Introduction

Health is “a state of complete physical, social, andmental well being and not
merely the absence of diseaseor infirmity”. Nevertheless, our health system is
pre-occupied with curative health care services and disease prevention, with
little attention on social and mental well being. Among these, mental health and
well being is the most neglected one, particularly in rural areas. Silence on
mental health services in rural India in the National Rural Health Mission
(NRHM) is a serious matter of concern. The omission of mental health in the
NRHM mission document becomes even more serious in the backdrop of the
uneven performance of the National Mental Health Program (NMHP, 1982) and
District Mental Health Programme (DMHP) which is operational in only 125
districts out of 626 districts of India. With various flaws and implementation
constraints in the NMHP and DMHP, there has been a very little effort so far to
improve the rural mental health services.
Data Analysis
Number of Households (2011 Census) Household Information

Average Annual
Family Income, Palra,
Number of 505270
Households (2011 Number of
Census), Patuka, 393, Households (2011
22% Census), Daulah, 551,
30%

Average Annual
Family Income, Average
Number of Daulah, 259236 Annual
Households (2011 Number of
Family
Census), Palra, 511, Households (2011
Census), Average Annual Income
28%
Harchandpur, 364, Family Income,
20% Harchandpur, 147383 Average Annual
Total 1819 Average
Family Income, Patuka,
Annual
Average
Average Annual Average Annual Average Annual Annual
99904
Expenditure on Health,
Expenditure on Health, Expenditure on Health, Expenditure on Health,Expenditure
Palra, 50702
Daulah, 35364 Harchandpur, 40883 Patuka, 36285 on Health
Daulah Harchandpur Palra Patuka
 Knowledge about
KnowledgeMental
Knowledge about aboutHealth Mental Health Illness Symptoms of Mental Illness
Mental Health Illness, Knowledge about
Illness, Daulah, 30 Harchandpur, 33 Patuka, Mentally ill
Mental Health
Illness, Patuka, 28 people identified in
the village and
Harchandpur,
Harchandpur, nearby ill villages,
Knowledge about Daulah, Depression, Mentally
Palra,
Daulah,
people
Mentally
Mentally ill69 Ever tried
Patuka,
ill
Patuka, Depression,
Depression, 39
36 identified
people in thedealing
identified
Mental Health 31Harchandpur,
Palra, Depression,
Daulah, 32 Harchandpur,
Addiction, people identified in in with a
Illness, Palra, 22 Palra, Psychosis, 25 Daulah,
Addiction, 23Palra, village
Learning the
Learning and nearby
village and
Harchandpur,
mentally Ever
ill person,
Daulah, Psychosis,
Harchandpur, Palra,
20Addiction,
Learning the villageDaulah,
22Disability,
Patuka, Learning andPalra, Ever tried
Ever tried
Disability, 17
Disability, villages,
nearby 17
villages,
tried 16
dealing with
15a aa
13 Psychosis,
Patuka,
Psychosis, 10 10 Patuka, Addiction, 12 14villages,
nearby
Disability,
10 12 dealing 13
dealingwithwith
Daulah mentally ill person,
mentally
mentallyill person, 462
ill person,
Harchandpur
Palra Daulah

Patuka

Harchandpur

Palra

Patuka
 Diagnosis and Medication Reasons for never dealing with Mentally
ill person
Harchandpur,
Patuka, NeedHarchandpur,
for Patuka,
Daulah, Daulah,
Patuka,
Harchandpur,
Palra, People
People
People Palra, It would not Harchandpur,
Daulah,Patuka,
Needtrained
for trained
Respondents
Mental
Respondents
Respondents or or or People
interested
interested
interested
in
in Daulah, Did not make a difference, Palra,
Acceptance Acceptance
Acceptance
Acceptance
of of of
Mental
HealthHealth
Firsttheir
Aider,
their
family
their family family in
attending
attending
attending such
such
such Patuka,
know how to Did not 4 of
presencepresence
presence of of ofof
presence
Daulah,
First Need for
Aider,36 33 mambersmambers Seminar/Worksho
Seminar/Worksho Harchandpur,
know
approach, 3Daulah,
Did
Harchandpur,
how toPatuka,
It wouldItItwould Mentally Mentally
Mentally
Mentally ill people
ill people
ill people
ill people
mambers
trained Mental interested Palra,
not know Did
approach, 2 not
how would
not
to make notmake
a makeHarchandpur,
a aPatuka,inAfraid in of
the family,
interested
interested in in in pp,,33
35
33
36 the
in the
family,
infamily, 5 2 5
the 6family,
Health First Aider,
takingtaking
know how
approach, to
1difference,
difference,1Daulah,
1 Palra,
difference, 1Afraid
Afraid Afraid
the of of the
ofperson
the ,1
taking upup training,
up training,
Palra,
training,
25 Need Respondents approach, 0 the person
person
person ,,00 , 0
Palra, for2430 30 or Daulah Daulah
trained Mentaltheir family
Health First Aider, mambers Harchandpur Harchandpur
17 interested in Palra Palra
Daulah,
taking up training,
Harchandpur,
Respondents who Patuka Patuka
12 Palra,
Patuka,
Respondents
have attended who
Respondents
Respondents who
who
Harchandpur, have attended
Mental Health
Harchandpur, Harchandpur,
Daulah, People on have
haveattended
attended
Daulah,Daulah,
Through
Patuka,
Through
Through Through Mental Health
Seminar/WorkshoDaulah,
Harchandpur,
Through
Patuka, Self
Through Through Medication,
Patuka,on
People 4People on Mental
Mental Health
Health
Palra,
Patuka,
Through
Through
Palra, Through
Palra,
Self Diagnosis, 3SelfThrough
Pyschatarist, 3 3Palra,
Pyschatarist,
Pyschatarist, 3 People on Seminar/Worksho
p, 3 Through
PMF's PMF's
Self Diagnosis,
Diagnosis, 2 2 Medication,
Medication, 2 2 Seminar/Worksho
Seminar/Worksho PMF's
PMF's
Diagnosis,Pyschatarist,
1 Medication,
1 1 p, 1 Intervention,
Intervention,1 1
p, p,
0 0 Intervention,
Intervention,0 0
Notions about Mental Health Problems

