Lay mental health workers at primary level can boost recovery

Goa research,reported in The Lancet,shows counselling at PHCs improve recovery by 55%.

At a time when primary health centres face a shortage of psychiatrists and trained counsellors,a study published in The Lancet has found that intervention by lay people roped in as health counsellors for patients with depressive and anxiety disorders can boost their chances of recovery by 55 per cent.

The study,conducted in 12 government-run primary health centres and 12 private clinics in Goa,aimed to test the effectiveness of the MANAS (Manashanti Sudhar Shodh which means project to promote mental health in Konkani) trial in primary care settings.

Out of 2,796 persons who were involved in the trial,80 per cent were found to suffer from depression and anxiety disorders,while the remaining showed some symptoms. The study found that intervention by trained lay persons at primary health centres had a huge impact. The chances of recovery from depressive disorders were as high as 55 per cent,said Dr Vikram Patel,the lead researcher. On the other hand,the intervention did not have such a marked impact in private clinics.

Patel,a professor of international mental health and a senior research fellow in clinical science at the London School of Hygiene and Tropical Medicine,told The Indian Express that those who were at a risk of developing mental health disorders were 48 per cent less likely to do so after the intervention.

The counsellors,who were locally recruited,did not have any health background. They were put through a structured two-month training course. They acted as case managers for all

patients who screened positive for common mental disorders,and took overall responsibility for delivering all the non-drug treatment,in close collaboration with the primary care physician and the clinical specialist. The difference was observed in patients at government health facilities who got MANAS treatment. They were more likely to have recovered at six months than those in the control group. There were three deaths and four suicide attempts in the MANAS group and six deaths and six suicide attempts in the control group. None of the deaths were from suicide,says Patel.

Inter-personal psychotherapy,delivered by the lay health counsellor,was chosen as the mode of treatment because of its documented feasibility and effectiveness in Uganda,another low-income country,and because of its focus on inter-personal problems such as grief,disputes and role transitions,which were common in the adverse life experiences of the Goa participants,explains the study.