Video conferencing, mobile apps may be the answer to rural India’s mental health care problem. They are low cost, can be scaled and are location agnostic.
For many years, Palani Selvakumar had trouble eating and sleeping. He couldn’t work and would stay in bed all day. He would imagine and hear things — he suspected his wife of having an affair, abused her verbally, and even hit her on that premise. He had no real relationship with his children as he hardly ever spoke to them.
Finally, help came in the form of a local health worker (LHW) who visited Selvakumar’s home in 2010, spoke to him about his mental health and referred him to Schizophrenia Research India’s (SCARF) mobile bus clinic.
Rural India is a dark place for those with mental health problems. Awareness is low and there is hardly any psychiatric help available
Rural India is a dark place for those with mental health problems. Awareness is low and there is hardly any psychiatric help available. Because of this, mental illnesses remain undiagnosed and patients don’t receive treatment for years. Shockingly, 75% of India’s 3,800 psychiatrists work in urban areas where just 31% of the country’s population lives.
Jammu and Kashmir has only two mental health hospitals. India’s northeast, which comprises seven states, has only one mental health hospital. A recent survey conducted by Medecins Sans Frontieres (MSF or Doctors Without Borders) found that nearly 1.8 million adults (45% of the population) in the Kashmir Valley show symptoms of significant mental distress.
The National Mental Health Programme (NMHP) and the District Mental Health Programme (DMHP) were launched in 1982 and 1996 respectively to provide mental health services. “The government implemented the DMHP in 250 districts, but it wasn’t successful in even one district due to lack of trained psychiatrists, psychiatric workers and nurses,” says Dr G Prasad Rao, president of the Indian Psychiatric Society and Director, Schizophrenia and Psychopharmacology Division, Asha Hospital.
The new National Mental Health Care Bill, 2013, which was passed in the Rajya Sabha recently, promises universal access to mental healthcare to all by 2020. This may very well be impossible because India lacks the necessary personnel, infrastructure and investments needed to achieve this.
One of the main ways to strengthen this mandate is by harnessing technology to supplement, or in some cases, supplant conventional methods of delivering mental health services. The new mental health care bill, recognises this, and talks of the need to leverage “…use of appropriate technology” to provide appropriate mental health care to the people of India.
“We see great potential in harnessing technology to reach out to the millions of unreached in underserved communities”
– Dr N Manjunatha, NIMHANS
The timing is ripe to expand the use of technology — low-cost mobile phones, smartphones and handheld devices — to diagnose mental illnesses and deliver health care. According to a paper titled “Mobile mental health care — an opportunity for India” by Peter Yellowlees and Steven Chan, published in the Indian Journal of Medical Research, mobile applications may be a viable solution to rural India’s mental health care problem. They are low cost, enable real-time collection of data and feedback, can be scaled and are location agnostic.
The George Institute for Global Health, a private non-profit, launched a pilot initiative called the SMART Mental Health programme in 2014 to test the effectiveness of digital mental health applications using tablets to gauge depression, stress and suicidal risk in rural patients.
They have screened 28,000 people in 42 villages in West Godavari district of Andhra Pradesh for common mental health disorders and found that about 5% of the population needs clinical intervention. These people have been referred to local PHCs for treatment. Those suffering from severe mental health disorders were referred to the closest district hospital with a psychiatrist.
Mobile apps may be a viable solution to rural India’s mental health care problem. They are low cost, enable real-time collection of data and feedback, can be scaled and are location agnostic