Assessing and Managing Mental Health Problems through Frontline Health Functionaries in Alwar of Rajasthan- A Pilot Study

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Promotion of mental health and well-being is recognized as health priorities within the global development agenda. The Sustainable Development Goal (SDG) 3 of the SDGs is to: Ensure healthy lives and promote well-being for all at all ages. Target 3.4 requests that countries: “By 2030, reduce by one third premature mortality from noncommunicable diseases through prevention and treatment and promote mental health and well-being.” Within Target 3.4, suicide rate is an indicator (3.4.2). Ayushman Bharat has included “screening and basic management of mental health ailments in the expanded range of services at Health and Wellness Center (HWC). The National Mental Health Policy focus is on enhancing availability of skilled human resources for mental health. Keeping in view scarcity of human resources for mental health in India (0.29 Psychiatrists per 100,000 population) it is an opportunity for skill upgradation of frontline health workers in mental health to provide services at the community level. Assessing and Managing Mental Health Problems through Frontline Health Functionaries in a District of Rajasthan- A Pilot Study was implemented with the financial support of Indian council of Medical Research (ICMR), New Delhi, India and technical support from University of Chester, UK. The objective of the study was to assess the change in identifying, detecting and managing mental health problems with frontline health functionaries in implementation and comparison areas.
The study was a quasi-experimental “Study and Comparison Group Pre-test/Post-test Design”, implemented in two primary health centers in Rajgarh block of Alwar district in Rajasthan, India. The frontline health workers were trained using digital technology, namely Global Mental Health Assessment Tool (GMHAT), developed by Prof. Vimal Sharma and Prof Copeland. Android based version in Hindi was developed and used for the study. It deals with epilepsy, depression, worries, anxiety, concentration, depressed mood, loss of interest, sleep, appetite, weight gain/ loss, libido, schizophrenia, hypochondriasis, obsession compulsion behavior, phobia, mania, disorientation, thought disorder, psychotic symptoms, alcohol and drug misuse, suicidal tendencies, and stressors.
The frontline health workers did not expose to any training on mental health issues before the study and even till December 2018 non-intervention areas. The frontline health workers conducted a total of 918 interviews using GMHAT. Of these, 84 (9%) were diagnosed by one or another mental illness, and 72 (8%) were validated by the Experts (Psychiatrists). Knowledge of mental health disorders before and after among people has been increased by six percentage points in the intervention areas as compared to no change in the non-intervention areas from pre-test to post-test results. The results were disseminated at the international conference, supported by World Psychiatric Association, South Asia Self Harm Initiative, and Indian Psychiatric Society.
The GMHAT study claim that this is an easy to use, comprehensive clinical diagnostic tool that takes about 15-20 minutes to administer. It then provides a clinically relevant output that assists in making good judgement in order to provide the correct treatment and care. A tool can only be useful if it serves the purpose it was intended for. In other words, GMHAT accessibility, ease of use and adding value to clinical decision making are important factors in determining its usefulness in routine practice of frontline workers. The findings of this survey are encouraging that most of the users found GMHAT easy to use. They also felt that in the era of advanced technology and computers have become an integral part of health care delivery systems such digital mechanisms are necessary where senior level experts are not easy to access physically. The frontline health workers not only diagnose but seek expert advice through telecommunication - video calling through skype in their district or state or anywhere in the world. This way, stigma and stereotype behavior may be countered by providing the services at their doorstep or nearby vicinity.
GMHAT based training may be incorporated in mental health assessment as integral part of their day to day work and assessment is one of the ways forward in meeting this need.



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