Indian Journal of Psychiatry 53(3), Jul-Sep 2011 261

Address for correspondence: Dr. Suman K. Sinha,

Department of Psychiatry & Drug De-addiction Center,
Lady Hardinge Medical College, Shaheed Bhagat Singh Marg,
New Delhi - 110 001, India.
E-mail: drsumansinha@gmail.com
The resources available to tackle the huge burden of
these disorders are insufficient, inequitably distributed
and inefficiently used, which leads to a treatment gap
of more than 75% in many countries with low and lower-
middle class incomes.
[3]
Poor awareness about symptoms
of mental illness, myths and stigma related to it, lack of
knowledge on the treatment availability and potential
benefits of seeking treatment are important causes for the
high-treatment gap.
In India, the prevalence estimates vary between 5.82
[4]
to
7.3%.
[5]
In terms of absolute number suffering from mental
illnesses, the prevalence estimate throws up a huge number
of about 7 crore persons.
INTRODUCTION
Mental disorders are significant public health issue and
pose a tremendous socioeconomic burden on community.
Neuropsychiatric conditions have an aggregate point
prevalence of about 10% for adult population.
[1]
About 450 million people are estimated to be suffering
from neuropsychiatric conditions worldwide. In 1990,
mental and neurological disorders accounted for 10% of
the total DALYs lost due to all diseases and injuries. This
increased to 12% in the year 2000 and an analysis of trends
indicates that the burden will further increase to 15% by
the year 2020.
[2]
How to cite this article: Sinha SK, Kaur J. National mental
health programme: Manpower development scheme of
eleventh five-year plan. Indian J Psychiatry 2011;53:261-5.
CURRENT THEME
National mental health programme: Manpower development scheme of
eleventh fve-year plan
Suman K. Sinha, Jagdish Kaur
1
Department of Psychiatry and Drug De-addiction Center, Lady Hardinge Medical College, New Delhi,
1
Directorate General
of Health Services, Ministry of Health & Family Welfare, Government of India, India
Mental disorders impose a massive burden in the society. The National Mental Health Programme (NMHP) is being
implemented by the Government of India to support state governments in providing mental health services in the
country. India is facing shortage of qualifed mental health manpower for District Mental Health Programme (DMHP)
in particular and for the whole mental health sector in general. Recognizing this key constraint Government of India
has formulated manpower development schemes under NMHP to address this issue. Under the scheme 11 centers of
excellence in mental health, 120 PG departments in mental health specialties, upgradation of psychiatric wings of
medical colleges, modernization of state-run mental hospitals will be supported. The expected outcome of the Manpower
Development schemes is 104 psychiatrists, 416 clinical psychologists, 416 PSWs and 820 psychiatric nurses annually
once these institutes/ departments are established. Together with other components such as DMHP with added services,
Information, education and communication activities, NGO component, dedicated monitoring mechanism, research and
training, this scheme has the potential to make a facelift of the mental health sector in the country which is essentially
dependent on the availability and equitable distribution mental health manpower in the country.
Key words: Development, India, manpower, NMHP, program, scheme
ABSTRACT
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Sinha and Kaur: NMHP-Manpower development schemes
The median number of psychiatrists in India is only 0.2 per
100,000 population compared to a global median of 1.2 per
100,000 population. Similarly, the figures for psychologists,
social workers and nurses working for mental health is 0.03,
0.03 and 0.05 per 100,000 population compared to a global
median of 0.60, 0.40 and 2.00 per 100,000 population,
respectively.
[6]
Growing awareness regarding the magnitude of mental
health problems in the country, a flurry of health activities
in the late 70s which included Alma Ata Declaration, the
commitment to provide health to all by 2000, and the
realization that mental health care was possible through
the existing primary health care system led to the launch
of National Mental Health Programme (NMHP) by the
Government of India in 1982.
[7]
NMHP strives to ensure availability and accessibility of
minimum mental health care for all in the near foreseeable
future, particularly to the most vulnerable sections of the
population; to encourage mental health knowledge and
skills in general health care and social development; to
promote community participation in mental health service
development and to stimulate self-help in the community.
