Even though mental disorders contribute significantly to the burden of illness in India — making it a nationwide public health priority — most of those affected do not receive evidence-based intervention. In low- and middle-income countries, such as India, non-specialist workers are key in providing healthcare to rural areas. Growing evidence demonstrates that with appropriate training and supervision, they can effectively deliver brief psychological treatments for mental disorders. However, the efforts to scale up these initiatives are prevented by a heavy reliance on the traditional methods of face-to-face training and supervision.
Through a collaboration between the Tata Trusts and the Mittal Institute, Project Empower is working toward bridging this gap by building a digital platform that can provide virtual training and supervision to community health workers as they identify and treat common mental health disorders. This effort originates from Project ESSENCE, funded by the National Institute of Mental Health (NIMH) and implemented by Sangath Bhopal, the collaborating partner for Empower and a leading research organization that pioneers innovative delivery models for mental health problems in collaboration with Harvard Medical School.
As part of ESSENCE, Sangath developed a digital program that trained community health workers to deliver a “Healthy Activity Program” that covered psychological treatment for depression over several sessions. This program digitized existing, validated treatment protocols designed by the world’s leading mental health treatment and implementation scientists. It has been evaluated in randomized controlled trials in India and Nepal, and is being piloted in Madhya Pradesh.
To implement Empower, the project team has been conducting workshops in the rural districts of Gujarat, where they are collaborating with SEWA Rural and NHM Gujarat. Additionally, in response to the pandemic, the project has modified the current program to include modules on treating the mental health outcomes related to COVID-19, information and guidelines on prevention, and other forms of psychological first aid.
To begin, the team conducted pre-contextualization assessment of the existing ESSENCE modules. Selected staff of SEWA Rural and a cohort of Hindi-speaking community health workers completed the ESSENCE training and provided their feedback on the quality of the training modules. In order to contextualize the modules for use by the Gujarat-government health system, the team hired two research assistants — Aakrushi Bramhbhatt and Darshana Rathore, both proficient in Gujarati — to translate the content of the existing training modules from Hindi into Gujarati. The next step was to conduct a fidelity check of the translated content by psychologists working with Sangath.
Recently, the team conducted its first two-day workshop with the help of SEWA Rural in Jhagadiya (Bharuch District) in the state of Gujarat. The workshop was conducted through a webinar and attended by the Accredited Social Health Activists (ASHAs), or community health workers, appointed by the government of India’s Ministry of Health and Family Welfare under the National Rural Health Mission. In the light of the ongoing pandemic, the organizers ensured that physical distancing protocols were observed. The participants were provided with the training modules for review. After reading the modules, each participant would provide their feedback to the team through a video call. The feedback shared by the community health workers has been helpful in contextualizing the modules to match the idioms and expressions common in rural Gujarat.
Sangath will further refine the technological infrastructure of the program by integrating feedback from community health workers. Digital literacy and adequate internet connectivity remains a distant goal for a large number of Indian people. The team hopes to add new content and features to make the platform more engaging and interesting, with the ultimate goal to make the digital platform accessible on smartphones completely offline for regions with low connectivity.