MINDS Community Mental Health Worker Program
One of the main problems in scaling up mental healthcare services and reducing the treatment gap is the shortage of skilled human resources.1,2,3,4,5 Naturally, the limited number of mental health care providers must be used as effectively as possible. CMHWs, as members of the community themselves, are able to leverage their social networks to facilitate the exchange of information, are more aware of cultural norms within their community and are able to reach out to vulnerable populations of their community.8 By utilizing CMHWs to detect at-risk individuals and provide basic Mental Health First Aid (MHFA), MINDS is able to improve access to and social impact of an already established referral system.
MHFA includes responding to people experiencing symptoms of mental disorders, referring them to the appropriate professionals within the MINDS system, and supporting the person and his or her family. Overall the program does two things: 1) it introduces more mental healthcare providers to the field, thereby expanding human resources; and 2) it allows for a more effective use of limited human resources through task sharing.1,2
The Role of Mobile Technology
In the field of mobile health, there is evidence suggesting that mobile technology can be effective in a range of delivery settings.3,4,5 Community health workers, dispatched with phones with SMS abilities, have been able to relay information on treatment adherence, appointment reminders and physician queries.6,7 The universal nature of mobile phone coverage and their straightforward functionality has led to expanded research plans based on their integration into global health.8 MINDS is piloting a stepped-care model with an innovative mobile health component, designed to optimize utilization of specialist care for the most at-risk in the community, while improving access to basic services through the CMHW Program.
CMHWs will be equipped with cellphones installed with SMS data collecting software. The CMHWs will use this software to screen the population for people exhibiting risk factors for mental illness. This information will be transferred automatically to a remote server and integrated into a digital map that will place flags indicating where the at-risk are located. Using this map, MINDS social workers and psychiatry team will be able to visit the homes of the at-risk persons, confirm the presence of symptoms, and provide them with the necessary care.
This technology allows CMHWs to quickly screen large populations, and the social workers and psychiatry team to respond swiftly to those most at-risk, establishing an efficient triage system. We envision that in the future, the SMS software will be harnessed to allow CMHWs and other providers to directly communicate, collect data, and follow-up with patients directly from their own phones.
This innovation capitalizes on the expansion of cellphone usage in LMICs like India. The widespread coverage of mobile phones allows us to overcome entry barriers to healthcare and reach more remote populations. Additionally it allows for quicker and cheaper remote screening and monitoring. There are also obvious benefits to research, as routine data is generated which may provide insight into the measurement of the mental healthcare delivery gap and cultural, socio-economic and geographical variations in treatment seeking behavior, etc.