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Title: The roles of primary-level health workers in delivering mental healthcare in India
Author: van Ginneken, N.
ISNI:       0000 0004 5357 1800
Awarding Body: London School of Hygiene and Tropical Medicine (University of London)
Current Institution: London School of Hygiene and Tropical Medicine (University of London)
Date of Award: 2015
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This research explored the history, effectiveness and feasibility of primary-level health workers (PHWs) in delivering care for mental, neurological and substance use (MNS) disorders in India, to better inform the organisation and delivery of mental health services at primary care and community levels. This thesis examined evidence for the effectiveness of PHWs in mental healthcare in low- and middle-income countries (LMICs) (Cochrane review – 38 included studies), and then focused on India. Seventeen oral history interviews described the experiences of integrating mental healthcare into primary care and 72 case-studies explored government and non-governmental models of PHW-delivered mental healthcare initiatives and their human resources. PHWs can be effective in delivering care for MNS disorders in LMICs. The case studies identified heterogeneous collaborative care models in India, most of which were delivered through community- rather than government- primary care. Other models (training and referral) which have less evidence for effectiveness were more widespread, and included the government model which was perceived as having ‘failed’. A new model was identified: community outreach services which were specialist-led but PHW-delivered. LHWs and care managers seemed more feasible and appropriate care managers than PHC doctors across models and provided more holistic psychosocial support. Specialists were valuable for PHWs’ and care managers’ training and ongoing support. Barriers to mental health care integration are discussed. Future research priorities are to assess whether variations of collaborative models are similarly effective to those described in HICs and whether these are feasible and effective if implemented at scale. Priorities for improving the DMHP would be to consider deploying care managers and LHWs and reorient as well as incentivise specialists to support them. Better inter-sectoral collaborations, health system strengthening and technical support at central- and state-government levels may improve leadership, implementation and evaluation of mental healthcare integration into primary care across India.
Supervisor: Patel, Vikram Sponsor: Wellcome Trust
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral