Hussain, Arshad

Kumar, Bhupinder

Kumar, Manasi

Roub, Fazle

English

eCommons@AKU

eCommons@AKU Brain and Mind Institute Centres of Excellence 5-2023 Reducing the mental health treatment gap in Kashmir: scaling up to maximise the potential of telepsychiatry Arshad Hussain Bhupinder Kumar Manasi Kumar Fazle Roub Follow this and additional works at: https://ecommons.aku.edu/bmi  Part of the Psychiatric and Mental Health Commons Reducing themental health treatment gap in Kashmir: scalingup to maximise the potential of telepsychiatryArshad Hussain,a Bhupinder Kumar,b Manasi Kumar,c,d,∗ and Fazle RoubaaDepartment of Psychiatry, Institute of Mental Health and Neurosciences, Government Medical College Srinagar, Jammu & Kashmir,IndiabHealth and Medical Education, Government of Jammu & Kashmir, IndiacDepartment of Psychiatry, University of Nairobi, KenyadBrain and Mind Institute, Aga Khan University, KenyaMental health in India remains a major concern withthe country facing numerous challenges such as poorawareness of mental illness, stigma, high treatment gapand shortage of mental health professionals to managewidely prevalent mental illnesses. The National MentalHealth Survey of India reported that the point preva-lence of any mental illness was 10.6% while 5.1% of theadult population was estimated to have some level ofsuicidality.1 The Global Burden of Disease Study1990–2017 estimates the number to be 197.3 millionpeople (95% uncertainty interval:178.4–216.4).2 Between2012 and 2030, mental illnesses would cost India 1.03trillion US dollars.3 The scenario is complicated by avery high treatment gap of 83% along with only 0.75psychiatrists per 100,000 population, even though theWHO desires at least three psychiatrists per 100,000population.4 Having a population of more 1.38 billion, alow number of overall mental health professionals inIndia, especially in rural areas, is not surprising as mostof these are concentrated in urban areas.India was one of the first lower- and -middle incomecountries to adopt the Mental Health Program (MHP) in1982. To take mental health out of the shadows, thegovernment has tried to increase the number of psy-chiatric training institutes as well as seats. However,COVID-19 had a substantial impact on mental health, asthe country witnessed approximately half a milliondeaths and bore prolonged lockdowns. To address psy-chological disorders associated with COVID-19 andimprove overall psychological functioning, the Govern-ment of India has launched the National Tele-MentalHealth Program (NTMHP), which involves setting upa network of 23 tele-mental health centres of excellenceto cater to a wide range of cultures in a diverse countrylike India. There is also a provision of free round-the-clock telepsychiatry services via Tele-Mental HealthAssistance and Nationally Actionable Plan throughStates (Tele-MANAS) and a mobile app called ‘MANASMitra’.5 Every Tele MANAS centre would have the fa-cility of trained psychiatrists and counsellors who wouldrefer the patients in acute psychological distress tolocally available Government runs mental health centresin case the need arises so.The impetus towards scaling up mental health ser-vices was taken by the Finance Ministry of India thatadded budget for tele-MANAS in its Union Budget of2022 for nation wise coverage of Tele-MANAS.6 With anestimated 1.2 billion mobile phone users and 600million smartphone users, NTMHP is expected to reacha large portion of patients, eventually reducing the co-lossal treatment gap. Scaling up tele-psychiatry is espe-cially relevant in regions such as Jammu and Kashmirthat have faced political conflict and natural disasterssuch as earthquakes, floods, and including impacts fromthe ongoing COVID-19 pandemic. The area has a hugemental health burden that authorities have tried toaddress by increasing the number of trained mentalhealth professionals, despite these efforts the gap re-mains largely unaddressed. Policymakers have alsoinitiated the Tele MANAS centre in Kashmir, wheremental health needs are being prioritised