Beruflich Dokumente
Kultur Dokumente
------------------------------------------------------------------------------------------------------------------------------
_________________________________
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
MC
MCI
MGNREGS
NCRB
NCW
NDPS
DLSA
DME
DMHP
DMO
DPN
DPM
GH
GHPU
NMHP
NR
NSSO
NTA
PG
PGIMER
GMA
GMHC
GO/GOVT
HHMH&R
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
TCMH
UG
UT
WHO
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
Foreword by NHRC
NATIONAL SCENARIO
Introduction
Volume 2
STATE LEVEL REPONSES ON
QUESTIONNAIRE
AFFIDAVITS
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
Page Numbers
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
59208
(15.6%)
66493
(17.5%)
174137
(45.8%)
77902
(20.5%)
2473
(0.8%)
Around
30000
N
(treatment
seeking)
7.9%
Source of
information
Affidavit
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
0
0
0
0
NA
0
0
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
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
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
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
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
6.6. 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
15
Score (out
of 100)
25
Primary
Health Care
mental health
services
District
Mental
Health
Programme
% of functional DMHPs
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)
Adequacy of
psychiatrists/clinical
psychologists/psychiatric
social
workers/psychiatric
nurses or mental health
trained nurses
16
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
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
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.
3.1.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
% 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.
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
4.5.
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.
N
0
NIL
NIL
NIL
NIL
02
NIL
NA
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)
07
NIL
02
NIL
NIL
NIL
NIL
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)
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
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
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
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
iv. ENGAGEMENT: NR
v. ADMINISTRATIVE
27
vii. TRAINING
vii. RESEARCH:
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
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
Total No of
facilities/beds
NR
0
31
0
0
0
1
300*
0.002
0.61
Females %
0
0
*Including DMHPs when they were functional. No data available for medical college hospitals,
general hospitals, private sector.
6.3. Information Systems
Data on No of
persons/activities
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
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
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
Specialised
services
Services for
substance
use
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
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
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
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
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.
N.A.
309
467
68
06
N.A.
37
N
(treatment
seeking)
Source of
information
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:
N.A.
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
No with dept/facility
Total No of units
% coverage
Nil
1
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.
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
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
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
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
i.
Status in 2008
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
vii. RESEARCH:
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
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
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
-
02
47
Clinical Psychologists
Psychiatric / Medical Social Workers
Trained Psychiatric Nurses
General Nurses
Other (Specify)
01
01
04
-
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
0.823
0.004
1.469
Females %
14.52
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
Psychiatrists
0.301
0.0364
2.893
Clinical Psychologists
0.047
0.010
0.033
0.003
Psychiatric Nurses
0.166
0.016
Occupational therapists
Other health workers
User
Yes
Family
Yes
Not routinely
Not routinely
53
6.6. MEDICINES
Type of Medication
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
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
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
N.A.
N.A.
N.A.
N.A.
N.A.
238
Survey by
DHS and
NGO
Ashadeep
12
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
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
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
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
MD Psychiatry
10+2
seats/yr
6 SEATS /YR
4
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
: DME, Assam
: DHS, Assam
: SMHA, Assam
: DSW, Assam
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
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.
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:
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:
3.
4.
5.
6.
7.
8.
9.
vii. TRAINING
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.
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
35
Nil
3
8
3
30
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
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
0.823
0.004
1.469
14.52
78
Females %
Data on patients
diagnosis are collected
and reported
YES/NO
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
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
Psychiatrists
0.301
0.0364
2.893
Clinical Psychologists
0.047
0.010
0.033
0.166
0.003
0.016
Occupational therapists
79
User
Yes
Family
Yes
Not routinely
Not routinely
6.6. MEDICINES
Type of Medication
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
Specialised
services
Services for
substance
use
Rating
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
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
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
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.
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
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
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
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
88
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)
89
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
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
Infrastructure
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
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
vii. RESEARCH:
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
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
0.823
0.004
1.469
101
Females %
14.52
Data on No of
persons/activities
collected and reported
YES/NO
Data on patients
diagnosis are collected
and reported
YES/NO
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
Psychiatrists
0.30
0.04
102
2.89
Clinical Psychologists
0.05
0.01
0.03
0.003
Psychiatric Nurses
0.17
0.016
Occupational therapists
Other health workers
User
Yes
Family
Yes
Not routinely
Not routinely
6.6. MEDICINES
Type of Medication
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
Specialised
services
Services for
substance
use
Rating
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
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
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
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
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
NR
Psychiatric
hospitals
(Private)
N=2
24
General
Hospitals
N=
District
Hospitals
N=
NGOs
N=
59
Total
83
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)
16
0
0
0
8
0
8
0
4
85
10
GMCH, PGIMER
PGIMER
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
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
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
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
Total No of
facilities/beds
5
2
59
0.18
5.36
0
0
0
0
2
24
0.18
2.18
Females %
1.18
54
0
0
Data on No of
persons/activities
collected and reported
YES/NO
N
Data on patients
diagnosis are collected
and reported
YES/NO
N
117
NA
NA
NA
NA
NA
NA
NA
NA
NA
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
-
Availability
Available
Available
Available
Available
Available
Available
118
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
119
Rating
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)
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
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
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
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
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
No data available
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
16
59.3%
5 govt. + 1 private
100%
7.4%
33.3%
N
3.1.e No of government
psychiatric hospitals
3.1.f No of private psychiatric
hospitals
1
1
124
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)
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.
