Safia : Enhance Healthcare Services and Patient Outcomes in Targeted Populations.
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- Safia : Enhance Healthcare Services and Patient Outcomes in Targeted Populations.
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CHLP LEARNING
As a private mental health professional I always felt a void within me. I was not able to
dismiss the fact that the gap between the public sector and private sector was huge.
Community mental health needs were only attended to when the crisis was too difficult to
handle. It was a glaring truth we chose to neglect. Even in crisis like violence or suicide attempt,
access to services like ambulance was difficult. Most of the time people don't know how to
navigate the situation. Situations in places like dargah were also concerning. Even though I had
no idea about how community based interventions work, I wanted to look into the possibilities.
And hence CHLP happened .
Through CHLP, I wanted to learn how to define the goal. How to make it a replicable model?
How to come up with a cost effective interventional plan? How to connect the dots between
government agencies, NGOs, families, caregivers and patients?
My learning in this journey is beyond what I expected. People I met during the course changed
the way I looked at life.
Each module took us through a journey of UNLEARNING. It was surprising to know how we
have learnt many things wrong .
All the modules made us accountable and realize that we are all in an effort to build a system
in which health for all becomes a reality. Our first assignment with Axioms of community health
with a different NGO was an eye opener. Dr Kiran Martin’s inspirational work through Action
for securing health for all [ASHA] motivated me to think big. Her learning through slum people
made me think how we are missing out on so many learning opportunities. Improving the
community participation, working on the partnership for expansion which was insisted by the
community, bringing in the basic developmental activities which were the contributors for better
health, women leading the game were the takeaway from the assignment. Another organization
which caught my attention was SANGATH working on mental health at ground level. Working
on Equity which is the inclusion through awareness, social accountability and community based
participatory research made a huge impact on my learning journey.
Solidarity from below is the ingrained message which was being told. Converting science to
service, empowering the community by improving capacity, task sharing, training lay counselors
are some of the interventional plans learnt.
It was interesting to understand how Alma Ata declaration 1978 evolved. WHO started giving
attention to social determinants after the World War. CHC was established in 1984 and then
called SOCHARA focused on the social paradigm of health and worked on rights and
responsibility. Achieving equity through establishing PHCs in 2005 was a milestone.
Politics and medicine can't be kept apart. There is a need for a local solution for challenging and
changing health needs. Equity is the unequal treatment of inequalities to equalize the
opportunity which is social justice. Social determinants of health focusing on intersectoral
policies and programmes which guide the epidemiology in public health and community health.
Improving individual health outcomes, improving community health outcomes and health
outcomes at all levels. Improving social cohesion and social capital increases community
participation. Trust, belonging and reciprocation helps in better community participation.
Nutcracker effect where there is a top down and bottom up action for health equity. There is a
need for a social vaccine which works on starvation, malnutrition, illness and debt bondage. We
were left with a lingering question: are you a tap turner or a mop cleaner? One who needs the
most gets the least. This is so true with the insurance facility. During catastrophic situations,
there is no plan in place. There is a need to look into promotion, prevention and palliative care.
Public health is not just above technical activity but is to be seen as a way of doing justice, as a
way of asserting the value of human life. Politics is to search for common good and just society.
Medicine is a social science and politics is nothing but medicine on a grand scale.
Social gradients in health shows disadvantage in terms of health in people from low economic
status. Hence only with prioritizing health, demanding for rights and pressurizing leaders we can
achieve health for all. Policy implementation is only in papers.
Working on the CSDH framework helps us get more clarity on locating the structural and
intermediary determinants of health in society. It helps us explore the hidden power dynamics at
play. Map out mechanism to know the interactive pathway and feedback loop between SDH.
Reflect on entry points at which action on the SDH can be taken using community health
approach. Overall improve the daily living conditions, tackle the inequitable distribution of
power, money and resources, measure and undertake the problem, knowledge gap, workforce,
macroeconomics, social policies, public policy and build evidence and influence the policy
change. Understanding the perceived needs of patients, understanding their rights and its
relevance, barriers and priorities.
GOBI: Growth monitoring, oral rehydration, breastfeeding and immunization, access to
emergency medicines, Ayushman bharath, NHM, CAH [Community action and health] were
the result of selective primary health care.
Self reliance and social awareness are key factors in human development. Community
participation encourages people as participants and not beneficiaries, becoming planners; Not
work for people but work with and through people. The people do not mean only the formal
leaders but includes women, youth, children, local healers, farmers and teachers. Care should be
taken to focus on those marginalized. Appropriate health technology is used. Start with a
problem and develop technology that is relevant to local conditions and resources, like use of
herbal and home remedies, nutritional bangles.
Intersectoral collaboration: PHC involves all related sectors such as education, agriculture, food
and nutrition, housing, women and child welfare and others. It demands for coordinated efforts
of these sectors. Local capacity building is the key.
But it is observed that there is a fragmented care. There is an increased burden on secondary and
tertiary facilities, compromising the quality of care.
Under the universal health coverage, Ayushman bharath is introduced. It helps with the health
and wellness center, pradhan mantri jan arogya yojana. Focusing on mid level providers, to offer
expanded range of services close to community, improve clinical care, care coordination,
Capacity building done through ECHO, MOOC.
Dr Regi George model of THI where the community looks after itself was an eye opener.
Instilling our knowledge into the collective community memory is the takeaway: Giving health
in peoples hand, reaching community the choice .
There is no path for the traveler, paths are made by walking. Until you walk with the community
you don’t realize where they want to go.
JHAMKED programme in india is an example of political will which translated into results.
There was a combined effort of politics and medical science.
Nicolas Rebello emphasized on the quality of being fair and impartial for equity in health.
Emphasizing on the disability persons organization [D.P.O], he emphasized on the CBR
[Community Based Rehabilitation].
Caregivers worldwide gave us the other dimension of the problem. Well Being of caregivers and
their empowerment.
Discussion on the health system gave us a better understanding of issues at ground level. A peek
into the traditional health system gave us a better understanding of stories from different systems
of medicine. Learning that collaboration is the only way ahead. We are looking at a health
system which is responsive, financially fair and respectful with good infrastructure, human
resource, pharmacy, leadership and governance. A system is a set of things, interconnected and
organized to achieve something. Different elements connect for a purpose. We have to
strengthen the health systems to improve the health outcomes.
We are looking at comprehensive, continuous, patient-centric, integrated quality, accessible,
affordable, available, acceptable and polyvalent.
Competent, interdisciplinary, information system, referral, community participation ,
intersectoral collaboration, close to the community, robust finance mechanism, accountable and
team approach. Because the barriers to access secondary healthcare weakens and threatens the
system.
As far as the traditional health systems are concerned prejudice, ignorance, and self interest have
prevailed over open minded scientific approach in this important area of medical care. TCAM
[Traditional,complementary ,alternative medicine]
Faith healers have a huge role to play. DawaDuwa project personifies the need for integration.
Trans disciplinary health science helps in better integration.
Asthana declaration, biodiversity act worked on the geography and community better. Building
trust, being a part of community and cultural experiences. There is an emphasis on pluralism,
getting to know the community, speaking to the leaders, healers and knowledge holders, building
health resources, human nature relationship, self reliance, and bringing everyone together.
Having the connection with nature gives us better access to naturally available ingredients.
Botanical survey helps us understand this. Involvement of other experts in the various field.
Wildlife, ecosystem protection, community resource mapping.
Pacchamarundu is a popular home remedy which is utilized extensively in rural set up.
Mentally ill are not a part of us, they are US echoing in my mind as I go through the module of
mental illness. Psychological first aid was a major takeaway. Bharath munis sadharanikaran
theory of communication from natyashasthra and a part of rural mental health programme called
ATMIYATA meaning shared compassion is changing the conversation around emotional
wellbeing in villages. The idea was to equip the community to define their own narrative of
mental health.
Champions and mitras are community leaders trained to provide low intensity counseling to
those facing psychological distress. They could be school teachers, a shopkeeper or members of
small informal group. We tap into people who already get approached for problem in the
community. They need to be sensitive, empathetic, and willing to improve the mental health
conditions in the village. Mitras on the other hand acts as eyes and ears of the champions. They
receive less training but are taught to spot distress among community members and refer them to
champions.
Universal Health coverage
It was interesting to compare between different countries with respect to accessibility, insurance,
tax payers, intentions, prioritization, monetization and product. Cuba’s model of work is well
appreciated due to the district being responsible for administrative units. India is a federal
country. 2015; health was considered as state subject; 2017; Niti ayog legislated right to
healthcare. Under Niti Ayog, Ayushman bharath insurance is a subsidy for the private sector.
Role of Volunteers
With right ATTITUDE
SKILL
KNOWLEDGE
Social prevention, rural involvement, coordinated son training is possible; Monastic approach in
many volunteers who work far more than their abilities create transformations at ground level.
Being watchful within, dividing labour and better communication volunteers contribution is
invaluable.
Civil societies
Organisations within a society that works to promote the common good, usually taken to include
state run institutions, families, charities and community groups
Jan swasthya Abhiyan is people's health movement in the country which is aimed at establishing
health and equitable development through comprehensive primary healthcare and action on the
social determinants of health.
It is a worldwide network of peoples organizations, ngos, social activists, civil society
organizations, health professionals, researchers etc
With better communication, dialogues, and learning from each other we can bring in change at
rural level.
DAWA DUWA model, PPP MODEL are examples of partnership and work at community level
to integrate health.
Value based practice, professional ethics is becoming an exception. Value based work based on
equity, gender, rights, integrity and quality is becoming scarce.
Uneven quality, substandard treatment, and financial exploitations is making health a commodity
for exploitation. Statutory regulations, maintaining minimum standards, helping them create
standards. Creating partnership helps us move more towards equity.
World is increasingly becoming hedonistic and sometimes its important to question the intent. It
was interesting to note that there was a questionnaire to assess the value system.
Topic on food and nutrition gave us an insight into ICDS (integrated child development
services); one of the flagship programmes of Government of India and represents one of the
largest and unique programmes for early childhood care and development. Anganwadi centers
deliver early education, health and nutrition services as a part of ICDS schemes. Child's early
years have a disproportionate impact on the rest of their lives. Experiences early in life can have
a lasting impact on later learning, behavior and health.
