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A STEP towards Telepsychiatry for Rural India

Natural disasters can cause a lot of loss in all aspects of life which can translate to severe mental health issues in survivors. The 2004 Tsunami that struck Southern India led to the loss of many lives that severely affected their families and loved ones. This enforced an increased need for psychiatrists especially in the rural areas of Tamil Nadu. However, it was difficult for the psychiatrists to visit these rural areas due to cost of travel, and lack of accommodation. Telepsychiatry was the best route to address these issues. 

The STEP or the SCARF Telepsychiatry in Pudukkottai program from the Schizophrenia Research Foundation was set up in order to provide assistance and care to those who suffered from mental health disorders as a result of the 2004 Tsunami Attack. The STEP program has since then helped people suffering from issues such as schizophrenia-related disorders, neurotic disorders, affective disorders etc. recover and lead a normal life. 

In a webinar conducted by MedPiper Technologies and JournoMed along with Bombay Psychiatric Society, Schizophrenia Research Foundation India (SCARF), and Indian Association of Private Psychiatry titled “Decoding Digital Mental Health Ecosystem in India” expert speaker, Dr. Kotteshwara Rao, Assistant Director, Schizophrenia Research Foundation India, Member, State Mental Health Authority (SMHA), Government of Tamil Nadu discussed at length about how the STEP program paved the way for making telepsychiatry available in rural areas. The event was moderated by Dr Avinash Desousa, Consultant Psychiatrist and chaired by Dr. Anu Kant Mittal. 

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The STEP program is India’s first foray into telepsychiatry and was funded by OXFAM in 2004 for 1 year. It was first set up in 2 centers in Nagapattinam district and expanded during 2005-2006. Currently, the program is supported by the Deutsche Bank Foundation and is set up in 8 sites in 4 districts with fixed clinics in two districts and mobile units that cover upto 156 villages in the remaining two districts. The program also includes collaborations with the local NGOs and state authorities for spreading awareness.

The program consists of surveying the residents of the villages to assess the incidence of the Severe Mental Disorders (SMD). The identified cases were confirmed by Mental Health professionals. Then, the professionals offered training to the Community Level Workers who were equipped to help those who are suffering as well as create awareness surrounding mental health. Through community level workers, the program was also able to provide employment opportunities to many people including homemakers. 

After screening the cases, the psychiatrists conducted sessions (teleclinics) with the patients using the video call facilities offered by telemedicine platforms, in both the mobile and the fixed units. The STEP program was able to provide treatment for over 1500 patients in 3 years. Electronic Medical Records is another aspect of Telemedicine that many psychiatrists used to store patient details.  The fixed and the mobile units also had pharmacies and the consultants provided medication free of cost to all the patients. 

Mobile technology was heavily leveraged for this program to remind patients about appointments, reschedule clinic dates, get updates on patient status, set the alarm function for medication and appointments and contact the respective psychiatrist in case of an emergency. 

Both the mobile clinics and fixed line clinics were successful in their own way. Mobile telepsychiatry Clinic (61%) had better coverage vs Fixed Line  clinic (49%) when local catchment area coverage was calculated. Fixed line telepsychiatry had a wider reach compared to Mobile telepsychiatry. But overall registrations at both clinics showed no significant difference. 45% of service utilizers were from outside the catchment area. 

Psychosocial Rehabilitation is an important part of the STEP Program and was provided to the patients by the community level workers in phases. Psychosocial rehabilitation is the process that allows persons with chronic mental illness to reach their optimal level of independent functioning in society and for improving their quality of life. 

The program still has many roadblocks to overcome such as the lack of availability of a digital network in very remote areas, managing acutely ill persons, those who require intensive psychosocial interventions and addressing physical comorbidity. Despite the challenges, the program has made a lot of progress and Dr. Rao summarises the achievements of the STEP Program into the following points: 

  1. Delivering telepsychiatry services even to the most remote areas of Tamil Nadu
  2. Reducing the mental health gap by over 50%
  3. Mobile telepsychiatry has better local coverage while Fixed line has wider reach
  4. Reinforcing the effectiveness of Telepsychiatry
  5. Telepsychiatry helps to redistributes resources rather than creating additional capacity

The STEP program is one among the many psychiatric programs that India has implemented to bring mental health treatments to everyone who is in need of it. These programs help to spread awareness about the importance of psychiatry and mental health, thus getting rid of the stigma surrounding them. However, for the programs to have widespread reach and impact throughout the country, more psychiatrists (as of 2019, there are only 0.75 psychiatrists per 1,00,000 people in India) and digital connectivity with proper bandwidth are needed.

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