Healthier mind builds healthier nation under ABArK

INTRODUCTION

The State of Karnataka launched a scheme called “Arogya Karnataka” as a part of universal health coverage following the Karnataka Integrated Public Health Policy 2017 and Karnataka Vision 2025 document. With the goal of achieving universal health coverage (UHC), Karnataka, a national leader in healthcare, launched the Arogya Karnataka scheme in March 2018. It was later integrated with the government of India’s national health protection scheme Ayushman Bharat Pradhan Mantri Jan Arogya Yojana(AB-PMJAY) to help with financial protection. Mental health, as defined by the World Health Organization (WHO), refers to “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community”. Under this integrated scheme, beneficiaries can avail themselves of the specified 1650 treatment procedures in both the Government Hospitals and Empanelled Private Hospitals across India with appropriate referral.¹ Ayushman Bharat scheme ensures timely treatment, patient satisfaction, improved productivity, improvements in health outcomes and efficiency, job creation. Thus, leading to an improvement in the quality of life.²

Mental health, as defined by the World Health Organization (WHO), refers to “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community”.³ There are various Individual biological and psychological factors that can increase a person’s susceptibility to mental health problems such as social support, social integration emotional and behavioural skills, prenatal damage, brain defects or injuries, substance abuse and genetics. Additional, exposure to adverse social, economic, environmental events such as poverty, inequality, violence and environmental deprivation can also increase the likelihood of experiencing mental disorders. In India mental disorders poses a significant public health challenges in terms of prevalence, burden of disease and disability. Conditions such as behavioral disorders due to psychoactive substance use, mood disorders and schizophrenia are the single largest cause of disability and impose a substantial economic burden.

Mental ill-health is a leading cause of disease burden globally. Overall, 14% of the global burden of disease is attributable to neuropsychiatric disorders. Such higher burden is mainly due to the chronic disabling nature of common mental disorders like Behavioral disorder due to psychoactive substance use, Schizophrenia, Mental Retardation and Psychosis4. The Census of India 2011 revealed that the proportion of disabled individual in relation to the total population is 2.21% in Residential areas, 2.24% in rural areas and 2.17% in urban areas5. This finding has drawn attention to the significance of mental disorders in public health. The burden of mental disorders is likely to have been overlooked due to lack of appreciation of their connectedness with other health conditions. Mental disorders can increase the risk of both communicable and non-communicable diseases, as well as contribute to unintentional and intentional injuries. Similarly, various health conditions increase the risk for mental disorder, and the presence of comorbidity complicates the process of help-seeking, diagnosis, treatment which ultimately influences prognosis. There are significant disparities in the provision of health services for individual with mental disorders, and there is a room for improvement in the quality of care for both mental and physical health conditions for these individuals.

METHODS

A cross-sectional analysis of data collected from the State Health Agency, Suvarna Arogya Suraksha Trust (SAST) portal. The study was conducted for a period 12 months from January to December 2022. Mental disorder related treatment packages were recognised from the 1650 treatment packages listed on SAST portal. 17 packages related to mental disorder were included (Table 1). Data collection involved extracting relevant information from the SAST portal regarding patients who availed the identified mental disorder-related treatment packages. Descriptive statistics were used to summarize characteristics of patients. The results were presented in terms of tables and graphs.

Inclusion criteria

Patients under 17 mental health packages were included in the study.

Exclusion criteria

Patients who didn’t use 17 mental health packages were excluded in the study.

Sample size

Out of 17,91,061 Preauth data we have taken 7292 who comes our inclusion criteria.

RESULTS

Socio-demographic characteristics

The study included 7292 mental disorder patients, majority of them were male (70.95%), in age group of 31-45 years (45.41%), and belonged to the below poverty line (BPL) (94.54%) (Table 2).

Among the major mental disorders, majority of cases were of mental and behavioural disorder due to psychoactive substance use (64%) followed by schizophrenia (22%) and mental retardation (14%) (Figure 1).

Among the 7292 patients, majority of the patient were from the age group 31-45 years (45.41%) (Figure 2).

Among all the patients, majority of patient (99.7%) received treatment from Government hospitals, while only 22 patients (0.3%) from private hospitals (Table 3).

The utilization of mental disorder treatment packages varied across different types of healthcare facilities. Majority (39%) availed treatment from super specialty, followed by medical colleges (33%), district hospital (22.72%), taluk hospital (2.77%) and other hospitals (2.09%). A small proportion of 0.3% opted for private hospitals (Table 4).

Among all the patients, 77.35% patients were admitted for mental disorder treatment in the routine ward for these patients, the preauthorization amount approved for their treatment was 98%. While only 26.64% patients admitted at the high dependency unit (HDU), and preauthorization approved amount was 2% (Table 5).

DISCUSSION

Good health and well-being are one of the 17 Sustainable Development Goals, SDG goal 3 not only focusses on physical health, but mental health as well. The inclusion of mental health in SDG reflects the increased acknowledgment of the role of mental health.

In our study it shows that males have seeked mental health care more compared to females.

It is estimated that four out of five people with mental illness in low and Middle-Income Countries (LMIC) receive no effective treatment and mental health is often one of the lowest health priorities in those settings compare to a study done by Rathod et al.¹² Health services insights, shows same findings that is despite these promising activities and the publication of high-profile reports in several countries, progress in mental health service development has been slow in most LMICs Scaling up mental health services in LMICs requires flexible policies, adequate resources, effective interprofessional communication, and evidence-based training, supplemented with an evaluation plan to measure successes against specific benchmark criteria.

Our study shows greater access in Karnataka to quality of mental disorder treatment facilities as mental health personnel are available in government hospitals.

The most common type of hospital admission was for mental and behavioural disorders due to psychoactive substance use at routine ward which accounted for 67.13%, schizophrenia were 23.43%, mental retardation were 9.43% and at high dependency units (HDU) for mental and behavioural disorders due to psychoactive substance use accounted for 57.86%, schizophrenia were 17.67% , for mental retardation were 24.45% same as the study done by Naser et al shows hospital admission rates were higher among males, the middle-aged, and elderly populations same as our study.¹³

CONCLUSION

Ayushman Bharat-PM-JAY Arogya Karnataka (AB-PMJAY ArK) has potential to reduce the out of pocket expenditure, distress financing and reduce catastrophic health expenditure which will lead to significant impact on health indices. Addressing disorders such as substance abuse (alcohol, tobacco, drugs) and complex mental disorders (schizophrenia, depression, anxiety), through health promotion and specific protection measures can have a major impact on early diagnosis and treatment.

Integrating the AB-PMJ Ark scheme with the National Mental Health Programme (NMHP) has the potential to significantly improve the treatment, rehabilitation, prevention and promotion of mental wellbeing. The specific objective of treating psychotic disorder is to achieve remission, reduce the frequency, severity and consequences of episode while maximizing the individual’s social and psychological functioning. These disorders can hinder the progress towards achieveing various millennium development goals, including gender equality and women empowerment, reducing child mortality, improving maternal health. To raise awareness about mental health and combat stigma it is essential to integrate mental health into all the aspects of health and social policy, through various means such as media campaigns, educational workshops in school, colleges and companies. Initiatives that involves individual with lived experience of mental disorder and psycho-social disability can ensure better quality of mental healthcare for the community. Active participation from all stakeholders is vital in promoting mental health awareness and combating stigma.

This study has few limitations. Lack of patient follow up. Due to secondary data we couldn’t analyse any other associate factors.

Funding: No funding sources

Conflict of interest: None declared

Ethical approval: Not required

REFERENCES

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