District
Hospitals
N=
NGOs
N=
Total
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.
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
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
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
v. ADMINISTRATIVE
vii. RESEARCH:
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
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
.
1
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
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.
1
2.
3.
4.
5.
6.
7.
8.
9.
10.
11.
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
-
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
0.823
0.004
1.469
14.52
138
Females %
Data on No of
persons/activities
collected and reported
YES/NO
Data on patients
diagnosis are collected
and reported
YES/NO
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
Psychiatrists
0.301
0.04
2.89
Clinical Psychologists
0.047
0.01
0.033
0.003
Psychiatric Nurses
0.166
0.02
Occupational therapists
Other health workers
139
User
Yes
Family
Yes
Not routinely
Not routinely
6.6. MEDICINES
Type of Medication
SECTION 7
STATE MENTAL HEALTH REPORT CARD
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
Specialised
services
Services for
substance
use
disorders,
old age,
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
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
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
50
(inadequate
information)
0 (no
information)
25
250
25%
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
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
General
Hospitals
N=1
District
Hospitals
N=
NGOs
N=
Total
10
146
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.
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
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
152
153
SECTION 6
6. SUMMARY OF MENTAL HEALTH CARE INDICATORS IN ____RAJASTHAN_ (name of state)
6.1. Availability of mental health facilities
Total No of
facilities/beds
1
0
10
2.9
0
0
0
0
Females %
0
NR
0
0
None
Data on No of
persons/activities
collected and reported
YES/NO
N
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
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
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
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
Specialised
services
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
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
75 25%
treatment gap
50 -50%
treatment gap
25 -75%
treatment gap
0- 100%
treatment gap
150
15%
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
N
(treatment
seeking)
Source of
information
700
NA
COMMENT: This has been calculated based on the OPD registrations at the Manochikitsa
Kendra PHC, Kachigam, as 7.8% of the attendees.
160
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
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
163
NIL
1
NIL
2
NIL
NR
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
NA
NA
NA
NONE
NONE
NA
NA
164
NONE
NONE
NONE
NONE
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
Total No of
facilities/beds
1
10
4.0
168
Females %
Data on No of
persons/activities
collected and reported
YES/NO
N
Data on patients
diagnosis are collected
and reported
YES/NO
N
169
Training of health
professionals in educational
institutions
Rate per 100,000
0.4
1
1
0.4
0.4
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
171
Rating
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)
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
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
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
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)
8.34 lakhs*
7%*
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
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
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.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
177
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
22
5
0
3
17
0
0
0
0
0
0
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.
8. GOVERNANCE:
8.1. Nodal Authority and responsibilities:
Name
Contact details
1.
Medical Education
2.
Social Welfare
Department
Ms. A Madhavi,
Dy.Director
(Disability)
3.
4.
5.
District Legal
Services Authority
180
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
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
Status in 2008*
New Buildings, State-of-the-art
infrastructure, Separate waiting
halls and toilets, Dharamshala
Specialty Clinics
Financial arrangements
Not reviewed
Diet
Not reviewed
Not reviewed
Not reviewed
Day care activity scheduling,
vocational training, Indoor and
outdoor games, TV, Radio,
Computer, Library
Not reviewed
Regular Picnics
*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
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%)
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.
vii. TRAINING
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.
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
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
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
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
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
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
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)
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
OPD services
and community
outreach
Programmes
5. ROSHINI
Awareness,
194
Psychiatrically ill
persons, general
public and policy
makers
Mentally ill persons in
shelter homes
family members of
6. SNEHI
7. NAMI
8. AANCHAL Charitable
Trust
11. MNGO
S-442, 2nd
Floor, School Block,
Near Bawa Palace,
Shakarpur
Delhi -110092
St. Stephen Hospital
Tis Hazari
Delhi
12. IGSSS
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
Students, parents,
teachers
Recovering/recovered
mentally ill persons
Children with
intellectual
disabilities
Persons with autism
Community
outreach clinics,
shelter home
Residential care,
rehabilitation,
legal and social
assistance
Awareness
about mental
illness, medical
illnesses and
substance use
Accommodation,
counselling,
medical care,
rehabilitation
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
OPD Days:
Timings:
Moti Nagar
OPD Days: Wednesday, Thursday &
Saturday
Timings:
09:30AM to 01:00PM
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.
