©2013 Indian Association for Social Psychiatry 102
INTRODUCTION illnesses in primary care setting (Isaac et al 1982;
Murthy et al 1978, Chandrasekhar et al 1981). Generally
This study attempts to assess patients attending clinics
it is reported that case finding using community health
conducted by a District Mental health Programme on
workers and imparting basic skills to handle mentally ill
the frequency of rehospitalisation, satisfaction with
persons have been successful.
service and level of disability. The District mental health
program – a component of the National mental health But very few studies have actually looked at the patients
program of Government of India has been operational attending the programs and how the programs are
since 1995-96. At present it covers 124 districts and by being run. There have been concerns about the
the end of the current five year plan, it is expected to effectiveness of the program from some psychiatrists.
cover many more districts of India. Other components Frustration has been expressed at attempts to
of the program include manpower development repackage and re-introduce a failed program (Jacob
schemes like establishment of centres of excellence, 2011). But others have argued that providing
providing funds for development of infrastructure in decentralized care is beneficial and recommends that
existing state mental hospitals etc. (Government of the program needs to be expanded in coverage
India 2011; Sinha & Kaur, 2012). There have been (Waraich et al 2003; Barua 2009). A recent study
several publications on the district mental health reported that community mental health programs
program dealing with issues like training of various modelled on DMHP are effective in achieving outcomes
categories of staff of health department including comparable to those from other settings (Kumar et al
doctors on the detection and treatment of mental 2011). There is concern regarding lack of data based
Abstract
Background: Though District mental health programs (DMHP) are operational in many districts of
India, and government is planning to extend its coverage, there have been doubts about this is an
effective strategy to provide mental health care to rural populations. Some have pointed out that
data based publications are lacking about this national flagship program. Aims: To assess the socio-
demographic profile, diagnostic breakup, satisfaction with service of patients attending DMHP
clinics in a district and see how many of those eligible for disability benefits are actually receiving
this. Materials and methods: Data were collected from patients attending DMHP clinics of a district
in this cross sectional study. Every fourth case on follow up was chosen to be included. A data sheet
covering relevant variables was used for this. 'IDEAS' was used to assess level of disability. Results: A
total of 216 patients were included in the study. Majority were male (58.3%), older (mean age
42.73; SD 13.85) unmarried (49.5%), unemployed (60.4%), belonged to the BPL category (68.1%),
and had long duration of illness(Mean duration of illness 15.8 years; SD 9.5 years).Schizophrenia
(43.5%) and mood disorders (37.5%) were the most frequent diagnoses. There were few cases of
common mental disorders (2.8%). A striking finding was the decrease in the number of
hospitalizations after enrolling in the program with only (4.7%) needing rehospitalisation. Majority
(77.5%) expressed good to excellent satisfaction with service offered. The level of disability was
high (49.5%) had moderate or above scores) and very few of those eligible (13%) were receiving any
government welfare benefits. Conclusion: DMHP seems to be an effective strategy to provide
decentralized mental health care for the rural population of the country. High level of disability and
poor coverage of welfare benefits is a cause for concern. As few number of patients with common
mental disorders using this service, there is a case for revising the staff pattern of the program.
Key words: District mental health program, disability, user satisfaction
A STUDY OF PATIENTS ATTENDING CLINICS OF DISTRICT MENTAL HEALTH PROGRAM
TO ASSESS SATISFACTION WITH SERVICE, REHOSPITALISATION AND DISABILITY
Harish M Tharayil, Jayanthi M Ramanujam, Rajeev Krishnan
Research Article
Indian Journal of Social Psychiatry, 2013, 29 (3-4), 102-107