PUB - Publikationen an der Universität Bielefeld

#### Introduction The mental health of older people - especially in low- and middle-income countries (LMICs) with ageing populations - is of increasing concern to public health research and practice. Although primary mental healthcare (PMHC) approaches are particularly important for old age-inclusive and equitable approaches to mental healthcare, there is a lack of understanding of how the mental health needs of older people can be addressed in policies and practice. An in-depth exploration at the country level considering contextual factors is needed. With its changing sociodemographic context and evolving PMHC system, India offers an interesting setting. #### Objectives The main objective of this dissertation is to understand and explore how the developing PMHC system in India addresses the mental health needs of older people. In addition, the aim of this dissertation is to understand the challenges and opportunities for strengthening PMHC for older people. #### Methods This cumulative dissertation builds on a qualitative research approach with a public policy document analysis (results published in two substudies) and semi-structured key stakeholder interviews (results published in two substudies) as its primary methods. #### Results and discussion Influenced by international policy developments, older persons – and their specific needs as well as socioeconomic context – are increasingly addressed in policies framing PMHC in India. This is underlined by new rights and entitlements for older persons. Consistent with the idea of primary healthcare (PHC), participatory community- and family-based as well as traditional Ayurveda, Yoga and Naturopathy, Unani, Siddha, Sowa-Rigpa and Homeopathy (AYUSH) approaches to mental healthcare for older people prevail. Moreover, stakeholders suggest strengthening PHC to overcome what is perceived as a major gap between policy ambitions and implementation capacities at the PHC level. This would need to go hand in hand with further embedding the concept of biopsychosocial health in policies and practice to move away from a medicalization of mental health. The state is expected to govern and steer these developments in close collaboration with older people and other important stakeholders. According to the findings in this dissertation, strengthening PMHC for older persons is crucial for addressing the negative social perceptions and norms of mental health and old age in India that hamper progress in developing old-age-inclusive PMHC. #### Conclusion This is the first comprehensive study on PMHC for older people in India. While several challenges in strengthening old-age-inclusive PMHC have been identified, the importance of PMHC in providing equitable and needs-based mental healthcare to older people is emphasized. The results can inform further research and evidence-based policymaking and the development of PMHC for older people in India and other countries.