Mental Health Module BRD

1. BUSINESS REQUIREMENTS DOCUMENT (BRD)

1.1 Background & Rationale 

Mental, Neurological and Substance Use (MNS) disorders contribute significantly to morbidity, disability, and loss of productivity in India. Despite high prevalence, treatment gaps exceed 60% for most conditions. The Government of India mandates integration of mental health services into Comprehensive Primary Health Care (CPHC) through Health & Wellness Centres (HWCs). 

The mAAM application is a digital backbone for CPHC service delivery. Integrating screening, basic psychosocial management, referral, and follow-up for mental health conditions into mAAM will: 

• Enable early identification at community and facility level 

• Support standardized screening tools 

• Ensure continuity of care across CHO–MO–DMHP 

• Reduce stigma by normalizing mental health within routine primary care 

1.2 Scope of Mental Health Services in mAAM 

Included Conditions: The application can incorporate the following services basis priority in 2 phases: Phase 1 and Phase 2 

Phase 1 

As per GoI Operational Guidelines: 

1. Common Mental Disorders (CMD) 

1. Depression 

1. Anxiety / Panic disorders 

1. Somatisation disorders 

1. Severe Mental Disorders (SMD) – screen & refer 

1. Schizophrenia 

1. Bipolar disorder 

1. Severe depression 

1. Substance Use Disorders (SUD) – screen & brief intervention 

1. Alcohol use disorder 

1. Tobacco use disorder (smoked and smokeless forms) 

1. Suicide Risk / Ideation 

1. Neurological (screen & refer) 

1. Epilepsy 

1. Dementia 

1. Maternal Mental Health 

1. Post-partum depression (linked with RMNCH+A) 

Phase 2 

• Specialist psychiatric diagnosis 

• Long-term psychotherapy documentation 

• AYUSH-specific treatment workflows 

1.3 Target Users & Roles 

1.4 High-Level Business Goals 

• Standardize mental health screening at HWCs 

• Digitally track patients longitudinally 

• Enable referral & counter-referral 

• Integrate mental health indicators into HMIS 

• Reduce treatment gap for CMDs 

PRODUCT REQUIREMENTS DOCUMENT (PRD) 

Screening & Basic Management of Mental Health Problems 

CPHC Services – mAAM Application 

1. Module Overview

Objective 

Enable life-course based mental health screening, basic management, referral, and follow-up for all age groups and genders at Comprehensive Primary Health Care (CPHC) level, as per GoI guidelines. 

Primary User 

• Community Health Officer (CHO) 

Secondary Users 

• Staff Nurse 

• Medical Officer (MO) – referral & follow-up view only 

1. Beneficiary Eligibility Matrix 

The Mental Health module must behave differently based on age, gender, and physiological status. 

Age- & Gender-Based Routing Logic 

Rule: If Age < 11: 

- Disable PHQ-9, Suicide tool, Alcohol screening 

- Enable ONLY: 

 → Symptom identification (Section 3.2) 

 → Mandatory referral workflow 

1.3 Gender-Specific Considerations 

1. MENTAL HEALTH SCREENING — ENTRY & CONSENT 

2.1 Entry Conditions 

Screening can be initiated if anyone applies: 

• Self-reported mental health concern 

• ASHA / MPW referral 

• Trigger during ANC / PNC / NCD / OPD visit 

2.2 Mental Health Consent  

System Rules 

• Consent is mandatory before any screening tool opens 

• Consent timestamp is stored 

• Consent Timestamp → Mandatory (system generated) 

• Consent captured by → Auto (user ID) 

• If consent = No → exit module 

1. DECISION GATE: WHICH SCREENING TOOL OPENS?

3.1 Screening Context Capture (Before Tools) 

3.2 Tool Activation Logic 

Note: If Age < 11: 

→ Skip tool activation 

→ Direct to referral module 

1. PHQ-9 DEPRESSION SCREENING

4.1 PHQ-9 Tool Metadata 

4.2 PHQ-9 Questions (MUST be hard-coded) 

Each question has identical response options. 

Response Scale (for all questions) 

PHQ-9 Questions  

1. Little interest or pleasure in doing things 

1. Feeling down, depressed, or hopeless 

1. Trouble falling or staying asleep, or sleeping too much 

1. Feeling tired or having little energy 

1. Poor appetite or overeating 

1. Feeling bad about yourself — or that you are a failure or have let yourself or your family down 

1. Trouble concentrating on things, such as reading the newspaper or watching television 

1. Moving or speaking so slowly that other people could have noticed? Or the opposite — being so fidgety or restless that you have been moving around a lot more than usual 

1. Thoughts that you would be better off dead or of hurting yourself in some way 

Note: These must be individual radio-button questions, not a single composite field. 

