J&K scales up tele- psychiatry

Mental health remains a major concern Globally and in countries like India the challenges are doubled because of poor awareness of mental health illnesses,  stigma, high treatment gap and shortage of mental health professionals to  manage widely prevalent mental illnesses. The National Mental Health Survey of India reported that the point prevalence of any mental illness was 10.6% while 5·1% of the adult population was estimated to have some level of suicidality.Mental Health survey done by GMC SRINGAR in 2017 revealed point prevalence of depression as high as 7 percent double than national average.The Global Burden of Disease Study 1990–2017 estimates the number to be 197·3 million people (95% uncertainty interval:178·4–216·4).2 Between 2012 and 2030, mental illnesses would cost  India 1.03 trillion US dollars.3  The scenario is complicated by a very high treatment gap of 83% along with only 0.75 psychiatrists per lac population, even though the WHO desires at least three psychiatrists per lac population.Having a population of more 1.38 billion, a low number of  overall mental health professionals in  India,   especially in rural areas, is not surprising as most of these are concentrated in urban areas.

India was one of the first LMICs to adopt the Mental Health Program (MHP) in 1982. To take mental health out of the shadows, the government has tried to increase the number of psychiatric training institutes as well as seats. However, Covid-19 had a substantial impact on mental health, as the country witnessed approximately half a million deaths and bore prolonged lockdowns. To address psychological disorders associated with COVID-19 and improve overall psychological functioning, the Government of India has launched the National Tele-Mental Health Program (NTMHP), which involves setting up a network of 23 tele-mental health centres of excellence to cater to a wide range of cultures in a diverse country like India. There is also a provision of free round-the-clock telepsychiatry services  via  Tele-Mental Health Assistance and Nationally Actionable Plan through States (Tele-MANAS) and a mobile app called ‘MANAS Mitra’.5 Every Tele MANAS centre has the facility of trained psychiatrists and counsellors who  would refer the patients in acute psychological distress to  locally available Government runs mental health centres   in case the need arises so. The impetus towards scaling up mental health services was taken by the Finance Ministry of India that added budget for tele-MANAS in its Union Budget of 2022 for nation wise coverage of Tele-MANAS.6 With an estimated 1.2 billion mobile phone users and 600 million smartphone users, NTMHP is expected to reach a large portion of patients, eventually reducing the colossal treatment gap.

Scaling up tele-psychiatry is especially relevant in regions such as Jammu and Kashmir that have faced conflict and natural disasters such as earthquakes, floods, and including impacts from the ongoing Covid-19 pandemic. The area has a huge mental health burden that we have tried to  address by increasing the number of trained mental health professionals, we are privileged in Kashmir to have Psychiatrist in every district thanks to GMC SRINGAR which ran an MCI recognised PG course in psychiatry and increased its capacity from 1 to 12 seats per year with help of national mental health programme , despite these efforts kashmir Mental Health survey of 2017 revealed that only 10 percent of people with mental illness are availing current mental health services,the gap remains largely unaddressed. We at GMC srinagar have initiated the Tele MANAS centre in Kashmir, The centre has a three-tier system in place. The first line is of counsellors who receive calls from people having depression, anxiety disorders, substance abuse disorders, exam stress and other anxiety issues(see figure 4)and for district wise calls received till date see figure 3. The counselors are all psychologists. The typical session lasts around 30 mins but sessions taking more time also are possible .In case the counselors feel that any caller needs a psychiatrist’s advice, they transfer a call to a psychiatrist or a clinical psychologist. Where mental health needs are being prioritized by introducing more professionals who can provide services in local Kashmiri and Urdu languages. Since its launch on 4th November, 2022, the centre has received 26477 calls with female predominance( female 53.97% ,males 45.87% and other 0.16%(see figure 2)) second highest number in country after Tamil Nadu as people with mental illness from every district of the Union Territory are seeking professional help. These include around 87.36% routine calls and 12.09%“crisis(see figure 1) interventions in people having self harming ideas  These numbers convey the enormous demand and needs but also show that TELE Manas is acceptable to people and they are initiating contact with mental health providers. The current step is expected to ensure cost-and-time-effective and comprehensive services for the poorly served population of the region, strengthening mental health, an area that has been historically neglected in Jammu and Kashmir. Tele Mental Health Service has two messages, quantitative and qualitative: “The quantitative statement is nearly 26477 people have sought help regarding mental health issues second highest in country meaning thereby that this mode of Mental Health delivery has acceptance in our society .And qualitatively these call have life saving potential statement as pause has been achieved and these people have been linked to mental health services. They definitely have chances of better outcomes if comprehensive safety plan and treatment is done.

  • EMERGENCY 09%
  • ROUTINE 36%
  • OTHER 55%

  • FEMALE 97%
  • MALE 87%
  • OTHER 16%

 

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