Addressing healthcare challenges in a country as vast and diverse as India is a difficult task, leaving aside the stigma and social and structural barriers that prevent people with mental health conditions from seeking treatment. the National Mental Health Survey (2015-16) estimates that nearly 150 million Indians need mental health interventions and there is a treatment gap of 70 to 92%. Considering that the overall impact is not only on the person, but also on those around them (hidden burden), the population actually affected can be much higher. This burden was compounded by the Covid-19 pandemic due to rising uncertainty and anxietyand becomes more and more critical to solve.
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India has only 0.75 psychiatrists per lakh population, largely concentrated in urban areas, even though almost 70% of the country’s population the population lives in rural areasagainst the desirable 3 lakh population – a deficit that would take at least 42 years to fill given the current rate of psychiatric education in the country. Despite this reality, most mental health conversations are either about breaking the stigma (which will increase demand for services) or about improving the delivery of quality services through psychiatrists (who are in short supply). . This article therefore seeks to bridge the care gap through the use of psychosocial interventions, through community-led models, to leverage informal caregivers and para-professionals, rather than relying solely on trained mental health professionals.
This paradigm shift would cultivate a rights-based approach to accessible mental health care, affordable, inclusive and encourages help-seeking behaviors at the community level. When a community comes together to address the unique stressors it experiences, in conjunction with connections and referrals to public health and welfare systems, these provide accessible, context-based care. . This can prevent the deterioration of the mental well-being of the individual, thus reducing the medical intervention required. Community care would allow mental health screening, as well as better use of a range of services. Being from the same community, having cultural understanding, more contextual intervention can also be undertaken by community volunteers, to meet the specific needs of different individuals. These may include trauma resulting from gender-based violence or caste-based discrimination, anxiety and substance abuse faced by adolescents, particularly due to pandemic and social media.
Following the Look-Listen-Relate (3L) model, this community of care could undertake needs-based interventions that allow non-formal, trained community workers to review the particular case mental health problems from the community. Trained workers could listen to what they were saying, identify if they had symptoms of common medical conditions (‘CMD’) such as depressionanxiety and suicidal thoughts — which can be dealt with at Community level, providing basic advice and linking them to reference institutes if necessary.
An effective and robust community-embedded model will have the ability to build a response system comprised of cadre of volunteers and community leaders to create “safe spaces”. They would rely on locally established peer support networks such as self-help groups (‘SHGs’), activity-based groups and civil society organizations to deliver care. It is important that everything Mental Health The program provides access to institutional social care benefits by establishing strategic partnerships with local governments, panchayats, educational institutions and other stakeholders to enable referral and access to existing social benefit schemes .
The success of the “Atmiyata Project” run by the Center for Mental Health Law and Policy in Mehsana, Gujarat and funded by the Mariwala Health Initiative (“MHI”) is remarkable in this regard. The program is led by community volunteers that identify people in distress and who can benefit from informal care. Volunteers provide them counseling sessions. It also addresses language, age and disability barriers, using videos to raise awareness about mental health. Two other CIM partner organizations should also be mentioned in this regard. The ‘Jamananas’ program run by Anjali, a Kolkata-based NGO, specifically focuses on addressing women’s differential mental health issues, by creating safe community spaces for other women in the community to come and assess and discuss their problems. Similarly, the SEHER program of Bapu Trust intervenes in the urban bastis of Pune, and initiates conversations about mental health at street corners.
The triumph of community involvement in other public health challenges such as tuberculosis where “TB Champions” who are survivors of the disease as well as “ASHAs” who contribute to the last mile connectivity of maternal and child health in the country, must also be considered. These programs have reduced the the stigma associated with seeking helpenabled access at the village level and established chains of awareness and support that work even in the midst of the pandemic.
In conclusion, diverse collaboration with the community can humanize existing public health institutions by reducing hesitation and strengthening mental health awareness. It also makes it possible to build mechanisms for early detection, assistance and prevention and to decentralize the provision of mental health services to make room for personalized and contextual solutions, thus closing the health gap and contributing significantly to the improved mental health.
(Dr Dalbir Singh, Chair, Global TB Coalition and Mental Health Policymakers Forum); (Dr. Virander Singh Chauhan, Professor Emeritus, ICGEB and Founder ETI); (Priti Sridhar, CEO, Mariwala Health Initiative)
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