Every country looking to make investments can learn something from ICDS. The program is
unusually ambitious in its drive to deliver high quality health, nutrition, community education
and preschool education. Below 18 years is a child and comes under the child welfare
committee. Protection and care of the child and also aiming at juvenile justice.
Following child and nutrition we spoke on women's health. Financial literacy, inheritance and
inequality were topics discussed. Inequality driving violence and work around it caught our
attention. SEHAT ngo work was understood in detail. Gender stereotypes and how it impacts the
decision making was looked into in detail.
Modules on mental health gave us a perspective on the ground realities.
Mentally ill are NOT a part of us
They are US
Was the loud message
We need to be extremely sensitive as everybody is fighting their own battles. Self help groups,
therapeutic community concepts are way ahead to deal with mental health issues at ground level.
BNI working on rehab camps partnering with locals is the best example of the community.
Mental health issues are becoming Syndemic.
Under national health policy DMHP, a district mental health programme was designed. In 1982
bellary model was incorporated. After more than a decade in 1996; it was incorporated in 4
districts; in another 2 decades it was present in more than 100 districts in around 757 districts in
india.
Ayushman Bharath also saw the need for insurance for people with mental health issues. In 2017
the Mental Health Act created a paradigm shift in the way mental health issues were perceived.
MHA 2017 gave a lot of emphasis on patient centric approach. Patient had a choice to make.
Nominated Representative and Advanced directives are given emphasis, the Mental health
review board involving the magistrate, advocate and mental health professional was set up to
protect the rights of people with mental health issues.
Screening tool is given in all the PHC to screen people with mental health issues. Medical
officers are trained to screen and treat the common mental health issues.
Bal swasthya karyakram and Rashtriya kishore swasthya karyakram looking at adolescent mental
health. There has to be intersectoral convergence to reach better.
Adolescent and child mental health needs attention as the issues with substance abuse are rising.
Human beings are good by nature.
COMMUNITY
BASED ACTION
THRUST AREAS
OF
PROJECT .
DMHP
REVIEW OF LITERATURE
1. Kangkan Pathak, The Central Government launched the District Mental Health Program
(DMHP) as a 100% centrally sponsored scheme for first five years, at the national level during
the 9th Plan as pilot project. It was launched in 1996-1997 in four districts, one each in Andhra
Pradesh, Assam, Rajasthan, and Tamil Nadu, with a grant assistance of 22.5 lakhs each. DMHP
was implemented in 27 Districts across 22 states/UTs in the 9th Plan. The DMHP was extended
to 7 districts in 1997-1998, five districts in 1998 and six districts in 1999-2000. During the Tenth
Five Year Plan, the DMHP was extended to 127 districts in the country. During the 10th Five
Year Plan, NMHP was restrategized and it became from single pronged to multi-pronged
programme for effective reach and impact on mental illnesses. DMHP was redesigned around a
nodal institution, usually the zonal medical college. The thrust areas were to expand DMHP to
100 districts all over the country, modernization of mental hospitals in order to modify their
present custodial role, upgradation of Psychiatry wings of Govt. Medical Colleges/General
Hospitals and enhancing the psychiatry content of the medical curriculum at the undergraduate
as well as postgraduate level, strengthening the Central and State Mental Health Authorities with
a permanent secretariat, IEC Activities and Research & Training in the field of community
mental health, substance abuse and child/ adolescent psychiatric clinics for improving service
delivery.
(Source: L.G. B. Regional Institute of Mental Health, Tezpur, Assam/ Future of District
Mental Health Programme/ Kangkan Pathak/ September 2021)
2. Harish M. Tharayil et. al District mental health program (DMHP) is the flagship program of
Government of India to deliver mental health-care throughout the country. Being an out-reach
program, it is likely that elderly people with mental health programs are accessing it more
frequently. If this is the case, there is potential for including additional components in this
program so that something more than the generic service is offered to them. The result of this
study indicated that a significantly higher number of elderly people are attending the clinics of
the DMHP compared to the outpatient service of a teaching hospital. This is important in view of
the increasing number of older people who may need these services in future. There has to be a
strong link with the existing outreach services. DMHP should take up the task of supporting and
guiding community-based initiatives as well as other outreach services. Community clinics run
by DMHP can support and supervise other community-based initiatives. Collaboration with
palliative care initiatives has the potential for wider application in the community. It is concluded
that DMHP can be further strengthened by adding additional components like service for the
elderly.
(Source: Tharayil, Harish M., et al. "Mental health care of older people: can the district
mental health program of India make a difference?" Indian Journal of Psychological
Medicine 35.4 (2013): 332-334.)
3. Ng, Chee, et al. District mental health programme (DMHP) activities with the core clinical
team were centred on early diagnosis and treatment, PHC staff training, and information,
education, and communication initiatives. A management team for conducting various DMHP
activities has been added, along with mental health promotion initiatives such life skills teaching
and counselling in schools, counselling services in colleges, workplace stress management, and
suicide prevention programmes. The creation of community mental health services in the most
underserved communities has been one of the program's primary successes. In terms of
challenges (areas where improvement required), the training needs for PHC staff are enormous
due to the large numbers of PHC workers in India. A shortage of qualified mental health human
resources, as well as little involvement of other primary care health workers in the mental health
services has meant difficulty in recruiting the district mental health teams. Lack of coordination
between Health and Medical Education Departments has resulted in conflict in program
implementation. Stigmas attached to mental illness remain widely prevalent, and still pose
formidable barriers between the mentally ill and community mental health services. Mental
health remains a comparatively neglected area, given the lowest priority in social and
development planning. There is still much to be done to integrate mental health into the
mainstream public and general health.
(Source: Ng, Chee, et al. "Integrating mental health into public health: The community
mental health development project in India." Indian Journal of Psychiatry 56.3 (2014):
215.)
4. Van Ginneken, Nadja, et al. In India very few of those who need mental health care receive
it, despite efforts of the 1982 National Mental Health Programme and its district-level
component the District Mental Health Programme (DMHP) to improve mental health care
coverage. The aim of this study is to explore and unpack the political, cultural and other
historical reasons for the DMHP’s failures and successes since 1947 (post-independence era),
which may highlight issues for today’s current primary mental health care policy and
programme. Oral history interviews and documentary sourcing were the methods used for this
study which was conducted in 2010–11 with policy makers, programme managers and observers
who had been active in the creation of the NMHP and DMHP. The results suggest that the
widely held perception that the DMHP has failed is not entirely justified, insofar that major
hurdles to the implementation of the plan have impacted on mental health coverage in primary
care, rather than faults with the plan itself. These hurdles have been political neglect, inadequate
leadership at central, state and district levels, inaccessible funding and improperly implemented
delivery of services (including poor training, motivation and retention of staff) at district and
community levels. At this important juncture as the 12th Five Year Plan is in preparation, this
historical paper suggests that though the model may be improved, the most important changes
would be to encourage central and state governments to implement better technical support,
access to funds and to rethink the programme leadership at national, state and district levels.
(Source: Van Ginneken, Nadja, et al. "The development of mental health services within
primary care in India: learning from oral history." International journal of mental health
systems 8.1 (2014): 1-14.)
5. Roy, Sushovan, and Nazish Rasheed. The Ministry of Health and Family Welfare, Govt. of
India formulated District Mental Health Programme (under National Mental Health Programme)
as a fully centrally funded 5-year pilot scheme. The programme was to be implemented in two
phases, the Phase I was to be taken up during 1996-97, and the Phase II was to be a continuation
of the programme during the IX Five Year Plan period (1997- 2002). This study indicates the
major draw backs and also the areas that need further improvement in the perspective of DMHP.
Lack of an inbuilt and dedicated monitoring and implementing mechanism for programme,
Shortage of skilled manpower in Mental Health, this is a major constraint in meeting the mental
health needs and providing optimal mental health services at the community level. Due to
shortage of manpower in mental health, the implementation of DMHP suffered adversely in
previous years, lack of awareness /stigma about Mental Illness, Lack of facilities for treatment of
mentally ill, lack of coordination between implementing departments of DMHP, lack of
Community involvement, protocol for early detection & treatment of mentally ill patients within
the community was inadequately disseminated, there was very little provision to treat &
rehabilitate mentally ill patients discharged from the mental hospitals within the community,
main emphasis remained on the curative services for the mental disorders and preventive
measures were largely ignored. In the absence of reasonably sensitive and specific indicators of
the effectiveness of the DMHP, one has to rely on the crudest. If one looks at the number of
districts currently covered by the DMHP out of the aimed 500, the figure is 241(2014-2015). So,
one may be tempted to state that even after 18 years of existence the program has achieved less
than 50% of its goals and objectives. But what is not immediately apparent is the natural and
expected ‘learning curve’ phenomenon. Currently, the bulk of the ‘learning’ has been done and
corrective changes identified for implementation as evidenced by the latest health ministry
report. So, one can take satisfaction in the fact that some comprehensive course correction has
been made. But no concrete mechanisms of monitoring the programme by valid indicators have
been incorporated in any significant quantum.
(Source: Roy, Sushovan, and Nazish Rasheed. "The national mental health programme of
India." Int J Curr Med Appl Sci 7 (2015): 7-15.)
6. Johann Alex Ebenezer Patients with mental disorders/epilepsy in rural settings across South
Asia face stigma and persecution, and often undergo painful and dangerous rituals as religious
“cures” due to superstitions. Remote locations, poverty, and lack of adequate transport facilities
make access to the hospital difficult, and the problem is compounded by a lack of trained mental
health professionals. Project “Shifa” is the Community Mental Health project at Padhar Hospital
which aims to address these problems. The team consists of a psychiatrist, a coordinator, 10
community field workers, and nursing students posted in the psychiatry department, covering a
target area of 75 tribal villages. The main objective of this project was to identify patients with
mental disorders and epilepsy and facilitate treatment, rehabilitation, and community
reintegration. The 75 target villages are divided into 11 clusters, so that each cluster gets revisited approximately once in 3 months. Home visits are available for selected patients who are
too sick or too far to come to the location. To date, a total of 523 patients have registered and
evaluated under this project. 200 of these patients have received medications in the field.
Currently, after excluding those whose courses are completed or who refused further treatment,
114 are on long-term follow up in the field.
