Dr. Shabana Khan 2003-FR 114.pdf

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Building on Understanding of Mental Health
in the Community
Two Years Community Health Fellowship Programme

By
Dr. Shabana Khan

Mentor
Sri Prasana Saligaram
Field Mentor

Seena Deshmuk

3
CHC-SOCHARA 2003

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lakhan. R, effect of play and exposure on development of children with intellectual
disabilities through community based rehabilitation, IJPMR, 2009.

4
5

Chatarjee S et al. outcomes of people with psychiatric disorders, 2009.
N.N. WIG a model for rural psycratric services Raipur, Rani experience, 1981

-Dr. Shabana Khan*

Mental Health is an importtmt^ical. mental, and
definition of health in the WHO Const'tu 1 nfdisease Or infirmityResearch conducted
.Wcial well-being and not merely the absenc f
inherently affects physical
in re< ent years has brought to our attention
twQ are inseparable in terms of
health and physical health a iectsJ™'” jhe World Health Organization defines mental
achieving a more complete state
realizes his or her (n\'n abilities, can
health a ■"a state of well-beingin which
v. (
ahle to make
c<)pc with the normal stresses of hje, can nor p
... the balance
u ccaribution to his or her community- @
emotional. It if tpacts on how we
helix en all aspects of life- social physica pj^
part of our overan
manage our surroundings and make choi
weli.being. family relationships, and
health. Mental health is fa™"
the development of societies and countries.
i-—’

it Z

reduces peop.es .fc.ru> .» U™ access <o hea.,b

SCV CCS.

lt i estimated that at any given time.about WVo of^P^1^

J from severe mental

aim behavioural disorders. Out of these, app
disordcrs require long-term
disorders. And 10% of those suffering
schizophrenia, bipolar disorder, organic
treatment. Severe mental
X nearly 20 per 1000 population^ This is a population
psvehosis and major depression affect ne Y
P attentjon Close t< ten million severely
that needs continuous treatment and regular fo
P
j cstiinate. More than half
m .Iltally ill are in our country
onX treatment availability & potential
remain without treatment. Lack of
g for the above. Out of those requiring longb. nefits of seeking treatment are important causes forthe
these estimate about 10
K „ .reuuuen., approximately 10% requ.re ,-J™ Jn ,im, Togcther these
population suffers
’ en Sense (GBDt and an analysis of trends
disorders account for 12% of the^obal bu
Rcport 2001) One in foUr
indicates this will increase to 15 o y
behavioural or mental disorder (WHO
families is likely to have at least one m
emotional support, but also bear the
2001).^ These families not only provide physical and emo
■ P
un.lreated. Poor
negative impact of stigma -d d^—i.it. lack of knowledge
& Xtial beX of seeking treatment are important causes
for the high treatment gap.

Mental or psychiatric illness is » main XsXadveSlyaffcc' thcCday-to-day functioning,
mental health, there is no health. Mental il ne
.
lhe overall
economic productivity, healthy /elationships
‘^cXiic l unes md affect a significant
quality of life. They ignore racial, ethnl° h genetic inheritance and environmental factors
proportion of communities wor^1 ^Mental health disoriers are determined by

XXXk ^XXnic.

" Z XX’ZXS

to
away
mental problems most of these ailments could be treated at an outP.itiei t basis and only a
services.
However,
Tali
requires hospitalization. This has led to aeceptante of eonrmunrty.
very
base d treatment of mental disorders worldwide.^

I^ai‘TShXePoTa large population in ourr country' on

X„e«’

fXS.r-d to change from custodial to therapeutic —ty care

and community based rehabilitation (CBR).@

Communitization of Mental Health Services.

Tr - litionallv “Mental Health” is considered to be of relevance to the affluent soc,c‘,es- 11

factors contributing to the relative neglect can be summarized as follows01 Firstly, until about a decade there was very little reliable epidemiological data
elating to the distribution and prevalence of the mental d.sorders m Indta and other

developing countries.

