State plans door-to-door care for mental health patients

The state health department in Mumbai will soon begin door-to-door services for mental health patients in an effort to reduce long stays in hospitals. A team comprised of primary and community healthcare workers, as well as nurses and doctors, will visit patients at home for follow-ups and treatment. The aim is to stabilise patients in hospital before monitoring their medication and care at home. The team will also provide other medical assistance if necessary. The department is planning to reduce patients' visits to primary healthcare centres by keeping a stock of medicines at the centres.

MUMBAI: Recognising a surge in mental health cases, the state health department will soon start door-to-door services for patients to curb their long stay in hospitals. A team will be set up to achieve the goal. It will comprise primary and community healthcare workers, and auxiliary nurses and doctors, who will visit homes for routine follow-ups and treatment.

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“Our plan is to stabilise patients that require a long stay at the hospital and then monitor their medication and care at home. The team will ensure that the treatment is on track, and if need be, offer other medical assistance as well,” said Dr Swapnil Lale, assistant director, health services.

Required stock of medicines will be kept at the primary healthcare centre (PHC), where either the patient will come every fortnight for a refill or the health team visiting the patient will reach the medicines to their homes for short durations.

“Some of the drugs used to treat the illnesses are both therapeutic as well as lethal, and hence the doses administered have to be closely monitored. We can only give a limited batch to the patient at a time,” said Dr Lale. The drugs will be stocked at the PHCs. He added that the department is also working on a plan to reduce the patients’ visit to the PHCs.

Another state health official said the team visiting a patient at home will monitor the drugs and health of the patient over structured durations. “A community worker will be in-charge of the weekly visits, a health assistance worker will visit a patient every fortnight and medical officer will visit every month. If there is an urgency, the medical officer can get in touch with the district psychiatrist who can facilitate admission to the nearest regional mental hospital,” said the official.

To cope with the increase of mental health cases, the department has adopted a three-level approach – strengthening mental health services at district hospitals, training MBBS doctors at primary healthcare centres for psychiatric evaluations and providing free tele-mental health services through tele-MANAS.

Each of the 36 district hospitals now houses a dedicated team comprising a psychiatrist, social worker, clinical psychologist and a nurse trained in psychiatry. This team conducts outreach services in various community health centres, rural and sub-district hospitals. MBBS doctors at 1670 primary healthcare centres have been trained for psychiatric evaluations, focusing on common illnesses like anxiety and depression.

A senior health official underscored the success of tele-mental health services – he said over 30,000 unique calls were fielded by the department in the last one year, the second highest in the country.

Dr Milan Balakrishnan, psychiatrist at Masina Hospital, and a member of Bombay Psychiatric Society (BPS), applauded the initiative and said, “We will have to see how it is implemented since it will be done at a grassroots level and at a mass scale.”

Dr Avinash Desousa, past president of BPS said, “Psychiatric patients tend to do better at home, post-treatment. It is therapeutic when they are in the midst of caring relatives. Managing them in the out-patient department will also ease the burden on bed occupancy which can be given to those in urgent need.”