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Home arrow Language & Literature arrow The Palgrave Handbook of Sociocultural Perspectives on Global Mental Health

Other impacts

  • (a) The PHC health workers were trained and sensitised to identify different types of mental illnesses like schizophrenia, depression and bipolar affective disorders. We found that this skill was dependent on observation, careful history taking and patient communication and was often neglected in medical training and lacking among professionals in several other primary health centres.
  • (b) Involvement in caring for the mentally ill also enriched the soft skills of the medical and para-medical staff to address other programmes for chronic diseases like diabetes, hypertension, epilepsy and tuberculosis.
  • (c) The experience also made us aware of the need for and feasibility of running an alcohol de-addiction programme at the community level.

As there are only about 3500 psychiatrists for over a billion people in India, they are better involved as trainers and not as the primary caregiver for the mentally ill. However, the presence of strong alliances between psychiatrists and PHC teams in the form of formal referral networks or through strategic linkages with NGOs and private practitioners is needed. The role of psychiatrist in providing a higher level of care as well as providing expert input on treatment plans for existing patients is crucial to the success of an integrated PHC-level mental health care programme. The psychiatrist may review the programme periodically and give on-site training and plan psychosocial rehabilitation facilities within local settings.

As the programme evolved, and access to mental health services increased in the local area, patients who were using the Gumballi services were subsequently referred to facilities closer to where they lived. Today, the availability of medicines in several PHCs across the state has improved and whenever possible patients are referred for care to their respective PHCs. Although there are still many challenges in the scale of human resources and capacity gaps for delivering mental healthcare in PHCs in Karnataka, there is no doubt that it is possible to do this cost-effectively when there is a local vision to provide mental health care within PHCs, a committed team led by a doctor as well as key linkages with tertiary mental health care facilities (medical colleges or specialty hospitals with psychiatry departments).

Broadly, the lessons learned may be summarised as follows:

  • 1. There is a wide range of unmet mental health care needs in the community, especially in the rural areas of India. The challenge of reaching services is accessibility, acceptability of the offered services and the affordability of care.
  • 2. It was possible to provide inclusive mental health care within primary care settings in a relatively deprived and largely rural south Indian district.
  • 3. A large number of people benefitted from decentralised mental health care, which was a specialist-assisted, but eventually non-specialist-driven programme.
  • 4. Our intervention increased the number of people who sought medical treatment for mental illness in addition to traditional healers and faith healers over a period of time, as evidenced by the fact that number of registrations for acute psychosis increased in the clinics. In view of early involvement and negotiations with these actors, it was also possible to establish an informal referral system from traditional providers to mental health services, especially for severe mental illnesses.
  • 5. People and their families exhibited a great degree of comfort using these services.
  • 6. It was gratifying to note that non-specialist primary care doctors associated with Karuna Trust and BR Hills were able to gain knowledge and skills to manage both acute and chronic mental health problems, substance use disorders, intellectual disability and seizure disorders.
  • 7. The programme appears to have reduced mortality and morbidity associated with mental health problems.
  • 8. The success of this programme resulted in up scaling of mental health into primary care in other PHCs run by Karuna Trust.[1]
  • 9. Many people with severe psychotic illness remained untreated despite the above-mentioned resources in the catchment area. Services for these people will require higher resources, better convergence and coordination with social and legal services.

  • [1] With the support of The Banyan, Chennai and Sir Ratan Tata Trust, the Karuna Trust has begun integrating mental health care into primary care settings in all its other PHCs in Karnataka, run under public private partnership with the government. However, several challenges remain in doing this in other PHC settings due to difficulty in establishing a systematic two-way referral system for mental illnesses as wellas the challenges in linking with psychiatrists for building capacity of doctors and health workers.
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