Mobile mental health care--an opportunity for India.

According to the World Health Organization, India had the highest number of suicides in the world in 2012 with 258,000 of 804,000 suicides worldwide. Indian youths between the ages of 15 and 29 years committed suicide with 35.5 deaths per 100,000, while suicide became the leading cause of death of young Indian women also1,2. Other mental health problems noted to be specific to India are depression related to economic insecurity, anxiety among youths over educational success, and distress among young women caught between the opportunities of a changing India and pressure from traditionally minded families to marry. India's first-ever National Mental Health Policy3, announced in 2014, aims to provide universal psychiatric care to the population by 2020, despite a relatively small health care budget per capita compared with other developing nations. The Policy describes how care should be provided through integrated care services which “should espouse the principles of universal access, equitable distribution, community participation, inter-sectoral coordination and use of appropriate technology”3. In India, with 75 per cent of the population living in rural areas, only 0.7 physicians per 1000 population and only one psychiatrist for every 343,000 Indians, access to quality mental health care is limited and traditional approaches to care are highly unlikely to reduce the high national suicide rate or reach the 20 per cent of the population who have mental disorders2,3. India, however, has one major advantage when it comes to delivering future mental health services and has the opportunity to deliver services just as described in the National Mental Health Policy, through the use of appropriate technology, especially mobile wireless technologies. Much of the population is young, technologically sophisticated and equipped with wireless smartphones that have become an integral part of their lives. Smartphone penetrance in India is rapidly increasing and the country will have more smartphone users than the USA by 2016, with over 200 million being used nationally already4. This is effectively an already paid for and developed health communications technology infrastructure through which a substantial proportion of India's future mental health services may be delivered. This could, if it is taken advantage of strategically, form the core of national preventive and patient centered mental health services for the country in future years. India has considerable internal experience using conventional telemedicine, especially through the partnership between the Indian Space Research Organization and the Apollo Telemedicine Networking Foundation which links more than 100 hospitals and provides tele-education to medical colleges and mobile telemedicine units in disaster relief camps5. Indian clinics and hospitals, especially in isolated areas, have long been the recipient of mobile email consultations and second opinions in many medical specialties, including psychiatry, from charities such as the Swinfen Foundation6, which accesses psychiatrist volunteers from the USA, UK and Australia. This early telemedicine and electronic health care experience, and the young wirelessly enabled population, lay the foundations for India, if it so decides, to take the leap into “mobile mental health” and to set up a series of preventive, assessment and treatment platforms that can be delivered to smartphones nationally, and which can support and supplement the current government and privately run mental health services efficiently and effectively.