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
Total No of
facilities/beds
41
1
170
0.005
0.91
0
0
0
0
1(govt.)+22(pvt.)
645
0.12
3.45
0
0
10.28
Data on No of
persons/activities
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
Psychiatrists
Clinical Psychologists
Psychiatric Social Workers
Psychiatric Nurses
200
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
Widely available
Widely available
Widely available
Widely available
Available at few centres
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
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
Specialised
services
Services for
substance
use
disorders,
old age,
mental
retardation,
child
psychiatry,
community
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
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
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
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
208
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
MD Psychiatry
DNB Psychiatry
Diploma in Psychiatry
Nil
2
NONE
NONE
Nil
Nil
Nil
Nil
Nil
Nil
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
Financial arrangements
Diet
Investigations and treatment
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
iv. ENGAGEMENT:
v. ADMINISTRATIVE
Community Programmes: NA
Networking with external agencies: 3 NGOs
Public mental health education:
213
vii. TRAINING
vii. RESEARCH:
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
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
Total No of
facilities/beds
3
0
10*
0
0
1
190
0.07
13.02
Females %
220
0
0
106
*incomplete
6.3. Information Systems
Data on No of
persons/activities
collected and reported
YES/NO
N
Data on patients
diagnosis are collected
and reported
YES/NO
N
221
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
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 (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
Specialised
services
Services for
substance
use
disorders,
Rating
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
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
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
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%)
28,00000
4.64%
226
N
%
Source of information
(treatment
seeking)
372398
0.62% Mental Health Mission
Report 2003
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
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
% 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:
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
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
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
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
MD Psychiatry
23
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
15
20
Nodal
Authority
1
2
3
4
5
Name
Contact details
231
Suicide prevention programme at all 6 Medical Colleges, with Surat as the nodal
centre
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
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
Diet
Investigations and treatment
25.21/day
ECTs
Supportive services
Recreation/Occupational
therapy/Rehabilitation
Networking with other agencies
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
v. ADMINISTRATIVE
TV Hall
Sanction of Budget for upgradation
Status in 2008
Infrastructure
Financial arrangements
Diet
235
NGOs working
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
vii. TRAINING
Poor maintenance
No Psychiatrist & No administrative officer.
Other staff also short.
Poor awareness about Human Rights amongst
staff
236
Status in 2008
Infrastructure
New Building
Short stay ward
Open ward added
Emergency non-functional
194 lakhs
Supportive services
Recreation/Occupational
therapy/Rehabilitation
Networking with other agencies
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
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:
237
v. ADMINISTRATIVE
vii. TRAINING
Domains
Status in 2008
Infrastructure
Constructed
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
SERVICES
i. Outpatient: Available
ii. Inpatient: Available
iii. DIAGNOSTICS AND THERAPEUTICS
Investigations: Available
Therapeutic facilities: Available
v. ADMINISTRATIVE
vii. TRAINING
239
Quality of care
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
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
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.
Total No of
facilities/beds
202 (WHO-AIMS
Report)
4
340
0
0
0
0
4
683
0.007
1.13
243
0.007
0.56
Females %
7.17
Data on No of
persons/activities
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
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
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
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
Specialised
services
Services for
substance
use
disorders,
old age,
mental
retardation,
child
psychiatry,
community
services,
forensic
services
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
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
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
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
0
0
1 (Govt.) + 6
(NGO)
19
0
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
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
Supportive services
Recreation/Occupational
therapy/Rehabilitation
SERVICES
i. Outpatient: Exists
ii. Inpatient: Services exist, but very low utilization.
257
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
vii. TRAINING
None
vii. RESEARCH:
None
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
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
Sector 6, Panchkula
Ambala City
YamunaNagar
Gurgaon
Kaithal
Kurukshetra
Karnal
GT Road, Panipat
Sirsa
Hissar
Faridabad
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
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.
Total No of
facilities/beds
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
Females %
0
0
0
0.22
Data on No of
persons/activities
collected and reported
YES/NO
N
Data on patients
diagnosis are collected
and reported
YES/NO
N
266
0.05
Training of health
professionals in educational
institutions
Rate per 100,000
0.024
0.004
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
Specialised
services
Services for
substance
use
disorders,
Rating
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
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
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
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
868
7022
7516
1033
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.
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.