4.3 Scoring Logic (Backend): PHQ9_TOTAL_SCORE = Q1 + Q2 + ... + Q9; Range: 0–27 

4.4 Severity Classification & System Action 

Note: If PHQ-9 ≥10 → Auto-trigger referral reason: 

“Moderate to severe depression” 

1. Suicide Risk Screening

Enabled if 

• PHQ-9 Question 9 ≥ 1 followed by 

• Open suicide risk assessment 

• Display red alert banner 

• Disable routine counselling 

Suicide Risk Classification and System Action 

The system shall classify suicide risk and enforce actions as per the table below. 
This logic must be implemented exactly as defined. 

7.5 Referral Handling 

For Moderate or High Suicide Risk, the system shall automatically: 

• If Suicide Risk = Moderate/High: 
  → Referral Required = Yes (locked) 
  → Reason = “Suicide risk / self-harm” 
  → Priority = Emergency (if High) 

• Enable selection of referral destination: 

• Primary Health Centre (PHC) 

• CHC 

• District Hospital 

• District Mental Health Programme (DMHP) 

• Auto-populate reason for referral as “Suicide risk identified” 

• Generate referral date and referral record 

7.6 Safety and System Constraints 

• Suicide risk assessment is not a diagnosis 

• No numeric scoring or prediction is permitted 

• No pharmacological treatment is initiated at HWC level 

• All High-risk cases must generate a referral record 

• The CHO cannot override the system-derived suicide risk level 

• All suicide risk assessments must be time-stamped and auditable 

1. Substance Use Screening (Alcohol & Tobacco – Brief)

6.1 Tobacco Use Identification (Brief) 

6.1.1. Applicability (Tobacco) 

Data Fields: 
• Current tobacco use (Yes / No) 
• Type of tobacco use (Smoking / Smokeless / Both) 
• Frequency of use (Occasional / Daily) 

System Behaviour: 
• If current tobacco use = Yes → Enable brief counselling (psychoeducation, cessation advice) 
• No diagnosis, no pharmacological initiation at HWC level 
• Referral to PHC if CHO assesses dependence or medical complications 

6.2 Applicability (Alcohol) 

6.3 Alcohol Use Screening Tool 

Screening Tool: 
Alcohol Use – Brief Screening (Guideline-based) 

6.4 Alcohol Use Identification  

6.5 System Behaviour After Determination 

6.6 Brief Intervention / Basic Management  

(As permitted for SUDs at HWC) 

6.7 Referral Management 

Auto-suggest referral if: 

Auto-referral if: 

• - Withdrawal symptoms = Yes 

• - Functional impairment = Yes 

• - CHO flags problematic use 

6.8 Follow-Up 

6.9 Explicit Exclusions  

At HWC / CHO level: 

• No diagnosis of alcohol dependence 

• No pharmacological initiation 

• No numeric severity classification 

All diagnosis and medication initiation occur at PHC / DMHP, as per guideline. 

1. Epilepsy & Dementia – Screening Checklist

(Screening only; No diagnosis or treatment at CHO level) 

Condition 
Enabled under Screening and Basic Management of Mental Health Ailments 
Applicable for all age groups (Dementia screening primarily for older adults) 

Embedded System Logic  

• If any screening checkbox is selected → Screening Outcome = Suspected 

• If Screening Outcome = Suspected → Referral Required = Yes 

• If Age ≥ 60 years AND memory loss / functional decline selected → Flag as Suspected Dementia 

• If jerky movements / loss of consciousness selected → Flag as Suspected Epilepsy 

• No treatment, no scoring, no confirmation at HWC level 

1. Psychosocial Intervention (CHO Level)

Enabled for 

• CMD (Mild–Moderate) 

• Anxiety 

• Alcohol use (brief intervention) 

Note: If ≥2 sessions completed AND no improvement: → Suggest referral → Reason = “No improvement / worsening” 

1. Referral Management

Referral Destination Logic 

Auto-Referral Conditions 

• PHQ-9 ≥15 

• High suicide risk 

• Suspected SMD / Epilepsy / Dementia 

• If one of the mental health screening options is answered “Yes” for children aged less than 11 years 

1. Follow-Up Visit,Enabled if

• Case status = Under Care 

Improvement Logic 

• If no improvement after 3 visits: 

• → Auto suggest referral 

• → Reason = “No improvement” 

Note: Please provide the option for CHOs to view previous case records before inputting in the follow up form 

1. Case Closure

If last status = Severe / High risk: 

→ Case cannot be closed unless: 

   - Referred OR 

   - Under specialist care