data on No of
persons/activities
collected and reported
YES/NO

Data on age and


gender are collected
and reported
YES/NO

Data on patients
diagnosis are collected
and reported
YES/NO

Yes

Yes

Yes

Yes

Yes

Yes

No

No

No

6.4. Human Resources at the State Level

Psychiatrists

Health professionals working


in the mental health sector
Rate per 100,000

Training of health professionals


in educational institutions
Rate per 100,000

0.301

0.0364

Medical doctors not specialised


in psychiatry

2.893

Clinical Psychologists

0.047

0.010

Psychiatric Social Workers

0.033

0.003

Psychiatric Nurses

0.166

0.016

Occupational therapists

Other health workers

725

6.5. INFORMAL HUMAN RESOURCES (Family and User Associations)


Present in the state
No of members
Participation in the
formulation/implementation of
policy/plan/legislation

User
Yes

Family
Yes

Not routinely

Not routinely

6.6. MEDICINES
Type of Medication

Expenditure at State level per year and per


100,000 population (inINR)

All psychotropic medication


Mood stabilisers
Antipsychotics
Anxiolytics
Antidepressants
Anti-craving medication/ Substitution
treatments

SECTION 7
14. STATE MENTAL HEALTH REPORT CARD
SUMMARY OF SECTIONS 1-7.
The State is providing mental health services through the SMHI, General Hospitals/Medical
Colleges and the DMHP (5 implemented DMHPs). The SMHI has been functioning since 2008,
but is understaffed and not functioning optimally. The Doon General Hospital appears very
active and has documented all its activities clearly. It also provides disability certification.
Details from other general hospitals and from the DMHPs are not provided. The affidavit
mentions no district hospitals. The ratings below may improve if all the information is
obtained.

726

MENTAL HEALTH REPORT CARD


Area

Focus

Parameters

Mental Health
Services
(Secondary
and Tertiary)

Medical
College
Depts,
General
Hospitals,
Specialised
psychiatric
hospitals

Adequacy of inpatient
beds
Functional Departments
Functional OP services

Primary
Health Care
mental health
services

District
Mental
Health
Programme

% of functional DMHPs

Rehabilitation
services

At all levels

Vocational training, day


care, longstay facilities in
govt sector/ppp

Specialised
services

Services for
substance

Whether existing, level of


functionality, present at
727

Rating

100- present, fully


satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100 All districts
covered; fully
satisfactory
75 majority of
districts covered
and functioning
50 half the
districts covered
and functioning
25 one-fourth of
the districts
covered and
functioning
0- No districts
covered/although
DMHP exists, not
functioning
100- present, fully
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100- present, fully
satisfactory

Score
(out of
100)
25

50

12.5

12.5

use
disorders,
old age,
mental
retardation,
child
psychiatry,
community
services,
forensic
services
(exclude
DMHP staff
here)

different levels of care

75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent

Adequacy of
psychiatrists/clinical
psychologists/psychiatric
social
workers/psychiatric
nurses or mental health
trained nurses

100 fully
adequate
75 moderately
adequate
50 somewhat
adequate
25- inadequate
0 grossly
inadequate

12.5

10% -separate
budget, fully
adequate
75 separate
budget,
moderately
adequate
50 separate
budget,
somewhat
adequate
25 no separate
budget, but some
financial
resources
available annually
0 no separate
budget/marginal
financial resource
allocation
100 Existing,
fully functional
75- Existing,
mostly functional
50- Existing,
somewhat
functional

25

Human
Resources

Financing for
mental health

State level

Existence of separate
budget for mental
health/mental health
activities

Governance
and Policy

State
Mental
Health
Authority
and other
authorities

Separate Mental Health


Nodal Officer
Functioning Mental
Health Authority
Nodal persons for mental
health in SHRC/Legal
Services
728

25

Authority/Others
State Mental Health
Rules
State Mental Health
Programme
Range of medications
Regular supply and
dispensing
Standard procurement
arrangements

Availability of
psychiatric
medication

At every
level

Affirmative
action for
persons with
mental illness

At every
level

Disability assessment
Pension
Travel concession
Health insurance
Special assistance
Educational benefits
Job reservation

10

Treatment
Gap

Overall

Approximate number of
persons with mental
illness approximate
numbers totally receiving
treatment in the state

Total Score (out of 1000)


Average Score (%)

25- Partial
0 Non existent

100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100 no
treatment gap
75 25%
treatment gap
50 -50%
treatment gap
25 -75%
treatment gap
0- 100%
treatment gap

25

12.5

12.5

212.5
21.3%

RECOMMENDATIONS: The State of Uttranchal needs to collate the information on mental


health services existing in the State more completely and then re-assess where it stands. It
needs to urgently improve mental health human resources and increase all specialties. The
DMHP needs review. The report from the Doon General Hospital is very comprehensive and
must serve as a model to other hospitals in the State and other parts of the country. Detailed
auditing of the clinical services is very important to improve and enhance the quality of these
services.
729

UTTAR PRADESH

SECTION 1. STATE LEVEL REPORT


1. GENERAL INFORMATION REGARDING THE STATE (Uttar Pradesh)
a. Area
240928 Sq.Mtr.
b. No of districts
75
c. Population, age distribution (as per census 2011) 19,98,00,000
O 14 Years 7.13 crore
15 59 years 11.14 crore
60 above
1.52 crore
d. Gender distribution
Male 10.46 crore
Female 9.50 crore
e. Life expectancy at birth male and female
NR
f. Per capita State Government expenditure on health
NR
g. Any health indicators for the state (life expectancy, etc) NR

h. Completeness/quality of information provided: Complete/Partially


Complete/Deficient
If deficient, areas of deficiency: In many areas information is incomplete.
2. MENTAL ILLNESS BURDEN/ INFORMATION REGARDING MENTAL ILLNESS
N
(prevalence)
2.1. Total number of
persons with mental
illness (all ICD categories)
2.2. Broad categories
2.2.a Severe mental
disorders (BPAD,
psychosis)
2.2.b Common mental
disorders
2.2.c Substance use
disorders (alcohol and
other drugs)

1.9 crore (Source


country wide
survey
www.google.co.in
15 lacs

19 lacs
4.2 lacs

730

N
(treatment
seeking)

Source of
information

2.2.d Mental Retardation

11.9 lacs

2.3. No of Males with


mental health problems
2.4. No of females with
mental health problems
2.5. No of children with
mental health problems
2.6. No of elderly with
mental health problems
2.7. No of homeless
mentally ill persons

N.A.
65 lacs
15 lacs
31 lacs
Not estimated

COMMENT: The State has estimated a relatively higher mental health morbidity and that puts
a greater demand on the state to meet these needs.
3. MENTAL HEALTH SERVICES IN THE STATE:
Organization of Services (description of number of psychiatric hospitals, medical college depts,
district hospitals)
N/N

No with dept/facility
Total No of units

% coverage

3.1.a No of district general


hospitals with separate
department of psychiatry
3.1.b No of medical colleges with
department of psychiatry

16

21.3

3.1.c No of district general


hospitals providing psychiatric
care
3.1.d No of District Mental Health
Programmes in the State

16

21.3

14

18.7

28

N
3.1.e No of government
psychiatric hospitals
3.1.f No of private psychiatric
hospitals
3.1.g Total No of psychiatric
hospitals in the state
3.1.h No of NGOs providing
mental health care

3
NR.
3
At least 4 5 in each districts

731

COMMENT: Despite there being 14 DMHPs, given the size of the state, the coverage is less
than one-fifth. There is no record of private psychiatric facilities. Details of NGOs working in
mental health care are not mentioned.
a. INPATIENT SERVICES
DESCRIPTION:

3.2.a. Total
Inpatient
sanctioned/availa
ble beds
3.2.b No of male
beds
3.2.c. No of female
beds
3.2.d. No of beds
for children
3.2.e. No of beds
for elderly
3.2.f. No of beds
for substance use
disorders
3.2.g. No of beds
for forensic
psychiatry
3.2.h. Occupancy
(%)
3.2.i. No of
admissions during
previous year
3.2.j. No of
discharges during
previous year
3.2.k. Average
duration of
inpatient stay in
days mean
3.2.l. Average
duration of
inpatient stay in

Psychiatric
hospitals (Govt.)
(Mental Hospital
Varanasi)

Psychiatric
hospitals
(Autonomous)
(Institute of
Mental Health
and Hospital,
Agra)

Psychiatric
hospitals
(Govt.)
Mental
Hospital,
Bareilly

331

838

408

252

633

304

79

205

104

N.A.

N.A.

N.A.

N.A.

N.A.

N.A.

N.A.

N.A.

N.A.

N.A.

N.A.

N.A.

76.13%

57%

47%

755

2655

199

462

2593

59

Two months

80 days

NR

Two months

NR

NR

732

General
Hospitals
N=

District
Hospitals
N=

NGOs
N=

Total

days median
3.2.m. No of
closed wards
3.2.n. No of closed
ward beds
3.2.o. No of open
wards
3.2.p. No of open
ward beds
3.2.q. No of paid
wards
3.2.r.No of paid
beds
3.2.s.No of
admissions
through courts
3.2.t. No of deaths
in the last year
3.2.u. No of
suicides in the last
year

18

No

331

698

No

Nil

Nil

140

180

Nil

Nil

165

35

12

Nil

N.A.

COMMENT:
Information from the General Hospitals and District Hospitals has not been collected.
b. OUTPATIENT SERVICES
Psychiatric
hospitals (Govt.)
(Mental Hospital
Varanasi)

Psychiatric
hospitals
(Autonomous)
(Institute of
Mental Health
and Hospital,
Agra)

Psychiatric
hospitals
(Govt.)
Mental
Hospital,
Bareilly

3.3.a. No of new OP
registrations in the
previous year
3.3.b. No of
emergency
attendees in the
previous year

4,703

5656

52754

NO

697

N.A.

