India’s innovative approach to mental healthcare explored

A new University of Liverpool study has identified innovative mental healthcare models being used in India, which have the potential to create profound positive change if implemented at scale.

In low- and middle- income countries, very few mentally ill people receive formal mental healthcare, due to scarce specialist resources and large inequities and inefficiencies in resource allocation. Given the lack of specialist mental healthcare in India, a variety of different community mental healthcare models have evolved over time, yet until now there has been no comprehensive review of the models in use.

This study, published in PLoS ONE, comprehensively explored and compared Indian models of mental healthcare and health workers’ roles within these. Exploring these models and their human resources is important to identify innovative strategies that could be implemented at scale.

Seventy two programmes across twelve states were visited. 246 primary- and community-care workers and associated supporting staff were interviewed to understand the programme structure, the model of mental health delivery and health workers’ roles.

Programmes were categorised using an existing framework of collaborative and non-collaborative models of primary mental healthcare. A new model was identified: the specialist community model, whereby lay health workers are trained within specialist programmes to provide community support and treatment for those with severe mental disorders.

Study author Dr Nadja van Ginneken, from the University’s Institute of Psychology Health and Society, commented: “Indian models differ significantly to those currently in high-income countries, with less reliance on specialists and doctors across all models. Instead there are some innovative use of lay health workers and care managers (intermediary links between lay workers and doctors) which provide better access to health care whilst maintaining a sustainable and scalable form of supervision. All countries, even high-income countries, could learn from these models.”

“Based on our review and findings we propose a revised framework of models for mental healthcare in India. We also advocate for several models to be used. For example a model with greater specialist involvement may be warranted for severe mental disorders though these models need further evaluation.”

The next steps are to evaluate the comparative effectiveness, cost-effectiveness and scalability of these models in resource-limited settings both in India and in other low- and middle- income countries.

The research was supported by a Wellcome Trust Clinical PhD fellowship and carried out in collaboration with the London School of Hygiene and Tropical Medicine (UK), Sangath (India), the National Institute of Mental Health and NeuroSciences (India), Yale University (USA) and Harvard Medical School (USA).


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