Project Lead(s): Pallab Maulik
Mental health disorders add significantly to the disease burden in India.
Community and professional awareness of mental disorders are low, and India has only a small fraction of the number of mental health professionals needed to deliver care in a manner consistent with that provided in more developed countries.
The project team developed and validated a decision support system for the identification and management of depression, stress and suicidal intent, based on the mhGAP-IG algorithm of the World Health Organization – an approach developed for use by healthcare providers working in non-specialized healthcare settings.
The system was field tested with a sample of non-physician health workers and primary care doctors in 30 rural Andhra Pradesh villages.
Activities undertaken included the following:
· An awareness campaign was undertaken to increase mental health awareness and knowledge, as well as awareness of the project.
· An algorithm-based mobile application was developed for use by Accredited Social Health Activists (ASHAs) and a separate algorithm-based clinical decision support tool was produced for use by primary care doctors.
· An Interactive Voice Response System (IVRS) was developed to motivate health workers and community members to seek care for mental health symptoms.
· ASHAs and doctors received training in screening, diagnosis and management of common mental disorders, using clinical decision support tools. Following this, some ASHAs and doctors were provided with the tablet-based mental health tools and screened community members for depression, suicidal risk and stress.
· Patients screening positive for these conditions were referred to primary care physicians, with the app allowing the ASHA to track the individual once referred and follow up to ensure compliance with treatment.
A 1,500% increase in the use of mental health services was documented in the study population – from 0.84% at the beginning of intervention to 12.61% at the end of the study period.
The awareness program was successfully implemented across all villages and the results show that, over the study period of time, the knowledge, attitude and behaviour of the villagers consistently showed improvement.
Results of the intervention were the subject of one published paper to date, with another having been accepted for publication.
While the quantitative data has been analyzed and is being finalized for submission to a peer-reviewed journal, qualitative data is still being analyzed.
The project team intends to apply for a Transition To Scale grant, and is in the process of identifying and discussing opportunities with other partners to provide some matching funds.
The goal is to conduct a randomized controlled trial (RCT) of the intervention to measure efficacy and to conduct a cost-effectiveness analysis.
The project team has had preliminary discussions with the officials of the Indian Ministry of Health to explore ways in which results of the RCT, if successful, could be scaled up.