3.3.c Total no of OP
follow-up in the
previous year

67904

67751

N.A.

District
Hospitals
N=

NGOs
N=

COMMENT: No mention of emergencies seen in two of the large psychiatric hospitals. No


information mentioned on the patient load in the general hospitals and district hospitals.

733

Total

4. REHABILITATION FOR PERSONS WITH MENTAL ILLNESS


a. Government residential rehabilitation/longstay facilities : No and description: NR
b. Government day care/outdoor rehabilitation facilities: No and description: NR
c. Government run half-way homes: No and description. If none, plans to establish
and details None
d. NGO participation in the half way homes: None
e. Longstay rehabilitation facilities: No and description; NGO participation: None
5. MENTAL HEALTH CARE IN OTHER COMMUNITY FACILITIES
State Level, in the Govt Sector
N
5.1. No of shelter homes, observation homes, special homes
and childrens homes
5.2. No of counsellors trained in mental health in the above
institutions
5.3. No of protection homes for destitute women
5.4. No of counsellors trained in mental health in the above
institutions
Survey proceeding are in
5.5. No of old age homes
process
5.6. No of counsellors trained in mental health in the above
institutions
5.7. No of Central Jails and District Jails in the State
5.8. No of counsellors trained in mental health in the above
institutions
5.9.No of counsellors trained in mental health in the above
institutions
Helplines for Mental Health: (Nature of helpline, who runs it, for whom, any information on
its utilization)
COMMENT: No information on the above.

734

6. MENTAL HEALTH HUMAN RESOURCES


Mental Health Care Professionals
Government Sector
medical
colleges/hospitals
6.1. No of
Psychiatrists
6.2. No of Clinical
Psychologists
6.3. No of Psychiatric
Social Workers
6.4. No of nurses
trained in mental
health
6.5. No of trained
counselors
6.6. Record Keeper
6.7. Case Registry
Assistant

Private

Private
Practice

Total

30
15
25
None

NR
NR
NR

COMMENT: Since there is no information on psychiatrists and other mental health


professionals working in the private hospitals, private medical colleges and in private practice, it
is not possible to ascertain the adequacy of mental health professionals in the State.
7. MENTAL HEALTH HUMAN RESOURCE DEVELOPMENT
7.1. Degree/Diploma Courses
In Entire state, Annual No of
Seats in
MD Psychiatry
DNB Psychiatry
Diploma in Psychiatry
PhD Clinical Psychology
MPhil Clinical Psychology
PhD Psychiatric Social Work
MPhil Psychiatric Social Work
PhD Psychiatric Nursing
MSc Psychiatric Nursing
BSc Psychiatric Nursing
Basic Diploma in Psychiatric
Nursing (DPN)

Institutions where the Programme is offered

25
04
1

K.G.M.U. Lucknow and IMHH, Agra


IMHH, AGRA

4+10=14

K.G.M.U. Lucknow and IMHH, Agra

735

COMMENT: There is pending proposal for enhancement of seat at MCI level, No. Of seats
requested double the available seats. Proposal sent to MCI for approval.
Although there are 28 medical colleges in the State, Psychiatry post graduation is being
offered in only 2 institutions and Clinical Psychology post graduation only in Lucknow.
7.2. Other training in mental health : HIV / IDU counselling for trainers of OST.
7.2.a. Details of Undergraduate MBBS training in psychiatry
Name of
medical college

No of hours of
theory

Duration of
psychiatry
posting during
UG

Duration of
psychiatry
posting during
internship

Qualifying
Examination
includes
competency
evaluation in
psychiatry

No information is provided on undergraduate psychiatry training in the State.


7.2.b. Details of in-service training for Govt medical officers (No trained, duration) : Yes,
Medical University is providing training to Govt. Medical Officers under DMHP Programme.
However the details are not available.
7.2.c. Any other training courses in mental health offered by the state : K.G.M.U. Lucknow is
offering in service training courses in psychiatric nursing for govt. nurses.
NR
8. GOVERNANCE:
8.1. Nodal Authority and responsibilities : 1. Medical Education Dr. V.N. Tripathi (Director
General Medical Education), 2. State Medical and Health Department Dr. Renu Jalolte, 3.
Social Welfare Department Dr. Surendra Vikram, 4. SMHA Dr. S.C. Tiwari, 5. District Legal
Services Authority Shri Tej Pratap Tiwari.
8.2. Presence of a State Mental Health Plan: NR
8.3. Enactment of State Mental Health Rules: NR
8.4. Oversight of policies and Programmes related to mental health : NR
8.5. Specific oversight of the DMHP programme. No. Of DMHP in the state = 10+4 (Newly
identified), No. Of District in which DMHP has been fully implemented = 6, No. Of districts in

736

which it has been partially implemented = 3, The reasons for incomplete implementation of
the DMHP in the district is that the supporting staff yet to be appointed.
8.6. Attempts towards integration of mental health care into general health care, NCD
management etc. NR
8.7. Examples of commitment to develop mental health services (high level involvement,
budgeting, networking NR
8.8. Examples of inter-sectoral collaboration to improve mental health services (including PPP
intitiatives) NR
8.9. Attempts towards mental health promotion NR
9. FINANCING
9.1. Sources of financing of different categories
S.No.

Funds

1.
2.

Plan (Amount in Rs.)


Non-Plan (Amount in Rs.)

Mental Hospital,
Varanasi
31,31,205.00
6,11,92,470.00

IMHH, Agra
15,00,00,000.00

Mental Hospital,
Bareilly
5.5 crores per
year

9.2 Budget provision from State and Centre in INR (for different facilities if required) NR
9.3. Mental Health Expenditure as proportion of Total Health Expenditure in State NR
(If available % spending on Health in the State may also be provided)
10. ANY OTHER SIGNIFICANT INFORMATION (e.g. litigation, insurance schemes for persons
with mental illness, pension and other assistance, job reservations) NR
11. INNOVATIONS NR
12. OVERALL SUMMARY OF STATE LEVEL MENTAL HEALTH SERVICES :
With so much paucity of information of psychiatric care outside specialised government
psychiatric institutions, a comprehensive picture of mental health care in Uttar Pradesh
cannot be drawn.

737

SECTION 2
2.1. PSYCHIATRIC INSTITUTIONS
Domains

Developments
since 2008
(IMHH, Agra)

Infrastructure

Total beds strength 718


(2008)
Current beds strength
838
Essential services in
OPD like drinking water,
toilets, lights,
ventilation are
available. Half way
home is available as
integral part of family
ward.

Amenities
and facilities

Diet

Investigation
s and
treatment

Free medicines are


provided to patients of
OPD inpatient.

Staff and
training

There is urgent need to


improve the staff
strength of psychiatrist
and other supporting
staff.

Supportive
services

Recreation/
Occupational
therapy/
Rehabilitation

Developments
since 2008
(Mental Hospital, Bareilly)

Exhaust Fans have been fitted


in the kitchen for better
ventilation. Died provided at
3000 kcal/person.
Modified ECT is being given
with the help of anaesthetist.
Hospital has acquired and EEG
machine and CT scan machine.
Four General nurses have been
posted, no clinical psychologist
and PSW post current exists.

Supportive services like


Kitchen, Laundry, Medical
Records need to be developed.

Two occupational
therapy units, one each
for male and female
patients are available

T.V., Music System, Indoor &


Outdoor games and two
recreational halls with male
and female instructor are
available.

Networking
with other
agencies
738

Developments
since 2008
(Mental Hospital,
Varanasi)
The
buildings
are
approximately 200 years
old. Patients are kept in
closed wards.
There is no proper facility
for
registration
and
recording of outpatient.
No separate medical
record department.

There are not PSW,


Clinical Psychologist,
Psychiatrist nurses.

One ambulance was


supplied by the State
Govt. in 2001. There is
one telephone for the
office of director and no
PCO.
There are no
rehabilitation facilities to
the patients.

i. Outpatient: (IMHH, AGRA) Separate OPD blocks are constructed, there are dedicated
emergency services, there are facilities for visiting relatives to stay, waiting hall for patients,
toilets for patients and relatives, separate interview rooms, drinking water, canteen, OPD Lab
services, OPD rehabilitation services, specialized childrens geriatric, forensic, de-addition
services. There is a separate medical records section. Psychotropic medicines are available
free of cost to the patients.
ii. Inpatient (improvement in in-patient facilities; any increase in open compared to closed ward
admissions; further reduction in court admissions; improvement particularly in the care of
women, children and elderly; use of disposables needles and syringes; no re-use of shaving
blades; any illness outbreaks and how contained; availability of psychotropic medication
including free medicines; use of ECTs including direct ECT):
Diagnostic categories seen:
iii. DIAGNOSTICS AND THERAPEUTICS :

Investigations:
Therapeutic facilities:
Improvements in rehabilitation:
iv. ENGAGEMENT:
Attempts to involve families of persons with mental illness: All families are educated
the consumers are always involved in the treatment decisions.
Disability certification and number of certificates issued in the previous year: Yes, No. Of
certificate issue in previous year 44.

v. ADMINISTRATIVE

Annual number of adverse events:


Mechanisms for redressal of patient complaints:

vi. COMMUNITY OUTREACH AND NETWORKING


Community Programmes: Yes, No. Of activity per month
17. Ram Krishan Mission Charitable Hospital, Vrindavan 1
18. Women Protection Home 1
19. Mother Teresa Home 1
20. Bal Samprekshan Garh 1
21. Central Jail & District Jain twice in a month
22. City Mental Health Clinic Fatima Hospital 1 visit per week.
23. Networking with external agencies: Yes with NGOs help Agra, Kabeer Peace Mission.
739

24. Public mental health education: Yes through school mental health Programme and
exhibition, play drama, organized in hospital for open public. District Legal Cell
Authority Programme organized to educate patients in caretakers about their rights.
vii. TRAINING

Post-graduate training new Programmes, enhancement of seats and measures to


maintain/improve quality of training: M.D. Psychiatry two seats, DNB Psychiatry four
seats, 10 M.Phil Psychology students, No. Of PGs posted for 15 days or more = 50
M.Sc. (Nursing), Psychology, Social Work students, No. Of UGs / interns posted for 15
days or more = 1566 (GNM, B.Sc. Nursing).

