Malhotra Savita, Chakrabarti Subho, Shah Ruchita
Department of Psychiatry, Postgraduate Institute of Medical Education and Research, Chandigarh, India.
Indian J Psychiatry. 2019 Jan-Feb;61(1):27-36. doi: 10.4103/psychiatry.IndianJPsychiatry_350_18.
Using digital technology to deliver mental health care can possibly serve as a viable adjunct or alternative to mainstream services in lessening the mental health gap in a large number of resource deficient and LAMI countries. Conventional models of telepsychiatric services available so far, however, have been inadequate and ineffective, as these address only a small component of care, and rely on engagement of specialists who are grossly insufficient in numbers.
To describe an innovative digital model of mental health care, enabling and empowering the non-specialists to deliver high quality mental health care in remote areas.
The model is powered by an online, fully automated clinical decision support system (CDSS), with interlinked modules for diagnosis, management and follow-up, usable by non-specialists after brief training and minimal supervision by psychiatrist, to deliver mental health care at remote sites.
The CDSS has been found to be highly reliable, feasible, with sufficient sensitivity and specificity. This paper describes the model and initial experience with the digital mental health care system deployed in three geographically difficult and remote areas in northern hill states in India. The online system was found to be reasonably comprehensive, brief, feasible, user-friendly, with high levels of patient satisfaction. 2594 patients assessed at the three remote sites and the nodal center represented varied diagnoses.
The digital model described here has the potential to serve as an effective alternative or adjunct for delivering comprehensive and high quality mental health care in LAMI countries like India in the primary and secondary care settings.
利用数字技术提供精神卫生保健，在减少大量资源匮乏和低收入与中等收入国家的精神卫生差距方面，有可能成为主流服务的可行辅助手段或替代方案。然而，迄今为止可用的传统远程精神病学服务模式并不充分且效果不佳，因为这些模式仅涉及护理的一小部分，并且依赖数量严重不足的专科医生参与。
描述一种创新的精神卫生保健数字模式，使非专科医生能够在偏远地区提供高质量的精神卫生保健服务。
该模式由一个在线的、全自动临床决策支持系统（CDSS）驱动，具有相互关联的诊断、管理和随访模块，非专科医生在经过简短培训并在精神科医生的最少监督下即可使用，以在偏远地区提供精神卫生保健服务。
已发现该CDSS高度可靠、可行，具有足够的敏感性和特异性。本文描述了在印度北部山区三个地理条件困难且偏远地区部署的数字精神卫生保健系统的模式和初步经验。该在线系统被认为相当全面、简洁、可行、用户友好，患者满意度高。在三个偏远地点和节点中心评估的2594名患者代表了不同的诊断结果。
本文所述的数字模式有可能在印度等低收入与中等收入国家的初级和二级保健环境中，成为提供全面和高质量精神卫生保健服务的有效替代方案或辅助手段。
