Mental health in India: Community-based interventions as the answer to India’s mental health burden

Addressing the challenges of healthcare in a country as diverse and vast as India is a difficult feat, setting aside the stigma and social and structural barriers that prevent people experiencing mental health problems from seeking care. the National Mental Health Survey (2015-16) estimates that about 150 million Indians require mental health interventions and there is a treatment gap of 70 to 92%. Considering that the overall impact affects not only the person, but also those around them (hidden burden), the actual affected population may be much higher. This burden has been aggravated by the Covid-19 pandemic due to increased uncertainty and anxietyand now it is becoming increasingly critical to address.

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India has only 0.75 psychiatrists per lakh of population concentrated largely in urban areas although nearly 70% of the country’s population the population resides in rural areasagainst the desirable 3 per lakh of population, a deficit that would take at least 42 years to reach given the current rate of psychiatric education in the country. Despite this reality, most conversations about mental health seek to break stigma (which will increase the demand for services) or improve the delivery of quality services through psychiatrists (of which there are a limited number). Therefore, this article seeks to close the care gap with the use of psychosocial interventions, through community-led models, to leverage non-formal caregivers and paraprofessionals, rather than relying solely on qualified mental health professionals.

This paradigm shift would foster a rights-based approach to accessible mental health, affordable, inclusive and encourages help-seeking behavior at the community level. As a community comes together to address the unique stressors they experience, along with linkages and referrals to public health and wellness systems, they provide context-based and accessible care. This can prevent the deterioration of the mental well-being of the individual, thus reducing the medical intervention required. Community-based care would allow detection of mental health problems, along with better acceptance of a range of services. Being from the same community, having cultural understanding, community volunteers can also undertake a more contextual intervention to address the specific needs of different individuals. These may include trauma resulting from gender-based violence or caste-based discrimination, anxiety and substance dependence faced by adolescents, particularly due to the pandemic and social media.

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mental health, mental health in India Considering that the overall impact affects not only the person, but also those around them (hidden burden), the actual affected population may be much higher. (Photo: Getty Images)

Following the ‘Look-Listen-Link’ (3L) model, this care community could carry out needs-based interventions that allow trained and non-formal community workers to investigate the particular problem. mental health challenges from the community Trained workers could listen to what they say, identify if they have symptoms of any common medical disorders (“CMDs”) such as depressionanxiety and suicidal ideation — that can be addressed at the community level, providing basic advice and linking them with reference institutes when necessary.

An efficient and robust community-integrated model will have the ability to build a response system of volunteer cadres and community leaders to create ‘safe spaces’. They would rely on locally established peer support networks such as Self Help Groups (‘SHG’), activity-based groups and civil society organizations to provide care. It is important that any community-based organization mental health The program provides access to institutional social care benefits by creating strategic alliances with local governments, panchayats, educational institutions and other stakeholders to enable referrals and access to existing social benefit schemes.

mental health, mental health in Indiamental health, mental health in India The mental health burden has been compounded by the COVID-19 pandemic due to increased uncertainty and anxiety, and it is now increasingly critical to address it. (Photo: Getty Images)

The success of the ‘Atmiyata Project’ led by the Center for Mental Health Law and Policy in Mehsana, Gujarat and funded by the Mariwala Health Initiative (‘MHI’) is notable in this regard. The program is run by community volunteers who identify people in distress and who can benefit from informal care. The volunteers provide counseling sessions. It also addresses language, age and disability barriers, making use of video to raise awareness of mental health. Two other MHI partner organizations should also be mentioned in this regard. The ‘Janamanas’ program run by Anjali, a Kolkata-based NGO, specifically focuses on addressing the differential mental health concerns of women, by creating safe community spaces for other women from the community to come, assess and discuss their problems. Also, the SEHER program of the Bapu Trust works in the urban bastis of Pune and initiates mental health conversations on street corners.

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The triumph of community participation in other public health challenges such as tuberculosis where attention should also be paid to the ‘TB Champions’ who are survivors of the disease, as well as the ‘ASHAs’ who help in the last mile connectivity of maternal and child health in the country. These programs reduced stigma associated with seeking helpenabled access at the village level and established outreach and support chains that work even in the midst of the pandemic.

To conclude, a diverse collaboration with the community can humanize existing public health institutions by reducing hesitancy and building mental health awareness. It also allows early detection mechanisms, assistance and preventive measures to be built and decentralize the provision of mental health services to make way for personalized solutions that are contextual, thus closing the health care gap and contributing significantly to the improvement of mental health. .

(Dr. Dalbir Singh, President, Global TB Coalition and Policy Makers Forum for Mental Health); (Dr. Virander Singh Chauhan, Professor Emeritus, ICGEB and Founder of ETI); (Priti Sridhar, CEO, Mariwala Health Initiative)

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