district mental health program ( dmhp ) is an approach to decentralize mental health - care in the community using the existing public health infrastructure and additional resources . this model has been pilot tested in bellary district of karnataka state and found to be useful in addressing the basic mental health needs of the population . later on , this model was developed as a program , which was thought fit to be applied to the whole of india . in most districts where the program is in operation , a team of the dmhp , consisting of a psychiatrist , psychologist , social worker , and nurse visits designated peripheral health centers . there are no special services for special populations such as women , children , elderly , and those with substance misuse , though persons with such problems could also be approaching these clinics . being a decentralized program , dmhp may be more accessible to older people with mental health problems and their families . is this presumption true ? if older people tend to access dmhp more than the traditional service , then there is a strong case to suitably modify dmhp to meet the mental health needs of the rapidly growing number of older people in our country . this would then open up an avenue for scaling up geriatric mental health services across the country . this study aims to examine whether there is an increased attendance of elderly persons at dmhp clinics , compared to a traditional tertiary care facility ( psychiatry out - patient department of a government medical college hospital ( mch ) ) by examining records available at these two setting . the out - patient records maintained by the department of psychiatry at a government mch , and the office of the dmhp at the nearby district and run by the same department were analyzed to find out the number and socio demographic details of out - patients seen at these two facilities during a period of 1 year . all subjects who attended the out - patient services during the study at these two facilities period were identified from the records . patients 60 years and older formed the geriatric group and the others formed the second group . the sample from these two centers were compared to see if there was any significant difference in the proportion of older people seen at these two care facilities . we also made sex - wise comparison of the older patients from both the settings to see if there was any difference between these two in terms of the proportion of women getting care . the data in table 1 shows that elderly account for only 9.5% of out - patient attendance at the mch while they account for 16.5% in the clinics of dmhp . comparison of patients attending a mch and community outreach clinics of dmhp ( 1 may 2007 and 30 april 2008 ) proportion of women in the geriatric age group seen at the dmhp clinics were more , compared to the sample from the mch . older people seeking care at mch and community outreach clinics of dmhp ( 1 may 2007 and 30 april 2008 ) our results show that a significant proportion of people who receive mental health - care through the community outreach clinics of dmhp are people above the age of 60 years . the proportion of older people among the users was dmhp clinics is 16.5% , whereas the proportion of people above the age of 60 years in the general population in the state of study is less than 11% . it is no big surprise to note that the decentralized services provided by the dmhp are more accessible to older people . this implies that the provision of care through community outreach clinics by the dmhp is a step in the right direction . however , the services currently provided through the dmhp are generic , and not tailored to meet special needs of the elderly . while planning decentralized programs , planners should understand that its users are likely to include special populations and provide additional services . there are no government funded specialized services for elderly in india and the outreach services generally do not include health - care for older people as part of their work . we need to ensure that the services provided do meet the needs of older people who seek help . for example , an attempt will have to be made to cater to the special needs of people with medical illness and depression . people with disabling conditions like dementia and their caregivers may need to be provided specialized care and support . dmhp should take up the task of supporting and guiding community based initiatives as well as other out reach services . primary care as well as outreach services can play a crucial role in scaling up services for older people with mental health needs . we need to develop a strategy to link the community clinics of the dmhp with primary care and outreach services . primary care need to receive continuous support and guidance from the mental health expertise available with the dmhp . they may be able to identify older individuals with unmet mental health needs and bring them to the notice of the services . once this is possible , clinicians will be in a better position to identify and manage common mental health problems of late life such as depression and dementia . they can play a huge role in providing information and education to the caregivers and could be entrusted to deliver simple caregiver interventions . support to home based care is particularly important in conditions such as dementia and various other disabling conditions affecting older people . dmhp should reorient itself by deciding to focus on the special needs of the older people . this need will become more evident in the future as we anticipate gradual increase in the number of older people in the population . it is time that we reevaluate the potential for dmhp to provide better mental health - care for older people . this will help to scale up the services for older people with mental health needs in india . we need to convince the governments and policy makers to make such changes in the dmhp .
background : district mental health program ( dmhp ) is the flagship program of government of india to deliver mental health - care throughout the country . 
 being an out - reach program , it is likely that elderly people with mental health programs are accessing it more frequently . 
 if this is the case , there is potential for including additional components in this program so that something more than the generic service is offered to them.aim:this study aims to find out whether the elderly are accessing the dmhp services frequently.materials and methods : we compared the proportion of elderly people attending two mental health - care facilities : - a government medical college out - patient department and the clinics run by the dmhp of the same department.results:a significantly higher number of elderly people are attending the clinics of the dmhp compared to the outpatient service of a teaching hospital.conclusion and implication : it is concluded that dmhp can be further strengthened by adding additional components like service for the elderly . 
 this is important in view of the increasing number of older people who may need these services in future .