Any other training Programmes: GNM, B.Sc. Nursing, M.Sc.Nursing, Psychology, Social
Work students, these students are posted from the other institutes for training in
psychology department.

vii. RESEARCH:

Research (areas, funding agencies, findings), Presented 44 research papers, published


research paper are 37, project completed 14, M.D., DNB, M.Phil thesis = 25,
viii. ANY OTHER SALIENT CONTRIBUTIONS OF THE HOSPITAL/INSTITUTE: ICMR
sponsored project 1, IPS sponsored project 1,

ix. Any monitoring of hospital (internal or external)- details :


x. Special Rapporteurs observation:
xi. Any other observations (including Inspection Committee Reports):
IMHH Agra- The IC visited on 26 June 2015. The committee was led by Shri Anshu Prakash, JS,
MOHFW. The IC noted that on most issues, the hospital was satisfactory. Vacant positions
needed to be filled. It urged that the ongoing construction activities be completed
expeditiously.
MH Bareilly- The IC visited on 27 June 2016. It observed that there were a large number of
longstay patients. There was no anaesthetist to support ECT procedures. There were no
facilities for couseling. There was no occupational therapist. Attendants were short. Staff
nurses were extremely short. This hospital had no monitoring. There were no specialised
services. Hygienic conditions were satisfactory.
MH Varanasi- The IC visited the hospital on 10 August 2015. It noted that the main building
was dilapidated. Patients were in enclosures. There were no specialised facilities. Cots were
740

inadequate.Recent upgradation work had not been completed. No ECTs were provided as
there was no anaesthetist. Large number of prisoners with mental health problems are
referred to Varanasi. Rights of patients was not displayed. The IC was of the view that the
infrastructure and human resource availability at the MH Varanasi could be substantially
improved.
xii. Summary and Recommendations from SECTION 2:
Areas of positive change
IMHH Agra (MONITORED)
Is an academic institution
Has started PG courses in all mental health
disciplines
Has facilities for treating special
populations (children, elderly under
construction, prisoners)
Has community outreach
Carries outreach activities
Has legal cell authority camp
NGO involved

Areas of poor progress

MH Bareilly (NOT MONITORED)


Pharmacotherapy adequate
Vocational training

Mostly closed wards (408)


No outreach
Large number of longstay
No counselling
No community engagement, no outreach
No NGO involvement
Nursing and attender vacancies

MH Varanasi (NOT MONITORED)


Pharmacotherapy adequate
Partial recreation/rehab
Some new infrastructure

No investigations
No counselling
No community linkages, outreach
Mainly enclosures
No NGO involvement
Human resource paucity
Main areas in a state of disrepair

Vacant positions still exist

The positive changes in the IMHH Agra can be attributed to the regular monitoring in the past
by the NHRC.

741

SECTION 3
3. General Hospital Departments of Psychiatry and District Hospital DepartmentsDETAILED INFORMATION IS AVAILABLE)

(NO

The broad outline for this section:


3.1. Names of GH/DH and their location. :
(If there are many, this could be done in a tabular column).
The following areas may be mentioned as a summary of all the units; where needed , examples
could be made of a specific dept to highlight both positives and negatives.
3.2. Areas (distribution throughout the states):
3.3. Whether separate funding and adequacy:
3.4. Whether OP/IP and emergency services available :
3.5. Diagnostic categories in rank order that present in the outpatient :
3.6. Adequacy of OP facilities : 3.7. Inpatient occupancy, free and paying beds, average cost of
inpatient stay per week; rank order of diagnostic categories :
3.8. Extent of family involvement :
3.9. Measures to protect rights including complaint redressal :
3.10. Any networking :
3.11. Staffing details and any shortages/vacancies :
3.12. Psychotropic medication availability/free/cost :
3.13. ECTs (Nos given across the facilities or average/No of direct ) :
3.14. Observations of extent to which counselling and psychotherapy are provided :
3.15. Whether disability certification is available (if available numbers certified/year)
3.16. Extent and nature of community involvement :
3.17. Whether engagement with the DMHP and extent :
3.18. Nature and partnership with NGOs for networking :

742

3.19. Presence of PG training- whether adequately distributed throughout the state :


3.20. Nature of public mental health material prepared and distributed/ activities to educate :
3.21. Areas of research, sources of funding and major findings :
3.22. Whether monitored and by whom. What were the observations? :
3.23. Special Rapporteurs observations3.24. Inspection Committees observations3.25. SUMMARY AND RECOMMENDATIONS WITH RESPECT TO SECTION 3:
In the absence of information, this cannot be commented upon.
SECTION 4
NO DETAILED INFORMATION IS AVAILABLE ABOUT THE NGOs working in the State in the area
of mental health.
4. NGOS WORKING IN MENTAL HEALTH:
4.1. A brief description of the NGO and its location :
4.2. Nature of work carried out by the NGO in the domains mentioned and details of each :
4.3. Description of clientele seen by the NGO and number of persons who use the services in
the previous year :
4.4. Research details :
4.5. Details of any training carried out by the NGO :
4.6. Networking activities of the NGO :
4.7. Salient contributions of the NGO :
4.8. Special Rapporteurs observations :
4.9. Inspection Committees observations :
4.8. SUMMARY AND RECOMMENDATIONS FOR SECTION 4
No details provided.

743

SECTION 5
5. DISTRICT MENTAL HEALTH PROGRAMME
5.1. A brief description of the location of the DMHP, when it started, total population covered:
District Mental Health Programme was initiated in 10 districts of Uttar Pradesh namely
Kanpur, Faizabad, Raibareilly, Sitapur, Banda, Etawah, Ghaziabad, Moradabad, Muzaffar
Nagar through four medical colleges / institute.
1. King Georges Medical College, Lucknow (Kanpur, Faizabad, Raibareilly and Sitapur
Districts).
2. G.S.V.M. Medical College, Kanpur (Banda and Etawah).
3. Meerut Medical College (Ghaziabad, Moradabad and Muzaffarnagar)
4. Alllahabad Medical College, Allahabad (Mirzapur).
5.2. A summary of annual registrations old and new, treatment outcomes in terms of those on
regular treatment and those dropped out, with diagnostic categories if provided. Would be
useful to know what kind of clientele is serviced under the DMHP:
S.No.

1.

2.

3.

4.
5.
6.

Annual
Registration
(Old)
Annual
Registration
(New)
Annual
Registration
(Total)
Patients on
Regular
Treatment
Dropped out
Irregular
Patients

DMHP
Faizabad
(Month
Dec.2014)

DMHP
Kanpur
(Dec.
2014)

DMHP
Sitapur
(Dec.14)

DMHP
Raibareilly
(Dec. 14)

DMHP
Etawah
(Dec.14)

DMHP
Banda
(Dec.14)

499

595

561

609

1212

92

116

148

110

91

183

36

615

743

671

700

1395

128

463

426

632

567

702

68

N.A.

35

21

48

181

10

36

24

18

77

157

16

744

5.3. Frequency of home visits carried out by the HW/ANM; numbers covered and for what
diagnostic categories, no of admissions facilitated:
5.4. Kinds of essential drugs available, number dispensed, number of patients receiving
medication under the DMHP in a month:

Sr.No.

1.
2.
3.
4.
5.
6.
7,
8.

Name of the
drug
Escitalopram
(10 mg.)
Risperidone
(2 mg.)
Carbamazepine
(200 ml.)
Olanzapine
(10 mg.)
Sertraline
(50 mg.)
Sodium
Valproate
(500 mg.)
Trihexyphenidyl
(2 mg.)
Sodium
Valproate
(200 mg.)

No. Of
Tablets
dispensed

No. Of
patients
receiving
medicines
Faizabad district

No. Of
Tablets
dispensed

No. Of
patients
receiving
medicines
Kanpur district

No. Of
Tablets
dispensed

No. Of
patients
receiving
medicines
Sitapur district

No. Of
Tablets
dispensed

No. Of
patients
receiving
medicines
Raibareilly district

2161

68

2215

144

2404

129

795

39

1485

34

435

17

307

18

930

17

3110

82

3187

76

1616

31

1215

35

2295

136

3145

145

446

32

1223

49

940

38

4364

237

600

12

305

36

2634

112

1474

27

570

12

550

12

5.5. Duration of untreated mental illness for different diagnostic categories if provided:
5.6. Monitoring of the DMHP by the concerned officer /impressions and trouble-shooting
(mention if there is a committee and its composition): Satisfactory
5.7. IEC activities of the DMHP: IEC activities include distribution of posters, pamphlets, street
plays, screening of slides in Cinema hall, Radio talks, debates, satisfactory in DMHP districts.
5.8. Training calendar of the DMHP (doctors, health workers, nurses, pharmacists, school
teachers/Anganwadi workers (whether any training conducted): Training of Health Worker,
Nurses, Pharmacist, School Teachers, Anganwadi Workers, Asha Workers, Sensitization of
Gram Panchayat Members and other administrative personnel have been conducted in all
DMHP districts.
5.9. Activities to sensitize the gram panchayats

745

5.10. Special Rapporteurs report on the activities of the DMHP, its reach, areas of good
performance, areas of poor performance, barriers for effective service delivery, measures to
streamline functioning, funding flow and barriers thereof. 5.11. Inspection Committees observations -

