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Background: Public funded outreach services for persons with severe mental disorders (SMDs), a norm in developed nations, is non-existent in India. We share our pilot experience with an indigenous model named ‘Care at Doorsteps’ (CADs) for persons with SMDs who dropped out from clinical care of District Mental Health Program (DMHP) at three sites of Karnataka, a south Indian state. Aim: The objectives of this study were to identify the reasons for drop outs from routine care and to assess the burden of illness and disability after the intervention. Methodology: Six-month prospective observational study on patients aged 18–60 years, diagnosed as Schizophrenia or bipolar disorder was conducted. Three home visits were made by the team and provided medications, also offered brief psychoeducation and counselling. Care-givers were interviewed to identify the reasons for drop outs and their expectations from the treating team. Patients were also assessed using the Clinical Global Impression Scale (CGI), Indian Disability Evaluation and Assessment Scale (IDEAS) and Burden Assessment Schedule (BAS) during each visit. Results: Ninety-six patients (50 males and 46 females) were followed up, of which 85 had a diagnosis of schizophrenia and 11 with bipolar illness. Common reasons for drop out were: single caregiver (breadwinner) unable to accompany the patient, loss of faith in medical treatment and financial constraints. Symptomatic improvement and restoration of productive work were the priority expectations. Over the course, the mean CGI-S showed significant reduction (4.81 ± 1.57, 4.46 ± 1.32 and 4.11 ± 1.39 respectively; p = 0.001). Mean score on BAS showed a significant reduction (85.76 ± 12.15, 83.46 ± 11.30, 84.27 ± 11.82; p = 0.04). Mean total IDEAS scores did not show significant change (13.27 ± 4.78, 12.82 ± 4.24, 13.17 ± 4.40; p = 0.16). Conclusion: Meaningful assertive outreach care is feasible in India and is found to be useful for persons with SMDs by utilising the already existing public sector resources.

The article is about a set of leadership programs on ‘mental health leadership under NMHP’ that was completed for 161 participants who are the district level health authorities and service providers (psychiatrists, psychologists, nurses and social workers) by the Community Psychiatry Unit of the Department of Psychiatry, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru. The overarching aim of these programs was to provide an impetus to mental health leadership at district levels that could enable them to upscale public mental healthcare delivery. Upon completion of the program, 109 participants provided a feedback on the content of the program. Majority (98 %) were satisfied with the format of the program in which it was conducted and felt that their expectations were either partially or completely satisfied with appropriate content (93 %). The health authorities (43 %) gained better insights into the magnitude of mental health concerns and agreed that mental health service delivery should scale up. The service providers (17 %) felt the need to upgrade their skills in specialty areas of psychiatry in order to gear up for comprehensive mental health care delivery. Finally, the authors argue that such local level learnings should drive the policy making at the national level

Background: Neurology services in rural and semi-urban part of India are very limited, due to poor infrastructure, resources, and manpower. Tele-neurology consultations at a non-urban setup can be considered as an alternative and innovative approach and have been quite successful in developed countries. Therefore, an initiative to bridge this health gap through Tele-Medicine has been taken by the Government of India. Aim: To study the sociodemographic and clinical profiles of patients who have received collaborative Tele-Neurology consultations from the Tele-Medicine Centre, National Institute of Mental Health and Neurosciences, Bengaluru. Methodology: We reviewed case files of such patients between December 2010 and March 2017. A total 189 collaborative tele-neurology outpatient consultations were provided through the Tele-Medicine Centre, located at a tertiary hospital-based research centre in southern India. Results: The mean age of the patients was 39.6 (±19) years and 65.6% were aged between 19 to 60 years; 50.8% were male. The most common diagnosis was a seizure disorder in 17.5%, followed by cerebrovascular accident/stroke in 14.8%. Interestingly, 87.3% were found to benefit from tele-neurology consultations using interventions such as a change of medications in 30.1%, referral to a specialist for review in 15.8%, and further evaluation of illness and inpatient care for 7.93%. Conclusion: This study has demonstrated the successful implementation of outpatient-based collaborative tele neurology consultation in Karnataka.