[7]
In line with the National Health Policy 2002, the objectives
of the NMHP and global trend of community care of mentally
ill, a field-tested model of community mental health care
was adopted as District Mental Health Programme (DMHP)
for NMHP.
[8,9]
This community-based mental health care at
district level was initiated in four districts in 1996 and it
was extended to 27 districts across 22 states/UTs in the
ninth 5-year plan. NMHP was restrategized during the
tenth 5-year plan to incorporate expansion of DMHP to
100 districts all over the country, modernization of state-
run mental hospitals, upgradation of Psychiatry wings
in the Government medical colleges/general hospitals,
IEC activities, research and training in mental health for
improving service delivery. By the end of the tenth 5-year
plan, DMHP was extended to 110 districts, upgradation of
psychiatric wings of 71 medical colleges/general hospitals
and modernization of 23 mental hospitals was funded.
The program showed an increased allocation from Rs. 280
million in ninth 5-year plan to Rs. 1900 million in tenth 5-year
plan period which was later reduced to Rs.1390 million.
[10]
A series of reviews, consultations and evaluations revealed
areas of concern in program implementation. Some of these
concerns are:
1. Non-availability of psychiatrists and other mental health
professionals like psychiatric social workers and clinical
psychologists in many states for manning DMHPs.
2. Lack of delegation of power for procuring medicines and
recruiting staff under the program at the district level.
3. The program was focused on catering mostly to severely
mentally ill and many important issues like suicide
prevention, workplace stress management, adolescent
mental health and college counseling services which
could benefit larger section of society and were not
covered under DMHP thus making these important
services inaccessible to the community.
4. Low level of community participation.
5. Lack of regular and dedicated monitoring and facilitating
mechanism.
6. Lack of detailed operational guidelines for
implementation of the schemes.
7. Lack of co-ordination between Department of Medical
Education and Health Department at the State level
lead to delays in implementation of DMHPs.
8. Some states were not able to take over the funding of
DMHP activities after the completion of 5 years.
The foremost area of concern facing the program and
mental health scene in the country is the shortage of skilled
mental health professionals in the country.
[11]

As against an estimated requirement of 11,500 psychiatrists,
17,250 clinical psychologists, 23,000 psychiatric social
workers and 3000 psychiatric nurses only approximately
3000 psychiatrists, 500 clinical psychologists, 400 PSWs and
900 psychiatric nurses are available at present. The estimated
figure is calculated using a norm of one psychiatrist per
100,000 population, 1.5 clinical psychologist per 100,000
population, two psychiatric social workers per 100,000
population and one psychiatric nurse per 10 psychiatric beds.
[12]

The existing training infrastructure in the country produces
approximately 320 psychiatrists, 50 clinical psychologists,
25 PSWs and 185 psychiatric nurses per year.
[10]
Manpower development schemes in mental health for the
11
th
5-year plan
To address the shortage of qualified mental health
professionals it was thought necessary to have dedicated
manpower development schemes in addition to continuing
with the community care approach adopted under DMHP.
These schemes are aimed at increasing the PG training
capacity in the mental health specialties of psychiatry,
clinical psychology, PSW and psychiatric nursing. The
PG courses identified specifically to be supported under
the scheme are MD/DPM/DNB in psychiatry, Diploma in
psychiatric nursing, M.Phil. in clinical psychology and
PSW. Ph.D in clinical psychology and PSW and M.Sc. in
psychiatric nursing has been excluded from the scheme
as they are of longer duration and usually candidates after
completing these degrees go into teaching rather than
into field-based programs. To support the expansion of
DMHP and implement Manpower Development Schemes
the allocation for NMHP during the 11
th
5-year plan period
has been raised to Rs. 10,000 million up from Rs. 1390
million in the last plan period. The schemes approved for
addressing the Manpower concerns in mental health are
as follows:
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Indian Journal of Psychiatry 53(3), Jul-Sep 2011 263
Sinha and Kaur: NMHP-Manpower development schemes
Centers of excellence in mental health
Also known as scheme A, this scheme aims at establishing
centers of excellence in the field of mental health by
upgrading and strengthening identified existing mental
health hospitals/institutes for addressing the acute
manpower gap and providing state of the art mental health
care facilities during the current 5-year plan period. These
institutes will focus on production of quality manpower in
mental health with primary aim to fulfill manpower needs
of the NMHP.
