Increasing use of mental health services in remote areas using mobile technology: a pre-post evaluation of the SMART Mental Health project in rural India.
Author(s)
Type
Journal Article
Abstract
BACKGROUND: About 25% of the Indian population experience common mental disorders (CMD) but only 15-25% of them receive any mental health care. Stigma, lack of adequate mental health professionals and mental health services account for this treatment gap, which is worse in rural areas. Our project evaluated task shifting and mobile-technology based electronic decision support systems to enhance the ability of primary care health workers to provide evidence-based mental health care for stress, depression, and suicidal risk in 30 remote villages in the state of Andhra Pradesh, India. METHODS: The Systematic Medical Appraisal Referral and Treatment (SMART) Mental Health project between May 2014 and April 2016 trained lay village health workers (Accredited Social Health Activists - ASHAs) and primary care doctors to screen, diagnose and manage individuals with common mental disorders using an electronic decision support system. An anti-stigma campaign using multi-media approaches was conducted across the villages at the outset of the project. A pre-post evaluation using mixed methods assessed the change in mental health service utilization by screen positive individuals. This paper reports on the quantitative aspects of that evaluation. RESULTS: Training was imparted to 21 ASHAs and 2 primary care doctors. 5007 of 5167 eligible individuals were screened, and 238 were identified as being positive for common mental disorders and referred to the primary care doctors for further management. Out of them, 2 (0.8%) had previously utilized mental health services. During the intervention period, 30 (12.6%) visited the primary care doctor for further diagnosis and treatment, as advised. There was a significant reduction in the depression and anxiety scores between start and end of the intervention among those who had screened positive at the beginning. Stigma and mental health awareness in the broader community improved during the project. CONCLUSIONS: The intervention led to individuals being screened for common mental disorders by village health workers and increase in mental health service use by those referred to the primary care doctor. The model was deemed feasible and acceptable. The effectiveness of the intervention needs to be demonstrated using more robust randomized controlled trials, while addressing the issues identified that will facilitate scale up.
Date Issued
2017-06
Date Acceptance
2017-06-01
Citation
Journal of Global Health, 2017, 7 (1), pp.1-13
ISSN
2047-2978
Publisher
Edinburgh University Global Health Society
Start Page
1
End Page
13
Journal / Book Title
Journal of Global Health
Volume
7
Issue
1
Copyright Statement
© 2017 The Author(s). This an open access article distributed under the terms of the Creative Commons Attribution-NonCommercial-NoDerivs 3.0, which permits redistribution and copy for non-commercial use, provided the original article is not altered, and the author(s) and source is credited. http://creativecommons.org/licenses/by-nc-nd/3.0/
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/28400954
PII: jogh-07-010408
Subjects
Adult
Anxiety
Awareness
Community Health Workers
Depression
Female
Humans
India
Male
Mass Screening
Mental Disorders
Mental Health Services
Middle Aged
Mobile Applications
Outcome Assessment, Health Care
Primary Health Care
Referral and Consultation
Rural Population
Social Stigma
Publication Status
Published
Coverage Spatial
Scotland
Date Publish Online
2017-06-01