N
22 Children
homes, 1 shelter
home at Shimla
run by NGO, 2 in
children home at
Hamirpur & Una
276
0
12
-
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
277
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
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
Infrastructure
280
Supportive services
Recreation/Occupational
therapy/Rehabilitation
281
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
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
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
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
284
Location
Aastha
Sirmour
Prem Ashram
Una
DCPU
Chamba
4
5
6
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
special
children, home
based services,
rehabilitation.
Mandi
Mandi
Mandi
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
31
0.19
4
62
0.05
0.90
288
Rate per
100,000
population
Females %
297.62
13.25
Data on No of
persons/activities
collected and reported
YES/NO
-
Data on patients
diagnosis are collected
and reported
YES/NO
-
yes
partial
yes
yes
na
289
12
13
14
47
-
Training of health
professionals in educational
institutions
Rate per 100,000
0.17
0.18
0.20
0.68
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
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
Specialised
services
Services for
substance
use
disorders,
old age,
mental
retardation,
child
psychiatry,
community
services,
forensic
services
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
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
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
2826587
(22.5%)
2651315
(21.1%)
4725968
(37.7%)
2195173
(17.5%)
126870
(1.0%)
1.5.
1.6.
294
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*
&
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.
297
0
1
0
1
0
1 central, 7
district
0
0
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
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
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
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:
v. ADMINISTRATIVE
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
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
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
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.
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:
v. ADMINISTRATIVE
vii. TRAINING
Post-graduate training MD Psychiatry and MPhil Clinical Psychology. The only seats
available for entire State
303
Post-Graduate Corses
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
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
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.
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
Total No of
facilities/beds
12
0
0
0
0
0
0
0
0
2
220
0.016
1.76
Females %
308
0
0
0
0
5.76
Data on No of
persons/activities
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
0.12
0.064
0.016
Training of health
professionals in educational
institutions
Rate per 100,000
0.024
0.032
User
No information
No information
No information
Family
No information
No information
No information
6.6. MEDICINES
Type of Medication
Availability
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
Specialised
services
Services for
substance
use
disorders,
old age,
mental
retardation,
child
psychiatry,
community
services,
forensic
services
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
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
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
2.62
Yet to be
studied
N
(treatment
seeking)
Source of
information
Census of
India 2011
COMMENT: Has not provided any estimation of the extent of mental health problems in the
state.
N/N
No with dept/facility
Total No of units
NIL
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
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
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.
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
16.3. 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
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
: Director, RINPAS
: JHALSA
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
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.
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
iv. ENGAGEMENT:
v. ADMINISTRATIVE
323
Public mental health education: IEC Material (booklets) in awareness Programme and
community outreach Programme, helpline for telecounseling
vii. TRAINING
vii. RESEARCH:
Research (areas, funding agencies, findings), : Institutional Projects, Ph.D. and M.D.
Thesis, M.Phil and DPM dissertation research papers.
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.
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
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
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
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
Total No of
facilities/beds
10
0.823
3
*
0.004
1.469
Females %
14.52
Data on No of
persons/activities
collected and reported
YES/NO
No
Data on patients
diagnosis are collected
and reported
YES/NO
No
No
No
No
331
No
No
No
No
No
No
No
No
No
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
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
User
Yes
Family
Yes
Not routinely
Not routinely
332
6.6. MEDICINES
Type of Medication
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
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
Specialised
services
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
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
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)
No information
available as per
categories
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
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.
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.
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
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
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
73
6
21
Multiple
346
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
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.
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:
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
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:
v. ADMINISTRATIVE
355
vii. TRAINING
vii. RESEARCH:
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
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
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
Total No of
facilities/beds
133
13
0.02
361
NR
2
NR
2
894
0.003
1.5
Females %
NA
13.7
Data on patients
diagnosis are collected
and reported
YES/NO
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
0.09
0.09
0.08
User
ACMI
Family
AMEND
6.6. MEDICINES
Type of Medication
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
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
Score
(out of
100)
50
25
mental health
services
Health
Programme
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)
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
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
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
2380000
N
(treatment
seeking)
Calculated Not
by state
provided
at 7%*
No
information
available as
per
categories
Not
provided
Not
provided
Not
provided
Not
provided
Not
provided
Source of
information
As per
information
provided by
state
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
26
3
16
18
81
105
944
239
310
5094
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
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
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
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:
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.
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
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
Financial arrangements
Diet
Investigations and treatment
Cable Tv
Remuneration
Cultivation
Film show
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:
v. ADMINISTRATIVE
Community Programmes:
Networking with external agencies:
Public mental health education:
vii. TRAINING
vii. RESEARCH:
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
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
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.
