Impact Evaluation of Technology Driven Mental Health Capacity Building in Bihar, India

Barikar C. Malathesh, Department of Psychiatry, AIIMS – Bibinagar, Hyderabad, India
Bhavya K. Bairy, Department of Psychiatry, NIMHANS Digital Academy, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
Channaveerachari Naveen Kumar, Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, 560029, India
P Lakshmi Nirisha, Department of Psychiatry, Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
Gopi V. Gajera, Department of Psychiatry, Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
Praveen Pandey, Department of Psychiatry, Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
Narayana Manjunatha, Department of Psychiatry, Tele Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
Aurobind Ganesh, Department of Psychiatry, NIMHANS Digital Academy, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
Kanika Mehrotra, Department of Psychiatry, NIMHANS Digital Academy, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
Binukumar Bhaskarapillai, Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
Durai Murukan Gunasekaran, Department of Biostatistics, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India
Sanjeev Arora, Distinguished Professor of Medicine, University of New Mexico School of Medicine, Albuquerque, NM, USA
Narendra Kumar Sinha, Department of Health & Family Welfare, Government of Bihar, Patna, Bihar, India
Suresh Bada Math, Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India

Document Type

Article

Publication Date

9-12-2021

Abstract

Task-shifting is an important means to address the barrier of inadequate specialist human resources for mental health in countries such as India. This paper aims to report the impact of one such task-shifting initiative. Twenty-two non-specialist Medical Officers of Bihar, an eastern Indian state were engaged in a ten-month long hybrid (a 15-days onsite orientation to psychiatry and periodic online mentoring in primary care psychiatry) training program to enable them to identify commonly presenting psychiatric disorders in their respective clinics. 20 online sessions (hub and spoke ECHO model) occurred over the next 10 months. Apart from didactic topics, 75 cases covering severe mental disorders, common mental disorders and substance use disorders were discussed (case presentations by the primary care doctors (PCDs)) and moderated by a specialist psychiatrist and clinical psychologist). 12 successive self-reported monthly reports (comprising of the number and nature of psychiatric cases seen by the trainee PCDs) were analyzed. The mean (SD) number of sessions attended was 9 (8.0) and median was 13 (Range: 0–20). Mean number of cases (per PCD) discussed was 3.4 (3.4) (Median: 4; Range: 0–10). Total 20,909 patients were cared for in the 12 months after initiation of the training program. Increasingly, a greater number of patients were cared for as the training progressed. This pattern was mainly driven by more identifications of severe mental disorders (SMDs), common mental disorders (CMDs), dementias and substance use disorders. Mean (SD) number of patients seen per month before and after training was 1340.33 (86.73) and 1876.44 (236.51) (t =  − 3.5, p < 0.05) respectively. A hybrid model of training PCDs is feasible and can be effective in identification of persons with psychiatric disorders in the community. Prospective, well designed studies are essential to demonstrate the effectiveness of this model.

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