COMMUNITY MENTAL HEALTH

INTRODUCTION:

Community Mental health ia an idea, a philosophy, an

enactment that came to reality in 1963 with the late American President John
F. Kennedy’s “Bold New Approach”. The community mental health
movement represents the fourth revolution in Psychiatry. In 1841, Dorothea
Dix appointed herself inspector of institution for the mentally ill and began
crusading for more humane treatment. She wanted each state assume
responsibility for its mentally ill. The result was the establishment of 32
mental hospitals in the United States. Most mental hospitals were built in
rural areas, which offered inexpensive land, the removal of troublesome
people from the mainstream of society and fresh air and quietness for the
patients, thus the concept of community mental health came into practice.

DEFINITION OF COMMUNITY MENTAL HEALTH

Community mental health describes a change in focus of

psychiatric – mental health care from the individual to the individual in
interaction with his environment, care is provided to client outside of
hospitals, in the least restrictive setting and it is provided at home or as close
as possible to where the client lives.

Community mental health services are designed to provide

comprehensive, continuous care to populations of people who need them and
it should be available to all, regardless of personal characteristics such as age,
ability to pay, or place of residence. They could be treated in freestanding
community mental health centres, in treatment units of general hospitals and
in translational homes.

-Dr.K.Lalitha

HISTORICAL DEVELOPMENT OF COMMUNITY MENTAL

HEALTH

The community mental health care services started with an aim of providing
mental health treatment in the community and thus to greatly reduce the
census of large public psychiatric hospitals located at a distance from the
homes and families of patients.
Initially it was designed to provide five basic services: outpatient, partial
hospitalization, inpatient, emergency and consultation and education
Subsequently it extended its service to children and geriatrics
The community mental health program created a community based system of
mental health care
A wide range of mental health services became available in communities.
Innovative services like mental health consultation to schools, geriatric
homes, and in day care centres.
The census of psychiatric hospitals decreased dramatically and the presence
of mentally ill in the community decreased the stigma about mental illness
In 1975, the World Health Organization strongly recommended the delivery
of mental health services through Primary Health system as a policy for the
developing countries.
In India, before Independence, there were no clear plans for the care of the
mentally ill patients. The approach was largely to build “ asylums” which
were custodial rather than therapeutic
 In 1946, Bhore committee recommended to increase manpower in the field of
mental health.
In 1962, the Mudaliar committee envisaged psychiatric services at all district
hospitals.
Later in 1975, an attempt was made by PGI, Chandigarh to develop a model
of psychiatric services in the PHC, Raipur Rani Block of Ambala District, and
Haryana, and in 1976, by NIMHANS, Bangalore at Sakalwara in Karnataka.

Thus the approach to development of services has been a rapid transition from
mental hospitals to psychiatric units of general hospitals and to community
care. The impetus for this approach has come from the following sources:

The commitment of the country to provide health services to all

The Alma Atta Declaration of Primary health care
The existence of a large infrastructure of general health services (PHC
system)
The realization of the magnitude of severe mental disorders in the rural
community (at least 1%) is as same as in the urban community and
availability of simple interventions for these conditions
The successful experience of community mental health care of Bangalore and
Chandigarh.

DEVELOPMENT OF COMMUNITY MENTAL HEALTH SERVICES

IN INDIA

 The institutional treatment for mental disorders in India and the use of
allopathic medicine were introduced by the European rulers.
 Charaka and others practiced indigenous medical systems considered mental
disorders to be asadhya (unmanageable)
 Thus their treatment was left to folk healers, who practiced their art in the
community setting.
 In 1970’s survey (Kapur) of mental disorders in a South Karnataka district,
75% of those suffering from severe mental illness were still being taken for
treatment to the traditional folk healers
 There were 26 traditional healers for a population of 10,000 which is a fair
therapist patient ratio by any standard,

INSPIRATION FOR THE COMMUNITY MENTAL HEALTH

MOVEMENT IN INDIA COMES FROM THREE SOURCES

o The treatment of mentally ill patients for long period in mental hospitals
results in social breakdown syndrome. Kennedy administration launched
American version of the community mental health program.
o Institution based psychiatry care through trained professionals can be very
expensive and country like India cannot afford to prepare sufficient
manpower
o The contribution of para- professionals and non professionals with simple and
short training delivered reasonably adequate mental health care.

