Community, facility and individual level impact of integrating mental health screening and treatment into the primary healthcare system in Sehore district, Madhya Pradesh, India

Rahul Shidhaye, Emily Baron, Vaibhav Murhar, Sujit Rathod, Azaz Khan, Abhishek Singh, Sanjay Shrivastava, Shital Muke, Ritu Shrivastava, Crick Lund, Vikram Patel, Rahul Shidhaye, Emily Baron, Vaibhav Murhar, Sujit Rathod, Azaz Khan, Abhishek Singh, Sanjay Shrivastava, Shital Muke, Ritu Shrivastava, Crick Lund, Vikram Patel

Abstract

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.

Keywords: India; health services research; mental disorders; primary healthcare; programme evaluation.

Conflict of interest statement

Competing interests: None declared.

Figures

Figure 1
Figure 1
Programme for Improving Mental Health Care India mental healthcare plan timelines. FDS, facility-based detection surveys.
Figure 2
Figure 2
Flow diagram of recruitment and follow-up process for the depression cohort. PHQ-9, Patient Health Questionnaire-9 item.
Figure 3
Figure 3
Flow diagram of recruitment and follow-up process for the AUD cohort. AUD, alcohol use disorder; AUDIT, Alcohol Use Disorder Identification Test.

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