60 SOCIAL SCIENTIST
Accordingly, and with sufficient impetus from the WHO'S Alma Ata Declaration ('Health for All by 2000 A.D.') and the National Health Policy, an alternative in the form of the National Mental Health Programme for India (hereafter NMHP) was introduced in 1982 with the following objectives:-
1. To ensure availability of minimum mental health care for all in its forseeable future, particularly to the most vulnerable and under-priviledged sections of the population.
2. To encourage application of mental health knowledge in general health care and in social development.
3. To promote community participation in the mental health service development and to stimulate efforts towards self-help in the community.'7
In order to effect these objectives the NMHP has devised a particular structure (apparently with a special eye on the needs of the deprived masses) which seeks to incorporate the state mental health and general health services.8 The high-priority mental illness categories chosen for intervention are the psychoses, epilepsy and mental retardation.9
In order to achieve its laudable public health goals the NMHP established certain time-bound targets especially in relation to coverage in rural areas, viz., (i) training of professionals and personnel, (ii) ensuring regular chemotherapy and supply of psychotropic drugs, and (iii) organisation of co-ordinating national-level and State-level bodies.10
However, over and above the rhetoric, the results of the target-implementation after over a decade of operation are not flattering.11 The central thread which surfaces from preliminary analysis of the evaluations of this public health approach done by the NMHP and other professionals and activists is that of unsatisfactory participation of the lay population in the efforts of the NMHP.
Participation in the NMHF
The problem of participation of the masses — both patients and their relatives, and the general populace—in the NMHP is acute. The rate of drop-out from the NMHP's treatment is high: amongst the registered patients, only 40 per cent to 50 per cent go regularly to the NMHP for follow-up treatment and counselling.12
Besides direct contact, the NMHP seeks to evoke the participation of the potential patients and the masses through mental health camps, formation of mental health committees/associations (incorporating politicians, bureaucrats, village leaders), orientation programmes for the media personnel, and use of the media itself for