(Source: Johann Alex Ebenezer, Community Mental Health Project of Padhar Hospital,
India, March 2017)
7.Addressing ASHA well-being And burnout for improving Depression care (Project
AANAND)
Sangath is a non-governmental, not-for-profit organisation working in Goa, and other Indian
states, for 25 years. The organization is committed to improving health across the life span by
empowering existing community resources and address the psychological and social needs of
people through comprehensive interventions. The people within Sangath are committed to bring
positive change in the society by amalgamating humanitarian approaches with science and
innovative technological solutions. Burnout and poor wellbeing are prevalent among rural health
workers in India. These health workers are responsible for providing last mile care in various
areas such as pregnancy care, vaccinations, child care, as well as basic mental health services.
The objective of this project was to provide coaching program for ASHAs based on the use of
character strengths grounded in Indian spiritual values, to negotiate stressful work situations and
relationships, and improve mental wellbeing. This intervention will be added on to the routine
supervision that ASHAs already receive. The project aim to deliver this coaching program to a
randomly selected group of ASHAs (or ‘intervention arm’) from Raisen district in Madhya
Pradesh, and measure its effectiveness on ASHA wellbeing, compared to another randomly
selected group of ASHAs who will receive routine supervision only (or ‘control arm’). The
duration of the project is from October 2021 to September 2024.All ASHAs will be comparable
in their baseline characteristics and previously trained on HAP. First identify their character
strengths and understand their routine work problems. Then develop the intervention, and deliver
the character-strengths based coaching to ASHAs in the intervention arm. The control arm
ASHAs will continue to receive routine supervision as usual. The coaching program will begin
with a 5-day residential ‘baseline’ workshop to orient ASHAs into the use of character strengths
in their routine work, rooted in concepts from Indian Psychology/spirituality. As ASHAs resume
field work and face problems and stress-inducing situations, we will reinforce the concepts
learned in the workshop, through once-a-week telephone calls between the coaching team and
each of the ASHAs over an 8-week period. The project measures wellbeing, burnout and
motivation of ASHAs in both arms for comparison, at ‘baseline’ or before the intervention, and
at 1, 3 and 6 months after baseline. Study outcomes will also include ASHA work performance
measures. Finally, we will compare the client’s satisfaction with ASHA’s HAP, and client’s
improvement in depression symptoms between both arms. This study will enrol 244 ASHAs, and
240 individuals identified with depression, for meaningfully explaining our results.
(Source: https://sangath.in/aanand/)
8. Banyan project: The Banyan addresses the issue of mental health among marginalized
groups, primarily persons affected by homelessness and poverty. Statistics on homelessness in
India from the 2001 census reported 1.94 million homeless people in India, of whom 1.16
million lived in villages, and 0.77 million lived in cities and towns. To address the lack of access
to comprehensive mental health care in both urban and rural areas, The Banyan was established
in 1993 to provide comprehensive services for people with mental illness living in poverty and
homelessness and their families. The organization adopts a multi-interventional approach toward
mental health, combining clinical services (psychiatric reviews, medication, counselling) and
social services (employment, disability allowance, social benefits facilitation, education/health
support). The Banyan currently operates two programs in Chennai and Kancheepuram:
The first one is Urban mental health program
Adaikalam: A transit care center with 160 beds for homeless women with mental illness.
Through a biopsychosocial model of care, Adaikalam enables various options for reintegration
back into the community including, reunion with family, employment, open cottage-style
community-based facility, group homes and supported housing for federated/non federated
persons.
Outpatient services: Mental health clinics are operated at four locations in urban areas: a transit
center in Mogappair; a state-run resource center for disability in KK Nagar; a Corporation of
Chennai clinic in Santhome; and a college in Choolaimedu. Services include:
Day care center, home visits, Disability allowance, Employment/other social benefits.
Open shelter: A 25-bed facility for homeless men with psycho-social disabilities, providing
treatment and rehabilitative services run in partnership with the local government, the
Corporation of Chennai.
The second one is Rural Mental Health Program:
Health center: Mental Health Clinics are run in tandem with General Health Services in
Thiruporur Block with 50 villages. Services include: 12-bed inpatient service, Vocational
training, home visits, Disability allowance, Employment/other social benefits
Community living: An open cottage-style long-term facility enables up to 60 women to live
close to the community.
Rented housing: 22 women live independently in Kovalam, in rented housing, and receive
additional support through self-help groups.
(Source: https://www.mhinnovation.net/organisations/banyan)
9. SCARF Tele-psychiatry in Puddukottai (STEP): India has 4,000 psychiatrists to serve a
population of 1.3 billion people. 70% of these psychiatrists are located in urban areas. The aim of
SCARF’s mobile tele-psychiatry innovation (STEP) is to provide accessible and affordable
mental health care services in Pudukottai – a rural community without access to mental health
care – through the integration of mobile clinics and tele-medicine.
Mobile tele-psychiatry service is provided on the STEP bus containing a consultation room and a
pharmacy, consultation takes place between a psychiatrist based at the SCARF office in Chennai
and the patient in Pudukottai through electronic means on the STEP, prescription is dictated by
the psychiatrist to the tele-psychiatry clinic facilitator in the bus and filled by the on-board
pharmacy; medication is provided free of cost etc bus were the major process delivered through
STEPS. 1500 clients treated for severe disorders, number of severely disabled clients who are
certified and will receive benefits increased by 10% (from 0 to 138), cost of care is $12 USD per
capita per month etc were the major impact summary of the project.
(Source:https://www.mhinnovation.net/innovations/scarf-tele-psychiatry-puddukottai-step)
10. ATMIYATA: A community-led intervention in rural India: The Atmiyata is a distinct
approach from the health sector approach but complementary, as it is a community led
innovation for the detection, support and referral for persons with common and severe mental
disorders.
The innovation involves a two- tier community led mental health model that develops capacity of
community volunteers (Atmiyata champions and mitras) to detect and provide primary support
and counselling to persons with common mental disorders. The innovation also uses digital
approaches that promote capacity development and raise community awareness of mental health.
Each champion is provided with a smart phone that includes capacity development and
community films. The second innovative aspect of the Atmiyata intervention is its integrated care
approach: Horizontal integration (integration of care between mental health and social care);
vertical integration (integrating professionals working at the community level, primary care level
and tertiary care level), and between preventive and curative services. 14000 population screened
with 7,600 reach of the programme.1350 people with mental health issues helped with mental
health care and 1350 people helped with social benefits, There was a 27.5% (from 63.8% to
36.3%) reduction in proportion of cases. Pre 14.2% with GHQ score 6+ (n= 120) and post is 9%
(n=76), 80% improved wellbeing outcome after intervention were the impact summary.
(Source:https://www.mhinnovation.net/innovations/atmiyata-community-led-interventionrural-india)
11. Nae Disha Project: Mental ill-health is a leading cause of the disease burden among young
people. In India, young people with mental health problems often experience social exclusion,
impacting their ability to meaningfully participate in their communities, with peers or seek care.
The risk of mental ill-health also increases with poverty, adversity, low skills and knowledge.
Nae Disha is a peer-led mental health intervention that aims to increase and strengthen key
psycho-social assets in adolescents to moderate the impacts of adversity and has been
implemented primarily in Uttarakhand state. It consists of an 18-module youth development and
positive psychology curriculum which is implemented in groups weekly by peer facilitators. The
project demonstrated that young people’s social inclusion and mental health can be improved
through a low-resource short term peer-led intervention involving group discussions and a
supportive curriculum. A total of 1900 adolescents have participated in the intervention to date,
reported a decrease in the proportion of adolescents scoring in the ‘abnormal’ range of Strengths
and difficulties by more than half (from 42.6% to 20.3% (p<0.001) were the impact summary.
(Source:https://www.mhinnovation.net/innovations/building-youth-resilience-and-mentalhealth-india-nae-disha)
12. Care for People with Schizophrenia in India (COPSI): In low- and middle-income
countries, most services for people living with schizophrenia are located at psychiatric hospitals
and other centralized facilities. Lack of human and financial resources inhibits the development
of more accessible services. COPSI (Care for People with Schizophrenia in India) was designed
to provide evidence for a feasible model of community-based rehabilitation for people with
schizophrenia in low- and middle-income countries. The COPSI trial tested a community-based
collaborative care (CBCC) intervention using lay community health workers to provide
rehabilitation services alongside facility-based specialist care. Structured needs assessments and
clinical reviews to tailor treatment plans, individualized rehabilitation and adherence
management strategies, strategies to address physical health problems in participants, linkages
with community agencies and self-help groups, psychoeducational information for both
participants and caregivers etc were the major focus area of the project.
(Source:https://www.mhinnovation.net/innovations/care-people-schizophrenia-india-copsi)
13. Chebolu-Subramanian, Vijaya, et al The Community Mental Health Program (CMHP) run
by the Foundation for Research in Community Health (FRCH) is one such program which
utilizes CHWs to provide health services in rural areas. The primary intent of the CMPH is to
respond to the large gap in mental health care through the delivery of a range of appropriate
interventions to persons with selected mental disorders. The project is designed on the lines of a
task-shifting model wherein the scarcity of health care personnel is addressed by shifting some of
the tasks of a psychiatrist and a psychologist to the primary care doctor and CHWs. Community
Health Workers (CHWs) are critical to providing healthcare services in countries such as India
which face a severe shortage of skilled healthcare personnel especially in rural areas. The aim of
this study is to understand the work flow of CHWs in a rural Community Mental Health Project
(CMHP) in India and identify inefficiencies which impede their service delivery. This will aid in
formulating a targeted policy approach, improving efficiency and supporting appropriate work
allocation as the roles and responsibilities of the CHWs evolve. A continuous observation Time
Motion study was conducted on Community Health Workers selected through purposive
sampling. The CHWs were observed for the duration of an entire working day (9 am- 3 pm) for 5
days each, staggered during a period of 1 month. The 14 different activities performed by the
CHWs were identified and the time duration was recorded. Activities were then classified as
value added, non-value added but necessary and non-value-added to determine their time
allocation. Home visits occupied the CHWs for the maximum number of hours followed by
Documentation, and Traveling. Documentation, Administrative work and Review of work
process are the non-value-added but necessary activities which consumed a significant
proportion of their time. The CHWs spent approximately 40% of their time on value added,
58.5% of their time on non-value added but necessary and 1.5% of their time on non-valueadded activities. The CHWs worked for 0.7 h beyond the stipulated time daily. The CHW’s are
“dedicated” mental health workers as opposed to being “generalists” and their activities involve
a significant investment of their time due to the specialized nature of the services offered such as
counselling, screening, and home visits. The CHWs are stretched beyond their standard work
hours. Non-value added but necessary activities consumed a significant proportion of their time
at the expense of value-added activities. Work flow redesign and implementation of Health
Management Information Systems (HMIS) can mitigate inefficiencies.