746

5.12. SUMMARY OBSERVATIONS OF DMHP AND RECOMMENDATIONS:


As per the information provided, it appears that the DMHP is fairly active, and several
programmes are being carried out in the community. The DMHPs seem to have been taken
up by the medical colleges and service delivery, training and community sensitisation are all
being undertaken.
SECTION 6
6. SUMMARY OF MENTAL HEALTH CARE INDICATORS IN UTTAR PRADESH(name of state)
6.1. Availability of mental health facilities
Total No of
facilities/beds
Mental health outpatient facilities in
the state

Rate per 100,000 population


0.329

Day treatment facilities


Psychiatric beds in general hospitals

0.823

Community residential facilities


Beds/places in community residential
facilities
Psychiatric hospitals

0.004

Beds in psychiatric hospitals

1.469

6.2. Access to Care


Rate per 100,000
population
Persons treated in mental health
outpatient facilities
Persons treated in mental health day
care facilities
General hospital admissions
Community residential facilities

747

Females %

Persons staying in community


residential facilities at the end of the
year
Admissions to mental hospitals

14.52

6.3. Information Systems

Persons with mental


disorders treated in
primary health care
Interventions delivered
in primary health care
for persons with
mental disorders
Persons treated in
mental health
outpatient facilities
Contacts in mental
health day treatment
facilities
Admissions in general
hospitals with
psychiatric beds
Admissions in mental
hospitals
Days spent in mental
hospitals
Admissions in
community residential
facilities

Data on No of
persons/activities
collected and reported
YES/NO

Data on age and


gender are collected
and reported
YES/NO

Data on patients
diagnosis are collected
and reported
YES/NO

Yes

Yes

Yes

Yes

Yes

Yes

No

No

No

748

6.4. Human Resources at the State Level

Psychiatrists

Health professionals working


in the mental health sector
Rate per 100,000

Training of health professionals


in educational institutions
Rate per 100,000

0.301

0.0364

Medical doctors not specialised


in psychiatry

2.893

Clinical Psychologists

0.047

0.010

Psychiatric Social Workers

0.033

0.003

Psychiatric Nurses

0.166

0.016

Occupational therapists
Other health workers

6.5. INFORMAL HUMAN RESOURCES (Family and User Associations)


Present in the state
No of members
Participation in the
formulation/implementation of
policy/plan/legislation

User
Yes

Family
Yes

Not routinely

Not routinely

6.6. MEDICINES
Type of Medication

Expenditure at State level per year and per


100,000 population (inINR)

All psychotropic medication


Mood stabilisers
Antipsychotics
Anxiolytics
Antidepressants
Anti-craving medication/ Substitution
treatments

749

SECTION 7
7. STATE MENTAL HEALTH REPORT CARD
SUMMARY OF SECTIONS 1-7.
Summary of areas where state has achieved good progress/little progress/no progress
The State of Uttar Pradesh has 3 psychiatric hospitals. Major changes in a positive manner are
seen in the IMHH Agra and these can be attributed to constant monitoring by the NHRC and the
beginning of academic courses. The other hospitals continue to have problems related to
paucity of working staff, infrastructural deficiencies, lack of comprehensive services for
patients.
Information from the Medical Colleges, which seem active in the DMHP, General Hospitals and
District hospitals is crucial to determine the extent of mental health service delivery coverage in
the State.
The large private sector has also not been covered.

MENTAL HEALTH REPORT CARD


Area

Focus

Parameters

Rating

Score (out
of 100)

100- present, fully


satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100 All districts
covered; fully
satisfactory
75 majority of
districts covered
and functioning
50 half the
districts covered
and functioning

25*
(score may
improve
with more
information)

Mental Health
Services
(Secondary
and Tertiary)

Medical
College
Depts,
General
Hospitals,
Specialised
psychiatric
hospitals

Adequacy of inpatient
beds
Functional Departments
Functional OP services

Primary
Health Care
mental health
services

District
Mental
Health
Programme

% of functional DMHPs

750

12.5*
(though
running
well, is only
present in
10 of 75
districts)

25 one-fourth
of the districts
covered and
functioning
0- No districts
covered/although
DMHP exists, not
functioning
100- present, fully 25
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100- present, fully 25
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent

Rehabilitation
services

At all levels

Vocational training, day


care, longstay facilities in
govt sector/ppp

Specialised
services

Whether existing, level


of functionality, present
at different levels of care

Human
Resources

Services for
substance
use
disorders,
old age,
mental
retardation,
child
psychiatry,
community
services,
forensic
services
(exclude
DMHP staff
here)

Adequacy of
psychiatrists/clinical
psychologists/psychiatric
social
workers/psychiatric
nurses or mental health
trained nurses

100 fully
adequate
75 moderately
adequate
50 somewhat
adequate
25- inadequate
0 grossly
inadequate

12.5* (may
improve
with more
complete
information)

Financing for
mental health

State level

Existence of separate
budget for mental
health/mental health
activities

10% -separate
budget, fully
adequate
75 separate
budget,
moderately

25

751

Governance
and Policy

State
Mental
Health
Authority
and other
authorities

Separate Mental Health


Nodal Officer
Functioning Mental
Health Authority
Nodal persons for mental
health in SHRC/Legal
Services
Authority/Others
State Mental Health
Rules
State Mental Health
Programme

Availability of
psychiatric
medication

At every
level

Range of medications
Regular supply and
dispensing
Standard procurement
arrangements

Affirmative
action for
persons with
mental illness

At every
level

Disability assessment
Pension
Travel concession
Health insurance
Special assistance
Educational benefits
Job reservation

10

Treatment

Overall

Approximate number of
752

adequate
50 separate
budget,
somewhat
adequate
25 no separate
budget, but some
financial
resources
available annually
0 no separate
budget/marginal
financial resource
allocation
100 Existing,
fully functional
75- Existing,
mostly functional
50- Existing,
somewhat
functional
25- Partial
0 Non existent

100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100 no

25

25* (may
improve
with more
information)

12.5

12.5*

Gap

persons with mental


illness approximate
numbers totally receiving
treatment in the state

treatment gap
75 25%
treatment gap
50 -50%
treatment gap
25 -75%
treatment gap
0- 100%
treatment gap

Total Score (out of 1000)


Average Score (%)

200
20%

RECOMMENDATIONS:
All the indices are likely to improve if comprehensive information is collected in the State,
particularly the information from the medical colleges/GH/DH as well as from the private
sector.
The State need to develop a time-bound mental health service delivery plan.
Regular monitoring of MH Bareilly and MH Varnasi to improve their deficiencies (which have
been pointed out in many earlier reports) need to be undertaken.
The DMHP appears to be functioning well. The model of being run by medical colleges needs
to be compared with other administrative mechanisms, and a detailed comparison must be
carriet out with other states. This will help to evolve functioning model/s for other states.

753

WEST BENGAL
SECTION 1. STATE LEVEL REPORT
1. GENERAL INFORMATION REGARDING THE STATE
a. Area: 88752 sq kms
b. No of districts: 26 Health Districts
c. Population (as per census 2011): 91347736
d. Gender distribution: Males 46927389 Females 4420347
e. Life expectancy at birth male and female: Male:63.2 ; Female:66.4
f. Per capita State Government expenditure on health: Not provided
g. Any health indicators for the state: Infant mortality rate at 31 and maternal
mortality ratio at 117 are both lower than the national average (40 and 178
respectively), Literacy rate at 77.1% is higher than the national (74.04%).
Health Development indicators- West Bengal & India
Indicator (with year)
West Bengal India
Birth rate, 2010
16.8
22.1
Death rate, 2010
6.0
7.2
Infant mortality rate, 2010
31
47
Total fertility rate, 2009
1.9
2.6
Neonatal mortality rate, 2009
25
34
Under 5 mortality rate, 2009
40
64
Maternal mortality ratio, 20072009
145
212
The Extent of Mental Health Problems in West Bengal State
Population in West Bengal State (2011 Census )
Prevalence of Psychiatric disorders (6%-as per the West Bengal State
affidavit)
Prevalence of severe psychiatric disorders (20/1000 Population)
Neurosis and Psychosomatic disorders (20/1000 Population)
Mental Retardation (0-1% of all children up to 6 years)

754

9,13,47,736
54,80,864
18,26,954
18,26,954
9,13,477

Completeness/quality of information provided: Partially Complete


If deficient, areas of deficiency:
Deficient information. There is no detailed information on private psychiatric facilities in the
state (as per the list provided from the WB Government).
1) 13 District Hospitals have started functioning with 58 Psychiatry Indoor Beds
2) There are 16 medical colleges and all have Departments of Psychiatry.

755

2. MENTAL ILLNESS BURDEN/ INFORMATION REGARDING MENTAL ILLNESS


N
(prevalence)
2.1. Total number of persons with
mental illness (all ICD categories)

54,80,864

N
(treatment
seeking)
Calculated Not
by state
provided
at 6%*

2.2. Broad categories


2.2.a Severe mental disorders
(BPAD, psychosis)
2.2.b Common mental disorders
2.2.c Substance use disorders
(alcohol and other drugs)
2.2.d Mental Retardation

No
information
available as
per
categories

2.3. No of Males with mental health


problems
2.4. No of females with mental
health problems
2.5. No of children with mental
health problems
2.6. No of elderly with mental health
problems
2.7. No of homeless mentally ill
persons

Not
provided
Not
provided
Not
provided
Not
provided
Not
provided

As per
information
provided by
state

3. MENTAL HEALTH SERVICES IN THE STATE:


Organization of Services
General health care system in West Bengal
Total Number of Medical Colleges
Total Number of Medical Colleges having Psychiatry
Department
Total Number of Government Medical Colleges
Government Psychiatric hospitals
District hospitals having DMHP
State General hospitals
Rural hospital
Block Primary health centre
Primary health centres
Subcentres

756

Source of
information

16
16
13
5
13
33
269
79
909
10356

As already mentioned, no information has been provided about the private psychiatric
facilities. There are a total of 19 psychiatric social workers, 22 psychologists and 233
trained nurses in WB as per the States submission.