0^ Secondly, in the past major efforts in planning the services were directed towards
establishing mental hospitals and psychiatric clinics. These mental hospitals were
more custodial than therapeutic.

03. Thirdly, there has been severe shortage of trained profs ssionals and most of those
available are working in metros.

04 Fourthly, the general public often views mental diserders from religious,
superstitious and magical stand points. This has limited the efft dive utilization of the
available modem psychiatric facilities.

fiSS ~ - ;w“

psychiatrists. The research efforts of professionals have only recently been directed
to this area. Lastly the production and supply of psychotropic urugs have been hmite
in the developing countries and there are very few welfare agencies to undertake
rehabilitative work.0

Ha; “"" N1"HANS'

k

predominant characteristics of community mental health are.
!

ceraia tap,an in l%7'"

Responsibility to a population for mental health care delivery
Treatment close to the patient in community based centers.
Provision of comprehensive services.
i. Multi-disciplinary team approach.
Providing continuity of care.
h. Emphasis on prevention as well as treatment.
\ Avoidance of unnecessary hospitalization.

U should U

jj

.ha. when ».

’SX.y based resources of .he .raddiooal
mi’S, «hkh still continue to nourish and which
”^‘^re"S ineffective or indeed
being ignored.0
hannful without sufficient exploration and systematic examina
i* "

insl)„,,ion for the community health movemen. i.

iZSnjTn

r„ st source is the realization in Western countrie^ ln the 196(ls. American Psychiatrists
nu ntal hospitals might, in fact, be cou"^r
h
from onu term hospitalization,
dtricussed the Social Sreakdown Syndro ,
h
American version of the community
1 his prompted the Kennedy administration to launchAh > A
inslitution.based
mental health programme. The second source is
psychiatry through trained PjofessionaIs can in
,b
iy J
services through
U will not have the sufficient personjtjm tmd&c Hjrnw *

Z'

i

b

£bv based memo! heakh programmes in Indin

the context of exciting experiments in U?A

““ZS

of closing the mental hospitals and !ran*yZents right in the community, the situation in
liospitals, community centers and keeping the patients ngntm^the co n^
Inciia remained almost Status qw. aming
KtabK5he(i during five year plans. The
hospitals increased from
,
shahdara Delhi. The number of total bed strength

....z - ofpo^
will.

tn m trie Unit (GHPU)
started at Bombay and
(GHPU) was
was
UJ General Hospital Psychiatr Unit
U
artmcmS started working in
Though the first
Calcmia way back in 1933, more and imore such unite
1Q years>
Calcutta way I---.
1960s
and
1970s.
Mudahar
’
^cts
of
the
country.
Even
in
1998.
except
1960s and UPOs. Mudahar Committee,
psychiatric units would be setup ii —
districts in the country do not have such
Kerala, Karnataka and Tamilnadu majori y
institute of Mental Health) was
units. In 1954 NIMHANS
NIMH ANS (Previously. it
established. In 1957, Dr. t Ya
involved the family members of the ^ent^y

management, by allowing them to stay
ital ca^pus. Based on this, the family

with their patients In open tents pi
Hosnital and CMC. \ allore. The decade of
wards were established in Bangalore Menta’^XcMn the area of mental health. WHO
1970 saw the third approach, the primly cam pp
’
community mental health

m ,HANS. Harare rmrf -er —to to/oped -cr O-e™ to <» u-—
cai c like-^
01. Extensive use of out door services
02. Extension programmes by “Satellite Clinic

•

St O^iSXSXHvate gene«o„ers

05. Training school teachers in mental health care ano pi

of mental health

06. InvoNementof ICDS personnel in child mental health care
07. Trainings for lay volunteers
08. Training programmes for village leaders
09. Students volunteers
10. Student enrichment programmes
11. Involvement of NGOs.

\ational Mental Health Programme (NMHP)As »e tliscussed before that the mental

With this aim

SS/aX”- fonnedtin
,■

ci, of Heaith^^^peamX . im—y »i.b the Nationai Heabh Policy

•HWlitv and accessibility of minimum mental health care for all in
XSSttX-y » fc vutaerabie ami imderpti^ed «et.ons
of population.
02. To encourage application of mental health knoseledgc in general henlth care and

in social development.