(Source: Chebolu-Subramanian, Vijaya, et al. "A time motion study of community mental
health workers in rural India." BMC health services research 19.1 (2019): 1-7.)
14. Gramina Abyuday Seva Samsthe (GASS) - Since 1996, GASS has been known in
Bangalore Rural and Urban, Chikkaballapur, Tumkur, Kalburgi, Chamarajanagar and Kolar
districts as a leading implementor of services for the Persons with disabilities (PWDs). The focus
on mental health and creating empowerment opportunities has impacted several thousand lives in
a positive way. The programs, implemented through staff members and community volunteers
are designed with empathy and service delivery as core values. Covering vital social
development domains like Health, Education, Livelihoods and Environment, our work reaches
vulnerable populace including Children, Women, Youth and Seniors from marginalised
communities. The various programs of GASS are supported by different funding partners. GASS
has been a preferred partner for the Government of Karnataka for the protection of children and
women in difficult situations. Child helpline, shelter for senior citizens and women short stay
homes are supported by the government. It is equally recognized by leading corporate sector for
reaching out to the marginalized through their CSR funds. GASS also enjoys international
partnerships with renowned organizations for specific theme-based interventions. During the
Covid19 pandemic the organisation had the support from all sectors to reach out to the most
vulnerable at the most remote areas. GASS also serves as the center for global research, training
and exposure for interns and students from various universities. Working in Mental Health and
community wellbeing has been our forte since inception. From operating PHC and Mobile
Health clinics to implementing health screening, tertiary referrals, counselling and provision of
medicines the organisation ensure the wellbeing of people in the areas of operation. The
programs work on increasing awareness in communities about general and mental health.
(Source: https://gassindia.org/programs/#health)
15. UDAAN- Udaan is an innovative health initiative that has taken flight under the aegis of the
Trusts. Meaning ‘flight’ this is the Trusts’ most recent and perhaps most ambitious health
initiative to develop and implement mental health programmes. Udaan has recently undertaken
two large and path-breaking programmes in collaboration with the Government of Maharashtra.
The first of these — psychiatric hospital reform — was initiated in 2016. It was introduced in the
Regional Mental Hospital of Nagpur, which serves 24 million people across 11 districts of
Vidarbha in Maharashtra. This hospital, established in 1864, continues — like other psychiatric
hospitals in the country — to have abandoned persons with chronic mental illness who have
become institutionalised. Through Udaan, the Trusts’ effort is to offer an alternative narrative in
the global mental health space through systematic and evidence-based reforms, repurposing the
role of a psychiatric hospital to offer vulnerable people an important element of care that is
otherwise not available in low-resource settings.
The second collaborative programme launched by Udaan is a district-wide community mental
health programme for the district of Nagpur. This ambitious programme directly covers a
population of five million people, providing mental health services at their doorstep. It aims to
work with communities to build awareness on mental health, early detection of illness and to
provide care closer to home.
(Source: https://www.tatatrusts.org/our-work/healthcare/mental-health)
16. Mental Health Care (2017-18), Sambandh Health Foundation is a charitable trust dedicated
to understanding mental illness and addressing mental health issues in India. The objectives
encompass building the capacity of people living with mental illness and their families to lead
fuller lives, raising awareness about mental health and mental illness while advocating for
improved treatment and community supports. Sambandh Health Foundation is successfully
running a community mental health program in Gurgaon for the last four years. The program
draws upon the recovery research, strengths-based practices, and the principles of community
development. The programs and activities facilitate the capacity of to gain life skills, make social
connections, and rebuild bonds with their natural communities. This is accomplished by building
social skills, confidence, facilitating social inclusion and the independence to choose desired life
paths. Sambandh initially initiated such activities from a Community Integrated Center (CIC)
from a government polyclinic in Gurgaon. CIC is a day support center designed to help people
suffering from mental illness to recover and get back to normal society. CIC is being run
successfully for past several years. In the financial year 2016-17 Sambandh also started this
project in 2 villages in the vicinity of Gurgaon with the goal of expanding recovery based
supports to semi urban area, wherein community workshops, street plays, educational &
awareness sessions, mental illness screening camps etc. are being organized with the objective of
generating awareness on mental health, its myths and symptoms and encourage the person
suffering with mental illness to gradually adopt the recovery based techniques. The Company’s
contribution to this Project is in accordance with the requirements of Section 135 of the Act, read
with Companies (Corporate Social Responsibility Policy) Rules, 2014, and Schedule VII to Act.
During the financial year 2017-18, the Company contributed an amount of INR 33.66 lakhs
towards this Project.
(Source:https://csrbox.org/India_CSR_Project_MPS-Limited-Mental-Health-CareHaryana-_15568)
17. JANAMANAS PROGRAMME Anjali Mental Health Rights Organisation, a Kolkata based
Non-Governmental Organisation, launched a community based Janamanas programme in 2006
to target mental illness. Overall, the organization is working towards bringing in systemic reform
in mental healthcare and advocating for the rights of people with psychosocial disabilities. The
programme implemented by Anjali Mental Health Rights Organisation aims to: ∙ Deinstitutionalise mental health services and make it accessible to ‘last mile communities. ∙
Demonstrate a model of community based mental healthcare that is driven by resource poor
women from within the community. ∙ Integrate mental health in the District Development Plan of
the government of West Bengal, which is followed by all the municipalities of the state. The
implementation design of Janamanas programme reflects the core value of the organization in
addressing the broader paradigm of mental wellbeing and right to positive mental health by
advocating for quality mental healthcare. Janamanas programme was launched after conducting a
needs assessment exercise in Khardah, Kamarhati and Rajarhat-Gopalpur municipalities of
Kolkata Metropolitan Area, where a significant proportion of population lived in slums and did
not have access to basic amenities. The study facilitated understanding of existing mental health
care services, helped in mapping existing healthcare facilities in the area and identified
constraints effective delivery of public mental healthcare service.
(Source: https://www.anjalimhro.org/wp-content/uploads/2020/03/janamanas.pdf)
18. Ramakrishna Mission: Ramakrishna Mission (RKM) has been providing health care
services through its village medical camps in 9 villages spread over 7 blocks of Mirzapur and
Sonbhadra districts since 2006. These villages range from 40 to 130 km from RKM, Varanasi.
The total population covered is around 70,000, with most people engaged in agriculture, and
40% of the population being Below Poverty Line. In 2013 mental health services were integrated
into the community-based primary health programs of (RKM) as part of the Jan Man Swasthya
Pariyojana (JMSP). The programme focused on the treatment needs of people with Common
Mental disorders (CMD), Severe Mental Disorders (SMD) and convulsive epilepsy. At that
time, no psychiatric facility existed in the area in the government or private sector. Psychiatric
patients had to go to Allahabad or Buxar (50-120 km) for treatment. Dr. Amiya Banerjee has
been the Mentor and Consultant psychiatrist for the mental health services at RKM since the
inception of the mental health programme in 2013. In 2018, this programme was further scaled
up to include telemedicine and telepsychiatry services. Dr. Bannerjee regularly conducts onsite
hands-on training for the middle-level team and the doctors, provides his supervision and clinical
expertise for the treatment and clinical monitoring of patients, develops booklets, manuals, and
videos for training along with conceptualizing research design and data analysis for scientific
publication of results and insights gained from the program. The mental health services were
integrated into the 3-tier primary care system, with: the physician being available in-person in
the Mobile Medical Units (MMU) or available virtually at the Telemedicine Units (TMU),
the Community Health Workers (CHW) providing door-to-door coverage, the Middle Level
Team (MLT) working as ‘physician substitutes and trainers of CHWs.
(Source: https://manas.org.in/mansik-soundarya-varanasi/)
19. COMMUNITY BASED MENTAL HEALTH INITIATIVES: The population of India has
crossed the billion marks but the state of services for mental health is yet to make strides with
equal pace. Given the rate of occurrence of major mental disorders being as high as 1-2% the
resultant situation is that there exists a huge gap in supply and demand for mental health
interventions. With the objective of creating access to mental health care and treatment for those
are socially, economically, and geographically marginalized Ashadeep initiated a Psychiatric
OPD in Guwahati in 2006 and undertook outreach mental health camps from 2006-12 in 8
remote regions of Assam including conflict areas such as Chirang, Baksa and Kokrajhar in Bodo
Territory areas. The outreach camps consisted of psychiatric treatment for persons with mental
illness and training of local NGOs who would continue to secure mental health needs for the
community they were serving. The outreach mental health camps have been shaped as
‘Community Mental Health Programmes’ (CMHP) in the year 2012. These programmes include
creating access to mental health interventions and developing sustainable measures for
empowering the community on mental health. During 2012-2016, these programmes were
implemented in one block each in the districts of Darrang, Morigaon, and Kamrup (rural) in
Assam with funding support from the Tata Trusts. A total of 1906 persons in the three blocks had
been intervened through this programme. The major aim of this programme is to facilitate mental
health interventions from the Government Health Care facilities within the block along with
home-based psycho-education by trained Community Health Worker. To sustain these efforts
partnership and capacity building of local Civil Society Organizations and Government Health
delivery systems are undertaken. Currently, the program is implemented in Rangjuli Block of
Goalpara district, Bhurbandha Block of Morigaon District in collaboration with Morigaon
Mahila Mehfil and Chumukedima Block of Dimapur District, Nagaland in collaboration with
Prodigals’ Home. The program is supported by Azim Premji Philanthropic Initiatives Pvt. Ltd.
Bangalore for a period of three years from June’2020.
(Source: https://www.ashadeepindia.org/community-based-mental-health-initiatives/)
20. PROJECT MAANASI -The “Project Maanasi” is a mission to deliver mental health and
primary care services to poor rural women and children in southern India. The goal of the
program has been to provide low cost or free care to villagers, sustained outreach to those who
cannot access the clinic, and educate patients and others about seeking care to improve their
lives.
The Project sets out a number of cost-effective strategies to tackle the treatment gap for mental,
neurological and substance use disorders in rural southern India. These include: screening of
women from villages for psychiatric treatment, bringing treatment near to their homes, bringing
medicine and medical assistance to women with varying degrees of mental illness. The project
relies on partnerships to scale up services with the objective of reducing the burden of mental,
neurological and substance use disorders.
