Indian J Psychiatry. 2011 Jul-Sep; 53(3): 261–265.
PMCID: PMC3221186
doi: 10.4103/0019-5545.86821: 10.4103/0019-5545.86821 PMID: 22135448
National mental health programme: Manpower development scheme of eleventh
five-year plan
Suman K. Sinha and Jagdish Kaur1
Department of Psychiatry and Drug De-addiction Center, Lady Hardinge Medical College, New Delhi, India
1
Directorate General of Health Services, Ministry of Health & Family Welfare, Government of India, India
Address for correspondence: Dr. Suman K. Sinha, Department of Psychiatry & Drug De-addiction Center, Lady
Hardinge Medical College, Shaheed Bhagat Singh Marg, New Delhi - 110 001, India. E-mail:
[email protected]
Copyright : © Indian Journal of Psychiatry
This is an open-access article distributed under the terms of the Creative Commons Attribution-Noncommercial-
Share Alike 3.0 Unported, which permits unrestricted use, distribution, and reproduction in any medium, provided
the original work is properly cited.
Abstract
Mental disorders impose a massive burden in the society. The National Mental Health
Programme (NMHP) is being implemented by the Government of India to support state govern‐
ments in providing mental health services in the country. India is facing shortage of qualified
mental health manpower for District Mental Health Programme (DMHP) in particular and for
the whole mental health sector in general. Recognizing this key constraint Government of India
has formulated manpower development schemes under NMHP to address this issue. Under the
scheme 11 centers of excellence in mental health, 120 PG departments in mental health special‐
ties, upgradation of psychiatric wings of medical colleges, modernization of state-run mental
hospitals will be supported. The expected outcome of the Manpower Development schemes is
104 psychiatrists, 416 clinical psychologists, 416 PSWs and 820 psychiatric nurses annually
once these institutes/ departments are established. Together with other components such as
DMHP with added services, Information, education and communication activities, NGO compo‐
nent, dedicated monitoring mechanism, research and training, this scheme has the potential to
make a facelift of the mental health sector in the country which is essentially dependent on the
availability and equitable distribution mental health manpower in the country.
Keywords: Development, India, manpower, NMHP, program, scheme
INTRODUCTION
Mental disorders are significant public health issue and pose a tremendous socioeconomic
burden on community. Neuropsychiatric conditions have an aggregate point prevalence of
about 10% for adult population.[1]
About 450 million people are estimated to be suffering from neuropsychiatric conditions
worldwide. In 1990, mental and neurological disorders accounted for 10% of the total DALYs
lost due to all diseases and injuries. This increased to 12% in the year 2000 and an analysis of
trends indicates that the burden will further increase to 15% by the year 2020.[2]
The resources available to tackle the huge burden of these disorders are insufficient, in‐
equitably distributed and inefficiently used, which leads to a treatment gap of more than 75%
in many countries with low and lower-middle class incomes.[3] Poor awareness about symp‐
toms of mental illness, myths and stigma related to it, lack of knowledge on the treatment avail‐
ability and potential benefits of seeking treatment are important causes for the high-treatment
gap.
In India, the prevalence estimates vary between 5.82[4] to 7.3%.[5] In terms of absolute num‐
ber suffering from mental illnesses, the prevalence estimate throws up a huge number of about
7 crore persons.
