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

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BACKGROUND: Mental 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. METHODS: The 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). RESULTS: The 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. CONCLUSION: This 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.

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