Innovation summary

In a context of poor access to specialist mental health care, the proliferation of mobile phones provides an opportunity to optimize mental health outreach and care using a familiar technology. MINDS Foundation has established a Community Mental Health Worker (CMHW) program to address shortages of specialist staff by training lay persons to screen the community for mental disorders and provide basic mental health first aid (MHFA). This model will be supported by a cloud-based mental health platform designed to connect rural populations with specialist care.

CMHWs will use cell phones equipped with SMS data collection software to screen the population. This information will be automatically integrated into a digital map, allowing MINDS social workers and psychiatry team to visit the homes of at-risk persons, confirm symptoms, and provide necessary care. The goal is to establish an efficient system which allows the limited specialist staff to focus on those most at-risk.

Impact summary

  • Screening to be rolled out to 29 villages in 2014-2015
  • Target to screen 60% of people in these villages by May 2015
  • Cost of implementation approximately $20,000 USD

Innovation details

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.

Key drivers

At this early pilot stage, key drivers appear to be:

  • Involvement of the local partners:  All the stakeholders have been actively involved since the inception of the project. This process has received input from all who will be affected: our health services delivery partner Sumandeep Vidyapeeth University, the local community including the chosen health workers, the school teachers, Sarpanch and local leaders.
  • Resources: Monetary support from IMF has helped in furthering the success of the project. The Globe Med group at University of Washington has also raised money for this project and sent four students to India to further assist in implementation of the project.

Challenges

At this early pilot stage, the main challenge anticipated is a lack of understanding of the project goals amongst community members. There is a potential for fear, suspicion and lack of engagement within the community with respect to the screening pilot.

Strategies to mitigate these risks will include extensive community outreach and engagement from the initial stages of the pilot continually throughout the pilot duration. CMHWs have also undergone training to effectively engage the community members and educate them about the goals of the pilot. Additionally, MINDS existing educational workshops will help reinforce the education and screening process in communities.

Continuation

The goal of our innovation is to make scaling and implementation of mental health care services easier. Our aim is to receive information from various “referral points” (e.g. CMHWs and social workers) and manage the data collected through a central server which pushes all the relevant information (e.g. location longitudes and latitudes, total population, number of patients screened, etc.) to the maps and on-the-ground clinicians. These maps will enable providers to use their time productively to reach the at-risk populations. This will save trips by social workers looking for at-risk people. We believe that the combination of health workers with mobile technology will help us save money and resources. We aim to incorporate more points of entry into the system, such as school teachers.  

Partners

Evaluation methods

The program is still in pilot stage, however all stakeholders from the MINDS foundation and Medic mobile will participate in a mixed-methods evaluation process to gather evidence on pre-selected indicators, with the goal of evaluating the process, outcomes and impact, including key inputs and outputs. 

Cost of implementation

In absence of this system, there would be an approximate spending of $40,000 USD to reach the community with the help of social workers. However, with this innovation it would be far more cost- effective. The innovation cost around $20,000 USD to put in place, which is a half the amount spent now. Utilizing CMHWs in coordination with a mapping system and mobile technology would allow us to hire fewer salaried employees, as, for example, one social worker would be able to monitor a cluster of villages using this technology. 

Impact details

The program is still in pilot stage. We have a formal target goal for implementing this project. Members of the Board of Directors have requested that we screen 60 % of the people of our current 19 villages by January 2015 and newer ten villages by May 2015.

References

  1. Spaniel F. Vohlídka P, Hrdlicka J, Kozený J, Novák T, Motlová L, Cermák J, Bednarík J, Novák D, Höschl C. 2008. ITAREPS: information technology aided relapse prevention programme in schizophrenia. Schizophrenia Research, 98(1-3), 312 – 317.
  2. Depp CA, Mausbach B, Granholm E, Cardenas V, Ben-Zeev D, Patterson TL, Lebowtiz BD, Jeste DV. 2010. Mobile interventions for severe mental illness: design and preliminary data from three approaches. Journal of Nervous Mental Disease, 198(10), 715 – 721.
  3. Harrison V, Proudfoot J, Wee PP, Parker G, Pavolvic DH, Manicavasagar V. 2011. Mobile mental health: review of the emerging field and proof of concept study. Journal of Mental Health, 20(6), 509 – 524.
  4. Gaggioli A, Pioggia G, Tartarisco G, Baldus G, Corda D, Cipresso P, Riva G. 2013. A mobile data collection platform for mental health research. Personal and Ubiquitous Computing.
  5. Proudfoot J. 2013. The future is in our hands: the role of mobile phones in the prevention and management of mental disorders. Australian & New Zealand Journal of Psychiatry, 47, 111 – 113.
  6. Mahmud N, Rodriguez J, Nesbit J. 2010. A text message-based intervention to bridge the healthcare communication gap in the rural developing world. Technological Heath Care, 18(2), 137 – 144.
  7. Aggarwal NK. 2012. Applying mobile technologies to mental health service delivery in South Asia. Asian Journal of Psychiatry, 5(3): 225 – 230. 
  8. Collins PY. 2011. The Executive Committee of the Grand Challenges on Global Mental Health. Grand challenges in global mental health. Nature, 475(7354), 27 – 30.

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Associates

Raghu Appasani

Comments

Submitted by Prabhat Chand on Sunday, 11th October 2015
Virtual Learning Centre, National Institute of Mental Health and Neurosciences (NIMHANS) provide online multipoint video-conference based training and clinical skill building in the are of "addiction" or "Substance Use Disorders" mental health. Virtual Learning Centre, NIMHANS ECHO, a collaboration of NIMHANS with Project ECHO, UNM, US has initiated a weekly LIVE online interactive skill based session. The objective of the NIMHANS ECHO is to transfer the skill, wisdom and knowledge in the area of addiction mental health to the health professionals. The heart of this NIMHANS ECHO model is its hub-and-spoke knowledge-sharing networks, led by expert teams who use multi-point videoconferencing to conduct virtual sessions (case based discussion with expert didactics) with community health care providers (doctors and other health care professionals). In this weekly training, the aim is to develop a learning loop and a knowledge-sharing network which will create in-depth knowledge, skills and self-efficacy among health care practitioners. I am very sure this can be helpful for your team in both promotion and intervention. Recently we have initiated in the area of "Perinatal mental health" and "Severe mental disorders" . I am sure your team can utilize this online skill building platform. website : vlc.nimhans.ac.in
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