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Somanathan R, Gandhi S, Sivakumar T, Manjunatha N, Jayarajan D, Thirthalli J, Parthasarathy R. Perspectives of Community Nurses on Treatment Engagement of Persons with Severe Mental Illnesses (PwSMI): A Qualitative Study from South India. Indian J Psychol Med 2024; 46:131-138. [PMID: 38725731 PMCID: PMC11076944 DOI: 10.1177/02537176231207986] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 05/12/2024] Open
Abstract
Background There is increasing evidence of the need for treatment engagement between Persons with Severe Mental Illnesses (PwSMIs) and Mental Health Professionals (MHPs). This therapeutic process involves collaborative work between patients and MHPs, which improves the condition. Community nurses are uniquely positioned to facilitate this process as they act as the focal point of interaction between patients and the health system. Methods This qualitative study explored the community nurses' experiences in treatment engagement with PwSMI through eight group interviews of 35 community nurses from District Mental Health Programs (DMHPs) across Karnataka (South India) from February 2020 to March 2020. The audio recordings of the interviews were transcribed and coded to arrive at themes and subthemes. Results The major themes identified were factors influencing treatment engagement, strategies to tackle treatment nonengagement, and challenges in dealing with nonengagement. The reasons for nonengagement were lack of insight and lack of knowledge of sociocultural, logistic, and treatment-related factors. The DMHP teams contacted patients through phone calls, home visits, and liaisons with health workers and intervened with them through education and depot injections. The major challenges were difficulty conducting home visits, distances, the unavailability of medications, and the need for adequate infrastructure and human resources. Conclusion Community nurses address a few factors of nonengagement, such as insight, sociocultural factors, and treatment-related factors. Addressing the systemic challenges and adequate training of nurses in intervening in the dropped-out PwSMIs would help to reduce the treatment gap.
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Affiliation(s)
- Revathi Somanathan
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | | | - Thanapal Sivakumar
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | - Narayana Manjunatha
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
| | | | - Jagadisha Thirthalli
- Dept. of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, Karnataka, India
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Vajawat B, Suhas S, Moirangthem S, Kumar CN, Varghese M, Gururaj G, Benegal V, Rao GN. Bipolar affective disorder in India: A multi-site population-based cross-sectional study. Indian J Psychiatry 2023; 65:1230-1237. [PMID: 38298870 PMCID: PMC10826869 DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_838_23] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2022] [Revised: 09/18/2022] [Accepted: 11/07/2023] [Indexed: 02/02/2024] Open
Abstract
Introduction Bipolar Affective Disorder (BPAD) merits careful consideration within the medical and healthcare communities, researchers, and policymakers. This is due to its substantial disability burden, elevated prevalence of co-morbidities, heightened lifetime risk of suicidality, and a significant treatment gap. This article focuses on the lifetime and current prevalence, correlates, co-morbidities, associated disabilities, socio-economic impact, and treatment gap for BPAD in the adult population of the National Mental Health Survey (NMHS) 2016. Materials and Methods The NMHS 2016 was a nationally representative study conducted across 12 Indian states between 2014 and 2016. A multi-stage, stratified, random cluster sampling technique based on probability proportionate to size at each stage was used. The diagnosis of BPAD was based on Mini-International Neuropsychiatric Interview 6.0.0. Sheehan's Disability Scale was used to assess the disability. Results A total of 34,802 adults were interviewed. The overall weighted prevalence of BPAD was 0.3% [95% confidence interval (CI): 0.29-0.31] for current and 0.5% (95% CI: 0.49-0.51) for lifetime diagnosis. Male gender [odds ratio (OR) 1.56] and residence in urban metropolitans (OR 2.43) had a significantly higher risk of a lifetime diagnosis of BPAD. Substantial cross-sectional co-morbidities were noted as per MINI 6.0.0 with the diagnosis of current BPAD such as tobacco use disorder (33.3%), other substance use disorders (14.6%), and anxiety disorders (10.4%). Two-thirds of persons with current BPAD reported disability of varying severity at work (63%), social (59.3%), and family life (63%). The treatment gap for current BPAD was 70.4%. Conclusion Most individuals with current BPAD reported moderate-severe disability. There were substantial co-morbidities and a large treatment gap. These warrant concentrated efforts from policymakers in devising effective strategies.
