Mental illness is curable, treatable, and preventable: a story of hope from India

On World Mental Health Day, here’s a fact to reflect on: people with mental illness are among the socially excluded and marginalized groups in society.  They are often misunderstood, ignored, or simply invisible.
 
In India alone, an estimated 70 million people—or 5% of the population—suffer from mental illness.  The southern state of Tamil Nadu, for instance, has one million people living mental disorders—about 3-5 cases per village. Meanwhile, the country faces a severe shortage of psychiatrists and psychiatrist nurses, and clinical care is scarce in rural India. Due to deep social stigma related to mental illness, such serious issues are largely invisible at the community level.
 
That’s why, in 2012, we launched a comprehensive social and clinical care program with the government of Tamil Nadu to inform and educate local communities on mental health issues, as well as to encourage families and people affected by mental illness to seek treatment. Working with leading local health practitioners, we based the campaign on a core message that was simple, powerful, and resonated with the community:
   
When we first started, it was not uncommon for patients and their family members to blame their disorders on past deeds or on being possessed. They would seek help through prayers, religious rituals, and traditional healers; confining patients to their homes; or at worse marrying girls off in the hope of curing them. 

To spread our message, we used a wide variety of tools, including wall paintings, posters, street theater, and flip books, to contrast prevalent misunderstandings and improper practices related to depression, anxiety, and other common mental disorders with new and hopeful messages. This was followed by an initial clinical screening of people suffering from mental illness or other forms of mental disability, as well as diagnosis, treatment, and counseling. Throughout the campaign, we blended social care with traditional clinical care approaches to mental illness in four stages: 

1. We built on the social and institutional capital created under the Tamil Nadu Empowerment and Poverty Reduction Project (TNEPRP) in the most underserved blocks of the state;
2. We engaged closely with an ongoing district-run mental health program that had a strong team and a supply of psychiatric drugs, but lacked a strong connection to communities;
3. We employed the experience and knowledge of medical hospitals and related civil society organizations dedicated to the cause; and most importantly,
4. We recruited and trained dedicated community facilitators, who eventually became community mental health workers. 

Key results and impact
 
Fast-forward to present-day Tamil Nadu, there is now greater appreciation among community members of the need for early detection to prevent simple mental disorders from turning chronic. Affected communities developed better understanding of the factors that cause mental illness, the options for treatment, where they could receive financial support for medicines and hospitalization, and employment opportunities for those undergoing treatment for chronic and simple mental disorders.

Specifically, over the course of three years, the campaign has reached communities in 578 villages, and helped identify around 7,500 cases of mental disability. A total of 5,400 people received counseling, 4,500 people were assisted with medicines and 800 people were supported with hospitalization. In addition, 3,500 people were included in self-help groups, and given access to a range of social safety nets—including 3,000 disability cards and 4,800 job cards under the National Employment Guarantee Program. To support the rehabilitation of persons suffering from mental disability and their families, the government provided funds for vocational trainings and other livelihood opportunities.
 
Lessons learned
 
What did we learn from this experience? Preliminary results from a recent evaluation show that: 

• Sharing clear messages in a simple form was a key driver for patients suffering from mental illness and their caregivers to seek treatment.
• Raising awareness among community members about various mental disorders and the causal factors, helped them to overcome stigma and support households with individuals suffering from mental illness.
• Our most critical takeaway is on prevention: most mental disorders can be averted.  This requires a safe space at home and in the community where mental illness is viewed as curable, treatable, and preventable.

In my next blog post, I will share more about the safe space created in Tamil Nadu, where faith and medicine go hand in hand to address mental illness.