Large study shows the impact of India's rural mental health program

In the largest study of its kind, The George Institute for Global Health has showed that a unique blend of digital health care and a community-based campaign can significantly reduce the risk of depression, anxiety, and self-harm in rural India. This groundbreaking program also led to a remarkable shift in knowledge, attitudes, and behavior related to mental health, helping to dismantle the stigma surrounding mental health issues.

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 village health workers in basic mental health care and using innovative methods of service delivery.

The study screened almost 170,000 adults across West Godavari, Faridabad and Palwal districts of Andhra Pradesh and Haryana for depression. Of them, 9,900 were part of the trial over 12 months, and implemented two key strategies: a community campaign to reduce mental health stigma and a digital health care initiative for those at high risk of mental disorders. The results were striking:

• 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% achieving full recovery, compared to just 50% 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 behavioral 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.

The research is published in the journal JAMA Psychiatry.

"Our research marks a significant milestone in mental health care," said Prof. Pallab Maulik, director of research and program director (Mental Health) at 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."

"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 Prof. David Peiris, Chief Scientist at The George Institute.

Mercian Daniel, Senior Research Fellow at 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 WHO and 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.