Sharing compassion

A grassroots innovation is redefining mental healthcare delivery in rural India, writes Deepika Gumaste

For years, Rita Patel, now 48, from Gujarat’s Mehsana district found it hard to put a name to her struggles. Rita longed for her daughters and struggled with day-to-day household duties after her daughters got married and left home. She explains her baichaini (restlessness), recounting a bout of headaches, lack of sleep and appetite. It was then that, Bhanumatiben, the village leader, and a champion with the Atmiyata programme, run by the Centre for Mental Health Law and Policy (CMHLP), offered Rita, a step-by-step talking therapy in a private setting, eventually unmasking depression as the culprit behind her physical distress.

India is home to an estimated 56 million people suffering from depression and 38 million more from anxiety disorders, according to the World Health Organisation (WHO). And yet, only 12 percent have easy access and aid to address their concerns. The situation is more pronounced in villages, which face unique challenges around literacy, agrarian distress, unemployment, poverty, caste, and gender-based discrimination.

Stigma

A 2014 Human Rights Watch Report indicated a severe treatment gap, highlighting a striking dearth of access to quality mental healthcare services in rural areas, where 72 percent of the country’s population lives but only 25 percent of the health infrastructure is located. Furthermore, the stigma and demonisation of mental illnesses lead many villagers to seek help from spiritual healers and priests, rather than risk being ostracised by the community for being ‘pagal (mad)’. It is this situation that Atmiyata seeks to address.

Jasmine Kalha, programme manager and research fellow, CMHLP, offers, “the traditional approach to mental healthcare revolves around providing treatment services. However, a lot of our bio-medical models of care, are usually not acceptable to people. They might not seek these services for various reasons. With Atmiyata, our effort is to move to a treatment plus model, that is better equipped to deal with the complexities of mental healthcare gaps in these areas. Our aim is to articulate better psycho-social interventions, required for our holistic well-being.” Using this insight, CMHLP’s programme, ‘Atmiyata’, meaning ‘shared compassion’ in Hindi, is leading a community-based intervention that enrols and trains non-medical volunteers from village communities to provide psychological first aid and enhance mental healthcare delivery to the remotest parts of the country.

These volunteers support their own community members through active listening, support and counselling services and therapeutic behavioural interventions for common mental disorders. For severe mental illness, the volunteers work through existing community groups to deliver any legal aid, shelter homes and make referrals to public healthcare facilities and district hospitals.

Informal caregivers

The programme is a two-tier network of volunteers, called champions and mitras who understand the local issues, signs of distress in a language the community uses and share the living circumstances of persons needing care. Champions work as informal caregivers equipped with smartphone learning aids and films that help simplify the subject and develop a sound understanding of every day social stressors.

The mitras, on the other hand, act as eyes and ears of the champion on the ground, spotting distress among community members and referring them to a champion who is equipped with skills to intervene. “The idea is to define a more bottom-up approach, where we empower the communities to understand their own mental health and social needs and address those,” adds Kalha.

Access to care

The idea seems to be working. The programme, which was initially implemented across 41 villages in Maharashtra, has now scaled up to Mehsana district in Gujarat, covering nearly 500 villages and identifying 537 champions, who are committed to creating safe spaces and enabling access to care.

Talking about her work, Parulben, another active Atmiyata mitra, says, “Even if we are from the same village, people don’t open up to us in the first visit. This trust-building requires multiple visits before we can even begin our sessions. My strategy is to keep trying and not give up in one visit. If I must get my message across, I need to keep meeting them to win their trust.” Having lived through years of spousal abuse, suicidal ideation, and mental distress herself, Parulben today lives with her daughters and actively reaches out to people in distress in her community.

The road might not be easy. But Parulben and her mitras are hopeful about the future.