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Connecting urban psychiatry with rural India

by Guest Author on 11 Dec 2018

Alison Garber - Author

Alison Garber

In India, more than 75% of people experiencing mental illness have no access to mental healthcare. Working with the Sangath organisation in Goa, Research Assistant Alison Garber explains how she’s hoping to provide healthcare from a distance for people in rural communities.

Meet Priya*, a 25-year-old woman who lives in a remote village in Goa, India. Ever since her adolescence, she’s been experiencing severe mental health issues that deeply affect her family. She breaks objects at home and hurts herself by hitting her hands and legs repeatedly. The family have travelled great distances seeking help, but with no success. They are growing increasingly desperate.

Connecting with remote patients

My aim is to help people like Priya by bringing mental healthcare to inaccessible settings. I’m part of a team implementing a project that aims to use technology, primarily video conferencing, to connect patients in rural areas of Goa to psychiatrists practising in urban areas. India’s remarkably wide network of connectivity makes this intervention promising, with great potential.

Unfortunately, Priya’s story is one of many. One of the main obstacles between patients and the care they need is geographical: while 70% of mental health professionals work in cities, 70% of the Indian population lives in rural areas.

Providing the right support

Our ‘Improving Access to Telepsychiatry’ programme (IMPACT) uses technology to bridge the mental health treatment gap. It relies on innovative solutions such as task-sharing – training lay health workers in delivering basic mental healthcare – and focusing on community-based care.

In the first phase of our research, we reviewed previous and current mental health interventions delivered through technology. We interviewed experts and potential patients about our programme, trained lay health workers and developed a series of tools for data collection.

Testing the technology

We’re now in the second phase: an uncontrolled treatment cohort study examining the acceptability and feasibility of telepsychiatry in our settings. We’re recruiting at the moment, and have begun conducting telepsychiatry sessions in which patients access both a psychiatrist and a trained lay health worker.

A patient, counselor, and family member in the consultation room and psychiatrist seen on the laptop

A patient, counsellor, and family member in the consultation room and psychiatrist on the laptop

Our psychiatrist delivers psychiatric care and prescribes medications whenever appropriate. And our lay health worker delivers counselling sessions and acts as a link between the patient and the psychiatrist.

Patients with a range of mental health problems have already accessed our service, including patients with depression, anxiety disorders and alcohol-use disorders. We’re able to meet our patients in community settings, including through a clinic set up in a local school. Sangath has provided the laptop and internet connection.

Sangath health assistants set up the technology in the clinic or the patients home. In this way, patients are not required to own any sort of technology or know how to use it. We also envision a future model in which patients and their family members can use their personal devices to connect to psychiatric services.

Overcoming challenges

We’re running up against some supply and demand barriers, such as stigma against mental health problems, and unreliable internet connectivity due to limited bandwidth in remote areas. But despite that, the intervention has been well-received.

In the coming months, we’ll continue recruiting and working with patients in Goa, to test the technology. Our hope is that this approach could also be used outside of Goa, in other low-resource areas, to get treatment to more patients like Priya who have been struggling to find it.

Headed by Professor Richard Velleman and Dr Abhijit Nadkarni, IMPACT is run by Sangath and funded by the MRC, the UK Department for International Development, the Global Challenges Research Fund, the National Institute for Health Research and Wellcome.

*name changed for this blog

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