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

Abstract

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.

Schizophrenia Assessment, Referral and Awareness Training for Health Auxiliaries (SARATHA): Protocol for a Mixed-Methods Pilot Study in Rural India

“…Our study also expands on other ongoing efforts in India aimed at building capacity among community health workers including ASHAs to support the community-based rehabilitation for persons with severe mental disorders. An ongoing study in Karnataka is evaluating whether a community-based rehabilitation program delivered by ASHAs in addition to normal treatment is more effective in reducing disabilities caused by severe mental disorders relative to usual treatment [ 56 ]. The secondary outcomes measured will include duration of clinical remission, work status and income, self-stigma, and community attitudes toward the person living with the illness.…”

Impact of incentivizing ASHAs on the outcome of persons with severe mental illness in a rural South Indian community amidst the COVID-19 pandemic

“…As part of ongoing CBR program, free mental health camps have been conducted fortnightly on Tuesdays at PHCs & the taluk hospital since August 2015 in partnership with the Government of Karnataka and NGOs. More details about Jagaluru taluk and the CBR program are described elsewhere ( Sivakumar et al, 2020 ).…”

Development of a Digital Program for Training Community Health Workers in the Detection and Referral of Schizophrenia in Rural India

“…In recent years, the workload for ASHAs has gradually shifted to cover more non-communicable disease (NCD) care services, including screening for common mental health conditions, such as depression, driven largely by the nationally roll out of the Ayushman Bharat initiative [ 41 ]. This has included efforts to build capacity of ASHAs for delivery of mental health services in community settings [ 42 , 43 ]. ASHAs represent the target group of community health workers in the SARATHA project, as they are ideally positioned to enable the scale up of brief interventions for mental disorders in primary care.…”