1 00:00:08,780 --> 00:00:14,210 So tents are going to Pramila and Oxford University for inviting me to do this talk, 2 00:00:14,210 --> 00:00:21,470 and it's show mcbrown I've read probably disagree on some of the fundamentals, so it hasn't. 3 00:00:21,470 --> 00:00:28,610 So that's the initial caveat that I wanted to give. So this is talking about some one of the programmes that we are doing in. 4 00:00:28,610 --> 00:00:36,770 We had done it on your application and now we are scaling it up in Haryana and also in Andhra Pradesh and subsequently into Delhi. 5 00:00:36,770 --> 00:00:45,640 Also, and I'll be just talking about the pilot phase of it, which I'm talking about here. 6 00:00:45,640 --> 00:00:53,800 So these are I think I don't need to talk about these and get on the field and people know gets results is statistics. 7 00:00:53,800 --> 00:00:56,380 And so a quickly shift to the next slide, 8 00:00:56,380 --> 00:01:03,760 which again has been talked to by Pratap about a few psychiatric psychologists resources that are again in India. 9 00:01:03,760 --> 00:01:11,200 And the real challenge that is to get those limited take actions and resources is just impossible 10 00:01:11,200 --> 00:01:18,250 that we can ever think about closing the burden off or the gap of treatment that gets care in India, 11 00:01:18,250 --> 00:01:23,940 which is actually quite huge, is close to almost 75 to 85 percent. 12 00:01:23,940 --> 00:01:26,400 And because of that, what we can't it's OK, 13 00:01:26,400 --> 00:01:34,950 let's think about how can we use mobile technology to enable the process to make it slightly easier to close the gap? 14 00:01:34,950 --> 00:01:42,150 And what I'm going to talk about right now, it's one of the projects that we started way back in 2014, 15 00:01:42,150 --> 00:01:46,890 funded by a welcome Djibouti intermediate carrier fellowship that I received. 16 00:01:46,890 --> 00:01:49,350 And also the Grand Challenges Canada. 17 00:01:49,350 --> 00:01:56,310 It's called a systematic medical appraisal, referral and treatment, or an acronym being smart mental health programme. 18 00:01:56,310 --> 00:02:00,770 And just this one, I'm just thinking that we were working in. 19 00:02:00,770 --> 00:02:08,420 In fact, the four key strategies are shifting using an electronic decision support system, 20 00:02:08,420 --> 00:02:16,400 incorporating a clinical decision, support foods on a mobile based platform and conducting an anti-stigma campaign. 21 00:02:16,400 --> 00:02:21,320 I believe in any stigma campaigns. 22 00:02:21,320 --> 00:02:32,190 So we get investigate every district, which is a coastal district of ongoing, piggish and a pit stop who with a large formative phase. 23 00:02:32,190 --> 00:02:38,120 And during that phase, few things that really came through was one that fear killers and Christian healers were 24 00:02:38,120 --> 00:02:44,030 considered as important for Canada as mental health service providers in the community. 25 00:02:44,030 --> 00:02:51,410 And yes, there was a definite lack of an understanding about community mental health or mental health disorders in the community as such. 26 00:02:51,410 --> 00:02:58,130 You spoke numbers very much focussed on common mental disorders and things that we told you about depression, 27 00:02:58,130 --> 00:03:03,820 anxiety and emotional stress and suicide risk. 28 00:03:03,820 --> 00:03:11,260 So as part of the formative phase, we used to catch the Couwels, essentially one was the HQ nine, 29 00:03:11,260 --> 00:03:18,010 which was a kind of screening tool which was used and the other was the image that pool of W.H.O., 30 00:03:18,010 --> 00:03:27,960 especially the depression and suicide and emotional stress modules affect, which were foods that get doctors the primary care doctors used. 31 00:03:27,960 --> 00:03:42,100 And we had all of these tools set up on a tablet based mobile, and we had created algorithms around that to facilitate the process. 