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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:

Common Mental Disorders (CMD)

Depression

Anxiety / Panic disorders

Somatisation disorders

Severe Mental Disorders (SMD) – screen & refer

Schizophrenia

Bipolar disorder

Severe depression

Substance Use Disorders (SUD) – screen & brief intervention

Alcohol use disorder

Tobacco use disorder (smoked and smokeless forms)

Suicide Risk / Ideation

Neurological (screen & refer)

Epilepsy

Dementia

Maternal Mental Health

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

Role	Responsibilities in Module
ASHA / MPW	Community identification, referral to HWC
CHO (Primary User)	Screening, PHQ-9, counselling, follow-up
Staff Nurse	Support screening & follow-ups
Medical Officer (MO)	Diagnosis, medication initiation
DMHP Specialist	Advanced care (outside mAAM)

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

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

Beneficiary Eligibility Matrix

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

Age- & Gender-Based Routing Logic

Beneficiary Group	Age	Conditions Covered	Screening at CPHC	System Behaviour
Children	< 11 years	Behavioural & developmental disorders	No structured tools	Identify → Auto-refer to RBSK
Adolescents	11–18 years	Depression, anxiety, SUD, behaviour	Limited screening	Refer to AFHC / RKSK
Adults	18–59 years	CMD, SMD, SUD, suicide risk	Full screening	Manage / refer
Elderly	≥60 years	CMD, dementia	CMD + dementia screen	Refer if suspected
Pregnant / Post-partum women	Any adult	Post-partum depression	PHQ-9 screening for depression	RMNCH+A linkage

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

Gender / Status	Mandatory System Logic
Female, Post-partum (≤12 months)	Auto-prompt Depression screening
Any gender	Suicide risk screening applies
Transgender	Same screening logic as adults

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

Field	Type	Rules
Consent Given	Radio	Yes / No
Type of Consent	Dropdown	Verbal / Written / Both
Consent Scope	Auto-text	“Mental health screening & basic counselling”
Consent Validity	Auto	One-time per case unless revoked

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

DECISION GATE: WHICH SCREENING TOOL OPENS?

3.1 Screening Context Capture (Before Tools)

Field	Type	Mandatory
Reason for Screening	Dropdown	Yes
Presenting Complaints	Multi-select	Yes
Duration of Symptoms	Dropdown	Yes

3.2 Tool Activation Logic

Condition Identified	Tool Activated
Low mood, loss of interest, fatigue	PHQ-9
Thoughts of self-harm	Suicide Risk Tool
Alcohol use	Alcohol Brief Screen
Fits / memory loss	Epilepsy / Dementia Checklist

Note: If Age < 11:

→ Skip tool activation

→ Direct to referral module

PHQ-9 DEPRESSION SCREENING

4.1 PHQ-9 Tool Metadata

Attribute	Value
Tool Name	Patient Health Questionnaire – 9 (PHQ-9)
Applicable Age	≥11 years (Adults & adolescents)
Cadre	CHO
Recall Period	Last 2 weeks
Frequency	Baseline + every follow-up

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

Each question has identical response options.

Response Scale (for all questions)

Option	Score
Not at all	0
Several days	1
More than half the days	2
Nearly every day	3

PHQ-9 Questions

Little interest or pleasure in doing things

Feeling down, depressed, or hopeless

Trouble falling or staying asleep, or sleeping too much

Feeling tired or having little energy

Poor appetite or overeating

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

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

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

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

Score	Severity	System Action
0–4	Minimal	Psychoeducation
5–9	Mild	Counselling + follow-up
10–14	Moderate	Refer to MO
15–19	Moderately Severe	Urgent referral
20–27	Severe	Emergency referral

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

“Moderate to severe depression”

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.

Thoughts of self-harm	Previous attempt	Current intent / plan	Access to means	CHO immediate risk	Suicide Risk Level	Mandatory System Behaviour
No	No	No	No	No	Low	Provide psychoeducation and reassurance. Enable routine mental health follow-up.
Yes	No	No	No	No	Low	Provide counselling and reassurance. Monitor in follow-up visits.
Yes	Yes	No	No	No	Moderate	Provide supportive counselling. Encourage family involvement. Urgent referral to PHC / DMHP.
Yes	Any	Yes	Any	Any	High	Display red alert banner. Ensure beneficiary is not left alone. Provide immediate supportive counselling. Immediate referral to PHC / higher facility.
Any	Any	Any	Any	Yes	High	Treat as emergency. Display red alert banner. Immediate referral required.

