Innovation summary

India has 4,000 psychiatrists to serve a population of 1.3 billion people. 70% of these psychiatrists are located in urban areas. The aim of SCARF’s mobile tele-psychiatry innovation (STEP) is to provide accessible and affordable mental health care services in Pudukottai – a rural community without access to mental health care – through the integration of mobile clinics and tele-medicine.

STEP is delivered through the following process:

  • Mobile tele-psychiatry service is provided on the STEP bus containing a consultation room and a pharmacy
  • Consultation takes place between a psychiatrist based at the SCARF office in Chennai and the patient in Pudukottai through electronic means on the STEP bus
  • Prescription is dictated by the psychiatrist to the tele-psychiatry clinic facilitator in the bus and filled by the on-board pharmacy; medication is provided free of cost

Impact summary

  • 1500 clients treated for severe disorders
  • Number of severely disabled clients who are certified and will receive benefits increased by 10% (from 0 to 138)
  • Cost of care is $12 USD per capita per month

"My wife and children are working and now that my health has improved, I can come by myself for review and collect medicines."

 

A STEP service user 

 

Innovation details

STEP is primarily engaged in the following:

Creating Mobile Services

  • Designing and custom-building a bus to include:
    • a tele-psychiatry consultation chamber (to ensure privacy)
    • a pharmacy
    • a large flat panel TV for screening awareness films
  • Creating a hub and spoke model for tele-psychiatry:
    • Hub: SCARF office in Chennai from which consultations are provided
    • Spokes: sites in Pudukottai district where wireless 3G broadband is available to enable consultation via video-conferencing
    • Identifying and creating partnerships with local NGOs in the delivery of tele-psychiatry services in the identified program areas

Building Capacity

  • Recruiting and training members from the local community and partner NGOs to:
    • identify and refer patients to the tele–clinics
    • provide psychosocial management
    • conduct family empowerment programs
  • Conducting regular disability certification camps in the program area in association with State Disability Commissioner
  • Empowering and training families and users in the psycho-social illness management, facilitating rehabilitation and reducing disability through the local health worker

Building Awareness

  • Creating public awareness at the community and Individual level about mental health problems to facilitate early identification, referral and utilization of the service

Key drivers

Expansion of Broadband

  • Rapid expansion of wireless broadband internet in rural Tamil Nadu coupled with low-cost technology (laptops and free video-conferencing software) enabled successful implementation of the program

Enthusiasm

  • Availability of local NGOs and their enthusiasm to participate in mental health initiatives in which they had no prior experience

Expertise

  • Availability of mental health expertise at SCARF to provide the psychiatric consultation and the technical support required

Challenges

  • Lack of network connectivity in rural, isolated areas
  • Frequent power failures contributing to delays in service provision
  • Fluctuating bandwidth availability leading to inconsistent video quality

Continuation

While tele-psychiatry is being implemented in several parts of India, mobile tele-psychiatry is yet to be replicated. There are few barriers to its implementation and can easily be scaled up.

Partners

  • District Mental Health Program of Tamil Nadu and State Disability Commissioner
  • Lay health workers
  • Local NGOs
    • Rural Developmental Society
    • Pudukottai
Funder

Evaluation methods

A mid-term evaluation of STEP, commissioned by the Tata Education Trust, was carried out by two consultants.[2] The main purpose of the evaluation was to understand how the program worked and reported on:

  • Strengths
  • Weaknesses
  • Cost-effectiveness
  • Efficiency
  • Replicability
  • Recommendations

Cost of implementation

Capital costs totaled about $25,000 USD for creation of infrastructure, inclusive of:

  • Hub at Chennai
  • Video-conferencing equipment (laptops and HD camera)
  • Custom-built bus

Per capita cost per month is $12 USD, inclusive of:

  • Consultation
  • Medication for a month
  • Home visit by health worker

Other recurring expenditures (internet bills, petrol costs, electricity, staff salaries, etc.)

Impact details

Expanding Access to Care

  • In the first 3 years of the project, 1500 patients have accessed care and have been treated for severe mental disorders in Pudukottai district. About 70% of them have been receiving treatment from the programme for over a year
  • More than 50% of the patients in the program who had never received treatment previously for mental health problems were covered under the program
  • The reach of the services extended well beyond the originally envisioned program area, with 45% of the beneficiaries from outside the program area

Expanding Access to Social Benefits

  • About 10% (138) of the patients who were severely disabled have been certified and will receive disability pension/benefits compared to 0% receiving benefits at the beginning of the program

References

  1. Sujatha R. (2012) Reaching out to the mentally ill. The Hindu.
  2. STEP (2012) Mid-Term Evaluation Report.

Research

Tools

Multimedia

Reports
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