The Project is running under the care of Department of Psychiatry and Community Medicine at
the St. John's Medical College, Bangalore, who provide a dedicated team of doctors under the
leadership and compassionate care of Dr. Ramakrishna Goud, and Dr. Pradeep Johnson of St.
John's Medical College.
In the year 2002, the first “Maanasi Clinic” was established at Mugalur (as the Pilot Project), a
tiny village 30 km outside Bangalore to provide integrated primary health care, depression,
anxiety and other mental health care in the villages nearby. The centre also serves as a centre `for
all community services including a general health clinic, antenatal and postnatal care, childcare,
services for the elderly, and for the blind and deaf. The centre serves more than 30 villages as the
nearest other medical care is 10 km away.
(Source: https://www.projectmaanasi.org/project_maanasi.html)
21.VENDA – Say no to drugs The menace of drug abuse in the younger generation has been
rising all over the world and India is no exception. Addiction to drugs and alcohol not only affect
the individuals involved but also disrupts the family and society. Addictions seem to have
affected all classes of society, and there are no age barriers either. The worst affected are the
adolescents. They use drugs for many reasons: Peer pressure, academic failure, ignorance of the
consequences, curiosity and fun, easy availability of the drugs, stress, lack of communication
with parents, low self-esteem, free money, Depression- the list is endless.
The results of a study done by National Drug Dependence Treatment Centre and the All-India
Institute of Medical Sciences, sites that alcohol, tobacco and inhalants are common initial
substances of abuse and have been described as ‘gateway substances. These substances are easily
available to the children, according to the revelations in the research and are a reason for
concern.
In this context, project Venda empowers the teenagers to say ‘NO’ to substance abuse and help
to rehabilitate addicted and affected teenagers. Project Venda also aims at equipping various
stake holders with information, skill and knowledge to broach and discuss the topic of drugs with
children and young adults. These Partnerships with parents and communities would indeed help
to integrate consistent and relevant messages into the home and society, thus improving the
student health of mind and body.
(Source: https://www.fourthwavefoundation.org/project/venda/)
22.SHRADDHA REHABILITATION FOUNDATION Shraddha Rehabilitation Foundation
was founded in the year 1988, to deal with the tragedy of the mentally ill, destitute wandering
aimlessly
on
the
streets
of
India.
Shraddha does not take in patients brought by family members or whose family antecedents are
known. Shraddha is a fully charitable, secular, social, apolitical and registered Non-Government
Organization (NGO) wherein all the services are provided free of charge.
Shraddha rescues wandering mentally ill destitute, brings them to their institute and provides
them care, food, shelter and appropriate psychiatric treatment. Once psychiatric wellbeing is
achieved (often taking 2-3 months), these destitute are helped in tracing out their antecedents,
from wherein the reunion with the original family and native home takes place in the farthest
corners of India and nearby countries. All these services, from the moment they are rescued from
the streets till the time they are reunited with their families in their native village, are rendered
absolutely free of cost.
Shraddha stands strong proving itself to be a time-tested and a very hopeful humane experiment
in itself, providing treatment, protective care and rehabilitation to a neglected group of
wandering mentally ill roadside destitute and reuniting them with their lost families (loved ones)
and correspondingly spreading awareness in the farthest corners of India. This model has
spearheaded more than 9,000 reunions and seems to be capable of replication at a national level
vide shelters run by government and NGOs, addressing the very much existent issue of
homeless destitute roaming around aimlessly on the streets of India and other neighbouring
countries as well.
(Source: https://www.shraddharehabilitationfoundation.org/)
Our journey through CHLP project .Finding Thrust areas of DMHP
PLANNING PHASE
Planning to initiate Community Mental Health Project
Prepared and studied upon the initiatives and various activities that come under District
Mental Health Programs.
Spoke to various NGOs (SHAMA, Masjid one, BIRDS) for providing volunteers for the
Community Mental Health Project.
Visited PHC Kodigehalli as part of the Community Mental Health Project.
Created poster as part of Community Mental Health care.
Created letters to BBMP Kodigehalli, Health Officer Yelahanka and also to The MLA
Sri. Krishna Byre Gowda based on assistance like volunteers, food kits etc.
18.07.2022- Dr. Safiya held a meeting with the staff of the organization on how to
proceed with the NGO activities and staff presented their opinions and suggestions.
19.07.2022- Spoke with various NGO personnel on how to go forward with the
community mental health program.
20.07.2022- Dr. Safiya M.S (Psychiatrist) and Mr. Allen A. Marattil (Psycho- Social
Worker) visited MLA Sri. Krishna Byre Gowda’s office to get the support from Asha
workers and link workers, to identify the people with mental illness from the
communities. MLA also gave permission to collect food kits from Indira Canteen.
20.07.2022- Dr. Safiya M.S (Psychiatrist) and Mr. Allen A. Marattil (Psycho- Social
Worker) have met the Health Officer in PHC Kodigehalli. The Health Officer agreed to
provide five Asha workers and one link worker for the Community Mental Health
Project.
Photos of Meeting with Health Officer in the PHC, Kodigehalli
22.07.2022- Dr. Safiya M.S (Psychiatrist) and Mr. Allen A. Marattil (Psycho- Social
Worker) met MLA Sri. S.R Vishwanath informed him about the Community Mental
Health Project to identify the people with mental illness from the communities. Also, the
team got permission to do the projects in the various Wards of Yelahanka.
Photos of Meeting with the MLA Sri. S.R Vishwanath
ü 28-07-2022- Dr. Safiya M.S (Psychiatrist) and Mr. Allen A. Marattil (Psycho- Social
Worker) met Dr. Lakshmi in Kodigehalli PHC for discussing about the Community
Mental Health project. In this meeting, it was proposed that the first training program for
the ASHA workers will be commenced from 3rd August 2022 (Wednesday). The venue of
the training will be the top floor of Urban Public Health Center Kodigehalli.
Photos of Meeting with Dr. Lakshmi in the PHC Kodigehalli
29-07-2022-Prepared the tentative plan for the Community Mental Health Project of
Mind and Brain Hospital.
05-08-2022- Conducted a meeting with Mr. Mani Kalliyath from BNI on a Community
mental health project.
08-08-2022- Conducted an online zoom meeting with Dr. Johann Ebenezer from Padhar
hospital regarding his experience while carrying out the community mental health
project. Also, the Mind and Brain Charitable trust received permission from Dr. Johan in
using the outcome tool and screening tool which was used for the Shifa project.
10-08-2022- Dr. Safiya M.S(Psychiatrist) and Mr. Allen A. Marattil (Psycho-Social
Worker) visited the PHC Kodigehalli for training purposes of ASHA Workers. The
training session for ASHA Workers was started at 10.00 on 10.08.2022 in the PHC
Kodigehalli. The keynote speaker of the session was Dr. Safiya M.S. Almost six ASHA
Workers, two nurses and the Health Inspecting Officer of the PHC participated in the
training session. During the meeting the major focus was given to the concept of Mental
illness.
01-09-2022- As part of the community mental health project, first case was referred to
Mind and Brain Hospital by the Kodigehalli PHC. The name of the client was Mr.
Mallika Arjun and Mr. Allen A. Marattil (Psycho-Social Worker) along with Ms.
Ruquiya Jabeen (Psychologist) took the case history from the client. Dr. Sony
(Psychiatrist) wrote the prescription for the client and Dr. Safiya verified and went
through the whole case as well as the prescriptions.
06-09-2022-Converted the Padhar hospital’s screening tool and outcome evaluation tool
from English to Kannada for the purpose of understanding among Kannada speaking
villagers and ASHA workers.
07-09-2022- Dr. Safiya M.S (Psychiatrist) and Mr. Allen A. Marattil (Psycho- Social
Worker) met Dr. Lakshmi in Kodigehalli PHC to discuss the Community Mental Health
project. In this meeting, Dr. Safiya discussed how to connect towards the traditional/
spiritual healers. The major reason for the discussion was that many people with mental
illness are being taken to the spiritual healers rather than to the psychiatric hospitals.
While doing so, the mental stability of the patients is getting worst day by day and the
chances of suicides are also high. Dr. Safiya put forward that she will be able to train
these spiritual healers and one intervention model will also be taught to these spiritual
healers to responsibly take care of the mentally ill cases that are coming to them.
ACTION PHASE
07-09-2022 – As part of the Community mental health Dr. Safiya, Mr. Allen along with
Mrs. Uma (staff of PHC) visited one of the villages near to the Kodigehalli PHC. In the
visit the team identified two cases with mental illness.
07-09-2022 – As part of taking case history Ms. Ruquiya (Psychologist) and Mr. Allen
(Psycho-social worker) from Mind and Brain hospital visited a house near to the PHC,
Kodigehalli. The informant of the case was Mr. Viswanath (husband of the patient). All
the concerned information about the client was taken from the husband and the neighbors
also gave their input into the same.
08-09-2022- Ms. Ruquiya (Psychologist) and Mr. Allen (Psycho-social worker) from
Mind and Brain hospital visited the PHC, Kodigehalli for preparing the list of psychiatric
medicines that are available in the PHC.
15-09-2022- Dr. Safiya and Mr. Allen have gone to the PHC Kodigehalli to meet the
staffs to make a plan of actions for the mentally ill people who are under the PHC. Dr.
Safiya also asked the help from the PHC for identifying the spiritual leaders related to
mental health.
16-09-2022 – Mr. Allen A. Marattil (Psycho Social Worker) along with Mrs. Kusumam
and Mrs. Uma visited the villages under the Kodigehalli PHC for the purpose of
collecting the data of the people who are having mental illness.
27-09-2022 – Mr. Allen A. Marattil (Psycho Social Worker) along with Ms. Ruquiya
(Psychologist) visited the villages under the Kodigehalli PHC for the purpose of
collecting the data of the people who are having mental illness.
15.11.2022- In collaboration with PHC Kodigehalli, Dr. Safiya initiated the medicine
distribution camp for the caregivers of the patients. So, the patients along with the
caregivers came to the PHC for taking the medicine and some of the cases were also
referred to the mind and brain hospital.
