MHI

About MHI

Mental Health Institute (MHI), Chandigarh was set up on the directions of the Hon’ble Supreme Court of India vide its orders in WP(C) No. 334 of 2001 wherein, on 12 Apr 2002, it directed all states and UTs to set up a mental health institute for the care of mentally ill persons. For implementation of these directions, the Chandigarh Mental Health Authority on 17 Feb 2003, approved the draft for setting up a mental health institute in Chandigarh under the direct supervision of the Dept. of Psychiatry, Govt. Medical College and Hospital, Chandigarh. Subsequently, after the approval from the Govt. of India, MHI was approved to be set up as an 80-bedded hospital under the overall administrative control of the Dept. of Medical Education and Research, Chandigarh, with the DMER-cum-Director Principal, GMCH, Chandigarh as the ex-officio Director of MHI, and the Head of Department of Psychiatry, GMCH was designated as the ex-officio Additional Director of MHI.

Since MHI is in close proximity to GMCH (within 1 km distance), MHI does not run separate emergency services, and the emergency services of GMCH-32 are available for all patients with psychiatric emergencies.

While awaiting construction of the MHI building, clinical services of MHI under the aegis of the Centre of Excellence Dept. of Psychiatry, GMCH, Chandigarh were inaugurated on 31 Dec 2012 by the Head of the Dept. of Psychiatry in the erstwhile Govt. Institute for Mentally Retarded Children (GIMRC) building in Sector 32 C. The focus of services at MHI, including at this facility is on the medical treatment as well as rehabilitation of persons with chronic severe mental illnesses such as schizophrenia and bipolar disorder who have recovered from the acute phase of illness, but still have significant deficit in social, cognitive and vocational skills. The rehabilitation services have been designed to address the issues of persistence of these deficits, which lead to poor long term outcome. As the services at this facility developed, it was christened as Disability Assessment, Rehabilitation, and Triage (DART) services centre.

In addition to the outpatient services, a 10-bedded indoor patient facility was made operational in the DART building in February 2017, with increase in the number of beds over time, and 40 beds became operational subsequent to inauguration of the new MHI building on 04 March 2019.

MHI/DART Services and Sections

Services at MHI are focussed mainly on the rehabilitation of persons with chronic severe mental illness (SMI) who have recovered from the acute phase of illness, but still have significant deficit in social, cognitive and vocational skills. These services have been designed to address the issues of persistence of these deficits, which lead to poor long term outcome. In addition, MHI/DART facilities also provide aid in issues related to mental illness such as in disability certification, psychoeducation, placement assistance, legal assistance, and so on.

Services at MHI are provided by a team comprising of psychiatrists, clinical psychologists, psychiatric social workers, medical social workers, and vocational instructors. In addition, MD (Psychiatry), M. Phil. (Clinical Psychology), M. Phil. (Psychiatric Social Work) and M.Sc. (Psychiatric Nursing) trainees from the Department of Psychiatry, GMCH are also posted here for academic activities and clinical training.

In addition to pharmacological management, the following services are provided by MHI/DART:

• Neurocognitive Rehabilitation Clinic
• Social Skills Clinic
• Vocational Rehabilitation Clinic
• Daycare services
• Crisis Resolution and Home-based Treatment
• Disability Certification Clinic
• Occupational Health Services
• Trainee Drop-in Centre
• PNLIC Clinic
• SLSA Liaison

Neurocognitive Rehabilitation Clinic:-

Clinical neuropsychology is a specialty in psychology that examines the relationship between behaviour and brain functioning in the realms of cognitive, motor, sensory, and emotional functioning. Neuropsychological assessment in patients suffering from chronic psychiatric illness is essential for determining the cognitive dysfunction and then to plan rehabilitation strategies. Potential cases of cognitive impairments due to chronic mental illness, traumatic brain injuries, dementia, etc. are referred from the Department of Psychiatry, GMCH to MHI. These patients have impairment in attention, memory, concentration, higher executive functions and so on. As a result of this, they find their day to day activities very difficult. At MHI, these patients are assessed by a multidisciplinary team for intellectual functioning, attention and concentration, memory, executive functions and social cognitions. Cognitive skill training is provided for enhancing cognitive skills, and computer-based techniques are also used for improving the deficits.