by introducingmore professionals who can provide services in localKashmiri and Urdu languages.Since its launch on 4th November, 2022, the centrehas received 4000 calls as people with mental illnessfrom every district of the Union Territory are seekingprofessional help.7 These numbers convey the enor-mous demand and needs but also show that TELEManas is acceptable to people and they are initiatingcontact with mental health providers. The current step isexpected to ensure cost-and-time-effective and compre-hensive services for the poorly served population of theregion, strengthening mental health, an area that hasbeen historically neglected in Jammu and Kashmir.Similar efforts are made by WHO special initiative formental health (2019–2023) which is targetingBangladesh, Jordan, Paraguay, the Philippines, Ukraine,and Zimbabwe. Since then, Argentina, Ghana andNepal. The initiative has started with a country levelassessment led by government stakeholders to get a*Corresponding author. Brain and Mind Institute, Aga Khan University, Kenya and Department of Psychiatry, University of Nairob, Kenya.E-mail address: mkumar@uonbi.ac.ke (M. Kumar).© 2023 The Author(s). Published by Elsevier Ltd. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).eClinicalMedicine2023;59: 101972Published Online 27 April2023https://doi.org/10.1016/j.eclinm.2023.101972www.thelancet.com Vol 59 May, 2023 1Correspondencebroad picture of the mental health needs, available ser-vices, opportunities, and main challenges for scale upand develop strategies for scale up of services.8ContributorsAH, BK and MK conceptualised of the Comment. FR wrote the originaldraft of the manuscript which was edited and revised by MK and AH. Allthe authors agreed with the submission.Declaration of interestsThe authors have conflicts of interest to disclose.References1 Amudhan S, Gururaj G, Varghese M, et al. A population-basedanalysis of suicidality and its correlates: findings from the NationalMental Health Survey of India, 2015-16. Lancet Psychiatr.2020;7:41–51. https://doi.org/10.1016/S2215-0366(19)30404-3.2 India State-Level Disease Burden Initiative Mental Disorders Col-laborators. The burden of mental disorders across the states of India:the Global Burden of Disease Study 1990-2017. Lancet Psychiatr.2020;7:148–161. https://doi.org/10.1016/S2215-0366(19)30475-4.3 Birla N. Mental health may hurt India to tune of $1.03 trillion; here’sa dose for cos. Economic Times (Online); 2019. https://economictimes.indiatimes.com/magazines/panache/mental-health-may-hurt-india-to-tune-of-1-03-trillion-heres-a-dose-for-cos/articleshow/71045027.cms. Accessed February 27, 2023.4 Garg K, Kumar CN, Chandra PS. Number of psychiatrists in India:baby steps forward, but a long way to go. Indian J Psychiatr.2019;61:104–105. https://doi.org/10.4103/psychiatry.IndianJPsychiatry_7_18.5 Sagar R, Singh S. National Tele-Mental Health Program in India: astep towards mental health care for all? Indian J Psychiatr.2022;64:117–119. https://doi.org/10.4103/indianjpsychiatry.indianjpsychiatry_145_22.6 Ahmed T, Dumka A, Kotwal A. Tele MANAS: India’s first 24X7 telemental health helpline brings new hope for millions. Ind J MentalHealth. 2022;9(4):403–406.7 Bashir R. In 3 months Tele-MANAS cell receives 4000 distress calls.Srinagar: Greater Kashmir; 2023. https://www.greaterkashmir.com/todays-paper/front-page/in-3-months-tele-manas-cell-receives-4000-distress-calls. Accessed February 27, 2023.8 World Health Organization. The WHO special initiative for mentalhealth (2019-2023). Universal Health Coverage for Mental Health;2019. https://www.who.int/initiatives/who-special-initiative-for-mental-health. Accessed March 27, 2023.Correspondence2 www.thelancet.com Vol 59 May, 2023

Reducing the mental health treatment gap in Kashmir: scaling up to maximise the potential of telepsychiatry

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Reducing the mental health treatment gap in Kashmir: scaling up to maximise the potential of telepsychiatry

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