Implementing integrated mental health and substance use disorder services in Indian primary care: a multi-state CFIR-based qualitative study.
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Ghosh Abhishek, Balhara Yatan-Pal-Singh, Dahiya Neha, Chauhan Ajay-Parsottamdas, Jamir Limalemla, Majumdar Anindo, Parmar Arpit, Ruben Johnson-Pradeep, Parmar Chirag, Pillai Renjith-R, Chaudhry Anshika, Bhooma Goud Ramakrishna, Grover Ashoo, Mohapatra Debadatta, Philip Sharad, Sutar Roshan Fakirchand, B George Blessy, Malav Pragyapti, Basu Debasish, Prinja Shankar, Imam Nagma, Mehra Manju, Ranchan Kashish, Shukla Manya, Aishwarya G V, Naik Aakanxa, Bhagawati Priyambada, Bhatia Riya Kaur, Bhatt Deeptiben, Dabar Deepti, Mallisha Subhra, Nasrin Tamanna, Panda Salinee, Shivashankar Supriya, Singh Gunjan, Vazalwar Deeksha, Verma Pulkit, ICMR MINDS Study Group
Аннотация
METHODS: We undertook a qualitative implementation study in Assam, Gujarat, Haryana, Karnataka, Madhya Pradesh, Odisha, and Punjab. The data included 211 in-depth interviews and 28 focus group discussions across seven states for the following cadres: medical officers (MO), community health officers (CHOs), Accredited Social Health Activists (ASHA), nurses, clinical psychologists, patients, caregivers, and policymakers. A combination of CFIR framework-guided and inductive thematic analysis was used to generate both cross-cutting and site-specific insights.
RESULTS: While most respondents supported mental health integration in principle, they reported barriers such as strained frontline capacities, absence of structured protocols, stigma-related avoidance, limited availability of medicines and inconsistent referral pathways. Training uptake was uneven, and consultation times were often too brief to manage mental health needs effectively. However, promising practices were identified, e.g. Gujarat's "Therapeutic Thursdays," Haryana's use of teleconsultation, and community mobilization efforts in Odisha and Assam. Increased Workload, lack of mental health-specific incentives, and digital infrastructure gaps were common challenges. Engagement from local champions (Individuals who dedicate themselves to supporting, marketing, and 'driving through' an implementation) was perceived to help adress structural gaps, but was rarely systematized.
CONCLUSION: This study highlights how integration efforts are shaped by the depth of contextual dynamics. Strengthening digital tools, clarifying referral pathways , and reinforcing the health workforce through supervision and incentives are urgent priorities.
TRIAL REGISTRATION: ClinicalTrials.gov - CTRI/2024/08/072748, registered on 20th August 2024, ( http://ctri.nic.in ).