Evaluation and Prevalence of Mental Illness in India

This grant proposal aims to evaluate the prevalence of severe mental morbidity in India and develop strategies for awareness programs for mental health. The target group is the rural population in selected states. The project activities include providing comprehensive mental health and social care services, implementing promotion and prevention strategies, and strengthening information systems. The expected results include estimating the prevalence of mental disorders and identifying treatment gaps and disabilities.

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Name of the Student:
Name of the University:
Author Note:

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1. Project abstract
Title: Evaluation and the prevalence of Mental Illness and awareness intervention
strategies in India
Introduction:
According to the World health organisation (WHO), health refers to physical, social,
spiritual as well as mental health and not only the simple absence of disease or infirmity
(Murthy, 2014). There have been evident problems of mental health and behavioural health
problems which has formed an integral part of the world wide health problems. There is an
enormous burden of illness in terms of psychiatric and behavioural disorders. According to
the reports given by WHO, there is a probable chance of the overall DALYs burden for
neuropsychiatric disorders to be projected to elevate to 15% by the end of the year 2020
(Srivastava, Chatterjee & Bhat, 2016). While the focus is shifted to India, it can be seen that
the services and resources available for addressing properly the mental and behavioural
disorders, there is a lack of the available resources and which are even disproportionately low
when compared to the burden of illness that is prevalent in India. However with the changing
model of healthcare in India, the council of health of India that started the strategies for
research in mental health (Mendenhall et al., 2014).
Background:
India in recent times has been thriving to provide importance to the health of people
and asp to highlight the need for a physically and mentally healthy society. Mental health
research in India has undertaken both clinical and population based settings, however often
there are differences in the priorities which are believed to be complementary to each other
(Barry et al., 2013). When viewed from a public health perspective, the pattern that is
prevalent in terms of mental illness along with its determinants and characteristics is

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examined. In addition to this, care related issues such as the aspects of service delivery along
with system issues have also been assessed. Some of the recent studies have shown that there
have been emergence of new problems related to mental illness because of the common
problems like alcohol and drug abuse, depression, suicidal behaviours and several others
(Shidhaye & Kermode, 2013). Therefore there is a need to achieve high standards in terms of
the quality of care in addition to the elevated outcomes which are based on the principles of
care that is universal as well as equity which is quite essential so that there is strengthening of
the health systems and this is made responsive for changing health priorities as well as the
concerns.
The mental disorders are responsible for providing a significant load of morbidity and
disability and often there is increasing mortality due to this. According to the Global Burden
of Disease report, it has been seen that the mental disorders accounts for 13% of total DALYs
lost for Years Lived with Disability (YLD) (Fazel et al., 2014). In the Indian context,
approximately a 100 million persons in India immediately require systematic care which
needs to be based on the obtained however they are a few decades old and is also has serious
limitations in the methodological. There is a need of preparedness in addition to
responsiveness along with the health systems capacity in order to address these probable
challenges which have not been understood well even till date (Semrau et al., 2015).
Although the reviews done previously in addition to the evaluations have been addressed in
an independent way along with its components. Therefore combining all these issues together
have contributed to the slowed the growth of mental health services, in addition to the
limitation of the expansion of the services in ways that are both quantitative and qualitative in
nature.

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Goal: The goal of this project is to determine and evaluate the prevalence of severe
mental morbidity in Indian along with the development of the strategies for the development
of awareness programs for mental health in India.
Objectives:
The specific objectives of the study will include:
a) Determination of severe mental illness prevalent in the community where focus will
be on psychosis and epilepsy.
b) To provide comprehensive, integrated and responsive mental health and social care
services in community-based settings.
c) To determine and evaluate the effectiveness as well as the feasibility of the
involvement of the multipurpose workers (MPWs) in addition to the primary health
centre (PHC) doctors.
d) To strengthen information systems along with evidence and research for mental
health.
Target groups:
The target group for this study are the population in and around the health care centres
of the selected states of Bangalore, Punjab, Kolkata and Baroda that have been identified near
the primary health care centres. The main focus will be on the rural population which will
constitute the major target group. The indicator for this target population will be people
suffering from the severe mental disorder such as psychosis; bipolar affective disorder;
moderate severe depression and mainly who are using the available services from the health
facilities (Patel et al., 2013).
Project activities:

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The project activities will be involving the provision of comprehensive, integrated and
responsive mental health and social care services in community-based settings, the strategy
implementation for promotion and prevention in mental health, and finally strengthening of
the information systems, evidence and research for mental health.
Expected results:
2. Project design
An essential part of the study will be the intervention that will carried out by the
primary health care personnel accompanied by their training in order to identify and manage
of severe mental illness and epilepsy. In addition to this, there will be an evaluation of the
carried out intervention through the implementation of a final field survey. The study areas
that will be selected will be identified keeping in mind that all of the centres will be around
then primary health centres, which would cover approximately 40,000 population at each of
the centre (Murthy, 2017). After the selection of the centres will be done, there will be a
conduction of the in-service training related to mental illness for the health workers and
primary health care doctors, however their routines tasks and activities will not be disturbed.
Training activities
There will be development of training programs along with the establishment of
separate manuals for the instructions regarding handling of the mental health issues which
will be provided to the mental health workers and the PHC doctors. Additionally the program
will also take into consideration the multipurpose workers. The training involving the PHC
doctors will include 15 sessions which will include 2 hours in each session. There would be
some kind of flexibility permitted in order to suit the local situation. It will be taken into
consideration that the training for the health worker was carried out in the local vernacular
language. There were another 11 sessions consisting of two hours and in each there would be

