Inter-rater Reliability and Concurrent Validity of a Novel Mental Health Screening & Counselling Tool for Community Health Workers of India

AIM/ OBJECTIVES: To examine the concurrent validity and inter-rater reliability of the Mental Health Screening and Counselling Tool [MERIT] for Community Health Workers of India. METHODOLOGY: We designed the MERIT instrument, established face, content validity, and subsequently translated it to regional languages. We undertook one training session for all the healthcare workers on the use and administration of MERIT. To assess concurrent validity, we compared the diagnoses made by accredited social health activists (ASHA) [n = 23] with trained mental health professionals [n=7; 5 Psychiatrists, 1 Psychiatric Social Worker, and 1 Nurse] who had independently assessed them for psychiatric illness in 116 households of 5 villages of Ramanagara district South Karnataka. For the inter-rater reliability exercise, we evaluated the diagnosis made by two independent ASHAs in 115 households after separate house visits and MERIT assessment. RESULTS: The measure of agreement between ASHAs and MHPs was substantial [k=0.792; p< 0.001], indicating excellent concurrent validity. The inter-rater reliability between ASHAs was also excellent [n = 115, k = 0.744; p< 0.001]. On average the tool required 5 minutes for administration per household. DISCUSSION: The MERIT tool consists of 11 simple categorical questions to help community health workers screen for probable common mental disorders, severe mental disorders, and substance use disorders. Upon positive screening, community health workers can refer potential patients to the Ayushman Bharath Health and Wellness Centres. MERIT tool enables easy, quick screening and identification of persons with mental health issues which can eventually help reduce the burgeoning treatment gap of psychiatric disorders in India. CONCLUSION: MERIT is a simple, reliable, and valid instrument that can be applied in under five minutes and is a gamechanger in community mental health delivery. It will lead to improved detection of mental illness and the facilitation of appropriate care in the community.