Potential role of technology in mental health care

Based on a WHO study, India has only ~0.29 psychiatrists and ~0.07 psychologists per 100,000 population, compared to a median of 0.51 psychiatrists and 0.26 psychologists in low-mid income countries, and a median of 11.87 psychiatrists and 9.04 psychologists in high income countries.

India has one of the highest mental health burdens globally, and which has been exacerbated by the COVID-19 pandemic. According to a Lancet study and the Global Health Data Exchange, India accounts for~15% of the global mental health burden, with one in seven Indians estimated to be suffering from mental health disorders. In addition to highlighting the significance of mental health, the pandemic has brought to fore the gaps in the current approaches to mental health care and the need to expand India’s mental health ecosystem. Mental health remains one of the most under researched and underfunded disorders in the country. Despite the high burden, there exists a vast treatment gap, estimated to be more than ~80%, according to a study by NIMHANS in 2016. Based on a WHO study, India has only~0.29 psychiatrists and ~0.07 psychologists per 100,000 population, compared toa median of 0.51 psychiatrists and 0.26 psychologists in low-mid income countries. Even within India, the existing scarce infrastructure is concentrated around urban areas and in the private sector, with larger treatment gap in rural areas.

One of the ways to address the existing care gap is through technology-enabled care. Technology solutions have the potential to be affordable and scalable, thereby allowing for a larger coverage across tier 2, 3 cities and rural areas. Currently, there are multiple favorable factors that could support large-scale adoption of technological interventions. Firstly, the smartphone ownership in India has been rising steadily and is expected to reach ~60% population penetration by2022. Second, the data charges have continued to decline and data usage per capita has continued to increase and is expected to almost double to 18 GB per month between 2018-2024. This provides a strong infrastructure for building and delivering digital mental health care. COVID-19 has also seen the uptake of tele-medicine for healthcare due to restrictions/ difficultly / averseness to physical appointments. A recent report by an online consultation platform points towards 3-5X increase in online consultations during COVID-19, a trend that is likely to persist even after the pandemic. Initial empirical studies have also shown that digital psychological interventions are moderately more effective compared to the usual care in low- and medium-income countries and can be considered for regions where the capacity and infrastructure for mental health care in minimal or absent.

Encouraged by these tailwinds of technology adoption, India has witnessed the emergence of various technology-based digital mental health solutions, both for awareness and capacity building, and diagnosis and treatment.

Technology solutions can play a significant role in building mental health awareness among rural communities and bridging capacity gap. This is evidenced by several successful interventions in India. NIMHANS’ ECHO tele-mentoring experiment shows promise, wherein smartphone was leveraged to train counselors from 11 underserved and remote districts in Chhattisgarh. Over a period of 6 months, there was a significant increase in learning and confidence. The Atmiyata programme by CMHLP (Centre for Mental Health Law & Policy) is another such example that involves providing its community volunteers smartphones loaded with Atmiyata app. The app contains training materials and films for training and awareness purposes. Technology can also be used to train general physicians, and lay workers (ASHA and Anganwadi workers) and facilitate care delivery in tier-2 and 3 cities and rural areas, as shown through the SMART(Systematic Medical Appraisal, Referral and Treatment) mental health project in Andhra Pradesh.

For diagnosis and ongoing care, especially in urban areas, several start-ups in the field of mental health are now offering innovative solutions. These include mobile apps for self-guided treatments, AI-enabled virtual assistants for diagnosis and assistance, and virtual counseling services. These solutions can be accessed at users’ convenience and have the potential to drive the overall treatment costs down. To enhance the reach and uptake in rural areas, such solutions are now also being made available in vernacular languages.

Digital mental health care solutions have immense potential in a country like India. Such solutions can increase accessibility and affordability of mental health care, even in rural and remote parts of the country. However, unlocking its true potential will require meaningful scale-up through adequate and sustained funding, and overcoming concerns related to lack of defined protocol for digital mental healthcare solutions, familiarity with digital tools, and ease of use.

Government should prioritize adequate investments in digital mental health care solutions as part of the National Mental Health Plan. There needs to be sustained focus on increasing capacity through training of specialist and non-specialist personnel for mental health care. Digital solutions need to be customized in the context of India, by making tools available in local languages and dialects, and ensuring user-friendly design that can operate in low data bandwidth situations and through multiple mediums such as audio, video, or text. Recent guidelines issued by NIMHANS and Medical Council of India should help in overcoming concerns related to lack of appropriate guidelines for telepsychiatry.

Technology solutions provide India an opportunity to leapfrog various hurdles related to funding and capacity. The COVID-19 driven adoption of digital solutions in all walks of life, including healthcare, also provides an unprecedented opportunity to drive digital mental healthcare solutions. With timely investment and attention from the government and other ecosystem stakeholders, technology has the potential to transform the mental health care landscape in India in the coming years.

This article was originally published in ET HealthWorld on November 09, 2021

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