32 00:03:42,100 --> 00:03:51,100 Yes. In total, they're going to about 42 villages, 41 tribal villages and 12 non tribal villages. 33 00:03:51,100 --> 00:03:54,790 I would be basically conseguir the quantitative results, 34 00:03:54,790 --> 00:04:03,460 which I'll be talking about subsequently will be on those tribal villages because sketches published literature the one, 35 00:04:03,460 --> 00:04:10,540 the results from the twelve villages I won't be talking about here because schools are under fabrication right now. 36 00:04:10,540 --> 00:04:19,330 And this was done. We had to set up questionnaires which was around you, looking at socio demographic variables, stresses social support systems. 37 00:04:19,330 --> 00:04:25,210 And then what we came across was I just run through gates because cases go. 38 00:04:25,210 --> 00:04:33,160 And how do you work or what am I? Oh, yeah. 39 00:04:33,160 --> 00:04:43,450 So what they started off was that the following in the household screening the offshore banking and screening the population using at the HQ nine. 40 00:04:43,450 --> 00:04:46,720 And anyone who was pretty positive on the Q nine, 41 00:04:46,720 --> 00:04:56,860 so got a squad of 10 on Page two nine or a score of recorded one on the suicide question you were referred to by a primary care doctor. 42 00:04:56,860 --> 00:05:01,090 Yeah, and all the data was obviously shared through the South system, 43 00:05:01,090 --> 00:05:08,260 and the primary care doctors had access to that beach to nine questionnaire and yet also used a major gap tool, 44 00:05:08,260 --> 00:05:13,820 which I've got to, which we had also put on a tablet device and using image copy. 45 00:05:13,820 --> 00:05:20,710 The primary care doctors were able to provide a clinical diagnosis and manage it as per the W.H.O. guidelines. 46 00:05:20,710 --> 00:05:28,780 And then that whatever treatment that the doctors provided, whether it be a pharmacological treatment or psychological counselling, 47 00:05:28,780 --> 00:05:36,970 it could just beefed up therapy at the primary care centre level on referral to a district hospital for more specialist care. 48 00:05:36,970 --> 00:05:45,010 That information was getting relayed back to the Asha worker, and she, using again an algorithm based device device, 49 00:05:45,010 --> 00:05:52,090 were able to follow up on those individuals to ensure treatment adherence and also use that time to ask, 50 00:05:52,090 --> 00:05:56,680 you know, really simple questions about stressors, how they were doing in life, 51 00:05:56,680 --> 00:06:02,560 the social support system and the way that they had gone in the North and those guys. 52 00:06:02,560 --> 00:06:08,240 And then eventually we went in and force intervention. 53 00:06:08,240 --> 00:06:22,000 That's just been around. And before we even started, oh yes, we had intensive treatment programme, maybe rolled out a major anti-stigma campaign. 54 00:06:22,000 --> 00:06:30,340 And you are some of the quantitative results that came out and we had, I guess this one got sick of title villagers that we had bombed. 55 00:06:30,340 --> 00:06:38,880 We had that was about 10000 the population and we also were able to screen five thousand seven years ago, 56 00:06:38,880 --> 00:06:49,280 adult population and you identified 238 individuals make who has been positive and. 57 00:06:49,280 --> 00:06:57,860 What we could find is that August 248 compared to this was before after this, and this was not random as well. 58 00:06:57,860 --> 00:07:03,380 The method of service use increased from 4.8 percent before we went in to 59 00:07:03,380 --> 00:07:08,120 twelve point six percent that this is over a three month intervention period. 60 00:07:08,120 --> 00:07:14,190 Depression and anxiety scores are definitely reduced significantly in the Post Intervention Group. 61 00:07:14,190 --> 00:07:21,530 I think that we have trained about twenty one, according to primary health care doctors and go the thinking. 