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Affiliation(s)
- Bhavika Vajawat
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Satish Suhas
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Sydney Moirangthem
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | | | - Mathew Varghese
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Gopalkrishna Gururaj
- Centre for Public Health, Department of Epidemiology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
| | - Vivek Benegal
- Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
| | - Girish N. Rao
- Centre for Public Health, Department of Epidemiology, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
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Tyagi V, Khan A, Siddiqui S, Kakra Abhilashi M, Dhurve P, Tugnawat D, Bhan A, Naslund JA. Development of a Digital Program for Training Community Health Workers in the Detection and Referral of Schizophrenia in Rural India. Psychiatr Q 2023; 94:141-163. [PMID: 36988785 PMCID: PMC10052309 DOI: 10.1007/s11126-023-10019-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 03/12/2023] [Indexed: 03/30/2023]
Abstract
This study aimed to develop and assess the acceptability of a digital program for training community health workers (CHWs) in the detection and referral of patients with schizophrenia in community settings in rural India. An iterative design process was employed. First, evidence-based content from existing community programs for schizophrenia care was incorporated into the curriculum, and reviewed by experts to ensure clinical utility and fidelity of the adapted content. Second, CHWs provided feedback on the appropriateness of language, content, and an initial prototype of the digital training program to ensure relevance for the local context. Focus group discussions were then used to understand the acceptability of the digital training prototype and to inform modifications to the design and layout. Qualitative data was analysed using a rapid thematic analysis approach based on predetermined topics pertaining to acceptability of the training content and digital platform. Development of the initial prototype involved content review by 13 subject matter experts with clinical expertise or experience accessing and receiving mental health services, and engagement of 23 CHWs, of which 11 provided feedback for contextualization of the training content and 12 participated in focus group discussions on the acceptability of the prototype. Additionally, 2 service-users with lived experience of schizophrenia contributed to initial testing of the digital training prototype and offered feedback in a focus group discussion. During contextualization of the training content, key feedback pertained to simplifying the language and presentation of the content by removing technical terms and including interactive content and images to enhance interest and engagement with the digital training. During prototype testing, CHWs shared their familiarity with similar symptoms but were unaware of schizophrenia as a treatable illness. They shared that training can help them identify symptoms of schizophrenia and connect patients with specialized care. They were also able to understand misconceptions and discrimination towards people with schizophrenia, and how to address these challenges by supporting others and spreading awareness in their communities. Participants also appreciated the digital training, as it could save them time and could be incorporated within their routine work. This study shows the acceptability of leveraging digital technology for building capacity of CHWs to support early detection and referral of schizophrenia in community settings in rural India. These findings can inform the subsequent evaluation of this digital training program to determine its impact on enhancing the knowledge and skills of CHWs.
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Affiliation(s)
| | | | | | | | | | | | | | - John A Naslund
- Department of Global Health and Social Medicine, Harvard Medical School, 641 Huntington Avenue, Boston, MA, USA.
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Sivakumar T, Jadhav P, Allam A, Ramachandraiah S, Vanishree BNG, Meera J, Santhosha S, Doddur D, Janardhana AL, Basavarajappa C, Kumar CN, Thirthalli J. Continuity of Care for Persons With Serious Mental Illness in a Rural Rehabilitation Program During the COVID-19 Pandemic in India. Psychiatr Serv 2022; 73:830-833. [PMID: 34991340 DOI: 10.1176/appi.ps.202100462] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
The COVID-19 pandemic has posed challenges to community-based rehabilitation (CBR) for persons with mental illness, especially in resource-constrained settings. This column discusses the pandemic-related challenges faced by a rural CBR program in Jagaluru taluk (a subdistrict) in Karnataka, India. Thanks to stakeholder collaboration, task shifting with lay health workers, and implementation of telepsychiatry, the authors' clinical team could ensure uninterrupted medical care for persons with serious mental illness. Other CBR components were reduced because of pandemic-imposed resource and logistic constraints.
