Improving Access to Mental Health Care for Adults with Chronic Mental Disorders in Rural Regions of India: The Role of NGOs

Problem Statement
Non-governmental organizations (NGOs) with a focus on mental health services have sought to address the problem of the rising prevalence of mental illness in rural Indian communities and the inaccessibility of mental health care in these communities for the past few decades. Approximately 10 million people in India are affected by mental illnesses, for which there are merely 4,000 licensed mental health practitioners to provide care. Given that the majority of the India’s population lives in rural regions, it can be inferred that a significant proportion of those 10 million individuals living with mental disorders reside in rural settings. Because most of these mental health NGOs are small-scale, their most valuable service is in providing mental health treatment to individual villages in states across the country. MINDS is such an NGO.
MINDS seeks to deliver mental health treatment to nineteen rural villages of Gujarat in the form of community health programs (CHPs). The organization partners with local communities to train individuals in the community as health workers, who can then provide basic mental health services such as diagnosis, screenings, and counseling to the local population. MINDS connects local hospitals with this network of community health workers to establish a CHP. This community-based model of mental health care seeks to solve the problem of the lack of central governmental oversight for mental health care by mobilizing individual communities to be responsible for their own health care. One of the biggest problems MINDS faces is that patients don’t seem to utilize the CHP service, even though it offers free medical screenings and free transportation. There are three primary barriers that prevent the current CHP model from effectively delivering mental health care services to patients in rural areas of Gujarat:

1. Ineffective implementation and maintenance of services. The local hospitals and community health workers tasked with implementing the day-to-day services of the CHP are ineffective in maintaining communication with each other and the organization of the program once the ownership is transitioned to them. Because the hospital staff is already overburdened with patients and because the community health workers already have other personal obligations outside the CHP, neither group really steps up to maintain the program once the leadership of MINDS phases out. The ineffectiveness of the local hospitals and community health workers in maintaining communication with each other after the initial connection hinders the model of the CHP from being realistically implemented and sustained.
2. Remaining barriers of access to services. That patients and their caretakers do not adequately utilize the services of the CHP, despite free transportation and medical treatment, points to the fact that there are yet remaining barriers to the accessibility of these services to patients. These patients also likely encounter a social cost in leaving their homes to seek treatment. The more public they are about seeking treatment, they more they risk others’ becoming aware of their condition and, whether knowingly or unknowingly, causing them to become pushed to the side in their communities. Most people in rural communities simply do not understand the causes and symptoms of mental disorders, so they might avoid interaction with individuals with these disorders.
3. Distancing of mental health care from general health care. The medical practice and the Indian government, which provides funding and establishes health policy, do not place nearly as much priority on mental health care as they do general health care. Part of this reason is that the government considers mental health to be more of a “social” concern rather than a truly medical concern. Thus, the local hospitals can be expected to avoid the effort of integrating the mental health care program into their services, making it more difficult for patients to access these services.