Gupta Snehil, Sagar Rajesh
Department of Psychiatry, All India Institute of Medical Sciences, New Delhi, India.
Indian J Psychol Med. 2018 Nov-Dec;40(6):509-516. doi: 10.4103/IJPSYM.IJPSYM_191_18.
India was one of the major World Health Organization (WHO) member countries to launch its National Mental Health Programme (NMHP) in 1982 in accordance with WHO's recommendations to deliver mental health services to the people under the framework of general health care system in the community. NMHP underwent major strategic revisions over its course, starting from setting a district as the unit for program planning and implementation under the District Mental Health Program (DMHP) to incorporating it with the National Rural Health Mission (NRHM) for effectively scaling up the program. The program also underwent evaluations by government bodies and independent agencies and was reviewed by many researchers. The program has been partly successful in terms of enhancing its reach to community, improving service delivery, and getting increased budgetary allocation, but at the same time, its impact was limited by financial and human resource constraints, lack of community participation, ineffective training, poor NGO/private partnership, and lack of a robust monitoring and evaluation (M and E) system. The latest National Mental Health Policy and the incorporation of its objectives have given a new impetus to the ongoing NMHP, however, its implementation needs to be monitored and the impact is yet to be evaluated. We attempted to review the available literature pertaining to NMHP and DMHP to highlight the determinants of its outcome, with special emphasis on on-going programs and to provide some important future directions.
印度是世界卫生组织（WHO）的主要成员国之一，于1982年根据WHO的建议启动了国家精神卫生项目（NMHP），以便在社区普通卫生保健系统框架下为民众提供精神卫生服务。NMHP在其发展过程中经历了重大战略修订，最初以区作为项目规划和实施的单位，即区精神卫生项目（DMHP），后来又将其与国家农村卫生使命（NRHM）相结合，以有效扩大该项目。该项目还接受了政府机构和独立机构的评估，并受到许多研究人员的审视。该项目在扩大社区覆盖范围、改善服务提供以及获得更多预算拨款方面取得了部分成功，但与此同时，其影响受到财政和人力资源限制、社区参与不足、培训效果不佳、非政府组织/私营部门伙伴关系不佳以及缺乏健全的监测与评估（M和E）系统的制约。最新的国家精神卫生政策及其目标的纳入为正在实施的NMHP注入了新的动力，然而，其实施情况需要监测，影响仍有待评估。我们试图回顾与NMHP和DMHP相关的现有文献，以突出其成果的决定因素，特别强调正在进行的项目，并提供一些重要的未来方向。
