Reducing the Treatment Gap for Psychiatric Disorders – The Role of Accredited Social Health Activists in South India

Abstract

Objective: The objective of this study was to evaluate the effectiveness of mental health work carried out by accredited social health activists (ASHAs) on reduction of the “treatment gap” for severe mental disorders (SMD), common mental disorders (CMDs), and substance use disorders (SUDs) in rural communities. Methods: This study is an offshoot of a larger randomized controlled trial designed to comprehensively compare the effectiveness of two methods of training and empowering grassroots-level workers in mental health. Three primary health centers (PHCs) were selected (simple random sampling) as the study group (SG). Thirty-five ASHAs were trained and mentored (National Institute of Mental Health and Neurosciences-Extension of Community Health Outcomes model of skilled capacity building using digital technology) for a period of 18 months in identifying/counseling/referral of commonly prevalent mental health problems in the community. Control group (CG) PHCs' ASHAs (n = 36) received “training as usual” (i.e. 1 day in person classroom training session). Both the groups were regularly contacted by the research team to monitor for progress. Reduction in “treatment gap” was evaluated using pre–post design for SG and CG separately, and the same was compared between SG and CG. Results: A total of 35,023 adults were screened, and positives were identified, counseled, and referred for care and treatment. Treatment gap for SMDs and SUDs reduced significantly both in SG and CG (SMDs: 10% vs. 38%, respectively; P = 0.03 for both; SUDs: 51% vs. 70% respectively; P < 0.001 for both) while it increased for CMDs (13% vs. 14% P < 0.01 and 0.09, respectively). Comparatively speaking, SG fared better for SUDs (P < 0.05), and CG did better for SMDs (P < 0.05). It was unequivocal for CMDs (P = 0.48). Conclusion: ASHAs could be effectively empowered to carry out mental health work resulting in meaningful reduction of treatment gap for the priority mental illnesses including SMD and SUDs.