The support under the program would cover capital
work (Academic block, Library, Hostel, Lab., Supportive
departments, Lecture theatres, etc.), equipments and
furnishing, support for induction and retention of additional
faculty for the current plan period. Preference would
be given to centers where the state government shows
commitment for faculty and other recurring and necessary
expenditure. This support for additional faculty could also
be used for paying as incentive to attract and retain new
faculty over the usual state government pay for the plan
period to enable starting PG courses. Under support for
engaging additional faculty, cost for two units of psychiatry,
four faculty posts of clinical psychology, eight non-faculty
posts of clinical psychology, four faculty posts of PSW, four
non-faculty posts of PSW, two faculty posts of psychiatric
nursing, one non-faculty post of psychiatric nursing has
been provided at a competitive rate [Table 1].
Budgetary support under the scheme is up to Rs. 300
million per center which will be need-based and assessed
by a team of experts. [Table 2] The proposal for availing the
scheme has to be routed through the state governments
and must include a definite plan with timelines for initiating/
increasing PG courses in psychiatry, clinical psychology,
PSW and psychiatric nursing.
It is planned to establish at least 11 centers of excellence
in mental health under the scheme during the current plan
period. This would result in increase in at least 44 PG seats
in psychiatry, 176 M.Phil. seats in clinical psychology and
PSW each and 220 seats in diploma in psychiatric nursing.
Thus, a total of 616 qualified mental health professionals
would be produced from these centers annually after
they are established. After the current plan period, the
concerned state governments is to take over the entire
funding of these centers. Total budgetary allocation under
this scheme is Rs. 3381.21 million.The centers which are
being supported under this scheme are Institute of Mental
Health-Hyderabad, Hospital for Mental Health-Ahmedabad,
Institute for Mental Health and Hospital-Agra, Mental
Health Institute-Cuttack,Institute of Psychiatry-Kolkata,
Government Medical College-Chandigarh, State Mental
Health Institute-Rohtak, Psychiatric Diseases Hospital-
Srinagar, Institute of Mental health and Neurosciences
(IMHANS)-Kozhikode, Institute of Human Behaviour &
Allied Sciences-Delhi. One more center is awaiting the
commitment of the concerned state government to avail
grant under the scheme. A recent review of progress of the
upgradation work of the centers of excellence in mental
health funded under this scheme has revealed that the
pace of work is slow and needs to be speeded up so that it
is complete within the plan period.
Scheme for manpower development in mental health
Also known as scheme B, this scheme aims at development
of PG training capacity on low input and high-output
pattern. Vis-a-vis the scheme A this scheme is more cost-
effective and would cover far more institutes. Under
this scheme Government Medical Colleges/Government
General Hospitals/state-run mental health institutes would
also be supported for starting PG courses or increasing the
intake capacity for PG training in mental health specialties.
The support would involve limited amount of physical
work for establishing/improving department in specialties
of mental health (psychiatry, clinical psychology, PSW
and psychiatric nursing), equipments, tools and basic
infrastructure (hostel, library, department, etc.), support
for engaging additional faculty. It is planned to support
setting up/strengthening of 30 units of psychiatry, 30
departments of clinical psychology, 30 departments of
PSW and 30 departments of psychiatric nursing during the
plan period. The financial support will extend from up to
Rs.5.1 million for each psychiatric nursing department to
up to Rs. 10 million for each PG department of psychiatry
[Table 3].
Table 1: Support for faculty Critical support for meeting the regulatory requirement support for one module
Department (Regulatory body) Additional faculty and technical staff
(Number supported)
Outcome
(PG seats/ year)
Cost during plan
period (Rs.)
Psychiatry (Medical Council of India)
1 Unit
Professor(1), Assoc. Professor(1), Assistant Professor(1) 1MD and 1 DPM or
2 DNB
59,40,000
Clinical psychology (Rehabilitation Council of
India, University)
Two faculty: Assistant/Assoc. Professor (2)
clinical psychologist(4)
8 M. Phil. 51,48,000
Psychiatric social work (University) Two faculty: Assistant/Assoc. Professor (2)
PSW(2)
8-16
M. Phil.
35,64,000
Psychiatric nursing (Nursing Council of India) Two faculty: Assistant/Assoc. Professor (2), Tutor (1) 20 DPN 26,14,000
For center of excellence two such modules will be supported - (Calculation rates/pm: Psychiatry: Asst. Prof.-Rs.40,000/-, Assoc.Prof.-Rs.50,000/-, Prof.-Rs.
