Impact of community-based rehabilitation for mental illness on ‘out of pocket’ expenditure in rural South India: An Article

Community Mental Health Awareness by APD India in Rural Karnataka

This article was originally published on The Asian Journal of Psychiatry, Volume 44, August 2019, Pages 138-142. The PDF version is available here

Here is the abstract.


In India, expenditure incurred to access mental health services often drives families to economic crisis. Families of Persons with mental illness (PMI) incur ‘out-of-pocket’ (OOP) expenditure for medicines, psychiatrist fee and travel in addition to losing wages on the day of visiting psychiatrist.

Aim: To describe impact of Community Based Rehabilitation (CBR) on OOP expenditure incurred by families of persons with severe mental illness (PSMI).

Methods: The sample comprised 95 PSMI who switched from treatment from other mental health facilities to CBR at Jagaluru, India.

Results: The PSMI were predominantly male (52%) with mean age 41 years and diagnosed with psychosis (75%). Most of them (84%) were earlier taking treatment from private sector and spent on an average Rs. 15,074 (US $ 215) per PSMI per annum in availing treatment. After availing CBR, the annual expenditure reduced to Rs 492 (US $ 7) on an average per PSMI. OOP expenditure on medicines (largest head of expenditure) and psychiatrist consultation fee dropped to zero.

Discussion: After excluding costs incurred to run the CBR, the net savings for the system for 95 PSMI included in study alone was Rs 3,83,755 (US $ 5,482) per annum. The amount would be much higher on including savings for PSMI initiated on treatment for the first time and PMI on regular follow-up in CBR.

Conclusions: Provision of CBR in partnership with public health system and NGO’s leads to dramatic fall in OOP health expenditure of families of PSMI. It is also cost-effective to the system.

Read the detailed paper here.

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