How India can make mental healthcare affordable and accessible to all

The community-based model can act as a potent care delivery mechanism in India's context to expand the coverage of mental health services.

Mental health (MH) forms an integral constituent of an individual's overall health, substantially affecting all areas of life. The significance of mental health has come to the forefront in the wake of the COVID-19 pandemic, which has exacerbated the existing mental health burden in India and shone a light on the gaps in the current approach to mental health care and the need to expand India's mental health ecosystem.

According to a Lancet study and Global Health Data Exchange, India accounts for nearly 15% of the global mental health burden and one in seven Indians is estimated to suffer from mental health disorders. Currently, people with mental health disorders face multiple challenges, such as lack of awareness, social discrimination, and stigma, and a paucity of appropriate resources.

According to a study conducted by The National Institute of Mental Health and Neurosciences (NIMHANS) in 2016, more than 80 per cent of people in India are not able to access treatment due to a dearth of capacity and proper infrastructure. At present, there aren't enough mental health professionals to bridge the care gap. Based on a WHO study, India has nearly 0.29 psychiatrists and around 0.07 psychologists per 100,000 population, compared to a median of 0.3-0.5 in low-mid income countries and 9-11 in high-income countries. Additionally, India has only 1.43 hospital beds available for mental health patients per 100,000 population, compared to a median of seven in low-income countries and 50 in high-income countries. Given the large mental health burden in India, it is crucial to critically evaluate the current care models available and focus on innovative delivery models that will help bridge the wide care gap.

The mental health services in India have largely followed a biomedical and institution-based approach. This model suffers from a lack of infrastructure and does not account for the role of sociocultural factors in care delivery. Additionally, there are no clear pathways for the rehabilitation of mental health patients and most patients end up in psychiatric institutions, neglected for multiple years.

As a result, there is a need to address gaps in capacity by overhauling the current care delivery model. This can be achieved by leveraging community-based care models, non-specialist programmes, and technology-based interventions. These models can be integrated with traditional, institution-based primary healthcare facilities to strengthen mental healthcare delivery.

The community-based model can act as a potent care delivery mechanism in India's context to expand the coverage of mental health services. The model has received substantial focus from the government through its DMHP (District mental health program) and NMHP (National mental health program) and is being leveraged by multiple NGOs and organisations as their primary care delivery model. Community-based care involves leveraging community volunteers to build awareness, manage patients' daily well-being, provide preliminary counselling, and improve access to mental health services. Community-based models are crucial to bridging the care gap as they enable care delivery closer to home, local awareness generation, better contextualisation of the problem, and early detection of disorders.

While there have been programmatic interventions from the government to create additional capacity through the Mental Healthcare Act 2017, public health systems can be supported and strengthened by utilising non-specialist workers for care delivery, specifically at a community level. These non-specialist care programmes involve training local general practitioners, PHC (primary health care) workers and other lay workers (such as ASHA and Anganwadi workers) on mental health disorders and care options. Since people in India prefer going to general practitioners for any ailment including mental health issues, training these doctors and frontline/lay workers will help bridge the capacity gap and facilitate early detection of illness.

The pandemic has also provided an impetus to technological and tele-based solutions and interventions as a delivery model for MH. Mobile technology-based mental health programmes, telemedicine, and tele/online counselling have been gaining traction and are being used across the patient lifecycle from building awareness to providing treatment. Technology solutions allow for a larger coverage and increased accessibility, as they can be expanded to tier-two or -three cities and rural areas, thereby providing basic care for all. Moreover, tech solutions can also be used to bridge the capacity gap by leveraging tele mental health programmes to provide training to physicians and other healthcare workers. Although this is an emerging solution, initial research in this area has provided encouraging results. A study published in Lancet in 2020 found that in low- and medium-income countries, digital interventions are moderately more effective than the usual care.

To successfully adopt these solutions, there is a need to drive sustained funding from both, public and private players. Evidence-based research could be employed to measure the efficacy of these models and generate reliable data to support the funding of these models.

These innovative solutions to care delivery have the potential to be scaled up, tailored as per need, and be integrated with the primary healthcare system. Through an integrated approach, there is potential to make mental health care affordable and accessible to all and bridge the care gap.

This article was originally published in Business Today on November 03, 2021

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