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LETTERS TO EDITOR  
Year : 2018  |  Volume : 60  |  Issue : 4  |  Page : 510-511
District Mental Health Program – Moving beyond Bellary model


Department of Psychiatry, College of Medicine and J.N.M. Hospital, WBUHS, Kalyani, Nadia, West Bengal, India

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Date of Web Publication28-Nov-2018
 

How to cite this article:
Chakraborty K. District Mental Health Program – Moving beyond Bellary model. Indian J Psychiatry 2018;60:510-1

How to cite this URL:
Chakraborty K. District Mental Health Program – Moving beyond Bellary model. Indian J Psychiatry [serial online] 2018 [cited 2018 Dec 17];60:510-1. Available from: http://www.indianjpsychiatry.org/text.asp?2018/60/4/510/246202




Sir,

In his editorial of April–June 2018 issue of Indian Journal of Psychiatry, Prof. O. P. Singh has rightly pointed out the shortcomings of the restrategized district mental health program (DMHP). Even after 22 years of implementation of DMHP, the current National Mental Health Survey 2016 shows that huge treatment gap still exists for all types of mental health problems ranging from 28% to 83% for mental disorders; common mental disorders affect nearly 10% of the population; 1 in 20 people in India suffer from depression; and there is a high prevalence of psychoactive substance use.[1] DMHP has been partially successful in providing mental healthcare to the community up to the district level. However, providing mental healthcare beyond the district level has faced many hurdles regarding training doctors and handing over of mental health treatment to primary care physicians.[2] Medical officers are being trained at the district headquarter, and although that training seems to be adequate and satisfactory, it seldom translates in those doctors actually treating psychiatric patients at the primary healthcare level. The reasons are many fold psychiatry as a subject is not taken seriously by the MBBS students in undergraduate medical curriculum as they do not have to appear for a separate examination in psychiatry; the doctors at primary healthcare level are overburdened, and at some places, they see around 400–500 patients per day; the Mental Healthcare Act (MHCA), 2017[3] allows only emergency treatment for 72 h by a physician before referral to higher center, and there is no provision for treatment by a nonmental health professional during follow-up;[4] MHCA requires diagnosis by internationally recognized classificatory systems such as the International classification of diseases 10th revision, and it is very difficult for primary care physicians to become familiar with such diagnostic system during the 3-day training program.

In addition to this, the training programs that we conduct (3- or 1-day) involve huge workforce and expenditure. Moreover, it is very difficult to orient naïve doctors and paramedical workers in this rather unchartered terrain of psychiatry in this short period. Hence, the whole exercise is not bearing the desired fruit. The virtual knowledge network of the National Institute of Mental Health and Neurosciences, Bengaluru, has started providing 3 month's training of medical officers to empower them in treating psychiatric disorders at the primary level. In my opinion, this is a rather pragmatic way of doing things. Incorporation of psychiatry as an examination subject in the undergraduate curriculum will go a long way in solving this problem. Increasing postgraduate seats in Psychiatry will also help in creating trained workforce to deal with the shortage of skilled professionals.

Hence, there is a need to strategize and look beyond the Bellary model to empower primary care physicians and health workers in diagnosing and treating psychiatric disorders in primary healthcare or making an adequate legal framework to safeguard them.[5] Otherwise, the desired integration of mental health into the primary healthcare will remain a distant dream.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
National Institute of Mental Health and Neuro-Sciences, Bengaluru. National Mental Health Survey of India, 2015-16. Bengaluru: NIMHANS; 2016.  Back to cited text no. 1
    
2.
National Mental Health Programme. Directorate General of Health Services. Available from: http://www.dghs.gov.in/content/1350_3_NationalMentalHealthProgramme.aspx. [Last accessed on 2018 Oct 30].  Back to cited text no. 2
    
3.
The Mental Health Care Act. Available from: http://www.prsindia.org/uploads/media/Mental%20Health/Mental%20Healthcare%20Act,%202017.pdf. [Last accessed on 2018 Oct 30].  Back to cited text no. 3
    
4.
Singh OP. District mental health program-need to look into strategies in the era of mental health care act, 2017 and moving beyond Bellary model. Indian J Psychiatry 2018;60:163-4.  Back to cited text no. 4
  [Full text]  
5.
Murthy RS. The national mental health programme: Progress and problem; mental health, an Indian perspective, 19462003. In: Agarwal SP, editor. Directorate General of Health Services. New Delhi: MOHFW; 2003.  Back to cited text no. 5
    

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Correspondence Address:
Dr. Kaustav Chakraborty
Department of Psychiatry, College of Medicine and J.N.M. Hospital, WBUHS, Kalyani, Nadia, West Bengal
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/psychiatry.IndianJPsychiatry_439_18

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