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Integrated Care in India: Part 2

Posted By Matthew P. Martin, Friday, July 7, 2017


A year ago we highlighted the work of Dr. Manjunatha from the National Institute of Mental Health and Neurosciences in Bangalore, India, who had written a report for the Lancet describing an ambitious program to integrate mental health services into primary care systems. The program, called the Manochaitanya Programme, provides mental health services every Tuesday in taluk hospitals, community health centres, and primary health centres in Karnataka. The services are also available during the rest of the week at all primary health clinics.


This week Dr. Manjunatha reached out again to share his recently published critical analysis of the Manochaitanya Programme.  Click here for the publication


Here is an excerpt from the article:


"This is the first-of-its kind dedicated public mental health programme in India, launched by the State government with exclusive aim to integrate mental health at the level of primary care. It includes the treatment of psychiatric disorders by primary care physicians, and refer only the difficult-to-treat cases to specialized centres. Another highlight is making available psychiatric specialist care at every taluk hospital (TH) at least once a month for these referred cases. These benefits are available at about 2310 primary health centres (PHCs) and 180 community health centres (CHCs) and 146 THs covering more than 60 million population of Karnataka.


Training programmes and a manual for primary care doctors: The World Health Organization recommends effective training programmes to develop mental health skills of primary health care staff [3]. Traditional training programmes for primary care physicians in India are criticized as 'never properly trained'[25]. Providing continuing education for primary care physicians is more likely to improve the quality of mental health care than the recruitment of more psychiatrists.


The previous psychiatric training manuals were complex and could not be adapted properly for primary health care and caused difficulty for primary care physicians who had no or little previous exposure to psychiatry...  Hence, there is a need for a practical, concise manual which is adapted for primary care psychiatry."


The authors conclude that this is a major project and that next steps include workforce development, dedicated budget allocation, and clearer project outcomes. Read more to learn about integrated care on a large scale in another part of the world. 


Dr. N. Manjunatha, MD, DPM, MBBS

Assistant Professor of Psychiatry, Department of Psychiatry

National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India

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