- Dr. Abhijeet Golhar

Framework  Definitions  Vision  Values and principles  Goals and objectives  Cross cutting issues  Strategic directions and recommendations of action  Critical appraisals

Definitions Mental health is defined as a state of well being in which the individuals realize their own abilities can cope with the normal stresses of life, can work productively and fruitfully, and are able to make a positive contribution to their community.

Global scenario WHO estimates that at any given time 10% of global population suffers from some form of illness and one in four persons will be affected at least once in their life. Depression - second leading cause of disability world wide by 2020.

vision To promote mental health,prevent mental illness, enable recovery from mental illness, promote de- stigmatization and desegregation, and Ensure socio economic inclusion by providing accessible, affordable and quality health and social care.

Values and principles  Equity : – Services should be sensitive and relevant to socio and cultural situations. – Equitable share of national budget. – No discrimination and equal opportunities for education, employment, housing and social welfare  Justice: – vulnerable and excluded members should receive particular attention.

Values and principles  Integrated care: – Provides with in existing health care system – For chronic illnesses provision of medium,long term and life long services – Services should be universally available and accessible – Should be comprehensive and address the need of person, care provider and health care professionals

Values and principles  Evidence based care: – Decisions based on findings from research, practice and feedback from clients.  Quality : – Mandated globally  Participatory and rights based approach : – Service users and caregivers should be involved – Human rights and dignity should be respected, protected and promoted. – Rights of caregivers and service providers should be respected.

Values and principles  Governance and effective delivery: – Union and state government have major role in actions for promotion, prevention and treatment. – Services and professionals involved in health care planning and delivery are responsible for their action.  Value base in all training and teaching programs: – Quality,integrity, justice, accountability and empathy should be built.

Values and principles  Holistic approach to mental health: – Recognition of the relation between mind, body and soul. – Cultural ethos, Indian traditions and their impact on behavioural pattern must be recognized and leveraged.

Goals and objectives  Goals : To reduce distress, disability, exclusion morbidity and pre mature mortality associated with mental health problem across life span of the person. To enhance understanding of mental health in the country. To strengthen the leadership in the mental health sector at he national,state and district level.

Objectives To provide universal access to mental health care To increase access to and utilization of comprehensive mental health services. To increase access to mental health services for vulnerable groups. To reduce prevention and impact of risk factors. To reduce risk and incidence of suicide and attempted suicide. To ensure respect for rights and protections from harms.

Objectives To reduce stigma associated with mental health problems. To enhance availability and equitable distribution of skilled human resources. To progressively enhance financial allocation and improve utilisation for mental health promotion and care. To identify and address the social, biological and psychological determinants of mental health problems and to provide appropriate interventions.

Cross cutting issues  Stigma: – Unwilling to recognize the presence of disease, lack of knowledge. – Government, Opinion makers, media and community leaders should encourage discussion.  Rights-based approach : – Violation of rights is common so the design and implementation of policies programmes and services should be on a rights-based perspective.

Cross cutting issues  Vulnerable populations: – Inter alia, children, women, economically and socially deprived, older and physically disabled. – Poverty – Homelessness – Persons inside custodial institutions – Orphaned persons with mental illness(OPMI) – Children of person with mental health problems – Elderly care-givers – Internally displaced persons – Persons affected by disasters and emergencies – Other marginalised populations

Cross cutting issues  Adequate funding: – Provision of funds: Is not expenditure but a social investment and a social right For new activities need more funding, NGOS must be encouraged and supported. – Provision of funds across related departments: Health, social welfare, women and child development, school education.

Cross cutting issues  Support for families: – Need access to information, guidance in accessing services.  Inter- sectorial collaboration: – Specialist, general health services, education, employment,housing and social care sector.  Institutional care: – Mental hospitals, private sector.  Promotion of mental health: – Challenges which should be recognised and addressed to promote mental health.

Cross cutting issues  Research : – Research questions : Causes, identification of effective treatment, dipper understanding of bio-psycho-social determinants and path way for action. – Monitoring and evaluation: To assess changing pattern of burden and to evaluate impact of programme. – Building research capacity: To use research finding for practitioners in scientific and socially accountable manner.

Strategic directions and recommendations of action  Effective governance and accountability for mental health: – Develop relevant policies, programmes, laws regulations. – Appropriate plans, adequate budgetary. – Motivate and engage stakeholders – Develop and sustain technical capacity.

Strategic directions and recommendations of action  Promotion of mental health: – Redesign Anganwadi centres, parenting skill education, – Train AWWs,school teachers, parents and care givers. – Life skilled education programmes- schools collages, youth club. – Programmes for handling stressful life circumstances – Increase awareness –policy makers, planners,Governments. – Individual attention at schools for signs and symptoms. – Encourage action to change poor living condition, homeless, overcrowding, sanitation – Act of violence against women's, Ayurveda and yoga need to be included

Strategic directions and recommendations of action Prevention of mental illness and reduction of suicide and attempted suicide: – Address stigma discrimination and exclusion. – Encourage persons, should be treated as disability, amending and/or replace policies which discriminate against these persons. – Facilitate education, implement suicide reduction programme, restrict access to means of suicide, – Decriminalize attempted suicide, train key community leaders. – Set up crisis intervention centre and help lines. – Address alcohol abuse and depression.

Strategic directions and recommendations of action  Universal access to mental health services: – Should be available across facility,community and family, multi-speciality government hospitals, – Community based rehabilitation centres, develop norms and standards – Programmes to support families and care-givers, formation of care giver groups. – Making provision for beds in district hospital, medical collages. – Reform mental hospitals – Financial support to care givers – Support for homeless persons

Strategic directions and recommendations of action  Improve of adequately trained mental health human resources to address the mental health need s of the community: – Higher number of professionals should be trained(psychiatrists, counsellors, social workers) – All health personals should be trained. – Psychiatric nursing should be started. – ANMs should be offered an opportunity for skill upgradation. – There should be a cadre specialised mental health service provider in district hospitals.

Strategic directions and recommendations of action  Community participation for mental health and development: – Remove legislative, policy and programmatic barriers to protect rights. – Promote education, housing, employment, social welfare. – Increase availability of appropriate housing. – Programmes to peruse education and vocational training, disability management. – Include these persons in all social welfare and disability benefit programmes. – Co-ordinated action between different departments and ministries, private sector, civil society. – Involve in VHNSC, rogi kalyan samiti

Strategic directions and recommendations of action  Research: – Develop and implement a comprehensive research agenda incorporating epidemiological, clinical and health system research. – Commit equitable funds – Partnership between centre for Excellence for Mental Health and Medical Collage Department of Psychiatry and District Mental Health Programme and NGOS. – Potential of traditional knowledge, practices and alternative therapies. – Translate research findings into action at the service delivery level.

- Thank you.