Early feasibility of telemedicine-based mental health wellbeing centers: an implementation study in district and sub-district health facilities in Bangladesh.

backgroundMental health disorders pose a critical burden globally, 400 million incident and 1.1 billion prevalent cases; and in Bangladesh, 10.38 million incident and 24.05 million prevalent cases in 2023. Despite the mental health burden in Bangladesh, the majority of the people (> 90%) do not receive required services, due to the concentration of service providers in big cities, leaving rural and marginalized people disproportionately affected. Therefore, to address these barriers, the Non-Communicable Disease Control (NCDC) programme established tele-mental health services in government facilitated Wellbeing Centers at district and sub-district level. Thus, our study aimed to assess early implementation outcomes of the Wellbeing Center model.

methodsThe Wellbeing Centers implementation model was established in January 2023 in two district and five sub-district level hospitals to provide mental health services. We measured WHO's implementation research outcomes comparing with preset benchmark. Data were collected using a structured questionnaire from healthcare providers (n = 167) and service recipient (n = 7825).

resultsThe findings revealed that the majority of the service providers perceived (96.4%, 95% CI: 92.3-98.6) the Wellbeing Centers fit well with the existing infrastructure of their facility. Whereas, half of the service providers (49.7%, 95% CI: 41.8-57.5) highlighted the shortages of staff in implementation. Besides, 99.8% (95% CI: 99.6-99.8) of user participants perceived that the WBC improved their access to mental health services, mental health services from WBC were acceptable (99.8%, 95% CI: 99.6-99.8), and the WBC was useful (99.9%, 95% CI: 99.7-99.9). Moreover, high prevalence of moderate to severe anxiety (85.1%, 95% CI: 84.1-85.8) and depression (84.3%, 95% CI: 83.4-85.1) highlights a clear requirement for mental health care among participants. Multiple logistic regression identified several determinants of accessibility (high income group had 24% higher access), acceptability (unmarried had 35% lower acceptability), and usefulness (people aged higher than 50 years had 22% lower usefulness) of the Wellbeing Centers.

conclusionThis implementation study indicated high initial service uptake, feasibility, accessibility, acceptability, and usefulness of Wellbeing Center in addressing mental health challenges in low-resource settings like Bangladesh. Acknowledging human resource shortages, retention barriers, staff training, and infrastructural resilience will be required to scaling up the intervention. CLINICAL TRIAL NUMBER: Not applicable.