Change in attitude of ASHAs towards persons with mental illnesses following participation in community based rehabilitation project.

BACKGROUND: Accredited Social Health Activists (ASHAs) play an important role in health care in rural India. AIM: To study the change in attitude of ASHAs towards persons with mental illness (PMI) after involvement in a community-based rehabilitation program. METHODS: ASHAs (n = 95) were trained to identify and refer PMI. Community Attitudes to Mental Illness scale was administered at baseline and after 18 months of training. RESULTS: Domains of benevolence, social restrictiveness, and community mental health ideology showed significant improvement p < 0.001. There was no change in authoritarianism domain. CONCLUSION: Engaging ASHAs in identification, referral and treatment positively changes their attitudes towards PMI.

Swavlamban Health Insurance scheme for persons with disabilities: An experiential account.

CONTEXT: Out-of-pocket expenditure on health in India is high. Many people including persons with disability (PwD) face catastrophic health expenditure. Health insurance is a promising strategy to overcome this burden. Swavlamban was the first health insurance for PwD which also covered mental illness. We conducted regular camps at the National Institute of Mental Health and Neurosciences (NIMHANS) for enrollment in the scheme. In this study, we present the features of the scheme and the sociodemographic profile of beneficiaries enrolled. AIMS: To describe the experience of conducting enrollment camps for the Swavlamban Health Insurance scheme at NIMHANS and the sociodemographic profile of beneficiaries enrolled. SETTINGS AND DESIGN: The study comprised all PwD and their family members enrolled in the Swavlamban through the camps conducted at NIMHANS from May 2016 to April 2017. RESULTS: A total of 1248 persons were enrolled, of which 643 were PwD. The beneficiaries (PwD) were predominantly male (69%), with a mean age of 31 years, from Bengaluru (84%), and majority had disability due to mental retardation (43%). Although camps were conducted in mental hospital and publicized among mental health professionals, only 135 persons disabled with mental illness (21% of PwD beneficiaries) were enrolled. CONCLUSIONS: Mental health professionals need to take the lead in coordinating with various stakeholders so that the PwD can avail health insurance and other welfare benefits. There is a need to lobby and advocate for making these schemes easily accessible.

Impact of community-based rehabilitation for mental illness on 'out of pocket' expenditure in rural South India.

In India, expenditure incurred to access mental health services often drives families to economic crisis. Families of Persons with mental illness (PMI) incur 'out-of-pocket' (OOP) expenditure for medicines, psychiatrist fee and travel in addition to losing wages on the day of visiting psychiatrist. AIM: To describe impact of Community Based Rehabilitation (CBR) on OOP expenditure incurred by families of persons with severe mental illness (PSMI). METHODS: The sample comprised 95 PSMI who switched from treatment from other mental health facilities to CBR at Jagaluru, India. RESULTS: The PSMI were predominantly male (52%) with mean age 41 years and diagnosed with psychosis (75%). Most of them (84%) were earlier taking treatment from private sector and spent on an average Rs. 15,074 (US $ 215) per PSMI per annum in availing treatment. After availing CBR, the annual expenditure reduced to Rs 492 (US $ 7) on an average per PSMI. OOP expenditure on medicines (largest head of expenditure) and psychiatrist consultation fee dropped to zero. DISCUSSION: After excluding costs incurred to run the CBR, the net savings for the system for 95 PSMI included in study alone was Rs 3,83,755 (US $ 5,482) per annum. The amount would be much higher on including savings for PSMI initiated on treatment for the first time and PMI on regular follow-up in CBR. CONCLUSIONS: Provision of CBR in partnership with public health system and NGO's leads to dramatic fall in OOP health expenditure of families of PSMI. It is also cost-effective to the system.