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Community, facility and individual level impact of integrating mental health screening and treatment into the primary healthcare system in Sehore district, Madhya Pradesh, India
  1. Rahul Shidhaye1,
  2. Emily Baron2,
  3. Vaibhav Murhar3,
  4. Sujit Rathod4,
  5. Azaz Khan3,
  6. Abhishek Singh3,
  7. Sanjay Shrivastava3,
  8. Shital Muke3,
  9. Ritu Shrivastava3,
  10. Crick Lund2,5,
  11. Vikram Patel6,7
  1. 1Center for Chronic Conditions and Injuries, Public Health Foundation of India, Gurugram, India
  2. 2Alan J Flisher Centre for Public Mental Health, Department of Psychiatry and Mental Health, University of Cape Town, Cape Town, South Africa
  3. 3PRIME Project, Sangath, Bhopal, India
  4. 4Department of Population Health, London School of Hygiene and Tropical Medicine, London, UK
  5. 5Centre for Global Mental Health, Health Service and Population Research Department, Institute of Psychiatry, Psychology and Neuroscience, King’s College London, London, UK
  6. 6Department of Global Health and Social Medicine, Harvard Medical School, Boston, Massachusetts, USA
  7. 7Sangath, Goa, India
  1. Correspondence to Dr Rahul Shidhaye; rahulshidhaye{at}gmail.com

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.

  • mental disorders
  • primary healthcare
  • programme evaluation
  • health services research
  • India

This is an open access article distributed in accordance with the Creative Commons Attribution 4.0 Unported (CC BY 4.0) license, which permits others to copy, redistribute, remix, transform and build upon this work for any purpose, provided the original work is properly cited, a link to the licence is given, and indication of whether changes were made. See: https://creativecommons.org/licenses/by/4.0/.

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Footnotes

  • Handling editor Seye Abimbola

  • Contributors RS, CL and VP provided overall leadership in conceptualising the work described in this paper and the structure of the paper. EB, SR and VM finalised the study design, supervised the data collection and analysed the data. SS, AK and AS supervised the work of Case Managers. RS wrote the first draft and CL and VP commented and edited all versions of the draft; EB, VM, SR, AK, AS, SS, SM and RSr commented and edited the advanced versions of the draft. All authors read and approved the final draft.

  • Funding This study is an output of the PRogramme for Improving Mental health carE (PRIME) which was funded by UK aid from the UK Government (GB-1-201446); however, the views expressed do not necessarily reflect the UK Government’s official policies. The funders had no role in study design, data collection and analysis, decision to publish or preparation of the manuscript.

  • Competing interests None declared.

  • Patient consent for publication All participants recruited into the three study designs gave informed consent prior to being interviewed, and signed a consent form with a thumbprint or signature. The informed consent form made clear there would be no negative effects for non-participation. Participants who endorsed questionnaire items about suicidality were referred to a provider in the clinic.

  • Ethics approval The institutional review boards of the World Health Organization (Geneva, Switzerland), University of Cape Town (South Africa), Sangath (Goa, India) and the Indian Council of Medical Research (New Delhi, India) reviewed and approved the protocol for the PRIME CS, FDS and cohort studies. Participants were not given any incentive to participate in any of the three studies.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data availability statement Interested parties may notify the PRIME investigators of their interest in collaboration, including access to the data set analysed here, through the following website: https://docs.google.com/forms/d/1–4oNm5xdEPlq-RjL_4GUyCPMpVWtyaNVcfDewnx-iL4/viewform.

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