The median number of psychiatrists in India is only 0.2 per 100,000 population compared to a
global median of 1.2 per 100,000 population. Similarly, the figures for psychologists, social
workers and nurses working for mental health is 0.03, 0.03 and 0.05 per 100,000 population
compared to a global median of 0.60, 0.40 and 2.00 per 100,000 population, respectively.[6]
Growing awareness regarding the magnitude of mental health problems in the country, a flurry
of health activities in the late 70s which included Alma Ata Declaration, the commitment to pro‐
vide health to all by 2000, and the realization that mental health care was possible through the
existing primary health care system led to the launch of National Mental Health Programme
(NMHP) by the Government of India in 1982.[7]
NMHP strives to ensure availability and accessibility of minimum mental health care for all in
the near foreseeable future, particularly to the most vulnerable sections of the population; to
encourage mental health knowledge and skills in general health care and social development;
to promote community participation in mental health service development and to stimulate
self-help in the community.[7]
In line with the National Health Policy 2002, the objectives of the NMHP and global trend of
community care of mentally ill, a field-tested model of community mental health care was
adopted as District Mental Health Programme (DMHP) for NMHP.[8,9] This community-based
mental health care at district level was initiated in four districts in 1996 and it was extended to
27 districts across 22 states/UTs in the ninth 5-year plan. NMHP was restrategized during the
tenth 5-year plan to incorporate expansion of DMHP to 100 districts all over the country, mod‐
ernization of state-run mental hospitals, upgradation of Psychiatry wings in the Government
medical colleges/general hospitals, IEC activities, research and training in mental health for im‐
proving service delivery. By the end of the tenth 5-year plan, DMHP was extended to 110 dis‐
tricts, upgradation of psychiatric wings of 71 medical colleges/general hospitals and modern‐
ization of 23 mental hospitals was funded. The program showed an increased allocation from
Rs. 280 million in ninth 5-year plan to Rs. 1900 million in tenth 5-year plan period which was
later reduced to Rs.1390 million.[10]
A series of reviews, consultations and evaluations revealed areas of concern in program imple‐
mentation. Some of these concerns are:
1. Non-availability of psychiatrists and other mental health professionals like psychiatric social
workers and clinical psychologists in many states for manning DMHPs.
2. Lack of delegation of power for procuring medicines and recruiting staff under the program
at the district level.
3. The program was focused on catering mostly to severely mentally ill and many important
issues like suicide prevention, workplace stress management, adolescent mental health and
college counseling services which could benefit larger section of society and were not
covered under DMHP thus making these important services inaccessible to the community.
4. Low level of community participation.
5. Lack of regular and dedicated monitoring and facilitating mechanism.
6. Lack of detailed operational guidelines for implementation of the schemes.
7. Lack of co-ordination between Department of Medical Education and Health Department at
the State level lead to delays in implementation of DMHPs.
8. Some states were not able to take over the funding of DMHP activities after the completion
of 5 years.
The foremost area of concern facing the program and mental health scene in the country is the
shortage of skilled mental health professionals in the country.[11]
As against an estimated requirement of 11,500 psychiatrists, 17,250 clinical psychologists,
23,000 psychiatric social workers and 3000 psychiatric nurses only approximately 3000 psy‐
chiatrists, 500 clinical psychologists, 400 PSWs and 900 psychiatric nurses are available at
present. The estimated figure is calculated using a norm of one psychiatrist per 100,000 popu‐
lation, 1.5 clinical psychologist per 100,000 population, two psychiatric social workers per
100,000 population and one psychiatric nurse per 10 psychiatric beds.[12] The existing train‐
ing infrastructure in the country producesapproximately 320 psychiatrists, 50 clinical psychol‐
ogists, 25 PSWs and 185 psychiatric nurses per year.[10]
Manpower development schemes in mental health for the 11th 5-year plan
To address the shortage of qualified mental health professionals it was thought necessary to
have dedicated manpower development schemes in addition to continuing with the community
care approach adopted under DMHP. These schemes are aimed at increasing the PG training
capacity in the mental health specialties of psychiatry, clinical psychology, PSW and psychiatric
nursing. The PG courses identified specifically to be supported under the scheme are
MD/DPM/DNB in psychiatry, Diploma in psychiatric nursing, M.Phil. in clinical psychology and
PSW. Ph.D in clinical psychology and PSW and M.Sc. in psychiatric nursing has been excluded
from the scheme as they are of longer duration and usually candidates after completing these
degrees go into teaching rather than into field-based programs. To support the expansion of
DMHP and implement Manpower Development Schemes the allocation for NMHP during the
11th 5-year plan period has been raised to Rs. 10,000 million up from Rs. 1390 million in the
last plan period. The schemes approved for addressing the Manpower concerns in mental
health are as follows:
Centers of excellence in mental health Also known as scheme A, this scheme aims at establish‐
ing centers of excellence in the field of mental health by upgrading and strengthening identified
existing mental health hospitals/institutes for addressing the acute manpower gap and provid‐
ing state of the art mental health care facilities during the current 5-year plan period. These in‐
stitutes will focus on production of quality manpower in mental health with primary aim to ful‐
fill manpower needs of the NMHP.
