Sustainable Community Mental Health Services: A Description and Review of an Integrated Care Model in Uttar Pradesh

Background: Mental health services were integrated into the primary health programs of Ramakrishna Mission, Varanasi (RKM) as part of the Jan Man Swasthya Pariyojana (JMSP).  The program was delivered with JMSP support for three and a half years till June 2017, when funding ended. From then onwards, mental health services continue to be delivered till date in a sustainable manner. Aim: We describe the implementation of the community mental health program during the 3.5-year JMSP period, and the subsequent 4 year sustained period till date. Materials and method: The program identified and treated persons with Common Mental Disorders (CMD) and Severe Mental Disorders (SMD). The enrollments and outcomes over the JMSP period and subsequent 4-year sustained period were analyzed. Results: 288 patients with CMD and 166 patients with SMD were enrolled in the JMSP period. The enrolment of patients during the sustained period was consistent with the forecast based on the JMSP period. Program fidelity was maintained over most activities. The primary care doctors demonstrated competence in diagnostic and pharmacotherapeutic skills. Program adaptation occurred through the introduction of telemedicine. Conclusion: This paper describes a sustainable community mental health program delivering services integrated with primary health care in eastern Uttar Pradesh. Over a four-year continued period, the program demonstrated sustained benefits to clients, as well as program fidelity and adaptation. This experience can contribute to new community mental health programs, as well as to the National Mental health Programme.