CRITICAL ACCOUNT OF THE MENTAL HEALTH SERVICES IN

INDIA

1. In the late 1950’s Dr. Vidyasagar began to involve family members in the
treatment of mentally ill patients who were admitted to the Amritsar mental
Hospital. This approach
- Reduced the hostility in the minds of the patients for having been abandoned
in a strange place
- Helped to remove the age-old myths about the incurability of mental illness
when the family began to see the patient recovering
- The relatives are made to learn the essential principles of mental health care
and were thus motivated towards imprisonment in their own ways of life.
Thus many patients actually went back with their families and the discharge
statistics began to rise.
2. Psychiatric Units in General Hospitals
- 1933- the GHPUs was set up at R.G Kar Medical college at Kolkatta
- 1960- many GHPUs came up because of the availability of anti-psychotics .
3. The NIMHANS Crash Progrmme
- The Director Dr. R.M.Varma and Dr. Karan Singh, Minister of health in the
Central Government, jointly introduced community based mental health
program at NIMHANS
- In October, 1975, a community Psychiatry Unit (CPU) was started. It initiated
the following activities

# Primary health centre based rural mental health programme: A manual was
prepared to train the multipurpose health workers to recognize cases of severe
mental illness and follow them under the leadership of the PHC doctor.
Another manual was prepared to train the doctors to diagnose cases of severe
mental disorders and treat them

# General practitioner based urban mental health programme: a manual

was prepared to teach GP methods of treating common mental disorders
 # School mental health program: school teachers were trained to
diagnose children with emotional problems and treat them

# Home based follow up of Psychiatric patients: nurses were trained to

follow up patients in their homes through monthly visits

# Psychiatric camps were organized: village leaders were involved in

therapeutic process and that helped to reduce the stigma against mental
patients.

Rural mental health program was started at a health centre

in the village of sakalwara, near Bangalore. It conducted 15 days training
program to PHC personnel on regular basis and they carried out the follow up
services in the absence of supervision by professionals.

4. The Chandigarh Experiment

- A rural mental health programme was started in the PGIMER, Chandigarh
with the help of WHO. Manuals were developed and training for the PHC
personnel were started and they carried out their work without the supervision
of professionals
5. ICMR- DST study on severe mental mortality: Bangalore, Vadodara, Patiala
and Kolkata centres were chosen to study the impact of training of MPHWs
and Gps in detecting and treating mental patients
6. The National Mental Health programme (1982) was launched to ensure the
availability and accessibility of minimum mental health care for all in the
foreseeable future
7. The District Mental Health Programme was launched as a pilot model
programme in the Bellary District by NIMHANS in 1980s
8. The national workshops on mental health care for the state health
administrators held at NIMHANS in 1996 and the workshop to review the
DMHP in October 2000 and by then DMHP model has been adopted by many
states.
9. Chatterjee et al conducted a study writing a 3-tier model for the delivery of
mental health services at Barwani.
- The first tier was the outpatient program
- The second tier employed mental health workers drawn from local
community
- The third tier consisted of family members and key people in the community
10.Involvement of lay volunteers to counsel the mentally sick. A short period of
training is given to them
11.Many industrial organizations provided personality-enhancement programs
for their employees
12.Role of folk-healing, spiritual and religious counseling and ancient techniques
like yoga are still continuing to help the mentally distressed.

ALTERNATIVES TO INSTITUTIONAL CARE:

NIMHANS, Bangalore and other institutions have developed other

alternatives to institutional care

 Extensive use of outdoor services: Family members are encouraged to treat

their patients at home and get drugs and suggestions from the hospital by
periodic regular visits. All types of treatment, including ECT, are given in the
outpatient setups. Short stay wards (for few hours to 48 hours) facility is
 organized in out patient building, so that acute problems are managed and the
patient is discharged.

 Extension Programs by Satellite clinics: Mental health team conducts a

weekly or monthly clinic at taluk or district headquarters. The local medical
and non-governmental voluntary organizations are motivated to be the local
hosts and help in patient care. Such satellite clinics are functioning
successfully in 6 centres of Karnataka and few centres in other parts of the
country.

 Domiciliary care program: a mental health professional or a visiting nurse

delivers the required services to the patients at their door steps. In a study, the
urban schizophrenic patients were treated at home and followed up for 6
months. Compared to the hospitalized patients, the home group consistently
did better both in clinical state and social functioning.

