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EV0693

Real-world implementation of community-based integrated care to close the rural mental health treatment gap in India: Evidence from the NAMAN rural program

REAL-WORLD IMPLEMENTATION OF COMMUNITY-BASED INTEGRATED CARE TO BRIDGE THE RURAL MENTAL HEALTH TREATMENT GAP IN INDIA: EVIDENCE FROM THE NAMAN RURAL PROGRAMME

The community-based integrated NAMAN program reduced the treatment gap by 40.93 and 53.66 percentage points in two rural taluks.

The aim was to assess treatment gaps before and after implementation of the NAMAN program, which seeks to reduce the persistent mental health treatment gap in rural and resource-constrained settings, and to identify points of attrition along the care pathway and associated sociodemographic factors. A community-based implementation design combining door-to-door screening with primary health centre (PHC) screening and longitudinal follow-up was used in two geographically distinct rural taluks (Belur and Munsyari). Trained community health workers (CHWs) administered the MERIT-plus tool alongside a digital customer relationship management (CRM)-based referral and follow-up system; individuals who screened positive received clinical and psychosocial care at taluk clinics, and data were assessed using routine CRM records through July 2026. In Belur, 2,037 (42.5%) of the 4,793 individuals requiring treatment received it, while 2,756 (57.5%) remained untreated; in Munsyari, 510 (57.4%) of 889 individuals received treatment, while 379 (42.6%) remained untreated. The treatment gap declined from 98.43% to 57.50% in Belur and from 96.29% to 42.63% in Munsyari, corresponding to absolute reductions of 40.93 and 53.66 percentage points and relative reductions of 41.6% and 55.7%, respectively. PHC-based case finding achieved stronger linkage to treatment than door-to-door screening. Persistent gaps in substance use cases, child and adolescent cases, and dementia cases indicate a need for diagnosis-specific, tailored interventions. The authors state that NAMAN was associated with a significant reduction in the treatment gap in both rural settings, but that the remaining gaps call for integrated referral, decentralized care, diagnosis-specific engagement, sustainable follow-up, and evaluation of treatment adequacy, retention in treatment, and clinical outcomes.

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