3.1.a No of district
general hospitals with
separate department
of psychiatry
3.1.b No of medical
colleges with
department of
psychiatry
3.1.c No of district
general hospitals
providing psychiatric
care
3.1.d No of District
Mental Health
Programmes in the
State

N/N No with
dept/facility
Total No of units
13/20

% coverage

16/16

100

13/20

65

4/20

20%

65

N
3.1.e No of
government psychiatric
hospitals
3.1.f No of private
psychiatric hospitals
3.1.g Total No of
psychiatric hospitals in
the state
3.1.h No of NGOs
providing mental
health care

Information not provided


35 private psychiatric nursing
homes/clinic/rehab centres including deaddiction centres
Information not provided

a. INPATIENT SERVICES
DESCRIPTION: The five major psychiatric facilities have filled up 2 different proforma,
and thus parameters cannot be accuarately compared between them.

757

Psychiatric
hospitals
(Govt) N=5

Psychiatric
hospitals
(Private)
NOT
Recorded

3.2.a. Total
750
Inpatient
sanctioned/available
beds
3.2.b No of male
395
beds
3.2.c. No of female
355
beds
3.2.d. No of beds for
children
3.2.e. No of beds for
elderly
3.2.f. No of beds for
substance use
disorders
3.2.g. No of beds for
forensic psychiatry
3.2.h. Occupancy
(%)
3.2.i. No of
admissions during
previous year
3.2.j. No of
discharges during
previous year
3.2.k. Average
duration of
inpatient stay in
days mean
3.2.l. Average
duration of
inpatient stay in
days median
3.2.m. No of closed
wards
3.2.n. No of closed
ward beds
3.2.o. No of open

General
Hospitals

District
Hospitals
N=20

NGOs
N=

Total

Total NOT
AVAILABLE
180

58

988

29

424

29

384

758

wards
3.2.p. No of open
ward beds
3.2.q. No of paid
wards
3.2.r.No of paid
beds
3.2.s.No of
admissions through
courts
3.2.t. No of deaths
in the last year
3.2.u. No of suicides
in the last year
b. OUTPATIENT SERVICES*

3.3.a. No of new OP
registrations in the
previous year
3.3.b. No of
emergency
attendees in the
previous year
3.3.c Total no of OP
follow-up in the
previous year

Govt.
Psychiatric
hospitals
N=5
31036

Private
Psychiatric
hospitals

General
Hospitals

District
Hospitals

NGOs

Not
available

Not
available

N=13
Not
available

N=5
Not
available

51

117959

COMMENT:
Information not provided for facilities apart from the psychiatric hospitals.
4. REHABILITATION FOR PERSONS WITH MENTAL ILLNESS

Government of West-Bengal does not have following facilities:


a) Residential Long Stay home for persons with mental illness
b) Half-way home for persons with mental illness
759

Total

c) Exclusive de-addiction centre


d) Rehabilitation centres or
e) Day care centres

5. MENTAL HEALTH CARE IN OTHER COMMUNITY FACILITIES


State Level, in the Govt Sector
5.1. No of shelter homes, observation homes,
special homes and childrens homes
5.2. No of counsellors trained in mental
health in the above institutions
5.3. No of protection homes for destitute
women
5.4. No of counsellors trained in mental
health in the above institutions
5.5. No of old age homes
5.6. No of counsellors trained in mental
health in the above institutions
5.7. No of
Central Jails and
District Jails in the State
5.8. No of counsellors trained in mental
health in the above institutions
5.9.No of counsellors trained in mental health
in the above institutions

N
78
0
1
0
1
0
6
12
3
0

Help lines for Mental Health: NR


COMMENT: State of WB has 25 shelters homes (run by NGO's), 14 Government run
observation homes, 3 NGO's run observation homes, 6 Government run special homes, 16
Government run children homes and 2 Non-Government run children homes. There are no
qualified mental health professionals in these homes and also no trained mental health
counsellors. State of WB has one protection home for destitute women and also has 36 short
stay home. Even here there are no qualified mental health professionals in these homes, as
well as no trained mental health counsellors. It has only one old age home funded by
Government. There are six central correctional homes and 12 district correctional homes.
Three clinical psychologists are posted in central correctional homes.

6. MENTAL HEALTH HUMAN RESOURCES


Mental Health Care Professionals
760

6.1. No of
Psychiatrists
6.2. No of Clinical
Psychologists
6.3. No of
Psychiatric Social
Workers

Government
Sector medical
colleges/hospitals
(include district
general hospital
information also)
117

Psychiatrists
in medical
colleges

14

131

34

36

231

6.4. No of nurses 227


trained in mental
health
6.5. No of
trained
counselors

Private
Practice

Total

Nil

COMMENT: The numbers in the private sector are not mentioned.


7. MENTAL HEALTH HUMAN RESOURCE DEVELOPMENT
7.1. Degree/Diploma Courses
P G Centres in Psychiatry
MD Seat in Psychiatry in Govt. Medical Colleges
16
DPM Seats in Psychiatry in Govt. Medical Colleges 10
MD Seat in Psychiatry in Pvt. Medical Colleges
NA
DPM Seat in Psychiatry in Pvt. Medical Colleges
NA
DNB (Psychiatry)
NIL
Mphil Clinical Psychology
8
MPhil PSW
16
MSc Nursing
7
Bsc Nursing
291
DPN
10
COMMENT: Although the State has facilities for post graduate training in mental health
specialities, in most areas, the number of seats are not substantial given the requirements of
the state.
7.2. Other training in mental health
761

Medical officers in the DMHP are being trained for 3 days (so far 520 trained), 1932 nursing
staff received 1 day training
7.2.a. Details of Undergraduate MBBS training in psychiatry

Name of
medical college

No of hours of
theory

Duration of
psychiatry
posting during
UG

All medical
20
15days
colleges
COMMENT: This is sub-optimal as per the MCI.

Duration of
psychiatry
posting during
internship

15days

Qualifying
Examination
includes
competency
evaluation in
psychiatry
No question
paper

This information has been asked for and will be provided


7.2.b. Details of in-service training for Govt medical officers (No trained, duration)
So far, 520 medical officers have been imparted training in mental health for 3days. But no
regular training provided per annum. So far, 1932 government nurses have been trained in
mental health for one day.
7.2.c. Any other training courses in mental health offered by the state
8. GOVERNANCE:
8.1. Nodal Authority and responsibilities : Director of Medical Education, Director of Health
Services (Mental Health), Commissioner Disability and JD Health Services (State Mental
Health Authority)
8.3. Enactment of State Mental Health Rules: NO
8.4. Oversight of policies and Programmes related to mental health: WB State Mental Health
Authority
NR
8.5. Specific oversight of the DMHP programme. Brief description of districts where fully
implemented, where partially implemented and details of reasons for incomplete

762

implementation. Also mention here a brief summary of availability of medicines and


psychosocial care for patients with mental illness.
WB implemented DMHP only in four districts. Out of these three districts have
comprehensive implementation and one is partial. State proposes to expand only in three
more districts in the next financial year
8.6. Attempts towards integration of mental health care into general health care, NCD
management etc.
None
8.7. Examples of commitment to develop mental health services (high level involvement,
budgeting, networking
None
8.8. Examples of inter-sectoral collaboration to improve mental health services (including PPP
intitiatives)
Details not available
8.9. Attempts towards mental health
The WB State Legal Services Authority has been conducting mental health awareness in most
districts of the state.
COMMENT: Strengths and weaknesses (see later)
9. FINANCING
9.1. Sources of financing of different categories
Not available
9.2 Budget provision from State and Centre in INR (for different facilities if required)
Not available
9.3. Mental Health Expenditure as proportion of Total Health Expenditure in State
NOT available
10. ANY OTHER SIGNIFICANT INFORMATION (e.g. litigation, insurance schemes for persons
with mental illness, pension and other assistance, job reservations)
763

NOT available
11. INNOVATIONS
None
12. OVERALL SUMMARY OF STATE LEVEL MENTAL HEALTH SERVICES
The State of West Bengal has provided a more comprehensive picture of its mental health
services compared to many other states. Apart from the government psychiatric hospitals,
mental health professionals positions are present in the government and private medical
colleges and psychiatrists and psychologists are working in the district hospital. There are
relatively fewer psychiatric social workers and it is not clear whether the trained nurses are
adequately trained in mental health. Information from private psychiatric institutions and
mental health professionals in private practice has not been obtained.