62 00:07:21,530 --> 00:07:34,350 We had done extensive qualitative study to look at the feasibility and acceptability of what we had done, and the results were quite positive answer. 63 00:07:34,350 --> 00:07:41,100 This is from the other part of your study and a larger study which are 12 villages. 64 00:07:41,100 --> 00:07:48,210 And here we actually had gone and screened almost twenty eight thousand fifty three thousand people. 65 00:07:48,210 --> 00:07:53,520 And some of those initial schools that came out from the baseline study, which was published, 66 00:07:53,520 --> 00:08:00,810 is that the depression and anxiety to moderate and severe was almost a 2.4 percent depression. 67 00:08:00,810 --> 00:08:08,940 And again, a two percent anxiety and an increased suicide risk was there in 1.6 percent 68 00:08:08,940 --> 00:08:13,890 off of able to screen about the 900 you found about 900 was being positive, 69 00:08:13,890 --> 00:08:21,410 which gave us about an average of 4.1 percent has been positive. 70 00:08:21,410 --> 00:08:23,420 This is about anti-stigma campaign, 71 00:08:23,420 --> 00:08:33,020 which I talked about this we evaluated across two villages only beginning to have the resources going across our food study site. 72 00:08:33,020 --> 00:08:42,950 And what we found is that and we had used the barriers to access for care evaluation and one of the knowledge, 73 00:08:42,950 --> 00:08:51,690 attitudes and behaviour skills, which are Grant Thornycroft has developed and I was part of this evaluation process. 74 00:08:51,690 --> 00:08:57,320 And we also get that evaluation at three months just after we had delivered the anti-stigma 75 00:08:57,320 --> 00:09:02,990 campaign and also two years down the line to just see what was the effect of it. 76 00:09:02,990 --> 00:09:13,640 Interestingly enough, across both our behaviour and attitude modules, we had been able to find that our campaign was effective. 77 00:09:13,640 --> 00:09:21,680 And in the campaign we had use multimedia approaches, brochures, pamphlets, videos, social contact, 78 00:09:21,680 --> 00:09:29,390 talking about his experiences and the drama and effects, but also positive after two years. 79 00:09:29,390 --> 00:09:35,210 And that was what encouraged as a lot that over the two year period we had essentially 80 00:09:35,210 --> 00:09:38,990 just delivered the email component company in Canada anti-stigma campaign. 81 00:09:38,990 --> 00:09:47,990 We still were able to see a decrease in our schools across all domains that we measured. 82 00:09:47,990 --> 00:09:53,900 So what did we learn, we learnt many of that service could be increased significantly if we had the right 83 00:09:53,900 --> 00:10:02,600 systems in place and and that our study could affect overall depression anxiety levels. 84 00:10:02,600 --> 00:10:11,360 We could find a helpful and a component and minimal intervention that we had could be implemented successfully, 85 00:10:11,360 --> 00:10:20,470 and a total process evaluation was a learning process and helps us to scale up to the next phase. 86 00:10:20,470 --> 00:10:29,320 So this has been a journey over the past five years from 2014, when this project started as a pilot project and in 2016, 87 00:10:29,320 --> 00:10:34,660 the initially got some preliminary results from our tribal villages. 88 00:10:34,660 --> 00:10:42,490 And then in 2017, I got a new grant from as part of the Global Alliance for Chronic Disease, 89 00:10:42,490 --> 00:10:47,560 which has now enabled me to scaling up across the board and Angarano. 90 00:10:47,560 --> 00:10:52,060 We are now doing this guest free screening of the pop up community. 91 00:10:52,060 --> 00:11:01,450 It's happening across a four-fold primary, health care centres across the border states and get IDs in the process. 92 00:11:01,450 --> 00:11:13,430 And we are also planning to diversify the same kind of model into an agile listening to rural adolescent urban slum community. 93 00:11:13,430 --> 00:11:29,002 So these are some of my colleagues who have been working with me and my funders, and I said, thank you.