NIMHANS (National Institute of Mental Health and Neurosciences), Bangalore, a public healthcare institute (under MOHFW, Govt of India) has always been at the forefront of human resource training in mental health and substance use. However, we realized more than a decade ago that face-to-face training is expensive, and its reach across the country is limited. The glaring “treatment gap” (the gap between need and availability of services), of > 75% spurred us to look for innovative cost-effective methods to expand our reach. The advent of 4G technology and Engagement with the Project ECHO (Extension of Community Healthcare Outcome), University of New Mexico, Albuquerque has enabled the NIMHANS to innovate and exponentially increase workforce training and simultaneously reach hundreds of health care professionals/providers to provide best-practices mental health care and reduce health disparities in the community.
Since 2014, NIMHANS has piloted creating a” Knowledge Network” with the mission of capacity building for healthcare providers who can work like local experts in their community. Thus the people get the care they need, where they live, by people they know and trust. ,
This model from NIMHANS Digital Academy ECHO has been using HUB and SPOKEs knowledge-sharing networks, led by expert teams of NIMHANS (an academic centre). They use smartphone app multipoint videoconferencing to conduct virtual sessions with healthcare providers . The focus of this weekly session/clinic is on “case-based learning to understand the complexities,” “following best practices like algorithms, and guidelines along with clinical wisdom for knowledge diffusion,” “using technology to leverage scarce resources” and “web-based monitoring for the outcome.”. This live virtual session is accessible through smartphones.These live sessions are linked to a mobile e-learning certification/accreditation through which learners can access the learning materials as well as relevant questions anytime and anywhere. NIMHANS provides accreditation for the learners who have completed this blended learning ( virtual synchronous tele-ECHO + self-paced e-learning). In this way, remote primary care doctors, nurses, counselor and other health providers learn to provide excellent specialty care to patients in their own communities. Initially, it was started in the area of Substance use disorder and later extended to perinatal mental health, dementia as well as general mental health etc. NIMHANS Digital Academy ECHO has created huge synergies between academicians from tertiary medical institutions and remote health care practitioners in implementing “best practices in mental health”. In a recent study, 26 primary health care providers could screen 2695 individuals and identify 832 (30.8%) as Alcohol use disorders. The PCPs reported retaining 49.1 percent of the cases for at least one follow-up and needed to refer only 80 (3%) cases to specialists in higher centres for further management. In another study, the primary care physician could provide care from to 23,000 and also rated an average of 4.5/5 on learning through NIMHANS ECHO tele-mentoring model.