MAANASI - A sustained, innovative, integrated mental healthcare model in South India

Geetha Jayaram, Ramakrishna Goud, Suhas Chandran, Johnson Pradeep

Research output: Contribution to journalArticle

Abstract

Studies in low and middle-income countries (LMICs) point to a significant association of common mental disorders with female gender, low education, and poverty. Depression and anxiety are frequently complicated by lack of disease awareness and non-adherence, the absence of care and provider resources, low value given to mental health by policy-makers, stigma, and discrimination towards the mentally ill. This paper aims to show that female village leaders/community health and outreach workers (CHWs) can be used to overcome the lack of psychiatric resources for treatment of common mental disorders in rural areas. A multidisciplinary team was set up to evaluate and treat potential patients in the villages surrounding Mugalur, a primary health care center in rural South India. A programme of care delivery was planned, developed and implemented by: (a) targeting indigent women in the region; (b) integrating mental health care with primary care; (c) making care affordable and accessible by training local women as CHWs with ongoing continued supervision; and (d) sustaining the programme long-term. Indigenous CHWs served as a link between the center and the community. They received hands-on training, ongoing supervision, and were taught using an abridged but focused training module to identify common mental disorders, help treatment compliance, networking, illness literacy and community support for villages by outreach workers. They used assessment tools translated into the local language, and conducted focus groups and patient training programmes. As a result, mental healthcare was provided to patients from as many as 150 villages in South India. Currently the services are utilized on a regular basis by about 50 villages around the central project site. The current active caseload of registered patients is 1930. Empowerment of treated patients is the final outcome, assisting them in self-employment. Rural mental healthcare must be culturally congruent, and must integrate primary care, using local CHWs for success. Training, supervision, ongoing teaching of CHWs, on-site resident medical officers, research and outreach are essential to the continued success over two decades.

Original languageEnglish (US)
Pages (from-to)104-113
Number of pages10
JournalDisability, CBR and Inclusive Development
Volume30
Issue number2
DOIs
StatePublished - Jun 1 2019

Keywords

  • Caseworkers
  • Community health care workers
  • Global mental health
  • Integrated care
  • Psychiatric care
  • Rural mental health

ASJC Scopus subject areas

  • Research and Theory
  • Fundamentals and skills
  • Community and Home Care

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