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Open Access 01-12-2024 | Research

Challenges and opportunities in strengthening primary mental healthcare for older people in India: a qualitative stakeholder analysis

Authors: Tom Kafczyk, Kerstin Hämel

Published in: BMC Health Services Research | Issue 1/2024

Abstract

Background

Primary mental healthcare (PMHC) allows for complex mental health issues in old age to be addressed. India has sought to improve PMHC through legislation, strategies and programmes. This study analyses the challenges and opportunities involved in strengthening PMHC for older persons in India from the perspectives of key stakeholders.

Methods

Semistructured interviews were conducted with 14 stakeholders selected from the PMHC system in India and analysed using thematic analysis. First, the analysis was organizationally structured in accordance with the six WHO mental health system domains: (1) policy and legislative framework, (2) mental health services, (3) mental health in primary care, (4) human resources, (5) public information and links to other sectors, and (6) monitoring and research. Second, for each building block, challenges and opportunities were derived using inductive coding.

Results

This study highlights the numerous challenges that may be encountered when attempting to strengthen age-inclusive PMHC. Among these challenges are poor public governance, a lack of awareness and knowledge among policy-makers and other stakeholders, and existing policies that make unrealistic promises to weak primary healthcare (PHC) structures with an excessive focus on medicalizing mental health problems. Thus, the mental health system often fails to reach vulnerable older people through PHC. Established approaches to comprehensive, family- and community-oriented PHC support attempts to strengthen intersectoral approaches to PMHC that emphasize mental health promotion in old age. Targeting the PHC workforce through age-inclusive mental health education is considered particularly necessary. Experts further argue that adequate monitoring structures and public spending for mental health must be improved.

Conclusions

In this study, we aim to elaborate on the mental healthcare developments that may serve to achieve equity in access to mental healthcare in India. Coordinated and collaborative efforts by public and private stakeholders involved in the care of older persons, both with and without lived mental health experiences, as well as their families and communities, are necessary to bring the vision of those policies for PMHC to fruition. The findings presented in this study can also inform future research, policies and practice in other low- and middle-income countries.

Available only for authorised users

To improve the readability of direct quotes from the interviews, we have linguistically corrected them where appropriate.

Health and Wellness Centres (HWCs) are a key component of ‘Ayushman Bharat– National Health Protection Mission’ and are envisioned as the main mode for the delivery of comprehensive PHC. They are expected to partially replace existing PHC structures, especially Sub Health Centres and Primary Health Centres [37].

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Title: Challenges and opportunities in strengthening primary mental healthcare for older people in India: a qualitative stakeholder analysis
Authors: Tom Kafczyk
Kerstin Hämel
Publication date: 01-12-2024
Publisher: BioMed Central
Published in: BMC Health Services Research / Issue 1/2024
Electronic ISSN: 1472-6963
DOI: https://doi.org/10.1186/s12913-024-10622-y

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Springer Medicine

Challenges and opportunities in strengthening primary mental healthcare for older people in India: a qualitative stakeholder analysis

Abstract

Background

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusions

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