Challenges:
·
·
·
·
Lack of medicines in the PHC
Unwilling attitude of the patients to come to PHC
Stigma associated with the psychiatric medications
Lack of hope from the family members
Case history
1. Priya
SOCIO-DEMOGRAPHIC DETAILS
Name : Priya
Sex : Female
Age : 25
Education : 10th grade
Occupation :Homemaker
Address : Oil Mill Road, Bangalore
Socio-economic status : Middle class
Religion : Hindu
Mother Tongue : Tamil
Languages Known : Tamil, Kannada, Telugu, English
Presenting Complaints
● Feels lonely and feels like being enclosed in jail
● Feels sad almost all the time
● Missing her children
● No one is supporting me
The onset of Illness :
The course of Illness :
Progress of Illness :
Predisposing Factors :
Precipitating Factors :
Perpetuating factors :
History of present Illness
The patient had conflicts with her husband two weeks back and decided to go to a
friend’s room to stay away from him. She had not reported the same to her husband or
any other family members. After a while when the family realized she was missing they
informed the police station. The official on receiving the complaint contacted the
individual she has been suspectedly having an extra marital affair with. On searching his
phone, as the officials found photographs of her with him, they asked him to contact her
on which he did. After talking to the police officials she returned to her home and went
with her husband’s family. Reportedly none of her family members behaved harshly with
her post the incident. But as the family members left the house without her for dinner, she
had a suicidal tendency. She attempted suicide by hanging herself and fell unconscious.
She was taken to hospital by her family members and was in the hospital for a week.
After her discharge from the hospital, in the pretext of an interview her cousin sister
brought the patient to the hospital.
Negative History
No h/o crying spells, significant weight loss
No h/o increased talk, tall claims, overfamiliarity
No h/o multiple, variable physical symptoms, additional subjective symptoms referred to
a specific organ or system
No h/o repetitive behaviours like washing hands, changing clothes, counting
No h/o of head injury, substance abuse
No h/o Fever, Hypertension, Diabetics
Past Psychiatric History : nil
Medical History : nil
Family History and Family Genogram
The patient belongs to a nuclear family with a mother and a younger brother. The
patient’s father left her mother when she was 6 years old. Later she remarried her love
interest. He used to sexually harass the patient. But the patient did not report it to her
mother as she thought she would not be believed by anyone. Later on after a few years a
case was filed against him following which he left the house. The patient and her family
then learned that he died by suicide. The patient reported that her mother does not share
anything with her nor does she share anything with her mother. The patient is more
closely attached to her younger brother with whom she shares everything.
Consanguinity : No
Type of family : Nuclear
Family History with any problems : nil
Birth and Development History : Normal delivery.
Developmental milestones were attained as per the knowledge of the patient
Child and Adolescent History
History of Hyperactivity : nil
History of conduct problems :nil
Educational History
The patient completed her education till 7th in Bangalore and later in 8th grade moved to
Tumkur to continue her education. The patient completed her 9th and 10th via
correspondence and later had to discontinue her education as her mother did not permit.
The patient also mentioned her interest in wanting to complete her education.
Sexual history
The patient reported having faced sexual harassment from her step father from the age of
5 till the age of 14. He used to forcefully make her watch pornography and touch her
inappropriately. The patient reported that her husband after being intoxicated with
alcohol forces her to indulge in sexual activities. She reported that she lost interest in
sexual activity during her second pregnancy. She stated that her husband constantly
doubts she is in a relationship with someone and therefore she lost interest. Although the
first child was planned, the second child was conceived when the husband forcefully had
intercourse with the wife.
Menstrual History
The patient attained menarche at the age of 10. The patient mentioned that she does not
face any particular mood changes or difficulties during her cycle. Her menstrual cycles
are normal.
The patient reported her last menstrual cycle as 20th February, 2022.
Marital History
The patient was in a relationship with her husband for one and a half years before the
wedding. They had met at work. The patient reported her marital life as unhappy. The
husband is an alcoholic and often comes home drunk and physically and sexually abuses
her. The patient also reported instances where the husband has urinated in his clothes
after being intoxicated by alcohol. The husband is often at home except for two weeks a
month when he has to travel regarding work. The patient reported that when the husband
is in a sober state, he doesn't talk much. She also mentioned that there have been
instances where she was asked to leave the house and she had to go to her mother’s place.
The patient also accepted having an extra marital relationship with a neighbor. She has
known him for three years and has been in a relationship with him for the past six
months.
History of psychoactive substance usage : No history of psychoactive substance usage
Premorbid Personality :
Attitude towards others :
Attitude towards self :
Moral and Religious attitudes and standards : Moderately religious
Leisure activities and interests: Interested in doing embroidery works and watching
television whenever the client used to be free at home.
Reaction patterns to stress : Vents out by crying or reacting back in the same manner as
the stressor does if it's a human figure.
EXAMINATION OF HIGHER MENTAL FUNCTIONS
Attention and concentration
Serial test :100-7=93,86,79,62,55,48,31,24,17 -Incorrect
40-3 = 37,34,31,28,25,22,19,16,13,10,7,4,1 -Incorrect
Week days or months backwards -Done
Impression -Easily aroused and sustained
Orientation : Oriented to place, time, person, date/day
Memory
Immediate : Digit span intact
Recent :Intact
Remote :Intact
Abstractability :
Proverb: “All that glitters is not gold”, the patient couldn’t explain the proverb.
Similarities: “Table and chair”, the patient couldn’t explain the proverb.
Differences: “Fly and Butterfly”, the patient couldn’t explain the proverb.
Impression : Concrete level
Judgment : Personal , social, and test intact
General Knowledge : Name of the capital/Chief minister/Father of our nation – Name of
the capital and father of our nation not answered.
Impression : Adequate
MENTAL STATUS EXAMINATION [31/03/2022]
GENERAL APPEARANCE AND BEHAVIOR
Consciousness : Alert and Awake
Eye contact : Maintained
Rapport : Easily established and maintained
General appearance : Well-kept and tidy
Hair : Well groomed
Finger nails : Well maintained
Grooming : Well groomed
Dressing : Appropriate
Comprehension : Intact
Gait and posture : Normal gait
Attitude towards examiner : Cooperative
Motor Behaviour : Within normal limits
Speech and Language Ability
Intensity : Audible
Pitch : Normal fluctuation
Reaction time : Adequate
Speed : Normal
Ease of speech : Spontaneous
Relevance of the speech : Relevant
Coherence : Coherent
Goal direction : Goal directed
Productivity : Adequate
Manner : Relaxed
Deviation : Does not divert conversations in between
Form of Thought : Thoughts were coherent and in flow. No loose associations,
circumstantial or tangential thoughts
Stream of Thought : The tempo of speech is maintained. No flight of ideas, thought
blocking, perseveration or neologisms. The thought processes were relevant to the
questions asked.
Content of Thought : Suicidal ideations mentioned, attempted twice; once in childhood
and the recent incident. The patient also mentioned thoughts of loneliness.
Possession of Thought : No thought insertion, withdrawal or broadcasting
Perceptual Abnormalities : Nil
Mood : Feels lonely, low mood
Affect : Blunted
Insight : Level I - Complete denial of illness
2. Asmataj
A. Identification
1. Name: Asmataj
2. Sex: Female
3. Age: 29
4. Education:
5. Languages Spoken: Hindi
6. Religion: Muslim
7. Nationality: Indian
8. Marital status: Married (With three children). First child in 2005 after 2004 (Year of
marriage).
9. Occupation: Housewife and Tailor (entrepreneur)
10. Referral: ----11. Previous admission: NIMHANS (84 IQ borderline)
12. Person’s living with client: Husband and children.
B. Chief Complaints
1. Presenting Complaints: Family complaints of violent beating and talking to walls.
2. Informant: Husband
C. History of Present Illness
1. Onset (with life circumstances): Acute Patient seemed to have a very wholesome and
peaceful life with family. About 3 years ago, patient left home with money and had
disappeared for about 8 days and when found had a drastic change in personality.
2. Progress: Continuous (mostly, patient has some periods of normalcy but never regains
Pre-Morbid personality)
3. Precipitating Factors: Questions about patient's behaviour triggers violence and
outrage.
4. Perpetuating factors: Insomnia. Eats only once a day and throws away food even then
(Doesn’t respond when asked about the taste of her daughter's cooking.). Refuses to take
medicine.
5. Predisposing Factors: The patient's grandmother had similar symptoms. Disappeared
for more than a week.
6. Pre-Morbid Personality (subsequent changes due to illness also): Devoted to family,
loving, religious, introverted, doesn’t talk to people. Had minor arguments with husband.
Concerned about kids' futures. Industrious (tailoring work). Drives on her own. Didn’t
hide things from husband.
7. Psychophysiological symptoms:
a. Nature and details of dysfunction: Some hand tremors at times. Reports of limbs,
organs (kidneys) and hair not her own. “This is not my hair? Where are my
kidneys? You sold them right? This is not my hair.” Later shaved her head. Son
reported moist hands at times. Patient was reported to be very restless. Couldn’t
and didn’t sleep without pills. Woke up family members when they tried to sleep.
b. Pain location, intensity and fluctuation: Severe and constant headaches, usually at
frontal lobe area.
8. Level of anxiety: Seems to be episodic. (from informants viewpoint)
9. Anxiety handling: Commits violence and cries frequently. Repeats same event.
10. Use of drugs or other activities for alleviation: Talks to walls as if she’s talking to real
people she knows. (Family members)
D. Past Psychiatric and Medical History
1. Emotional or mental disturbances: Admitted at NIMHANS for 4-5 days. Attacked
doctor. Later discharged. Took only 2 days of medicine. Illness now prevalent for 3 years
since 2019.
2. Psychosomatic disorders:
3. Medical conditions:
4. Neurological disorders: Severe and frequent headaches. Son reports bump on patients
head.
E. Family History:
1. Ethnic traditions: Normal.
2. Religious traditions: Namaz
3. National traditions: Normal.
4. Descriptions of other people in home:
Members of home
Husband
Descriptions
Personality
Thin and average
Agreeable
height. Has a pepper personality. Very
salt beard.
cooperative and
open.
Intelligence
At least average
intelligence
Eldest son
(17)
Thin and
lanky boy
with a
mature air.
Composed,
agreeable.
At least average
intelligence
Middle
brother (16)
Thin and
lanky boy.
Q little shy
At least
average
Shy and
cooperative
Youngest
daughter
Thin and
average
Shy and
cheerful.
