Alcohol policies in India: A scoping review.

Globally, alcohol consumption causes significant societal harm and is a leading risk factor for death and disability in adults. In India, 3.7% of all deaths and 3.1% disability adjusted life years (DALYs) can be attributed to alcohol. In the context of rapid economic development and emphasized by the COVID-19 pandemic, India's lack of a consolidated and comprehensive alcohol policy has posed significant challenges to addressing this harm. In this context, the aim of our review was to undertake a comprehensive mapping of the State and national policy environment surrounding alcohol and its use in India, based on an analysis of policy documents. We did this though a scoping review of academic and grey literature, which helped to iteratively identify the websites of 15 international organizations, 21 Indian non-governmental organizations, and eight Indian Federal governmental organizations as well as State/Union Territory government sites, to search for relevant policy documents. We identified 19 Federal policy documents and 36 State level policy documents within which we have identified the specific policy measures which address the 10 categories of the World Health Organization's Global Action Plan to Reduce the Harmful Use of Alcohol. We found that there are major gaps in regulation of marketing and price controls, with much of this controlled by the States. In addition, regulation of availability of alcohol varies widely throughout the country, which is also a policy area controlled locally by States. Through the clear elucidation of the current policy environment surrounding alcohol in India, policy makers, researchers and advocates can create a clearer roadmap for future reform.

Stigma towards dependent drinking and its role on caregiving burden: A qualitative study from Goa, India.

INTRODUCTION: Stigma towards alcohol use disorders is prevalent in India and can lead to social exclusion and hamper treatment access and outcomes. Family members of individuals with dependent drinking are often their primary caregivers and play a key role in decisions around help-seeking, treatment and recovery. The nature and role of stigma in caregiving, and the consequent burden on family caregivers of those with dependent drinking, has not been qualitatively studied in India. METHODS: We conducted in-depth interviews with: (i) men with probable alcohol dependence (n = 11); (ii) family caregivers (n = 12); and (iii) doctors with experience of treating alcohol dependence (n = 13) in community settings in Goa. Data were analysed using inductive thematic analysis. RESULTS: Two primary themes were identified from the data: (i) stigma in the form of ignorance, prejudice and discrimination; and (ii) the impact of this stigma on caregiving decisions and the mental health of caregivers. DISCUSSION AND CONCLUSIONS: We found that stigma functioned as a barrier to a proper course of treatment and care, as well as a detrimental factor for caregiver's mental health and caregiving decision-making. Stigma towards dependent drinking in the forms of ignorance, prejudice and discrimination is prevalent within homes, workplaces and health systems and might exacerbate the caregiving burden among female family caregivers. Policies, educational programs and campaigns aimed at preventing stigma in these forms would likely enable access to more inclusive and appropriate health services, benefit the health of family caregivers and improve the treatment outcomes of drinkers.

Substance use and help-seeking among justice-involved young people in Queensland and Western Australia: A cross-sectional survey of 14-17-year-olds.

INTRODUCTION: This study investigated substance use and help-seeking among justice-involved young people to inform and improve service provision during and after contact with the justice system. METHODS: Young people (14-17 years) in the community with current or prior contact with the justice system were recruited in Queensland and Western Australia, Australia using purposive sampling between 2016 and 2018. A cross-sectional survey was delivered by computer-assisted telephone interview. Information was collected on sociodemographic and health factors; lifetime and frequency of use of alcohol, tobacco and other drugs; and use of health services related to substance use and mental health. RESULTS: Of the 465 justice-involved young people surveyed, most had used alcohol (89%), tobacco (86%) or other drugs (81%). Of the latter, cannabis use was most prevalent (79%), followed by ecstasy (26%) and amphetamine (22%). Young people engaging in higher risk drug use (daily use, injecting use) were more likely to also have an alcohol use disorder, be disengaged from education, unemployed, have attempted suicide and experienced incarceration. Of the cohort, 24% had received treatment at an alcohol and drug service in the past year and 30% had seen a health professional about emotional/behavioural problems. Males and Aboriginal and Torres Strait Islander young people were less likely to have sought professional help. CONCLUSION: The high levels of substance use and disproportionate levels of help-seeking observed in this study illustrate the importance of delivering tailored, comprehensive and coordinated trauma-informed and culturally safe alcohol and drug services to justice-involved young people.

'He was trapped in his own web'-Dependent drinking as a poverty trap: A qualitative study from Goa, India.

INTRODUCTION AND AIMS: Of the Indian population, 2.7% have alcohol dependence, the most severe of alcohol use disorders. Alcohol use disorders have previously been found to be correlated with a range of negative economic outcomes, but dependent drinking has yet to be causally identified as a poverty trap. We use qualitative data as the first step towards identifying the mechanisms that may underlie a dependent drinking driven poverty trap in India. DESIGN AND METHODS: Thirty-six in-depth interviews were conducted and analysed using inductive thematic analysis. Participants were men having probable alcohol dependence (n = 11), doctors (n = 13) who come into contact with patients presenting with alcohol dependence at government hospitals and clinics, and family members of men with probable alcohol dependence (n = 12) in Goa, India. RESULTS: Our key findings showed that families of those who have alcohol dependence have less opportunity for saving, more job instability and poor treatment opportunity to aid recovery and allow escaping from the trap. DISCUSSION AND CONCLUSIONS: Households in Goa, India with a member with alcohol dependence display patterns consistent with a poverty trap, though the mechanisms derived from these qualitative data need to be further demonstrated by longitudinal quantitative data to corroborate a causal relationship between alcohol use disorders and poverty.

