Diversity in approaches in community-based mental health interventions in India: A narrative review and synthesis

Mental health is a global priority, fundamental to the health and development of all nations. The contribution of mental disorders to the global burden of disease is widely recognized; however, a significant care gap exists, particularly in the context of low-and middle-income countries. In India, for instance, there are 0.3 psychiatrists per 1,00,000 population. To address this severe shortage of mental health professionals and resources globally, the World Health Organization has suggested the adoption of a community-based mental health care approach, where the locus of services shifts from institutional care to local communities. Over the last five decades in India, diverse approaches to mental health care have emerged because of the interaction of dominant discourses on community-based mental health care with various socio-cultural contexts. In addition to the government-run mental health program and programs run by medical colleges, civil society organizations have increasingly contributed to this space. Although studies have assessed individual interventions, there exists a need to map these interventions and synthesize the approaches for service delivery to inform public health practice in India and in low-and middle-income countries at large. This narrative review attempts to map and synthesize insights from community-based mental health interventions in India implemented across diverse contexts. We searched peer-reviewed journal articles and book chapters published in the English language between 2010 and 2023. We present the synthesis of approaches used in 41 community-based mental health interventions, where we unpack key intervention components and processes adopted for primary prevention and promotion; identification and case detection; treatment and care, and rehabilitation in the community. This review presents key recommendations for practitioners about the role of community, the diversity and commonalities in various approaches across contexts, the roles of various actors in service delivery, and the shared values guiding the conceptualization and implementation of community-based mental health interventions in India.