‘Mental Health in Rural India? Is there a need?’ This is a question that echoes in the minds of many as we emerge from the intense stress of the pandemic, and is a key point of query for development sector professionals working at the grassroots.

The World Health Organisation estimates that approximately 7.5 per cent of Indians suffer from some form of mental disorder, with 56 million Indians crippled by depression and another 38 million suffering from anxiety disorders.  And with approximately 70% of India’s population living in rural areas, the numbers soon stack up.*

And yet the mental health workforce in India is simply not there to support this national issue.  WHO cites a huge shortage of psychiatrists and psychologists in the country, with just 0.3 psychiatrists and 0.07 psychologists available per 100,000 population.  These numbers fall significantly short of the recommended 3 per 100,000 population.

So as the population struggles with mental health, what is being done in rural India to address this pressing issue? 

ACF: Leading the Way

When ACF kickstarted its program to address Non-Communicable Diseases in 2016, a baseline study was conducted where people talked widely about hypertension, cardiovascular disease and diabetes. However, no one ever mentioned Mental Health. Was there a lack of awareness? Perhaps. But Mental Health has such a strong stigma in India that even those in urban areas are afraid to talk about it.  How then can we expect rural India to say a thing?

To find out more, ACF investigated further and a study in 2017 included Mental Health as a key component of the questionnaire.  It turned out that while 60% were aware of issues like depression and anxiety, only 54% knew about mania and illness with psychotic symptoms.

 Surprisingly from the 1440 respondents, 21% reported that a doctor had diagnosed them with mental illness but from that, only 7% sought treatment. 1/4th of the respondents didn’t believe there was a cure. Citing reasons for mental illness, the respondents claimed that economic difficulties (46.5%), day-to-day-problems (55.2%) and conflicts with family members and the community (44.9%) were the primary causes of mental health issues.

Of course, these issues were significantly exacerbated during the pandemic and nationwide lockdown. COVID-19 generated immense stress for bread winners and families as, for almost two years, many struggled to put food on their plates.

The problem was compounded in rural India where acute lack of resources, lack of awareness and the widespread stigma further isolate sufferers. With little to no service provision in their areas, many villagers turned to ACF for mental health support during the pandemic. More than men, women shared the challenges of livelihood with subsequent stress, anxiety and even suicidal tendencies. The issue was clearly serious!   But whilst ACF was glad that people were finally coming forward to talk about it, our on-ground team was ill-equipped at the time and required the necessary skills to handle such delicate matters.

It was then that ACF commenced a pilot program and reached out to the Centre for Mental Health Law & Policy (CMHLP) to act as a knowledge sharing facilitator. They had significant experience in training people on Mental Health in rural India along with an expert team of trainers to support the same. 

And so, they trained ACF staff, volunteers and community leaders, to create a cadre of 590 mental health advocates within ACF communities. Trained in problem solving, active listening, behavioral activation, relaxation techniques and appropriate referrals, these trainers ventured out as an army - reaching out to community members across 101 villages in Maharashtra, Chhattisgarh, Uttarakhand and Himachal Pradesh, with counselling support. ACF even involved SHG and community leaders to help identify beneficiaries with suspected conditions for referral to our health coordinators.

Hope for the future …

With a vision to build prosperous, healthy communities, ACF is committed to the provision of Mental Health support in rural communities, as an integral component of its Non-Communicable Disease prevention program. 

This model of support has the potential to play a crucial role in helping rural India address its mental health burden of disease.  By capitalizing on the tight-knit nature of rural communities, avenues can be created to reach out to individuals in a timely, but delicate way. 

 If avenues for treatment and ‘community care’ are combined, India can go a long way fostering the holistic well-being of its people. By empowering heads of panchayats and local leaders to recognise mental distress and seek adequate help, we can start to fill the gaping chasm in service provision that exists today.

Civil Society Organisations, local health workers (ASHA, SAKHI and the like) and community volunteers have a crucial role to play - if they are properly trained to deal with cases of mental health and are empowered with technology, they can create the necessary linkages for support that people with mental health issues need.

It’s time we recognized the need for more mental health services in rural India, and unite to create a network of support to address this pressing issue. 

Vinayak Sonawane is the Senior Program Manager overseeing to the CSR-related projects in Health. Reach out to him at vinayak.sonawane.ext@ambujafoundation.com

Sources

* https://swachhindia.ndtv.com/world-mental-health-day-2020-in-numbers-the-burden-of-mental-disorders-in-india-51627/