Kerala's 'Amma Manasu' emerges as model for maternal mental healthcare: WEF report

New Delhi: Kerala's "Amma Manasu" programme has emerged as a model for integrating perinatal depression screening into routine maternal care, even as gaps in screening, diagnosis and follow-up services continue to affect women's health globally, according to a report by the World Economic Forum (WEF).

The "Amma Manasu" (Mother's Mind) programme is a state-wide maternal mental healthcare initiative aimed at integrating mental health screening and support into routine antenatal and postnatal care.

The report, published in collaboration with the McKinsey Health Institute (MHI), provides a comprehensive roadmap for improving women's health by closing gaps in care delivery.

"In Kerala, India, the government integrated perinatal depression screening and management into routine antenatal and postnatal care through programmes such as Amma Manasu, delivered by public health nurses and linked to the National Health Mission. These state-led models show how maternal mental health services can be embedded within publicly financed maternal care systems," the report stated.

It noted that governments, as primary stewards of national health systems, play a key role in updating clinical guidelines, financing care delivery models, strengthening healthcare workforces, including community health worker programmes, and supporting integrated care models and accountability mechanisms to close gaps in care delivery.

"Addressing the women's health gap could add at least USD 1 trillion annually to the global economy by 2040 by reducing years lost to poor health, boosting workforce participation and enhancing productivity, better health for women translates to stronger economies," the report said.

The report further stated that women spend 25 per cent more of their lives in poor health compared to men on average, with inadequate and inconsistent healthcare delivery accounting for nearly one-third of the women's health gap, according to the report.

"Better sex-and gender-appropriate care delivery could reduce the women's health burden by 26 million disability-adjusted life years (DALYs) per year globally by 2040, corresponding to 2.5 days per woman per year," the report stated.

It highlighted major gaps in care delivery, including underscreening of conditions such as cancer, mental health conditions and cardiovascular risks, underdiagnosis due to atypical symptoms and lack of gender-specific diagnostic criteria, and undertreatment, including lower access to guideline-recommended interventions and delays in care escalation.

The report said health systems could address these gaps through the CARE framework -- conduct research and gather clinical evidence, align care and integrate referral pathways, report using clear guidelines and standards, and engage patients and stakeholders in patient-centred care.

The report said it deepens the investment case for women's health by highlighting opportunities in care delivery and their potential to improve health outcomes and economic growth.

It focuses on three pathways -- breast arterial calcification and cardiovascular disease risk, pregnancy-related cardiovascular risk and perinatal depression -- seen as representative of broader cardiovascular, maternal and mental health challenges.

While the report centres on improving care within existing clinical pathways, it notes that larger drivers such as chronic disease management, unequal access in rural and underserved areas and affordability constraints require wider systemic action.

The report added that strengthening care delivery through existing health systems and enabling earlier intervention, along with a shift from reactive to proactive care, can help slow disease progression, improve near-term outcomes and reduce the long-term burden on women's health systems and economies.

"Maternal mental health disorders are a significant problem for mother-infant dyads in India, but have not received the attention that they should," according to a study published in BJPsych International and referenced in the WEF-MHI report.

"However, recent major developments hold promise: the increase in coverage of the District Mental Health Programme; the growing emphasis in public health systems on newborn health; integration of maternal mental health into the Reproductive and Child Health Programme in the state of Kerala," it stated.

It also highlighted the Mental Health Care Act, 2017, which mandates mother-infant joint care when a mother is admitted for mental illness, saying these measures could lead to policy changes in services.

"Innovative implementation and translational research is needed to generate knowledge to strengthen maternal mental healthcare systems and improve maternal and child outcomes. Valuable 'research rupees' should be spent on ensuring equity of resources for physical and mental healthcare of mothers and providing optimal environments for every mother-infant dyad," it added.

Based on the experience of the Kerala initiative, the National Health Mission is considering replicating the integrated maternal mental healthcare model into other states in India, the study said.

According to the study, investing in perinatal mental health is important for preserving families and ensuring the physical and mental health of the coming generations.

"Policymakers and research funding bodies in India must ensure that there is equity of resources between the physical and mental health needs of mothers and provide an environment in which every mother-infant dyad has the best opportunity to thrive," it added.