Community, facility and individual level impact of integrating mental health screening and treatment into the primary healthcare system in Sehore district, Madhya Pradesh, India
Introduction Programme for Improving Mental Health Care (PRIME) designed a comprehensive mental healthcare plan (MHCP) for Sehore district, Madhya Pradesh, India. The objective of this paper is to describe the findings of the district-level impact evaluation of the MHCP.Methods Repeat community-base...
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BMJ Publishing Group
2019-06-01
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| Series: | BMJ Global Health |
| Online Access: | https://gh.bmj.com/content/4/3/e001344.full |
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| author | Crick Lund Vikram Patel Rahul Shidhaye Emily Baron Vaibhav Murhar Sujit Rathod Azaz Khan Abhishek Singh Sanjay Shrivastava Shital Muke Ritu Shrivastava |
| author_facet | Crick Lund Vikram Patel Rahul Shidhaye Emily Baron Vaibhav Murhar Sujit Rathod Azaz Khan Abhishek Singh Sanjay Shrivastava Shital Muke Ritu Shrivastava |
| author_sort | Crick Lund |
| collection | DOAJ |
| description | Introduction Programme for Improving Mental Health Care (PRIME) designed a comprehensive mental healthcare plan (MHCP) for Sehore district, Madhya Pradesh, India. The objective of this paper is to describe the findings of the district-level impact evaluation of the MHCP.Methods Repeat community-based CS were conducted to measure change in population-level contact coverage for depression and alcohol use disorders (AUD), repeat FDS were conducted to assess change in detection and initiation of treatment for depression and AUD, and the effect of treatment on patient outcomes was assessed using disorder-specific prospective cohort studies.Results PRIME MHCP did not have any impact on contact coverage/treatment seeking for depression (14.8% at the baseline and 10.5% at the follow-up) and AUD (7.7% at the baseline and 7.3% at the follow-up) and had a small impact on detection and initiation of treatment for depression and AUD (9.7% for depression and 17.8% for AUD compared with 0% for both at the baseline) in the health facilities. Patients with depression who received care as part of the MHCP had higher rates of response (52.2% in the treatment group vs 26.9% in the comparison/usual care group), early remission (70.2% in the treatment group vs 44.8% in the comparison/usual care group) and recovery (56.1% in the treatment group vs 28.5% in the comparison/usual care group), but there was no impact of treatment on their functioning.Conclusions While dedicated human resources (eg, Case Managers) and dedicated space for mental health clinics (eg, Mann-Kaksha) strengthen the ‘formal’ healthcare platform, without substantial additional investments in staff, such as Community Health Workers/Accredited Social Health Activists to improve community level processes and provision of community-based continuing care to patients, we are unlikely to see major changes in coverage or clinical outcomes. |
| format | Article |
| id | doaj-art-dcd1adb878bc4664bbf488d62c6814e7 |
| institution | Kabale University |
| issn | 2059-7908 |
| language | English |
| publishDate | 2019-06-01 |
| publisher | BMJ Publishing Group |
| record_format | Article |
| series | BMJ Global Health |
| spelling | doaj-art-dcd1adb878bc4664bbf488d62c6814e72024-12-15T12:25:09ZengBMJ Publishing GroupBMJ Global Health2059-79082019-06-014310.1136/bmjgh-2018-001344Community, facility and individual level impact of integrating mental health screening and treatment into the primary healthcare system in Sehore district, Madhya Pradesh, IndiaCrick Lund0Vikram Patel1Rahul Shidhaye2Emily Baron3Vaibhav Murhar4Sujit Rathod5Azaz Khan6Abhishek Singh7Sanjay Shrivastava8Shital Muke9Ritu Shrivastava1012 Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa11 Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USACenter for Chronic Conditions and Injuries, Public Health Foundation of India, Gurugram, IndiaAlan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South AfricaPRIME Project, Sangath, Bhopal, IndiaDepartment of Population Health, London School of Hygiene and Tropical Medicine, London, UKPRIME Project, Sangath, Bhopal, IndiaOrthopaedics, Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, IndiaPRIME Project, Sangath, Bhopal, IndiaPRIME Project, Sangath, Bhopal, IndiaPRIME Project, Sangath, Bhopal, IndiaIntroduction Programme for Improving Mental Health Care (PRIME) designed a comprehensive mental healthcare plan (MHCP) for Sehore district, Madhya Pradesh, India. The objective of this paper is to describe the findings of the district-level impact evaluation of the MHCP.Methods Repeat community-based CS were conducted to measure change in population-level contact coverage for depression and alcohol use disorders (AUD), repeat FDS were conducted to assess change in detection and initiation of treatment for depression and AUD, and the effect of treatment on patient outcomes was assessed using disorder-specific prospective cohort studies.Results PRIME MHCP did not have any impact on contact coverage/treatment seeking for depression (14.8% at the baseline and 10.5% at the follow-up) and AUD (7.7% at the baseline and 7.3% at the follow-up) and had a small impact on detection and initiation of treatment for depression and AUD (9.7% for depression and 17.8% for AUD compared with 0% for both at the baseline) in the health facilities. Patients with depression who received care as part of the MHCP had higher rates of response (52.2% in the treatment group vs 26.9% in the comparison/usual care group), early remission (70.2% in the treatment group vs 44.8% in the comparison/usual care group) and recovery (56.1% in the treatment group vs 28.5% in the comparison/usual care group), but there was no impact of treatment on their functioning.Conclusions While dedicated human resources (eg, Case Managers) and dedicated space for mental health clinics (eg, Mann-Kaksha) strengthen the ‘formal’ healthcare platform, without substantial additional investments in staff, such as Community Health Workers/Accredited Social Health Activists to improve community level processes and provision of community-based continuing care to patients, we are unlikely to see major changes in coverage or clinical outcomes.https://gh.bmj.com/content/4/3/e001344.full |
| spellingShingle | Crick Lund Vikram Patel Rahul Shidhaye Emily Baron Vaibhav Murhar Sujit Rathod Azaz Khan Abhishek Singh Sanjay Shrivastava Shital Muke Ritu Shrivastava Community, facility and individual level impact of integrating mental health screening and treatment into the primary healthcare system in Sehore district, Madhya Pradesh, India BMJ Global Health |
| title | Community, facility and individual level impact of integrating mental health screening and treatment into the primary healthcare system in Sehore district, Madhya Pradesh, India |
| title_full | Community, facility and individual level impact of integrating mental health screening and treatment into the primary healthcare system in Sehore district, Madhya Pradesh, India |
| title_fullStr | Community, facility and individual level impact of integrating mental health screening and treatment into the primary healthcare system in Sehore district, Madhya Pradesh, India |
| title_full_unstemmed | Community, facility and individual level impact of integrating mental health screening and treatment into the primary healthcare system in Sehore district, Madhya Pradesh, India |
| title_short | Community, facility and individual level impact of integrating mental health screening and treatment into the primary healthcare system in Sehore district, Madhya Pradesh, India |
| title_sort | community facility and individual level impact of integrating mental health screening and treatment into the primary healthcare system in sehore district madhya pradesh india |
| url | https://gh.bmj.com/content/4/3/e001344.full |
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