Mental Health in Primary Health Care: The Karuna Trust Experience

Abstract

Mental health services are an integral component of primary health care. Yet, provision of mental health services in rural areas of several countries in the Global South is scarce. In spite of a long history of establishment of centres of excellence in mental health and national mental health programmes, India lags behind in terms of making mental healthcare available and accessible in rural areas. Several experiences have shown the important role of non-professional health workers in primary health care in identifying and providing care and support to individuals and families with mental health problems. Based on our experience, we conclude that it is possible to build the capacity of primary health workers to identify mental health problems and participate as the first point of contact within a system involving primary health centres with trained doctors and visiting psychiatrists. Through a well-coordinated local health system and referral of complicated cases, it is possible to provide basic mental health care services within primary health care in a cost-effective manner. In this chapter, we describe the response of the Indian health system in the form of the district mental health programme and discuss the gaps in its implementation. Subsequently, we describe our experience with provision of mental health services within an Indian primary health centre (PHC) setting and discuss its history, implementation strategy and impact in terms of diagnosis, treatment, follow-up and rehabilitation. We also discuss the implications (lessons learned and challenges/limitations) for country policymakers and for Global Mental Health.