Treatment gap for mental and behavioral disorders in Punjab

Rohit Garg; Bir Singh Chavan; Subhash Das; Sonia Puri; Arvind A Banavaram; Vivek Benegal; Girish N Rao; Mathew Varghese; Gopalkrishna Gururaj

doi:10.4103/indianjpsychiatry.indianjpsychiatry_839_23

Treatment gap for mental and behavioral disorders in Punjab

Indian J Psychiatry. 2023 Dec;65(12):1269-1274. doi: 10.4103/indianjpsychiatry.indianjpsychiatry_839_23. Epub 2023 Dec 11.

Authors

Rohit Garg¹, Bir Singh Chavan², Subhash Das³, Sonia Puri⁴, Arvind A Banavaram⁵, Vivek Benegal⁶, Girish N Rao⁵, Mathew Varghese⁶, Gopalkrishna Gururaj⁷

Affiliations

¹ Department of Psychiatry, Government Medical College and Rajindra Hospital, Patiala, Punjab, India.
² Department of Psychiatry, Government Medical College and Hospital, Chandigarh, India.
³ Department of Psychiatry, North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences, Shillong, Meghalaya, India.
⁴ Department of Community Medicine, Government Medical College and Hospital, Chandigarh, India.
⁵ Department of Epidemiology, Centre for Public Health, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India.
⁶ Department of Psychiatry, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.
⁷ Department of Epidemiology, Centre for Public Health, WHO Collaborative Centre for Injury Prevention and Safety Promotion, National Institute of Mental Health and Neurosciences, Bengaluru, Karnataka, India.

PMID: 38298876
PMCID: PMC10826874
DOI: 10.4103/indianjpsychiatry.indianjpsychiatry_839_23

Abstract

Background and aims: There is no data on the treatment gap and health care utilization for mental disorders from Punjab. The present study reports on the same by using the data collected during the National Mental Health Survey.

Settings and design: Multisite, multistage, stratified, random cluster sampling study conducted in four districts, namely Faridkot, Moga, Patiala, and Ludhiana (for urban metro areas). Data were collected from October 2015 to March 2016.

Materials and methods: Mini International Neuropsychiatric Interview 6.0.0 and Adapted Fagerstrom Nicotine Dependence Scale were used to diagnose mental and behavioral disorders and tobacco use disorder, respectively. Pathways Interview Schedule of the World Health Organization was applied to persons having any disorder to assess treatment gap and health care utilization. Exploratory focused group discussions (FGDs) were conducted to understand the community perceptions regarding mental and behavioral disorders.

Results: The treatment gap for mental and behavioral disorders was 79.59%, and it was higher for common mental disorders than severe mental disorders and higher for alcohol and tobacco use disorders as compared to opioid use disorders. The median treatment lag was 6 months. Only seven patients out of 79 were taking treatment from a psychiatrist, and the average distance traveled by the patient for treatment was 37.61 ± 45.5 km. Many attitudinal, structural, and other barriers leading to high treatment gaps were identified during FGDs in the community, such as stigma, poor knowledge about mental health, deficiency of psychiatrists, and distance from the hospital.

Conclusions: Vertical as well as horizontal multisectoral integration is required to reduce the treatment gap and improve healthcare utilization. Increasing mental health literacy, providing high-quality mental health services at the primary-healthcare level and human resources development are the need of the hour.

Keywords: Mental disorders; NMHS; Punjab; substance use disorders; treatment gap.