Policy Symposium on SMART Mental Health Project

Background

The recent National Mental Health Survey in India estimated the lifetime prevalence of any mental disorder among adults is about 15%, with nearly 150 million Indians in need of treatment. However, gaps in access to adequate health services for people with common mental disorders (depression, anxiety and increased risk of suicide) are large – estimated to be 75-85% in resource-limited settings such as India, with only around 4% of people with major depressive disorders receiving adequate care.

The George Institute for Global Health, India is currently conducting a Randomised Control Trial named “The Systematic Medical Appraisal, Referral and Treatment (SMART) Mental Health”, which is conceived as an implementation trial for improvement of mental health services in India, especially through primary care system. The aim is to evaluate clinical effectiveness and cost-effectiveness of a multifaceted primary healthcare worker intervention in 44 PHCs in Haryana and/or Telangana. This intervention package involves a community-based anti-stigma campaign and a mobile device based decision support system to improve management of adults at high risk of common mental health disorders.

Key Recommendations:

• As health is a state subject, we must work closely with the State governments in order to effectively translate the goals of the National Mental Health Program.  
• The delivery of mental health services can be aligned with the services being offered by the Health and Wellness Centres as part of the new comprehensive primary health care scheme prepared by the Government of India.   
• The primary objective of NMHP is to improve access of mental health services to the population by training and increasing primary healthcare workers. This aligns closely with SMART mental health programme of The George Institute for Global Health and there is a possibility of learning from each other.
• The National Mental Health program is giving a lot of emphasis to the anti-stigma campaign and development of IEC and multi-media material.  But this needs to be evaluated periodically so that we can know what works and what does not on the ground. This will help in scaling up the campaign and make it evidence-based.
• In order to meet the shortage of existing mental health manpower, a team approach involving the community health workers and primary health care doctors needs to be put in place so that the existing primary health care facilities are geared up to meet the rising burden of common mental disorders.