India's District Mental Health Programme (DMHP) is a government initiative that aims to integrate mental healthcare into the public health system and seeks to make mental well-being accessible across districts. Launched in 1996 under the National Mental Health Programme (NMHP), the DMHP is the Government of India's flagship initiative for decentralised community-based mental healthcare.
Tracing the genesis of the DMHP
The DMHP grew out of a pilot in Karnataka known as the 'Bellary Model.' Developed by the National Institute of Mental Health and Neurosciences (NIMHANS), this model demonstrated that local healthcare personnel could be trained to provide essential mental health services at the district, taluk and primary health care levels. This initial success paved the way for the DMHP's nationwide rollout as a key part of the NMHP. In 2012, the Ministry of Health and Family Welfare (MoHFW) established a Mental Health Policy Group to suggest updates for the program. Subsequently, the DMHP was revised and now operates under guidelines issued in 2015. Although the Planning Commission that set these guidelines has been replaced by NITI Aayog, no new framework has been issued. Today, the DMHP is approved for implementation in 767 districts, with support from the National Health Mission.
For more details about the historical background and introduction to the DMHP, please refer to Deconstructing the DMHP: Part I - Introduction to India’s District Mental Health Programme.
Service provisions under the DMHP
DMHP services focus on diagnosis and treatment, offering psychiatric services, counselling, and psychosocial support across two main components. The first component is based in district hospitals for both outpatient and inpatient services. The second component comprises outreach services that extend care into the community through referrals at local health centres, providing medication, training, and strengthening of intersectoral linkages.
In the recent decade, the DMHP has been augmented by other centrally-sponsored programmes for mental health. Ayushman Bharat and Tele MANAS are initiatives designed to strengthen community mental healthcare and facilitate referrals to the DMHP for specialised services. Ayushman Bharat's Ayushman Arogya Mandirs aim to integrate basic mental health services, including screening and counselling, into primary care. Tele MANAS provides around-the-clock tele-mental health support via a helpline, offering counselling and referring individuals to DMHP facilities for in-person or advanced care. An integrated approach through both Ayushman Bharat and Tele MANAS aims to create a referral pathway from community level care to specialised services.
For more information on the framework and implementation processes of the DMHP, please refer to Deconstructing the DMHP: Part II - Understanding the Framework and Implementation.
Understanding the fiscal landscape of the DMHP
The DMHP is funded through the National Health Mission (NHM), specifically integrated within the 'Flexible Pool for RCH & Health System Strengthening, National Health Programme and National Urban Health Mission'. Funds are allocated based on State Project Implementation Plans (PIPs), with a typical 60:40 centre-state sharing ratio and 90:10 for Himalayan/North-eastern states. The largest portion of the budget, approximately 50%, is allocated to staff salaries. After the initial five-year funding from the central government, the DMHP's sustainability relies on state resources. States often encounter difficulties in taking over this financing, as not all possess the necessary infrastructure or financial resources to effectively sustain implementation, which can affect the DMHP’s overall functioning.
For more details about the fiscal processes involved in the DMHP, please refer to Deconstructing the DMHP: Part III - Mapping the Fiscal Process.
Critical reflections on the DMHP
The DMHP has expanded significantly, however, there are persistent challenges in its financial management and operational effectiveness. The DMHP fosters an 'administrative psychiatry' model that emphasises a reliance on psychotropic medication as a singular form of treatment, with limited consideration for social dynamics, and without adequate provisioning of psychosocial interventions. Concerns about the program include the absence of service user and caregiver participation in its design, implementation, and monitoring – with a disproportionate focus on outputs rather than an evaluation of clinical, social and functional outcomes. Additionally, staff shortages, inconsistent data collection, and low participation from the private sector have made it difficult for the program to operate as effectively as it could.
For more details about the critique on the DMHP, please refer to Deconstructing the DMHP: Part IV - A critique of the District Mental Health Programme.
Underutilisation of funds and the way forward
States and Union Territories have consistently underutilised the funds allocated by the central government, with less than 38% of allocated funds being used in recent years. This disparity in fund usage varies widely across regions, with some states demonstrating better absorption rates than others. States with the highest percentage of utilisation are Andhra Pradesh (78%), West Bengal (71%) and Chhattisgarh (64%) while states with the lowest utilisation of funds are Telangana (5%), Uttarakhand (12%) and Jharkhand The underutilisation of funds impacts the provision of services like psychosocial interventions, community awareness programs, and prevention and promotion activities within districts.
For more information on the state-wise utilisation of funds, please refer to Deconstructing the DMHP: Part V - Understanding funding and state-wise allocation.
From the foundational Bellary Model to its fragmented implementation today, the DMHP has increased access to mental health services for many. Yet, like any large-scale endeavour, its journey is marked by evolving challenges, particularly in areas of implementation, financial management, and resource utilisation. The ongoing efforts to refine and adapt the DMHP reflect a commitment to enhancing mental healthcare across the nation, highlighting a dynamic process of growth in the public health domain of the country.
To delve deeper into the District Mental Health Programme in India, explore the series of issue briefs available: Issue Brief I, Issue Brief II, Issue Brief III, Issue Brief IV & Issue Brief V.
