Needs of patients with common mental disorders

Sir, A fundamental shift has been taking place in the expectations of members of the public about the quality of the services they receive and this increased attention has redirected the focus on the need to develop patient-centered outcome services.[1] There is a growing recognition that the social and economic context in which a patient lives, gets sick, and manages the illness is a key health determinant.[2] A subset of social determinant of health that is particularly relevant is “needs.” Needs are what is necessary for humans to develop and function normally.[3] However, what do we mean by the word “needs” especially with regard to health and health care? “Health-care needs” are those that can benefit from health care (health education, disease prevention, diagnosis, treatment, rehabilitation, etc.,). Most health-care professionals will consider needs in terms of health-care services that they can offer. “Health needs” absorb the social and environmental determinants of health, such as finances, accommodation, food, education, employment.[4] Thus, a patient may have a different view of what would make them healthier – for example, a job, a bus route to the hospital, or decent housing. Such needs would be constantly changing and are not be amenable to medical intervention. The “unmet need” here would represent the proportion of people who meet criteria for a disorder but remain sufficiently distressed or disabled and “met un-need” refers to those who have no current mental disorder and yet are utilizing the health services. The National Mental Health Survey estimates that about 10% population suffers from common mental disorders (CMDs).[5] Due to the chronicity, the basic needs, health needs, social needs may be more important for people with CMDs than what is provided by the health system. However, such needs have not been systematically studied and the focus seems to be tilted toward severe mental illnesses. Further, considerable portion of available literature is focused solely on health-care needs rather than health needs. Among a few, perceived needs among depression and anxiety disorders have been investigated in Canada, Australia, and the Netherlands. When compared between the two health-care systems of Australia and Netherlands, the majority of people had unfulfilled care needs.[6] Likewise, when service needs were assessed in help seeking, Australian rural residents, females were over-represented among those with unmet needs. Financial difficulties were also more marked among those reporting unmet needs with costs of treatment and distance to health-care facility as a structural barrier contributing to unmet needs.[7] Some disagreement exists as to which diagnoses have greater unmet needs. The higher reporting of needs in nonpsychotic versus psychotic illnesses has been documented by Simons and Petch’s series,[8] but this was not uniformly agreed upon in subsequent studies.[9] Many governments are unable to provide universal care and there is a large variation in availability and use of health care by geographical area and point of provision. The mental health resources are unlikely to be adequate to address the burden of mental disorders even in rich countries, leave alone countries such as India. One of the alternative sectors for mental health care is primary health care. The integration of mental health in primary health care has been a mantra for several decades – it retains its relevance in this context. Its integration could help address the physical and psychological health-care needs. To address the social determinants of mental health (social unmet needs) will require action across multiple sectors and levels that include education, welfare, transport, and housing sectors apart from the health sector. It will require the participation and cooperation of international organizations, governments, nongovernmental organizations, social institutions and service providers, community and voluntary groups, as well as the private sector. Finally, we need advocacy not only address the vast unmet need for mental health care but also to challenge events in our society that promote social inequalities.[10] Needs are infinite, whereas resources for the health system are finite. At the moment, we are unaware about the size of unmet need in patients with CMDs. It is important in addressing this burden and look beyond specific health system needs as most of the time the individual manages his or her condition falls outside of the realm of the health system. Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest. Acknowledgments This manuscript has been generated as one of the outcomes of the ongoing research project titled “Outcome of services at the community extension clinics for patients with CMDs: A client centered approach” sponsored by the Indian Council of Medical Research, New Delhi.

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