For India's Families Caring for the Mentally ill, an App Was Never Going to Be Enough
Dr Jyoti Kapoor is a psychiatrist at Maarga Mind Care. Kapoor tells Arunima Rajan that our healthcare system does not address recovery and focuses only on managing symptoms of mental illness.
India's treatment gap sits between 70 and 92% depending on the condition. In your experience, how often does a patient reach clinical stability but still fall through the system before reaching real recovery? What does that gap look like on the ground?
The problem facing India in terms of mental health is not merely the treatment gap of 70%–92% discussed by WHO and the NMHS, but also a recovery gap. In practical medicine, a substantial number of patients manage to achieve symptom stabilisation, but still fail to resume normal functioning or employment, or maintain relationships or independence. This is what the gap is all about - the "gray zone" that can be seen quite frequently in conditions such as schizophrenia or bipolar disorder.
In real life, those are people who do not relapse anymore, but are far from being healthy, usually dependent on their family, having cognitive and social deficits, and prone to relapse. It appears that our system does not address recovery, and focuses only on managing the symptoms.
AI-driven tools are increasingly positioned as front-door entry points to mental health care. At what point in a patient's journey, if at all, do these sorts of tools have a legitimate role?
These types of AI technologies do have a valid place within the treatment continuum as an initial point of contact for screening, psychoeducation, and managing mild-to-moderate cases of psychological distress, especially within a health care system where up to 70%-92% do not receive appropriate care as highlighted by the World Health Organization and the National Mental Health Survey. There certainly comes a time where AI-powered solutions are no longer effective due to the presence of suicidal thoughts, psychoses, impaired functioning, and other complexities where only clinician intervention will suffice. The benefits provided by these solutions are mainly seen among low-risk patients. Therefore, their use must come before transitioning the client into clinician-led care through a stepped-care process.
Research shows that AI chatbots demonstrate small-to-moderate effects on depression and anxiety and are effective or useful for low-to-moderate issues, but Maarga treats complex psychiatric conditions, including schizophrenia, bipolar, and PTSD. Where precisely is the clinical floor at the point at which a chatbot or digital tool must hand over to a psychiatrist who decides that? Is the Indian system currently equipped to manage their transition?
While there seems to be merit to using AI chatbots in the case of moderate mental health issues, the clinical threshold gets crossed in severe, risky, and/or complex scenarios that involve suicidality, psychosis, manic states, marked functional impairment, or even disorders like schizophrenia, bipolar disorders, or post-traumatic stress disorder.
At such a point, digital means should transfer these cases to the care of clinicians and psychiatrists, which will help provide specialised, patient-centered care along with multiple forms of intervention that algorithms simply cannot provide at present.
Ideally, this process should depend on pre-defined risk evaluation processes that form a part of the software itself. However, this may also depend on the clinical perspective.
Unfortunately, the Indian context still lacks such an integrated framework, making it difficult for any such process to flow seamlessly from one level to another.
