So tents are going to Pramila and Oxford University for inviting me to do this talk,
and it's show mcbrown I've read probably disagree on some of the fundamentals, so it hasn't.
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.
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.
Also, and I'll be just talking about the pilot phase of it, which I'm talking about here.
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.
And so a quickly shift to the next slide,
which again has been talked to by Pratap about a few psychiatric psychologists resources that are again in India.
And the real challenge that is to get those limited take actions and resources is just impossible
that we can ever think about closing the burden off or the gap of treatment that gets care in India,
which is actually quite huge, is close to almost 75 to 85 percent.
And because of that, what we can't it's OK,
let's think about how can we use mobile technology to enable the process to make it slightly easier to close the gap?
And what I'm going to talk about right now, it's one of the projects that we started way back in 2014,
funded by a welcome Djibouti intermediate carrier fellowship that I received.
And also the Grand Challenges Canada.
It's called a systematic medical appraisal, referral and treatment, or an acronym being smart mental health programme.
And just this one, I'm just thinking that we were working in.
In fact, the four key strategies are shifting using an electronic decision support system,
incorporating a clinical decision, support foods on a mobile based platform and conducting an anti-stigma campaign.
I believe in any stigma campaigns.
So we get investigate every district, which is a coastal district of ongoing, piggish and a pit stop who with a large formative phase.
And during that phase, few things that really came through was one that fear killers and Christian healers were
considered as important for Canada as mental health service providers in the community.
And yes, there was a definite lack of an understanding about community mental health or mental health disorders in the community as such.
You spoke numbers very much focussed on common mental disorders and things that we told you about depression,
anxiety and emotional stress and suicide risk.
So as part of the formative phase, we used to catch the Couwels, essentially one was the HQ nine,
which was a kind of screening tool which was used and the other was the image that pool of W.H.O.,
especially the depression and suicide and emotional stress modules affect, which were foods that get doctors the primary care doctors used.
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.
Yes. In total, they're going to about 42 villages, 41 tribal villages and 12 non tribal villages.
I would be basically conseguir the quantitative results,
which I'll be talking about subsequently will be on those tribal villages because sketches published literature the one,
the results from the twelve villages I won't be talking about here because schools are under fabrication right now.
And this was done. We had to set up questionnaires which was around you, looking at socio demographic variables, stresses social support systems.
And then what we came across was I just run through gates because cases go.
And how do you work or what am I? Oh, yeah.
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.
And anyone who was pretty positive on the Q nine,
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.
Yeah, and all the data was obviously shared through the South system,
and the primary care doctors had access to that beach to nine questionnaire and yet also used a major gap tool,
which I've got to, which we had also put on a tablet device and using image copy.
The primary care doctors were able to provide a clinical diagnosis and manage it as per the W.H.O. guidelines.
And then that whatever treatment that the doctors provided, whether it be a pharmacological treatment or psychological counselling,
it could just beefed up therapy at the primary care centre level on referral to a district hospital for more specialist care.
That information was getting relayed back to the Asha worker, and she, using again an algorithm based device device,
were able to follow up on those individuals to ensure treatment adherence and also use that time to ask,
you know, really simple questions about stressors, how they were doing in life,
the social support system and the way that they had gone in the North and those guys.
And then eventually we went in and force intervention.
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.
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.
We had that was about 10000 the population and we also were able to screen five thousand seven years ago,
adult population and you identified 238 individuals make who has been positive and.
What we could find is that August 248 compared to this was before after this, and this was not random as well.
The method of service use increased from 4.8 percent before we went in to
twelve point six percent that this is over a three month intervention period.
Depression and anxiety scores are definitely reduced significantly in the Post Intervention Group.
I think that we have trained about twenty one, according to primary health care doctors and go the thinking.
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.
This is from the other part of your study and a larger study which are 12 villages.
And here we actually had gone and screened almost twenty eight thousand fifty three thousand people.
And some of those initial schools that came out from the baseline study, which was published,
is that the depression and anxiety to moderate and severe was almost a 2.4 percent depression.
And again, a two percent anxiety and an increased suicide risk was there in 1.6 percent
off of able to screen about the 900 you found about 900 was being positive,
which gave us about an average of 4.1 percent has been positive.
This is about anti-stigma campaign,
which I talked about this we evaluated across two villages only beginning to have the resources going across our food study site.
And what we found is that and we had used the barriers to access for care evaluation and one of the knowledge,
attitudes and behaviour skills, which are Grant Thornycroft has developed and I was part of this evaluation process.
And we also get that evaluation at three months just after we had delivered the anti-stigma
campaign and also two years down the line to just see what was the effect of it.
Interestingly enough, across both our behaviour and attitude modules, we had been able to find that our campaign was effective.
And in the campaign we had use multimedia approaches, brochures, pamphlets, videos, social contact,
talking about his experiences and the drama and effects, but also positive after two years.
And that was what encouraged as a lot that over the two year period we had essentially
just delivered the email component company in Canada anti-stigma campaign.
We still were able to see a decrease in our schools across all domains that we measured.
So what did we learn, we learnt many of that service could be increased significantly if we had the right
systems in place and and that our study could affect overall depression anxiety levels.
We could find a helpful and a component and minimal intervention that we had could be implemented successfully,
and a total process evaluation was a learning process and helps us to scale up to the next phase.
So this has been a journey over the past five years from 2014, when this project started as a pilot project and in 2016,
the initially got some preliminary results from our tribal villages.
And then in 2017, I got a new grant from as part of the Global Alliance for Chronic Disease,
which has now enabled me to scaling up across the board and Angarano.
We are now doing this guest free screening of the pop up community.
It's happening across a four-fold primary, health care centres across the border states and get IDs in the process.
And we are also planning to diversify the same kind of model into an agile listening to rural adolescent urban slum community.
So these are some of my colleagues who have been working with me and my funders, and I said, thank you.