We have organized community mental health programs in Malappuram, Kozhikode and Kasargode districts for nearly ten years from 2007 to 2017. started the programs in Kozhikode and Malappuram in 2007 and Kasargode in 2009. We had 48 clinics at the PHC level in the Malappuram district, 20 at the PHC/CHC level in Kozhikode, and 17 in Kasargode. During the ten years, around 15 thousand patients were given free psychiatric treatment, including drugs. We could support several community-based rehabilitation centres as part of the project.
Implemented the programs in the model of the DMHP of NMHP with appropriate modifications suitable to the local needs. The program aimed to provide psychiatry care at the PHC/CHC level to integrate mental health services with the primary health care system. A team of psychiatrists, medical officers, psychiatric social workers, clinical psychologists, pharmacists and attender visited selected community health centres/primary health centres once a month to provide psychiatric care to the target population. Routinely organized training programs for health workers and public awareness programs in these districts helped increase awareness and reduce the stigma related to mental illnesses.
When the program began in 2007, it was a unique model of community mental health care delivery with funding from the National Rural Health Mission (NRHM). The NRHM fund for mental health care delivery was for the first time in India. Apart from the NRHM funding for mental health care, we could develop several replicable service delivery models along with the CMHP. One such model is a local panchayath supporting mental health clinics and rehabilitation activities which was done first in Balusseri and subsequently in several other panchayaths. Another model attempted was that of the local palliative care clinics and community-based initiatives supporting the mental health clinics.
In the Malappuram district, the program was implemented as part of the PARIRAKSHA project of the district panchayath for persons with chronic illnesses. In many centres, local palliative care volunteer networks provided medicines and human resources to the program.
The programs were handed over to the DHS on 31st March 2017 due to technical reasons when extended mental health programs to all the fourteen districts in the estate in a uniform pattern under the DHS. Kerala now has a unique distinction among the Indian states of having community mental health programs in all districts.