Finding hope

There is a definitive need to focus on community development, raise awareness, and help people with mental disorders manage their symptoms effectively, writes Prakriti Poddar

The World Health Organisation states that “Mental health is an inseparable part of general health, essential for the well-being and functioning of individuals, families, communities, and societies.” However, in India, there is a severe lack of awareness and sensitivity about the rising health epidemic. A Lancet study on mental health disorders within different states in India revealed that 45 million Indians suffered from depressive disorders in 2017, with some states worse off than others. The majority of the north-eastern and southern states had a higher number of patients suffering from depression as compared to the states in central and north India.

With the growing concern of mental health issues across the country, there is a definitive need to focus on community development, raise awareness, and help people with mental disorders manage their symptoms effectively and improve functioning. That is where community-based rehabilitation (CBR) programmes can make a significant difference by helping people with mental disorders find hope, meaning, and growth irrespective of their abilities or the effects of their illness.

Mental health has always received low priority on the development agenda in India, and for society in general. Apart from a lack of knowledge and awareness about mental health issues, there is widespread prejudice, stigma, and discrimination. Almost in every community, people with mental health issues are likely to face abuse, isolation, and deprivation of their fundamental human rights.

CBR programmes recognise that mental illness can affect different areas of life including social, biological and psychological systems. Considering the same, CBR takes a whole-person approach facilitating a mixture of services and effective treatment. The approach to care often requires access from different domains. For instance, a person with a mental disorder may require psychosocial rehabilitation services targeting social skills and basic living. However, he/she might also require treatment involving psychotherapy and medication.

The whole approach to community-based rehabilitation programmes is holistic as it strives to address different areas of a person’s life that contribute to overall physical and mental well-being. Professionals working for CBR programmes look at different factors like basic living skills, peer and social relationships, family relationships, education, employment, health, recreation, and wellness to promote mental health in partnership with all these factors.

Efficacy & possible outcomes

To evaluate the efficacy of a community-based rehabilitation model for people with mental health problems in a disadvantaged part of rural India, a CBR programme was conducted. Altogether, 207 participants entered the study, 127 in the CBR group, and 80 in the outpatient care (OPC) group. Local members of the community were trained as CBR workers to deliver comprehensive, home-based services, like identifying people with chronic schizophrenia and ensuring easy access to the clinical team in outreach clinics, regular follow-up and monitoring along with education for people and their families, and planning of rehabilitation interventions. On top of that, efforts were made to address stigma, promote awareness, and facilitate social and economic rehabilitation. Compared to patients who received outpatient care, the outcomes for patients within the CBR programme were better.

In another example, the Mtwara Mental Health Programme in Tanzania collaborating with five district health departments is working towards setting up affordable, accessible and consistent treatment options in the community for people with mental health problems. The psychosocial support and access to treatment has enhanced the quality of life for many people with mental health problems.

By improving quality of life, fostering community integration, and promoting recovery, CBR programmes can be a vital resource for those who have been diagnosed with a mental health condition. The possible outcomes that can be achieved through CBR include:

Community members valuing mental health and recognising it as a prerequisite for community development.

Increased awareness about mental health conditions with a reduction in discrimination and stigma.

People with mental health disorders getting access to psychological, social, economic and medical interventions supporting their recovery process.

Increased inclusion and better participation in community and family life.

Family members receiving practical and emotional support.

CBR programmes take a unique approach to address the issue of mental health problems. Instead of just treating mental health disorders, they focus on the person’s potential for recovery and centres on providing social inclusion, empowerment, support, and coping skills.

The comprehensive approach to mental health treatment can be the answer to the overgrowing burden of mental health issues in India.

(The author is a mental health expert.)