scholarly journals SMART Mental Health Project: process evaluation to understand the barriers and facilitators for implementation of multifaceted intervention in rural India

2021 ◽  
Vol 15 (1) ◽  
Author(s):  
Abha Tewari ◽  
Sudha Kallakuri ◽  
Siddhardha Devarapalli ◽  
David Peiris ◽  
Anushka Patel ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Disorders ◽  
Health Services ◽  
Process Evaluation ◽  
Primary Care Physicians ◽  
Health Centre ◽  
Health Concern ◽  
Field Staff ◽  
Services Delivery ◽  
Health Project

Abstract Background Globally, mental health problems are a growing public health concern. Resources and services for mental disorders are disproportionately low compared to disease burden. In order to bridge treatment gaps, The Systematic Medical Appraisal, Referral and Treatment (SMART) Mental Health Project was implemented across 12 villages in West Godavari district of the southern Indian state of Andhra Pradesh. This paper reports findings from a process evaluation of feasibility and acceptability of the intervention that focused on a mental health services delivery model to screen, diagnose and manage common mental disorders (CMDs). Methods A mixed methods evaluation was undertaken using quantitative service usage analytics, and qualitative data from in-depth interviews and focus group discussions were conducted with stakeholders including primary care physicians, community health workers, field staff and community members. Barriers to and facilitators of intervention implementation were identified. Andersen’s Behavioral Model for Health Services Use was the conceptual framework used to guide the process evaluation and interpretation of data. Results In all, 41 Accredited Social Health Activists (ASHAs) and 6 primary health centre (PHC) doctors were trained in mental health symptoms and its management. ASHAs followed up 98.7% of screen positive cases, and 81.2% of these were clinically diagnosed and treated by the PHC doctors. The key facilitators of implementation were adequate training and supervision of field staff, ASHAs and doctors, use of electronic decision support, incorporation of a door-to-door campaign and use of culturally tailored dramas/videos to raise awareness about CMDs, and organising health camps at the village level facilitating delivery of intervention activities. Barriers to implementation included travel distance to receive care, limited knowledge about mental health, high level of stigma related to mental health issues, and poor mobile network signals and connectivity in the villages. Lack of familiarity with and access to mobile phones, especially among women, to accessing health related messages as part of the intervention. Conclusions The evaluation not only provides a context to the interventions delivered, but also allowed an understanding of possible factors that need to be addressed to make the programme scalable and of benefit to policy makers.

scholarly journals Operational challenges in conducting a community-based technology-enabled mental health services delivery model for rural India: Experiences from the SMART Mental Health Project

2018 ◽  
Vol 3 ◽  
pp. 43
Author(s):  
Pallab K. Maulik ◽  
Sudha Kallakuri ◽  
Siddhardha Devarapalli
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Health Services ◽  
Health Services ◽  
Mental Health Care ◽  
Rural India ◽  
Operational Strategies ◽  
Health Services Delivery ◽  
Services Delivery ◽  
Health Project

Background: There are large gaps in the delivery of mental health care in low- and middle-income countries such as India, and the problems are even more acute in rural settings due to lack of resources, remoteness, and lack of infrastructure, amongst other factors. The Systematic Medical Appraisal Referral and Treatment (SMART) Mental Health Project was conceived as a mental health services delivery model using technology-based solutions for rural India. This paper reports on the operational strategies used to facilitate the implementation of the intervention. Method: Key components of the SMART Mental Health Project included delivering an anti-stigma campaign, training of primary health workers in screening, diagnosing and managing stress, depression and increased suicide risk and task sharing of responsibilities in delivering care; and using mobile technology based electronic decision support systems to support delivery of algorithm based care for such disorders. The intervention was conducted in 42 villages across two sites in the state of Andhra Pradesh in south India. A pre-post mixed methods evaluation was done, and in this paper operational challenges are reported. Results: Both quantitative and qualitative results from the evaluation from one site covering about 5000 adults showed that the intervention was feasible and acceptable, and initial results indicated that it was beneficial in increasing access to mental health care and reducing depression and anxiety symptoms. A number of strategies were initiated in response to operational challenges to ensure smoother conduct of the project and facilitated the project to be delivered as envisaged. Conclusions: The operational strategies initiated for this project were successful in ensuring the delivery of the intervention. Those, coupled with other more systematic processes have informed the researchers to understand key processes that need to be in place to develop a more robust study, that could eventually be scaled up.

