A model for digital mental healthcare: Its usefulness and potential for service delivery in low- and middle-income countries.

Background: 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.

Aim: 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.

Methods: 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.

Results: 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.

Conclusions: 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.