Lay therapists in India can make a difference in mental illness

December 13, 2010

Joanne Silberner

When stacked up against HIV/AIDS, malaria and other fast-moving, deadly diseases, mental illnesses don’t score as high with governments and philanthropies. One reason: the perception that tackling mental illness is too complicated and too costly.

Now an intriguing study in the online version of the medical journal The Lancet suggests that it’s not that hard to tackle some mental conditions. And what may help most of all are therapists with minimal training.

Mental illnesses exact a heavy toll in developing countries, where they can make it even harder for people to provide for themselves and their families, as the World Health Organization found in an analysis.

In India, there is only 1 psychiatrist for every 400,000 people, according to the Indian government. The Lancet study involved about 2,600 people in the state of Goa with common mental illnesses such as anxiety or depression. About half were assigned case managers who had taken a two-month training course in mental health counseling.

All of the patients in the study got whatever routine care was provided by private doctors or public clinics. And half of them had 6 to 12 meetings with the lay therapists. The therapists talked with them about their illnesses and problems, taught them coping mechanisms such as breathing exercises, and in some cases offered psychotherapy.

In the public health clinics, 66 percent of the people who talked to the lay therapists recovered after six months, compared to 43 percent of people who got the standard care. The researchers call this "modest evidence of a beneficial effect" of using lay counselors.

The approach, however, isn’t perfect –  it turns out lay therapists are better at treating anxiety than depression. And at private clinics, where the standard of care was presumably higher to begin with, having a lay therapist around didn’t help much.

Still, experts in the field say the approach suggests a new way to reduce the global burden of mental illness. The lead author of the study, Vikram Patel of the London School of Hygiene and Tropical Medicine, says the hope is that NGOs and governments will consider the model as "an affordable and feasible framework" for improving standard primary health care. Copyright 2010 National Public Radio. To see more, visit http://www.npr.org/.

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