© 2000 The Royal College of Psychiatrists
Integration of mental health care into primary care
Demonstration cost-outcome study in India and Pakistan
Centre for the Economics of Mental Health, Institute of Psychiatry, King's College London
Centre for Development Studies, Swansea (formerly Institute for Health Sector Development, London
National Institute of Mental Health and Neurosciences, Bangalore, India
Institute of Psychiatry, Rawalpindi, Pakistan
Correspondence: Daniel Chisholm, Senior Lecturer, Centre for the Economics of Mental Health, Institute of Psychiatry, 7 Windsor Walk, Denmark Hill, London SE5 8BB
Declaration of interest The study was funded by the Department for International Development, UK (HP-ACORD Small Project Grant RD 463).
Background Targeting resources on cost-effective care strategies is important for the global mental health burden.
Aims To demonstrate cost-outcome methods in the evaluation of mental health care programmes in low-income countries.
Method Four rural populations were screened for psychiatric morbidity. Individuals with a diagnosed common mental disorder were invited to seek treatment, and assessed prospectively on symptoms, disability, quality of life and resource use.
Results Between 12% and 39% of the four screened populations had a diagnosable common mental disorder. In three of the four localities there were improvements over time in symptoms, disability and quality of life, while total economic costs were reduced.
Conclusion Economic analysis of mental health care in low-income countries is feasible and practicable. Our assessment of the cost-effectiveness of integrating mental health into primary care was confounded by the naturalistic study design and the low proportion of subjects using government primary health care services.
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