The support under the program would cover capital work (Academic block, Library, Hostel,
Lab., Supportive departments, Lecture theatres, etc.), equipments and furnishing, support for
induction and retention of additional faculty for the current plan period. Preference would be
given to centers where the state government shows commitment for faculty and other recur‐
ring and necessary expenditure. This support for additional faculty could also be used for pay‐
ing as incentive to attract and retain new faculty over the usual state government pay for the
plan period to enable starting PG courses. Under support for engaging additional faculty, cost
for two units of psychiatry, four faculty posts of clinical psychology, eight non-faculty posts of
clinical psychology, four faculty posts of PSW, four non-faculty posts of PSW, two faculty posts
of psychiatric nursing, one non-faculty post of psychiatric nursing has been provided at a com‐
petitive rate [Table 1].
Budgetary support under the scheme is up to Rs. 300 million per center which will be need-
based and assessed by a team of experts. [Table 2] The proposal for availing the scheme has to
be routed through the state governments and must include a definite plan with timelines for
initiating/ increasing PG courses in psychiatry, clinical psychology, PSW and psychiatric nursing.
It is planned to establish at least 11 centers of excellence in mental health under the scheme
during the current plan period. This would result in increase in at least 44 PG seats in psychia‐
try, 176 M.Phil. seats in clinical psychology and PSW each and 220 seats in diploma in psychi‐
atric nursing. Thus, a total of 616 qualified mental health professionals would be produced
from these centers annually after they are established. After the current plan period, the con‐
cerned state governments is to take over the entire funding of these centers. Total budgetary
allocation under this scheme is Rs. 3381.21 million.The centers which are being supported un‐
der this scheme are Institute of Mental Health-Hyderabad, Hospital for Mental Health-
Ahmedabad, Institute for Mental Health and Hospital-Agra, Mental Health Institute-
Cuttack,Institute of Psychiatry-Kolkata, Government Medical College-Chandigarh, State Mental
Health Institute-Rohtak, Psychiatric Diseases Hospital- Srinagar, Institute of Mental health and
Neurosciences (IMHANS)-Kozhikode, Institute of Human Behaviour & Allied Sciences-Delhi.
One more center is awaiting the commitment of the concerned state government to avail grant
under the scheme. A recent review of progress of the upgradation work of the centers of excel‐
lence in mental health funded under this scheme has revealed that the pace of work is slow
and needs to be speeded up so that it is complete within the plan period.
Scheme for manpower development in mental health Also known as scheme B, this scheme
aims at development of PG training capacity on low input and high-output pattern. Vis-a-vis the
scheme A this scheme is more cost-effective and would cover far more institutes. Under this
scheme Government Medical Colleges/Government General Hospitals/state-run mental health
institutes would also be supported for starting PG courses or increasing the intake capacity for
PG training in mental health specialties. The support would involve limited amount of physical
work for establishing/improving department in specialties’ of mental health (psychiatry, clinical
psychology, PSW and psychiatric nursing), equipments, tools and basic infrastructure (hostel,
library, department, etc.), support for engaging additional faculty. It is planned to support set‐
ting up/strengthening of 30 units of psychiatry, 30 departments of clinical psychology, 30 de‐
partments of PSW and 30 departments of psychiatric nursing during the plan period. The fi‐
nancial support will extend from up to Rs.5.1 million for each psychiatric nursing department
to up to Rs. 10 million for each PG department of psychiatry [Table 3].
