Mental Health Issues in TB patients

The burden of mental health in India 

Depression is one of the major mental health conditions and is expected to be the most widespread health disorder by 2030.
TB and Mental Health 

Depression, anxiety, and psychosis are the most common mental health disorders reported in the studies. The overall pooled prevalence was 25% for depression, 24% for anxiety, and 10% for psychosis. However, there was substantial heterogeneity in the estimates. 

Multidrug-resistant TB patients and TB patients with comorbidities are at high risk of depression. The prevalence of suicidal ideation and attempt among TB patients was 17.3% and 7.5 % respectively. 

 Screening of TB patients for mental health issues 

Common mental health issues can be screened through a basic validated questionnaire. i.e. PHQ4/PHQ2/PHQ9. Patients requiring interventions based on the screening tool are linked to the necessary clinical or counselling services based on the need. The focus is on the early identification of Common mental health disorders (CMD) among TB patients aged 15 years and above at the time of TB diagnosis at least within seven days of TB treatment initiations. Screening for depression and psychosocial support should be integrated into routine TB services and provided throughout treatment. Substance cessation activities need to be linked to pharmacological and psychotherapeutic interventions for substance use disorders. Besides this, psychosocial support for battling stigma, discrimination and for vocational rehabilitation is necessary. This can be achieved through  collaborating with the National Mental Health Programme entities. 

National Mental Health Programme (NMHP)
The Government of India has implemented the National Mental Health Programme (NMHP) to address the burden of mental disorders since 1982. The programme aims to provide prevention and treatment of mental and neurological disorders and their associated disabilities through the use of mental health technology to improve general health services and the application of mental health principles in national development to enhance the quality of life.
The primary objectives of the programme are:
-To ensure availability and accessibility of minimum mental health care for all in the foreseeable future, particularly to the most vulnerable and underprivileged sections of the population.
-To encourage the application of mental health knowledge in general health care and social development.
-To promote community participation in mental health services development and to stimulate efforts towards self-help in the community.
Moreover, under this programme, the government is implementing workforce development schemes for establishing Centres of Excellence and strengthening/establishing Post Graduate (PG) Departments in mental health specialities and the District Mental Health Programme (DMHP) for detection, management and treatment of mental disorders.

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