 Organizing care through private general Practitioners: short term courses

are arranged to improve the knowledge and skills of private general
practitioners in managing psychiatric problems seen in their routine practice.
They are easily accepted by people and delivered good care for the needy.
They have to be supported by mental health professionals, by being available
for consultation in managing difficult cases.
 Training school teachers in mental health care and promotion of mental
health through schools: Training programs are organized in two phases for
school teachers in recognizing and managing psychosocial problems of
students through counseling. The experience so far indicates that it is possible
 to sensitize teachers in recognizing and intervening when faced with problems
pertaining to mental health. This approach towards the ‘problem Children’
changes for the better.

 Involvement of ICDS personnel in Child mental health care: Anganwadi

workers are trained in basic mental health care, so that they identify and refer
children with mental retardation and behavioral problems to medical
institutions and later manage them. They would also improve the child-
rearing practices of parents to improve the psychosocial development of
children.

 Training lay volunteers: Interested and committed ‘natural helpers’ in the

community are given 40 sessions of training in counseling, so that they can
help individuals who are in distress because of psychosocial problems. They
have to be supervised and monitored by mental health professionals. In
voluntary sector, there are several counseling centres offering services to
people with marital discord, people with problem children, people who are
having interpersonal problems and students who have problems with their
studies. There is regular training course in counseling in CMC, Vellore.
 Training Village Leaders: Training village leaders to work like referral and
change agents in the society has yielded mixed results.
 Student Volunteers: As part of NSS, College students were educated about
mental illness and were motivated to extend social services to mentally ill.
This training decreased authoritative and negative attitudes in the trained
students, compared to the control group. The trained students were allotted to
 interact with mentally ill in a hospital set up, with a control group of patients
who were not exposed to such interaction. Six months later, it was found that
the condition of experimental group had improved significantly. Thus, the
college students can form one of the community resources to manage the
mentally ill.

 Student enrichment program: poor classroom performance and poor

performance in examinations are the common problems in almost all the
schools. These children are subjected to humiliation and punishment by
parents and teachers. A student enrichment program of 30 sessions has been
developed. Subjects like how to study, how to learn better, how to
communicate and write in the examination, and role of emotional factors in
learning are dealt with.
 Non Governmental voluntary organizations: Many non-governmental
organizations are working in the area of mental health. There are many
suicide prevention centres in India in the voluntary sector doing good work,
helping those who need help. Helping Hand and MPA (Medico-Pastoral
Association) in Bangalore, Sneha in Chennai, Sahara in Mumbai, Sanjivini
and Sumaithri in New Delhi are the few examples.
 NATIONAL MENTAL HEALTH PROGRAMME

INTRODUCTION:

Health is defined as a state of complete physical, mental and social

wellbeing, and not merely absence of disease or deformity.(WHO). Mental
health therefore forms an essential part of total health and as such forms an
integral part of the national health policy. Mental health is one of the essential
component of patient care, this aspect was neglected earlier. It is well
established fact that mental health principles can improve the health delivery
care to patients. The government of India realizing that mental health is an
integral component of the total health formulated the- National Mental Health
Programme.

EVOLUTION OF NMHP:

The government of India felt the necessity of evolving a plan of action

aimed at the mental health component of the National Health Programme. For
this, an expert group was formed in 1980, who met a number of times and
discussed the issue with many important people concerned with mental health
in India as well as with the Director, Division of Mental Health, WHO,
Geneva. Finally, in February 1981, a small drafting committee met in
lucknow and prepared the first draft of NMHP. This was presented at a
workshop of experts (over60 professionals) on mental health, drawn from all
over India at New Delhi on 20-21 july 1981. Following the discussion, the
draft was substantially revised and a new one was presented at the second
workshop on 2 August 1982 to agroup of experts from not only the psychiatry
 and medical stream but also educaton, administration, law and social welfare.
The final draft was submitted to the Central Council of health, India’s highest
health policy making body at its meeting held on 18-20 August 1982, for its
adoption as the National Mental Health Programme for India. In this way
NMHP came into existence.

Aims

Three aims are specified in the NMHP in planning mental health services for
the country:

1. Prevention and treatment of mental and neurological disorders and their

associated disabilities.
2. Use of mental health technology to improve general health services.
3. Application of mental health principles in total national development to
improve quality of life.

OBJECTIVES
1. To ensure availability and accessibility of minimum mental health care for all
in the foreseeable future, particularly to the most vulnerable and
underprivileged sections of population
2. To encourage application of mental health knowledge in general health care
and in social development
3. To promote community participation in the mental health services
development and to stimulate efforts towards self-help in the community.