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
Total No of
facilities/beds
31
NOT available
NOT available
389
80
0.24
NOT available
3
0.009
9.2
Females %
NR
Not complete
NR
NR
22.5
Data on patients
diagnosis are collected
and reported
YES/NO
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
391
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
Score
(out of
100)
25
hospitals
Primary
Health Care
mental health
services
District
Mental
Health
Programme
% of functional DMHPs
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)
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
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
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
8.5.
8.6.
8.7.
8.8.
481
396
N
(treatment
seeking)
197(as per
affidavit)
Source of
information
11
186
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.
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
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
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
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
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
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
Total No of
facilities/beds
0
0
0
0
0
0
0
0
0
0
0
0
0
Females %
0
0
0
0
405
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
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
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
407
Rating
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)
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
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
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
54
40
230 178
2.9
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
411
DESCRIPTION: The following table gives details of the in-patient services of the psychiatric
institutes as well as the GHPUs of Madhya Pradesh.
Psychiatric
hospitals
(Govt)
2
350
Psychiatric
hospitals
(Private) N=
MC
General
N=14 Hospitals
N=
300
(including
GHPUs in
govt sector
and
district
hospitals)
District
Hospitals
N=5
NGOs
N=
Total
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
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.
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
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
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
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
vii. TRAINING
421
Indore Also, other courses such as clinical psychology, social work and nursing training
needs immediate attention
Any other training Programmes:
vii. RESEARCH:
Domains
Infrastructure
Amenities and facilities
Status in 2008
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
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
vii. RESEARCH:
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
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
GHPU
GHPU
Dt hospital
Dist
Hospital
Dt hospital
Dt Hospital
Dt Hospital
Dt Hospital
Dt Hospital
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
Total No of
facilities/beds
21 psychiatric
facilities overall
apart from
DMHP facilities
in 3 districts
1
NR
NR
NR
2
359
0.003
0.49
430
Females %
NR
Not complete
NR
3.5
Data on patients
diagnosis are collected
and reported
YES/NO
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
0.02
0.02
0.19
User
No
Family
No
6.6. MEDICINES
Type of Medication
All psychotropic medication
Mood stabilisers
Antipsychotics
Anxiolytics
Antidepressants
Anti-craving medication/ Substitution
treatments
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
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)
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
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
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
437
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
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.
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
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:
v. ADMINISTRATIVE
448
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
SECTION 5
5. DISTRICT MENTAL HEALTH PROGRAMME:
453
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
Total No of
facilities/beds
31
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
22.8
455
Data on patients
diagnosis are collected
and reported
YES/NO
0.18
0.07
0.14
*To be verified
456
Training of health
professionals in educational
institutions
Rate per 100,000
User
ACMI
Family
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
458
Rating
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)
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
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
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
N.A.
N.A.
N.A.
24051 (Source of
Information
RIMS, DMHP
Report)
1,231
2,350
1,032
202
461
N
(treatment
seeking)
Source of
information
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
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
N.A.
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)
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
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
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
465
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
3 per year
7 per year
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
No of hours of
theory
Duration of
Duration of
Qualifying
psychiatry posting psychiatry posting Examination
during UG
during internship includes
competency
evaluation in
psychiatry
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
54
100
200
3
47
20
82
3
4
4
4
-
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
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
Total No of
facilities/beds
0.329
40
0.823
0.004
1.469
474
Females %
20
N.A.
N.A.
14.52
Data on No of
persons/activities
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
Psychiatrists
0.301
0.0364
2.893
Clinical Psychologists
0.047
0.010
0.033
0.003
Psychiatric Nurses
0.166
0.016
Occupational therapists
Other health workers
User
Yes
Family
Yes
Not routinely
Not routinely
6.6. MEDICINES
Type of Medication
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.
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
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
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
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)
178013 (WHO :
Mental Health
Atlas 2005)
47470
481
N (treatment
seeking)
Source of
information
61414
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
Nil
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
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
n.a.
3 Months
Nil
150
Nil
Nil
11
Nil
11
Nil
Nil
Nil
60
Nil
Nil
Nil
Nil
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
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)
COMMENT: No post graduate training in psychiatry and other mental health speciality except
for MPhil PSW is available in the State.