(15)
height.
Affectionate
to mother.
Responsible
5. Role of illness in family: Husband sometimes hits wife in anger.
intelligence
At least
average
intelligence
Family history of mental illness: Patients grandmother reported to have similar
symptoms.
6. Where patient lives: at home, crowded space, single room for sleep, socializing, and
kitchen.
7. Sources of family income: Husband works. Patient used to work as a tailor and even
travelled to Saudi for nearly a year working as a house helper, to secure her patients
future (after returning complained of bad treatment by women and good treatment by
men).
8. Child care arrangements: Patient used to take care of children before incident 3 years
ago.
F. Personal History (Patient uncooperative and unwilling to continue case history,
husband has no knowledge of patients early and middle childhood life before
marriage)
1. Adulthood
a. Occupational history: Housewife, tailor and house helper (Went abroad to work in
2015).
b. Social activity: Limited to only family. Little to no communication with
neighbours.
c. Adult sexuality
1) Premarital sexual relationships: No info.
2) Marital history: Husband reported no problems.
3) Sexual symptoms: None
4) Attitude towards pregnancy, children and contraceptives: Positive.
5) Sexual practices: None.
d. Military history: None.
e. Value systems: Positive value system. Children are a joy.
Mental Status Examination
A. Appearance
1. Personal Identification: Initially cooperative but unwilling to respond and turning
disinterested once questions began to take effort or invade privacy.
2. Behaviour and Psychomotor activity: Preferred to remain lying down to answer
questions. Kept glancing down or turning away from facing the examiner. Expressed
hostility to husband in tone, facial expression and gaze.
3. General Description: Looked apathetic and slightly irritated. Usually good eye contact
except when trying to avoid answering questions
B. Speech
1. Volume: Low
2. Tone: Soft
3. Pace: Normal
4. Quality: Hesitant (almost mumbling)
5. Intensity: Soft but turns intense when speaking to husband
6. Reaction Time: Normal
C. Mood and Affect
1. Mood: Reported as normal.
2. Affect: Apathetic, disinterested and anxious to go home.
3. Leisure: None.
D. Thinking and Perception
1. Form of Thinking:
a. Productivity: Speaks only when asked. (May not answer)
b. Continuity of thought: Evasive
c. Language Impairments: None. Dysarthria absent.
2. Content of thinking
a. Preoccupations about the illness: Wishes to go home
b. Obsessions, compulsions, phobias: Wears men’s clothes.
c. Obsessions or plans about suicide and/or homicide:
d. Hypochondriacal symptoms: Hits and beats people (family and strangers).
Burns bikes, things and her own clothes. Attacked husband with knife as well.
Breaks phones and kids gadgets. Talks angrily. Leaves home and turns phone
off if not supervised so kids have to stay home and can’t go to school.
3. Thought Disturbances
a. Delusions: Claims her family is not her own. Fails to recognise family
members. Is suspicious of the family's intentions. Suspects husband sold her
kidneys. Becomes physically hostile when questioned.
b. Ideas of reference and ideas of influence:
c. Thought broadcasting:
d. Thought insertion:
4. Perceptual Disturbances:
a. Hallucinations and illusions: Talks to the wall. Calls names of brother, parents
etc.
b. Depersonalization and Derealization: Asks if body parts are her own. Claims
her limbs are not hers.
5. Dreams and Fantasies: -----a. Dreams:
b. Fantasies:
E. Sensorium
1. Alertness: Seemed to be lucid and aware.
2. Orientation:
a. Time: Aware of the time period of day but not exact time.
b. Place: Knew general place as hospital but not area.
c. Person: Knew herself and her family members.
3. Concentration and Calculation: Gave up calculation because of fatigue after one
calculation. 100-7=93. Misheard questions at first as 100-70= 30.
4. Memory: Uncooperative.
a. Remote memory:
b. Recent past memory:
c. Recent memory:
d. Immediate recollection and recall
e. Effect of defect on patient:
5. Fund of Knowledge: ----a. Level of functioning:
b. General knowledge:
6. Abstract Thinking: ---7. Insight: Complete Denial. Evasive, does not respond to relevant questions.
8. Judgment: ------a. Social judgment:
b. Test judgment:
3. Sana Zainab
1. General Information
Name – Sana Zainab
Sex – Female
Age – 14 years 2 months
Education – 4 th standard ( English medium )
Language – English, Hindi, Urdu, (can understand Kannada)
Religion – Muslim
Marital Status – unmarried
Informant – Parents
Reliability and Adequacy of information – The information is reliable and
adequate.
2. Presenting complaints –
1. Mobile Addiction
2. Unhealthy attachment with doll from the past one year
3. Negative changes in behavior from the past one month
4. Aggressive behavior from the beginning of May 2022
5. Tearing her own clothes in anger
6. Obsessive thoughts related to pregnancy
7. Inappropriate behavior with the doll from the beginning of May
(breastfeeding the doll)
8. Violent behavior; started hitting parents.
9. Lack of eye contact
10. Associating human factors and emotions with doll
11. Fact checks on YouTube or internet on all aspects of pregnancy
12. Engaged in watching porn or related video
13. Breaking things in anger
3. History of present illness
Total duration of illness –For the past 13 years
Age of onset –2 years
Onset - sub acute
Precipitating factors - psychological in nature
Course of the illness - fluctuating
Associated disturbanceImpairment in ADL
● Sleep
She has problems sleeping, and has an irregular pattern of sleep. During her
schooling she followed a schedule to sleep and wake up. She mostly has 7-8 hours
of sleep. Before sleeping she stays awake for 1 ½ - 2 hours and repeats what she
had seen on her phone and TV to herself.
● Appetite
Increase in appetite since she has started taking psychiatric medicines.
● Weight
Her weight is 92 kgs and is considered as overweight for her age.
● Social life
Doesn’t stay in touch with her friends. Isn't allowed to leave her home.
● Negative history
Had a fever at the age of 1
4. Past history
● Past physical illness - she was diagnosed with PCOS in February
2022.
● Psychiatry illness - she was diagnosed with ASD and ADHD in
2012.
5. Family history
She is the older of the two children, born of a non consanguineous marriage. Her
younger brother is 12 years old. Father has had a basic formal education and is a
businessman. Mother is an educated housewife. Theirs is a nuclear family. Mother
tongue is Urdu.
6. Personal history
Birth history
Mother had history of 2 miscarriages, has a diagnosis of PCOS before the
conception of the patient. Was on bed rest for the entire pregnancy, had undergone
cervical stitch on the 6 th month of pregnancy. She had gestational diabetes, high
blood pressure and high sugar level for the entire pregnancy. In the 8 th month 1
week, the baby was taken out through cesarean and had a birth weight of 2.2 kg.
The patient had no fever, had normal skin tone during birth, had immediate cry and
had a history of jaundice which was treated appropriately. Post delivery the mother
was admitted to ICU for 3 days and breastfed there. The patient was breastfed for 1
year and 9 months.
Developmental milestone
The patient started walking after the age of 1. Started babbling between the age of
3 and 4. Started walking at the age of 6 years, but has difficulty in speaking in full
sentences.
Behavior during childhood
She had tantrums. Parents were scared to take her anywhere. Used to cry when she
didn’t get the things that she wanted and broke things at home. She had the habit of
bedwetting until the age of 10. She had no issue with mingling with kids of her
own age, did not get into a fight with them, had healthy competition with them.
She was a good student and used to listen to her teachers but was unable to sit in
one place in school.
Physical illness during childhood Didnt have physical illness during childhood and had one occasion of a fever at
the age of 1 and was treated for it.
School -
She has studied till 4th class. She was regarded as a student with potential to do better
according to her teachers. Couldnt sit in one place for a long period of time throughout
her school life and due to extreme issues with distractibility her parents couldn’t continue
her education through the means of online class due to covid19.
Menstrual history She got her periods in 2018. For 2 and half years there were no problems with her
menstruation and had problems from September 2021, as her psychiatric medicines were
started from then. After which she gained weight and had irregular periods. She was
diagnosed with bilateral polycystic ovary in February 2022. She has painful cramps for
which she has meftal spas. She has heavy flow throughout her periods. Her menstrual
cycle usually lasts for 5 days.
7. Premorbid personality
Attitude to othersShe was good to her brother but the past 1 year has been hostile towards him. Has always
bet her parents in anger.
Attitude to self Wasnt much interested with pregnancy related things earlier on.
Moral and religious attitudesShe had the habit of praying everyday and could remember Quran verses.
Mood –
Was always adamant about things she wanted. Liked to maintain conversation about her
favorite topics.
Leisure activity and interests –
She liked to color, do embroidery, cycling, dancing, singing and painting.
Fantasy life Wanted to be a director. Wanted to be a doctor who does scanning for babies in
womb. Wanted to be married and have 1 kid.
Reaction pattern to stress –
Becomes aggressive when stressed, breaks things in anger, had the habit of kicking on
things near her and cries when overwhelmed.
Habits –
Had selfcare habits and reading habits.
4. Mallika Arjunan
PERSONAL DETAILS
Name: Mallika Arjunan
Address: Kariyanna Layout, Hebbal Kempepura, Bangalore – 560024
Age: 32
Phone no.: 9019096002
Marital status: Single
Siblings: Five
Educational qualification: SSLC Failed
PROBLEMATIC AREAS
Repetitive thoughts and images.
Anxiety and fear (Fear of hitting by someone)
Consumes alcohol to overcome the fear
5 to 10 years he is undergoing the fear and anxiety
Past 10 years he is not going to work because of this anxiety and fear
Not able to sleep properly
Past 10 years he is consuming alcohol
Sexual thoughts towards ladies after seeing them
Appetite is not proper
Suicidal thoughts occur
Tried to commit suicide by lying on a railway track
PRESCRIPTION
5. Kalpana
Name: Kalpana
Sex: Female
Age: 37
Education: 5th grade dropout
Languages Spoken: Tamil and Hindi
Religion: Christian
Marital Status: Married
Informant: Husband
Reliability and Adequacy of Information: The information provided was reliable but not
adequate.
Presenting Complaints: (15 years)
• Poor hygiene
• Irregular appetite
• Insomnia
• Self-medication
• Excessive caffeine intake
• Overdosing medication
• Violent outbursts
• Manic episode
History of Present Illness: Detailed and Coherent Account of the Symptoms from the
Onset to the time of Consultation.
