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LETTERS TO EDITOR  
Year : 2019  |  Volume : 61  |  Issue : 3  |  Page : 319-321
Integrating mental health into primary care for addressing depression in a rural population: An experience from North India


1 Department of Community Medicine, School of Public Health, PGIMER, Chandigarh, India
2 Department of Psychiatry, PGIMER, Chandigarh, India

Click here for correspondence address and email

Date of Web Publication16-May-2019
 

How to cite this article:
Bashar M A, Mehra A, Aggarwal AK. Integrating mental health into primary care for addressing depression in a rural population: An experience from North India. Indian J Psychiatry 2019;61:319-21

How to cite this URL:
Bashar M A, Mehra A, Aggarwal AK. Integrating mental health into primary care for addressing depression in a rural population: An experience from North India. Indian J Psychiatry [serial online] 2019 [cited 2019 Aug 18];61:319-21. Available from: http://www.indianjpsychiatry.org/text.asp?2019/61/3/319/258330




Sir,

Depression is an illness that affects both the mind and the body. According to the latest estimates, more than 300 million people are living with depression globally with an increase of more than 18% between 2005 and 2015.[1] Lack of support for people with mental disorders, coupled with a fear of stigma, prevent many from accessing the treatment they need to live healthy, productive lives.[2]

According to a recent report by the World Health Organization, 56 million, i.e., 4.5% of Indians suffer from depression and another 38 million i.e., 3.5% Indians suffer from anxiety disorders.[3] The community psychiatry movement, which attempted to bring mental healthcare to people living in the community, started many decades ago.[4] However, its impact on the delivery of such care in India has been marginal. The current re-strategized National Mental Health Programme too is a long way from the vision of integration of mental health services into primary care.[5] The situation is dismal as not more than 10% of those who need mental healthcare are not receiving the required help with the existing services.[6] We document, here, successful experience of integrating mental health into primary care for addressing the problem of depression in a village.

Kheri is a village in Raipur Rani Block of district Panchkula, Haryana, North India with a total population of 1634 and adult population of around 800. The village is served by a health centre under the Department of Community Medicine, PGIMER, Chandigarh, providing primary healthcare services to the villagers by the resident doctors. On World Health Day, 2017, based on theme of “Depression-let's talk”, a screening cum awareness camp for depression was organized by involving the district health authorities and local administration, and awareness was created about the problem of depression – how common it is, how to suspect and whom to contact. The participants were informed about the availability of the psychiatric services at the health center. They were encouraged to be open about it and consult if required.

Following this, community-based screening for depression was instituted in the village. All the villagers ≥18 years coming to the health center for any illness were screened by the community medicine resident doctor and a trained female health worker done the screening though house to house visits. A validated screening tool, Physical Health Questionnaire-9 (PHQ-9),[7] in the local language (Hindi) was used.

A total of 250 individuals aged between 18–70 years consented and were screened. Of these, 86 (34.4%) scored ≥10 in the PHQ-9 scale and were labeled as screen positives. These screen positive cases were counseled and were advised to consult the Psychiatrist visiting the village every week. A total of 56 (65.1%) screen-positive individuals consulted the psychiatrist and 54 (96.4%) out of the 56 screen positives were confirmed as having depressive disorder as per ICD-10 criteria. Among them, two individuals had past history of depressive disorder but were not taking treatment. An arrangement was made with the nearest Community Health Centre to provide free medicines to the patients. Patients were advised follow-up every week/fortnight at the health center according to their status of illness. At the end 3 months, out of the 54 patients diagnosed and started on treatment, 40 (74.1%) were regularly taking the prescribed medications and all reported significant improvement in their symptoms. All the individuals also received counseling and behavior therapy by a psychiatric social worker at follow-up.

Our current experience of integrating mental healthcare into primary care successfully addressed the major gap in diagnosis and treatment of depression in a rural population. Integrating mental health services into primary care is the most viable way of closing the treatment gap for mental health and ensuring that people get the mental healthcare they need.[8] Our experience shows that this integration can easily be achieved with desirable success and can successfully address the large mental healthcare gap prevalent in the country.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
   References Top

1.
Depression. Key Facts. Available from: http://www.who.int/news-room/fact-sheets/detail/depression. [Last accessed on 2018 Aug 21].  Back to cited text no. 1
    
2.
Depression: Let's talk” Says World Health Organization, as Depression Tops Causes of Ill Health. News Release. Geneva. Available from http://www.who.int/news-room/detail/30-03-2017--depression-let-s-talk-says-who-as-depression-tops-list-of-causes-of-ill-health. [Last accessed on 2018 Aug 21].  Back to cited text no. 2
    
3.
World Health Organization. Depression and Other Common Mental Disorders: Global Health Estimates. Geneva: World Health Organization; 2017.  Back to cited text no. 3
    
4.
Jacob KS. Community mental health in India. Indian J Psychiatry 2013;55:209.  Back to cited text no. 4
  [Full text]  
5.
Padmavathi R, Rajkumar S, Srinivasan TN. Schizophrenic patients who were never treated – a study in an Indian urban community. Psychol Med 1998;28:1113-7.  Back to cited text no. 5
    
6.
Murthy RS. The national mental health programme: Progress and problems. In: Agarwal SP, editor. Mental Health an Indian Perspective 1946-2003. Ch. 7. New Delhi: Directorate General of Health Services, Ministry of Health and Family Welfare. 2004. p. 75-91.  Back to cited text no. 6
    
7.
Kroenke K, Spitzer RL, Williams JB, Löwe B. The patient health questionnaire somatic, anxiety, and depressive symptom scales: A systematic review. Gen Hosp Psychiatry 2010;32:345-59.  Back to cited text no. 7
    
8.
World Health Organization, & World Organization of National Colleges, Academies, and Academic Associations of General Practitioners/Family Physicians. Integrating Mental Health into Primary Care: A Global Perspective. Geneva, Switzerland: World Health Organization; 2008.  Back to cited text no. 8
    

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Correspondence Address:
Dr. M A Bashar
Department of Community Medicine, School of Public Health, PGIMER, Chandigarh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/psychiatry.IndianJPsychiatry_374_18

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