Lok Sabha Question No. 935 (UNSTARRED), answered on 2023-12-08
Subject: Mental Health Services in Rural Areas
Ministry: HEALTH AND FAMILY WELFARE
Asked by: S. Jothimani

## GOVERNMENTOFINDIA MINISTRY OFHEALTH AND FAMILY WELFARE DEPARTMENTOFHEALTH AND FAMILY WELFARE

## LOK SABHA UNSTARRED QUESTION NO. 935 TO BE ANSWERED ON 08 TH DECEMBER, 2023

## MENTALHEALTH SERVICES IN RURALAREAS

## 935. MS. S. JOTHIMANI:

Will the Minister of HEALTHANDFAMILYWELFARE be pleased to state:

- (a) whether the Government has conducted any study to understand rural mental health challenges and if so, the details thereof along with steps taken to offer mental health services at Primary Healthcare Centers (PHCs) and village health clinics, particularly for those in the BPL category;
- (b) the number of PHCs offering mental health services in the country and whether the Government proposes to introduce schemes for providing athome mental health services, especially for women and if so, the details thereof;
- (c) whether the Government provides support to children experiencing mental health issues by offering mental health services along with personal and career counseling in Government schools, particularly those situated in rural areas and if so, the details thereof;
- (d) the steps taken to reduce the financial burden involved in accessing such mental health services; and
- (e) the number of psychiatrists, social workers, psychologists and counselors practicing in rural India along with necessary steps taken to increase their number?

## ANSWER THE MINISTER OF STATE IN THE MINISTRY OF HEALTH AND FAMILYWELFARE (PROF. S. P. SINGH BAGHEL)

- (a) to (e) The Government conducted the National Mental Health Survey (NMHS), 2016 of India through the National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru in 12 States of the country, as per which the prevalence of mental disorders in adults over the age of 18 years is about 10.6%. Further, as per the Survey, the prevalence of mental morbidity is higher in urban metro regions (13.5%) as compared to rural areas (6.9%) and urban non-metro areas (4.3%).

To generate awareness among masses about mental illnesses Information, Education and Communication (IEC) activities are an integral part of the NMHP. At the District level, sufficient funds are provided to each District under the DMHP under the Noncommunicable Diseases flexi-pool of National Health Mission for IEC and awareness generation activities in the community, schools, workplaces, with community involvement. Under the DMHP various IEC activities such as awareness messages in local newspapers and radio, street plays, wall paintings etc. are undertaken by the States/UTs.

For providing affordable and accessible mental healthcare facilities in the country, the Government is implementing the National Mental Health Programme (NMHP) in the country. The District Mental Health Programme (DMHP) component of the NMHP has been sanctioned for implementation in 738 districts for which support is provided to States/UTs through the National Health Mission. Facilities made available under DMHP at the Community Health Centre(CHC) and Primary Health Centre(PHC) levels, include outpatient services, assessment, counselling/ psycho-social interventions, continuing care and support to persons with severe mental disorders, drugs, outreach services, ambulance services etc. In addition to above services there is a provision of 10 bedded in-patient facility at the District level.

In addition to the above, the Government is also taking steps to strengthen mental healthcare services at primary healthcare level. The Government has upgraded more than 1.6 lakh SHCs, PHCs, UPHCs and UHWCs to Ayushman Arogya Mandirs. Mental health services have been added in the package of services under Comprehensive Primary Health Care provided at these Ayushman Arogya Mandirs. Operational guidelines on Mental, Neurological, and Substance Use Disorders (MNS) at Ayushman Arogya Mandirs have been released under the ambit of Ayushman Bharat.

Under Pradhan Mantri Jan Arogya Yojana (PMJAY), health insurance cover of Rs. 5 lakhs per family per year for secondary or tertiary care hospitalization to over 60 cr. beneficiaries is provided. The treatment packages under AB-PMJAY are very comprehensive covering various treatment related aspects such as drugs and diagnostic services. Mental health services are also covered under PMJAY.

Besides the above, the Government has launched a ' National Tele Mental Health Programme ' on 10th October, 2022, to improve access to quality mental health counselling and care services in the country. As on 04.12.2023, 34 States/ UTs have set up 46 Tele MANAS Cells and have started tele mental health services and more than 4,81,000 calls have been handled on the helpline.

