Gururaghavendra - Final edited learning report of my fellowship - 15th April 2014.pdf · Community Health

Gururaghavendra - Final edited learning report of my fellowship - 15th April 2014.pdf

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extracted text: My learning report – Fellowship program 2013-14
Acknowledgements
I would like to thank SOCHARA and BNI for providing me this opportunity. Indeed
the fellowship program was a unique and great experience which supported me to
learn and understand the concept of community health/public health. I would like to
extend my special thanks to BNI Trustees Dr. Rajaram, Mr. Ramachandran, Ms.
Mallika, Dr. Thelma, Vandana and Dr. Mani Kalliath.
I would like to thank the contributors for my learning; SOCHARA team members,
special thanks to Dr. Ravi Narayan who was my mentor, all the SOCHARA team
members Chander, Prasanna, Aditya, Dr. Yuvaraj, Karthik, Shani, Prahlad, Swamy
and Mr. Mohammed.
Acknowledgement is also due to the other team members of SOCHARA Maria,
Pushpa, Jospeh, Mathew, Naveen, and Victor who made the fellow’s team to feel
comfortable and for their supportive contribution in organizing logistics.
Thanks are due to the following; Gopinath Director APD, Basayya mental health
coordinator, Santhosh and Bhagirathi for their assistance and support in the data
collection to accomplish my research study.
I would like to express my deep appreciation to the individuals with mental illness,
caregivers, who participated in the study.
Thanks are due to “Sir Ratan tata trust” for funding this fellowship program and
creating opportunity for the young learners to understand community health and put
in to practice..
I would like to appreciate my fellow travellers – Bhimraj, Rouf, Shanti, Ankit,
Pravesh, Rohit, Venkatesh, Ranu Sharma and Shashirekha who made this journey
friendly, group learning and group contributing for each other’s learning. The journey
was joyful and energetic. I still remember few of the field trips together where we
made the visits meaningful and inspiring.
This fellowship program added new dimension in my thought process and approach
towards community mental health and development – “Inclusion of health in all the
development policies and mental health inclusion in all the health policies”.

About me
I am a Social Work professional working in the field of mental health and
development; I have worked in different settings for over 17 years. Worked as
psychiatric Social worker at NIMHANS and having more than 10 years experience in
Community based Rehabilitation for PWMI with Basic Needs India - BNI (Basic Needs

India is a resource organization in Community Mental Health and Development. It
works with partner organizations in 6 states – South India, Orissa and Maharashtra to
implement community based rehabilitation program for people with mental illness).
Facilitating trainings, organizing and coordinating campaigns, workshops and
seminars, conducting Community based Research Activities-Fact findings
(conducting small studies), identifying issues and advocate for it through strategies
like , RTI, Public Hearing , Press meets etc. Program planning, implementation,
monitoring and evaluation through Logical Frame Work Approach (LFA). Facilitating
the formation of Community based organization/federations, Preparation of Project
Proposals, Team building within BNI and with partner organizations are some of my
roles and my specific areas of strengths are training, communication and maintaining
relationship with partners, inter personal relationships and barefoot counseling.
.Why I joined this program
Learning objectives – Fellowship Program
1. Broaden/enhance my knowledge on concepts like Social determinants of health, Alma
Atta declaration, globalization, community and public health and health policies in
India
2. Understanding Primary health care approach in mental health
3. In-depth understanding on networking and advocacy
4. Developing linkages with national level health movements and advocating for the
rights of people with mental illness
5. Learning and sharing knowledge – orienting BNI team and partners on social
determinants and primary health care approach

Learnings from the theoretical sessions
1. What is community?
As a sociology student my academic understanding of community was
The word Community is derived from a Latin word communité means: fellowship,
shared by all or many or community of relations.

Simple definitions
•

People living in one locality-geographical area

•

A group of people having cultural, religious, ethnic, or other similarities

But today my understanding of community is in depth and focussed. As a mental
health professional working in the mental health sector my understanding of my
community is people living with mental illness, families of PWMI, partners and the
staff who are involved in rehabilitation of PWMI and the disability federations who
are advocating for the rights of PWMI are my community.

2. Communitization under NRHM
Communitization means to make health systems and services accountable, for the first
time in India they are brought under PRIs – Sub centre and PHC under Gram
Panchayat, CHC and Taluk Hospitals under Taluk Panchayat and District health
systems under Zilla Parishad. Community participation through village health and
sanitation committee to monitor and implement the health services and if needed
advocating for the health rights through Jan Sunwai’s and Jan Samwad’s.
The concept of communitization under National Rural Health Mission really inspired
me and it triggered the idea of the similar process under District Mental Health
program. I am educating the partners of BNI, disabled federation and PWMI and
families on the process of communitization under DMHP.

