Corresponding author. Nadja van Ginneken: moc.
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Received Mar 15; Accepted Jul This article has been cited by other articles in PMC. Methods Oral history interviews and documentary sourcing were conducted in —11 with policy makers, programme managers and observers who had been active in the creation of the NMHP and DMHP. Results The results suggest that the widely held perception that the DMHP has failed is not entirely justified, insofar that major hurdles to the implementation of the plan have impacted on mental health coverage in primary care, rather than faults with the plan itself. Conclusion At this important juncture as the 12th Five Year Plan is in preparation, this historical paper suggests that though the model may be improved, the most important changes would be to encourage central and state governments to implement better technical support, access to funds and to rethink the programme leadership at national, state and district levels.
Background In low- and middle- income countries LMICs very few mentally ill people receive mental health care despite available evidence for cost-effective and feasible packages of care [ 1 , 2 ]. Methods The first author NvG conducted oral history interviews in — Open in a separate window. Results An overview of the recent milestones of primary mental health care developments in India is presented to set the context for the second section of the results which will explore the reasons for achievements and failures of the DMHP.
A brief overview of phases The overview starts from Independence of India to set the full context of primary mental health care developments. Budget: 1.
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ASHA worker created. Budget: 10 billion rupees. What have been the reasons for the achievements and failures of the DMHP? Governance arrangements and leadership Since the start of the NMHP, leadership and government commitment have been poor, and have lacked transparent and accountable systems. Inadequate leadership Firstly, respondents generally agreed that the government had neglected mental health and failed to adequately integrate it into their agenda. Accountability and transparency Certain system weaknesses were identified through internal evaluations [ 39 , 40 ] but were largely ignored.
Participatory and inclusive decision making The stagnation of the NMHP in the s was associated with a dearth of external lobbying groups. Financing hurdles in the last decade Since the 10th Five Year Plan the budget has been more realistic 1.
Delivery arrangements Interviewees debated whether the DMHP model was appropriate in terms of its organisation of services and human resources. Primary care doctors Early pilot project leaders explained the initial challenge in the s was to train a new human resource, the PHC doctors. Respondents suggested PHC doctors were never properly trained. Discussion These oral histories and documentary sources have given insight into the achievements, limitations and personal struggles involved since the s in trying to increase mental health coverage in India.
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How does this history shed light on current policy recommendations? Table 3 Mental Health Policy Group key recommendations. Promote intra- and inter-sectoral collaborations. Technical support Provide an overarching technical support and advisory group TSAG for all the States which will provide mentoring to districts to help with implementation difficulties. Revitalising human resources: Provide technical and quality inputs to increase the number of specialist resources through relaxing educational requirements.
Introduce a new cadre, a community mental health worker to identify, treat, provide basic counselling, and help access social benefits. Improve training. Incorporate life skills education and improve current preventative and promotive services Create collaborations with other concerned departments such as education. Extend services to urban areas Include the provision of a community mental health worker. Acknowledgements This work was supported by the Wellcome Trust []. References Patel V, Thornicroft G. Packages of care for mental, neurological, and substance use disorders in low- and middle-income countries.
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