Innovation summary

The global burden of mental disorders and treatment gap is especially large in countries like India likely due to lack of awareness about mental health and few available resources for providing care.1-3 A potential strategy to narrow this gap is by enabling the available primary-care workforce through provision of affordable, accessible and high-quality electronic clinical decision support. The goal of this innovation is to develop and evaluate the feasibility, acceptability and preliminary effectiveness of a multifaceted primary healthcare worker intervention utilising a mobile device based electronic decision support system to improve the identification and management of common mental disorders (CMD).

The study involves two key phases: the development of an intervention to enable suitably trained Accredited Social Health Activists (ASHAs) and primary-care doctors to screen, identify and manage CMD in the community, and the implementation of a pilot to evaluate this intervention utilising quantitative and qualitative methods. 

Impact summary

  • 20% relative increase in the number of people who access mental health services is anticipated following the intervention

“If successful, this will be an innovative way to provide affordable basic mental health care to disadvantaged populations"

 

-Pallab Kumar Maulik, PI of SMART Mental Health

Innovation details

After developing the intervention, it will be piloted across two sites involving 32 villages in the West Godavari districts of Andhra Pradesh. The intervention will involve training ASHAs to use a mobile based screening tool and primary-care doctors to use a mobile based clinical decision support tool based on WHO’s mhGAP-IG algorithm4, to identify and manage CMD in the community.

In addition, there will be a mobile based follow-up system between the ASHAs and doctors to ensure regular follow-up and treatment adherence for those needing mental health care.

The tools will undergo prior testing and validation prior to implementing in the field.

The Grand Challenges Canada funded study will be conducted over 18 months during 2014-2015. The Welcome Trust/Department of Biotechnology funded study will be for five years from 2014 to 2019.

Key drivers

Development of the Applications

Development of the appropriate applications, within the timeframe, is essential to maintain the timelines. Since these applications also needed to be tested prior to taking to the field, it is essential that they are developed well and integrated within the whole system

Successful Implementation of an Anti-Stigma Campaign

Since stigma is a major issue in mental health, having a mental health awareness campaign and a framework to address stigma against mental health in the community is essential to a more successful project.

Involvement of the Local Community and Health System 

Getting the local community and health system involved in developing the innovation is essential to get local buy in and to ensure greater acceptability 

Challenges

Some anticipated challenges are:

Connectivity Issues

Since this will be a mobile platform based project, consistent power connectivity will be needed to charge the phones. This may be a challenge in rural areas.

Anti-Stigma Campaign – Engaging with the Community

Ability to engage with the community and conduct the anti-stigma campaign is a major challenge

Engaged Local PHC Doctor

Ability to get the local PHC doctor engaged enough to provide mental health care

Adequate Supply of Anti-Depressants in PHC

Secure adequate supply of anti-depressants in the PHCs and ensure that the supply chain is maintained

Continuation

Following successful completion of this grant, the team plans to use the results of the pilot study to develop a cRCT and then scale up to other parts of the state and possibly to other parts of the country. 

Partners

Implementing Partners:

Funders:

Evaluation methods

A mixed methods approach will be used to evaluate the key outcomes of the study and processes involved. The pre and post evaluation of the intervention would involve a set of questions with the main objective to ascertain change in mental health services use amongst those who screen positive. Focus Group Discussions and in-depth interviews will be conducted to discuss different process indicators and understand barriers/enablers in the project.

Impact details

SMART Mental Health will estimate of the proportion of people suffering from CMD out of the total covered population (approximately 50,000 people). In addition, the team predicts a change in mental health awareness and attitude towards mental health following the anti-stigma campaign covering ~5,000 villagers.

References

  1. World Health Organization (2001). The World Health Report 2001- Mental Health: New Understanding, New Hope. WHO: Geneva, Switzerland.
  2. Gururaj G, Girish N, Issac MK. (2005). Mental, Neurological and Substance abuse disorders: Strategies towards a systems approach. In: Burden of Disease in India; Equitable development - Healthy future. National Commission on Macroeconomics and Health. Ministry of Health and Family Welfare, Government of India: New Delhi, India.
  3. World Health Organization. (2011) Mental Health Atlas 2011. WHO: Geneva, Switzerland.
  4. World Health Organization. (2011) WHO Mental Health Gap Action Programme (mhGAP). WHO: Geneva, Switzerland.

Research

Multimedia

Associates

Pallab Maulik Principal Investigator

Comments

Submitted by Joshua Thaisen on Friday, 28th July 2017
Hi Pallub, I'm wondering if you have had enough time to observe the impact of this program? I've worked with ASHAs in Southern India focused on primary/maternal/neonatal healthcare , however I wasn't able to observe their referral and diagnostic capacity regarding mental health.. would be interested to talk with you.. my e-mail is joshuathaisen@gmail.com
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