44 affected family members (AFMs) were referred to the programme [33 (75%) by gatekeepers and 11 (25%) self referred].
We were able to approach 36 (81.8%) AFM for assessment of eligibility, and completed eligibility assessment of 25 (69.4%) AFMs.
Of these, 22 (88%) AFMs were eligible for inclusion in the case series. 21 (95.5%) consented to receive the intervention and 18 entered treatment. 16 (88.8%) completed the treatment (all five sessions).
We completed outcome assessments in 17 (80.9%) of the 21 who consented to receive the intervention.
These numbers indicate that it is possible to identify AFMs through gatekeeper/self referral, and recruit most of them through a systematic process of eligibility assessment. The low refusal of participation (4.5%) and reasonable treatment completion rate indicate the good acceptability of the intervention.
Some of the areas in which the innovation is expected to influence the mental health scenario is:
The SAFE project places priority on the needs of AFMs. Some of the positive outcomes arising from this include capacity building of lay health workers, increased case detection, better delivery of and/or referral for mental health care, improved service provision, and better help-seeking behaviors of AFMs. The systematic methodology to adapt the 5-Step Method will result in a contextually appropriate intervention manual to be utilized for capacity-building efforts. On an individual level, if the project has a similar impact in India to that in high-income countries, a large majority of AFMs that receive the intervention will show significantly improved symptom levels and coping strategies. By changing the ways that AFMs act towards their addicted relatives, we also anticipate that the behavior of some of these relatives will also improve.
Societal and economic impact
The project is expected to produce socioeconomic impact at a broader level due to the improved health of individuals and families, including better wellbeing, functioning and productivity, and a higher likelihood of contributing to the economic wellbeing of society. Cost-savings will also be made to patients, employers, and society. From a health systems perspective, the task-sharing approach is cost-effective by integrating a minimally trained workforce (at a low cost) into primary care.
Impact on policy and funding
The current national mental health policy is envisaged to inform efforts to bridge the huge treatment gap for mental disorders through programmes that are yet to be successfully implemented. The project meets a number of priorities stated in the policy, including universal access to mental health services, support for family members, adequate training of human resources, use of non-specialist health workers to increase access to treatment, and quality research to inform mental health services.