Schizophrenia Research Foundation

To explore barriers to seeking mental health services among young people in Chennai, South India, using a qualitative study. Young people aged 18 to 24 years with a diagnosis of any mental disorder were purposively recruited from a tertiary mental health centre in Chennai, South India, between April 2022 and March 2023. Face-to-face in-depth interviews were conducted. Questions pertaining to barriers to help-seeking included personal and emotional, social and cultural, environmental, and financial barriers. Each interview was audio-recorded and transcribed verbatim or translated into English. Thematic analysis was performed. In total, eight male and seven female participants (mean age 21.2 years) were included in the analysis. Five major themes emerged: (1) stigma and discrimination (including feelings of isolation and neglect, societal labelling, and reduced employment opportunities due to mental illness), (2) religious and spiritual factors (characterised by ignorance and high levels of stigma), (3) mental health literacy (poor understanding of mental health), (4) logistical barriers (limited access to healthcare facilities and transportation difficulties), and (5) financial barriers (high treatment costs and difficulties accessing government medical schemes). Young people with mental disorders in India face multiple barriers to accessing mental health services. These findings may inform researchers, clinicians, and policymakers in developing targeted interventions, strategic frameworks, and policy reforms to promote early help-seeking among this population.

Children in the Juvenile Justice System (JJS) face multiple adversities that may predispose them to developing mental health (MH) problems. Interventions that enhance the MH and well-being of these children while providing access to appropriate MH care are needed. This study examines the effect of a multipronged, low-intensity intervention on adolescents' well-being, stress levels, MH knowledge, and stigma perceptions in Childcare Institutions (CCIs) across Odisha and Tamil Nadu, India. Implemented in 7 CCIs, the intervention aimed to enhance the MH Literacy (MHL) and well-being of children in the CCIs through the Youth-Friendly Spaces (YFS) using experiential methods. It also sought to improve the MHL of the staff and administration within the JJS and provide access to MH care by linking CCIs to available local resources. Information using validated scales was obtained at baseline and six months. Only 180 of the 310 children for whom baseline data was available remained in the CCI at six months. A statistically significant improvement in well-being (34.5 +13.7-55.9 +12.2, p < 0.001), stress (18.5 +6.8-17 +6.1, p = 0.044) and stigma (32 +11.9-29.4 +11.4, p = 0.023) scores were observed. Adjusted linear regression analysis showed significant differences across genders, sites, and child types. This intervention, comprising YFS creation, MHL enhancement, and referral system development, is significantly associated with improved well-being of children in CCIs. The results underscore the need for tailored interventions based on gender, location, and child type. The study highlights the potential scalability of such programs in resource-constrained settings for vulnerable children.

Patient-reported measures are increasingly valued in psychosis care and research. For patient-reported measures to reflect patient perspectives, patients must be involved in developing them. Furthermore, their development and evaluation must consider sociodemographic characteristics influencing patient experiences and outcomes and measurement. As reviews reflect the state of the field and guide clinicians/researchers in selecting measures, our aim was to evaluate literature reviews of patient-reported measures on their consideration of factors affecting equity and patient involvement. For this review of reviews, we searched 3 databases (MEDLINE, Embase, and PsycINFO) for reviews on patient-reported measures in psychosis. Two reviewers independently screened titles, abstracts, and full texts, and descriptively synthesized and appraised the quality of included reviews. Using Cochrane's PROGRESS-Plus and a Canadian equity framework, reviews were evaluated on their consideration of sociodemographic characteristics, accessibility, and patient involvement. Of 10 reviews (6 systematic, 4 nonsystematic; 1111 studies; 313 measures), 6 limited their search to English. Barring 2 reviews that reported the age, gender, and countries of samples in included studies, the reviews did not extract/comment on population/sociodemographic characteristics. One commented on one measure's readability; none commented on the samples' literacy levels. Four reviews considered the availability of translations; only 1 evaluated cross-cultural validity. Only 2 considered the costs of measures. Only 1 evaluated patient involvement in developing patient-reported measures. One referenced equity frameworks/standards. Reviews of patient-reported measures in psychosis demonstrate minimal attention to equity and patient involvement. We offer recommendations to strengthen patient-reported measures research by attending to equity, social determinants, and patient-centrism.

The United Nations Convention on the Rights of the Child (UNCRC) is the most comprehensive set of standards promoting and protecting children's interests. It can be utilized to create appropriate policies and legislation that enshrine the values identified in the UNCRC. In India, children have been considered only in the context of their family and were welfare recipients in the past, but more legislation has been enacted to protect and promote the child's rights. A comparative review will help identify how the new legislation enacted after India ratified the UNCRC directly or indirectly addressed children's mental health. Legislation enacted after 1992 with the search term "child" was identified in the Indian national portal for legislation. These were compared against specific articles of the UNCRC identified to have a direct or indirect bearing on children's mental health. The review revealed that only 11 of the 32 legislation enacted after 1992 address different aspects of children's mental health. Only three refer to the UNCRC in their preamble or content. Six of the 11 legislation addressed Article 24, while Article 32 and Article 34 were addressed in only one legislation each. Notably, most of the legislation is focused on child protection, while very few address the participation component of the guiding principles. The UNCRC is a valuable guide to creating a legal framework to support child rights. This review highlights the need to consider children's mental health as a fundamental right and incorporate the principles into future Indian legislation.

