There is a critical gap between mental health related provisions in policy documents and its implementation at primary and district level.
Authors
Amanpreet Kaur, Associate Professor, Jindal School of Psychology & Counselling, O.P. Jindal Global University, Sonipat, Haryana, India; The George Institute for Global Health, Delhi, India.
Sudha Kallakuri, The George Institute for Global Health, Delhi, India.
Ankita Mukherjee, The George Institute for Global Health, Delhi, India.
Syed Shabab Wahid, Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, The George Washington University, Washington, DC, USA; Department of Global Health, Georgetown University, Washington, DC, USA.
Brandon A. Kohrt, Division of Global Mental Health, Department of Psychiatry and Behavioral Sciences, The George Washington University, Washington, DC, USA.
Graham Thornicroft, Centre for Global Mental Health and Centre for Implementation Science Health Service and Population Research Department, Institute of Psychiatry, Psychology & Neuroscience, King’s College London, De Crespigny Park, London, SE5 8AF, UK.
Pallab K. Maulik, The George Institute for Global Health, Delhi, India; University of New South Wales, Sydney, Ausralia, Australia; Prasanna School of Public Health, Manipal University, Manipal, India.
Summary
Stigma, discrimination, poor help seeking, dearth of mental health professionals, inadequate services and facilities all adversely impact the mental health treatment gap. Service utilization by the community is influenced by cultural beliefs and literacy levels. We conducted a situational analysis in light of the little information available on mental health related stigma, service provision and utilization in Haryana, a state in Northern India. This involved: (a) qualitative key informant interviews; (b) health facility records review; and (c) policy document review to understand the local context of Faridabad district in Northern India. Ethical approvals for the study were taken before the study commenced. Phone call in-depth interviews were carried out with a purposive sample of 13 participants (Mean = 38.07 years) during the COVID-19 pandemic, which included 4 community health workers, 4 people with mental illness, 5 service providers (primary health care doctors and mental health specialists).
Data for health facility review was collected from local primary health and specialist facilities while key policy documents were critically analysed for service provision and stigma alleviation activities. Thematic analysis was used to analyse patterns within the interview data.
We found poor awareness and knowledge about mental illnesses, belief in faith and traditional healers, scarcity of resources (medicines, trained professionals and mental health inpatient and outpatient clinics), poor access to appropriate mental health facilities, and high costs for seeking mental health care. There is a critical gap between mental health related provisions in policy documents and its implementation at primary and district level.
Published in: International Journal of Mental Health Systems
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