Integration of mental health care into primary care. Demonstration cost-outcome study in India and Pakistan

Abstract

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.