Rural India Sees Major Drop in Depression from SMART Programme
Hyderabad: A unique mental health programme implemented in the rural areas of Andhra Pradesh and Haryana has led to a significant reduction in depression, anxiety, and self-harm, according to a groundbreaking study by The George Institute for Global Health.
The study, the largest of its kind, revealed that 75 per cent of the 9,900 participants in a year-long trial fully recovered from depression, a striking improvement compared to 50 per cent in the control group.
The Systematic Medical Appraisal Referral and Treatment (SMART) Mental Health Programme was rolled out in West Godavari, Andhra Pradesh, and in Faridabad and Palwal districts of Haryana.
The programme combined two innovative approaches: a robust digital healthcare initiative and a comprehensive community-driven campaign. Nearly 1,70,000 adults were screened for depression, with the intervention showing a 50 per cent reduction in depression risk. Mental health knowledge among participants improved by 70 per cent, while the stigma surrounding mental health decreased by 40 per cent.
The SMART programme's methodology involved training Accredited Social Health Activists (ASHAs) and primary healthcare doctors to identify and manage common mental health conditions like depression and anxiety. These community health workers, equipped with digital tools such as tablets loaded with mental health assessment software, were able to conduct screenings and provide basic counselling. The digital platform also facilitated referrals to doctors when more specialised care was needed.
The community-driven aspect of the programme included public campaigns aimed at reducing the stigma associated with mental health issues. Workshops, educational sessions, and group discussions were organised to improve awareness and encourage help-seeking behaviours.
The involvement of local leaders and influencers was key to changing the community’s attitudes towards mental health.
“This study marks a significant milestone in mental health care,” stated Prof. Pallab Maulik, the director of research and programme director (Mental Health) at The George Institute India. “Our dual intervention approach — combining digital tools with community engagement—has proven to be effective in not only reducing depression but also in changing how mental health is perceived in these communities.”
Prof. David Peiris, chief scientist at The George Institute, highlighted the scalability of the programme. “The strategy we used is simple, safe, and clinically effective. It demonstrates that community health workers, supported by digital tools, can deliver high-quality mental health care even in the most underserved areas. This model can be adapted and scaled to other regions and countries facing similar challenges.”
Mercian Daniel, a senior research fellow at The George Institute India, emphasised the importance of ongoing support for ASHAs and doctors in the field. “The success of this large-scale trial was due in part to the regular supportive supervision we provided, along with continuous engagement with the community. This ensured that the mental health interventions were delivered consistently and effectively.”
The findings of this study align with the WHO and Lancet Commission's recommendations for innovative strategies to combat mental health disorders. The success of the SMART programme in India suggests that similar approaches could be implemented in other low- and middle-income countries, or even in impoverished regions of high-income nations, with suitable local adjustments.