According to the World Health Organization, roughly 450 million people around the world suffer from a mental illness. In 2010, basic mental and behavioral conditions such as depression, anxiety, and substance abuse caused almost a fourth of total years of life lost due to disability .
Doubtless, the global prevalence of mental disorders is a pressing public health concern. Mental health is affected by socioeconomic, biological, and environmental factors – and goes much further than simply the absence of a mental disorder. Furthermore, the political and structural climate of an area, such as the presence of poverty or other types of inequality, can have a broad impact on the expression of mental health conditions, and so mental health programs should be sensitive of context and cultural issues as well.
For over 30 years, CRHP has worked in hundreds of villages in rural India, providing the support and resources for communities to bring about social change through empowerment and health. At the heart of CRHP programs is the village health worker (VHW), a woman who is selected by her village to receive training at CRHP each week along with several other VHWs from nearby villages, in order to be an essential first line of healthcare and health education for her community. Through the formation of additional grassroots collectives – Farmer’s Clubs and women’s self-help groups – there is a system of support through which VHWs can spread knowledge on not just health-related topics such as sanitation, prenatal care, and nutrition, but also on pressing social issues such as caste injustice, treatment of women, and alcoholism.
CRHP has shown that through a community-based and social approach, radical changes in quality of life can be achieved – for instance, in 1970, when programs first began, the infant mortality rate in the Jamkhed block was 176 per 1,000 live births. Many project villages today average about 18 per 1,000 live births (far lower than the national average), and less than 5% of children suffer from malnourishment. It is time to apply the Jamkhed Model toward tackling major mental health issues in our communities.
As a holistic view of health has always been a key tenet of CRHP’s work, the importance of mental well-being and removing stigma or blame from mental illness have been a key part of VHW and mobile health team (MHT) trainings. From 2003 to 2011, CRHP conducted needs-assessment research in project villages and found that the most prevalent mental illnesses are behavioral conditions like anxiety, depression, substance abuse, stress, violence and trauma, and psychosomatic conditions. A small fraction of the population suffers from more severe conditions such as schizophrenia. Among youth, we observed various factors associated with psychosocial stress. Among boys, challenges included anger management, conflict resolution, and issues with the opposite gender, often leading to violent behavior. Among girls, persistent issues have included anxiety and depression as well as feeling restricted in decisions and access to education. Being at the cusp of adulthood and poised to set a precedent for the well-being of future generations in their village, the challenges of these youth are especially crucial to address.
Based on these findings, CRHP has received a grant from the Paul Hamlyn Foundation to establish the comprehensive Mental Health Program (MHP). Just as the key actor in village-level health programming is the VHW, the MHP will be largely based on a “barefoot” counselor, who will serve the village as counselor and facilitator. The counselor will likely be someone already in a leadership position, such as a member of a women’s self-help group, but ultimately, the choice will be up to the village, as is the case for VHWs. The individual will receive intensive training from physicians and consultant psychiatrists at CRHP in biomedical approaches toward psychotherapy, and will be equipped to refer complicated cases for more intensive care or drug prescriptions, with the help of the local VHW or MHT. At the same time, the counselor will be a member of their local community with a keen sense of the cultural context and pre-existing beliefs surrounding various mental health issues, and will have the trust of local villagers. This dual capability will make the counselor ideal as a first line of mental health support for other community members. Through the formation of regular support groups, the counselor can also disseminate knowledge and be a leader in a safe space for people to voice their issues.
Local youth will be able to speak to their village counselors as well, but in order to provide more specialized support, peer groups will take place at CRHP once a week for a month of training. Twenty youth from each of two villages will go through month-long sessions together, and there will be separate groups for boys and girls. This scheme is similar to our existing Adolescent Programs but will be more exclusively geared toward exchanging peer support with those in the same, as well as neighboring villages, ultimately setting the stage for healthier adolescent years.
Through the MHP, we aim to cause a 25% drop in the incidence of mental illness – especially depression and anxiety – as compared to the levels that will be found in our baseline survey prior to implementation. We also aim to promote awareness among village youth of mental health issues and daily life stressors, as well as culturally appropriate strategies to address these stressors, which will be assessed through pre- and post-session evaluations.
With the advent of the Mental Health Program this spring, CRHP is embarking on a new initiative – though in many ways, there is nothing unusual about this project. We are still tackling a prominent health issue hand-in-hand with communities, through locally relevant approaches that are informed by scientific knowledge. Sustainability is a key factor here; like the VHWs, counselors are chosen by their own neighbors, and if they are one day unable or not willing to continue, a new counselor will be selected. Existing village programs like Farmer’s Clubs and Women’s Groups also help provide infrastructure and the space to try out new initiatives like this one. Stay tuned this April as we launch the program!