On World Mental Health Day, a study conducted by The George Institute for Global Health India shows that a unique blend of digital healthcare and a community-based campaign can reduce the risk of depression, anxiety, and self-harm in rural India. This programme aimed to impact the knowledge, attitudes, and behaviour related to mental health, helping to dismantle the stigma surrounding mental health issues.
This study shows how government programmes, enhanced by digital solutions and local expertise, can effectively improve, and sustain mental health care in rural areas over time. The findings from the study are:
- Reduction in depression risk: There was a significant reduction in depression risk among those involved in the intervention over one year.
- Higher cure rates: The cure rate, measured by remission, was significantly higher in the intervention group, with 75 per cent achieving full recovery, compared to just 50 per cent in the control group.
- Improved knowledge and attitudes: There was a marked increase in knowledge and attitudes related to mental health, accompanied by a notable decrease in the stigma associated with seeking help. While behavioural changes related to mental health were not significant at the one-year mark, the study did observe positive effects as early as three months into the program.
This study was conducted at 44 rural primary health centres in Haryana and Andhra Pradesh. It screened nearly 170,000 adults across West Godavari, Faridabad and Palwal districts of both the states for depression. The study achieved a high level of success, with 91.2 per cent of participants completing the 12-month follow-up across two different Indian states.
A major factor was the involvement of Accredited Social Health Activists (ASHAs), who, despite their other responsibilities, achieved high follow-up rates due to their local knowledge of the community and ability to reach people at their homes. The use of a digital health app helped streamline their work by creating prioritisation lists, making it easier for ASHAs and primary health care doctors to organize care effectively.
Mental health remains a critical global challenge, with nearly 150 million people in India needing treatment, yet only a fraction receiving adequate care. The shortage of mental health professionals in India is particularly acute, especially in rural areas where trained health workers are scarce. India’s Systematic Medical Appraisal, Referral and Treatment (SMART) Mental Health Program was developed to address this gap by training primary health workers in basic mental health care and using innovative methods of service delivery.
Pallab Maulik, Director of Research and Program Director (Mental Health), The George Institute India. “This study, the largest of its kind globally, revealed a substantial reduction in depression risk over one year and highlighted the profound impact of our dual intervention approach. It showed the benefits of implementing efficient models of mental health care within existing government health systems ”
“This study shows that community health workers, supported by doctors and simple digital tools, can provide high-quality, effective health care. The strategy is simple, safe, clinically effective and can reach large numbers of people missing out on mental health care worldwide” said David Peiris, Chief Scientist, The George Institute.
Mercian Daniel, Senior Research Fellow, The George Institute India said, “The success of such a large trial at the primary care level included providing initial handholding and regular supportive supervision to ASHAs and primary health care doctors along with actively engaging with the community”.
Digital health solutions can be an asset to India’s National Mental Health Program. This finding supports the Government of India and WHO’s strategies for implementing mental health care in primary health care settings and the Lancet Commission’s call for new strategies to reduce the impact of mental disorders worldwide. These strategies can work in low- and middle-income countries and impoverished areas of high-income countries, with some adjustments for local conditions.