Social Skills Clinic:-

Due to chronic illness, patients have to re-learn many social skills such as greeting people politely, how to initiate conversation, maintain eye contact while talking, express gratitude by saying ‘thank you,’ etc. Social skills’ training is very useful in such a situation. It is a structured, concrete treatment intended for individuals who suffer from severe and persistent symptoms. Social skills’ training consists of behaviorally based instruction, modelling, corrective feedback, and contingent social reinforcement aimed at improving social competence through the acquisition of social skills, self-care and independent living skills. After assessment, social skill training sessions are conducted to achieve competence in conversational skills. The social skills training package at MHI/ DART includes training in basic social skills, conversational skills, assertiveness, conflict management, and health and maintenance.

Vocational Rehabilitation Clinic:-

: Patients with mental illness find it very difficult to get new jobs or to continue with their present occupation. Most of them find it difficult to perform even day-to-day life activities. In this regard, a Vocational Rehabilitation strategy for these patients is necessary and helpful as it helps them to develop and restore functional capacity, achieve functional independence and even get employment. In DART, vocational activities have been started with the aim to train patients in different vocations which in turn will help them get gainful employment.

MHI, along with NGO Parivartan, provides vocational rehabilitation for persons with mental illness (outpatients as well as in-patients) in a variety of trades viz. Cutting & tailoring unit, Art & crafts unit, Jute products making unit, Nursery and gardening unit, Computer training unit, Masala grinding and packaging unit, Kitchen and bakery unit etc. The training gives a great boost to self-confidence of patients and some are able to shift to competitive employment in the open market. Those who continue to learn and work under the sheltered workshop environment are also provided remuneration through the NGO Parivartan.

A placement cell is run by Medical Social Workers at MHI to facilitate employment of persons with mental illness. Patients who get employed through placement cell are regularly followed up at their workplace to ensure continuity of care.

Daycare Services:

It is a known fact that chronic SMIs are associated with a high degree of disability which can lead to tremendous burden on family members. Despite resolution of acute symptoms, patients continue to have cognitive, social and vocational deficits for a long time. These deficits interfere in day-to-day functioning, community participation and quality of life of persons with mental illness. Long-term hospitalization is neither justified nor feasible in a developing country like ours. Daycare services provide an effective alternative to hospitalisation while maintaining the patient’s link with the community.

Rationale of providing daycare services:

• Daycare services provide comprehensive psychiatric care in a setting which does not break the patient’s link with the community and act as an effective alternative to inpatient care.
• Daycare provides a transition phase from inpatient setting to full participation in the community.
• Some patients require long-term supervised social support due to their disability; daycare ensures continuity of care.

Advantages of Day Care Services:

• Daycare services promote independent living.
• The services inculcate discipline as patients are expected to reach the centre at 9 am and leave by 5 pm.
• The daycare centre promotes a structured schedule as patients are encouraged to follow a structured routine which resembles a normal work routine.
• There is continuous monitoring of medical treatment, including treatment adherence and side effects.
• The staff at the daycare centre regularly monitors changes in behaviour to detect early relapse.
• Daycare services promote social interaction through group activities.
• Patients are linked with facilities targeting neurocognitive and social deficits.
• Through pre-vocational training, staff at daycare observes vocational skills and interests of the patients, which is used for vocational training and placement.
• Daycare services provide respite to caregivers of patients.
• Daycare services provide linkages with other facilities including disability certification, legal aid services, crisis resolution and home-based treatment.
• As patients improve, they may transition from daycare to get enrolled in various vocations necessary for job placement.

Various activities at the DART and MHI Daycare centres include:

• Participation in prayer, exercise, yoga, outdoor gym
• Indoor and outdoor games, fun games
• Participation in celebration of festivals and various occasions
• Participation in social skills, neurocognitive training, prevocational activities
• Newspaper and magazine reading
• Making paper bags from newspaper

Intake criteria for daycare services:

• Patient must have a diagnosis of chronic severe mental illness
• Patient should be under the care of a psychiatrist
• Patient should have been referred by a mental health professional
• Must be stable, without active psychotic symptoms or behavioural issues that cause disruption
• Patient should not have ongoing active substance dependence (except tobacco)

Crisis Resolution and Home-based Treatment (CRHT):

There are large numbers of persons suffering from mental illness who lack insight and do not feel the need to seek treatment despite being violent or aggressive and other myriad of reasons. Family members fail to convince them to seek treatment. In order to cover this gap, CRHT services facilitate treatment of such patients at hospital or in the home setting

Disability Certification Clinic:

The Disability Certification Clinic comprises of a disability board for assessment and certification of disability. In addition to certification, information regarding the disability benefits is imparted to the patients and their caregivers. This service is run at MHI on the first Wednesday of every month

Occupational Health Services (OHS):

OHS provides services to those experiencing mental health issues that can impact/has impacted their functioning at workplace; experiencing stress and mental health problems at work place; facing stigma/discrimination at workplace due to mental illness; facing stigma/discrimination at workplace due to disability related to mental illness. OHS facility is provided in MHI. These services are operational as a walk-in service on all working days of the week.