03 To promote community participation in the mental heal.h service development

andto stimulate efforts towards self-help in the comma

.

Three airr.s are specified in the NMHP in planning mental health services for the country:

and treatment of mental and neurological disorders and their
01. Prevention
assoc:iated disabilities.

02. Use of mental health technology to improve general health sei wees.
of mental health principles in total national c evelopment to improve
03. Application
quality of life.

Two strategics complimentary to

each other were planned for immediate iction.

airX^ctPhlS/w^

1.

S
°PUlatiOn
hing the
the Ppopulation

for mental health services.

poor and the under privileged, directly benefiting about 200 million people.

The mental health care service was envisaged to include three components or subprogrammes: Treatment; Rehabilitation and prevention.0

I

Treatment Subprogram:

Multiple levels were plannedA. Village and sub-centre level: Multi-purpose workers (Ml’W) md health supervisor
(1 IS), under the supervision of medical officer (MO), to e t aim or.

Management of psychiatric emergencies.

i.
ii.

iii.
iv.

v.

Administration and supervision of maintenance treatment for chronic

psychiatric disorders.

Diagnosis and management of epilepsy, especially in children.

Liaison with local school teacher and parents regarding mental
retardation and behavioural problems in children.
Counselling in problems related to alcohol and drug abuse

, to be trained for:
B. Primary Health Center (PHC): MO aided by HS

i.

Supervision of MPW’s performance.

ii.

Elementary diagnosis.

iii.

Treatment of functional psychosis.

iv.

Treatment of uncomplicated cases of psychiatric disoiders associated
physical diseases.

v.

Management of uncomplicated psychosocial problems.

vi.

Epidemiological surveillance of mental morbidity.

C. District Hospital: It was recognized that there should be at least 1 psychiatrist attached
to every district hospital as an integral part of the district health serv *ces. The district
hospital should have 30-50 psychiatric beds. The psychiatrist in a district hospital was
envisaged to devote only a part of his time in clinical care and greater part in training
and supervision of non-specialist health workers.
D

Mental hospitals and teaching psychiatric units: The major activities of these higher
centers of psychiatric care includes:
i.

Help in care of “difficult*’ cases.

ii.

Teaching

iii.

Specialized facilities like occupational therapy
counseling and behavior therapy.

mit5. psychotherapy,

2. Rehabilitation subprogram:

The components of this subprogram include maintenance treatmait of epileptics and
psychotics at the community levels and development of rehabilitation centers at both
the district level and the higher referral centers.
3. Prevention Subgroup:

fhe 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 adjustment problems like suicidal attempts are to be
addressed.
I he approaches designed to achieve the objectives of the NMHP inc lude:

i.

Integration of basic mental health care in to general health sendees.

ii.

Mental Health training of general medical doctors and paramedical health
workers.

Goals of NMHP (1982)-0
. I ihin on ct year, each stale will have adopted the present plan < > • cict’on in the Ji eld of
mental health.
. , . ..
IVnhin one year, the Government of India will have appointed a local point within the
Ministry of Health, specifically for mental health action.
Within one year, a National Coordinating Group will be formed comprising
representatives of all states, senior health administrators and professionals from
psychiatry, education, social welfare and other related professionals.
Within one year, a task force will have worked out the outlines of a curriculum of
mental health workers identified in the different states as the most suitable to apply
basic mental health skills, and for medical officers working at pCim ry health centers

.
.

.

.

.

.
.

