This book discusses approaches used by NGOs in formulating and implementing mental health care in the community in the context of high treatment gap, insufficient public expenditure on health, human resource shortages, heterogeneity of communities as well as cultural beliefs in India. It uses a qualitative case study approach to document and analyse the work of some major NGO-run community mental health programmes in India, all of which cater to vulnerable populations and are in different and diverse regional settings. It casts the spotlight on envisioning community mental health in policy and law, implementation by the government, how it is practised by select NGOs and the challenges involved in programme implementation. In doing so, it hopes to understand the trigger factors that have led to NGOs embarking on community mental health programmes: how needs of the community are understood, the funding mechanisms, how the human resource gap was addressed, type of networks formed in the community, therapeutic and social interventions, accountability mechanisms, achievements and limitations of the programmes. This book is for students and researchers in the fields of social work and psychology, and NGOs, government and funding agencies, and for those interested in understanding and working with community mental health programmes.
Author(s): Gayathri Balagopal, Aruna Rose Mary Kapanee
Publisher: Springer
Year: 2019
Language: English
Pages: 204
City: Singapore
Acknowledgements
Contents
About the Authors
List of Figures
List of Tables
1 Mental Healthcare Services in the Community: Where Does India Stand?
1.1 District as the Unit of Implementation: District Mental Health Programme
1.1.1 How Is Community Mental Healthcare Conceptualised by the WHO and DMHP?
1.1.2 Integration of Mental Healthcare with Primary Healthcare: Sakalawara and Raipur Rani Blueprint
1.1.3 Implementation of District Mental Health Programme
1.1.4 Criticism of DMHP
1.1.5 Impact of the DMHP
1.1.6 DMHP Coverage
1.2 Complexities in Measuring Outcomes in Mental Health
1.3 National Mental Health Policy of India, 2014 and Community Mental Health Programme
1.4 Mental Healthcare Act 2017 and Community Mental Healthcare
1.4.1 Mental Illness and Capacity to Make Mental Healthcare and Treatment Decisions
1.4.2 Right of Persons with Mental Illness to Access Mental Healthcare and Community Living
1.5 Prevalence of Mental Illness in India and Treatment Gap
1.6 State Expenditure on District Mental Health Programme
1.7 Can Public Health Infrastructure and Human Resources in Health in India Support Mental Healthcare Provision?
1.7.1 Human Resource Gap in Mental Health
1.7.2 Dominance of Private Sector in Healthcare Utilisation
1.8 Scope and Methodology
References
2 How Janamanas Partners with Government and Women Self-help Groups to Embed Mental Health and Resilience in the Community
2.1 Civil Society as Community and Community Ecosystems for Mental Healthcare and Well-Being
2.2 Lack of Publicly Provided Comprehensive Mental Healthcare and Deprivations in the Community
2.3 Interpersonal Relationship Conflicts, Intimate Partner Violence, Patriarchal Norms and Substance Use Problems in the Community
2.4 Evidence on Intimate Partner Violence in West Bengal
2.5 Workshops with the Municipality to Overcome Resistance to the Programme
2.6 Knowledge Sharing with Community-Level Resources Like Self-help Groups
2.6.1 Audience Analysis