Investment in Australian mental health carer services: how much and does it reflect evidence of effectiveness?

Objective The aims of this study were to quantify Australian federal and state government expenditure on mental health carer services for 2014-15, map the types of services being provided and explore how funded service types compare with the evidence base for the outcomes of these carer services. Methods Web searches were conducted to identify in-scope mental health carer services in Australia funded by federal and state and territory governments. Funding estimates were confirmed where possible with available government and carer organisation contacts. A literature search was conducted for reviews of studies investigating mental health carer service outcomes. Results In 2014-15, the estimated Australian national, state and territory government expenditure on mental health carer services was approximately A$90.6million. This comprised A$65.6million in federal expenditure and A$25.0million in state and territory expenditure. Most funding streams provided respite and psychoeducation. The literature showed positive carer outcomes for psychoeducation and intensive family interventions. Evidence was lacking for the effectiveness of respite services. Conclusions These findings suggest a mismatch between what is known about the extent to which different service types deliver positive carer outcomes and the current allocation of funds across Australia's mental health system. This study also highlights the fragmentation of the mental health carer services system, supporting the need to streamline access. What is known about this topic? Informal carers of people with mental disorders provide a critical role to the significant number of individuals with mental illness in Australia, and provide an unpaid workforce to the Australian mental health system. This role comes with significant physical, emotional and financial burden, which government-funded services can assist with to allow mental health carers to continue to serve in their caring role while improving their quality of life. What does this paper add? Using both published data and communication with health and non-government officials, we have estimated federal and state expenditure on mental health carer services at A$90.6million in 2014-15 fiscal year and have provided a mapping of the services this expenditure funds. In addition, through analysis of the literature on outcomes of carer services provided, we have seen a mismatch of expenditure and the evidence base. What are the implications for practitioners? There is a necessity for both more research into service outcomes aimed particularly at mental health carers and thinking critically about whether the current prioritisation of funds can be increased and/or reallocated to create better outcomes for mental health carers.

Implementation of the mental health Gap Action Programme (mhGAP) within the Fijian Healthcare System: a mixed-methods evaluation.

BACKGROUND: To facilitate decentralisation and scale-up of mental health services, Fiji's Ministry of Health and Medical Services committed to implementing the World Health Organization's mental health Gap Action Programme (mhGAP). mhGAP training has been prolific; however, it remains unclear, beyond this, how successfully Fiji's national mental health program has been implemented. We aim to evaluate Fiji's mental health program to inform Fiji's national mental health program and to develop an evidence-base for best practice. METHODS: The study design was guided by the National Implementation Research Network and adhered to the Consolidated Framework for Implementation Research. CFIR constructs were selected to reflect the objectives of this study and were adapted where contextually necessary. A mixed-methods design utilised a series of instruments designed to collect data from healthworkers who had undertaken mhGAP training, senior management staff, health facilities and administrative data. RESULTS: A total of 66 participants were included in this study. Positive findings include that mhGAP was considered valuable and easy to use, and that health workers who deliver mental health services had a reasonable level of knowledge and willingness to change. Identified weaknesses and opportunities for implementation and system strengthening included the need for improved planning and leadership. CONCLUSION: This evaluation has unpacked the various implementation processes associated with mhGAP and has simultaneously identified targets for change within the broader mental health system. Notably, the creation of an enabling context is crucial. If Fiji acts upon the findings of this evaluation, it has the opportunity to not only develop effective mental health services in Fiji but to be a role model for other countries in how to successfully implement mhGAP.

Policy environment impacting the societal harm caused by alcohol in India: protocol for a scoping review.

INTRODUCTION: The aim of this review is to provide the first consolidation of the policy environment surrounding alcohol-related societal harm in India giving researchers and policy-makers a clearer base for future reforms. This review is also an important adaptation on the scoping review method for policy reviews in low-resource settings that may serve as an example for other policy reviews in similar settings. METHODS AND ANALYSIS: We will undertake a scoping review with policy relevant adaptations in order to map the alcohol-related policy environment in India. Following the six-step approach put forward by ArskeyandO'Malley and refined by Levac, we will first undertake an academic scoping search to identify relevant knowledge already existing in the literature about the policy environment in India. We will then use the knowledge that appears in this search iteratively, as is true to the scoping method, to develop a more targeted search of grey literature and Indian government websites for Indian policy documents. These documents will be analysed using qualitative methods to synthesise the current alcohol policy environment in India. ETHICS AND DISSEMINATION: This study will only use already published information and therefore does not require an ethics review. We will circulate this protocol and the final report to policy researchers in similar settings who could make use of our adaptation of the scoping review method for a low-resource setting. We will also publish our findings in a peer-review journal.