Sir,
Depression is an illness that affects both the mind and the body. According to the latest estimates, more than 300 million people are living with depression globally with an increase of more than 18% between 2005 and 2015.[1] Lack of support for people with mental disorders, coupled with a fear of stigma, prevent many from accessing the treatment they need to live healthy, productive lives.[2]
According to a recent report by the World Health Organization, 56 million, i.e., 4.5% of Indians suffer from depression and another 38 million i.e., 3.5% Indians suffer from anxiety disorders.[3] The community psychiatry movement, which attempted to bring mental healthcare to people living in the community, started many decades ago.[4] However, its impact on the delivery of such care in India has been marginal. The current re-strategized National Mental Health Programme too is a long way from the vision of integration of mental health services into primary care.[5] The situation is dismal as not more than 10% of those who need mental healthcare are not receiving the required help with the existing services.[6] We document, here, successful experience of integrating mental health into primary care for addressing the problem of depression in a village.
Kheri is a village in Raipur Rani Block of district Panchkula, Haryana, North India with a total population of 1634 and adult population of around 800. The village is served by a health centre under the Department of Community Medicine, PGIMER, Chandigarh, providing primary healthcare services to the villagers by the resident doctors. On World Health Day, 2017, based on theme of “Depression-let's talk”, a screening cum awareness camp for depression was organized by involving the district health authorities and local administration, and awareness was created about the problem of depression – how common it is, how to suspect and whom to contact. The participants were informed about the availability of the psychiatric services at the health center. They were encouraged to be open about it and consult if required.
Following this, community-based screening for depression was instituted in the village. All the villagers ≥18 years coming to the health center for any illness were screened by the community medicine resident doctor and a trained female health worker done the screening though house to house visits. A validated screening tool, Physical Health Questionnaire-9 (PHQ-9),[7] in the local language (Hindi) was used.
A total of 250 individuals aged between 18–70 years consented and were screened. Of these, 86 (34.4%) scored ≥10 in the PHQ-9 scale and were labeled as screen positives. These screen positive cases were counseled and were advised to consult the Psychiatrist visiting the village every week. A total of 56 (65.1%) screen-positive individuals consulted the psychiatrist and 54 (96.4%) out of the 56 screen positives were confirmed as having depressive disorder as per ICD-10 criteria. Among them, two individuals had past history of depressive disorder but were not taking treatment. An arrangement was made with the nearest Community Health Centre to provide free medicines to the patients. Patients were advised follow-up every week/fortnight at the health center according to their status of illness. At the end 3 months, out of the 54 patients diagnosed and started on treatment, 40 (74.1%) were regularly taking the prescribed medications and all reported significant improvement in their symptoms. All the individuals also received counseling and behavior therapy by a psychiatric social worker at follow-up.
Our current experience of integrating mental healthcare into primary care successfully addressed the major gap in diagnosis and treatment of depression in a rural population. Integrating mental health services into primary care is the most viable way of closing the treatment gap for mental health and ensuring that people get the mental healthcare they need.[8] Our experience shows that this integration can easily be achieved with desirable success and can successfully address the large mental healthcare gap prevalent in the country.
Financial support and sponsorship
Nil.
Conflicts of interest
There are no conflicts of interest.
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