Demand for, access to and use of community mental health care: lessons from a demonstration project in India and Pakistan.
BACKGROUND
A widely promoted model of mental health care and prevention appropriate to many low-income countries is one that is integrated into the local primary health care system.


OBJECTIVE
To examine the influence of health-seeking behaviours (demand-side factors) and the access to/availability of services (supply-side factors) on local service utilisation patterns for people with common mental disorders.


METHODS
Two rural catchment populations outside Bangalore (India) and Rawalpindi (Pakistan), one with the standard primary health care system, the other with additional mental health care training and support, were screened for common mental disorders. Diagnosed cases were interviewed about their use of and perceptions of local health care services (repeated three months later).


RESULTS
Individuals' use of integrated mental health and other care was modest. Principal (self-rated) supply-side factors were the cost of care, distance from treatment centre, a perception that care would not be effective, and concerns regarding stigma. Perceptions improved over three months, accompanied by an increased preference for public over private providers, but this was not restricted to the integrated care localities.


CONCLUSIONS
The use (and therefore effectiveness) of mental health services integrated into primary care is influenced by the health-seeking behaviours and perceptions of the local population. Efforts to integrate mental health into primary care need to be accompanied by educational activities in order to increase awareness, reduce stigma and draw attention to the availability of effective treatment.
James
Sarah
S
Institute for Health Sector Development, London, UK.
Chisholm
Daniel
D
Murthy
R Srinivasa
RS
Kumar
K Kishore
KK
Sekar
K
K
Saeed
Khalid
K
Mubbashar
Malik
M
D000293:Adolescent; D000328:Adult; D000368:Aged; D003156:Community Mental Health Services / Q000706:statistics & numerical data*; D003710:Demography; D005260:Female; D006297:Health Services Accessibility / Q000706:statistics & numerical data*; D006301:Health Services Needs and Demand / Q000706:statistics & numerical data*; D006801:Humans; D007194:India; D008297:Male; D001523:Mental Disorders / Q000628:therapy*; D008875:Middle Aged; D010154:Pakistan; D010342:Patient Acceptance of Health Care / Q000706:statistics & numerical data; D010865:Pilot Projects; D012423:Rural Health