60,000/-. Cl. Psychology: faculty-Rs.25,000/-, clinical psychologist-Rs.20,000/-. PSW: faculty-Rs.25,000/-, PSW-Rs.20,000/-. Psych. Nursing: faculty-Rs.25,000/-,
Tutor-Rs.16,000/-). States may pay at this rate or as per the state government norms. This support could also be used for paying as incentive to attract and retain
faculty over the usual state government pay for the plan period to enable starting PG courses
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Indian Journal of Psychiatry 53(3), Jul-Sep 2011 264
Sinha and Kaur: NMHP-Manpower development schemes
This scheme is expected to generate about 60 psychiatrists,
240 clinical psychologists, 240 PSWs and 600 psychiatric
nurses per year. The support under this scheme is approved
for the current plan period and it is expected that the
concerned state government will take over the additional
infrastructure at the end of the period. The proposal
should have definite timelines for starting/increasing
training seats in mental health specialties. Total budgetary
allocation under this scheme is Rs. 700 million. A total of
23 PG departments have been funded under this scheme
and about 100 more PG departments could be taken up
for upgradation in the plan period. The scheme provides
a golden opportunity for initiating PG courses as well as
increasing PG seats in mental health specialties.
Spill over activities of 10
th
5-year plan
Spill over activities of 10th 5-year plan comprises two
schemes viz. upgradation of psychiatric wings of Government
Medical Colleges/ General Hospitals and modernization of
state-run mental hospitals. Total allocation during the plan
period is Rs. 580.3 million.
Upgradation of psychiatric wings of Government Medical
Colleges/General Hospitals
Every medical college should ideally have a Department
of Psychiatry with minimum of three faculty members
and inpatient facilities of about 30 beds as per the norms
laid down by the Medical Council of India. There should
be outpatient facilities, as well as facilities for providing
various forms of therapy including electroconvulsive
therapy. In addition to psychiatrists, clinical psychologists,
psychiatric social workers and psychiatric nurses are
essential for an ideal psychiatric department in a medical
college. Out of the existing medical colleges in the country,
approximately one-third

of them did not have adequate
psychiatric services.
Looking at the huge manpower gap in the psychiatry
and concerned disciplines, this scheme was adopted for
upgradation of the UG and PG training in psychiatry in
medical colleges. It is sought to upgrade the psychiatry
wings by supporting:
1 Provision for independent psychiatry department in
medical colleges where they did not exist
2 Upgradation of existing psychiatry services including
provision of inpatient services, with necessary
equipment; provision of trained manpower
3 The department of psychiatry to be responsible for
implementing and providing support for execution of
NMHP/DMHP
4 Facilities to train psychiatric social workers and nurses;
provision for accreditation and licensing for health
professionals
5 Provision of enhancing capacity of existing central/state-
governmental institutes/colleges to train manpower.
Under this scheme one-time grant will be provided to the
psychiatry departments of Government Medical Colleges
which have not been funded earlier under NMHP. Some
of the deserving areas, where there is no well-established
Government Medical colleges, Government General
hospitals/district hospitals could be funded for establishment
of a psychiatry wing. The grant to be provided would cover
non-recurring expenditure of up to Rs. 5 million per college
for upgradation of facilities and equipments. Preference
would be given to medical colleges/hospitals planning to
start/increase PG seats (MD/DPM/DNB) in psychiatry.