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lectures along with discussions. There would also be examples of the cases along with
original demonstration of cases. The demonstration of the pre and post training assessments
that will lead to the knowledge gain of the doctors and health workers at all the four centres
will be satisfactory (Patel et al., 2015).
The study instruments
The primary instruments that will be included in the study were Indian Psychiatric
Survey Schedule (IPSS) for measuring psychiatric morbidity and the Katz's Social
Adjustment Scale (KAS Behaviour Inventories) for the measurement of the social
dysfunctioning in relation to the IPSS. There is a need to modify the instrument according to
the Indian setting. A 15-item questionnaire of short lenght will be developed in order to
assess attitudes towards mental illness and epilepsy. A short screening proforma will also be
developed (Kyu et al., 2016).
The prevalence study
During the end of intervention phase, there will be a conduction of a field survey
which will be carried out by the research team. This will be done at all the 4 centres which
were identified in order to estimate the magnitude of severe mental morbidity prevalence.
The survey that will be conducted will be a two-stage survey. At the beginning of the initial
stage, the trained research investigators will be involved in administration of a simple 15
questions screening proforma. This will be provided to one adult member of every household
in the study. This will be carried out after the collection of certain basic socio-demographic
information regarding the concerned household (Thomas et al., 2015). This so called
'symptom in others' questionnaire will be responsible for asking them if they happen to know
anybody who is suffering or was suffering from one or more of the 15 symptoms that is
mentioned either in their families or in their villages. While the conduction of the second

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stage, there is a conduction of all such nomination of the probable cases which will be
assessed in detail using the IPSS. This is based on the symptoms that is recorded by the IPSS,
where the patients will be diagnosed (Shidhaye, Gangale & Patel, 2016). The 'symptoms in
others questionnaire' is basically an important instrument which will be involved in detecting
the severe mental morbidity, which are the different forms of psychoses and epilepsy that is
the focus of this study.
National and target area context
With the available background on the topic, a study was undertaken to examine the
state of mental health services in India in reference to the perspective of public health. This
considers the aspects of promotion and prevention of the mental health along with the social
and cultural factors related to the services of mental health. As mentioned earlier the primary
objective of the study is to review the mental health services in India in addition to analysing
the implementation of programs which will try to follow the National Mental Health
Programme (NMHP), keeping the national and target area context (Vellakkal et al., 2013).
Methodology for the intervention promotion
The study mainly focused on the various secondary sources like the government
reports along with the policy papers which are related to mental health and is published by
the Ministry of Health and Family Welfare and also the Directorate General of Health
Services including the reports from the Planning Commission in addition to the books and the
articles that were published in the various Journals. This will be taken into consideration for
the literature review so that there is clarity of concepts related to the subjects of mental
health. The study will involve collection of both primary and secondary sources which will
be used to gather information regarding the services that are rendered. In the initial stages, the
information will be gathered from the various studies and the research articles obtained from

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various sources. The information will also be collected from the field through the
administration of interviews and some case studies. This will include the informal interviews
with the local people along with the patients and their family members, and service providers
like the doctor and social worker (Goel, Subramanyam & Kamath, 2013).
Goals and objectives of project
(i) To estimate the prevalence as well as the pattern of various mental disorders in a
representative Indian population.
(ii) To identify the treatment gaps, along with the health care utilisation, and also the
disabilities with its impact.
(iii) To assess the current mental health services along with the systems in the states
that is surveyed.
Sampling and selection of the individuals
Sampling will be carried out in the rural regions especially in the areas which are near the
primary health care facilities. This involves including the states, out of which certain districts
were selected. From these districts, some talukas were selected and from this some clusters
were selected. Out of these clusters, the households which were nearer to the primary health
facilities were selected and then the individuals who were required to be diagnosed. The
section procedure is shown as below:
States
Districts
Talukas
Clusters
Households

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Individuals
Tools for data collection
In order to collect information for the study, the schedule of the structured and the
unstructured interview and the techniques of observation were mainly. Apart from this, there
will also be collection of secondary data from the various sources in addition to which there
will be some cases where there will be conduction of informal unstructured interview which
will also be carried out. The conduction of the informal interviews will be done with the
patients and also their family members when they will be waiting for their turn at the
psychiatric OPD regarding the services and also the facilities that are available and also about
their perception of mental health and the need for services. For the purpose of interviewing
the service providers it is required for the doctor and social worker to also be interviewed
using the same method as mentioned previously.
The data collection schema

