Symposium summary on "Community Psychiatry and DMHP-An update"

Impact of Technology Driven Mental Health Task-shifting for Accredited Social Health Activists (ASHAs): Results from a Randomised Controlled Trial of Two Methods of Training

Mental health task shifting is a potential way to address the burgeoning treatment gap for mental illness. Easily available and accessible digital technology can be utilised to continuously engage grassroot level health workers (for example, Accredited Social Health Activists (ASHAs). However, the impact of such a strategy is not yet systematically evaluated. In this randomised controlled trial, longitudinal hybrid training of ASHAs [1 day in-person classroom training and seven online sessions (ECHO model), aimed to screen and refer to commonly prevalent mental health issues in communities] was compared with traditional one-day in-person classroom training. ASHAs (n = 75) from six Primary Health Centres in Ramanagara district, Karnataka, India were randomized into study (SG-ASHAs) and control (CG-ASHAs) groups. After excluding drop-outs, 26 ASHAs in each group were included in the final analysis of the scores on their Knowledge, attitude, and practices (KAP) in mental health. Two house-to-house surveys were conducted by both groups to identify and refer possible cases. The number of screen positives (potential persons with mental illnesses) and the KAP scores formed the outcome measures. Online sessions for SG-ASHAs were completed over 18 months, the COVID-19 pandemic being the main disruptor. SG-ASHAs identified significantly higher number of persons with potential alcohol use disorders [n = 873 (83%); p ≤ 0.001] and common mental disorders [n = 96(4%); p = 0.018], while CG-ASHAs identified significantly higher number of those with potential severe mental disorders [n = 61(61.61%); p ≤ 0.001]. As regards KAP, after controlling for baseline scores, the time effect in RMANOVA favoured SG-ASHAs. Mean total KAP score increased from 16.76 to18.57 (p < 0·01) in SG-ASHAs and from 18.65 to 18.84 (p = 0.76) in CG-ASHAs. However, the Time-group interaction effect did not favour either (F = 0.105; p = 0.748). Compared to traditional training, mentoring ASHAs for extended periods is more impactful. Easily accessible digital technology makes the latter feasible. Scaling up such initiatives carry the potential to considerably improve treatment access for those in need.

A report on successful introduction of tele mental health training for primary care doctors during the COVID 19 pandemic

Treatment gaps of 60-70%, reflecting, amongst many other factors, Human Resources shortfalls means that 150 million India never accessed mental healthcare. In Punjab, mental health training is required in primary health centers. A short-term synchronous training was conceptualized by the National Institute of Mental Health and Neurosciences. A total of 114 primary care doctors participated for the training. Substantial positive changes in knowledge, attitudes and practices were noted. Task sharing and capacity building initiatives can be undertaken during the pandemic to meet the demand for mental healthcare service delivery.

Implementing National Mental Health Program: Local leaders' perspectives and lessons for national action

The article is about a set of leadership programs on 'mental health leadership under NMHP' that was completed for 161 participants who are the district level health authorities and service providers (psychiatrists, psychologists, nurses and social workers) by the Community Psychiatry Unit of the Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru. The overarching aim of these programs was to provide an impetus to mental health leadership at district levels that could enable them to upscale public mental healthcare delivery. Upon completion of the program, 109 participants provided a feedback on the content of the program. Majority (98 %) were satisfied with the format of the program in which it was conducted and felt that their expectations were either partially or completely satisfied with appropriate content (93 %). The health authorities (43 %) gained better insights into the magnitude of mental health concerns and agreed that mental health service delivery should scale up. The service providers (17 %) felt the need to upgrade their skills in specialty areas of psychiatry in order to gear up for comprehensive mental health care delivery. Finally, the authors argue that such local level learnings should drive the policy making at the national level.

Change in attitude of ASHAs towards persons with mental illnesses following participation in community based rehabilitation project

BACKGROUND

Accredited Social Health Activists (ASHAs) play an important role in health care in rural India.

AIM

To study the change in attitude of ASHAs towards persons with mental illness (PMI) after involvement in a community-based rehabilitation program.

METHODS

ASHAs (n = 95) were trained to identify and refer PMI. Community Attitudes to Mental Illness scale was administered at baseline and after 18 months of training.

RESULTS

Domains of benevolence, social restrictiveness, and community mental health ideology showed significant improvement p < 0.001. There was no change in authoritarianism domain.

CONCLUSION

Engaging ASHAs in identification, referral and treatment positively changes their attitudes towards PMI.