Public mental health and suicide

2021 ◽  
pp. 95-112
Author(s):  
Danuta Wasserman ◽  
Kristian Wahlbeck
Keyword(s):  
Public Health ◽  
Mental Health ◽  
Mental Health Services ◽  
Mental Disorders ◽  
Health Services ◽  
Media Coverage ◽  
Primary Care Physicians ◽  
Psychosocial Health ◽  
Healthcare Services ◽  
Behavioural Disorders

The full public health impact of mental health is largely unrecognized. The allocation of the burden of disease attributable to mental and behavioural disorders, which is already substantial, will probably increase steadily in the future, due to the transition of the global disease burden towards mental and behavioural disorders. In addition to the demands that mental disorders put on social welfare and health systems, they also cause decreased productivity in the workplace, prolonged disability, and diminished resources within families. Mental disorders are linked to socioeconomic disadvantages and addressing mental health determinants will reduce health inequalities. Stigma of mental disorders is widespread, and it is a barrier for help-seeking behaviours, as well as the development of healthcare services. Modern mental health policies should aim at improving psychosocial health by addressing determinants of mental health in all public policies. Key measures in effective public health suicide prevention programmes comprise improved awareness in the population about mental health promotion and suicide preventive measures, the restriction of access to lethal means of suicide, responsible media coverage of suicide issues, school-based awareness programmes, and improvements in the identification of depression and suicidality by peers, gatekeepers, and health professionals. Modern community-based mental health services, with a diversified service provision, result in better outcomes on a broader scale compared to ‘old school’ hospital-centred mental health service systems. Primary care physicians in collaboration with multidisciplinary teams have a central role in provision of mental health services to the population.

scholarly journals The Systematic Medical Appraisal Referral and Treatment Mental Health Project: Quasi-Experimental Study to Evaluate a Technology-Enabled Mental Health Services Delivery Model Implemented in Rural India (Preprint)

2019 ◽  
Author(s):  
Pallab K Maulik ◽  
Siddhardha Devarapalli ◽  
Sudha Kallakuri ◽  
Amritendu Bhattacharya ◽  
David Peiris ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Services ◽  
Health Services ◽  
Suicide Risk ◽  
Health Workers ◽  
Primary Care Doctor ◽  
Depression And Anxiety ◽  
Services Delivery ◽  
Health Project

BACKGROUND Although around 10% of Indians experience depression, anxiety, or alcohol use disorders, very few receive adequate mental health care, especially in rural communities. Stigma and limited availability of mental health services contribute to this treatment gap. The Systematic Medical Appraisal Referral and Treatment Mental Health project aimed to address this gap. OBJECTIVE This study aimed to evaluate the effectiveness of an intervention in increasing the use of mental health services and reducing depression and anxiety scores among individuals at high risk of common mental disorders. METHODS A before-after study was conducted from 2014 to 2019 in 12 villages in Andhra Pradesh, India. The intervention comprised a community antistigma campaign, with the training of lay village health workers and primary care doctors to identify and manage individuals with stress, depression, and suicide risk using an electronic clinical decision support system. RESULTS In total, 900 of 22,046 (4.08%) adults screened by health workers had increased stress, depression, or suicide risk and were referred to a primary care doctor. At follow-up, 731 out of 900 (81.2%) reported visiting the doctor for their mental health symptoms, compared with 3.3% (30/900) at baseline (odds ratio 133.3, 95% CI 89.0 to 199.7; <i>P</i>&lt;.001). Mean depression and anxiety scores were significantly lower postintervention compared with baseline from 13.4 to 3.1 (<i>P</i>&lt;.001) and from 12.9 to 1.9 (<i>P</i>&lt;.001), respectively. CONCLUSIONS The intervention was associated with a marked increase in service uptake and clinically important reductions in depression and anxiety symptom scores. This will be further evaluated in a large-scale cluster randomized controlled trial.

scholarly journals The Systematic Medical Appraisal Referral and Treatment Mental Health Project: Quasi-Experimental Study to Evaluate a Technology-Enabled Mental Health Services Delivery Model Implemented in Rural India

10.2196/15553 ◽  
2020 ◽  
Vol 22 (2) ◽  
pp. e15553 ◽  
Author(s):  
Pallab K Maulik ◽  
Siddhardha Devarapalli ◽  
Sudha Kallakuri ◽  
Amritendu Bhattacharya ◽  
David Peiris ◽  
...  
Keyword(s):  
Mental Health ◽  
Primary Care ◽  
Mental Health Services ◽  
Health Services ◽  
Suicide Risk ◽  
Health Workers ◽  
Primary Care Doctor ◽  
Depression And Anxiety ◽  
Services Delivery ◽  
Health Project

Background Although around 10% of Indians experience depression, anxiety, or alcohol use disorders, very few receive adequate mental health care, especially in rural communities. Stigma and limited availability of mental health services contribute to this treatment gap. The Systematic Medical Appraisal Referral and Treatment Mental Health project aimed to address this gap. Objective This study aimed to evaluate the effectiveness of an intervention in increasing the use of mental health services and reducing depression and anxiety scores among individuals at high risk of common mental disorders. Methods A before-after study was conducted from 2014 to 2019 in 12 villages in Andhra Pradesh, India. The intervention comprised a community antistigma campaign, with the training of lay village health workers and primary care doctors to identify and manage individuals with stress, depression, and suicide risk using an electronic clinical decision support system. Results In total, 900 of 22,046 (4.08%) adults screened by health workers had increased stress, depression, or suicide risk and were referred to a primary care doctor. At follow-up, 731 out of 900 (81.2%) reported visiting the doctor for their mental health symptoms, compared with 3.3% (30/900) at baseline (odds ratio 133.3, 95% CI 89.0 to 199.7; P<.001). Mean depression and anxiety scores were significantly lower postintervention compared with baseline from 13.4 to 3.1 (P<.001) and from 12.9 to 1.9 (P<.001), respectively. Conclusions The intervention was associated with a marked increase in service uptake and clinically important reductions in depression and anxiety symptom scores. This will be further evaluated in a large-scale cluster randomized controlled trial.

