Psychiatry in Primary Health Care: Indian Perspectives

Abstract

One of the key elements of the declaration of Alma-Ata (Primary Health Care, 1978) was the emphasis on primary health-care as the backbone of the health-care delivery system. The target of providing an acceptable level of health services worldwide was to be achieved by 2000. However, more than a decade later, mental health services at the primary-care level are still very limited in most developing countries. In India, pioneering work was undertaken by Prof. N.N Wig and others to develop models for community-based mental health care (Wig in J Assoc Physicians India 49:405–407, 2001; Murthy in Natl Med J India 24:98–107, 2011). The National Mental Health Programmes have also invested a great deal of resources in expanding the mental health workforce over the years. Nevertheless, integrated mental health services with strong primary-care and public health bases, necessary to overcome inequalities in health- care in India, have still not materialized (Khandelwal et al. in Int Rev Psychiatry 16:126–141, 2004; Balarajan et al. in Lancet 377:505–515, 2011). Perceived challenges in extending mental health services to the primary-care level include limited mental health specialists, the low priority given to mental health, inadequate training and skills of the primary-care workforce, and inadequate specialist support to primary-care workers. Only training of health-care workers to detect and manage mental disorders can reduce the mental health gap. The use of computer-assisted diagnostic and treatment tools such as the Global Mental Health Assessment Tool/Primary Care (Sharma et al. in World Psychiatry 3:115–119, 2004; 2008; 2010) could assist this process further. Psychiatrists and other mental health professionals need to provide more support for primary-care workers, spend more time in training these frontline workers, and also take up leadership roles in ensuring that mental health remains high on the agenda in the policymakers’ list.