Organizing primary mental healthcare for older persons in India: Challenges and opportunities from the perspective of key stakeholders
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School of Public Health, Bielefeld University Universitätsstraße 25, 33615 Bielefeld, Germany Germany
School of Public Health, Bielefeld University, Bielefeld, Germany
) School of Public Health, Bielefeld University, 2) HelpAge Deutschland e.V. "1) Universitätsstraße 25, 33615 Bielefeld 2) Arndtstraße 19, 49080 Osnabrück, Germany Germany
School of Public Health, Bielefeld University Universitätsstraße 25, 33615 Bielefeld Germany
Publication date: 2023-04-26
Popul. Med. 2023;5(Supplement):A1289
Background and objective:
Health systems able to address the mental health needs of older persons contribute to health equity. Primary mental healthcare (PMHC) is considered a key strategy for promoting mental health. India has embarked on improving PMHC in legislations, strategies and programmes that identify older persons as vulnerable to impaired mental health. This study analyses perspectives of key stakeholders on the challenges and opportunities in strengthening age-inclusive PMHC in India.

We conducted semi-structured interviews with 14 stakeholders from the PMHC system in India. Data analysis was based on thematic analysis. Themes were organizationally structured alongside the six WHO health system building blocks; challenges and opportunities were derived through inductive coding.

The stakeholders support the policy discourse on strengthening PMHC for older persons in India which ties into already established concepts of community-oriented primary health care (PHC). They denote, however, that the health system still focuses overly on medicalizing mental health problems by this shifting towards secondary and tertiary care levels failing to reach most older people vulnerable to mental health issues through PHC. Experts see as a main obstacle to further development of PMHC that policies built on unrealistic promises such as functioning primary care structures. Improving PHC capacity in general and the integration of viable PMHC approaches, such as building capacity among primary care physicians, and targeting community health workers to improve older peoples’ mental health are seen as important. Experts argue that unaccountable governance structures, poor monitoring-structures, inappropriate public spending, and a still widely spread lack of awareness of the mental health needs of older people in the health sector would need to be addressed.

While first steps have been taken in India to strengthen PMHC, more structured and integrated approaches are needed to unfold PMHC policies’ visions.