Proactive Community Case Detection Increases Mental Health Care Seeking in Nepal

Training volunteers with the Community Informant Detection Tool (CIDT) increased the number of people seeking mental health care, according to a pragmatic randomized controlled trial published in Psychiatric Services. 

In low and middle income countries, mental health conditions are considerably undertreated, and efforts to expand the availability of mental health services have not increased levels of use. The CIDT, developed in Nepal, may address this issue by training trusted and respected volunteers in the community to identify individuals who may be in need of mental health care and to encourage these individuals to seek care.  

The study was part of the multiyear Program for Improving Mental Health Care (PRIME) and took place in the Chitwan district of southern Nepal.  Female community health care volunteers from 24 health facilities, with 12 facilities in each treatment arm, received 2 days of training in either basic community outreach alone (n=91) or combined with CIDT (n=105). The CIDT consists of context-sensitive vignettes which describe fictionalized individuals displaying symptoms of depression, psychosis, alcohol use disorder, or epilepsy. When community volunteers identify individuals seeking help, they encourage the individual to access services at the community health center.

Training in CIDT significantly increased the number of patients diagnosed with mental health disorders. Over the baseline period of 6 months before training of community volunteers, only 2 patients were diagnosed with mental health disorders in each treatment arm. After 6 months of training intervention, 309 patients were diagnosed with mental health disorders at the treatment facilities with CIDT-trained community volunteers as opposed to 182 patients using basic community outreach alone (U, 36.50; r, 0.42; P =.04). 

The study may have been limited by potential regional differences between facilities between the treatment arms, as well as bias introduced by average walking distance to health facilities, socioeconomic status of household, and quality of service. 

“Similar gaps in help seeking are observed in high-resource settings” noted the researchers, “The existence of community networks among immigrant families, military families, and rural populations suggests the CIDT could contribute to reducing the gap in access to mental health care.”

Reference

Jordans MJD, Luitel NP, Lund C, Kohrt BA. Evaluation of proactive community case detection to increase help seeking for mental health care: a pragmatic randomized controlled trial [published online ahead of print, April 23, 2020]. Psychiatr Serv. 2020;appips201900377.