764

SECTION 2
2.1. PSYCHIATRIC INSTITUTIONS
State run hospitals Calcutta Pavlov Hospital, Lumbini Park Hospital, Kolkata, Berhampore
Mental Hospital, Murshidabad, Institute of Mental Care, Purulia, Toofanganj Mental Hospital,
Coochbehar. Forms have been returned from all the hospitals.
There is no information on private psychiatric facilities in the State.
SERVICES :
i. Outpatient: At Calcutta Pavlov Hospital, the canteen services, lab services, specialised
services are said to be lacking. There is no separate MRD. There are no educational materials
available for patients. Patients diagnostic break-up is not available. The Hospital has catered
to 6686 new cases and has had 55538 follow-ups. The hospital has 14 psychiatrists, 6 clinical
psychologist, 1 mental health trained nurse and 55 general nurses, 123 ward attendants.
Lumbini Park hospital reports seeing 3506 new OP registrations and 11866 follow-ups, but
outpatient facilities appear to be non-existent.
Behrampore Mental Hospital has a separate OPD building and sees emergencies. It reports no
specialised services and no OPD canteen services. There are no laboratory facilities. The
hospital reports seeing 21114 new patients, the diagnostic breakup of which is given in
percentages and does not add up. 50535 follow-up cases are reported.
IMH Purulia reports adequate outpatient services apart from canteen, outpatient
rehabilitation and educational materials. This Institute has not filled up the proforma for
psychiatric hospitals.
At Toofanganj mental hospital, outpatient has a separate building with a waiting hall and
toilets, but there are no specialised services, including rehabilitation. 5943 outpatients were
seen in the previous year and 21082 follow-ups were registered.
ii. Inpatient : Calcutta Pavlov Hospital- mainly closed wards (only 1 open ward with 15 bedsno admissions). 138 with stay more than one year and 243 patients with stay more than 5
years). 136 patients are destitute. There were 28 deaths in the previous year. Facilities are
reported as adequate.
Lumbini Park Hospital- There are a total of 200 beds (100 male and 100 female). All are closed
ward beds. Toilet facilities are inadequate. There are no separate interview rooms to see
patients. Duration of inpatient stay is between 65 to 86 months. There are no specialised
facilities.
765

Behrampore Mental Hospital: 350 bedded hospital, 175 male and 175 female beds. There
were only 210 amdisions in the last year. It appears that all these admissions are through the
court. Median duration of stay is 16 years. The report mentions that there are no closed
wards and no open wards. It is unclear where the patients are admitted. 140 patients have
duration of stay over 1 year and 50 over 5 years. 32 patients are reported to be destitute.
There were 12 deaths in the last year. Amenities are reported to be satisfactory.
IMH Purulia had 128 admissions in the previous year.
The Toofangunj MH does not indicate the number of inpatient beds, the number and type of
admissions, and facilities in the hospital.
Diagnostic categories seen: Calcutta Pavlov Hospital mainly psychotic patients
iii. DIAGNOSTICS AND THERAPEUTICS

Investigations: At Calcutta Pavlov hospital, investigations are not available. Lumbini


Park Hospital has no investigation facilities. Behrampore Mental Hospital has basic
laboratory facilities.
Therapeutic facilities: At Calcutta Pavlov hospital, medication availability is
satisfactory. This is one of the few hospitals where female beds exceed male beds (140
and 40 respectively). ECT services are not available.Counseling and psychotherapy is
said to be provided to all. There are no specialised services. At Lumbini Park Hospital,
medicines are said to be satisfactory. NO ECTs are provided. Some patients are said to
receive counselling and psychotherapy. At Behrampore Mental Hospital, medicines
are reported to be satisfactory. No ECT services are available. At IMH Purulia,
medicines are available. No ECTs are provided. An email from the Superintendent of
the Toofangunj MH indicates that medications are available.
Improvements in rehabilitation: At Calcutta Pavlov hospital, there is no outreach and
no in-patient rehabilitation. NGOs Anjali and Paripurnata are engaged in rehabilitation
after discharge. At Lumbini Park Hospital, there is no rehabilitation service. Anjali is
involved in rehabilitation. At Behrampore Mental Hospital there are no rehabilitation
facilities. Anjali is engaged in rehabilitation. At IMH Purulia, there is no NGO
collaboration.

iv. ENGAGEMENT:

Attempts to involve families of persons with mental illness: Only a third of patients at
Calcutta Pavlov hospital are taken back by their families. At Lumbini Park, families are
rarely involved in care. At Behrampore, it has been reported that there is interaction

766

with families 100% (this needs to be verified). IMH Purulia reports no interactions with
family. Toofangunj- not mentioned.
Disability certification and number of certificates issued in the previous year: Calcutta
Pavlov hospital issues disability certificates. Lumbini Park Hospital does not.
Behrampore Mental Hospital provides disability certification. Toofangunj MH has a
board for disability certification.

v. ADMINISTRATIVE
Annual number of adverse events: At Calcutta Pavlov Hosptial- 13
Mechanisms for redressal of patient complaints:
Calcutta Pavlov Hospital Has Board of Visitors (not clear if functioning);. MS is not a
psychiatrist.
Lumbini Park- There is no separate records section. MS is not a psychiatrist.
No visits by NHRC/SHRC/SMHA
Behrampore Mental Hospital No separate records section. MS is not a psychiatrist. Has
not mentioned any details of monitoring
Toofangunj- MS is not a psychiatrist. The SHRC visited once in 2013. There is a Board of
Visitors.
vi. COMMUNITY OUTREACH AND NETWORKING

Community Programmes: Calcutta Pavlov Hosptial Nil, Lumbini Park Hospital- Nil;
Behrampore Mental Hospital Nil; IMH Purulia- Nil
Networking with external agencies: - Nil
Public mental health education: - Nil

vii. TRAINING

Post-graduate training new Programmes, enhancement of seats and measures to


maintain/improve quality of training: Calcutta Pavlov Hosptial-post graduate trainees
and UG trainees posted. Lumbini Park Hospital-there is no post-graduate training. IOP
is affiliated to the college and has an academic programme.
Any other training Programmes:

vii. RESEARCH:

Research (areas, funding agencies, findings),

viii. ANY OTHER SALIENT CONTRIBUTIONS OF THE HOSPITAL/INSTITUTE:


ix. Any monitoring of hospital (internal or external)- details.
767

Calcutta Pavlov Hospital- No monitoring visits


x. Special Rapporteurs observation:
The Special Rapporteur Shri Shyam Sundar all the three government psychiatric institutes. As
per his observations there have been micro-achievements in terms of infrastructure.
However, the situation has become bad to worse in terms of overcrowding and sanitation.
xi. Any other observations (including Inspection Committee Reports):
The IC visited IMH Purulia on 4th June 2015. The IC was headed by Smt. Dharitri Panda, Joint
Secretary, MOHFW. The IC noted a lack of fans, need for civil repairs of the OPD building and
minor repairs of the staircases and footpaths. ECT machines had been procured but not used.
The land and building were still owned by the Ministry of Home (the hospital was earlier a
jail) and required to be handed over to the Ministry of Health and Family Welfare. The
admission required to be more transparent and easier.
The IC visited Calcutta Pavlov Hospital on 6 June 2016. Salient observations were that many
posts were vacant; there was a need for repairs in the out-patient; ECT facilities were not
being offered; there was inadequacy of IEC; drinking water needed to be provided and there
was a need for improving the toilet sanitation; TV sets needed to be provided in the wards;
recreational facility was required in the wards. The IC appreciated the work of the NGO Anjali
in counselling and recreation. They opined that the patients were generally satisfied with the
services.
The IC visited the Behrampore Mental Hospital on 5 June 2015. They observed that facilities
like adequate fans and drinking water was insufficient in the out-patient; there was a need of
more nursing and group D staff; shortage of male nurses in the male ward; need for
rehabilitation of the recovered patients; lack of ECT treatment; lack of waiting spaces in the
out-patient; need for IEC materials; need for more toilets and better sanitation; need for
repair of TV and music sets; need for injectable medication; need for training of all categories
of staff. They found that the NGO Anjali was providing recreational facilities and providing
counselling for the women inpatients and recommended that this be extended to the mens
ward. They commented on the adequacy of food and observed that the patients were
satisfied with the services which were generally satisfactory.
The IC visited Lumbini Park
documentation.

on 6 June 2016. This report was not available in the

The IC visited the Institute of Psychiatry on 12 August 2015. Their observations were not
available in the documentation.
768

xii. Summary and Recommendations from SECTION 2:


Treatment
Most of the psychotropics are available free of cost in most of the centres.
Records
All mental hospitals have separate medical records for inpatients.
Administrative Issues
Most of the mental hospitals do not have psychiatrist as the medical superintendent. All have
Board of Visitors and Disability Boards. None of them have received any human rights
violation complaints or legal litigation with regard to patient care.
Community outreach and partnerships
Most of the hospitals do not have community out-reach Programmes
Partnerships
Liaising with NGO's is inadequate.
Post-graduate training
Only two of the five mental hospitals have post-graduate training facilities. Institute of
Psychiatry has started new courses such as MSc in psychiatric nursing, MPhil clinical
psychology and psychiatric social work. IOP needs to get government support for further
human resources development.
Areas of positive change
Academic involvement in the IOP
Limited NGO involvement for counselling
and recreation
Medicines generally available
Diets wholesome

Areas of poor progress


Infrastructure problems
Basic amenties still lacking in some places
Lack of adequate rehabilitation facilities

SECTION 3
21. General Hospital Departments of Psychiatry and District Hospital Departments
The broad outline for this section:
769

3.1. Names of GH/DH and their location. Forms have been received from 13 District Hospitals
and 16 medical colleges (13 in government) DH Barasat, MR Bangura, DH Howrah, DH
Hooghly, DH Nadia, Dh Birbhum, Deven Mahata Hospital, Purba M Dt Hospital, DH, Dakshin
Dinajpur, Raiganj Dt Hospital, Jalpaiguri Dt Hospital, Darjeeling DH, MJN Hospital Cooch
Behar, MC Kolkata, Ratan Sarkar MCH, RG Kar MCH, Burdwan MCH, College of Medicine and
JNM Hospital, BS Medical College and Hospital Bankura, Malda Medical College and Hospital,
Midnapore MC and Hospital, College of Medicine and Sagore Dutta Hospital, North Bengal
Medical College and Hospital, ICARE Haldia, IQ City MC and Hospital.
Staff sanctioning at the District Hospitals include 20 psychiatrists,
Psychologists/Psychologists, 28 Psychiatric Nurses/trained general nurses

