The development of mental health services within primary care in India: learning from oral history.

BACKGROUND: In India very few of those who need mental health care receive it, despite efforts of the 1982 National Mental Health Programme and its district-level component the District Mental Health Programme (DMHP) to improve mental health care coverage. AIMS: To explore and unpack the political, cultural and other historical reasons for the DMHP's failures and successes since 1947 (post-independence era), which may highlight issues for today's current primary mental health care policy and programme. METHODS: Oral history interviews and documentary sourcing were conducted in 2010-11 with policy makers, programme managers and observers who had been active in the creation of the NMHP and DMHP. RESULTS: The results suggest that the widely held perception that the DMHP has failed is not entirely justified, insofar that major hurdles to the implementation of the plan have impacted on mental health coverage in primary care, rather than faults with the plan itself. These hurdles have been political neglect, inadequate leadership at central, state and district levels, inaccessible funding and improperly implemented delivery of services (including poor training, motivation and retention of staff) at district and community levels. CONCLUSION: At this important juncture as the 12th Five Year Plan is in preparation, this historical paper suggests that though the model may be improved, the most important changes would be to encourage central and state governments to implement better technical support, access to funds and to rethink the programme leadership at national, state and district levels

The phenomenon of co-morbid physical and mental illness in acute medical care: the lived experience of Australian health professionals

BACKGROUND: An estimated 30–50% of patients admitted to acute medical care settings experience co-morbid physical and mental illness. Research suggests that health professionals in these settings find managing this patient group challenging. A number of studies have investigated health professional’s attitudes and perceptions however there is limited research that investigates the lived experience in a current Australian healthcare context. The aim of this study was to explicate an in-depth description of the health professional’s experience when caring for patients experiencing co-morbid physical and mental illness in Australian acute medical care settings. METHODS: A phenomenological design was undertaken with six participants representing nursing and medical disciplines. In 2013–2014 one-on-one semi-structured interviews were used and the data collected underwent thematic analysis using an extended version of Colaizzi’s phenomenological inquiry. RESULTS: Six themes emerged including—challenging behaviours, environmental and organisational factors, lack of skills, knowledge and experience, hyper-vigilance and anxiety, duty of care and negative attitudes with an overarching theme of fear of the unknown. CONCLUSIONS: Staff in acute medical care settings were unsure of patients with mental illness and described them as unpredictable, identifying that they lacked requisite mental health literacy. Regular training is advocated. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s13104-015-1264-z) contains supplementary material, which is available to authorized users