Familial factors have been studied to be an important risk factor for suicidal behaviour among young people. Within families, conflicts across generations have been found to have a significant impact on young people’s mental health and wellbeing. This scoping review aimed to identify existing literature examining intergenerational conflicts and its association with suicidal behaviour among young people aged 10–24 years. English articles related to intergenerational conflicts, suicide, suicidal ideation, and suicidal behaviour in a familial context experienced by young people have been included. OVID, PubMed, and Scopus databases were searched using relevant search terms and articles were selected based on the inclusion and exclusion criteria. On database search, four articles met the inclusion criteria and four more were included based on cross-referencing. Overall, eight studies were including in the synthesis of results. Significant positive association between intergenerational conflicts and suicidal ideation and behaviour among adolescents and young adults has been elucidated from the scoping review. Age-specific differences have been noted in the experience of conflicts, with adolescents primarily facing conflicts related to academic performance and cell phone usage and older youth facing conflicts about financial independence and interpersonal relationships. Females have been found to experience more intergenerational conflict and higher associated distress than males.

In 2019, the WPA set up an Expert International Advisory Panel for Early Intervention in Psychosis (EIP) in Low- and Middle-Income Countries (LMICs), as part of a presidential initiative1 linked to the WPA Action Plan 2020-20232-4. Here we present an update on recent activities related to that initiative. The WPA has promoted several symposia and keynote/plenary lectures at international conferences on EIP models in LMICs, their clinical effectiveness, cultural contextualization, and implementation challenges. These conferences included the 21st World Congress of Psychiatry (virtual, October 2021); the WPA/UK National Institute for Health and Care Research (NIHR) Webinar on EIP in LMICs (December 2021); the WPA Thematic Conference "Public Health and Associated Opportunities" (Lahore, Pakistan, March 2022); the 22nd World Congress of Psychiatry (Bangkok, August 2022); and the WPA Thematic Conference "Early Intervention across the Lifespan" (Athens, June 2022). Some recent examples (illustrative, not an exhaustive list) of EIP programmes in LMICs include the Schizophrenia Research Foundation (SCARF)'s dedicated EIP service in Chennai, India5, developed in collaboration with the Prevention and Early Intervention Program for Psychosis in Montreal6; the University of Chile High-risk Intervention Program for Ultra-High-Risk Youth7; and a pilot EIP service in Malawi8. Understanding that inadequate mental health workforce, fragmented health care systems and scarcity of research and implementation capacity are significant barriers to introducing such programmes in LMICs, the Warwick-India-Canada (WIC) network was formed with a shared strategic vision to reduce the burden of psychotic disorders in resource-poor settings9. This network brought together knowledge and expertise of four internationally recognized institutions: the University of Warwick, UK; the McGill University, Canada; the All India Institute of Medical Sciences (AIIMS), New Delhi, India; and the SCARF, Chennai, India. The largest cohort of first-episode psychosis cases in LMIC settings was recruited and followed through the WIC programme at SCARF and AIIMS. A comprehensive package of biopsychosocial care, ready to use in any LMIC setting, has been developed. The integration of faith/traditional/indigenous healing with mental health services in LMICs appears a promising way for community detection of untreated psychosis, but there are significant challenges in such collaborations. Trusting relationships are difficult to build, ongoing training and supervision beyond the project timelines are hard to deliver, and sustainability is more easily promised than achieved. The COllaborative Shared care to IMprove Psychosis Outcome (COSIMPO) trial10 assessed the effectiveness of a collaborative shared care (CSC) for psychosis delivered by traditional healers and primary health care providers, compared to enhanced care-as-usual, in Ghana and Nigeria. Participants randomized to the CSC model had significantly lower symptom scores at 6-month follow-up. CSC led to greater reductions in overall care costs. Such models offer the prospect of scaling up across LMICs. A new programme of such collaborations is under way in Nigeria and Bangladesh. Digital technology can play a vital role in overcoming resource and infrastructure limitations in LMICs11. The WIC early psychosis study9 co-designed the Saksham app for people with schizophrenia and their caregivers. The app is ready for public roll out in India. Telepsychiatry offers another innovative approach to reaching individuals in rural regions who may otherwise not have access to treatment. Several models of telepsychiatry have been launched in India: the SCARF STEP tele-psychiatry model12; the psychiatristonweb application13; the Ganiyari model; and the National Institute of Mental Health and Neurosciences (NIMHANS) hub-and-spoke model14. Emerging evidence suggests that these models improve medication and appointment adherence, and lead to reductions in relapses and fewer hospitalizations.

One small suggestion, as the sampling was done in institution-enrolled students, draw an overview of the city's literacy rate, school enrollment rate, drop-outs, and other socio-economic contexts relevant to this.

Young adults experience an increased risk of developing mental health problems as they transition from school life to university life. This is also the period of life where the peer group plays a significant role in their decisions. We describe this process of co-creating a peer support (PS) program in a residential university setting in India. The collaborative design process is described from a baseline felt need assessment to selecting and training student peer support volunteers (PSVs). The ongoing implementation and design of the program were informed by design thinking by the university staff and PSVs.The survey conducted among the first-year students of a University in South India revealed that the students were predominantly focused on difficulties in social interactions, lack of adequate mental health services, and issues related to help-seeking. This guided the content and skill development of the PSVs. The PSVs used reflective learning as the program was being implemented to identify the lacunae in the training and implementation of the PS program. They were able to provide constructive feedback and implement the changes.The PS program is an example of a low-intensity intervention that provides contextual support to students in an academic setting. This program also highlights task-sharing that is more acceptable to the youth and, therefore, more sustainable. A co-design and iterative process will give the youth-focused program a greater reach, reduce stigma, and improve help-seeking for mental health issues. This also helps create appropriate referrals for a higher level of care. This program description does not include a formal evaluation of the impact of the same, which could guide future work.

Sanjali, A. M. Gurupriya; Srinivasan, Shiva Prakash1; Raghavan, Vijaya1, Author Information