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Tele-mentoring on Integrated Mental Health and Addiction for DMHP counsellors in Chhattisgarh: A Feasibility Study
1. Tele-mentoring on Integrated Mental Health and Addiction
for DMHP counsellors in Chhattisgarh: A Feasibility Study
Presenter: Kanika Mehrotra
Clinical Psychologist
Kanika Mehrotra, Prabhat Chand, Mrunal
Bandawar, Mallikarjun Rao Sagi, Sandeepa Kaur,
Aurobind, Aravind Raj, Sumi Jain**, Pratima
Murthy, Miriam Komaromy*, Sanjeev Arora*
*Project ECHO, University of New Mexico
** State Health Society, Chhattisgarh National Addiction Conference AIIMS 2017
3. Disease burden of SUD &
Mental Illness in Chhattisgarh
Substance use disorders : 655005
Schizophrenia and other psychotic disorders: 10916
Neurotic and stress related disorders: 54584
Mood disorders: 38209
Total mental illness: 2183350
National Addiction Conference AIIMS 2017
4. Treatment Gap
National Mental health Survey, 2016
Report of Technical Committee on Mental health, National Human Rights Commission, 2016
11 psychiatrists
2 psychiatric social workers
1 Clinical Psychologist
National Addiction Conference AIIMS 2017
5. To bridge the significant GAP
Need for Innovating health care delivery solution
Geographical Distance and Cost should NOT be a barrier for
Quality Addiction & Mental health Care
Struminger et al., Lancet 2017National Addiction Conference AIIMS 2017
6. Virtual NIMHANS ECHO Amplify the Capacity to
provide Best Practice Care in Addiction mental Health
in Community by Leveraging Technology
VKN NIMHANS
Physicians/Health Provider
National Addiction Conference AIIMS 2017
8. VKN NIMHANS ECHO: Core components
• Sharing “best practices” to reduce disparities
• “Case based learning” & “Wisdom” to master complexities
• “Co-management” of remote patients
• Immersive, Deep & Continued Learning
• “Web based” database to monitor outcomes
• Using “Technology” to leverage scarce resources
• Linked to an “Accreditation” certificate and course
National Addiction Conference AIIMS 2017
9. Sharing “Best Practices” to reduce
treatment disparities
▪ SOP
▪ Guidelines
▪ Algorithms
▪ Expert consensus
* Delivered through mobileapp
National Addiction Conference AIIMS 2017
10. Case Based Learning & Wisdom to share
complexities
NIMHANS
ECHO
National Addiction Conference AIIMS 2017
11. Objectives
OBJECTIVES –
• Identification, screening for Addiction and Mental health disorders and factors influencing
it
• Ability to decide and provide “best practices” in psychosocial intervention
• Decision making about what type of psychosocial intervention to be provided by
psychologist and psychiatry social workers.
• Maintaining follow up using contemporary technology
• Fortnight discussion with NIMHANS team at VKN tele-ECHO clinics
National Addiction Conference AIIMS 2017
12. Spokes from Community: Chhattisgarh District
DMHP counselors
National Addiction Conference AIIMS 2017
Easy to access anywhere:
No cost to participants
Secured, encrypted, HIPAA
compliant
13. Anatomy of fortnight virtual ECHO clinic
Counsellor send
the anonymous
case three days
prior
He/she mentions
specific question
about the case for
the HUB multi-
disciplinary team
Presents the case
during the fortnightly
virtual tele-ECHO
clinic
The Hub facilitator
invites other
connected
doctors/counsellor
for clarifications
Hub Experts compiles
and at the end give
their
“recommendations”
Also advise to present
the case again after 2-4
wks
Ends with a “brief
didactic” as per
Curriculum
National Addiction Conference AIIMS 2017
14. Case Recommendations and follow-ups
(shared by secured mobile platform to remote
treating doctor/counsellor)
National Addiction Conference AIIMS 2017
22. No. of counsellors participated
No. of districts
No. of Counsellors attending at least one virtual tele-ECHO clinic out of
six
No. of Counsellors attending 3 or more virtual tele-ECHO clinics (>50%)
out of six
No. of Counsellors attending 4 or more virtual tele-ECHO clinics (>80%)
out of six
No. of Counsellors who presented patient cases
12(100%)
11
12 (100%)
12 (100%)
7 (58%)
10 (83%)
Synchronous virtual tele-ECHO
half-way through (3 Months)
100% join through Smartphone
Participant Engagement
National Addiction Conference AIIMS 2017
23. Nature of cases Number
Substance Use
disorders
3
Severe Mental
Disorders
9
Common Mental
Disorders
5
Co-management with NIMHANS
multidisciplinary team
N=17
Total number of patients benefited
National Addiction Conference AIIMS 2017
N=17
N=88
24. Conclusion
Lessons learnt
• Feasible, sustainable, replicable and
easy to implement
• Ability to increase capacity in the
form of “local experts” at the
community level
• Ubiquitous - combination of formal
and informal methods of learning
• Smartphone with 4G gamechanger in
leveraging resources through
technology
Challenges
• Language related challenges
• Difficult to customize acc. to
individual needs
• Local leadership
• Making the environment more
conducive to peer led learning
• Sustaining engagement and
motivation
National Addiction Conference AIIMS 2017