Total,
Curable, 98
Total,
Genetic
Disorder , 61 Daulah
Total, Needs
Total,Patuka,
Patuka, Medication, Harchandpur
Daulah,
Harchandpur Patuka, Harchandpur
Daulah,
Harchandpur
Palra, Palra,
Daulah,
Harchandpur
Communicab Needs
Palra, 33
Needs Total, Total,
Is a Only
Genetic
Curable,
Genetic 29 25Total, Palra,
Patuka,
Daulah,
,le,Needs
,28
Needs Palra, Patuka,
IsaIs Only
a Affects
Palra
, Genetic
, Curable,
Curable,
Genetic 23 Daulah, Harchandpur
Harchandpur
Medication, IsPalra,
Daulah,
Patuka, a Only
Only
DisorderCurable, 21Communicab Medication,SocialAffects
Disorder , 16, 20 Daulah, Communicab
Communicab
Communicab
Palra,
Incurable, Medication,
Medication,
15 aSocial
Disorder 11Harchandpur
Disorder, ,14 Patuka,
le,
le,
13 Social
, Is , Only
Social
88 659 Creation,
Affects
Affects12
Affects
Social
Creation, Adults,
9 Patuka
Incurable,
Incurable,
, Incurable, 6le,
le,
3
Incurable, 246 6 Creation,
Creation, 2 0 1335
Adults,
4
Adults,
3Adults,
Adults,
Creation,
Total
 Problem Identification
• The biggest problem are mental illness faced by villagers, there were
only 113 household from 1819 household who knows about the mental
well being(lack of knowledge about mental illness).
• Annual expenditure in health was very low.
• There are more number of genetic dissorder and curable disease.
• Depression is the main reason of mental illness after that addiction is in
second number.
• Learning disability and psychosis are also the main reason of menntal
illness.
• Lack of awareness regarding mental well being
 Suggestion
• Convergence of National Mental Health Programme/ District Mental
Health Programme under National Rural Health Mission Programme and
using existing PHCs and sub centres to provide mental health services
• Capacity building of Rural/registered Medical Practitioners/Primary
Health care doctors/ASHA workers/ teachers/Aanganwadi workers on
tailor made modules
• Advocacy through community, social and other bodies and involvement
of religious leaders, teachers, local community leaders with key
stakeholders
• Targeted awareness programme using available rural media
• Provisioning social security to the mentally ill patients
• Training for caregivers and relatives.
• Model of health center should be prepare accordance with different
parameter
 Strategy
• Proposed decentralization and synchronization of National Mental
Health Programme (under 11th Five Year Plan, 2007-2012) with
National Rural Health Mission is a good opportunity and has a wider
prospect
• We can hope that this will ensure Primary Health Centre (PHC) based
mental health services to the rural popula- tion. Involving and training
village level Accredited Social Health Activists (ASHA) is another
opportunity
• ASHAs will definitely help in early detection, treatment, and
rehabilitation of patients in the community in the rural areas
• Developing short-term special curriculum based training for medical
officers is another prospect which will help in providing clinical
services at block level.
Conclusion
The rural mental health services are neglected area which needs
immediate attention considering the burden of disease and
treatment gap. District Mental Health Programme needs
restructuring and convergence within the NRHM. The “extension
clinic” approach needs to be replaced with integration of mental
health services with general health services, particularly under
NRHM. Involving ASHAs under NRHM is an opportunity to pro-
vide mental health services at door steps in rural areas. Lastly,
ensuring bottom up approach and community ownership are must
to achieve universal mental health services, care and support in
rural areas.