Trainee Drop-in Centre (TDC):

An offshoot of OHS, the trainee drop-in centre (TDC) caters to trainees of various specialities and MBBS students of GMCH to provide them with specialized mental health services. This service is run by Psychiatrist, Clinical Psychologist and counsellors and addresses the needs of students or trainees facing any mental health related issues, or requiring counselling. GMCH students with mental health issues like stress, anxiety, insomnia, adjustment issues etc. are referred to this clinic. Both pharmacological and non-pharmacological treatment is provided. This is run every Thursday from 2-5 pm in the Trainee Drop-in centre near Geriatric Clinic, Ground Floor, opposite MRD, B block, GMCH.

Psychiatric Nurse Led Intervention Clinic (PNLIC):

The clinic runs 2 days in a week on Wednesday and Friday from 9.00 am to 1.00 pm at the MHI OPD. Trained mental health nursing faculty is responsible for its overall functioning. The clinic was started to combat the physical especially cardio-metabolic comorbidities in patients with severe mental illness (SMI). The treating psychiatrist refers patients to the clinic for interventions targeted at identification of risk factors through timely screening and provision of lifestyle interventions. The clinic also screens inpatients of MHI, Halfway Home and patients coming to the DART (Disability assessment and rehabilitation treatment) centre for cardio-metabolic comorbidities.

Legal help: State Legal Services Authority (SLSA):

MHI liaises with the State Legal Services Authority (SLSA) of Chandigarh for facilitating legal services to patients for matters. A lawyer from the SLSA is available every Thursday afternoon at the DART building.

3)OPD services and schedule :

OPD services of MHI, including DART services, are available on all working days. Mon - Sat: 9.00 am - 1.00 pm; Registration timings are from 9.00 am till 12 noon Sundays and gazetted holidays: Closed The annual registration fee for new patients is Rs. 20/- only, valid for one calendar year. There is no fee for follow-up visits. a) Routine OPD for pharmacological management of persons with SMI is available on all working days (9.00am-1.00pm). b) Special clinics: The following special clinics are run at MHI/DART: ⮚ Clozapine clinic (Saturday 9.00 am - 1.00 pm, MHI) ⮚ Family intervention services (Saturday 9.00 am - 1.00 pm, DART) ⮚ Psychosocial rehabilitation clinic (Tuesday 9.00 am - 1.00 pm, DART) ⮚ Disability Certification Clinic (First Wednesday of every month 9.00 am-1.00 pm, MHI) ⮚ Occupational Health Services (Friday 2.00 pm - 4.00 pm)

4) Inpatient services :

MHI has been established as an 80-bedded facility of which 40 beds are operational currently. Of these, 30 beds are for the wards, 15 each in the male and female wards, while 10 beds are available in the Halfway Home run by MHI on the DART building premises. The charges for inpatient services in the MHI wards are as below: General Ward: Security charges at the time of admission: Rs. 200/- Admission charges to be collected at the time of discharge Rs. 25/- Daily charges including food: Rs. 115/- (Rs. 100/- for diet, 15 for bed) Daily Private Diet Charges: Rs. 271.87/-

5)Laboratory Investigations and Intervention Charges :

The charges for these services are the same as applicable at GMCH-32, Chandigarh for laboratory investigations, neuropsychological assessments, non-pharmacological therapies and interventions, ECT, etc.

5)6) District Mental Health Programme (DMHP) :

