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Lay care helps mentally ill

New Delhi, Nov. 22: Trained health workers and even schoolteachers can provide effective care to patients with an array of mental disorders and make up for shortages of psychiatrists, medical researchers from India and Europe said on Wednesday.

The researchers, who examined experiments done in 22 developing countries including India, have found that doctors, nurses and even lay health workers untrained in mental health or neurology can provide health care to mentally ill patients.

Their review, published on Tuesday by The Cochrane Collaboration, a global effort to promote medical practice backed by rigorous evidence, shows that non-specialist health workers can alleviate some depression or anxiety and reduce symptoms of patients with dementia.

“The primary message is that non-specialist health workers have an important role in delivering interventions for a range of mental disorders,” said Vikram Patel, a co-author of the review and professor of international mental health at the London School of Hygiene and Tropical Medicine, in a media release by the institute.

“They can thereby play a key role in addressing the human resource shortages in mental health care in low and middle-income countries.”

The review suggests that care given by non-specialist health workers provides greater benefits to patients with depression, including maternal depression, anxiety and dementia, than the usual care they would receive amid a shortage of psychiatrists.

“In India, we desperately need such a parallel workforce at the level of primary health centres where there are no psychiatrists at all,” Sudha Chandrashekar, another co-author of the review and a doctor turned-health economist at the St John’s Research Institute in Bangalore, told The Telegraph.

Trained health workers, she said, could help screen patients and refer them to specialist psychiatric care, ensure that the patients take the prescribed medications regularly, and provide the counselling and support that many mentally ill patients require.

“Short-term training programmes could equip health workers and even schoolteachers to develop the expertise to perform some of these tasks,” Chandrashekar said.

Mental health professionals estimate that India has about 120 million patients with mental disorders but only about 4,500 psychiatrists, most of whom are in cities and towns.

“This review, while confined to mental disorders, provides evidence to support a longstanding proposal to establish a cadre of non-MBBS rural health workers,” said K.M. Shyamprasad, surgeon and former member of a government task force on medical education.

The Union cabinet last week approved a health ministry proposal to introduce a three-year course called Bachelor of Science in Community Health to create a parallel cadre of health workers who would serve in rural areas bereft of doctors.

The review, which covered 38 studies from 22 countries — including two studies from Goa — is being described as the first systematic analysis of the impact of deploying non-specialist health workers to provide care to patients with mental disorders, including substance-abuse problems.

The findings suggest that non-specialist workers may also be able to help patients with alcohol abuse and post-traumatic stress disorder, although the improvements in these sets of patients are smaller than in those with anxiety or depression.

The researchers have cautioned that some of the studies they reviewed were of “poor quality”, so there is still need for more evidence.

The London School of Hygiene and Tropical Medicine said more evidence was needed also to assess the impact of non-specialists in treating epilepsy and severe mental disorders.