(PHC s) level.
Within five years, at least 5,000 of the target non-medical p'ofes ionals will have
undergone a two-weck training programme in mental health.
Within five years, at least 20% of all physicians working in PH( will have undergone
a two-week training programme in mental health.
The creation of the post of a psychiatrist in at least 50%> of the district within Jive

years.
,
. .
J psychiatrist at the district level will visit all PHC setting regularly and at least once
every month, for supervision of the mental health programme for continuing
education. This programme will be fully operational in at lecot one district m every
note and UT. and in at least half of all districts in some states u ithin Jive years.
. Each state will appoint a programme officer responsible for the organisation and
supervision of the mental health programme within five years.
. Each state will provide additional support for incorporating community mental health
components in the curricula of teaching institutions (within Jive years).
. On the recommendation of a task force, appropriate psychotropic c 'rugs to be used at
the PHC level will be included in the list of essential drugs in India.
• Psychiatric units with in-patient beds will be provided at all medical college hospita s
in the country within five years.

.

Barriers to the Reach NMHP Goals:0

Poor funding
Limited undergraduate training in psychiatry
Inadequate mental heath human resources
Limited number of models and their evaluation
Uneven distribution of resources across states.
Non-implementation of the MHA-1987
Privatization of health care in the 1990s.

Mai or Developments during the past two decades-^
Increased range of treatments
Greater recognition of the role of families
Community mental health care
Wide variety of care models
Increased human resources, especially psychiatrists

.
.

Person with disability act-1995
Judicial activism

*.

X^dwidTfocuson mental health on the occasion of the World I icalth Day.J -ctoher
2001, with the WHO World Health Report 2001 being devoted to mental health.

Plan >f action for mental Health care:gi]

I. Organizing services
('(immunity mental health care facilities
' Support to families
a I luman resource development
s. Public mental health education
6. Private sector mental health care
7. Support to voluntary organizations
S. Promotion and preventive interventions
o Administrative support.
Priorities for the future:^
1.
2.
3.
4.
5.
6.
7.
8.
9.

Family as the focus of care
Public mental health literacy
Intersectoral Collaboration
Role of voluntary organization
Integration with general health care services
Human resource development
Enhancing funding for mental healthcare
Emphasis on prevention and promotion
Better administration.

Pt ' sent components of NMHP:@

Un let the NMHP. following programmatic components are includec
a. Develop the mental hospitals and department of psychiatry of medical colleges as a
Centre of Excellence in mental health
b.

Increase the process of developing human resources in mental ht alth like increase the
number of seats in psychiatry, clinical psychology, psychiatric social work and
psychiatric nursing. For achieving this, enhance the process ot starting new' courses tn
the mental health related areas and open the new department in medical colleges an
mental hospitals also scheduled.

c.

Up-gradation of General
colleges/general hospitals.

Hospital

Psychiatry

Units

(GHPU)

in

medical

' d. Modernization of state run mental hospitals
c.

Running District Mental Health Programmes (DMHP) in various districts of all states.

Promotion of Information; Education; Communication (1EC >

ac ivit es in the areas of

f.

mental health.
, yonduoting researches in the different areas of behavioral science.
g

national mental
.ndia W„s one of the first deveioping countries to <is al a crucial
Si programme. This year NMHP w. 1 oomple«>29 years, fbe p

stage of expansion to cover a large popu a ton
concentrate on providing
X.ri« 'be imPPhance of 7“' “thZ Ito for all. es;^!^, people affected

bZia'^

x— -

of

to a
of
mul-pronged programme in the XthJ. e Ye
ih£
modernlMtlon 0
Distl lct Mental Health
ngS of Government medical colleges general
meiiUil hospitals, up-gradation of psych y
g
the district mental health
hospitals, IEC improving the service d
throughout the country with interpreramme is under impiementation. *n 1
tion approach. The National Mental Health
sec.nral co- ordination and communi y' p
P
j as well as t0 urban population but
Prooramme was implemented to provide servtces to
service< Grants have also been
80 jier cent of the people in
of 84 Government medical colleges/general
released for up-gradation of psy
hospitals.^ The 10th plan could not meet the
hospitals and modernization of
adoption of revised national mental health
obiectives of NMHP whic nec
has
onosed to decentralize

-i'Xa'XS. R- Hchh Missior. for ophmmmg lhe
re nlts.g
for the
,11C m l i<e-Y«r Pta has ahoeated Rs.
“ "'he tertiary level. To
Kith
i’-’TS'™
»d PsyohiatrR Nu.sint. 40 medical coliegea will
^tadedsv^ year for better mental health services in the country.

