title: The development of mental health services within primary care in India: learning from oral history.
abstract: 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.
  
  
  OBJECTIVE
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, and Sangath, LSHTM, Keppel Street, London WC1E7HT, UK ; Sangath, Porvorim, Goa, India.
authors.forename: Nadja
authors.initials: N
authors.lastname: van Ginneken
authors.affiliation: National Institute for Mental Health and NeuroSciences, Bangalore, India.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Jain
authors.affiliation: Centre for Global Mental Health, London School of Hygiene and Tropical Medicine, and Sangath, LSHTM, Keppel Street, London WC1E7HT, UK ; Sangath, Porvorim, Goa, India.
authors.forename: Vikram
authors.initials: V
authors.lastname: Patel
authors.affiliation: Centre for History in Public Health, London School of Hygiene and Tropical Medicine, London, UK.
authors.forename: Virginia
authors.initials: V
authors.lastname: Berridge
keywords: Developing countries; Health planning; Health policy; Health workers; History; India; Mental health; Primary health care
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