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Systematic Medical Appraisal, Referral and Treatment (SMART) Mental Health Programme for providing innovative mental health care in rural communities in India

  • P. K. Maulik (a1) (a2), S. Devarapalli (a3), S. Kallakuri (a3), D. Praveen (a3), V. Jha (a4) (a2) and A. Patel (a5)...
Abstract
Background.

India has few mental health professionals to treat the large number of people suffering from mental disorders. Rural areas are particularly disadvantaged due to lack of trained health workers. Ways to improve care could be by training village health workers in basic mental health care, and by using innovative methods of service delivery. The ongoing Systematic Medical Appraisal, Referral and Treatment Mental Health Programme will assess the acceptability, feasibility and preliminary effectiveness of a task-shifting mobile-based intervention using mixed methods, in rural Andhra Pradesh, India.

Method.

The key components of the study are an anti-stigma campaign followed by a mobile-based mental health services intervention. The study will be done across two sites in rural areas, with intervention periods of 1 year and 3 months, respectively. The programme uses a mobile-based clinical decision support tool to be used by non-physician health workers and primary care physicians to screen, diagnose and manage individuals suffering from depression, suicidal risk and emotional stress. The key aim of the study will be to assess any changes in mental health services use among those screened positive following the intervention. A number of other outcomes will also be assessed using mixed methods, specifically focussed on reduction of stigma, increase in mental health awareness and other process indicators.

Conclusions.

This project addresses a number of objectives as outlined in the Mental Health Action Plan of World Health Organization and India's National Mental Health Programme and Policy. If successful, the next phase will involve design and conduct of a cluster randomised controlled trial.

