Academic journal article Indian Journal of Psychiatry

Research Priorities for Indian Psychiatry

Academic journal article Indian Journal of Psychiatry

Research Priorities for Indian Psychiatry

Article excerpt

Byline: Vikram. Patel

This article summarises the findings of recent priority setting exercises for psychiatric research and of a mapping of research capacity and resources in south Asia. The priorities for research in the region, as in other developing countries, are related to 'implementation' science, i.e. the field of inquiry investigating acceptable and affordable methods of delivering effective treatments for mental disorders, which aims to help close the large treatment gap. "Discovery" research which aims to strengthen our understanding of the nature of mental disorders through well-designed epidemiological and descriptive clinical studies, and expand the armamentarium of effective treatments by mapping and evaluating indigenous approaches to mental health care is also an important priority. However, research capacity and resources in the region are scarce and need strengthening by action from diverse stakeholders including the Indian Psychiatric Society.

The primary role for research in the context of medicine is to generate knowledge which will ultimately lead to improvement in health. In the field of psychiatry, our primary concern is the mental health of the population we serve. The reality of mental health care in India is bleak: A population of over a billion is served by less than 4000 psychiatrists, the majority of whom are based in cities and concentrated in a few states; about 20,000 inpatient beds, 80% of which are located in 40 odd mental hospitals most of which were built decades ago; and the almost total absence of community or primary care based mental health services with the notable exceptions of a few NGO and public initiatives scattered around the country. [sup][1] It is not surprising, then, that this situation leads to a large "treatment gap". At best, no more than half of all persons with serious mental disorders in India receive the care we know can help improve their quality of lives; amongst those who do, the care is often entirely medication based, and for many who find their way to mental hospitals, characterized by loss of dignity and frank human right abuse. [sup][2] This situation is by no means unique to India; indeed it is mirrored in most low and middle income countries.

The large treatment gap was the primary motivation for the landmark Lancet series on global mental health published in 2007. As part of that series, a systematic research priority setting exercise was carried out in the context of the call to action to scale up services for people with mental disorders based on the twin principles of evidence and protection of human rights. [sup][3] The detailed findings of this exercise were published recently. [sup][4] This exercise focused on four mental disorders: Schizophrenia and other major psychotic disorders; major depressive disorder and other common mental disorders; alcohol abuse and other substance abuse disorders; and child and adolescent mental disorders. Across all four conditions, priority research questions related to delivery issues: i.e. How can we deliver treatments know to be effective in a cost-effective manner and through routine health care systems. Child and adolescent mental disorders, and alcohol use disorders were given the highest priority, an indication of the relatively large treatment gaps for these conditions and the paucity of contextually appropriate evidence on these conditions. The lowest rankings were given to discovery r esearch options, for example those that proposed the development of new interventions and technologies, new drugs, vaccines or pharmacological agents.

This exercise proposed that in the context of the large treatment gaps, and with a time frame of the next 10 years, investments would be best placed in health policy and systems research in order to provide guidance about how to increase access to cost-effective treatments. In particular, the emphasis in these priorities was to better understand how to deliver what we know works in an affordable manner, what has been referred to as 'implementation' science. …

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