CM15.1-4 | Mental Health — Graded Quiz

Correct. The biopsychosocial model, foundational in community mental health, holds that mental disorders result from interacting biological (genetics, neurobiology), psychological (cognition, affect), and social (poverty, discrimination, social support) factors.

The biopsychosocial model underpins NMHP and the Mental Healthcare Act 2017's focus on rehabilitation and community care, not merely biological treatment.

The biopsychosocial model is the answer. No single cause — biological, psychological, or social — alone explains mental disorders. Their interaction is the key concept.

Correct. Mandatory insurance coverage is not a defined NMHP component (though the Mental Healthcare Act 2017 introduced a right to mental healthcare). NMHP components are: DMHP, modernisation of state mental hospitals, and manpower development.

NMHP has three main components: DMHP, Modernisation of State Mental Hospitals, and Manpower Development. Memorise these; distractors often include policies from other programmes.

NMHP components are DMHP (district delivery), modernisation of state mental hospitals, and manpower development. Mandatory insurance is not one of its defined components.

Correct. DMHP uses the district hospital as hub, with trained staff extending services through the PHC and sub-centre network — a hub-and-spoke model integrating mental health into general health services.

Hub-and-spoke: district hospital (specialist outreach/inpatient) → PHC (trained MO, counsellor) → sub-centre (ASHA recognition and referral). This maximises reach in resource-limited settings.

DMHP operates at the district level with the district hospital as hub. It integrates into the general health system (PHC/sub-centre) rather than relying on specialised facilities alone.

Correct. The two-question screen validated for low-resource primary care settings asks: (1) 'Over the past two weeks, have you felt down, depressed, or hopeless?' and (2) 'Have you had little interest or pleasure in doing things?' — the two cardinal symptoms of depression.

Depressed mood + anhedonia are the two core symptoms of depression. A PHQ-2 positive (either question answered positively over 2 weeks) warrants full PHQ-9 or clinical assessment. This screen can be administered by any health worker.

The two-question screen asks about depressed mood AND anhedonia (loss of interest/pleasure). These are the two core diagnostic symptoms of a depressive episode per ICD/DSM.

Correct. The Mental Healthcare Act 2017 guarantees the right to access mental health care from government services without discrimination, as near to home as possible, in the least restrictive setting. This is a rights-based approach.

Key rights under Mental Healthcare Act 2017: right to treatment (without discrimination, nearest to home), right to confidentiality, right to make advance directives, and right to free legal aid. Section 115 decriminalises attempted suicide.

The Act guarantees access to care without discrimination and closest to home — not unlimited choice of facility. Emergency care can be provided even without consent in specific circumstances.

Correct. The treatment gap is the proportion of people with a diagnosable mental disorder who do not receive appropriate treatment. In India, NMHS 2016 documented this at >70% for most conditions — meaning most people with mental illness receive no treatment.

Treatment gap is a key public health metric. India's high treatment gap (>70%) reflects stigma, limited mental health workforce, poor service integration, and financial barriers. Monitoring and reducing the treatment gap is a NMHP/DMHP objective.

Treatment gap = untreated proportion. In India this exceeds 70-80% for most mental disorders, representing a public health crisis that NMHP/DMHP aims to address.

Correct. Under DMHP, PHC medical officers are trained to diagnose and manage common mental disorders (depression, anxiety, alcohol use disorders, epilepsy — included in mental health package), prescribe first-line medications, and monitor, referring complex/severe cases to the district hospital.

DMHP task-shifting hierarchy: ASHA (detect + refer) → PHC MO (diagnose, prescribe first-line, manage common conditions) → district hospital (complex cases, psychiatrist) → state mental hospital (tertiary). Each level has defined responsibilities.

PHC MOs under DMHP are trained to prescribe first-line medications for common mental disorders, not just refer. This task-shifting is central to the DMHP strategy of extending reach beyond specialist care.

Correct. Suicide rate is an outcome indicator — it reflects the real-world impact of mental health programmes on population health. Options A, B, and D are process/input indicators, not outcome indicators.

Monitoring framework: Input indicators (budget, workforce) → Process indicators (activities, coverage) → Outcome indicators (morbidity, disability, suicide rate). NMHP uses all three, but outcome indicators are the ultimate test of programme effectiveness.

Outcome indicators measure programme impact on health (suicide rate, morbidity, disability). Process indicators measure activities (camps held, workers trained). Budget allocation is an input indicator.