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

印度精神疾病负担沉重，有近7000万人患有某种形式的精神疾病。为有需要的人提供精神保健的训练有素的专业人员严重短缺，使这一问题更加严重。现有的人力资源只能满足三分之一的心理健康需求。此外，70%的人口不公平地集中在城市地区，而70%的印度人口生活在农村。这种不匹配是一项巨大的公共卫生挑战，迫切需要寻找创新方法来克服这一获取障碍。今天在印度很容易获得的负担得起的技术可能会成为精神保健服务领域的转折点。在这个项目中，我们计划使用视频会议技术为到初级保健诊所就诊的患者提供心理保健。我们计划发现这样的创新是否可行，是否安全，是否为各利益相关者所接受，是否对人们的心理健康产生积极影响。将在地区医院和初级保健中心之间建立视频会议设施，大多数病人在初级保健中心获得保健服务。研究人员将确定患有抑郁症、酗酒障碍和严重精神疾病的患者，并通过视频会议向区医院的精神病医生提供咨询。初级保健中心将提供药品和后续服务。前后评估将衡量症状和残疾程度的变化。由于该服务是在社区中提供的，我们期望更高的遵从率。将与包括服务提供机构、患者及其家属在内的所有利益攸关方进行深入访谈，以确定远程精神病学的可接受性。表明通过远程精神病学提供精神保健是可行和可接受的，具有重要的政策意义。远程精神病学可以在资源匮乏的环境中发挥变革性作用。

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.