ESSENCE

The long-term goal of ESSENCE (Enabling translation of Science to Service to ENhance Depression CarE) is to bridge the science to service gap and strengthen an existing collaborative network of institutions in South Asia by generating knowledge on cost-effective implementation approaches for scaling up of evidence-based interventions for mental disorders, and building capacity in a range of key stakeholders to enhance the conduct of implementation research, the dissemination of its findings, and the uptake of this evidence in policy and programs, ultimately resulting in reduction of treatment gap for mental disorders.

Project Period: 1st July 2017 to 31st May 2022

Objectives

1) Evolving the existing administrative infrastructure of SHARE Hub (the South Asian Hub for Advocacy, Research and Education on mental health) for International Mental Health Research, to provide overall coordination for the ESSENCE components and building on the existing research partnerships to establish a South Asian Mental Health Implementation Science Hub comprising of the ESSENCE partners which include governmental, non-governmental, academic, and implementing agencies in the region.

2) Carrying out implementation research to assess the comparative effectiveness of technology-enabled interventions to train non-specialist health workers and provide them implementation support to address the key barriers to the coordinated delivery of evidence-based clinical treatments for depression (Healthy Activity Program and Antidepressant Therapy) at the primary health care level.

3) Developing and offering a range of opportunities, including fellowships and online courses tailored for the region, to build the capacity of the researchers to generate knowledge, of the media professionals and service user representatives to disseminate that knowledge, and of policy makers and program, managers to ensure uptake of the knowledge.

Background

In India, depression accounts for 37% of the mental health related Disability Adjusted Life Years (DALYs) and significantly contributes to the burden attributed to suicide and ischemic heart disease thus making it a critical public health priority. However, despite the knowledge of evidence-based clinical treatments (EBT) treatment gaps exceed 90% in rural areas. ESSENCE will address the critical knowledge gap regarding the training and implementation support strategies necessary to scale-up evidence-based delivery strategies for treatments for depression in a low resource setting. The innovations in the study are focused on developing and testing strategies for effective delivery of evidence-based treatments in low-income settings.

Study Design

Scale-up (Research) component of ESSENCE consists of two complementary, sequential randomized control trials, the ‘Training Trial’ to evaluate the equivalence of Online Training interventions (OLT) compared with traditional Face-to-Face (F2F) methods for training ASHAs to deliver the Healthy Activity Program; and the ‘Implementation Trial’ to evaluate the impact of progressively resource intensive implementation support strategies on the fidelity of the implementation and patient outcomes of the ESSENCE package.

Training Trial is a three-arm (OLT alone; OLT with guidance; F2F) individual parallel randomised controlled trial. Our predictions are that 1) OLT alone is of equivalent effectiveness to and is cost saving compared with F2F on competence outcomes; and 2) OLT with guidance is of superior effectiveness to and is cost-effective compared with, F2F on competence outcomes.

Implementation Trial is a three-arm cluster randomised controlled trial with a 12-month intervention delivery period. Our predictions are that 1) both of the technology enabled implementation support intervention arms will be superior to the training alone arm (“let it happen”); and 2) Arm 3 (“make it happen”) is superior to Arm 2 (“help it happen”) in improving outcomes of patients with depression.

 

Expected Impact

ESSENCE will contribute knowledge on cost-effective implementation approaches for scaling up of interventions for mental disorders, and build capacity to conduct, disseminate and uptake implementation research, ultimately resulting in a reduction of treatment gap for mental disorders in South Asia.

Within the five year time-frame of the program, ESSENCE is expected to strengthen the existing administrative infrastructure of SHARE to establish a South Asian Mental Health Implementation Science Hub comprising of the ESSENCE partners which include governmental, non-governmental, academic, and implementing agencies in the region. An implementation research will help ESSENCE to assess the comparative effectiveness of technology-enabled interventions to train non-specialist health workers and provide them implementation support to address the key barriers to the coordinated delivery of evidence-based clinical treatments for depression (Healthy Activity Program and Antidepressant Therapy) at the primary health care level. This will open new avenues for integration of mental health in primary care using modern technology support system. A range of opportunities, including fellowships and online courses tailored for the region, to build the capacity of the researchers to generate knowledge, of the media professionals and service user representatives to disseminate that knowledge, and of policy makers and program managers to ensure uptake of the knowledge will be developed and offered. This will help in building sustain capacities of researchers and media professionals in the field of mental health.

For more information, contact:

▪ Rahul Shidhaye (rahulshidhaye@gmail.com)

▪ Vaibhav Murhar (vaibhav.murhar@sangath.in)