This scheme is expected to generate about 60 psychiatrists, 240 clinical psychologists, 240
PSWs and 600 psychiatric nurses per year. The support under this scheme is approved for the
current plan period and it is expected that the concerned state government will take over the
additional infrastructure at the end of the period. The proposal should have definite timelines
for starting/increasing training seats in mental health specialties’. Total budgetary allocation
under this scheme is Rs. 700 million. A total of 23 PG departments have been funded under
this scheme and about 100 more PG departments could be taken up for upgradation in the
plan period. The scheme provides a golden opportunity for initiating PG courses as well as in‐
creasing PG seats in mental health specialties.
Spill over activities of 10th 5-year plan Spill over activities of 10th 5-year plan comprises two
schemes viz. upgradation of psychiatric wings of Government Medical Colleges/ General
Hospitals and modernization of state-run mental hospitals. Total allocation during the plan pe‐
riod is Rs. 580.3 million.
Upgradation of psychiatric wings of Government Medical Colleges/General Hospitals Every med‐
ical college should ideally have a Department of Psychiatry with minimum of three faculty
members and inpatient facilities of about 30 beds as per the norms laid down by the Medical
Council of India. There should be outpatient facilities, as well as facilities for providing various
forms of therapy including electroconvulsive therapy. In addition to psychiatrists, clinical psy‐
chologists, psychiatric social workers and psychiatric nurses are essential for an ideal psychi‐
atric department in a medical college. Out of the existing medical colleges in the country, ap‐
proximately one-third of them did not have adequate psychiatric services.
Looking at the huge manpower gap in the psychiatry and concerned disciplines, this scheme
was adopted for upgradation of the UG and PG training in psychiatry in medical colleges. It is
sought to upgrade the psychiatry wings by supporting:
1. Provision for independent psychiatry department in medical colleges where they did not
exist
2. Upgradation of existing psychiatry services including provision of inpatient services, with
necessary equipment; provision of trained manpower
3. The department of psychiatry to be responsible for implementing and providing support for
execution of NMHP/DMHP
4. Facilities to train psychiatric social workers and nurses; provision for accreditation and
licensing for health professionals
5. Provision of enhancing capacity of existing central/state-governmental institutes/colleges to
train manpower.
Under this scheme one-time grant will be provided to the psychiatry departments of
Government Medical Colleges which have not been funded earlier under NMHP. Some of the
deserving areas, where there is no well-established Government Medical colleges, Government
General hospitals/district hospitals could be funded for establishment of a psychiatry wing.
The grant to be provided would cover non-recurring expenditure of up to Rs. 5 million per col‐
lege for upgradation of facilities and equipments. Preference would be given to medical
colleges/hospitals planning to start/increase PG seats (MD/DPM/DNB) in psychiatry.
Modernization of state-run mental hospitals There are 43 state-run mental hospitals in the
country. Out of them 29 mental hospitals have been funded for modernization and some still
remain to be modernized. A one-time grant of up to Rs. 30 million per mental hospital would
be provided to mental hospitals based upon submission of firmed up proposal under NMHP
through the concerned state government for modernization of facilities and equipments from
custodial to a modern therapeutic setup.
CONCLUSION
NMHP was launched in 1982 with very comprehensive objectives which stand true even today.
National Health Policy 2002 recognised and incorporated the objectives and strategies of
NMHP. DMHP was launched in 1996 with an aim to achieve the objectives of NMHP. DMHP was
expanded and more components were added to make it more comprehensive. Eleventh plan
period focuses on consolidation of achievements made under NMHP and seeks to address the
biggest barrier in development of mental health services by addressing the manpower short‐
age in mental health. The strategy of upgrading psychiatric centers with into centers of excel‐
lence will address the manpower shortage to some extent and at the same time develop infra‐
structure for effective implementation of NMHP in their regions and make the concerned re‐
gion self-sufficient in quality mental health care. The scheme B which is slated to give a better
outcome in terms of increase in PG training seats in mental health as compared to scheme A fo‐
cuses on the quantity of mental health human resource. Establishment of 120 PG departments
as planned in the scheme will lead to spread of mental health training to many centers and in‐
crease the level of care available in addition to address the manpower shortage for the pro‐
gram and the country. Expansion of DMHP services along with manpower development will
lead to creation of posts of mental health specialists in districts as well as in mental health insti‐
tutions availing support under manpower development schemes.