486
No of hours of
theory
Duration of
psychiatry
posting during
UG
Duration of
psychiatry
posting during
internship
Qualifying
Examination
includes
competency
evaluation in
psychiatry
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
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:
vii. TRAINING
vii. RESEARCH:
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
- 15
- 40
4. Mental Retardation
- 39
- 10
- 30
2. Schizophrenia
- 271
- 82
- 355
- 66
6. Depressive Disorder
- 67
- 152
- 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
- 03
- 17
5. OCD
- 01
- 03
491
7. Depression
- 04
8. Adjustment Disorder
- 04
- 27
492
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
0.82
0.004
1.47
Females %
14.52
Data on patients
diagnosis are collected
and reported
YES/NO
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
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
User
Yes
Family
Yes
Not routinely
Not routinely
496
6.6. MEDICINES
Type of Medication
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
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
Score
(out of
100)
25
Primary
Health Care
mental health
services
District
Mental
Health
Programme
% of functional DMHPs
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)
Adequacy of
psychiatrists/clinical
psychologists/psychiatric
social
workers/psychiatric
nurses or mental health
trained nurses
498
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
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
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
NR
NR
501
N
(treatment
seeking)
Source of
information
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
Nil
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
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) ()
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
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
504
Detailed information is
not available
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)
No of hours of
theory
Duration of
psychiatry
posting during
UG
Duration of
psychiatry
posting during
internship
Qualifying
Examination
includes
competency
evaluation in
psychiatry
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
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
Psychiatric hospitals
Beds in psychiatric hospitals
Females %
Data on No of
persons/activities
collected and reported
YES/NO
Data on patients
diagnosis are collected
and reported
YES/NO
Yes
Yes
Yes
513
Yes
Yes
Yes
No
No
No
0.37
0.37
0.37
Psychiatric Nurses
0.37
Occupational therapists
Other health workers
Family
6.6. MEDICINES
Type of Medication
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
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
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)
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
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
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
Source of
information
Nil
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
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:
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
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
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
11. INNOVATIONS
NR
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.
Financial arrangements
Diet
Investigations and treatment
Supportive services
Recreation/Occupational
Nil
Nil
526
therapy/Rehabilitation
Networking with other
agencies
SERVICES
Nil
iv. ENGAGEMENT:
Community Programmes: NR
Networking with external agencies: NR
Public mental health education: NR
vii. TRAINING
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
528
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
0.823
0.004
1.469
14.52
532
Females %
Data on No of
persons/activities
collected and reported
YES/NO
Data on patients
diagnosis are collected
and reported
YES/NO
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
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
Family
6.6. MEDICINES
Type of Medication
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
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
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
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
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
162.5
16.25
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
51
40
235
178
2.1
2.4
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
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
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
542
0
6 (run by NGOs)
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
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
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
Status in 2008
Yes
Improved
Yes
546
therapy/Rehabilitation
Networking with other
agencies
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:
v. ADMINISTRATIVE
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
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
Total No of
facilities/beds
160
Rate per
100,000
population
Females %
7.8
553
Data on No of
persons/activities
collected and
reported YES/NO
Data on patients
diagnosis are
collected and
reported
YES/NO
YES
YES
YES
YES
YES
YES
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
Family
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
556
Rating
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)
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
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
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
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:
559
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
21,918
3,530
6,330
Nil
497 (2014)
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)
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)
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
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
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
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.
44
(36 in Puducherry
7 in Karaikal
1 in Yanam)
No details
provided
11
(Puducherry 9
Karaikal 2)
Not mentioned
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
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
569
Diploma in Psychiatry
PhD Clinical Psychology
Nil
12
Nil
Nil
Nil
Nil
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
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
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
IGGHPGI*
GGH Karaikal
5214
11001 (new
cases)
9302 (Follow- up)
Dementia
2789 (org
disorders)
21 (org
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
575
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
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
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
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.
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
Total No of
facilities/beds
155
12.5
Females %
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
Family
Participation in the
formulation/implementation of
policy/plan/legislation
6.6. MEDICINES
Type of Medication
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
Score
(out of
100)
50
hospitals
Primary
Health Care
mental health
services
District
Mental
Health
Programme
% of functional DMHPs
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)
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
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
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
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
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
591
N
15
0
1
0
592
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
MD Psychiatry
11
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
Developments since
2008
Geriatric ward
Forensic Ward
Financial arrangements
Diet
lunch, evening
tea and dinner
with food meeting
nutritional
standards. Kheer
is served twice a week with
daily
lunch including a
seasonal fruit.
Supportive services
Recreation/Occupational
therapy/Rehabilitation
Networking with other
agencies
SERVICES
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
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
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
Total No of
facilities/beds
89
83
0.30
16
0.06
8
418
0.03
1.50
Females %
4.31
-
0.38
Data on No of
persons/activities
collected and reported
YES/NO
Y
Data on patients
diagnosis are collected
and reported
YES/NO
Y
600
0.11
Training of health
professionals in educational
institutions
Rate per 100,000
0.06
0.01
0.08
-
0
0
0.014
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
602
Rating
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)
Human
Resources
Financing for
mental health
State level
Existence of separate
budget for mental
health/mental health
activities
Governance
and Policy
State
Mental
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
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%
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
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
% 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
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
N
0
NIL
NIL
NIL
NIL
36
NA
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
24
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
NONE
NONE
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
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
Financial arrangements
Diet
Details of laboratory
investigation
services provided
in the hospital are not
mentioned
in the report.