STRATEGIES FOR ACTION

 Two strategies, complementary to each other were planned for immediate
action:
1. Centre to periphery strategy: establishment and strengthening of psychiatric
units in all district hospitals, with OPD clinics and mobile teams reaching the
population for mental health services.
2. Periphery to centre strategy : training of an increasing number of different
categories of health personnel in basic mental health skills, with primary
emphasis towards the poor and the underprivileged, directly benefiting about
200 million people.
APPROCHES TO NATIONAL MENTAL HEALTH PROGRAMME:
To achieve the objectives the following approaches were formed:

1.Diffusion of mental health skills: Instead of centralising mental health skills

and expertise in an urbanised community it should reach periphery (i.e. the
primary health care structure at the community level like PHC, Sub centres
and Village level workers). Mental health care must start at the grass root
level.

2.Appropriate appointment of tasks in mental health care: the tasks to be

performed at each level (village workers, sub centre, PHC, district hospital,
regional hospital) will be specified and a referral system set up so that the
total system works in an integrated fashion.

3.Equitable and balanced territorial distribution of resources: Every effort will

be made to introduce or strengthen mental health first in those regions which
are at present deprived of it or where it is seriously deficient.
4.Integration of basic mental health care into general health services: This will
facilitate in dealing with patients without gross psychiatric disturbances. It
 will enable the health worker to identify psychosocial problems. Psychiatric
mental health worker will be able to identify and relate psychosocial factors
contributing to ill health.
Rehabilitation sub programmes: The components of this sub-programme
include maintenance treatment of epileptics and psychotics at the community
levels and development of rehabilitation centres at both the district level and
the higher referral centres.
Prevention sub programme: The prevention component is to be community
based, with the initial focus on prevention and control of alcohol related
problems. Later, problems like addictions, juvenile delinquency and acute
adjustments problems like suicidal attempts are to be addressed.
Mental health training.
Mental retardation and drug dependence: Though these are not mental
illness still the health workers should be able to counsel the parents, provide
public education and knowledge to refer such children to social welfare
agencies for rehabilitation.
REVISED GOALS FOR THE MENTAL HEALTH PROGRAMME
I. Strengthening families and communities for the care of persons suffering
from mental disorders.
II. Organisation of a wide range of mental health initiatives to support
individuals and families, with special focus on immediate delivery of the most
essential services to the ones with greater needs.
III. Supporting through mental health initiatives rebuilding of social cohesion,
community development, promotion of mental health and the rights of the
persons with mental disorders.
 IV. Eradicating stigmatization of mentally ill patient and protecting their rights
through regulatory institutions like the central mental health authority and
state mental health authority.
V. Provision of tertiart care institutions for treatment of mental disorders. E.g
(NIMHNS)
The plan of action to achieve the goals consists of nine components:
 Organising services
 Provide community mental health care facilities
 Support to families
 Human resourse development
 Public mental health education
 Private sector mental health care
 Support to voluntary organisations
 Promotion and preventive activities
 Administrative support

DISTRICT MENTAL HEALTH PROGRAMME (DMHP)

The District Mental Health Programme as component of NMHP was launched

in 1996-97 in four districts one each in Andhra Pradesh, Assam, Rajasthan
and Tamilnadu on the recommendation of the central council of health in
1995 and a workshop for health administrators of the country was held in feb
1996 to discuss about the problem of mental health. The DMHP was extended
to 7 districts in 1997-98, five districts in 1998-99 and six in 1999-2000, with
the addition of 3 more districts in 2000-01, this programme is under
implementation in 25 districts in 20 states and union territories.
The programme envisages a community based approach to deal with menatal
health problems in the country. It includes the following interventions:

1. Training programmes of all workers in the mental health team at the

identified Nodal Institute in the State.
2. Public education in the mental health to increase awareness and reduce
stigma.
3. For early detection and treatment, the OPD and indoor services are
provided.
4. Providing valuable data and experience at the level of community to the
state and Centre for future planning, improvement in service and research.

5. Funds are provided by the Government of india to the state government and
the nodal institutes to meet the expenditure on staff, equipments, vehicles,
medicines, stationery, training ,IEC activities etc.

6. The training to the trainer at the state level is being provided regularly by
the National Institute Of Mental Health and Neuro Sciences, Bangluru under
the NMHP.

Thrust areas for 10th Five Year Plan

1. District mental health programme in an enlarged and more effective form

covering the entire country.

2. Streamlining/ modernisation of mental hospitals in order to modify their

present custodial role.
 3. Upgrading department of psychiatry in medical colleges and enhancing the
psychiatry content of the medical curriculum at the undergraduate as well as
postgraduate level.