Upgradation of psychiatric wings of government medical colleges will improve the UG as well as
PG training facility in mental health leading ultimately to start of more PG training course in
psychiatry. Many colleges have already availed of this grant and established full-fledged psychi‐
atric ward, OPD and department. This has changed the perception of psychiatry as a discipline
in patients and health professionals alike. Modernization of state-run mental hospitals which
began in 2004 has improved the infrastructure and level of care of many custodial hospitals
and many of these are now coming forward to avail grant under manpower development
schemes to rise to a further higher level of services and care. These schemes are an opportu‐
nity to improve the mental health facilities and he departments and institutes which have not
availed of this grant should avail of it at the earliest.
Slow work of projects funded under manpower development schemes and a luke warm re‐
sponse in taking up scheme B of manpower development scheme points towards dearth of
leadership in mental health sector in the country and the danger of continuing with business as
usual. To truely implement these schemes and achieve the scheme objectives it will require a vi‐
sion to transform the mental health institutes/departments. Being the most knowledgeable
about mental health it is the prime responsibility of the senior mental health professionals who
are heading their departments to foster and spread the vision among all stakeholders in their
area to develop their departments into a modern multidisciplinary teaching institutions.
Other issues like stigma, NGO participation, innovative pilot schemes, research, training in sub‐
specialty areas, dedicated monitoring mechanism, support for statutory bodies in mental
health, integration with other development sectors, preventive and promotive mental health
services under DMHP are also being taken up earnestly. Together these developments have a
potential to change the face of mental health in India and give us an opportunity to bring men‐
tal health from the shadows of darkness into sunshine.
Footnotes
Source of Support: Nil
Conflict of Interest: None declared
REFERENCES
1. Murray CJ, Lopez AD. Progress and directions in refining the global burden of disease approach: A response to
Williams. Health Econ. 2000;9:69–82. [PubMed: 10694761]
2. Mental Health: New Understanding, New Hope. Geneva: World Health Organization; 2001. The World health report; pp.
19–45.
3. mhGAP: Mental Health Gap Action Programme: Scaling up care for mental, neurological and substance use disorders.
Geneva: World Health Organization; 2008. [PubMed: 26290926]
4. Reddy MV, Chandrasekhar CR. Prevalence of mental and behavioural disorders in India: A meta-analysis. Indian J
Psychiatry. 1998;40:149–57. [PMCID: PMC2965838] [PubMed: 21494462]
5. Ganguli HC. Epidemiological finding on prevalence of mental disorders in India. Indian J Psychiatry. 2000;42:14–20.
[PMCID: PMC2956997] [PubMed: 21407903]
6. Mental Health Atlas. Geneva: World Health Organization; 2005. World Health Organization.
7. National Mental Health Programme for India. New Delhi: Ministry of Health and Family Welfare, Government of India;
1982. Directorate General of Health Services (DGHS)
8. Community Mental Health News. 11 and 12. Bangalore: NIMHANS; 1988. Apr-Sep. pp. 2–16.
9. National Mental Health Program: A Progress Report (1982-1990) Directorate General of Health Services, Ministry of
Health and Family Welfare. 1990
10. Salhan RN, Sinha SK, Kaur J. Asia Australia Community Mental Health Development Project, Asia Australia Mental
Health. Melbourne: 2008. Country Report-India.
11. Kaur J, Sinha SK. Health Programme series 14, National Institute of Health and Family Welfare. New Delhi: 2008.
National Mental Health Programme.
12. Goel DS, Agarwal SP, Ichhpujani RL, Shrivastava S. Mental Health 2003: The Indian Scene. In: Agarwal SP, Goel DS,
Ichhpujani RL, Salhan RN, Shrivastava S, editors. Mental Health: An Indian Perspective, 1946–2003. New Delhi:
Directorate General of Health Services; 2004. pp. 3–24.
Figures and Tables
Table 1
Support for faculty – Critical support for meeting the regulatory requirement support for one module
Table 2
Centres of excellence in mental health
Table 3
Cost of establishing/strengthening training departments in mental health (scheme B)
