A task shifting mental health program for an impoverished rural Indian community

Psychiatric disorders constitute a major source of disability across the globe. In India, individuals with mental disorders are diagnosed and treated inadequately, particularly in under-served rural areas. We implemented and evaluated a psychiatric 'task shifting' program for a rural, marginalized, impoverished South Indian tribal community. The program was added to a pre-existing medical program and utilized community workers to improve health care delivery. Following community wide discussions, health workers were trained to provide community education and to identify and refer individuals with psychiatric problems to a community hospital. Subsequently, they also followed up the psychiatric patients to improve treatment adherence. The program was evaluated through medical records and community surveys. Treated patients experienced significant improvement in daily function (p=0.01). Mean treatment adherence scores remained stable at the beginning and end of treatment, overall. The proportion of self-referrals increased from 27% to 57% over three years. Surveys conducted before and after program initiation also suggested improved knowledge, attitudes and acceptance of mental illness by the community. The annual per capita cost of the program was 122.53 Indian Rupees per person per annum (USD 1.61). In conclusion, the community-driven psychiatric task shifting program was implemented successfully. It was accompanied by positive changes in knowledge, attitudes and practice. Initial community consultations and integration with a pre-existing medical program increased acceptance by the community and reduced costs. We recommend a similar model with integrated medical and psychiatric health care in other resource-deficient communities.