• Onset: Sudden onset
• Precipitating Factors: Psychological in Nature
• Course of the Illness: Continuous
• Associated Disturbance: Impairment in ADL (Sleep, Appetite, Sexual Life, Social Life,
Occupation)
• Negative History: Has High blood pressure
Past History: Absence of physical illness, Psychiatric illness (Yet to be diagnosed)
Family History: Husband is a fruit merchant and had lost his eyesight in 2011.
Personal History:
• Birth and Early Development: Normal; no delay in milestones
• Behaviour During Childhood: Normal
• Physical Illness During Childhood: None
• School: Dropped out after 5th standard
• Occupation: Unemployed
• Menstrual History: Normal
• Sexual History: Not sexually active
• Marital History: The patient has been married for 22 years. The patient is violent
towards her husband and her children.
• Substance Abuse: Has the habit of excessive consumption of over-the-counter
medication (Vicks action 500)
Premorbid Personality:
• Attitudes to Others: She used to mingle with everyone and had a healthy martial
relationship. She was a caring mother and used to love spending time at home.
• Attitude to Self: Self-destructive (Self-medicates and overdoses the said medication)
• Moral And Religious Attitudes and Standards: The patient does not follow rituals or
attend any religious gatherings.
• Mood: Normal
• Leisure Activities and Interests: None
• Fantasy Life: None
Diagnosis: Schizophrenia.
Summary:
The patient was unkempt, lacked personal hygiene, aggressive and violent on arrival. The
symptoms were first observed in 2007 where her behavior suddenly turned aggressive
and this was when she started overdosing on over-the-counter medication. She was also
prescribed medication for her condition in NIMHANS. She consumed the prescribed as
well as unprescribed drugs. After consuming her behavior turns out to be short-tempered
and violent and attacks the people around her. She abuses her family physically and
verbally. She has anxiety and gets aggressive if she notices her family as she feels that
they are following her, to spy on her. She possibly had a manic episode on her mother’s
death where she did not cry but instead laughed loudly and uncontrollably. In 2016 she
was admitted to Home, Indiranagar for 6 months where she was physically abused by the
staff. She was also on a different occasion physically abused by 5 transgender people on
the road when she accused them of talking about her. After all this she started going out
at odd hours and returned home at 1:00 am. She watches TV the whole night without
sleeping. Recently she was taken to Charitable medical Centre who then referred this
organization for further treatment.
Plan of action
• Medication
• Psychotherapy (could not be initiated as the patient was uncooperative and aggressive,
rapport could not be established)
Treatment Plan
Injections were induced for starting four consecutive days continuously in order to reduce
the aggression.
• Injection Lorazepam, Haloperidol and Phenergan
After 4 days medication was induced and injection was induced on need basis.
• Syrup Oprex and Risnia
After 14-15 days tablets were given.
• Tablet Olanate 20 mg
• Tablet Oprex 20 mg
After 15 days of admission the patient was diagnosed with Hepatitis-B.
6. Bhagya Lakshmi
PERSONAL DETAILS
Name: Bhagya Lakshmi
Age: 46 years
Educational qualification: 9 th standard
Address: Near to PHC Kodigehalli, Bangalore
Pincode: 560092
Marital status: Married
Mobile Number: 9620035618
PROBLEMATIC AREAS
Wandering
Forgetfulness
Self-talk
Aggression
Appetite and sleep are not regular
Poor hygiene
Low eye contact
OCCUPATIONAL HISTORY
Six years before she had quit her job from Columbia Asia Hospital.
PERCEPTION
Her husband suspect that something might have happened to her in the work
place.
7. Gayatri
PERSONAL DETAILS
Name: Gayatri
Address: Near to PHC Kodigehalli, Bangalore, Pincode: 560092
Age: 18
Phone no.: 8217396926
Marital status: Single
Siblings: One
Educational qualification: Nil
PROBLEMATIC AREAS
Large head because of excess amount of water
The shunt inside the head is not functioning properly
Fluctuations in behavior
Sleep is not proper
8. Guru Raj
PERSONAL DETAILS
Name: Guru Raj
Age: 50 years
Educational qualification: 7 th standard
Address: Near to PHC Kodigehalli, Bangalore, Pincode: 560092
Marital status: Unmarried
Mobile Number: 8884209164
PROBLEMATIC AREAS
●
●
●
●
●
Self-talk
Does not do the work which is allotted by others
Aggression
Wandering around the house
Poor hygiene
MEDICAL HISTORY
● He was treated in NIMHANS for a duration of 15 years.
● The family members had to give small punishments to him especially
● during covid to control his misbehaviours.
9. Suhas
PERSONAL DETAILS
Name: Suhas
Address: Near to PHC Kodigehalli
Bangalore
Pincode: 560092
Age: 10
Phone no.: Marital status: Single
Siblings: One
Educational qualification: 7
PROBLEMATIC AREAS
● The first Seizure attack occurred when Suhas was one year old.
● With the help of medication the seizure attack was controlled but three
● months back it occurred again.
10. Vinod
PERSONAL DETAILS
Name: Vinod
Address: Near to PHC Kodigehalli, Bangalore
Pincode: 560092
Age: 27
Phone no.: Marital status: Single
Siblings: One
Educational qualification: PUC
PROBLEMATIC AREAS
● From six year onwards he was paralyzed
● Experienced seizure attacks from childhood
● The level of aggression is very high
11. Dhanush
PERSONAL DETAILS
Name: Dhanush
Address: Near to PHC Kodigehalli
Bangalore
Pincode: 560092
Age: 5
Phone no.: 9964829579
Marital status: Single
Siblings: One
Educational qualification: Nil
PROBLEMATIC AREAS
● No proper growth of brain
● No proper eye contact
● Discontinued the treatment due to financial issues
12. Yahon
PERSONAL DETAILS
Name: Yahon
Address: Near to PHC Kodigehalli, Bangalore
Pincode: 560092
Age: 2
Phone no.: 9964829579
Marital status: Single
Siblings: One
Educational qualification: Nil
PROBLEMATIC AREAS
● No proper growth of brain
● No proper eye contact
● Discontinued the treatment due to financial issues
13. Sathish (Antiha’s brother)
PERSONAL DETAILS
Name: Sathish (Anitha’s brother)
Address: Near to PHC, Kodigehalli, Bangalore
Pincode: 560092
Age: 57 years
Marital status: Single
Siblings: 2
Educational qualification: SSLC Failed
PROBLEMATIC AREAS
●
●
●
●
●
Aggressive traits
Wandering around
Fear
Aloof
Constantly searching
(NB: Could not continue treatment due to family reasons)
Three follow up sessions were given to all the patients.
Home visits were done.
Medications were initiated.
Family therapy was given
Group sessions were organized.
REFLECTION:
The problem is not the accessibility, but the acceptability.
Hence, to improve the accessibility, we have initiated with NIMHANS to improve the
community acceptability regarding mental health illness.
LOCAL PROBLEMS, LOCAL SOLUTIONS
Area of interest: to improve community participation, increase the acceptability of the treatment
of the mentally ill, and reduce stigma.
Research question: Will community participation reduce stigma?
Potential resources: psychiatrist, psychologist, nurse, driver, and social worker.
Supervisors: Under discussion
Weekly one-on-one visits for case identification, diagnosis, documentation, psychosocial
intervention, family therapy, and follow-up.
Follow-up plans: If the patients come to the Dargah for the follow-up, the follow-up will be done
in the Dargah itself. If the patients do not come to the Dargah, the follow-up will be done
through phone calls. In case the patients do not have phone facilities at home, the follow-up will
be done through ASHA workers or Masjid Imams.
Target area: Chintamani-Murmalla Dargah
Beneficiaries: People who predominately seek faith-based treatment.
Outline of the research: To address the global challenge of mental illness within the local
context. The prayer treatment model offers a unique opportunity to blend faith and medicine. It
allows for medical practitioners and religious leaders to work alongside each other to find viable
solutions to help those in need of mental health care.
We want to conduct a prospective, impact-based study. A sample will be collected from the
patients attending Dargah. Medications will be prescribed as per the diagnosis. The Quran will
serve as a foundation for the DUWA aspect. A few simple Quranic verses will be used for
supportive psychotherapy, cognitive therapy, and the grounding technique model.
The objective is to improve community participation and increase the acceptability of the
treatment of the mentally ill. The planned activities are to strengthen the rapport, complete
clinical assessments, track progress, and evaluate the impact of the therapy with and without it.
We are expecting the compliance to be better and reduce the dropout rate. The outcome at the
community level is to reduce the barrier to accessibility for treatment and increase acceptability.
Better follow-up, better compliance, reduced stigma, the reference of other patients, early
identification and early intervention, psycho-social rehabilitation, and the prevention of
complications due to untreated illness are the main indicators of effective intervention.
Our motive is to work towards proper documentation and future publications to facilitate
replications of the model by preparing booklets and training other prayer places and communities
to overcome the stigma.
BUDGET
SN
Item head
One Year (In Indian Rupees)
1. Staff
Social worker
300000
2. Non recurring
(equipment)
Computer/ accessories,
printer, phone, software for
analysis
50000
3. Contigencies
Stationary etc
50,000
4. Travel
Travel expenses for Local
panchayats, investigator and
Research staff travel to
Research site
1,00,000
5. Overhead
5% Institute overhead charges 25000
Grand total
Note: Payment can be done in 3 times installments.
5,25,000
Budget Requirements Breakup
Full justification
1
Social worker
The proposed study will be conducted
across the community. Research staff
will go to the community to meet
stakeholders and conduct individual
interviews and focus group
discussions. Here, the research staff
will identify all persons disabled in
mental health conditions (PDMHC)
due to mental illness (MI) or
intellectual disability (ID) in each
panchayat through the key informant
method. The research staff will
provide support in the coordination,
assessments, data collection, and
analysis of the research project
2
Nonrecurring (equipment)
Computers and accessories, storage,
phones, software for analysis, one
computer for staff (a research fellow),
who will be working with computers
on review, developing interview
schedules, qualitative data collection,
and analysis
3
Contingencies
Stationery, and the research staff to get
training in qualitative analysis, the
process of systematic review, and
ethical considerations in research.
They can attend workshops and
training programs during the project
period.
4
Travel
The research team will be travelling
across the community for permission,
data collection, and intervention
delivery.
- Media
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