After an accident at his workplace, Bhoomi, a 26-year-old from rural Tamil Nadu, India, lost interest in work and isolated himself from everyone. His neighbors were at a loss to understand the change in his behavior. He was labeled a “lunatic,” which worried his parents and propelled them to seek help.
Thirty-year old Vijaya (name changed) spent 10 years of her life not talking to anybody. Her parents were daily wage laborers, scraping together a sparse living in India’s southern state of Tamil Nadu. Unaware of any treatment, and afraid of being stigmatized or shunned by their community, they did not disclose their daughter’s illness to anyone. Instead, Vijaya suffered in silence, confined to the house, and hidden from public view.
It was only when the Tamil Nadu government’s Mental Health Program (TNMHP) reached out to their community that Vijaya’s life underwent a dramatic change. After six months of working with the program’s community facilitators, Vijaya’s parents took her for treatment, and within a year, the young woman began interacting with others more frequently.
Poor mental health places a huge burden on individuals, families, and society. From developed countries to emerging market economies, mental disability – ranging from common mental disorders such as depression to severe mental illnesses and retardation – has profound impacts on people’s economic and social well-being.
Erwadi is known for its 550-year-old Badusha Nayagam Dargah—“Erwadi Dargah,” one of the biggest shrines in India. Every day, numerous devotees of different faiths visit the shrine from surrounding villages, states, and countries. Among these visitors is a large number of people who suffer from mental illness and have come to pray for a cure. Some of them see the Dargah as their first and only hope—guided by the magico-religious belief that illness is caused by the possession of evil spirits or the performance of wicked magic—while others have turned to the shrine as a last resort after receiving ineffective treatment.
When I visited Erwadi Dargah in 2013 and met with a team working on a local program called District Mental Health Project (DMHP), an important partner of the World Bank-supported Tamil Nadu Mental Health Project, they expressed an urgent need to help the devotees affected by mental illness. Their subsequent discussions with representatives of the shrine revealed a lack of information on potential treatment options and strong resistance to medical interventions among the devotees. At that time, the team knew of a similar circumstance in another part of India—the state of Gujarat—so they invited the representatives of Erwadi’s religious community to learn from peers in Gujarat about complementing religious rituals with medical treatment.
And thus started a unique experiment called “Dawa-Dua,” or prayer-treatment.
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:
For decades, the leading causes of mortality have differed between low income countries and high income countries. Those who have worked their careers in health and development probably never thought they would see the day when maternal/child health and communicable diseases would not be the leading health burden in many low income countries.
The new actor is non-communicable diseases (NCDs), which are characterized by chronic diseases (cardiovascular disease, diabetes, cancer, and chronic respiratory disease), along with injury and mental health which are now responsible for half the health burden in South Asia. Thus, the challenge now is how best to juggle this “double burden”.
Currently, many compelling reasons are pushing countries toward starting to tackle NCDs. From both a social and political standpoint, South Asians are 6 years younger than those in the rest of the world at their first heart attack. This type of trend threatens a country’s ability to fully capitalize on the demographic dividend from a larger mature working force because healthy aging is necessary, which in turn, requires tackling NCDs.