Implementation outcome measures.

Non-Communicable Diseases (NCDs) are now a leading cause of mortality and morbidity globally, and mental illness is a significant part of it. In India, the treatment gap for common mental disorders is over 80%. In order to bridge this gap, mental health treatment models recommend task-shifting to non-specialists and integration of mental health care into general healthcare services. Other NCDs are being managed effectively by non-specialist healthcare workers (HCWs) at primary care, and mental illness and substance misuse are highly comorbid with other NCDs; hence, integrating mental health care within the NCD services and care framework seems logically feasible and effective. However, country-specific characteristics pose a significant challenge to the implementation of integrated care for mental disorders and NCDs. The primary objective of this study includes the development and implementation of a service delivery model that would result in at least 70% coverage of screening, linkage to care, and management of common mental disorders and substance use disorders (MSUD) among persons seeking care for NCDs at public health facilities. Secondary objectives include assessment of the feasibility of adoption of the implementation model by the health care system and to evaluate the cost of the mental health service strengthening intervention package from the health system’s and the patient’s perspectives. It will be a multi-site implementation research study, employing a mixed-methods quasi-experimental, within-site, three-phase, single-arm, interrupted time series design. The implementation model comprises screening, treatment, and linkage of mental health services integrated into NCD care in at least three blocks in each of the seven selected districts of the seven selected states of India, which are geographically far apart. The expected outcome would be to increase the proportion of patients screened and managed for MSUDs among persons seeking care for NCDs at the public health facilities. The results of this implementation research will provide a roadmap for scaling up of integrated MSUDs services within general healthcare.Trial registrationClinicalTrials.gov CTRI/2024/08/072748.非传染性疾病（Non-Communicable Diseases, NCDs）目前已成为全球范围内致死与致残的首要病因，而精神疾患是其中重要的组成部分。在印度，常见精神障碍的治疗缺口超过80%。为弥合这一缺口，精神卫生治疗模型建议向非专科医师转移任务，并将精神卫生服务整合至全科医疗服务体系中。目前，非专科医护人员（healthcare workers, HCWs）已能在基层医疗卫生机构有效管理其他非传染性疾病；且精神疾患与物质使用障碍常与其他非传染性疾病共病，因此将精神卫生服务整合至非传染性疾病服务与照护框架内，在逻辑上具备可行性与有效性。不过，各国本土特征会对精神障碍与非传染性疾病整合照护的实施构成显著挑战。本研究的首要目标是开发并实施一种服务提供模型，使得在公立医疗卫生机构寻求非传染性疾病诊疗的人群中，常见精神障碍与物质使用障碍（Mental and Substance Use Disorders, MSUD）的筛查、转诊至治疗及管理的覆盖率至少达到70%。次要目标包括：评估医疗体系采纳该实施模型的可行性，并从医疗体系与患者双视角，评估精神卫生服务强化干预包的成本。本研究为多中心实施性研究，将采用混合方法类实验设计，具体为单臂、三阶段、位点内中断时间序列设计。实施模型将整合精神卫生服务的筛查、治疗与转诊环节至非传染性疾病照护体系中，覆盖印度7个选定邦的7个选定区县的至少3个街区，且这些区域地理跨度较大。本研究的预期成果为：提升公立医疗卫生机构中，寻求非传染性疾病诊疗的人群针对MSUD的筛查与管理比例。本实施性研究的结果将为在全科医疗体系内规模化推广MSUD整合服务提供实施蓝图。试验注册：ClinicalTrials.gov CTRI/2024/08/072748。