M.rss media campaign throughdM,M>oTds NMHR During the
' > crore has been provided in 2008-09 tor

i

P

ize it with the National Rural Health Mission

decen'rali;e the programme and

eptimiahtg t. e resu.ts 0

which found that man}states took any
.. national review of the NMHP was done in
m 2006-'07
““ZJyZtgi^'neitherX
; ;yChiatrics, psychiatric social worhers
dm-■* P^d
bxk 0 f coordination between
.... level leads to delays
initiative to strengthen the programme.
’ D partment at the state
the Department^Medjca^an
^.re not involved in DMHP.
of Social Justice and
under’the Xlth Five-Year Plan,
^^^"h^ev’e'rely mentally ill and
severely mentally ill
limpowerment is proposed to
tQ release funds for the programme through the
tomeless mentally ill. It is also p p
; fl of fund from the central Government
■state 1 lealth Societies to overcome the difficulty in

O (he districts.^

NMUP & Madhya Pradesh:

Government of India was provided the one time grant (Rupees 50 l akhs for each Med ca
Colleges) for up-gradation of department of psychiatry to Indore and abalpur medica
coll les and forBhopal, Gwalior & Rewa medical colleges such grant is still awaited. Along
with this Jhe lW grant for modernization of mental health services also provided to Indore
Mental Hospital & Gwalior Mansik Arogyashala.^

Di-rict Menial Health Programmes (DMHP) also scheduled for S dislricls of M P bul£
pre ent only one DMHP (In Sehore District) is running in proper manner and shivpu
Mandala & Dewas was stopped because of improper administration an other
DMHP for Satna was never started. The over all budget for each DMHP is 1 Crore 15 Lakhs
which is provides by Central Government but state of M.P. is unable to utilize such budget in
proper manner. The main reason behind this situation is in act we State Mental Health
Auihority and lack of political as well as administrative will®
Montal Health in M.P. State Health Policy (Draft)®

IMPROVING MENTAL HEALTH OF STATE ( II IZENS

crs littlZ attention from the Government though anecdotal experience seem- m suggest that mental illness
He is not low The area of mental health is an important area which has bee- rtudied little: and aPPr°Pr'^
te mental health have been even less in the state. The policy aims to addre- -mes related to mental health,
reduce the prevalence of mental illness, and to provide the best cost effect-. : care and support to patients
with mental illness in the state.
STRATEGIES

Setting up an apex institute of Mental Health in the State to rr .ide direction for an overall mental

in the state in terms of policy towards mental health, services and research ; my -ftuc
irutilized State Institute of Health Management & Communication, Gw ala and .sociated s-ith
Hospital in Gwalior.

. lenta

1 he following aspects of the NMHP require attention®

‘■The overall effort should be to create structures that will meet the long term mental health
development in the country, ns .gainst the focus on only mp.d expansion of the
current models of care. There is a need to recognize that no amount »t progress m private
psychiatry m India will take us to the goal of providing essential mental health care tor

majority”.
•

*; on development of mental health
Firstly, there is a need for greater emphasis
in
technology of community mental health care, in addition to the cu rent emphasis on
ideology.

.

Secondly, there is a need for a national level initiative for hi man resource
development for mental health care. This should include improv•> ig the psychiatric
training in the undergraduate medical education, increasing the training tor non
medical mental health professionals, utilizing to a larger extent nd bringing clear
guidelines for the different paraprofessionals like counselors, volui teers, family level
carers, etc., to be part of the mental health care programmes.

rhirdlys there is a need for consolidating the different models of care by systematic
.■valuation, specifically the DMHP, the school-based interventions, the suicide
prevention programme, substance abuse programmes, family support initia ives,
rehabilitation needs of the chronic patients to enable the viab e programmes to be
implemented to cover a large population. A big challenge in huha is that /0 per cent
of health care contacts occur with the private sector. In an environment where the
private sector is largely unregulated, there is a need to engage these stakeholders
within the context of a national mental health programme.

