Overall assesment of state mental health system
Mental Health specialist human resources
Despite the acceptance of the fact that primary and community care is the need of the hour, some patients need institutional mental health care and rehabilitative services. There was at least one mental hospital in all the surveyed states, except in Manipur; all states have medical colleges with a psychiatric department, general hospitals with a psychiatric unit and a few have de-addiction centres. Apart from the major mental health facilities, there were 450 mobile mental units and 249 de-addiction centres providing mental health services in the 12 states. However, the existing facilities had inter-state variations, were inadequate and unevenly distributed thereby resulting in limited care accessibility. Information on private mental health facilities was limited.
The number of medical officers at the state and district levels trained to deliver mental health services (per lakh population) ranged from 0.1 in Jharkhand and Madhya Pradesh to 0.1 in Uttar Pradesh and 9.73 in Manipur. This is a reflection of progress or rather the lack of it, towards the integration of mental health service delivery in Primary care. Information on rehabilitation workers, special education teachers and paraprofessional counselors was not available. Wherever available, it was found to be grossly inadequate to meet the current needs.
As far as training institutions in mental health were concerned, Tamil Nadu had the maximum number of institutions (19) providing a postgraduate course in psychiatry followed by Kerala (15) and Uttar Pradesh (12). The yearly intake across institutions in the NMHS states ranged from nil to 52 per year.
In accordance with the Mental Health Act, 1987 and following the Supreme Court directive, there has been significant progress in the setting up of a Mental Health Authority in each state. The State Mental Health Authority has a defined role for improving care in institutions and the certification of institutions. However, the delivery of mental health care in each state is the responsibility of that state’s health services and some had an in-charge programme officer who had diverse roles and responsibilities with very little time left for mental health. Coordination between the mental health authority, the state department of health, medical education and welfare was found lacking in many states.
Prevalence of psychoactive substance use