Is Pacific language ability protective of prevalence of mental disorders among Pacific peoples in New Zealand?

2018 ◽  
Vol 21 (1) ◽  
pp. 10-16 ◽  
Author(s):  
Eirenei Taua'i ◽  
Rose Richards ◽  
Jesse Kokaua
Keyword(s):  
Mental Health ◽  
New Zealand ◽  
Mental Health Services ◽  
Mental Disorders ◽  
Health Services ◽  
Common Mental Disorders ◽  
Mental Health Disorder ◽  
Positive Role ◽  
Pacific People ◽  
Language Promotion

Aims: To explore associations between experiences of mental illness, migration status and languages spoken among Pacific adults living in NZ. Methods: SURVEY FREQ and SURVEY LOGISTIC procedures in SAS were applied to data from Te Rau Hinengaro: The New Zealand (NZ) Mental Health Survey, a survey of 12,992 New Zealand adults aged 16 and over in 2003/2004. Pacific people were over sampled and this paper focuses on the 2374 Pacific participants but includes, for comparison, 8160 non-Maori-non-Pacific (NMNP) participants. Results: Pacific migrant respondents had the lowest prevalence of mental disorders compared to other Pacific peoples. However, Pacific immigrants were also less likely to use mental health services, suggesting an increased likelihood of experiencing barriers to available mental health care. Those who were born in NZ and who were proficient in a Pacific language had the lowest levels of common mental disorders, suggesting a protective effect for the NZ-born population. Additionally, access to mental health services was similar between NZ-born people who spoke a Pacific language and those who did not. Conclusions: We conclude that, given the association between Pacific language and reduced mental disorder, there may be a positive role for Pacific language promotion in efforts to reduce the prevalence of mental health disorder among Pacific communities in NZ.

scholarly journals Setting the scene: controversies on trends in mental health among adolescents in the Nordic countries

2020 ◽  
Vol 30 (Supplement_5) ◽  
Author(s):  
C Eriksson ◽  
A M Arnasson ◽  
N Lyyra ◽  
K R Madsen ◽  
T Torsheim ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Mental Disorders ◽  
Health Services ◽  
Adolescent Mental Health ◽  
Nordic Countries ◽  
Daily Hassles ◽  
Data Availability ◽  
Increased Risk ◽  
Advanced Analysis

Abstract At present there are different positions regarding trends in adolescent mental health. Can we trust trend data on the mental health among adolescents in the Nordic countries? Some question the trustworthiness of adolescent self-reports, which describe ordinary daily hassles as health complaints, which cannot be interpreted as signs of mental disorders. In addition, today there is a more open climate for talking about mental issues, which can lead to an overestimation of the prevalence of mental disorders. Statistics on mental health services statistics report increased psychopharmaceutic prescriptions as well as consumption of professional care. Such data argues for increased governmental investment in adolescent mental health services. Is this pattern due to increased availability of mental health services and/or increased prevalence of mental health problems in the adolescent population? A concern is that data availability influences policymaking and allocation of resources. If there is an emphasis on self-reported data from adolescents that may an increased risk of medicalization of young people's dealing with their daily lives. If on the other hand the reported problems among young people is disregarded, this would be against the UN Child Convention. The survey data has important qualities especially if the data is analysed and reported properly. The validation of survey measure has been done both regarding psychometric quality and content validity. Advanced analysis of the data can draw a more nuanced picture. Moreover, some screening instruments have been developed as a first step towards making diagnosis. Instead the HBSC surveys ask boys and girls about their health and well-being, social environment and health behaviours. HBSC uses findings at national and international levels to gain new insights into young people's health and wellbeing, understand the social determinants of health, and inform policy and practice to improve young people's lives.

Mental health data: A case for the African communities in New South Wales

2021 ◽  
Vol 42 (1) ◽  
pp. 64-80
Author(s):  
Daniel Kwai Apat ◽  
Wellington Digwa
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Mental Disorders ◽  
Health Services ◽  
New South ◽  
Mental Health Policy ◽  
New South Wales ◽  
Community Members ◽  
South Wales ◽  
Health Related

This paper examines mental health policies in relation to African communities residing in New South Wales, Australia and the attitudes of African communities toward mental disorders and mental health services. Current mental health policy frameworks have shown an inadequate inclusion of African communities. This may negatively affect the design of mental health interventions and how African communities engage with mental health services. The available mental health literature on African communities showed disjointed and uncoordinated data which focuses on specific community-groups within African communities. Insufficient mental health or suicide data, combined with African community members’ perception toward mental disorders and mental health services, makes it very difficult to progress engagement and interventions. There is a need for proper and sizable data on mental health related to people of African descent in NSW and Australia wide, if positive outcomes are to be realised.

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