CM15.1-4 | Mental Health — Practice Quiz

Correct. The WHO definition emphasises positive functioning — not merely the absence of illness. Mental health is a state of well-being encompassing realisation of potential, coping with stress, productive work, and community contribution.

Mental health is not the mere absence of mental disorder — it is a positive state. This distinction is fundamental to community medicine, where promotion and prevention (not just treatment) are the primary objectives.

The WHO definition is broader than the absence of disease. It is a positive construct: well-being, potential realisation, productive functioning, and community contribution. Review the WHO 2001 definition of mental health.

Correct. NMHP was launched in 1982, making India one of the first low- and middle-income countries to establish a national mental health programme.

NMHP 1982 → DMHP integrated 1996 → Mental Healthcare Act 2017. Knowing this timeline helps place policy context in community medicine questions.

NMHP was launched in 1982. The District Mental Health Programme (DMHP) was integrated into NMHP later in 1996. Do not confuse the two dates.

Correct. DMHP's core strategy is integration of mental health into general health services at district level, with training of general health workers (doctors, nurses, paramedics) to detect and manage common mental disorders at the primary care level.

The DMHP model: district hospital as hub, primary health centres and sub-centres as spokes, trained general health workers as providers. Integration reduces stigma and extends reach cost-effectively.

DMHP's strategy is horizontal integration into existing general health services, NOT vertical specialist care. This avoids the 'mental hospital' model and reduces stigma.

Correct. Social withdrawal, self-neglect, and disorganised speech over 3 months are classical warning signals warranting referral. Sub-centre staff should not delay — early referral to PHC is the appropriate response.

Warning signals (changed sleep, social withdrawal, neglect of responsibilities, speech changes, mood extremes) are the recognition tools at the community level. Sub-centre health workers are the first responders — they detect and refer; they do not diagnose.

Social withdrawal, personal neglect, and incoherent speech are key warning signals that should trigger prompt referral under the DMHP pathway, not delayed observation or self-referral to a mental hospital.

Correct. Both are true and causally linked. The social determinants model (Marmot) shows chronic poverty creates chronic stress, depletes coping resources, increases allostatic load, and raises risk for depression, anxiety, and psychosis.

Social determinants of mental health operate through the allostatic load pathway: chronic adversity → sustained stress hormone activation → neurobiological changes → increased vulnerability. Upstream interventions (poverty reduction, education) are therefore genuine mental health interventions.

The assertion is factually supported by NMHS 2016 data and global evidence. The reason accurately explains the biological and psychological mechanism through which social disadvantage causes mental illness.

Correct. Section 115 of the Mental Healthcare Act 2017 decriminalised attempted suicide by presuming that a person who attempts suicide is under severe stress, and shall not be tried under Section 309 IPC. This is a landmark public health intervention.

Before 2017, attempted suicide was a criminal offence under Section 309 IPC in India. Section 115 of the Mental Healthcare Act 2017 reversed this, replacing punishment with a duty of care. This has major implications for suicidal behaviour management in primary care.

Section 115 specifically addresses attempted suicide. It creates a legal presumption of severe stress and mandates that the state provide care and rehabilitation, removing criminal liability under Section 309 IPC.

Correct. NMHS 2016 found that approximately 1 in 7 Indians (~197.3 million) was affected by a mental disorder, with a treatment gap exceeding 70-80% for most conditions — meaning most affected individuals receive no treatment.

Key NMHS 2016 figures: ~197 million affected (~1 in 7), depression and anxiety commonest, treatment gap >70%, rural burden significant (not negligible). These are the epidemiological numbers you are expected to know for community medicine.

NMHS 2016 showed a higher burden than 1 in 20. The correct figure is approximately 1 in 7, with a massive treatment gap. Severe disorders are a minority; common mental disorders (depression, anxiety) dominate.

Correct. This woman presents warning signals of depression (low mood, anhedonia, sleep disturbance for 6 weeks) plus a suicidal statement. Immediate referral under DMHP is required — the ASHA should not delay or attempt pharmacological management.

A 6-week history with functional impairment and a statement about having no reason to live is an emergency referral trigger. Reassurance or delay is inappropriate; self-medication by an ASHA is outside her role.

Correct. The treatment gap in India (>70% per NMHS 2016) is multifactorial: stigma deters help-seeking, limited mental health literacy means symptoms are not recognised, trained health workers are scarce, and financial costs (indirect: travel, lost wages) deter attendance. All four factors apply in periurban slums.

The treatment gap is not due to lower biological prevalence or stronger social support. It reflects a system problem: stigma + literacy + workforce + financial barriers.