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

Substance Use Screening (Alcohol & Tobacco – Brief)

6.1 Tobacco Use Identification (Brief)

6.1.1. Applicability (Tobacco)

Criteria	Rule
Age ≥18 years	Identification and brief counselling at HWC level only

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)

Criteria	Rule
Age <11 years	Alcohol screening not applicable
Age 11–18 years	Identification only → Referral to RKSK / AFHC
Age ≥18 years	Screening & brief intervention at HWC

6.3 Alcohol Use Screening Tool

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

6.4 Alcohol Use Identification

S. No.	Data Field	Field Type	Value / Options	Validation	Logic
1	Current alcohol use	Radio Button	Yes / No	Mandatory	If ALL of the following conditions are met: No current alcohol use OR Occasional use without: loss of control functional impairment withdrawal symptoms ➡ Classified as “No problematic alcohol use identified”
2	Frequency of alcohol use	Dropdown	Occasional / Regular / Daily	Mandatory if Q1 = Yes
3	Loss of control over drinking	Radio Button	Yes / No	Mandatory if Q1 = Yes
4	Impact on daily functioning (health, family, work)	Radio Button	Yes / No	Mandatory if Q1 = Yes	If ANY ONE of the following is present: Regular or frequent alcohol use Loss of control over drinking Impact on daily functioning (health, family, work) Withdrawal symptoms suspected CHO clinical judgement indicates harmful use ➡ Classified as “Problematic alcohol use suspected”
5	Symptoms suggestive of withdrawal	Radio Button	Yes / No	Mandatory if Q1 = Yes
6	CHO assessment of problematic alcohol use	Radio Button	Yes / No	Mandatory

6.5 System Behaviour After Determination

Screening Outcome	Next Action
Negative	Psychoeducation → Close screening
Positive	Enable Brief Intervention + Referral Decision (open text field)

6.6 Brief Intervention / Basic Management

(As permitted for SUDs at HWC)

Data Field	Field Type	Validation
Brief intervention provided	Radio	Yes / No
Type of intervention	Multi-select	Psychoeducation, Harm reduction counselling, Family counselling
First aid required	Radio	Yes / No
Remarks	Text	Optional (250 chars)

6.7 Referral Management

Data Field	Field Type	Validation / Logic
Referral required	Radio	Yes / No
Referral level	Dynamic dropdown	PHC / DMHP / De-addiction centre
Reason for referral Referral Priority	Multiselect dropdown Dropdown	Suicide risk / self-harm Moderate to severe depression Severe mental disorder suspected Substance dependence / withdrawal Functional impairment Neurological condition suspected Child behavioural concern Risk to self or others No improvement / worsening Requires specialist care Routine / Urgent / Emergency
Referral date	Auto	System generated

Auto-suggest referral if:

Auto-referral if:

- Withdrawal symptoms = Yes

- Functional impairment = Yes

- CHO flags problematic use

6.8 Follow-Up

Data Field	Field Type	Validation
Follow-up date	Date	Mandatory
Improvement noted	Radio	Yes / No
Adherence to advice	Radio	Yes / No
Escalation required	Radio	Yes / No

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.

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)

Data Field	Field Type	Values / Options	Validation / Logic
Episodes of loss of consciousness	Checkbox	Yes	Optional
Recurrent jerky movements / fits	Checkbox	Yes	Optional
Confusion or drowsiness after episode	Checkbox	Yes	Optional
Progressive memory loss	Checkbox	Yes	Optional
Disorientation or confusion	Checkbox	Yes	Optional
Decline in daily functioning (self-care, routine activities)	Checkbox	Yes	Optional
Age ≥ 60 years	Auto	Yes / No	Auto-derived from beneficiary profile
Screening Outcome	Auto	Suspected / Not suspected	Suspected if ANY ONE of the above is selected
Referral Required	Auto	Yes / No	If Screening Outcome = Suspected: → Referral Required = Yes → Reason = “Neurological condition suspected” Yes if Screening Outcome = Suspected

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

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”

Data Field	Field Type	Value / Options	Validation
Type of Intervention	Multi-select	Psychoeducation, Basic counselling, Stress management, Relaxation, Behavioural activation, Family counselling	Mandatory
Session Date	Date	dd-mm-yyyy	Cannot exceed current date
Duration (minutes)	Numeric	10–60	Mandatory
Remarks	Text	250 chars	Optional

Referral Management

Referral Destination Logic

Condition	Options
Age <6	RBSK DEIC
Age 6–10	PHC / CHC / DH
Age ≥11	PHC / CHC / DH / DMHP / De-addiction

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

Follow-Up Visit,Enabled if

Case status = Under Care

Data Field	Field Type	Validation
Follow-up Date	Date	Cannot exceed current date
Repeat PHQ-9	Same as baseline	As applicable
Improvement Status	Auto	Improved / Same / Worse
Medication adherence	Radio	Yes / No / NA
Side effects	Radio	Yes / No
Referral escalation	Radio	Yes / No

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

Case Closure

Closure Reason	Logic
Recovered	PHQ-9 <5 in two consecutive visits
Referred	Referral accepted
Lost to follow-up	No visit for 90 days
Death	Sync with beneficiary status

If last status = Severe / High risk:

→ Case cannot be closed unless:

- Referred OR

- Under specialist care