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Justification of methodology
The above methodology was chosen for this study in order to assess the prevalence of mental
illness in India in an unbiased manner. With the conduction of the interviews, the primary
data was obtained for the study.
Expected results
The prevalence of the severe mental morbidity will be tabulated as the following:
Diagnoses Bangalore Baroda Kolkata Punjab
No
of
case
s
Rate/
1000
No
of
case
s
Rate/
1000
No
of
case
s
Rate/
1000
No
of
case
s
Rate/
1000
Epilepsy
Organic
brain
syndrome
Schizophreni

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a
Mania
Depressive
Psychosis
Total no of
cases and the
prevalence
rate/1000
Population
studied
The mental health care by PHC personnel
Bangalore Baroda Kolkata Punjab Total
Population
studied
Total
number of
patients with
severe
mental
morbidity
Rates per

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1000
population
No of
patients
identified
and
managed by
then PHC
team during
the
intervention
phase
Percentage
of patients
managed by
the PHC
team
The primary health care staff will be responsible for the identification and the management of
the severely mentally ill individuals and also who are epileptic in their respective catchment
areas along with the maintenance of simple case records. Most of the patients will be detected
and will be managed by the PHC team and in addition to which they will also be assessed by
the research staff.

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There will also be a conduction of an altitude survey, which will be conducted before and
after the intervention phase that will be able to show that at all the 4 centres where there were
overall changes in the attitudes directed in positive direction. After obtaining the overall
satisfactory results along with the item wise analysis there is seen to be some crucial items
including then sustainability of the local health centre (Srivastava, Chatterjee & Bhat, 2016).
Evaluation of cost
The cost evaluation of the overall study as approximated will include the estimated
cost for the training purpose that will be including the case finding and case holding by PHC
personnel, along with the cost of monitoring and cost of the final survey. This will also be
including the cost of records, along with the drugs, training material and other such incidental
expenses. There will also be some expenses on the research staff and cost of travel were the
main costs which are required to be taken in to consideration. However in the cost estimation,
the usages of the PHC personnel will not be taken into consideration as they are already in
employment. The estimated total cost of the program responsible for interventions and
training along with the monitoring in addition to the final survey is approximately to be about
1,914.95 Australian Dollar that is one lack of Indian currency which is applicable at each of
the centre. The study was carried out in the form of a research project therefore, a major
portion of the total costs will be needed to be constituted by the salaries for the research staff.
In case of the large-scale replication of the intervention programme along with the costs will
be likely to be less.
Strengthening the health care system using interventions
The existing health care system can be associated with a number of drawbacks and
lacunas. The major lacuna identified would comprise of inefficient healthcare infrastructure
across various health care organizations (Andrade et al., 2014). Also, societal stigma can be

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accounted as a major reason which significantly serves as a barrier that reduces the
accessibility to health care facilities among common people (Becker & Kleinman, 2013).
Mental health is perceived as a ‘curse’ within the society and is often associated with a
number of superstitions (WHO, 2014). Mental health patients are often secluded and there is
a major lack of education and awareness about the seriousness of mental illness among the
people (Murthy, 2014), (Patel et al., 2013). Therefore, it is extremely important to adapt
measures and strengthen the health care system by introducing reforms that would help in
improving the access to health care facilities among the entire population base.
How will the results of this study be useful?
As has been discussed above, the research study would underpin conducting one-on-
one semi-structured interview with health care professionals. This would be done in order to
estimate the average number of mental health patients that seek treatment intervention. The
study would also help in critically evaluating the factors that serve as major societal barriers
that restrict the reporting of the mental health cases. Also, through the interview responses,
the findings of the research study would help in adapting measures to strengthen the existing
policies and take up intensive awareness campaigns in order to popularise the concept of
mental health wellness among the entire population set.
Conclusion
Hence, to conclude it can be said that mental health wellness is perceived as a stigma
in most of the developing nations. There are innumerable instances where patients are unable
to seek treatment opportunities. The primary reason for the same has been identified as the
inaccessibility to health care facilities or the victimization due to societal stigma and other
associated superstitions. Further, it should also be mentioned here that the prevalence rate of
mental health patients is gradually increasing with every passing day. In context of the

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emerging seriousness, it can be said that there is an immediate need to introduce reforms in
the healthcare system so as to provide quality services that would yield positive patient
outcomes. It can be commented here that in order to take steps as to ensure reforms it is
pivotal to identify the existing gaps and lacunas within the healthcare system and accordingly
initiate reforms. For the successful identification of the gaps within the health care policies
the research study would conduct a thorough investigation.
This would be done by conducting a semi-structured interview with the health care
professionals so as to develop an idea about the existing barriers that facilitate lack of access
to health care opportunities. Also, in order to develop a clear understanding about the existing
health care policies and evaluate the gap, a thorough and intensive literature review was
conducted to get a clear idea about the effectiveness of the policies in the context of
healthcare. It can be thus be expected that conducting awareness campaigns about the
seriousness of mental health issues can help in making people aware about the merging
seriousness of the issue. Further, incorporating the fundamentals of maintaining mental health
as a part of the academic curriculum in schools can also help in spreading awareness with
respect to mental health.

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