Nabeela Khan in Sydney
Published on 14th July, 2017
Technology is opening a new frontier in mental health support. The privacy and round-the-clock availability of mobile phones is helping provide mental healthcare and is giving doctors and researchers new ways to offer care and monitor progress. However, mobile technologies are still largely untapped sources of innovation for mental health in India.
Here in Australia’s most populous city, Sydney, I met Prof. Anushka Patel and Professor David Peiris of the George Institute for Global Health. Prof. Patel is a chief scientist at the Institute, she oversees global research programmes and Prof Peiris is leading research in health systems as a director.
They spoke how mobile technology can be used to help fill in the gap between mental health care availability and reach. The institute initiated a project called SMARTmHealth (Systematic Medical Appraisal Referral and Treatment) Mental Health project which is conducted in some villages of rural Andhra Pradesh.
"The mobile technology is essentially used as a platform for coordination between the ASHAs and the doctors, ensuring patient follow-up, and to provide decision support for screening and management." said Prof. Anushka. "So it is just an enabler – it allows the front-line healthcare worker identify patients in their homes". The project evaluated use of mobile–technology to enhance the ability of primary care health workers and provide evidence–based mental health care in remote areas. Its aims to develop an intervention that will enable suitably trained primary-care workers to identify and manage common mental disorders (CMD) in the community.
When asked if it was difficult to reach out to people because there is a stigma attached with mental health issues, Prof. Anushka explained: "We initiated an anti-stigma programme for three months, since the results were promising; we started training ASHA health workers who are primary healthcare providers at village level.”
Prof. David was one of the member of field team who worked on the training of health workers in India. "The health workers were first trained to use tablets, " said Prof. David.
A questionnaire developed by WHO was used to seek responses from patients. The health workers collected the responses and fed them into the system. Based on the answer results, the doctors diagnosed patients with the help of another app and chalked out a treatment plan. This intervention led to individuals being screened for common mental disorders by village health workers. The study was initiated in 30 remote villages of Andhra Pradesh with a population of 5,000.
The global burden of mental disorders and treatment gap is large, especially in countries like India where because of poor healthcare facilities and awareness people have limited access to healthcare. In India alone, there are about 60 million people who suffer from mental health problems. Worse still, the number continues to increase because there is a huge gap in treatment. One psychiatrist in India is currently catering to the needs of 10,000 mentally disabled patients.
Given shortage of healthcare providers and infrastructure, the question is whether there is an innovative alternatives to offer mental health care?
At Sydney’s Black Dog Institute, a prominent mental health organization in Australia, the researchers have designed world’s first suicide prevention app they hope will lower Australia's shockingly high Indigenous suicide rate. Together with the Western Australia based suicide prevention group, the Black Dog Institute launched the i-bobbly app in 2014 for young (16-30 years) Indigenous Australians.
Bill Reda, who is currently researching suicide prevention strategies at the Black Dog Institute and is working on iBobbly app trial said that 48% of people who commit suicide do not seek out help.
"But there is a significant reduction in depression and psychological distress after using the app," said Bill. Participants from the Kimberley region in Western Australia who used the app over a six-week period reported a 42% reduction in symptoms of depression, 30% reduction in suicidal ideation and 28% reduction in distress.
The user of app progresses through a series of questions designed to provide insight into their mental well-being. After each module the app outlines how a person thinks to how he feels to how he behaves. The data is then analysed by the counselling team who talk with the app user. The app does not require an internet connection once downloaded – an advantage in remote regions. The program maintains patient’s privacy and is password protected.
Back home in India, where mental health is a major health issue and there is a shortage of mental healthcare providers, there might be lessons in this use of similar mobile technology. India's advantage is that it already leads world in accessing the internet by mobile phones.
"India will never be able to produce mental health experts and psychiatrists as required," said Dr. Pallab Maulik of the George Institute India who was leading SMARTmHealth programme in India. "To reach out to people who do not have access to specialists, mobile technology can help multiply reach and better monitoring.”