Clinical

At the medical college, there are 79 psychiatrists in the government medical colleges, 14
psychiatrists in the private medical colleges (and 18 in the government psychiatric hospitals).
Six of the 13 district hospitals have a psychologist/clinical psychologist. There are 20
psychologists woring across the 13 government medical colleges and one psychologist each in
the 3 private medical colleges. There are 4 psychiatric social workers in the government
medical colleges (3 attached to IOP and one to Malda Medical College). The 3 private medical
colleges have 4 psychiatric social workers in total. Five of the 13 district hospitals have
trained nurses (totally 23) and 8 of the government medical colleges have trained nurses
(totally 45 including the IOP). One of the 3 private medical colleges has 4 trained nurses.
The IPGMER (Institute of Psychiatry) has been upgraded to a Centre of Excellence. It has
academic facilities. Specialised services are being developed. It has an active outpatient
department. It has an inpatient bed strength of 60 (30 male, proposed to increase to 60 and
20 female, proposed to be increased to 30; has a 10 bed de-addiction ward proposed to be
increased to 24; proposed 16 bed childrens ward; 10 bed geriatric ward. Average inpatient
stay is 23 days. Medications are regularly available. The IOP carries out outreach activities. It
has received monitoring by the NHRC/SHRC twice and is regularly visited by the ADHS
(Mental Health).
3.2. Areas (distribution throughout the states): Well distributed
3.3. Whether separate funding and adequacy: Not separate
3.4. Whether OP/IP and emergency services available: Generally available
3.5. Diagnostic categories in rank order that present in the outpatient: Psychosis including
schizophrenia, common mental disorders, substance use disorders.
3.6. Adequacy of OP facilities: Variable with nil upto 20 beds.
770

3.7. Inpatient occupancy, free and paying beds, average cost of inpatient stay per week;
rank order of diagnostic categories- not detailed
3.8. Extent of family involvement- generally involved
3.9. Measures to protect rights including complaint redressal- not detailed
3.10. Any networking-little
3.11. Staffing details and any shortages/vacancies- not detailed
3.12. Psychotropic medication availability/free/cost- generally available
3.13. ECTs (Nos given across the facilities or average/No of direct )- variable
3.14. Observations of extent to which counselling and psychotherapy are provided- generally
available
3.15. Whether disability certification is available (if available numbers certified/year)- most
hospitals
3.16. Extent and nature of community involvement- little
3.17. Whether engagement with the DMHP and extent- little involvement
3.18. Nature and partnership with NGOs for networking- little
3.19. Presence of PG training- whether adequately distributed throughout the stateinadequate
3.20. Nature of public mental health material prepared and distributed/ activities to educatelittle
3.21. Areas of research, sources of funding and major findings -little
3.22. Whether monitored and by whom. What were the observations?3.23. Special Rapporteurs observations: The Special Rapporteur Shri D Sarangi, in his visit to
West Bengal on 7th and 8th May 2015 noted that the Medinipur Medical College and Hospital
was started by upgrading the District HQ Hospital, no psychiatric ward was created here. Only
outpatient services were provided. It had no post graduate course in psychiatry. The college
was managing the Paschim Medinipur DMHP unit. Medicines provided were adequate but
required regular review with newer medications being available.
3.24. Inspection Committees observations: 771

3.25. SUMMARY AND RECOMMENDATIONS WITH RESPECT TO SECTION 3:


This section has been comprehensively reported in the affidavit. It appears that many of the
general hospitals are active in seeing patients with psychiatric problems. OPD facilities have
inadequacies which need to be corrected. The information needs to be consolidated by the
State to understand the patterns of service delivery by different facilities.
SECTION 4
22. NGOS WORKING IN MENTAL HEALTH:
The main NGOs providing mental health care are Ishwar Sankalpa, Kolkata, Paripurnata,
Kolkata, Antara, Kolkata and Sevak, South 24 Parganas.
4.1. A brief description of the NGO and its location: ANJALI is located in Kolkata
Paripurnata is a halfway home located in Kolkata.
SEVAC is located in Kolkata.
ANTARA is located in Kolkata.
ISHWAR SANKALPA is located in Kolkata.
4.2. Nature of work carried out by the NGO in the domains mentioned and details of each:
Anjali provides counselling, legal assistance, social assistance, residential care, aftercare and
homebased programmes.
SEVAC provides counselling, legal assistance, social assistance, residential care, rehabilitation
and aftercare.
ANTARA provides counselling, legal and social assistance, residential care, rehabilitation,
aftercare and home-based programmes.
ISHWAR SANKALPA offers counselling, legal assistance, social assistance, residential care,
aftercare and homebased programmes.
4.3. Description of clientele seen by the NGO and number of persons who use the services in
the previous year Anjali has provided assistance to 175 patients in the State hospital,
rehabilitated 107 patients with their family and met 300 families for rehabilitation and
aftercare. It has counselled 1900 individuals through the mental health kiosks, reached more
than 5000 through awareness camps.

772

Paripurnata is a half-way home which has been providing services ato about 30 patients . It
has a liaison with Calcutta Pavlov Hospital.
ANTARA carries out CGC clinics, chemical dependency clinics, satellite clinics at Noorpoor,
Canning, Gazipur and Kolkata. It has a 200 bed indoor facility. It has an occupational therapy
programme, a day treatment programme and recreational programmes for inpatients. It has
a general medical clinic for persons with mental illness and has a self-help group. ANTARA
also admits the wandering mentally ill on court orders.
ISHWAR SANKALPA has provided comprehensive services to about 121 women in the last
year. Under the UMHP, it has provided counselling support to more than 700 persons.
4.4. Research details: ISHWAR SANKALPA has published some of its research work.
4.5. Details of any training carried out by the NGO:
Anjali has trained more than 225 women from various Municipality/Panchayat areas in
mental health and wellness; Anjali has trained 65 CSOs/CBOs on mental health and human
rights.
SEVAC has been spreading mental health awareness among police personnel and prison
personnel with the support of the NHRC, SHRC and Police Academy.
ANTARA has been involved in the training of mental health workers (1 year basic psychiatric
care-giving), internship for PG Psychology and Social Work students of IGNOU, conducts
periodic seminars and conferences for school students, lay persons and professionals; has
trained the police personnel in Kolkata; takes classes on mental health and addiction to local
clubs, NGOs; Panchayat Committes; conducts practical training in psychiatry for nurses from
over 40 nursing schools and colleges from Kolkata.
ISHWAR SANKALP has carried out training for the staff. It has worked with Calcutta Pavlov
Hospital, IOP, NRS Hospital, MR Bangur Hospital, RG Kar Hospital for the outpatient.
4.6. Networking activities of the NGO: Anjali has set up 4 mental health kiosks in the
Municipality. ISHWAR SANKALP also liaises with private mental health facilities.
ISHWAR SANKALPA works with KMC to provide shelter. This organisation also works with the
Disability Commissioner to distribute disability cards to persons with mental illness and with
the police for the homeless mentally ill.
It has helped with procuring disability and ration cards for over 40 women and helped in
supported employment.
773

4.7. Salient contributions of the NGO - Anjali has been involved with prohibition of ECTs in the
state hospitals; guidance formulation to prevent sexual abuse in the state hospitals, in
formulated the National Mental Health Policy; Rehabilitation Policy; Introduction of sanitary
napkins and undergarments for women residents; improving the quality of food and drinking
water; providing new clothes to women inpatients during festivals.
SEVAC has been involved with mental health advocacy through national seminars. It has
engaged with the NHRC in raising issues on human rights. It filed a PIL drawing attention to
several inadequacies in mental health care delivery throughout the country. It ran a
psychiatric clinic in the Chindwara District where patients were chained in the name of faith
healing. It has started a Clubhouse model for rehabilitation and mainstreaming.
ANTARA has worked with teh NHRC on Operation Oasis to identify mental health problems
among persons in prison and offer rehabilitation. It has worked with the National
Commission for Women to study the basic needs for the community based rehabilitation of
women with mental illness and revealed the deplorable conditions of the women who wre
released from the government mental hospitals.
ISHWAR SANKALPA proveds awareness on mental illness to the police, government health
staff, community stakeholders, general public, schools, colleges, clubs and other NGOs.
4.8. Special Rapporteurs observations 4.9. Inspection Committees observations4.8. SUMMARY AND RECOMMENDATIONS FOR SECTION 4
There are few NGOs working exclusively in mental health in West Bengal, mainly based in
Kolkata. However, their engagement with persons with mental illness is exemplary and their
work demonstrates the possibilities of rehabilitation and re-integration of patients and gives
examples of fruitful collaborations. When it comes to upscaling, however, the State needs to
take the primary responsibility through its social welfare mechanisms to appropriately
rehabilitate patients.

SECTION 5
5. DISTRICT MENTAL HEALTH PROGRAMME
5.1. A brief description of the location of the DMHP, when it started, total population covered:
The summary of DMHP findings:
774

Some details are provided for the South 24 Parganas, DMHP Jalpaiguri and DMHP Paschim
Medinipur. But the information is not complete.
i.Training of all the general health personnel in essentials of mental health care, so that
following the training they can survey the general population, organise camps and provide care
to the ill persons and their families; PARTIALLY COMPLETED
A time bound Programme to train required number of psychiatrists, clinical psychologists,
psychiatric social workers, psychiatric nurses and rehabilitation professionals; PARTIALLY
COMPLETED
Creation of District Mental Health Teams to support and support the community mental
health care Programmes; PARTIALLY COMPLETED
Strengthening of the Departments of Psychiatry of the 4 Government medical colleges
and enhancing the training in psychiatry for medical undergraduates to two months
and making psychiatry an examination subject in final year; PARTIALLY COMPLETED
Short term plan to train professionals for mental health care through focussed courses
to doctors, psychologists, social workers, nurses; PARTIALLY COMPLETED
Specific schemes to support the families to acquire the skills of caring, form self-help
groups and financial support as appropriate to the most needy; INITIATED IN MINIMAL
WAY
Funding support for voluntary organisations to take up wide range of community based
mental health care activities like setting up of day care centres, half-way homes and
long-stay homes; NOT INITIATED
Involvement of the private mental health professionals and organisations in the state
Programme; NOT INITIATED
Public mental health education on a regular and continuous basis; NOT INITIATED
Mechanism for the licensing of all mental health facilities based on agreed upon
standards for different types of mental health facilities; COMPLETED
State Mental Health Rules; COMPLETED (This is at variance with the earlier noting that
State Mental Rules have not been enacted)
District Mental Health Programme (DMHP) of West Bengal
3) State Mental Health Authority under the chairmanship of Prin. Secy, Dept. of H &
FW
4) Zonal Screening Committees (five in number) for admission of mentally ill
persons, Board of Visitors (five in number) for proper monitoring & supervision
of mental hospitals & psychiatry nursing homes have been formed
5) Rogi Kalyan Samiti for all mental hospitals of the State has also been formed.
6) Institute of Psychiatry, Kolkata has been selected as Centre of Excellence in
Mental Health under NMHP
7) District Mental Health Programme (DMHP) is on going in 13 Districts at
775

i.
ii.
iii.
iv.
v.
vi.
vii.
viii.
ix.
x.
xi.
xii.
xiii.

