Change in attitude of ASHAs towards persons with mental illnesses following participation in community based rehabilitation project

James, Joseph W.; Sivakumar, Thanapal; Kumar, Channaveerachari Naveen; Thirthalli, Jagadisha

doi:10.1016/j.ajp.2019.09.031

Cited by 11 publications

(13 citation statements)

References 21 publications

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“…Twenty-three (59%) studies provided interventions that addressed common mental disorders (CMD) (24, 25, 29, 34-36, 38, 39, 41-43, 47-49, 52, 54, 55, 57, 67-71), five (13%) addressed severe mental illness (26,27,30,37,40), and 10 studies (26%) addressed both common and severe illnesses (28,31,33,44,45,49,50,53,56,58). Thirty-six studies (92%) provided training to participants face-to-face (24-28, 31, 33-58, 67-70) and eight (21%) used digital technology and web-based training (24, 28-30, 50, 67, 68, 71).…”

Section: Synthesis Of Resultsmentioning

confidence: 99%

Educational and Training Interventions Aimed at Healthcare Workers in the Detection and Management of People With Mental Health Conditions in South and South-East Asia: A Systematic Review

et al. 2021

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Background: To bridge significant mental health treatment gaps, it is essential that the healthcare workforce is able to detect and manage mental health conditions. We aim to synthesise evidence of effective educational and training interventions aimed at healthcare workers to increase their ability to detect and manage mental health conditions in South and South-East Asia.Methods: Systematic review of six electronic academic databases from January 2000 to August 2020 was performed. All primary research studies were eligible if conducted among healthcare workers in South and South-East Asia and reported education and training interventions to improve detection and management of mental health conditions. Quality of studies were assessed using Modified Cochrane Collaboration, ROBINS-I, and Mixed Methods Appraisal Tools and data synthesised by narrative synthesis. Results are reported according to Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines. A review protocol was registered with the PROSPERO database (CRD42020203955).Findings: We included 48 of 3,654 screened articles. Thirty-six reported improvements in knowledge and skills in the detection and management of mental health conditions. Training was predominantly delivered to community and primary care health workers to identify and manage common mental health disorders. Commonly used training included the World Health Organization's mhGAP guidelines (n = 9) and Cognitive Behavioural Therapy (n = 8) and were successfully tailored and delivered to healthcare workers. Digitally delivered training was found to be acceptable and effective. Only one study analysed cost effectiveness. Few targeted severe mental illnesses and upskilling mental health specialists or offered long-term follow-up or supervision. We found 21 studies were appraised as low/moderate and 19 as high/critical risk of bias.Interpretation: In low resource country settings, upskilling and capacity building of primary care and community healthcare workers can lead to better detection and management of people with mental health disorders and help reduce the treatment gap.Systematic Review Registration:https://www.crd.york.ac.uk/prospero/, identifier CRD42020203955.

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Section: Synthesis Of Resultsmentioning

confidence: 99%

Educational and Training Interventions Aimed at Healthcare Workers in the Detection and Management of People With Mental Health Conditions in South and South-East Asia: A Systematic Review

et al. 2021

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“…We have demonstrated that engaging ASHAs in the identification, referral, and treatment of persons with SMI positively changes their attitudes toward persons with mental illness. 12 A proportion of ASHAs have proactively identified patients with SMI and referred them for treatment. After initiating treatment, ASHAs are supervising treatment and following up the patients.…”

Section: Background Of Existing Workmentioning

confidence: 99%

“…Illness (CAMI) 21 : It consists of four subdomains namely authoritarianism, benevolence, social restrictiveness, and community mental health ideology total of 40 items, measured on a 5-point scale. This scale has been used in Indian studies (James et al, 2019). The investigators have obtained permission from the authors for translation into Kannada and use them in studies at our center.…”

Section: Community Attitude Toward Mentalmentioning

confidence: 99%

“…We have demonstrated that engaging ASHAs in the identification, referral, and treatment of persons with SMI positively changes their attitudes toward persons with mental illness. 12…”

Section: Background Of Existing Workmentioning

confidence: 99%

“…11 ASHAs are not paid an honorarium for working with persons with mental illness. 12 Assuming that an ASHA covers a village of 1,000 people, there are likely to be 7 persons with SMI. 13 SMI is relatively easy to identify, treat with available resources, and result in a reduction of disability and meaningful work functioning.…”