Supportive services
Recreation/Occupational
therapy/Rehabilitation
614
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
iv. ENGAGEMENT:
Attempts to involve families of persons with mental illness:Disability certification and number of certificates issued in the previous year:-
v. ADMINISTRATIVE
vii. TRAINING
vii. RESEARCH:
615
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:
v. ADMINISTRATIVE
vii. TRAINING
vii. RESEARCH:
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
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
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
Total No of
facilities/beds
17
0
143
0.21
0
0
2
395
0.003
0.58
622
Females %
0
0
6.35
Data on No of
persons/activities
collected and reported
YES/NO
N
Data on patients
diagnosis are collected
and reported
YES/NO
N
623
0.10
NA
Training of health
professionals in educational
institutions
Rate per 100,000
0.035
0.012
0.009
NA
NA
NA
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
Services
(Secondary
and Tertiary)
Focus
Medical
College
Depts,
General
Parameters
Adequacy of inpatient
beds
Functional Departments
Functional OP services
624
Rating
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
Specialised
services
Services for
substance
use
disorders,
old age,
mental
retardation,
child
psychiatry,
community
services,
forensic
services
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
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
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:
42700
N
(treatment
seeking)
Source of
information
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
Psychiatric
hospitals
(Govt) N=
Psychiatric
hospitals
(Private) N=
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
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
N
1
0
0
1
0
2
Weekly visit by
Psychiatrist
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
2
0
0
0
0
0
0
0
0
632
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
634
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
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
Total No of
facilities/beds
5 (Including
DMHP)
20
0
0
0
0
639
Females %
NA
0
43
0
0
Data on No of
persons/activities
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
Training of health
professionals in educational
institutions
Rate per 100,000
0.3
0.18
0
0
0
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
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
Score
(out of
100)
50
75
Health Care
mental health
services
Mental
Health
Programme
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)
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
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
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
43201
15515
Mental Retardation
NA
Geriatric
NA
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
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
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
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)
43
3
14
NR
20
NR
NR
NIL
3
311
20
Private Sector
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
Status in 2008
Present
Networking with other
agencies present
SERVICES
650
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
vii. TRAINING
vii. RESEARCH:
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
GHPU
GHPU
GHPU
Thanjavur, 613004
GHPU
Tirunelveli
GHPU
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)
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,.
656
Soumanasya Hosp
Miracle Foundation
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:
Total No of
facilities/beds
546
Details not
adequate
Details not
adequate
Details not
adequate
Beds/places in community
residential facilities
Details not
adequate
Psychiatric hospitals
Details not
adequate
Details not
adequate
Details not
adequate
Details not
adequate
Details not
adequate
Details not
661
Females %
of the year
adequate
Details not
adequate
Data on No of
persons/activities
collected and reported
YES/NO
Details not adequate
Data on patients
diagnosis are collected
and reported
YES/NO
662
Training of health
professionals in educational
institutions
Rate per 100,000
Details not adequate
Psychiatric Nurses
Occupational therapists
User
Details not adequate
Family
Details not adequate
No of members
Participation in the
formulation/implementation of
policy/plan/legislation
6.6. MEDICINES
Type of Medication
All psychotropic medication
Mood stabilisers
Antipsychotics
Anxiolytics
Antidepressants
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
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
State
India
NR
40
NR
178
NR
2.4
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
INPATIENT SERVICES
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
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
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
NR
NR
NR
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
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
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
Financial arrangements
Diet
Investigations and treatment
Staff and training
Available
Many staff vacancies in
Psychiatry, hardly any
faculty positions in the
other disciplines
Supportive services
Recreation/Occupational
therapy/Rehabilitation
Networking with other
agencies
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
675
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
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
160
Females %
Data on patients
diagnosis are collected
and reported
YES/NO
YES
YES
YES
YES
Training of health
professionals in educational
institutions
Rate per 100,000
0.22
0.02
0.02
0.24
Family
682
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
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
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
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
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
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
NR
NR
NR
687
N
(treatment
seeking)
Source of
information
NR
NR
NR
NR
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
NR
Nil
1
688
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
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
20
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
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=
690
Total
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.
6.1. 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)
1 SEAT / YR.
692
No of hours of
theory
Duration of
psychiatry
posting during
UG
Duration of
psychiatry
posting during
internship
Qualifying
Examination
includes
competency
evaluation in
psychiatry
693
SECTION 2
2.1. PSYCHIATRIC INSTITUTIONS (Modern Psychiatric Hospital, Narsingarh, Agartala, Tripura)
Domains
Infrastructure
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.
attendant, 2 cooks,
security guards and
sweeping assistant.
