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.
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.
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.
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.