In order to ensure holistic development of adolescent population, the Ministry of Health and Family Welfare implements the Rashtriya Kishor Swasthya Karyakram (RKSK) since 2014. RKSK covers both school going and Non School going adolescents. It is a paradigm shift from the clinic-based services to promotion and prevention and reaching adolescents in their own environment, such as in schools, families and communities. Mental Health is one of the key thematic areas of RKSK apart from Sexual and Reproductive Health (SRH), nutrition, injuries and violence (including gender-based violence), non-communicable diseases and substance misuse.

RKSK through its interventions namely Adolescent Friendly Health Clinics (AFHC), Peer Education Programme and Adolescent Health and Wellness Days (AH&WD) focusing on creating awareness on mental health issues and providing counselling services, involving the parents, village elders, teachers, healthcare providers and the adolescents themselves as the critical stakeholders.

Ayushman Bharat School Health & Wellness Programme incorporates ' Emotional Wellbeing and Mental Health ' as a dedicated module. Health and Wellness Ambassadors (Teachers) are trained on mental health along with other thematic areas of the programme to support and provide awareness to school children on mental health and well-being. The training focuses on identifying self-emotions signs of distress in self and others and recognizing that ' mental health and well-being ' exists along a continuum. Health and Wellness Ambassadors take interactive sessions with the students and percolate the messages through weekly sessions promoting joyful learning.

Under the aegis of the School Health Programme under Ayushman Bharat, NCERT has developed a comprehensive package titled ' Training and Resource Material: Health and Wellness of School-going Children ' . A specific module has been included on ' Emotional Wellbeing and Mental Health ' , which has activities related to the mental health and wellbeing of students and teachers.

Modular Handbook on Early Identification and Intervention for Mental Health Problems in School Going Children has been developed in collaboration with Public Health Foundation of India (PHFI) which contains guidelines for early identification, detection and intervention of mental health problems (stress/illness) in school- going children, for handson training of teachers, counsellors and other stakeholders. The Handbook was launched by Ministry of Education on 06th September, 2022.

The Ministry of Education has taken up a proactive initiative, named, ' Manodarpan ' , covering a wide range of activities to provide psychosocial support to students, teachers and families for Mental Health and Emotional Wellbeing during the COVID outbreak and beyond. Under the Manodarpan initiative, a Web page (URL: http://manodarpan.education.gov.in) has been created carrying advisory guidelines, Frequently Asked Questions (FAQs), Practical tips, posters, videos, do ' s and don ' ts for students, teachers/faculty and families for psychosocial support have been uploaded on the Web-page. A National Toll-free Helpline (8448440632) for a country-wide outreach to students from schools, colleges and universities to provide them tele-counselling to address their mental health and psychosocial issues during and after the COVID-19 situation has been set up.

NCERT has started ' NCERT Counselling Services for School Children ' in April, 2020 to help school students across the country share their concerns. This service is provided free of charge by about 270 counsellors across different regions of the country. Live interactive sessions on ' SAHYOG: Guidance for Mental Wellbeing of Children ' are telecast on 12 PM eVidya DTH-TV channels for classes 1 to 12. To handle stress and anxiety, recorded videos on Yoga are telecast through 12 DTH TV channels with effect from 1st September, 2020 from Classes 1 to 12 and also digital resources are made available in digital platforms, i.e., DIKSHA.

The Central Board of Secondary Education (CBSE) provides pre and post examination tele -counselling facilities through centralized toll-free helpline.

Under the tertiary care component of NMHP, 25 Centres of Excellence have been sanctioned to increase the intake of students in PG departments in mental health specialities as well as to provide tertiary level treatment facilities. Further, the Government has also supported 19 Government medical colleges/institutions to strengthen 47 PG Departments in mental health specialties. Mental Health Services are also provisioned for 22 AIIMS. These services are also available under PMJAY.

The Government is also augmenting the availability of manpower to deliver mental healthcare services in the underserved areas of the country by providing online training courses to various categories of general healthcare medical and para medical professionals through the Digital Academies, since 2018, established at the three Central Mental Health Institutes namely National Institute of Mental Health and Neuro Sciences, Bengaluru, Lokopriya Gopinath Bordoloi Regional Institute of Mental Health, Tezpur, Assam, and Central Institute of Psychiatry, Ranchi.

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