Bridging the Mental Health Treatment Gap through Tele-psychiatry - 'IMPACT-India', a Formative Research Project from Goa, India

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India has a significant burden of mental illness with almost 70 million people having some form of mental illness. This problem is compounded by an acute shortage of trained specialist manpower to provide mental healthcare to those who require it. The existing manpower can only provide care for one third of the mental health needs. Furthermore, 70% of this manpower is inequitably concentrated in urban areas while 70% of the Indian population lives in the villages. This mismatch is a great public health challenge and there is an urgent need to look at innovative ways to overcome this barrier to access. Affordable technology, which is easily accessible in India today, might provide the turning point in the field of mental healthcare delivery. In this project we plan to use videoconferencing technology to provide mental healthcare for patients attending primary care clinics. We plan to discover whether such an innovation is feasible and safe to deliver, acceptable to the various stakeholders and has a positive impact on the mental health of the people. Videoconferencing facilities will be established between District Hospital and Primary Health Centres, where most patients access health care. Patients with Depression, Alcohol use disorders and Severe mental illness will be identified by research workers, who will be offered consultations with a psychiatrist based in the District Hospital via videoconferencing. Medication and follow up services will be provided in the primary health centres. Before-after assessment will measure change in symptoms and disability level. Since the service is delivered in the community we expect better compliance rates. In-depth interviews will be conducted with all stakeholders including service delivery agents, patients and their families to determine the acceptability of tele-psychiatry. Demonstrating that delivering mental health care through tele-psychiatry is feasible and acceptable has significant policy implication. Tele-psychiatry can then play a transformational role in mental health delivery in low resource settings.