Abstract
Over the last four decades, the Indian National Mental Health Program (NMHP) has evolved in its objectives, strategies, resource allocations, and reach. The core District Mental Health Program model has now been extended to over 500 districts. 1 Capacity building in the context of NMHP till this decade has always meant clinical skills and developing alternative mental health workforce. While direct research support to inform the NMHP has taken place to some extent, a systematic effort to build capacity for implementation research in mental health space in the country has been lacking. This supplement brings together a focus on one very large initiative in this regard. This program has been supported by the Indian Council of Medical Research (ICMR) and lead by research groups within Ram Manohar Lohia Hospital/Atal Bihari Vajpayee Institute of Medical Sciences (RML/ABVIMS), New Delhi, India, and the University of Pittsburgh, Pittsburgh, PA, USA. A summary of the lead up to this Capacity Building Workshop for Implementation Research in Mental Health has been captured by Hawk et al. 2 and is also detailed in the lead article of this issue. The supplement lists 12 major research protocols of the studies underway under this initiative, including 5 multicentric studies. It covers over 15 sites with two dozen Principal Investigators and strongly reflects the intense background work that has gone into this exercise.
The study protocols in this supplement all refer to the basic ground realities that the NMHP must contend with. The protocols include prevalence studies and studies of needs, supports, and service barriers using mixed methods. There are many clinical- and community-based randomized implementation trials and evaluation of innovative manpower training programs. There is a tool development study too. The intervention trials include clinical, rehabilitative, and even preventive efforts. The spectrum of psychiatric disorders covered include severe mental illness, common mental disorders, adolescent substance use, geriatric mental health burden, suicide attempts in clinic and community settings, and perinatal mental health besides issues at the medical--psychiatric interface. The trials are all registered with Clinical Trial Registry—India, the reports follow Standard Protocol Items: Recommendations for Interventional Trials reporting styles, have committed to later sharing the findings using Consolidated Standards of Reporting Trials guidelines. Such clarity needs a lot of preparation, a lot of learning, and indeed represent a unique achievement in Indian mental health services research. The experts that conducted workshops and helped evolve these research designs and have continued to support such an extensive spread of research initiatives over 2--3 years, deserve fulsome praise for their efforts.
The spread of researchers across the country in this initiative needs to be remarked upon. Karnataka and Delhi appear to have more representation; overall, however, these protocols involve researchers from ten States, hailing from a mix of public and private medical institutions including one non-teaching NGO. While southern centers are in relatively large numbers, nationally renowned institutions are also represented, as well as, relatively new private/public medical colleges. The locus of research varies from urban to rural area and tribal areas. As described in the lead article, the researchers are all below 45 years of age. This augurs well for their development as they can build on the findings from these initial studies and develop more useful collaborative research in the coming years. The lead article describes how the researcher groups were selected and trained and continue to be nurtured.
The common data management system, i-MANN (ICMR Mental Health Assessment National Network), which is described in a stand-alone article in the supplement, represents another major milestone in public health research in the country. This is a web-based system for data management of mental health research in India. It is built using open source and “is extendible for data collection, integration, data management, and analysis of data on mental health in India.” All the data being gathered under the studies described here has been uploaded for potentially independent analysis. It is reported that as of August 2020, there are over 17,000 records of research participants from these studies, including 93 different scales. It has inbuilt analytical platforms and can be adapted for more. Various data protection steps are described. Such pooling of data allows for studying more patterns than those specified under each study. This is likely to become an ongoing resource and help with conducting and analyzing mental health research under ICMR; moreover, also become an invaluable tool for research training.
It may be remarked that there is unevenness in the spread of quality, depth, and scope of the protocols in the supplement. It is possible that the initiative had to meet several objectives and face constraints in selection of sites and researchers. Some protocols are extremely well detailed while a few are written in broad terms. Qualitative methods have been frequently mentioned but not elaborated upon. This by no means takes away from this grand initiative of international researchers from the University of Pittsburgh (supported by Fogarty International) and the leaders from RML/ABVIMS, New Delhi. I am sure that seeing the collection itself will help researchers learn from variations across studies. Thus, this supplement becomes a further step in continuing capacity building for these researchers as well as the readers. Furthermore, as the findings get presented in later publications, many of these aspects would be available for scrutiny.
It may be mentioned here that the same leadership has recently launched a new research capacity building initiative termed PRIIIA—Psychiatric Research Infrastructure for Intervention and Implementation in India. This has opportunities for medium (6 months) and long-term research training through four hubs in the country, over the coming 4–5 years. The Indian Psychiatry Society South Zonal (IPSSZ) Branch has partnered with the St. John’s Medical College Hub in this program. This ties well with the objectives of the Research Capacity Building Committee that has become one of the initiatives of the IPSSZ Executive Committee in recent years.
A word on the idea of the supplement: In recent times, we have seen excellent topical supplements covering issues related to Mental Healthcare Act, telepsychiatry, psychiatry, and COVID infections. Through advanced chronicling of full protocols across multiple ongoing studies, this current supplement represents a major milestone in mental health research publication in India. It aptly highlights the well thought out capacity building program in mental health implementation research that has been supported by Indian and international agencies. I am confident that this publication would influence mental health research literature in the coming decade.