Improving access to mental health services in remote areas

Pallab - Doctor seeing patient-Optimized
The percentage of people who sought mental health care shot up from 0.8% at the beginning of the intervention to 12.6% at the end of the three-month intervention period.

While about 10% of the population in India suffers from common mental disorders, only about 15-25% of this receives mental health care. But a small-scale study carried out on approximately 5,000 people living in 30 tribal villages in West Godavari district of Andhra Pradesh was able to improve the practice of seeking out mental health care significantly.

The intervention was carried out for three months from November 2015 to January 2016 by involving 21 ASHA (Accredited Social Health Activists) workers and two primary health care (PHC) doctors who were trained for about 10 days. A mobile technology-based mental health service delivery model was used by ASHA workers and doctors for screening, diagnosing and treating people with common mental disorders such as depression, anxiety, suicide risk and stress.

Increased uptake

Of the nearly 5,000 people who were screened, 238 were identified as being positive for common mental disorders and were referred to primary care doctors for treatment. Thirty of the 238 people visited a primary care doctor for further diagnosis and treatment. The percentage of people who sought mental health care shot up from 0.8% at the beginning of the intervention to 12.6% at the end of the three-month intervention period. The results were published in the Journal of Global Health.

Pallab-Optimized
Dr. Pallab Maulik. – Photo: R. Prasad

“This is a significant increase in the number of people who accessed a doctor for mental disorder,” says Dr. Pallab K. Maulik from Delhi’s The George Institute for Global Health and the first author of the paper. “There was significant reduction in the depression and anxiety scores between the start and end of the intervention in those who were screened positive.” Dr. Maulik is an Intermediate Fellow of the Wellcome Trust DBT India Alliance and this paper was part of the fellowship work.

Considering that there were not sufficient mental health professionals to treat all patients across the country, the study has been successful in training ASHA workers and PHC doctors to provide basic mental health care that included screening and providing treatment.

Prior to intervention, an anti-stigma campaign was carried out for three months. The campaign improved the awareness level and changed the attitude and behaviour related to mental health.

“Our study showed that it is feasible to carry out an intervention of this kind, and acceptability was high among the people, especially since we carried out an anti-stigma campaign,” says Dr. Maulik.

Larger study

Following the proof-of-concept study carried out in the 30 villages, Dr. Maulik and his team members are carrying out a larger pilot study in West Godavari district of Andhra Pradesh involving around 40,000 people living in 12 non-tribal villages. While the other protocols such as training of ASHA workers and doctors and anti-stigma campaign are essentially the same, the intervention was carried out for one year, much longer than the intervention in the smaller study, which was only for three months.

The primary outcome of the study is to evaluate the use of mental health services by people with depression, anxiety, stress and suicide risk. “The uptake of mental health services by the affected people was more than the smaller study and very encouraging,” says Dr. Maulik. The results of the study are being evaluated and are yet to be published.

Published in The Hindu on June 3, 2017

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