Fewer than 50 percent of the more than 300 million people with depression worldwide receive effective treatments (WHO). Inequitable distribution of skilled human resources for mental health is enormous, with low-income countries having 0.05 psychiatrists per 100,000 people (WHO). Frontline health workers are uniquely positioned to fill the gap in mental health care globally, but many lack training and adequate screening tools.
To improve access to effective and affordable care, communities need (1) cost effective mental health training of frontline health workers and (2) updated, online screening tools to support them, both of which should be linguistically and culturally tailored, an approach we call ANIMAid.
Utilizing reverse innovation, ANIMAid proposes training based on an evidence-based psychological intervention called Problem Management Plus (PM+), currently used in developing countries like Kenya and Pakistan. The training is highly scalable and can be distributed online. Our screening tool for depression is an application based on the PHQ-9, with multimedia such as animation and narration, tailored to culture, language, and literacy level. Self-administration of the app assists with the reluctance of patients to directly state that they may be suffering from depression while ensuring privacy, confidentiality, and cost effectiveness, since no additional personnel are required. The app will be deployed using a tablet computer through mobile clinics, which can more easily go where mental health needs are greatest.
ANIMAid will be piloted on The Family Van, a mobile clinic in Boston. Ninety percent of clients are people of color, 50 percent are immigrants, and the majority are uninsured or rely on public insurance. The Family Van’s version of ANIMAid will be available in the languages predominantly spoken by its clients; Spanish, Portuguese, Cape Verdean Creole, Haitian Creole, and English. A prototype using emojis has been tested on The Family Van and found to be relatable to clients, thereby promoting further discussion of mental health issues. Across the US, mobile clinics are improving access to care with up to 6.5 million visits annually and provide an ideal expansion opportunity for our solution.
Though all frontline workers in resource poor countries would benefit from ANIMAid, this solution addresses a dire need in underserved communities in our own backyard. The target population for our pilot consists of communities in urban areas including immigrants (documented and undocumented), refugees, and those of low socioeconomic means, all of whom for which the complexity of navigating the US healthcare system can make appropriate care difficult.
Data collection and analysis through ANIMAid will aid frontline health workers in understanding depression trends, case management and evaluation of treatment delivery.
ANIMAid has tremendous potential for impact because it offers a local solution to a global problem. Our current world is mostly urban, with nearly one-quarter of the total global urban population living in slums (WHO) with large healthcare disparities. ANIMAid supports frontline health workers, both in developing and developed countries, through the use of technology to reduce stigma, diagnose depression, ensure timely intervention, and thereby increase access to mental healthcare for all.
