Embracing Technology for Capacity Building in Mental Health: New Path, Newer Challenges

Community Ment Health J

Kulal

et al. 2022

Self Cite

Mental health task shifting is a potential way to address the burgeoning treatment gap for mental illness. Easily available and accessible digital technology can be utilised to continuously engage grassroot level health workers (for example, Accredited Social Health Activists (ASHAs). However, the impact of such a strategy is not yet systematically evaluated. In this randomised controlled trial, longitudinal hybrid training of ASHAs [1 day in-person classroom training and seven online sessions (ECHO model), aimed to screen and refer to commonly prevalent mental health issues in communities] was compared with traditional one-day in-person classroom training. ASHAs (n = 75) from six Primary Health Centres in Ramanagara district, Karnataka, India were randomized into study (SG-ASHAs) and control (CG-ASHAs) groups. After excluding drop-outs, 26 ASHAs in each group were included in the final analysis of the scores on their Knowledge, attitude, and practices (KAP) in mental health. Two house-to-house surveys were conducted by both groups to identify and refer possible cases. The number of screen positives (potential persons with mental illnesses) and the KAP scores formed the outcome measures. Online sessions for SG-ASHAs were completed over 18 months, the COVID-19 pandemic being the main disruptor. SG-ASHAs identified significantly higher number of persons with potential alcohol use disorders [n = 873 (83%); p ≤ 0.001] and common mental disorders [n = 96(4%); p = 0.018], while CG-ASHAs identified significantly higher number of those with potential severe mental disorders [n = 61(61.61%); p ≤ 0.001]. As regards KAP, after controlling for baseline scores, the time effect in RMANOVA favoured SG-ASHAs. Mean total KAP score increased from 16.76 to18.57 (p < 0•01) in SG-ASHAs and from 18.65 to 18.84 (p = 0.76) in CG-ASHAs. However, the Time-group interaction effect did not favour either (F = 0.105; p = 0.748). Compared to traditional training, mentoring ASHAs for extended periods is more impactful. Easily accessible digital technology makes the latter feasible. Scaling up such initiatives carry the potential to considerably improve treatment access for those in need.

Section: Methodological Issuesmentioning

confidence: 96%

Impact of Technology Driven Mental Health Task-shifting for Accredited Social Health Activists (ASHAs): Results from a Randomised Controlled Trial of Two Methods of Training

Nirisha

Community Ment Health J

Kulal

et al. 2022

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“…Further, a randomized controlled trial is underway to prospectively compare the outcomes of the traditional training module and digitally driven training module on a number of patient related outcomes (22). In addition to opening newer avenues to overcome the traditional barriers, use of technology are associated with a few challenges as well, particularly when we talk about the field level workers (23). Clearly, more data is needed in this area.…”

Section: Implementation Research Evaluating Outcomes Of Digital Train...mentioning

confidence: 99%

Tele-Mentoring and Monitoring of the National Mental Health Program: A Bird’s-Eye View of Initiatives from India

Gajera

Nirisha

et al. 2021

TMT

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Objective: To provide a glimpse of various digital programs and modules that are being implemented across the country by the National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India (an institution of national importance under the Ministry of Health and Family Welfare, Government of India; one of its mandates is to develop innovative strategies to improve mental health capacity building as part of the National Mental Health Program, a publicly funded health program to cater to the public health need posed by psychiatric disorders). Design: The information is presented in a narrative fashion by organizing the activities into three categories of digital training methods: webinar mode, blended mode and hybrid mode. Results: Cadres ranging from lay-counsellors (volunteers in the community), non-specialist health workers to professionals including medical officers are covered with these initiatives. During the period from August 2016 till December 2020, more than 16 million man hours of training is delivered for more than 35,000 participants from across the country. Conclusions: These have a tremendous potential to exponentially increase skilled human resources capable of providing quality care to hitherto unserved remote areas of the rural hinterland and ultimately reduce the burgeoning treatment gap. In-depth outcome assessments are the need of the hour.

“…[ 8 ] These results hold a lot of promise in scaling up their involvement in integrating mental health care into primary health care (Ibrahim et al , 2021; Malathesh et al , 2021). [ 7 9 ] It is imperative, however, to understand the perspectives of ASHAs and other stakeholders with regard to the delivery of mental health services at the grass-root level. The objective of this study is to explore the qualitative aspects of these newly identified community mental health workers (ASHAs) in terms of service provision and foster a template for further expansion of the same whilst developing an adequate feedback system to enhance which discussions with experts in the field of community mental health have been included.…”

Section: Introductionmentioning

confidence: 99%

Stake holder perspectives on the role of accredited social health activists (ASHAs) in Indian public mental healthcare space: A qualitative study

Kumar

Varshney

Journal of Family Medicine and Primary Care

et al. 2022

A BSTRACT Background: Community health workers such as Accredited Social Health Activists (ASHAs) are existing resources who can facilitate the bridging of the mental health treatment gap. Knowing about the perspectives of ASHAs in delivering mental health care and other professionals with experience working in the area of community mental health is imperative. Method: As part of an implementation research project aimed at comparing the effectiveness of two training methods for community health workers (ASHAs), we conducted five focussed group discussions including four with ASHAs ( n = 34) and one with other stakeholders ( n = 10). Focussed Group Discussion (FGD) was conducted under the following themes: acceptance and feasibility of provision of mental health services from ASHA’s point of view and understanding the supply and demand side opportunities and challenges. The discussion began with open-ended questions, allowing for new themes to emerge until saturation was reached. Results: ASHAs were willing to incorporate mental health identification (and referral) in their regular activities without additional perceived burden. ASHAs were easily able to identify severe mental disorders (SMDs). For substance use disorders (SUDs), due to factors such as normalization of substance consumption and stigma, there was a felt difficulty in the recognition by ASHAs. ASHAs’ difficulty in identifying the CMDs was because of poor awareness in both those with mental illness and ASHAs. Incentivizing the work of ASHAs was thought to yield more returns. Conclusions: ASHAs have the potential to be excellent resources for easy screening, identification, and follow-up of those with mental health concerns in the community. Policies to involve them need to evolve.