Supportive services
Recreation/Occupational
therapy/Rehabilitation
6
6
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
695
vii. RESEARCH:
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
27
2
4
Nil
1
6
Clerk 1, Lab. Asstt. 1, Store Keeper - 1
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
0.823
701
0.004
1.469
Females %
14.52
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 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
0.301
Training of health
professionals in educational
institutions
Rate per 100,000
0.0364
2.893
Clinical Psychologists
0.047
0.010
0.033
0.003
Psychiatric Nurses
0.166
0.016
Occupational therapists
Other health workers
User
Yes
Family
Yes
Not routinely
Not routinely
703
6.6. MEDICINES
Type of Medication
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
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
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
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
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
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
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.
709
N/N
3.1.a No of district general
hospitals with separate
department of psychiatry
Nil
04
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
Nil
1
COMMENT: There appear to be few facilities in the government sector providing mental
health care.
710
INPATIENT SERVICES
DESCRIPTION:
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
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
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
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)
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
No of hours of
theory
Duration of
psychiatry
posting during
UG
Duration of
psychiatry
posting during
internship
Qualifying
Examination
includes
competency
evaluation in
psychiatry
Status in 2008
Founded in 2004
Financial arrangements
Diet
716
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
Investigations: No
Therapeutic facilities: Medications available. No counseling
Improvements in rehabilitation: Nil
ENGAGEMENT:
Attempts to involve families of persons with mental illness:
717
v. ADMINISTRATIVE
vii. RESEARCH:
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
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
29
31
09
51
13
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 -
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
0.823
0.004
1.469
14.52
724
Females %
Data on No of
persons/activities
collected and reported
YES/NO
Data on patients
diagnosis are collected
and reported
YES/NO
Yes
Yes
Yes
Yes
Yes
Yes
No
No
No
Psychiatrists
0.301
0.0364
2.893
Clinical Psychologists
0.047
0.010
0.033
0.003
Psychiatric Nurses
0.166
0.016
Occupational therapists
725
User
Yes
Family
Yes
Not routinely
Not routinely
6.6. MEDICINES
Type of Medication
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
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
Specialised
services
Services for
substance
Rating
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)
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
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
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%
UTTAR PRADESH
19 lacs
4.2 lacs
730
N
(treatment
seeking)
Source of
information
11.9 lacs
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
16
21.3
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=
733
Total
734
Private
Private
Practice
Total
30
15
25
None
NR
NR
NR
25
04
1
4+10=14
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
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.
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
Amenities
and facilities
Diet
Investigation
s and
treatment
Staff and
training
Supportive
services
Recreation/
Occupational
therapy/
Rehabilitation
Developments
since 2008
(Mental Hospital, Bareilly)
Two occupational
therapy units, one each
for male and female
patients 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.
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
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
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:
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
No investigations
No counselling
No community linkages, outreach
Mainly enclosures
No NGO involvement
Human resource paucity
Main areas in a state of disrepair
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
742
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
0.823
0.004
1.469
747
Females %
14.52
Data on No of
persons/activities
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
Psychiatrists
0.301
0.0364
2.893
Clinical Psychologists
0.047
0.010
0.033
0.003
Psychiatric Nurses
0.166
0.016
Occupational therapists
Other health workers
User
Yes
Family
Yes
Not routinely
Not routinely
6.6. MEDICINES
Type of Medication
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.
Focus
Parameters
Rating
Score (out
of 100)
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
Specialised
services
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
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
treatment gap
75 25%
treatment gap
50 -50%
treatment gap
25 -75%
treatment gap
0- 100%
treatment gap
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
755
54,80,864
N
(treatment
seeking)
Calculated Not
by state
provided
at 6%*
No
information
available as
per
categories
Not
provided
Not
provided
Not
provided
Not
provided
Not
provided
As per
information
provided by
state
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
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
Total
N
78
0
1
0
1
0
6
12
3
0
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
Private
Practice
Total
Nil
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
762
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
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
vii. RESEARCH:
The IC visited the Institute of Psychiatry on 12 August 2015. Their observations were not
available in the documentation.
768
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
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
Total No of
facilities/beds
NOT available
238
0.3
NOT available
NOT available
5
988
Females %
777
0.7
Data on patients
diagnosis are collected
and reported
YES/NO
Psychiatrists
Medical doctors not specialised
in psychiatry
Clinical Psychologists
Psychiatric Social Workers
Psychiatric Nurses (general
nurses undergone training in
psychiatry)
Occupational therapists
0.04
0.008
0.25
NOT available
778
NOT available
6.5. INFORMAL HUMAN RESOURCES (Family and User Associations): NOT RECORDED
User
Family
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.
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
780
Rating
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)
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
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
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
783