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Affiliation(s)
- Thanapal Sivakumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Prabhu Jadhav
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Abhishek Allam
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Sujai Ramachandraiah
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Byalya Nanje Gowda Vanishree
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Jyothi Meera
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Shivamurthy Santhosha
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Dundappa Doddur
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Akkalapura Lokappa Janardhana
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Chethan Basavarajappa
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Channaveerachari Naveen Kumar
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
| | - Jagadisha Thirthalli
- Department of Psychiatry, National Institute of Mental Health and Neurosciences (Sivakumar, Jadhav, Allam, Ramachandraiah, Vanishree, Meera, Doddur, Basavarajappa, Kumar, Thirthalli) and Association of People With Disability (Santhosha, Janardhana), Bengaluru, India
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Abstract
PURPOSE OF REVIEW We reviewed the existing and recent community models of care in schizophrenia. We examine characteristics, recent updates, evidence, cost-effectiveness, and patients' acceptance for existing and new community-based care models in high-income (HI) and low- and middle-income (LAMI) countries. RECENT FINDINGS Assertive Community Treatment (ACT), Intensive Case Management (ICM), and Crisis Intervention are cost-effective interventions for schizophrenia and time tested in the last few decades in HI countries. The growing evidence suggests that tailor-made ACTs and ICM can effectively reduce substance use, homelessness, and criminal activity in persons with schizophrenia who live in the community. Similarly, in LAMI Countries, a few community-based care models for schizophrenia have been developed and tested based on community-based rehabilitation principles. The modality of a community model of care and interventions for a person with schizophrenia should be chosen based on the person's co-existing psychosocial difficulties and challenges such as homelessness, criminal behaviour, and substance use.
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Affiliation(s)
- Guru S. Gowda
- Department of Psychiatry, National Institute of Mental Health and Neuro Sciences (NIMHANS), Bengaluru, 560029 India
| | - Mohan K. Isaac
- Clinical Professor of Psychiatry, Division of Psychiatry, Faculty of Health and Medical Sciences, The University of Western Australia, Fremantle Hospital, Fremantle Hospital, Level 7, T Block, Fremantle, WA 6160 Australia
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Kassir G, El Hayek S, Charara R, Cherro M, Itani H, El Khoury J. Predictors of admission to an assertive outreach service for psychosis in Lebanon. PLOS GLOBAL PUBLIC HEALTH 2022; 2:e0001428. [PMID: 36962861 PMCID: PMC10021548 DOI: 10.1371/journal.pgph.0001428] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 12/04/2022] [Indexed: 12/29/2022]
Abstract
Schizophrenia is a chronic, debilitating mental illness that contributes significantly to the global burden of disease. Assertive outreach treatment for patients with schizophrenia and psychotic disorders has been implemented to improve treatment adherence and outcomes. The suitability of this model of care outside the western context has not been fully established. We describe the characteristics of 45 patients enrolled in the Psychosis Recovery Outreach Program (PROP), a program developed at a leading psychiatric facility in Lebanon. We collected twelve-month data for patients and used logistic regression models to identify predictor variables for enrollment in the service compared to those receiving standard treatment. Patients were mostly males (77.8%), younger than 39 years (80%), of college or higher education (68.2%), and diagnosed with schizophrenia (46.7%) or schizoaffective disorder (48.9%). About one-quarter (22.7%) had a comorbid cannabis use disorder. A majority received more than one oral antipsychotic (75.6%) while half (51.1%) were maintained on a long-acting injectable (LAI) antipsychotic. The following variables were significant predictors of enrollment in PROP: having a comorbid cannabis use disorder (OR 2.83 [1.25 - 6.37]), being prescribed a LAI antipsychotic (OR 9.99 [4.93-20.24]) or more than one oral antipsychotic (OR 4.57 [2.22-9.39]), visiting the emergency department more than once (OR 8.7 [2.64-28.68]), and admission to the psychiatry unit (OR 13.91 [3.17-60.94]). In addition, those following up in PROP were younger and less likely to be in the oldest age group (over 54 years) [OR 0.11 (0.01-0.93)], less likely to be females (OR 0.39 [0.18-0.81]), and less likely to be diagnosed with "other psychotic disorder" as compared to schizophrenia (OR 0.14 [0.03 - 0.62]). Our findings highlight that the assertive outreach model of care is applicable to its target population in the context of psychiatric care in Lebanon, namely young individuals with psychosis, higher comorbidities and a severe course of illness.
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Affiliation(s)
- Ghida Kassir
- Department of Psychiatry, American University of Beirut, Beirut, Lebanon
| | - Samer El Hayek
- Department of Psychiatry and Behavioral Sciences, University of Miami Miller School of Medicine, Miami, Florida, United States of America
| | - Raghid Charara
- Center for Behavioral Health, Neurological Institute, Cleveland Clinic, Cleveland, Ohio, United States of America
| | - Michele Cherro
- Department of Psychiatry, American University of Beirut, Beirut, Lebanon
| | - Hala Itani
- Department of Psychiatry, American University of Beirut, Beirut, Lebanon
| | - Joseph El Khoury
- Department of Psychiatry and Behavioral Health, American Hospital Dubai, Dubai, United Arab Emirates
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