North 24-Parganas,
South 24-Parganas,
Howrah,
Hooghly,
Purbo Mednipur,
Birbhum,
Nadia,
Uttar Dinajpur,
Dakshin Dinajpur,
Purulia,
Coochbehar,
Darjeeling &
Jalpaiguri districts

5.2. A summary of annual registrations old and new, treatment outcomes in terms of those on
regular treatment and those dropped out, with diagnostic categories if provided. Would be
useful to know what kind of clientele is serviced under the DMHP:
5.3. Frequency of home visits carried out by the HW/ANM; numbers covered and for what
diagnostic categories, no of admissions facilitated:
5.4. Kinds of essential drugs available, number dispensed, number of patients receiving
medication under the DMHP in a month:
5.5. Duration of untreated mental illness for different diagnostic categories if provided:
5.6. Monitoring of the DMHP by the concerned officer /impressions and trouble-shooting
(mention if there is a committee and its composition):
5.7. IEC activities of the DMHP:
5.8. Training calendar of the DMHP (doctors, health workers, nurses, pharmacists, school
teachers/Anganwadi workers (whether any training conducted):
5.9. Activities to sensitize the gram panchayats
5.10. Special Rapporteurs report on the activities of the DMHP: Shri D Sarangi reviewed the
Paschim Medinipur District DMHP. The DMHP unit provides outdoor treatment but has no
inpatient facilities, which are much needed. Medicines are adequate. IEC fund utilization was
low. While training of professionals was occurring, IEC in schools and colleges was not being
undertaken. He pointed out some errors in the affidavit regarding the figures of receipts and
expenditure. He recommended upgradation of the psychiatric services at the Medinipur
776

Medical College and Hospital, filling up of vacancies, placing of the charge of the DMHP under
the CMOH rather than the Medical College and a greater role of the State in the further
running of the DMHP.
5.11. Inspection Committees observations
5.12. SUMMARY OBSERVATIONS OF DMHP AND RECOMMENDATIONS:
SECTION 6
6. SUMMARY OF MENTAL HEALTH CARE INDICATORS IN WEST BENGAL
6.1. Availability of mental health facilities

Mental health outpatient


facilities in the state
Day treatment facilities
Psychiatric beds in general
hospitals
Community residential facilities
(includes shelter homes,
observation homes, juvenile
home, destitute, old age,
orphanage, rehab, long stay
home etc )
Beds/places in community
residential facilities
Psychiatric hospitals
Beds in psychiatric hospitals
Government
Private

Total No of
facilities/beds

Rate per 100,000


population

NOT available
238

0.3

NOT available

NOT available
5
988

Rate per 100,000


population
33.98

Females %

6.2. Access to Care: NOT RECORDED

Persons treated in mental


health outpatient facilities
Persons treated in mental
health day care facilities
General hospital admissions
Community residential facilities
Persons staying in community

777

residential facilities at the end


of the year
Admissions to mental hospitals

0.7

6.3. Information Systems: NOT available


Data on No of
persons/activities
collected and reported
YES/NO

Data on age and gender


are collected and
reported
YES/NO

Data on patients
diagnosis are collected
and reported
YES/NO

Persons with mental


disorders treated in
primary health care
Interventions delivered
in primary health care
for persons with
mental disorders
Persons treated in
mental health
outpatient facilities
Contacts in mental
health day treatment
facilities
Admissions in general
hospitals with psychiatric
beds
Admissions in mental
hospitals
Days spent in mental
hospitals
Admissions in community
residential facilities

6.4. Human Resources at the State Level-

Psychiatrists
Medical doctors not specialised
in psychiatry
Clinical Psychologists
Psychiatric Social Workers
Psychiatric Nurses (general
nurses undergone training in
psychiatry)
Occupational therapists

Health professionals working in


the mental health sector
Rate per 100,000
0.13

0.04
0.008
0.25

NOT available
778

Training of health professionals


in educational institutions
Rate per 100,000

Other health workers

NOT available

6.5. INFORMAL HUMAN RESOURCES (Family and User Associations): NOT RECORDED
User

Family

Present in the state


No of members
Participation in the
formulation/implementation of
policy/plan/legislation

6.6. MEDICINES: NOT RECORDED


Type of Medication

Expenditure at State level per year and per


100,000 population (in INR)

All psychotropic medication


Mood stabilisers
Antipsychotics
Anxiolytics
Antidepressants
Anti-craving medication/ Substitution
treatments

SECTION 7
7. STATE MENTAL HEALTH REPORT CARD
SUMMARY OF SECTIONS 1-7.
Summary of areas where state has achieved good progress/little progress/no progress
Areas of good progress
The State has made considerable progress in establishing active psychiatric services in
the medical colleges/general hospitals/district hospitals. There have been some
improvements in the state hospitals. However, the state hospitals still continue to be
involuntary, long-stay and promote institutionalisation. Amenities need improvement
as per reports (only micro-improvements as per the Special Rapporteur). Information

779

needs to be obtained from the private psychiatric facilities and the psychiatrists in
private practice enumerated.

MENTAL HEALTH REPORT CARD


Area

Focus

Parameters

Mental Health
Services
(Secondary
and Tertiary)

Medical
College
Depts,
General
Hospitals,
Specialised
psychiatric
hospitals

Adequacy of inpatient
beds
Functional Departments
Functional OP services

Primary
Health Care
mental health
services

District
Mental
Health
Programme

% of functional DMHPs

Rehabilitation
services

At all levels

Vocational training, day


care, longstay facilities in
govt sector/ppp

780

Rating

100- present, fully


satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100 All districts
covered; fully
satisfactory
75 majority of
districts covered
and functioning
50 half the
districts covered
and functioning
25 one-fourth of
the districts
covered and
functioning
0- No districts
covered/although
DMHP exists, not
functioning
100- present, fully
satisfactory
75- present,
reasonably
satisfactory

Score
(out of
100)
50

50

25

Specialised
services

Human
Resources

Financing for
mental health

50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent
100- present, fully
satisfactory
75- present,
reasonably
satisfactory
50 present,
somewhat
satisfactory
25 present,
unsatisfactory
0- absent

Services for
substance
use
disorders,
old age,
mental
retardation,
child
psychiatry,
community
services,
forensic
services
(exclude
DMHP staff
here)

Whether existing, level of


functionality, present at
different levels of care

Adequacy of
psychiatrists/clinical
psychologists/psychiatric
social
workers/psychiatric
nurses or mental health
trained nurses

100 fully
adequate
75 moderately
adequate
50 somewhat
adequate
25- inadequate
0 grossly
inadequate

25

State level

Existence of separate
budget for mental
health/mental health
activities

10% -separate
budget, fully
adequate
75 separate
budget,
moderately
adequate
50 separate
budget,
somewhat
adequate
25 no separate
budget, but some
financial
resources
available annually
0 no separate
budget/marginal
financial resource

37.5

781

12.5

Governance
and Policy

State
Mental
Health
Authority
and other
authorities

Separate Mental Health


Nodal Officer
Functioning Mental
Health Authority
Nodal persons for mental
health in SHRC/Legal
Services
Authority/Others
State Mental Health
Rules
State Mental Health
Programme
Range of medications
Regular supply and
dispensing
Standard procurement
arrangements

Availability of
psychiatric
medication

At every
level

Affirmative
action for
persons with
mental illness

At every
level

Disability assessment
Pension
Travel concession
Health insurance
Special assistance
Educational benefits
Job reservation

10

Treatment
Gap

Overall

Approximate number of
persons with mental
illness approximate
numbers totally receiving
treatment in the state

Total Score (out of 1000)


Average Score (%)

allocation
100 Existing,
fully functional
75- Existing,
mostly functional
50- Existing,
somewhat
functional
25- Partial
0 Non existent

100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100- Fully
satisfactory
75- Mostly
satisfactory
50 Somewhat
satisfactory
25
Unsatisfactory
0- Not available at
any level
100 no
treatment gap
75 25%
treatment gap
50 -50%
treatment gap
25 -75%
treatment gap
0- 100%
treatment gap

50

37.5

37.5

25

412.5
41.25

782

RECOMMENDATIONS:The State has made considerable effort of collating information from


different facilities. This effort can be completed by obtaining information for the same period
from private psychiatric institutions, enumerating private psychiatrists and obtaining
comprehensive information from the DMHPs. The State will have to then consolidate this
information, make a comparison of the extent of mental health problems and its responses.
This will allow the State of West Bengal to make a mental health service delivery plan. The
State Mental Hospitals continue to have problems not related only to their structure and
function but also the long-term rehabilitation of patients who have recovered. This needs
careful planning and regular monitoring.

783

Das könnte Ihnen auch gefallen