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Copyright
This is an Open Access article, distributed under the terms of the Creative Commons Attribution licence (http://creativecommons.org/licenses/by/3.0/), which permits unrestricted re-use, distribution, and reproduction in any medium, provided the original work is properly cited.
Corresponding author
* Address for correspondence: P. K. Maulik, Research & Development, George Institute for Global Health, 219-221 Splendor Forum, Jasola District Centre, New Delhi 110025, India. (Email: pmaulik@georgeinstitute.org.in)
References
Hide All
Armstrong G, Kermode M, Raja S, Suja S, Chandra P, Jorm AF (2011). A mental health training program for community health workers in India: impact on knowledge and attitudes. International Journal of Mental Health Systems 5, 17.
Cellular Operators Association of India (2014). http://www.coai.com/Statistics/Telecom-Statistics/National (Accessed 2 September 2014).
Clement S, Schauman O, Graham T, Maggioni F, Evans-Lacko S, Bezborodovs N, Morgan C, Rüsch N, Brown JS, Thornicroft G (2014). What is the impact of mental health-related stigma on help-seeking? A systematic review of quantitative and qualitative studies. Psychological Medicine 26, 117.
Eaton J, McCay L, Semrau M, Chatterjee S, Baingana F, Araya R, Ntulo C, Thornicroft G, Saxena S (2011). Scale up of services for mental health in low-income and middle-income countries. Lancet 378, 15921603.
Free C, Phillips G, Watson L, Galli L, Felix L, Edwards P, Patel V, Haines A (2013). The effectiveness of mobile-health technologies to improve health care service delivery processes: a systematic review and meta-analysis. PLoS Medicine 10, e1001363.
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, 226250.
Institute of Psychiatry, King's College London (2011). Barriers to Access to Care Evaluation – Treatment Stigma Subscale (BACE-TS Version 3). Institute of Psychiatry, King's College: London.
Joshi R, Alim M, Kengne AP, Jan S, Maulik PK, Peiris D, Patel AA (2014). Task shifting for non-communicable disease management in low and middle income countries – a systematic review. PLoS ONE 9, e103754.
Kakuma R, Minas H, van Ginneken N, Dal Poz MR, Desiraju K, Morris JE, Saxena S, Scheffler RM (2011). Human resources for mental health care: current situation and strategies for action. Lancet 378, 16541663.
Kawamoto K, Houlihan CA, Balas EA, Lobach DF (2005). Improving clinical practice using clinical decision support systems: a systematic review of trials to identify features critical to success. British Medical Journal 330, 765.
Kermode M, Bowen K, Arole S, Pathare S, Jorm AF (2009). Attitudes to people with mental disorders: a mental health literacy survey in a rural area of Maharashtra, India. Social Psychiatry and Psychiatric Epidemiology 44, 10871096.
Kochhar PH, Rajadhayksha SS, Suvarna VR (2007). Translation and validation brief patient health questionnaire against DSM IV as a tool to diagnose major depressive disorder in Indian patients. Journal of Postgraduate Medicine 53, 102107.
Koschorke M, Padmavati R, Kumar S, Cohen A, Weiss HA, Chatterjee S, Pereira J, Naik S, John S, Dabholkar H, Balaji M, Chavan A, Varghese M, Thara R, Thornicroft G, Patel V (2014). Experiences of stigma and discrimination of people with schizophrenia in India. Social Science and Medicine 123, 149159.
Kroenke K, Spitzer RL (2002). PHQ-9: a new depression diagnostic and severity measure. Psychiatric Annals 32, 17.
Lund C, Tomlinson M, De Silva M, Fekadu A, Shidhaye R, Jordans M, Petersen I, Bhana A, Kigozi F, Prince M, Thornicroft G, Hanlon C, Kakuma R, McDaid D, Saxena S, Chisholm D, Raja S, Kippen-Wood S, Honikman S, Fairall L, Patel V (2012). PRIME: a programme to reduce the treatment gap for mental disorders in five low- and middle-income countries. PLoS Medicine 9, e1001359.
