Integration of mental health care into primary care. Demonstration cost-outcome study in India and Pakistan.

BACKGROUND

Targeting resources on cost-effective care strategies is important for the global mental health burden.

AIMS

To demonstrate cost-outcome methods in the evaluation of mental health care programmes in low-income countries.

METHOD

Four rural populations were screened for psychiatric morbidity. Individuals with a diagnosed common mental disorder were invited to seek treatment, and assessed prospectively on symptoms, disability, quality of life and resource use.

RESULTS

Between 12% and 39% of the four screened populations had a diagnosable common mental disorder. In three of the four localities there were improvements over time in symptoms, disability and quality of life, while total economic costs were reduced.

CONCLUSION

Economic analysis of mental health care in low-income countries is feasible and practicable. Our assessment of the cost-effectiveness of integrating mental health into primary care was confounded by the naturalistic study design and the low proportion of subjects using government primary health care services.