Manochaitanya: integrating mental health into primary health care

Manochaitanya: integrating mental health into primary health care

Correspondence Critical enablers Innovations close to the individual Person-centred care Information technology Quality measures Infrastructure I...

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Critical enablers

Innovations close to the individual Person-centred care Information technology

Quality measures


Incentive systems

Contracting High quality strategies

Prevention Low cost

Figure: The relation between the seven themes identified by WE CARE to be important for cost containment of future health care

representatives from 28 European countries) identified seven themes (figure): quality measures of health care; patient/person engagement; health promotion and disease prevention; infrastructure, service delivery, and organisational models; information technology to support quality, effectiveness, and efficiency; incentive systems that give new impetus to innovation; and contracting strategies that promote efficient and high quality care. If future cost containment and quality of care is to be achieved, the seven themes need to be addressed within a concerted action across stakeholders and EU member states. A large investment is needed— probably about €100 million—to explore the challenges and be able to produce actions for solutions. Such an investment might seem like a large sum but is in fact a very small part of the annual expenditure on health care in the EU (less than 0·01% or about 20 cents per EU citizen). WE CARE proposes to establish several health-care laboratories, each of which will test prototypes of completely new ways of conducting health care in regions or networks across Europe. The laboratories should have common features while also differentiating from each other. Short-term results can be presented within the first 5 years, whereas larger, more comprehensive outcomes and policy propositions could be formulated in a long-term timeframe. The first 3 years will serve as a period of experimentation, iteration, and learning. In the last 2 years, each Vol 387 February 13, 2016

laboratory will be assessed and compared with an area that is similar in terms of population and healthcare provision. LvI, AK, AO, and VS report grants from the European Commission. AK is a member of the board of directors of Coöperatie VGZ. All other authors declare no competing interests.

*Inger Ekman, Reinhard Busse, Ewout van Ginneken, Chris Van Hoof, Linde van Ittersum, Ab Klink, Jan A Kremer, Marisa Miraldo, Anders Olauson, Walter De Raedt, Michal Rosen-Zvi, Valentina Strammiello, Jan Törnell, Karl Swedberg [email protected] Institute of Health and Care Sciences, Sahlgrenska Academy (IE), Centre for Person Centred Care (IE, JT, KS), and Department of Molecular and Clinical Medicine (KS), University of Gothenburg, Gothenburg, Sweden; Department of Health Care Management, Berlin University of Technology, Berlin, Germany (RB, EvG); Berlin School of Public Health, Berlin, Germany (RB); Imec, Wearable Health Solutions, Leuven, Belgium (CVH, WDR); Talma Institute, Faculty of Social Sciences, VU University Amsterdam, Amsterdam, Netherlands (LvI, AK); Radboud University Nijmegen Medical Centre, Radboud University, Nijmegen, Netherlands (JAK); Imperial College Business School (MM) and National Heart and Lung Institute (KS), Imperial College, London, UK; European Patients´ Forum, Luxembourg City, Luxembourg (AO, VS); and Healthcare Informatics Department, IBM Research Lab, Haifa, Israel (MR-Z) 1


The Council of the European Union. Council conclusions on common values and principles in European Union health systems. 2006. TXT/?uri=CELEX:52006XG0622(01) (accessed Dec 10, 2015). WHO Regional Office for Europe. Health for all database. 2014. data-and-evidence/databases/europeanhealth-for-all-database-hfa-db (accessed Dec 10, 2015).

Manochaitanya: integrating mental health into primary health care Coinciding with World Mental Health Day, the Government of Karnataka, India, launched an ambitious programme: the Manochaitanya Programme, 1 in 2014. It covers a population of 61·1 million people. The meaning of manochaitanya in the Kannada language is empowering the mind. The aim of this programme is to integrate mental health care in all public health-care institutions— eg, all taluk (administrative divisions in districts of India) hospitals, community health centres, and primary health centres of states. The Manochaitanya Programme was launched with use of the title super Tuesday, whereby every Tuesday is dedicated to the care of patients with mental health disorders in all public health institutions of the state. To the best of our knowledge, it is the first programme dedicated to integration of mental health care in Indian public health-care institutions, and possibly worldwide. The salient components of this programme are as follows.1 Every Tuesday is dedicated to the care of mental health disorders (using the name Manochaitanaya clinic) at taluk hospitals, community health centres, and primary health centres in Karnataka, but will also be available during the rest of the week at all primary health centres. A board will be displayed with the vernacular Kannada translation of Manochaitanya clinic, stating that every Tuesday dedicated mental health care will be available. Each clinic should have one consultation room and a waiting hall containing psychoeducation materials for patients. These clinics will be able to dispense the following psychotropic medications to all patients free of charge: three oral (chlorpromazine, haloperidol, or risperidone) and 647


one depot antipsychotic (fluphenazine), three antidepressants (amitriptyline, imipramine, or fluoxetine), two antiepileptic drugs (phenobarbital or phenytoin), two anticholinergic drugs (trihexyphenidyl or promethazine), and one benzodiazepine (diazepam). Medical officers in charge of clinics will send a report regarding clinic performance to mental health authorities once a month. Manochaitanya clinics at taluk hospitals should be supported by a psychiatrist (government or privately employed), or by psychiatric faculties and residents of psychiatric departments from nearby government or private medical colleges. A local organisation called The Indian Psychiatric Society Karnataka Chapter supports this programme. Remuneration of up to INR 1000 in addition to travel expenses will be paid to private psychiatrists participating at Manochaitanya clinics. This Manochaitanya Programme mandates the training about mental health disorders for medical officers at primary health centres (for 3 days, twice a year) and paramedics (1 day, twice a year). Inpatient care should be arranged in every district hospital or hospitals of medical colleges. District hospitals will be equipped with at least ten beds for inpatient care and facilities for modified electroconvulsive therapy. Finally, the Manochaitanya Programme aims to strengthen the patient referral system in public mental health, which currently states that only difficult-to-treat patients should be referred to specialist healthcare centres. Against the background of increased neglect for worldwide integration of mental health into primary health care,2 the Government of Karnataka’s ambitious programme is a welcome step forwards. We hope that with this integration the burden of untreated mental disorders will be substantially reduced. We declare no competing interests.


*Narayana Manjunatha, Gaurav Singh [email protected] National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore 560029, India 1


Karnataka State Mental Health Authority. Guidelines for Manochaitanya Programme. (accessed Nov 2, 2015). WHO. Integrating mental health into primary care: a global perspective. Geneva: World Health Organization and World Organization of Family Doctors, 2008.

A call to improve the submission process In his book In Praise of Mathematics,1 the French philosopher Alain Badiou asserts that language possesses authority depending on who speaks it: “If the King speaks, it is true because he is the King, if God speaks, it is true because He is God”. Scientific language, he says, is the first to hold authority irrespective of who speaks it. The process of scientific publication has changed greatly in the past decade, and because authority also depends on the capacity to be heard, the role of the editor should certainly be deemed a major determinant of scientific authority. Putting aside any self-interest, we are of the opinion that publication inflation has led to fierce competition not only between authors, but also between editors. As a consequence, many papers are published after being rejected several times by other journals. We feel that, in our efforts to publish, the time dedicated to formatting and then submitting a manuscript has dramatically increased, and each journal has different specifications and requirements for submission. Successful papers should be selected on merit, rather than on how much time a hard-pressed doctor has to negotiate the idiosyncrasies of each journal’s submission process. In our modest experience as young researchers, we have faced rejection by an average of three to four journals before acceptance, a success rate of less than 25%. The

effort involved is a huge waste of time for researchers, reviewers, and editors. As public institutions employ many researchers and reviewers, and pay for the cost of publication, this additional work also results in an unacceptable waste of public money. For these reasons, we would like to see the development of new submission processes that would restore the intrinsic authority of scientific language. Perhaps a universal submission format could be used for pre-submission inquiries on a web-based server. Editors could access the resource spontaneously or by invitation, and browse the presubmission inquiries by themes and keywords. Similar to an auction, the editors would make bids for the papers that they wished to review for their journals or editorial groups. To save time and money by pulling research to the publication rather than pushing it through an inflexible and resistant series of hoops, a new system such as that suggested here could be the future of scientific publishing. We declare no competing interests.

*Pierre Galichon, Aurélien Bataille [email protected] Renal Intensive Care Unit and Transplant Center, Hôpital Tenon, Assistance Publique des Hôpitaux de Paris, Paris, France (PG); and Department of Anesthesiology and Critical Care, Hôpital Saint Louis, Assistance Publique des Hôpitaux de Paris, Paris, France (AB) 1

Badiou A, Haéri G. Éloge des mathématiques. Paris: Flammarion, 2015.

Department of Error Lobo MD, Sobotka PA, Stanton A, et al. Central arteriovenous anastomosis for the treatment of patients with uncontrolled hypertension (the ROX CONTROL HTN study): a randomised controlled trial. Lancet 2015; 385: 1634–41—The Declaration of interests statement was missing. This correction has been made to the online version as of Feb 11, 2016. Vol 387 February 13, 2016