Maulik PK, Daniels A, McBain R, Morris J (2013). Global mental health resources. In Global Mental Health: Principles and Practice (ed. Patel V., Minas H., Cohen A. and Prince M. J.). Oxford University Press: New York, NY, 167192.
Ministry of Health and Family Welfare, Government of India (1982). National Mental Health Programme. Available: http://mohfw.nic.in/WriteReadData/l892s/9903463892NMHP%20detail.pdf (Accessed 15 October 2014).
Ministry of Health and Family Welfare, Government of India (2014). National Mental Health Policy. Available: http://mohfw.gov.in/index1.php?lang=1&level=2&sublinkid=4523&lid=2964 (Accessed 15 October 2014).
Murray CJ, Vos T, Lozano R, Naghavi M, Flaxman AD, Michaud C, Ezzati M, Shibuya K, Salomon JA, Abdalla S, Aboyans V, Abraham J, Ackerman I, Aggarwal R, Ahn SY, Ali MK, Alvarado M, Anderson HR, Anderson LM, Andrews KG, Atkinson C, Baddour LM, Bahalim AN, Barker-Collo S, Barrero LH, Bartels DH, Basáñez MG, Baxter A, Bell ML, Benjamin EJ, Bennett D, Bernabé E, Bhalla K, Bhandari B, Bikbov B, Bin Abdulhak A, Birbeck G, Black JA, Blencowe H, Blore JD, Blyth F, Bolliger I, Bonaventure A, Boufous S, Bourne R, Boussinesq M, Braithwaite T, Brayne C, Bridgett L, Brooker S, Brooks P, Brugha TS, Bryan-Hancock C, Bucello C, Buchbinder R, Buckle G, Budke CM, Burch M, Burney P, Burstein R, Calabria B, Campbell B, Canter CE, Carabin H, Carapetis J, Carmona L, Cella C, Charlson F, Chen H, Cheng AT, Chou D, Chugh SS, Coffeng LE, Colan SD, Colquhoun S, Colson KE, Condon J, Connor MD, Cooper LT, Corriere M, Cortinovis M, de Vaccaro KC, Couser W, Cowie BC, Criqui MH, Cross M, Dabhadkar KC, Dahiya M, Dahodwala N, Damsere-Derry J, Danaei G, Davis A, De Leo D, Degenhardt L, Dellavalle R, Delossantos A, Denenberg J, Derrett S, Des Jarlais DC, Dharmaratne SD, Dherani M, Diaz-Torne C, Dolk H, Dorsey ER, Driscoll T, Duber H, Ebel B, Edmond K, Elbaz A, Ali SE, Erskine H, Erwin PJ, Espindola P, Ewoigbokhan SE, Farzadfar F, Feigin V, Felson DT, Ferrari A, Ferri CP, Fèvre EM, Finucane MM, Flaxman S, Flood L, Foreman K, Forouzanfar MH, Fowkes FG, Fransen M, Freeman MK, Gabbe BJ, Gabriel SE, Gakidou E, Ganatra HA, Garcia B, Gaspari F, Gillum RF, Gmel G, Gonzalez-Medina D, Gosselin R, Grainger R, Grant B, Groeger J, Guillemin F, Gunnell D, Gupta R, Haagsma J, Hagan H, Halasa YA, Hall W, Haring D, Haro JM, Harrison JE, Havmoeller R, Hay RJ, Higashi H, Hill C, Hoen B, Hoffman H, Hotez PJ, Hoy D, Huang JJ, Ibeanusi SE, Jacobsen KH, James SL, Jarvis D, Jasrasaria R, Jayaraman S, Johns N, Jonas JB, Karthikeyan G, Kassebaum N, Kawakami N, Keren A, Khoo JP, King CH, Knowlton LM, Kobusingye O, Koranteng A, Krishnamurthi R, Laden F, Lalloo R, Laslett LL, Lathlean T, Leasher JL, Lee YY, Leigh J, Levinson D, Lim SS, Limb E, Lin JK, Lipnick M, Lipshultz SE, Liu W, Loane M, Ohno SL, Lyons R, Mabweijano J, MacIntyre MF, Malekzadeh R, Mallinger L, Manivannan S, Marcenes W, March L, Margolis DJ, Marks GB, Marks R, Matsumori A, Matzopoulos R, Mayosi BM, McAnulty JH, McDermott MM, McGill N, McGrath J, Medina-Mora ME, Meltzer M, Mensah GA, Merriman TR, Meyer AC, Miglioli V, Miller M, Miller TR, Mitchell PB, Mock C, Mocumbi AO, Moffitt TE, Mokdad AA, Monasta L, Montico M, Moradi-Lakeh M, Moran A, Morawska L, Mori R, Murdoch ME, Mwaniki MK, Naidoo K, Nair MN, Naldi L, Narayan KM, Nelson PK, Nelson RG, Nevitt MC, Newton CR, Nolte S, Norman P, Norman R, O'Donnell M, O'Hanlon S, Olives C, Omer SB, Ortblad K, Osborne R, Ozgediz D, Page A, Pahari B, Pandian JD, Rivero AP, Patten SB, Pearce N, Padilla RP, Perez-Ruiz F, Perico N, Pesudovs K, Phillips D, Phillips MR, Pierce K, Pion S, Polanczyk GV, Polinder S, Pope CA 3rd, Popova S, Porrini E, Pourmalek F, Prince M, Pullan RL, Ramaiah KD, Ranganathan D, Razavi H, Regan M, Rehm JT, Rein DB, Remuzzi G, Richardson K, Rivara FP, Roberts T, Robinson C, De Leòn FR, Ronfani L, Room R, Rosenfeld LC, Rushton L, Sacco RL, Saha S, Sampson U, Sanchez-Riera L, Sanman E, Schwebel DC, Scott JG, Segui-Gomez M, Shahraz S, Shepard DS, Shin