Mental Health in Primary Health Care: The Karuna Trust Experience

N.S. Prashanth, V.S. Sridharan, Tanya Seshadri,

H. Sudarshan, K.V. Kishore Kumar, and R. Srinivasa Murthy

Arguing that there cannot be physical health without mental health, all World Health Organization (WHO) member states in the 2013 World Health Assembly approved a comprehensive Mental Health Action Plan 2013-2020 (WHO 2013). The plan is a commitment by all WHO member states to take specific actions to improve mental health and to contribute to the attainment of a set of global targets. Such a global commitment is in line with the comprehensive primary health care approach, which includes the provision and promotion of mental health within its ambit. It is vital that country health systems take into consideration the need to provide mental health care in an accessible manner, while taking into consideration geographical, financial and

N.S. Prashanth (*)

Institute of Public Health, Girinagar, Bangalore, Karnataka, India V.S. Sridharan

Swami Vivekananda Youth Movement, Saragur, Karnataka, India T. Seshadri

The Malki Initiative, Karnataka, India H. Sudarshan

The Karuna Trust, Bangalore, Karnataka, India K.V.K. Kumar

The Banyan Academy of Leadership in Mental Health, Chennai, Tamil Nadu, India R.S. Murthy

The Shankara Cancer Hospital and Research Centre, Bangalore, Karnataka, India © The Author(s) 2017

R.G. White et al. (eds.), The Palgrave Handbook of Sociocultural Perspectives on Global Mental Health, DOI 10.1057/978-1-137-39510-8_34

socio-cultural barriers to deciding to seek mental health care. The provision of good quality and accessible mental health care hence requires a functional primary health care system staffed by trained primary health care workers with appropriate referral systems in place. In such a system, specialist mental health services become only a part of the solution, wherein a responsive primary health care system addresses the majority of mental health problems. Seen in this manner, mental health care requires demystification as well as task shifting from psychiatrists in centrally located tertiary care institutions to health workers in primary and secondary care. Indeed, task shifting is a worldwide phenomenon even in countries with a relatively good numbers of psychiatrists, albeit with a young and growing evidence base (Patel 2009). For example, the UK National Health Service initiative called Improving Access to Psychological Therapies aims to provide accessible evidence-based psychological treatment for anxiety and depression through a large network of well- trained health workers in each locality functioning within a well-supervised system of mental health care (Clark et al. 2009). In the UK, the systematic progression from the publication of national-level guidelines identifying the need for evidence-based psychological therapy (as opposed to only antidepressant medications) at the level of PHC to the funding and deployment of a cadre of therapists at local levels makes for a useful lesson in accessible and evidence-based mental health care (Layard 2006).

In this chapter, we briefly discuss the large unmet need for mental health care in several low- and middle-income countries (LMICs) including India. With this background, we present our experience with integrating mental health services into the primary health care system in one of the districts in the south Indian state of Karnataka. We describe the history of a programme initiated by R. Srinivasa Murthy and K.V. Kishore Kumar of the National Institute of Mental Health and Neurosciences, Bangalore (NIMHANS) in 1995. Both of them were psychiatrists (then at NIMHANS), and have worked closely with non-governmental organisations (NGOs), doctors in primary health care and community health workers to develop decentralised mental health care. The need to develop such a programme was identified by them in order to understand the mental health needs of a tribal and rural population, and explore the feasibility of working with primary health care workers. We illustrate some of the lessons learned using two brief interview-based case studies, and discuss the limitations and challenges of this experience. We hope that such experiences can shape a systemic response by governments and policymakers to make mental health care accessible through the wide network of primary health centres (PHCs).

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