RESUMO
Background & objectives: Investment in mental health is quite meagre worldwide, including in India. The costs of new interventions must be clarified to ensure the appropriate utilization of available resources. The government of Gujarat implemented QualityRights intervention at six public mental health hospitals. This study was aimed to project the costs of scaling up of the Gujarat QualityRights intervention to understand the additional resources needed for a broader implementation. Methods: Economic costs of the QualityRights intervention were calculated using an ingredients-based approach from the health systems’ perspective. Major activities within the QualityRights intervention included assessment visits, meetings, training of trainers, provision of peer support and onsite training. Results: Total costs of implementing the QualityRights intervention varied from Indian Rupees (?) 0.59 million to ? 2.59 million [1United States Dollars (US $) = ? 74.132] across six intervention sites at 2020 prices with 69-79 per cent of the cost being time cost. Scaling up the intervention to the entire State of Gujarat would require about two per cent increase in financial investment, or about 7.5 per cent increase in total cost including time costs over and above the costs of usual care for people with mental health conditions in public health facilities across the State. Interpretation & conclusions: The findings of this study suggest that human resources were the major cost contributor of the programme. Given the shortage of trained human resources in the mental health sector, appropriate planning during the scale-up phase of the QualityRights intervention is required to ensure all staff members receive the required training, and the treatment is not compromised during this training phase. As only about two per cent increase in financial cost can improve the quality of mental healthcare significantly, the State government can plan for its scale-up across the State.
RESUMO
Background: Somatization is the state of being symptomatic which is not explained medically associated with psychological distress and health-seeking behavior and is present in at least 10% to 15% in OPD. Methods: 50 patients with long standing history of MUS were evaluated by using modified Bradford inventory. Results: Somatization was most common in younger age, female and lower socio-economical class. Feeling of weakness or lack of energy much of the time in both male and female respectively 94.7% and 96.7% are the most common symptomatic presentation in Somatization during last 2 years, although there were symptomatic differences in males and females. Severity of symptoms was higher among females. 13% of female pts had undergone hysterectomy due to persistent gynecological problems during course of illness. 82% pts had illness of more than 2 years. The mean duration of illness at the time of assessment was 6.8 years. Most of the patients had visited to multiple consultants and underwent many costly diagnostic procedures for their symptoms .Most of the patients after multiple investigations and consultations were not ready to accept psychological origin of their physical illness and continued to see next practitioner as they remained dissatisfied and distressed. One or more physical illness is the common explanation by physicians. Patients presented with somatization has an another diagnosis in significant cases like Major depressive disorder, anxiety disorder, alcohol use disorder. Conclusion: Somatization was common among female, but it was not uncommon in male. Patient suffering from somatization disorder has very high rate of health care utilization and they perceived themselves as severely ill and were willing to undergo multiple hospitalizations, diagnostic studies, and operations, remained dissatisfied. Need to strengthened consultation liaison between physician and psychiatrist.