Reducing mental health gap: Reaching out to the unreached

Volume 5 Issue 8 August 2015

World health organization (WHO) estimates that 12% of global burden of disease is accounted by mental and behavioral disorders. A WHO survey showed that 76%–85% in lower and middle income countries (LAMICs) had received no treatment in the previous 12 months. The three main reasons for this mental health gap (mhGAP) are scarcity of resources, inequitable distribution and inefficient utilization of available resources.

There is a need to train more mental health professionals and ensure their equitable distribution within the country to cater to the needy in the Government setup. Existing mental health professionals and services are concentrated in big cities and institutions. As mental health services are unavailable in primary health care, many patients travel long distances to cities to consult psychiatrists. Expenses incurred in travelling, consulting psychiatrists and purchasing medications are barriers in accessing mental health services.

WHO states that majority of mental health care can be managed by self or informal community mental health services or primary health care. Such settings score over specialized mental hospitals in terms of cost and accessibility to the population. We need to replicate success of our neighboring countries in providing mental health services at general hospitals (Nepal) and community (Sri Lanka).

One of the important barriers in providing mental health services in primary health care is competence of MBBS doctors in diagnosing and treating mental disorders. Concerted efforts are needed to improve the quality of psychiatry training in undergraduate medical curriculum to handle this issue. Administration needs to ensure continuous availability of essential psychotropic medications at PHC. In addition, referral systems need to be in place for managing more complicated cases which cannot be managed at PHC.

Experience in implementation of National Mental Health Program (NMHP) has important lessons for future. Experts have pointed out that efficient leadership, creating awareness among users, coordination among various stakeholders, continuous monitoring at ground level and early trouble shooting are required for successfully delivering services.

We need to focus resources to widen the base of ‘WHO Service Organization Pyramid for an Optimal Mix of Services for Mental Health’ (WHO 2007) in a systematic and planned manner (as shown in above figure). It is the right of every Indian citizen to have affordable, accessible and quality mental health care.