Mental Health Programme in India: Has the tide really turned?

Mental disorders in India form a major public health concern and the efforts to tackle these dates back to four decades, by way of the National Mental Health Programme (NMHP) and its operational arm, the District Mental Health Programme (DMHP). Although the progress of NMHP (and DMHP) was relatively slower till recently, the last 4-5 years have seen rapid strides with several initiatives, including (i) expansion of DMHPs to 90 per cent of the total districts of the country, (ii) the National Mental Health Policy and (iii) strengthening the Mental Health Legislation by way of providing explicit provisions for rights of persons with mental illnesses. Among others, factors responsible for this accelerated growth include the easily accessible digital technology as well as judicial activism. Federal and State cooperation is another notable feature of this expansion. In this review, the authors summarize the available information on the evolution of implementation and research aspects related to India's NMHP over the years and provide a case for the positive turn of events witnessed in the recent years. However, the authors caution that these are still baby steps and much more remains to be done.

A Phenomenal Depiction of Paranoid Schizophrenia With Auditory Hallucinations: A Case Report.

This case report provides a vivid illustration of a schizophrenic case in a 59-year-old man with auditory hallucinations, illuminating the nature of his symptoms. Auditory hallucinations were prominent, and the patient received voices urging him to perform actions that clearly corresponded to his paranoid thoughts. Through comprehensive research and long-term follow-up, this report reveals the complexity of traumatic schizophrenia, highlighting the importance of early recognition and intervention. One must emphasize a multidisciplinary approach, including psychiatric assessment, pharmacotherapy, and psychotherapy. This case report aims to highlight the critical role of comprehensive individual care in improving the patient's condition and emphasizes the importance of compassionate healthcare practices.

Establishing Performance Indicators of Telemedicine-Based "On-Consultation Training" of Primary Care Doctors: An Innovation to Integrate Psychiatry at Primary Care.

BACKGROUND: A "functional treatment gap" exists in primary care of India despite the higher prevalence of psychiatric disorders at primary care. Traditional classroom training for primary care doctors (PCDs) fails to translate into adequate clinical skills to provide basic psychiatric treatment. An innovative telepsychiatric on-consultation training (Tele-OCT) is designed exclusively for practicing PCDs where a telepsychiatrist trains PCDs in live video streaming of their own real-time general consultations of primary health centres. The aim of this study is to establish performance indicators of Tele-OCT for its effective implementation. METHODOLOGY: The data collected using a file review method from a naturalistic design of the implementation of Tele-OCT for 73 PCDs from August-2016 to October-2018 across Mandya district, Karnataka, India. RESULTS: Flexibility in the scheduling of Tele-OCT sessions is key to success. Personal smartphones of PCDs with available videoconference applications are the popular choice. Four consecutive Tele-OCT sessions are planned for each PCD with a gap of 2-4 weeks over two months. The first three sessions are considered the "optimum Tele-OCT training package" for each PCD, followed by the fourth one as a 'Tele-OCT impact evaluation session' in a live, real-time general consultation. Each Tele-OCT is conducted in an average ten general patients in about two hours per session, totalling about 30 patients in 6 hours of Tele-OCT training package per PCD. Patient's profiles especially common mental disorders are reflective of a true picture of Indian primary care. CONCLUSIONS: Performance indicators of Tele-OCT for future implementation are established. Tele-OCT appears to be a path-breaking training model for PCDs to integrate psychiatric care in their general practice.

Implementing National Mental Health Program: Local leaders' perspectives and lessons for national action.

The article is about a set of leadership programs on 'mental health leadership under NMHP' that was completed for 161 participants who are the district level health authorities and service providers (psychiatrists, psychologists, nurses and social workers) by the Community Psychiatry Unit of the Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru. The overarching aim of these programs was to provide an impetus to mental health leadership at district levels that could enable them to upscale public mental healthcare delivery. Upon completion of the program, 109 participants provided a feedback on the content of the program. Majority (98 %) were satisfied with the format of the program in which it was conducted and felt that their expectations were either partially or completely satisfied with appropriate content (93 %). The health authorities (43 %) gained better insights into the magnitude of mental health concerns and agreed that mental health service delivery should scale up. The service providers (17 %) felt the need to upgrade their skills in specialty areas of psychiatry in order to gear up for comprehensive mental health care delivery. Finally, the authors argue that such local level learnings should drive the policy making at the national level.

A Report on a Series of workshops on "Mental Health Leadership" for Maharashtra State.

The article is a report on a series of workshops conducted by the National Institute of Mental Health And Neurosciences (NIMHANS), Bengaluru, India in collaboration with the Government of Maharashtra for the local leaders responsible for leading, organizing and delivering public mental health services throughout the state of Maharashtra. The overarching aim of these workshops was to sensitize and orient the participants on the mental health services offered/provided by NIMHANS, the collaborative activities between NIMHANS and Govt. of Karnataka to further the cause of public mental health and also to showcase the scope of DMHP (District Mental Health Program) activities in Karnataka. The professionals were divided into 5 batches as per their specialty or role i.e. Psychiatrists, Psychologists and Social Work besides the health administrators (Civil Surgeons and District Health Officers). Each batch underwent the training 2-3 days. Major areas covered included: Farmers' suicide, programs, policies and laws for the elderly, orientation to the new Mental Health Care Act 2017 and a fully functioning District Mental Health Program (DMHP).

Taluk Mental Health Program: The new kid on the block?

This article highlights the platform and framework for the new public mental health initiative, the Taluk Mental Health Program (TMHP), rolled out by the Government of India, as part of the expansion of the District Mental Health Program. In this initial phase, TMHP has been approved for ten taluks of Karnataka state. In the authors' collective opinion, few of the initiatives in the country could be considered as foundations for conceptualizing the TMHP (a) research programs and projects in the community, (b) community intervention programs running in two taluks of Karnataka since the past one and a half decade (Thirthahalli and Turuvekere taluks of Karnataka), and the (c) Primary Care Psychiatry Program of National Institute of Mental Health and Neurosciences. The article briefly describes the above initiatives and ends with further suggestions to scale up TMHP.

Symposium summary on "Community Psychiatry and DMHP-An update".

This summary provides details of a one-day symposium, titled 'Community Psychiatry and District Mental Health Program (DMHP)- An update' that was organized jointly by the Departments of Psychiatry and Epidemiology, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru in collaboration with the Department of Health and Family Welfare, Government of Karnataka on September 3rd 2018. This symposium was supported by Dr. Ramachandra N Moorthy, foundation for Mental Health and Neurological Sciences, NIMHANS, Bengaluru.

A case of craniopharyngioma presenting as rapidly progressive dementia.

Rapidly progressive dementia (RPD) is generally obvious to family member but often difficult for physicians to pinpoint the underlying pathology. Some common causes, such as prion's disease, Alzheimer's disease, central nervous system vasculitis, or infection, might present with disease-specific signs or symptoms where many etiologies do not produce such warning signs. Here, we are presenting a case who attended the psychiatric clinic for decreased motivation to do work, easy fatigability, infrequent falls, recent memory impairment, increased appetite, polydipsia and polyuria, and provisionally diagnosed with RPD. Magnetic resonance imaging revealed solid cystic lesion in suprasellar location involving hypothalamus, optic chiasma, and optic tracts, compressing the floor of the third ventricle suggestive of craniopharyngioma which is one of the very few reports in literature.