Sangath

Experience

One of the reasons for the large treatment gap for mental disorders in low resource countries like India is the shortage of specialist mental health professionals who can deliver evidence based treatments. To overcome this barrier, Sangath, an Indian NGO, uses the approach of using lay people to deliver evidence based psychosocial interventions for mental health problems, inspired by similar approaches to ‘task-sharing’ interventions in other areas of health care in India, such as maternal and child health. This approach is characterised by several principles: designing interventions based on global evidence of effectiveness and local evidence of cultural acceptability; systematically testing intervention delivery to ensure feasibility of its delivery by lay health workers and acceptability by patients and families; involving diverse stakeholders, in particular people affected by the target mental health problems, in shaping the content and delivery of the intervention; embedding the intervention in established health care platforms, most commonly those run by the government, to ensure scalability; evaluating the effectiveness and cost-effectiveness of the intervention in randomized controlled trials; disseminating the findings in a variety of methods, ranging from scientific papers to audio-video media; and working closely with federal and state ministries of health to scale up the innovations. This approach is built around a collaborative care framework with four key human resources: the front-line lay health worker; the person with a mental health problem and his/her family; the primary or general health care physician; and the mental health professional. We have completed randomized controlled trials using this approach for three conditions (dementia, schizophrenia, common mental disorders) and all have shown significant benefits on clinical and social outcomes. The dementia trial (“the Home Care Trial”) was the first such study from a developing country and won Alzheimer Disease International’s international prize for psychosocial interventions in 2010. The common mental disorders trial (the “MANAS” trial) was the largest trial in psychiatry from the developing world and the first to demonstrate the cost-effectiveness of task-sharing for mental health care. Results of our trials for alcohol use disorders, maternal depression, mental health in young people and autism will become available in the near future. This evidence has been used to scale up mental health care in rural communities in one of the poorest regions of the country through VISHRAM (Vidarbha Stress and Health Program), a partnership between Sangath, social development NGOs, the Ministry of Health and psychiatrists. A key component of our work is also with families of children with disabilities, especially children with developmental and mental health problems. Over the past decade, Sangath's research on youth health has thrown up interesting facets of the issues surrounding some of the most exciting and challenging phases of life. Through various programmes, our researchers have trained peers, teachers and lay people to help adolescents find solutions to their problems. Our work with the youth has extended across Goa and to several other states in India. Our vision is to develop an integrated package of interventions which addresses a wide range of health needs in young people (for example, reproductive and sexual health, mental health, substance abuse and nutrition), implement these packages using various modes of delivery, evaluate the impact on youth health and ultimately, scale up our programmes to address the health needs of youth across India.

Disease areas

• Mental Health
• Other

Child development/disability and adolescent health

Other information

Sangath has gained national and international recognition for its work and was awarded the prestigious MacArthur Foundation International Prize for Creative & Effective Institutions in 2008. Sangath is recognized by the Department of Scientific and Industrial Research, Government of India as a Scientific Research Organization. Sangath works in close partnership with Ministries of Health in India, with the Centre for Global Mental Health in London, and the Public Health Foundation of India.

Sangath was awarded a prize in the Global Health Trials International Trials Day Competition for its excellent video about the work of Sangath, see below.

Media

URL: http://www.ted.com/talks/vikram_patel_mental_health_for_all_by_involving_all