Delhi Mental Health System Has Major Gaps: AIIMS Report

Delhi's mental health system has significant gaps in human resources, infrastructure, training and implementation of mental health programmes, with the overall situation found to be “not very encouraging” in an assessment carried out by AIIMS New Delhi.

The findings are part of the Mental Health System Assessment (MHSA) undertaken along with the second National Mental Health Survey (NMHS-2) by the health experts from the NIMHANS, Bangaluru and AIIMS Delhi. The MHSA looked at how mental health services are functioning in hospitals and health facilities across the national capital and whether they have the capacity to identify and manage people with mental health problems.

The detailed assessment report along with the NMHS-2 study will be made public on October 10, World Mental Health Day, at an event to be held in the national capital.

“The situation is not very encouraging. There are gaps in human resources, infrastructure and training. We have also looked at how well the mental health programme is being implemented at different levels of healthcare,” said Dr Harshal Ramesh Salve, Professor, Centre for Community Medicine, AIIMS New Delhi, who was part of the Delhi MHSA team.

The assessment examined major hospitals as well as primary and secondary healthcare facilities to understand how mental health services are being delivered and where patients may face difficulties in getting appropriate care.

One of the key areas looked into was whether general healthcare workers have been trained to identify and manage common mental health conditions such as depression and anxiety.

“Since there are a very few psychiatrists in the country, focus has been to train general healthcare providers so that they can recognise common psychiatric disorders, start appropriate management and know when a patient needs to be referred to a specialist,” Dr (Prof) Salve said.

However, the assessment has found that implementation of this approach needs to be strengthened.

“Training and capacity building, awareness generation and implementation of the programme at the primary and secondary levels are still lacking. These areas need to be strengthened,” he maintained.

As part of the wider exercise, the AIIMS team also looked at mental health among patients with TB and diabetes. “The aim was to understand whether mental health needs are being recognised among people who are already seeking treatment for physical illnesses and whether facilities have the capacity to respond to those needs.”

The experts said the findings point to a larger problem in the way mental healthcare is organised. “A person with depression or anxiety may not necessarily walk into a psychiatry department. They may first visit a general physician or a primary health centre with complaints such as poor sleep, tiredness, headaches or other physical symptoms,” she added.

Similarly, people being treated for chronic physical diseases may also need mental health support.

“If mental healthcare is available only in specialist hospitals, many people who need help may not reach these services,” Dr (Prof) Salve said.

Integrating mental health into primary and secondary healthcare can make services more accessible. But this requires trained staff, medicines, referral systems and regular support from specialists.

The problem, according to Dr (Prof) Salve, is not only the shortage of psychiatrists but also their uneven distribution, suggesting that a large tertiary hospital may have several specialists, while a primary or secondary healthcare facility may have little or no specialist support.

This can make it difficult for patients to receive timely diagnosis, treatment and follow-up care.

Training general healthcare workers to identify common mental health conditions can help extend the reach of services. But such training needs to be supported by a proper referral system so that patients with more serious or complex conditions can be referred to psychiatrists and other mental health professionals.

The assessment also examined the availability of essential psychiatric medicines, added Dr (Prof) Salve.

For people with mental health conditions, treatment often requires regular medication and follow-up. Any interruption in the availability of medicines can affect continuity of care.

Ensuring that essential psychiatric medicines are available at health facilities is therefore an important part of strengthening the mental health system.

The assessment has also looked at awareness and health-seeking behaviour. Although people are now more willing to talk about mental health than before, stigma continues to be a barrier, particularly for common conditions such as depression and anxiety.

Health-seeking for mental health problems is still not at the same level as it is for many physical illnesses, Dr (Prof) Salve said.

The other experts in the Delhi team included Dr (Prof) Anand Krishnan, both from the Centre for Community Medicine, and Dr (Prof) Rajesh Sagar, Dr (Prof) Ramandeep, and Dr (Prof) Alok Aggarwal, all from the Department of Psychiatry, along with the NMHS-2 Field Data Collection Team.

To review the findings of the system assessment and provide inputs for the final report, a workshop was held at AIIMS New Delhi on September 18, bringing together mental health experts, healthcare professionals, government and institutional representatives and civil society organisations.