2.6.2 Training Programme for Community Cadre
2.7 Outreach Camps to Sensitise Community About Mental Health
2.8 Community Women-Led Mental Health Kiosks
2.9 Involvement of Community Stakeholders in Identifying Persons in Need of Mental Health Assistance
2.10 Counselling Services at the Mental Health Kiosk
2.11 Referral to Other Service Providers
2.12 Autonomy in Decision on Follow-up Care: Client-Centred Practice
2.13 Networking and Advocacy with Government, Other NGOs: Mental Healthcare Needs, Livelihood and Legal Service Providers
2.14 Internal Monitoring
2.15 Impact of Janamanas: Institutionalising the Community Mental Health Programme with the Municipality
2.15.1 Developing Community-Based Leadership
2.15.2 Deliver Mental Healthcare to Last Mile Communities
2.15.3 Mainstreaming Mental Healthcare in Urban Local Bodies
2.15.4 Concerns and Suggestions
2.16 Challenges of Funding, Staff Motivation and Community Awareness
2.17 Recommendation to Other Organisations Wishing to Start Community-Based Mental Health Services
Appendix
References
3 Integration of Mental Healthcare with General Healthcare Services for Tribals: The Decentralised Approach to Community Mental Health Programme by ASHWINI
3.1 Decentralised Mental Healthcare Services
3.2 Public Education and Medical Services for Tribals Comprise a Community Mental Health Programme
3.3 High Suicide Mortality Among Tribals and Community Perspectives on Mental Illness
3.4 Empowering the Community: Capacity Building of Tribals as Human Resources in Health
3.4.1 Training Programmes for Staff
3.4.2 Training Programmes for Village Health Guides
3.4.3 Training Programmes for ACCORD and Viswa Bharati Vidyodaya Trust Staff
3.4.4 Training and Capacity Building Needs
3.5 Incorporation of Mental Health into Health Education Programme and Acceptance of Plural Health Seeking Behaviour
3.6 How Are Persons with Mental Illness Identified in the Community?
3.7 Pharmacological Interventions Through Outpatient Clinics and Inpatient Services
3.8 Preventing Drop out Through Follow-up Services
3.9 Restoration of Routine Functioning
3.10 Impact of CMHP
3.10.1 Innovations
3.10.2 Awareness on Mental Illness: Improved Knowledge that Psychiatric Disorders Are an Illness, but Persistence of Belief in Faith Healing
3.10.3 Early Detection
3.10.4 Capacity Building for Staff
3.10.5 Follow-up Services
3.10.6 Inadequate Rehabilitation Options
3.11 Suggestions for the Programme
3.12 Challenge of Human Resource Shortage and Emerging Problems of Alcoholism
3.13 Future Goals for the CMHP
3.14 Recommendation to Other Organisations Wishing to Start Community-Based Mental Health Services
Appendix
References
4 Strategising Community Mental Health Service Provision for Underserved Areas and Resource-Poor Population: Satellite Clinics, and Care and Support Programme of Antara
4.1 Providing Locational Access to Mental Healthcare in Underserved Areas
4.2 Conceptualisation of Neighbourhood as Community and Use of Community Resources in Delivering Mental Health Services
4.3 Specialised Human Resource for the Community Programme
4.4 Care and Support Programme of Community Mental Health Unit
4.5 Dispelling Myths About Mental Illness Using Local Clubs, Schools and Local Self-government Institution Functionaries
4.6 Multi-stakeholder Identification and Referral
4.7 Comprehensive Mental Health Treatment and Rehabilitation for Care and Support Programme Clients and Usual Treatment for Clients Using OPD and IPD
