The SMHSA tool is organized into sets of domains and sub-domains. A domain is defined as an area of interest or related interest. The tools captures related information about the Mental Health Systems within the state under 10 domains . Currently, the SMHSA includes information on all 10 domains along with their sub-domains.

  • 1. General information about the state
  • 2. State health resources
    • a. Number of health care institutions in the state from both Government and Non-Government sectors (NonGovernment Organization includes for profit, not for profit, voluntary, etc.)
    • b. Health human resource availability 
    • c. State health management Information System 
  • 3. Mental health systems and resources
    • a. Mental health policy 
    • b. Mental health action plan 
    • c. State level authority responsible for supervising mental health related activities/programmes within the state
    • d. Human resources development
      • I. Mental health human resources (1 : Health sector 2 : Health-related sector)
      • II. Training in mental health and related areas
      • III. Mental health education / sensitization programmes 
    • e. Mental health legislation and implementation
    • f. Financing and budgetary provisions for mental health care 
    • g. Mental health services within the State 
      • I. Facilities for mental health services
      • II. Other facilities 
  • 4. Management of mental health problems 
    • a. Details of inpatient care 
      • I. Total number of patients in mental hospitals (by length of stay) 
      • II. Involuntary and total admissions to inpatient mental health facilities
    • b. Burden  
      • I. Mental Neurological and Substance use disorders 
      • II. Suicides
    • c. Information sources and maintenance of records 
    • d. Availability of drugs e. Additional services 
  • 5. Intra- and inter-sectoral collaboration 
  • 6. Social welfare activities 
  • 7. Engagement with civil society 
  • 8. Information education and communication activities 
  • 9. Mental health indicators(monitoring) 
  • 10. Monitoring and Evaluation

It was evident from our earlier work that the data required for assessing the mental health systems under different domains could not be obtained from a single source. Even within each domain, a combination of data sources rather than a single data source was required. There were certain areas where precise data was not available or was difficult to obtain from routine data sources. Thus, multiple sources and methods were required to provide a clear and broad picture of a mental health system.

  • Report of National Health Profile of India
  • NRHM annual reports
  • Rural health statistics report
  • District Statistical Handbook
  • Statistical Diary
  • State crime records bureau
  • National Crime records bureau
  • Office of Director General of Health Services
  • Secretary, State mental health authority
  • State nodal officer for mental Health
  • District Mental health programme officers
  • Communication with Mental hospitals/Institutes
  • Communication with Medical Colleges
  • Personal communication with practicing psychiatrist/ psychiatric professional bodies
  • Personal communication with NGOs
  • State Health and Family Welfare department
  • District CMOs office
  • Department of Health Education
  • Department of Medical Education
  • Medical Council of India
  • Rehabilitation Council of India 

The guidelines for data collection laid down the three phases of SMHSA which included obtaining administrative permission to gather data, methods to sensitise different levels of administration to obtain relevant data / information, steps to identify different sources of data for different sections of the questionnaire, data collection mechanisms, steps to reconcile information from different sources and most importantly to establish a method for finalising the data in the proforma during the consensus meeting.

A set of 15 quantitative indicators, covering various domains was developed based on quantitative information collected by using the SMHSA proforma. Data drawn from the Na¬tional Mental Health Survey was used to de¬velop 5 morbidity indicators. These domains focused on the coverage of the DMHP, human resources for mental health, facility coverage for mental health, financing for mental health, burden of mental morbidity, treatment gap and incidence of suicides. A set of 10 qualitative indicators covering 10 essential domains of the mental health system, based on a scoring pattern has been developed as qualitative indicators. These include mental health policy, plan of action, service delivery, availability of drugs, budget, IEC activities, legislation, inter-sectoral activities and monitoring of programmes.

  • Number of general health care facilities (Public and Private sector) in the state per 100000 population
  • Number of health professionals/ personnel available in the state per 100000 population
  • Percentage of districts in the state covered by DMHP
  • Percentage of state population covered by DMHP
  • Percentage of tribal population covered by DMHP
  • Number of Mental health facilities (in each category) in the state per 100000 population
  • Percentage of District/General hospitals in the state providing mental health services
  • Percentage of Taluka hospitals in the state providing mental health services
  • Percentage of PHCs in the state providing mental health services
  • Number of beds available for mental health inpatient services in the state per 100000 population
  • Number of Mental health professionals/ personnel (in each category)in the state per 100000 population
  • Percentage of health professionals/ personnel(in each category) in the state who have undergone training in mental health in the last 3 years
  • Percentage of total health budget allotted for mental health by state health department for the year 2014
  • Percentage of total allotted mental health budget that is utilized
  • Number of suicides per 100000 population, by age and gender
  • Mental health Policy
  • Mental health action plan and its implementation
  • State mental health Co-ordination mechanism
  • Budget for Mental Health
  • Training programme for mental health
  • Availability of Drugs for mental illness
  • IEC materials and Mental health education activities
  • Intra and Intersectoral collaboration for mental health activities
  • Monitoring of mental health activities
  • Implementation status of legislation related to mental health

The purpose of the state level experts’ consensus meeting was to have a broader discussion and better documentation of the mental health systems in the state, to review the collected information, to examine the indicators, to suggest changes/modifications and to agree on areas requiring further data inputs. Furthermore, where data for some domains / components were not available, an agreement / consensus had to be arrived at to provide an understanding as a first step. The experts (15 to 20 in number) participating in the consensus meeting varied across states and often included one or more of the following: State Principal Health Secretary or representative, State NHM Director or representative, State Mental Health Programme Officer, Member-Secretary of the State Mental Health Authority, psychiatrist(s) from both the private and public sectors, public health specialists, civil society members, legal advisors, a representative from the state IEC cell, etc. During the consensus meeting each of the components of the proforma was discussed in detail and The group deliberated, debated and discussed issues before reaching consensus on the ten core parameters of mental health systems.

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