Scaling up Behavior Activation in India
The Aim of the Study:
EMPOWER India is a collaborative initiative led by Sangath and the Mental Health For All Lab at Harvard Medical School. Its aim is to scale up the delivery of the Healthy Activity Program (HAP), a brief evidence-based psychological treatment for depression, through India's community health workforce (Accredited Social Health Activists, or ASHAs) across multiple districts of Madhya Pradesh.
The Background:
India faces a severe mental health treatment gap, with over 50 million people living with depression and the vast majority having no access to evidence-based care. HAP was developed and validated by Sangath as an effective, low-cost psychological treatment for depression that can be delivered by trained non-specialist health workers. EMPOWER India applies the EMPOWER framework to deploy HAP at scale through the existing national primary health system.
The Project Plan:
Sangath leads the training, supervision, and quality monitoring of ASHAs to screen for and deliver HAP counseling sessions through primary care. Digital training methods developed under the ESSENCE project are used to prepare ASHAs for their roles. The program uses standardized depression screening (PHQ-9) and ongoing fidelity monitoring to ensure quality of care.
Here is a glimpse of the ASHA undergoing the HAP training and delivering patient care:
ASHA undergoing HAP training
ASHA Delivering Counseling Sessions to Patients
Findings:
As of 2023, over 1,000 ASHAs have completed HAP training and detected close to 2,900 persons with depression. Approximately 90% of these individuals completed treatment, with over 87% achieving remission by the end of treatment. ASHAs have collectively delivered more than 15,300 counseling sessions for adult depression across Madhya Pradesh.
Next Steps:
The program continues to expand to additional primary healthcare facilities and districts in Madhya Pradesh and is integrating lessons learned into the OptimizeD and SAMARTH trials.
Publications:
Voices of the ASHA
- Tara Goswami, ASHA, Raisen, Madhya Pradesh
"Mental health is major issue which needs to be focused on and prioritized. Training has helped us in understanding that mental health issues are common and treatable. We don't need to stigmatize it. Early identification and treatment is the key."
- Saira Bano, ASHA, Vidisha, Madhya Pradesh
"This training has been really significant for us. It has improved our understanding of mental health. Through this training we will now be able to understand the depressive symptoms and be able to help such individuals."
- Hemlata Sharma, ASHA, Vidisha, Madhya Pradesh
"I really enjoyed doing the online training on mental health designed by Sangath Bhopal. The audio-visual content used in the training programme helped in retaining the content and I was able to absorb it. I think the module has been really beneficial for all of us."