H, Shivakoti R, Singh D, Singh GM, Singh JA, Singleton J, Sleet DA, Sliwa K, Smith E, Smith JL, Stapelberg NJ, Steer A, Steiner T, Stolk WA, Stovner LJ, Sudfeld C, Syed S, Tamburlini G, Tavakkoli M, Taylor HR, Taylor JA, Taylor WJ, Thomas B, Thomson WM, Thurston GD, Tleyjeh IM, Tonelli M, Towbin JA, Truelsen T, Tsilimbaris MK, Ubeda C, Undurraga EA, van der Werf MJ, van Os J, Vavilala MS, Venketasubramanian N, Wang M, Wang W, Watt K, Weatherall DJ, Weinstock MA, Weintraub R, Weisskopf MG, Weissman MM, White RA, Whiteford H, Wiebe N, Wiersma ST, Wilkinson JD, Williams HC, Williams SR, Witt E, Wolfe F, Woolf AD, Wulf S, Yeh PH, Zaidi AK, Zheng ZJ, Zonies D, Lopez AD, AlMazroa MA, Memish ZA (2012). Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet 380, 21972223.
Patel V, Weiss HA, Chowdhary N, Naik S, Pednekar S, Chatterjee S, Bhat B, Araya R, King M, Simon G, Verdeli H, Kirkwood BR (2011). Lay health worker led intervention for depressive and anxiety disorders in India: impact on clinical and disability outcomes over 12 months. British Journal of Psychiatry 199, 459466.
Pfizer Inc. (2013 a). Patient Health Questionnaire-9. Available: http://www.phqscreeners.com/pdfs/02_PHQ-9/English.pdf (Accessed 3 April 2014).
Pfizer Inc. (2013 b). Instructions for Patient Health Questionnaire (PHQ) and GAD-7 measures. Available: http://www.phqscreeners.com/instructions/instructions.pdf (Accessed 3 April 2014).
Pfizer Inc. (2013 c). Generalized Anxiety Disorders-7. Available: http://www.phqscreeners.com/pdfs/03_GAD-7/English.pdf (Accessed 3 April 2014).
Press Information Bureau, Government of India (2012). Available: http://pib.nic.in/newsite/erelease.aspx?relid=85669 (Accessed 2 September 2014).
Saraceno B (2004). Mental health: scarce resources need new paradigms. World Psychiatry 3, 35.
Saraceno B, van Ommeren M, Batniji R, Cohen A, Gureje O, Mahoney J, Sridhar D, Underhill C (2007). Barriers to improvement of mental health services in low-income and middle-income countries. Lancet 370, 11641174.
Souza NM, Sebaldt RJ, Mackay JA, Prorok JC, Weise-Kelly L, Navarro T, Wilcyzynski NL, Haynes RB, for the CCDSS Systematic Review Team (2011). Computerized clinical decision support systems for primary preventive care: a decision-maker-researcher partnership systematic review of effects on process of care and patient outcomes. Implementation Science 6, 87.
The WHO World Mental Health Survey Consortium (2004). Prevalence, severity, and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. Journal of American Medical Association 291, 25812590.
Thornicroft G, Brohan E, Kassam A, Lewis-Holmes E (2008). Reducing stigma and discrimination: candidate interventions. International Journal of Mental Health Systems 2, 3.
Thornicroft G, Brohan E, Rose D, Sartorius N, Leese M, for the INDIGO Study Group (2009). Global pattern of experienced and anticipated discrimination against people with schizophrenia: a cross-sectional survey. Lancet 373, 408415.
van Ginneken N, Tharyan P, Lewin S, Rao GN, Meera SM, Pian J, Chandrashekar S, Patel V (2013). Non-specialist health worker interventions for the care of mental, neurological and substance-abuse disorders in low- and middle-income countries. Cochrane Database Systematic Review 11, CD009149.
World Health Organization (2001). The World Health Report 2001 – Mental Health: New Understanding, New Hope. WHO: Geneva, Switzerland.
World Health Organization. (2011 a). Mental Health Atlas 2011. WHO: Geneva, Switzerland. Available: http://www.who.int/mental_health/evidence/atlas/en/ (Accessed 15 September 2011).
World Health Organization (2011 b). WHO Mental Health Gap Action Programme (mhGAP). WHO: Geneva, Switzerland. Available: http://www.who.int/mental_health/mhgap/en/index.html (Accessed 8 September 2011).
World Health Organization (2013). Mental Health Action Plan 2013–2020. WHO: Geneva, Switzerland.
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