DMHP was launched by the Ministry of Health and Family Welfare Govt. Of India under the National Mental Health Programme (NMHP) in the year 1996. The Department of Psychiatry, GMCH, Chandigarh ran DMHP at Civil Hospital, Manimajra from January, 2002 till it was transferred to GMSH, Sector 16 on 23.3.2009. In 2015, the programme was transferred back to GMCH, Sector 32, Chandigarh and DMHP has been running at Rural Health Training Centre (RHTC) at Palsora, Sector 56, Chandigarh since then. Since July 2018, the funding and administrative control is under Mental Health Institute, Chandigarh. OPD services under DMHP are available at RHTC, Palsora in the morning on all working days. Regular OPD services with comprehensive treatment with free distribution of all types of medicines and non- pharmacological interventions are provided to the patients. Community services to the service-deprived areas of UT Chandigarh have been prioritized under DMHP by the Department of Psychiatry, GMCH, and MHI. Chandigarh, thus providing mental health care to the patients with mental health issues and substance use disorders. The primary purpose of DMHP is to make mental health care accessible to all by setting up psychiatric services in peripheral areas, to train primary health care personnel, and to involve the community in promotion of mental health care. This is a community-based Mental Health Programme in which awareness among the community regarding management of mental health problems and disorders is emphasized by a DMHP team (psychiatrist, clinical psychologist, psychiatric social worker, staff nurse) and referral linkage with other multidisciplinary services provided by Department of Psychiatry, GMCH, Chandigarh and MHI Chandigarh in this region. It has been suggested that the basic mental health care i.e. detection and management of all cases should be decentralized and integrated with general health care services. In order to create awareness in the community, multi media awareness techniques are used including pamphlet distribution, loudspeaker announcements, talks for students in schools in the vicinity, home visits in the sector, etc. Regular follow up of the patients is ensured through field home visits and telephonic calls by psychiatric social worker.

5)7) Half Way Home (HWH)

Half Way Home (HWH) was started under the aegis of MHI at DART building on 10.10.2020 with a capacity for 10 patients (5 male and 5 female patients). A half-way home is the next step after the hospitalization phase is over, and when the patient has stabilized on medication. A half way home, as the name suggests, is a transient place of stay between the hospital and the person’s home. Half-way homes function as ‘Rehabilitation Homes’, because the whole emphasis is to prepare the patient to lead a more independent life within the family and/or in the community. Persons having capacity as per MHCA, 2017, in the age range of 18 to 65 years can avail these services provided they give written informed consent for staying at HWH. However, all persons desirous of availing the service are first assessed at MHI for suitability. Besides providing the basic facilities such as shelter, food etc., all residents of HWH are supervised for medications, activities of daily living, social skills training, cognitive enhancement therapy, soft skills training, vocational training etc. Further all attempts are made so that the residents are able to obtain open employment as financial independence is considered the first step of becoming independent and also gives a huge boost to the community. Some hobby classes for the residents, based on their individual interest, such as dance class, arts and crafts classes etc. are also organized to improve quality of life. The residents are provided a safe, secure, non-stigmatizing and socially inclusive environment to flourish that helps in building their self esteem. The overall aim of all interventions, activities and supervision is to prepare the persons with mental illness to re-integrate into the society. The charges for staying at the Halfway Home are as below: Security charges at the time of admission: Rs. 3000/- Admission charges to be collected at the time of discharge Rs. 25/- Daily charges including food: Rs. 115/- (Rs. 100/- for general diet, for diet, 15 for bed) Daily Private Diet Charges: Rs. 271.87/-

Faculity :

Dr. Priti Arun -Additional Director, MHI (Professor-cum-Head, Dept. of Psychiatry, GMCH) Dr. Ajeet Sidana - Medical Superintendent, MHI (Professor, Psychiatry, GMCH) Dr. Aprajita Lobana - Deputy Medical Superintendent, MHI Dr. Sushmita Bhattacharya - Assistant Professor, Psychiatry, GMCH (COE) Dr. Padmini Prabhakar - Assistant Professor, Psychiatry, GMCH Dr. Shikha Tyagi - Assistant Professor, Psychiatric Social Work, GMCH (COE) Dr. Jyoti Misra - Assistant Professor, Clinical Psychology, GMCH (COE) /p>

9) Organization chart :

Director Additional Director Medical Superintendent Deputy Medical Superintendent Office Superintendent

Recruitment Rules: Visit GMCH, Chandigarh website :

Helpline for emergency mental health issues: :

In case of emergency mental health issues, please call the helpline numbers 0172- 2660078, 2660178

IEC material: Go to Department of Psychiatry website, GMCH, Chandigarh

Training:

MHI provides Short Term Training in Rehabilitation in the branches of Clinical Psychology, Psychiatric Social Work, Psychiatric Nursing, and Psychiatry, with the training duration of one to two months. The broad objectives of this short term training are to provide exposure to/or upgrade existing skills in the respective field; provide orientation to rehabilitation-related mental health services; and to generate interest and to encourage trainees to join these specialized services to meet the growing demand of mental health professionals. For details, please contact the MHI office at 0172-2601738 or mail at mhipsychiatry@gmail.com

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