Fourthly, there is a need for integrating the mental health components in national
level programmes like the ICDS, education system, and use of traditional systems like
voga. meditation, so that the mental health promotive activities become part of the

.

programme.

Fifthly the areas not included in the earlier plan periods lik su port for families of
the mentally ill persons, prevention of suicide, life skills education, disaster men a
health care, care of the elderly, should be taken up to develop models during the 11th
Plan, so that suitable expansion in the next Plan period can occui.
.

Sixthly, there is a greater need to use the mass media and information technology to
spread the mental health information to the total population. 1 his effort of mass
mental health literacy should be a continuous process and to be included in both the
public and private sector initiatives.

.

Seventhly, similar to the recent focus of HIV/AIDS programme targeting the migrant
labor as a high risk group for interventions, there is a need for greater attention to the
mental health impact of rapid social change, urbanization md changes in the family
life and to develop corrective interventions to address the. c . dec s.

The " ay forward-^

The repeated failure of such programmes begs the question. 'W hy do national and
intern itional leaders and agencies regularly repackage and reintroduce faded Pr°gramn .
The answers seem to suggest that they mistake activity for accomphshment and advocacy for
technical leadership and solutions.

The coal of mental health for all, a socialistic ideal struggling in tod tv's capitalistic world
demands a reappraisal of past programmes. Medical education needs to be skill-based to
□ e coJipc" nt practitioners The strengthening of the general healtl mfrastructure, to
S' X primary health care delivery, is mandatory for the effective mtegration of mental
hc;ih into primar- care practice. Leadership from politicians, admims ra ors, health and
men; .1 health professionals is crucial. The changed reality in India . emt nds new techmca
inpui.. including the use of the private sector. Educating the populatmn a iout mental illness

using the mass media will erase stigma and increase the demand for services.
The availability of effective and affordable treatments and improved nationaH
not closed the gap between mental health need and services. A HIV,AIDS model of
activism, where users, families, interest groups, health professionals and scientists come
tom- her with the single aim of service provision, is required for transformation. Si ck
documents, scintillating launches, stirring speeches and shallow programmes.
h ch
rep, kuge tailed strategies, are no substitute for hard technical input- for translatmg research

evi. mcc into primary care practice.
Knowing is not enough; we must apply

Willing is not enough; we must do
—Goethe

R< lercnccs01.
02.

Park K.(2000) Text Book of Preventive & Social Medicine, 6th Edition, M/s
Health Report 2001 Mental Health;
NXnM^InsmutT^f Health and Family Welfare.. 2010 )The Transcendence

03.

04.
05.

Quarterly Newsletter, Mental Health Programme in India: Needs A Revamp, Vol.
XII, No. 1, January-March.
.
World Health Organization.(2008) Mental Health Gap Action Programme.
Scaling up care for mental, neurological and substance use disorders.
P1B Press release.(2007) Ministry of Health and Family Welfare Govt, of India.
Consultative Committees Of The Ministry Of Health And Family Welfare
Discusses On The Subject National Mental Health Programme. Thursday, May

06.

Agarwal S.P. (2004) Mental Health - An Indian Perspective 1946-2003.
Directorate General of Health Services, Ministry of Health and Family Welfare,

07.

Website of Ministry of Health & Family Welfare. Govt, of India. National Mental
Health Programme (NMHP) http://mohfw.nic.in.

08.

09.

10.

II.
12.

IV
II.

15.
16.
17.
18.

10.
20.
21.

24.

25.
26.

27.

28.

29.

30.
31.

32.