Modernization of state-run mental hospitals
There are 43 state-run mental hospitals in the country. Out of
them 29 mental hospitals have been funded for modernization
and some still remain to be modernized. A one-time grant of
up to Rs. 30 million per mental hospital would be provided
Table 2: Centres of excellence in mental health
Components Years Total
2007-08 2008-09 2009-10 2010-11 2011-12
Capital work 0 1.25 4 7.75 5 18
Technical equipments 0 0 0 3 2 5
Non-technical equipment 0 0 1 1 1 3
Library including books, journal and equipments 0 0 0.5 0.5 0 1
Additional faculty and technical staff as per regulatory requirements 0 0 .78 1.06 1.16 3.0
Total for one center 0 1.25 6.28 13.31 9.16 30
Year-wise break-up of support for a center of excellence [Rs. 10 million (in crores)]
Table 3: Cost of establishing/strengthening training departments in mental health (scheme B)
Capital work (academic facility and
hostel), furnishing and equipments
Faculty+ technical staff
cost (No.)
Total cost per department Number of department
established/ Supported
Psychiatry
1 Unit
40.6 59.4 (3) 100 30 (10 /year)
Clinical psychology 31.52 51.48 (2+4) 83 30 (10/year)
Psychiatric social work 24.36 35.64 (2+2) 60 30 (10/year)
Psychiatric nursing 24.86 26.14 (2+1) 51 30 (10/year)
[in Rs. Lacs (0.1 million)]
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Indian Journal of Psychiatry 53(3), Jul-Sep 2011 265
Sinha and Kaur: NMHP-Manpower development schemes
to mental hospitals based upon submission of firmed
up proposal under NMHP through the concerned state
government for modernization of facilities and equipments
from custodial to a modern therapeutic setup.
CONCLUSION
NMHP was launched in 1982 with very comprehensive
objectives which stand true even today. National Health
Policy 2002 recognised and incorporated the objectives
and strategies of NMHP. DMHP was launched in 1996 with
an aim to achieve the objectives of NMHP. DMHP was
expanded and more components were added to make it
more comprehensive. Eleventh plan period focuses on
consolidation of achievements made under NMHP and seeks
to address the biggest barrier in development of mental
health services by addressing the manpower shortage
in mental health. The strategy of upgrading psychiatric
centers with into centers of excellence will address the
manpower shortage to some extent and at the same time
develop infrastructure for effective implementation of
NMHP in their regions and make the concerned region
self-sufficient in quality mental health care. The scheme
B which is slated to give a better outcome in terms of
increase in PG training seats in mental health as compared
to scheme A focuses on the quantity of mental health
human resource. Establishment of 120 PG departments as
planned in the scheme will lead to spread of mental health
training to many centers and increase the level of care
available in addition to address the manpower shortage
for the program and the country. Expansion of DMHP
services along with manpower development will lead to
creation of posts of mental health specialists in districts
as well as in mental health institutions availing support
under manpower development schemes.
Upgradation of psychiatric wings of government medical
colleges will improve the UG as well as PG training facility
in mental health leading ultimately to start of more
PG training course in psychiatry. Many colleges have
already availed of this grant and established full-fledged
psychiatric ward, OPD and department. This has changed
the perception of psychiatry as a discipline in patients
and health professionals alike. Modernization of state-run
mental hospitals which began in 2004 has improved the
infrastructure and level of care of many custodial hospitals
and many of these are now coming forward to avail grant
under manpower development schemes to rise to a further
higher level of services and care. These schemes are an
opportunity to improve the mental health facilities and he
departments and institutes which have not availed of this
grant should avail of it at the earliest.
Slow work of projects funded under manpower
development schemes and a luke warm response in taking
up scheme B of manpower development scheme points
towards dearth of leadership in mental health sector in
the country and the danger of continuing with business
as usual. To truely implement these schemes and achieve
the scheme objectives it will require a vision to transform
the mental health institutes/departments. Being the
most knowledgeable about mental health it is the prime
responsibility of the senior mental health professionals
who are heading their departments to foster and spread
the vision among all stakeholders in their area to develop
their departments into a modern multidisciplinary
teaching institutions.
Other issues like stigma, NGO participation, innovative
pilot schemes, research, training in subspecialty
areas, dedicated monitoring mechanism, support for
statutory bodies in mental health, integration with other
development sectors, preventive and promotive mental
health services under DMHP are also being taken up
earnestly. Together these developments have a potential
to change the face of mental health in India and give us an
opportunity to bring mental health from the shadows of
darkness into sunshine.
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Source of Support: Nil, Confict of Interest: None declared
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