4. Strengthening the Central and State Mental Health Authorities with a

permanent secretariat. Appointment of medical officers at state headquarters
in order to make their monitoring role more effective;

5. Research and training in the field of community mental health, substance

abuse and child/ adolescent psychiatric clinics.

ROLE OF NURSE

 Three primary goals of community health nurse, Promotion of mental health,

Prevention of mental illness, Provision of holistic care and support for
individuals experiencing mental ill health.
 ROLE OF CHN IN PRIMARY PREVENTION
 Child care and child-rearing measures include: Antenatal care to mother and
educating her regarding the adverse effects of irradiation, drugs and
prematurity.
 Essential timely and efficient obstetrical assistance to guard against the ill
effects of anorexia, injury at birth,
 Liberalisation of laws regarding termination of pregnancy, when it is
unwanted
 Counselling of the parents of physically and mentally handicapped children.
 Programmes to enrich child mother relationship by stressing the importance
of warm accepting intimate relationship.
 Programmes Oriented to the child in the school : Early signs of learning
difficulties or behavioural abnormalities should be detected, teachers should
 be taught to identify the early symptoms of abnormal conduct and behaviour
in the children and refer cases.
 Family-Centred Activities Programs: Attitudes of mutual trust, love and
respect for one ,another need to be fostered . Educational services in the field
of mental health ,Parent -teacher associations Home-maker services ,Child
guidance clinics, Marital counselling.
 Programmes for Families in Crisis Crises like adolescence, Birth of a new
baby, Retirement or menopause, Death of a wage earner in the family,
Desertion by the spouse can be Handled at mental hygiene clinics,
psychiatric first-aid centres, walk-in-clinics.
 Society-centred Preventive Measures Community development social
administration. Collection and evaluation of epidemiological, biostatisical
data. Budgeting These measures require coordinated activities among persons
belonging to different norms and disciplines.

ROLE OF CHN IN SECONDARY PREVENTION

 Early Diagnosis and Case Finding achieved by educating the public and
community leaders,mahila Mandals, Balwadis etc. in recognising early
symptoms.
 Early Reference.
 Screening programmes: Simple questionnaires should be developed and
administered.
 Early and Effective Treatment
 Mental Health Education: Mass camps and through film shows, flash cards,
and also through mass media communication.
 Training of Health Personnel Orientation courses.
 Crisis Intervention
ROLE OF CHN IN TERTIARY PREVENTION

Accomplished by preventing complications of the mental illness &

promoting achievement of each individual’s maximum level of functioning
through Regular follow up, Diversion therapy, Recreation therapy,
Community Mental Health Facilities, Day-Evening Treatment/ Partial
Hospitalization Programs, Community Residential Facilities,

SUMMARY:

In this seminar we had learned about the definition of community

mental health, historical development of community mental health,
development of community mental health service in India, Inspiration for the
community mental health movement in India comes from three sources,
critical account of the mental health services in India and alternatives to
institutional care. Today we have discussed about NMHP, its evolution,
objectives of NMHP, various approaches to achieve the objectives of NMHP.
Then we have discussed about DMHP (District Mental Health Programme),
its components and finally the role of nurse in the implementation of National
Mental Health Programme.

.
CONCLUSION:

National mental health programme is designed with a view to prevent

mental illness, promote mental health of the people. Therefore being a
graduate nurse, the knowledge and understanding of NMHP is essential, so
that we can better understand our role and take part in the implementation of
these programmes. Operationally community mental health means the process
of involving in raising the level of mental health among people in a
community and reducing the number of those suffering from mental
disorders. Hence community care has a better effect than institutional
treatment on the outcome and quality of life of individuals with chronic
mental disorders. Community based services can lead to early intervention
and reduce the stigma of taking treatment.
 BIBLIOGRAPHY:

 GAIL W.STUART “Principles and practice of Psychiatric Nursing” eighth

edition; published by Mosby; page no: 779
 Dr.K.LALITHA; “ Mental Health and Psychiatric Nursing an Indian
Perspective; First Edition 2007; VMG Book house publishers; page No: 635-
641
 KAREN SAUCIER LUNDY AND SHARYN JANES; “ Essentials of
Community based Nursing; First edition 2003; Jones and Barlett publishers;
page no: 34
 STANHOPE LANCASTER; “ Community health Nursing Process and
Practice for promoting health” Third Edition; 1992; Mosby Publishers; page
no:45-50
 K. PARK., “Text Book Of Preventive And Social Medicine” 20th Edition,
M/s. Banarsidas Banot Publisher., Jabalpur.,
 Ahuja Niraj, A Short Textbook of Psychiatry, VIth Edition, New Delhi; Jaypee
Brothers (Pvt) Ltd,2001:Pp 251-254.
 Kapoor Bimla, Textbook of Psychiaric Nursing, Vol-II, New Delhi; Kumar
Publishing House, 2006: Pp 424-425.
 Park K, Textbook of Preventive & Social Medicine,18 th Edition, Jabalpur;
Banarsidas Bhanot: Pp 347.
 Literature from IGNOU, BNS-108, Mental Health Nursing, Block-4, IGNOU, New
Delhi:2005:Pp 58-62.
 www.google.com

NET REFERENCE:
 http://www.pubmed.nl/
 http://nnlm.gov/training/resources/pmtri.pdf
 RESEARCH ABSTRACT

Developing Community Mental

Health Services
Report of the Regional Workshop
Bangkok, Thailand, 11-14 December 2006
(1) Currently, mental health services are extremely limited in some Member
States, particularly in rural and remote areas.
(2) The treatment gap for mental illnesses is huge, leading to substantial
preventable morbidity in the community. Given the availability of knowledge
and appropriate medications, this needs urgent attention. Even though there is
a scarcity of mental health services in Member States, even existing mental
health services are not being optimally utilized.
(3) A substantial proportion of mental health care is provided by the private
sector, mostly by the informal sector (faith healers, religious healers,
traditional healers). This issue needs to be addressed by governments,
professionals and civil society. A sensitive issue is: can this sector be
constructively engaged as limited partners
(4) The existing mental health services in most Member States need to be
improved. The quality of service is poor and there are numerous human rights
violations.
(5) Community mental health care is the optimum direction for future
development of mental health services by Member States. This is based on the
following observations:
(a) Evidence that community-based mental health care is superior to psychiatry
hospital-based care.
(b) Great scarcity of qualified mental health professionals to meet all the needs of
the community.
(c) Problems in transportation of patients from their homes to tertiary-care
hospitals.
(d) Preference of people to seek health care
(e) Preference of people to seek health care locally in the community.
(6) Community mental health service should be integrated into the existing
primary health care delivery system to ensure its long term sustainability.
(7) The capacity of staff at the primary health care level should be enhanced
through appropriate training. Care should be taken not to over-burden the
PHC staff with too many details which are not essential at the primary care
level. Different countries may use different models, e.g. dedicated mental
health worker (Sri Lanka) or enhancing the capacity of general PHC staff
(Indonesia).
(8) Countries should consider whether the successful Thai model of
Village Health Volunteers can be replicated, or paid workers are needed.
(9)Mental health care is closely linked to the culture of the community, thus
culturally-sensitive programmes should be developed, e.g. the deeply
religious beliefs, strong family ties of the regional countries, etc.
(10) Community mental health services should meet all the mental health
needs of the community, including mental health promotion, prevention of
mental illness, psychosocial needs of the community, needs of special groups
(adolescents, elderly, refugees, etc.), prevention of harm from substance
abuse, etc.
(11) Community awareness programmes are urgently needed focusing on
issues such as:
(a) Medical nature of mental illness
(b) Changing the health-seeking behavior of the community
(c) Stigma removal
(d) Removal of myths and misconceptions
(e) Ensure community ownership of the programme
(f) Communities and families need to be prepared to care for
Persons with mental illness.

(12) Traditional methods and practices (traditional healers, faith

Healers, religious healers) should be scientifically evaluated. If appropriate
and effective, they should be promoted. New programmes being developed
should be evidence-based and periodically evaluated for their impact
 INDEX

S.N CONTENT PAGE

O NO

1. INTRODUCTION
2.
DEFINITION OF COMMUNITY MENTAL
HEALTH
3.
HISTORICAL DEVELOPMENT OF
COMMUNITY MENTAL HEALTH
4.
INSPIRATION FOR THE COMMUNITY
MENTAL HEALTH MOVEMENT IN INDIA
5.
CRITICAL ACCOUNT OF THE MENTAL
HEALTH SERVICES IN INDIA
6.
ALTERNATIVES TO INSTITUTIONAL CARE.
7.
NATIONAL MENTAL HEALTH PROGRAMME

8.
DISTRICT MENTAL HEALTH PROGRAMME

9. SUMMARY
10.
CONCLUSION

BIBLIOGRAPHY

JOURNAL REFERENCE