4.7.1 Outpatient Department: Preference for Pharmacological Intervention in Rural Areas and Psychotherapy in Urban Areas
4.7.2 Satellite Clinics
4.7.3 Inpatient Services
4.8 Follow-up Services
4.8.1 Follow-up of Clients Under the Care and Support Programme
4.8.2 Follow-up of Clients Enrolled with OPD, Antara
4.9 Rehabilitation
4.9.1 Day Treatment Unit
4.10 Networking with Local Government, Local Clubs and Schools
4.11 Capacity Building of Specialist Human Resources
4.12 How Has Antara Fared?
4.12.1 Action Taken on Expert’s Recommendations
4.13 Recommendation to Other Organisations Wishing to Start Community-Based Mental Health Programmes
Appendix
References
5 Mental Health Service Provision and Enabling Agency Among Clients, Caregivers: The Case of Rural Mental Health Programme of The Banyan
5.1 Key Functionaries Perception of a Community Mental Health Programme: Well-Being of People, Comprehensive Services and Use of Local Resources
5.2 Household-Level Deprivation in Tamil Nadu
5.3 Disaster Relief Services and Needs Assessment: Community Demand for General Healthcare
5.4 Deployment of Local Human Resources as Community Health Workers
5.5 Information Dissemination on Mental Illness and Services
5.5.1 Mass Awareness Campaign with Participation of Local Self-government Institution Leaders to Launch Services
5.5.2 Mixed Strategies of Community Awareness Programmes
5.6 Changing Locus of Identification from the Organisation to the Community
5.7 Physical Infrastructure for Clinical Services: From a Temple to Health Centre
5.8 Treatment: Outpatient and Inpatient Facilities
5.8.1 Functioning of Psychiatric Outpatient Clinic
5.8.2 Functioning of Psychiatric Inpatient Services
5.8.3 Internal Monitoring
5.9 The Role of Continuity of Care in Reducing Treatment Drop Out
5.10 Capacity Building on Mental Illness and Intervention Protocols
5.11 Engaging with Stakeholders in the Community: Anganwadi, Local Self-government Institutions and Faith-Healing Institutions
5.12 Mobilising Client–Caregiver Support Group: Provision of Disability Allowance and Collective Action
5.13 The Challenges of Finding Livelihood Opportunities, Access to Government Entitlements and Childcare
5.14 Community Acceptance: Community Immersion, Recovery, Satisfaction with Services
5.15 Impact of RMHP: Perspectives of External Evaluators and Programme Functionaries
5.16 Organisational- and Community-Level Challenges
5.17 Expansion of Services and Partnering with Government: Way Ahead
Appendix
References
6 Altruism and Activating Neighbourhood Care for Persons with Mental Illness in the Community: Mental Health Programme of Mental Health Action Trust
6.1 Robust Associational Life as Enablers of Community-Based Programmes in Kerala
6.2 Community Mobilisation and Community Ownership: Guiding Principles of Pain and Palliative Care Society
6.3 Community-Driven Demand for Mental Healthcare from Palliative Care Volunteers
6.4 Interdependence of People as Community: Perspectives from Functionaries of MHAT
6.5 Volunteers as Backbone and Specialist Human Resource to Deliver Services at MHAT
6.6 What Are the Training Modalities of Volunteers and Staff?
6.7 Volunteer-Driven Identification, Screening and Referral
6.8 Treatment at Outpatient Clinics
6.8.1 Pharmacological Intervention
6.8.2 Tailored Psychosocial Interventions
6.9 Follow-up Care: The Critical Role of Volunteers
6.10 Restoring Functioning Through Day Care Centres Managed by Trained Volunteers
6.11 Social Care: Community Organised Provision of In-kind Transfers Like Foodgrains and Clothing
6.12 Participation of Palliative Care Clinics, Citizens and Government in the Mental Health Programme
6.13 Need to Expand Awareness in the Community by Volunteers
6.14 Monitoring Mechanisms and Impact of the Programme
6.15 Challenge of Human Resource Shortage and Sustaining the Intensity of Home Visits
6.16 Future Goals: Foray into Mental Health Education and Expansion of Services
6.17 Recommendation to Other Organisations Wishing to Start Community-Based Mental Health Services
Appendix
References
7 Lessons Learnt from NGO Approaches to Mental Healthcare Provision in the Community
7.1 Rolling Out Community Mental Health Services: Rationale and Local Priorities
7.2 Who Is the Community?
7.3 Capacity Building of Local Population as Community Health Workers
7.4 Dealing with Local Belief Systems
7.5 Activating Community Involvement
7.6 Intersectionality Between Vulnerability and Mental Illness: Is There a Pro-poor Bias in the NGO-Driven Mental Health Programmes?
7.7 Have the NGOs Achieved Their Aims?
7.8 Challenges, Accountability and the Way Ahead
References
