Community Workers Help to Bridge Treatment Gap in Mental Health
Thursday, February 16, 2012
A report in the Lancet last year concluded that improving access to effective mental healthcare could help to alleviate poverty. Mental healthwas framed as a “development priority”. But access to that crucial healthcare remains a barrier to many people in poor countries. While in Europe a third of people experiencing mental illness do not receive treatment, in developing countries the situation is much worse. In some countries, basic care eludes nine out of 10 people in need.
However, the largest psychiatry trial to be conducted in the developing world, the Manas intervention, convincingly demonstrated that training lay people can play a crucial role in helping to deliver effective care for depression and anxiety in resource-poor, primary healthcare settings.
Community healthcare programmes are not uncommon, and the Manas trial applied similar principles – training people to deliver basic care in their own communities – to mental health.
The randomised controlled trial was conducted in Goa, India, and involved more than 2,700 participants. After community consultation about the programme (which led to some changes in how the subject was addressed – for example, depression is explained as a stress-related illness), local people, mostly women, attended four-week training sessions on helping to manage depression, with an additional two weeks to cover specific disorders such as alcohol abuse. Typically, they are female university graduates, although it is envisaged that community members with a lower educational attainment will be used if the programme is scaled up.
On completing training, the community worker is based within the primary health centre and works alongside a primary care doctor, under the supervision of a psychiatrist. There are only 4,000 psychiatrists in India, serving a population of 1.3 billion. Shifting certain aspects of care to non-specialists allows specialists to achieve greater coverage of the population. Primary health centres are also easily accessible and are a far cry from the old psychiatric institutions that are heavily imbued with stigma.
Professor Vikram Patel, clinical psychiatrist and former Rhodes scholar, set up the trial, which found that patients receiving care experienced a 30% decrease in common mental disorders and were less likely to attempt suicide. There was also a substantial reduction in the number of days out of work due to illness. Patel insists armies of mental health professionals are not needed to provide care. Instead, he believes in “mental health for all, by all”.
- Health Care