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confidence: 99%

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Community-Based Rehabilitation for Persons with Severe Mental Illness in a Rural Community of Karnataka: Methodology of a Randomized Controlled Study

Sivakumar

Thirthalli

Kumar

et al. 2020

Indian Journal of Psychological Medicine

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Background: Task shifting has been recommended as a strategy to reach out to persons with mental illness and bridge the treatment gap. There is a need to explore task-shifting using existing health staff like Accredited Social Health Activists (ASHAs). Aim and Context: ASHAs are involved in ongoing community-based rehabilitation (CBR) program run with a public–private partnership over the last 5 years at Jagaluru Taluk (an administrative block) in Davanagere district (Karnataka, India). This article aims to summarize a randomized controlled trial (RCT) to examine whether CBR delivered by ASHAs is more effective than treatment as usual (TAU) control group in reducing disability associated with severe mental illness (SMI). Method: A group of proactive ASHAs is already working with us for a follow-up of persons with SMI. For the study, we would allocate areas that are currently not being covered proactively by ASHAs randomly in a 1:1 ratio via computer-generated randomization list to receive either ASHAs delivered CBR arm or TAU control group. A sample size of about 100 in each arm is enough to identify an effect size of 0.5 in total IDEAS score between the intervention and control arms with a power of 90% and an alpha of 0.05. We use the SPIRIT (Standard Protocol Items: Recommendations for Interventional Trials) statement to describe the methods of the trial. Result: The study has been approved by the institute ethics committee and registered with CTRI (CTRI/2019/08/020585 dated 6th August 2019). The recruitment of subjects is ongoing. The patients will be followed up for 1 year and assessed. The trial is funded by the Indian Council of Medical Research, Government of India. Discussion: The results of the study will be helpful from a public health perspective in delivering cost-effective and replicable CBR for persons with SMI through ASHAs. If the model turns successful, this could be expanded throughout the state/country. This would go a long way in bridging the huge treatment gap.

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Feasibility testing of a peer support programme for prisoners with common mental disorders and substance use

Thekkumkara

Jagannathan

Muliyala

et al. 2023

Criminal Behav Ment Health

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Background The prevalence of mental disorders and substance use among prisoners is high. Convicted prisoners of ‘good behaviour’ can be part of a peer support system in prisons. Aim To evaluate the feasibility of a peer support programme for prisoners with common mental disorders and substance use in prison. Method The study used a mixed method research design, with a quasi‐experimental approach (single group pre‐post without control). It was conducted in two phases: Phase I. Thirty‐five peers/convicted prisoners were recruited through advertisements on the prisoners' community radio station. Volunteers with good behaviour reports were given training over 5 days to recognise mental and substance use disorders and provide basic peer support in prison; their attitudes and knowledge were tested before and after the training. Phase II. Feasibility of the peer support programme was tested by (i) recording the number of cases identified and referred, (ii) pre‐ and post‐evaluation of well‐being, coping, and symptom severity of those supported and (iii) evaluating qualitatively the experience of the peer supporters and service users. Results Thirty‐five peer supporters identified 49 cases over 3 months. These cases showed significant improvement in well‐being (Z −1.962; p < 0.050) and reduction in symptom severity (Z −1.913; 0.056). There was a significant improvement in the peers supporters' self‐esteem from pre‐ to post‐training (t −3.31; p < 0.002), improvement in their benevolence (t −4.37; p < 0.001) and a significant reduction in their negative attitudes to mental illness (Z −3.518; p < 0.001). A thematic model of peer support encompassed self‐experienced benefits for the peer supporter, wider recognition of peer supporters in the prison, challenges to this kind of support, experience of training and visions for future work. Conclusion The peer support programme was experienced positively by the peer‐supporters and supported. Common mental disorders, substance use and suicidality were recognised and appropriately referred. A full‐scale evaluation of this promising programme is warranted.

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Change in attitude of ASHAs towards persons with mental illnesses following participation in community based rehabilitation project

Cited by 11 publications

References 21 publications

Educational and Training Interventions Aimed at Healthcare Workers in the Detection and Management of People With Mental Health Conditions in South and South-East Asia: A Systematic Review

Educational and Training Interventions Aimed at Healthcare Workers in the Detection and Management of People With Mental Health Conditions in South and South-East Asia: A Systematic Review

Community-Based Rehabilitation for Persons with Severe Mental Illness in a Rural Community of Karnataka: Methodology of a Randomized Controlled Study

Feasibility testing of a peer support programme for prisoners with common mental disorders and substance use

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