Website of Ministry of Health & Family Welfare. Govt, o Ind a. Implementation
of NMHP during 11th Five Year Plan. Letter No. V-l oil 6/2007-PH (Pt2),
Dated 24lh April 2009.
Ahuja Niraj,(2005) A Short Text Book of Psychiatry. Fifth Edition. Jaypee
Brothers. 241-42.
Wig N.N., R. Srinivasa Murthy & T. W. Harding (1981) A Model tor Rural
Psychiatric Services - Raipur Rani Experience, Indian Journal of Psychiatry.
23(4), 275-290.
j
n u.
Vyas J.N. & Ahuja Neeraj(2000), Text book of Post Graduate PsychiatryVolume-2 Second Edition, Jaypee Brothers, New Delhi.
Ibid.

Wig N.N., Murthy R. Srinivasa & Harding T. W. A.. o.Si . Model lor Rural
Psychiatric Services - Raipur Rani Experience. Indian Joirnal of Psychiatry,
23(4), 275-290.
Anon. Innovations in Neuropsychiatric services. NIMHANS J i983;l:l-14
Ahuja Niraj,(2005) A Short Text Book of Psychiatry Fr h Edition. Jaypee
Brothers. 241-42.
Agtrwal S.P.(2004) Mental Health - An Indian Perspective, 1946-2003.
Directorate General of Health Services. Ministry of Health and Familv Welfare.
New Delhi 2004.
Ibid.
Ibid.
Ibid.

Website of Ministry of Health & Family Welfare. Govt. I India. National Mental
Health Programme (NMHP) http://mohfw.nic.in.
Murthy R. Srinivas, (2007) Mental Health Programme m the 1 1’ Five year plan,
Indian Journal of Medical Research 125, June 2007, PP 1 -’12.
Ibid.
, -T’ National Institute of Health and Family Welfare. (2010)The Transcendence,
Quarterly Newsletter, Mental Health Programme in India: Needs A Revamp, Vol.
XII, No. 1, January-March, 2010.
Pathak Kangkan, (2010) Future of District Mental Health Programme. Eastern
Journal Of Psychiatry, Vol. 13, Number I&2, Feb-Aug-2010.
Sharma Rahul,(2007) Status & Challenges of Mental Health Services in Madhya
Pradesh, Peoples Rural Health Watch Report (Year 200t>-07), M. P. Jan Swasthya
Agarwal S.P. (2004) Mental Health - An Indian Perspective 1946-2003.
Directorate General of Health Services, Ministry of Health and Family Welfare,
New Delhi 2004.
Website of Government of M.P. http://www.health.mp goyjn/
Murthy R. Srinivas, (2007) Mental Health Programme in the 1 ll five year plan,
Indian Journal of Medical Researchl25, June 2007, PP "07-712.
”- New
Jacob K. S.(2010) Repackaging Mental Health Programme.,.,, ‘-The Hindu
:
Delhi, 4th Novembe.

*Z>r. Shabana Khan, Clinical Psychologist & Community /leal h Fellow in Center
for Public Health & Equity (CPHE)E), Bhopal.

■

STATUS OF MENTAL HEALTH SERA OES
■

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Mental Health in Pregnancy and Reproduction

Reproductive events and processes^

psychological effect?^

f?|y foU*xAcu<

cfH? Psychopathological State

^.Menarche. Menstrual Cycling,

Pregnancy, Postpartum cCT Menopause ol’tfl Psysiological Processes cp c£t<|cH Women

Interpersonal life 9ft UWfftcT
Adulthood, Middle life cTOT late life

tjft Adolescence young
<Hf^c4l3ft 4ft Psychological functioning 3ft

394lfclrl T^sTcft

3^T FRTTTT nftwiart

Psychiotry and Reproductive Medicine &

cP!

f5l<H<A fcK Female Psyche and Soma d’HcPl Gynaecolog cal &

VT’dRI 3TT?t

Psychological functioning cpt

Psychology of Pregnancy : Pregnancy Women #

Pregnancy ft ulc^

ft H3 $<11

W

Psychological changes

33 oft Attitude^ 3^ 3Tlft Reproduction 4ft H^rT 3
Pregnancy planned^ 3T

3f 9ft

unplanned 3T under pressure, pregnancy 33 3^ 9ft Wfcld

$ fft cjrrfft ft

UnrftT 373^ fiRT
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