Improving Mental Health through Integration with Primary Care in Rural Karnataka

The overall goal of this study is to improve screening, diagnoses and treatment of Common Mental Disorders among individuals with dual mental illness and cardiovascular disease diagnoses in rural South India. The multi-level intervention uses a collaborative care model that will be tested in a cluster RCT and includes low-cost, evidence-based sustainable strategies targeting multiple chronic diseases. This five-year study is being conducted in collaboration with our colleagues at St. John’s National Academy of Health Sciences in Bangalore and the Karnataka State government. Specific objectives include:

• Train community health outreach workers (ASHAs) to conduct community-based screening of depression, anxiety, type-2 diabetes and CVD risk factors during community health fairs to examine: a) whether this increases subsequent diagnoses in the Primary Health Clinics (PHC) of patients diagnosed with co-morbid mental health and chronic disease; and b) whether such patients are as likely to remain in treatment, compared to the standard PHC-based screening.
• Implement and evaluate the effects of providing staff training in the collaborative care model of integrated mental health (depression, anxiety) and cardiovascular disease (hypertension, diabetes, CVD) to PHC staff and compare them to control PHC staff with respect to: a) knowledge and clinical skills using clinical patient vignettes; and b) perceived satisfaction reported by clinic patients in intervention and control PHCs.
• Evaluate the effects of our multi-level integrated clinic and community-based intervention for co-morbid primary care patients compared to the enhanced standard non-integrated treatment services in a cRCT with 50 participating PHC, with regard to both mental and physical health outcomes at post-intervention, 6 and 12 month follow up.