3. Difference between Primary health care and primary health
centre
Fellowship program helped me to understand the clear simple difference between 2
PHC’s- primary health centre and primary health care. Primary health centre is one of
the line health systems which cater the treatment services, for every 30,000
populations one primary health centre is established according to the Indian public
health standards. It is the service delivery system of all the national health programs.
Where as the primary health care is the concept of prevention, promotion and
rehabilitation strategies for health and achieving health for all through focusing social
determinants of health. It is a concept and strategy to achieve health for all by Alma
Atta Declaration in the year 1978. Understanding on the 8 components and 4 key
principles of primary health care is very interesting.
The 8 key components of primary health care are:
1.
2.
3.
4.
5.
6.
7.
8.

Education/awareness on prevention and promotion of health
Nutrition
Drinking water and sanitation
RCH/mother and child program
Immunization
Preventive, promotive and curative health care services
Effective treatment
Essential drugs

The 4 principles of Primary health care are:
1.
2.
3.
4.

Equity
Community participation
Appropriate technology
Inter sectoral collaboration

4. In depth understanding on Health systems
Fellowship program also provided me an opportunity to visit and understand the
health systems and service delivery mechanisms. I visited the sub centre, PHC,
District hospitals, Anganwadi, interaction with ASHA. These visits enhanced my
knowledge on role of Anganwadi worker in prevention and promotion of health
through nutrition and RCH program, role of ASHA, Role of ANM and the 3 tier
system under PHC that is sub centre, ASHA and Anganwadi which coordinates and
works in addressing the health needs of the people.
Secondly the health services at the district hospital, district hospital administration
under district surgeon and the role of DHO and the national health programs under
the district health and family welfare officer. In this regard I visited two district
hospitals one at Chikkaballapura and another at Bijapura districts. I visited sub centre,
Anganwadi and interaction with ASHA at Chintamani Taluk Kolar district in
Karnataka.

5. Strengthening District mental health program
As part of the fellowship field program I took the option of placing myself in the
working areas of our partner organization so that the current 3 district level mental
health programs (East Godhavari in Andhra, Thiruvallur in Tamil Nadu and Bijapura
in Karnataka) could be strengthened further. The learnings from the fellowship
program like communitization, the concept of primary health care was linked to
mental health and the same information was disseminated to the partners and the
representatives of disabled federations and the caregivers associations.
This field program enabled me to build the capacities of the partner staff and
stakeholders at the ground. This capacity building process resulted in initiating
advocacy process in all the 3 districts towards treatment services and entitlements.
East Godhavari team submitted a petition to the district Lok Adalat (district grievance
committee) to start medical camps for people with mental illness in their working
blocks and they are following it up. Secondly caregivers association at Bijapura
submitted the memorandum of demands to District collector and the District health
officer and demanding the district authorities to appoint a psychiatrist at the district
hospital, thirdly Thiruvallur district partners together submitted the memorandum of
demands to the district collector and the collector immediately responded to 3 needs.
The first decision was he gave the directions to the District disabled welfare officer to
contact one of the private psychiatrist in the district and directed to organize treatment
services for PWMI, secondly he directed the health department officials to indent the
basic required psychiatric drugs and regular supply of the medicines and thirdly he
also directed the DDRO to issue the ID cards for children with disabilities under Sarva
Shiksha Abhiyan program.

Especially the situation in Bijapura district in Karnataka is very pathetic without the
treatment services even at the district level. The situation in Bijapura and the needs of
PWMI was brought to the notice of the state health officials and very strongly to
Mental Health Task Force a committee formed to study the situation in Karnataka and
recommend the possible options to strengthen the mental health care services in
Karnataka.

6. Networking with District and state officials
During my field visit program and as part of my research study I met district officials
like D.C, DDRO’s, and DHO, District surgeon, Deputy Director mental health services
and the Secretary State mental health Authority and Chairman and members of the
Mental Health task force. All these platforms gave the opportunity to interact and
raise the issues, situations and needs of PWMI and their families and recommended
for the speedy actions. This process also supported in building relationship with the
officials and I was able to link partners, PWMI, caregivers and the disability forums
with the concerned district officials towards follow up. DHO of the Bijapura district
has assured that within 3 months he will see that a psychiatrist is deputed to district
hospital. He also said the basic required psychiatric drugs will be indented and
supplied at all the block hospitals of Bijapura. Deputy Director mental health said they
have deputed one medical officer to NIMHANS to undergo psychiatric training and
immediately after the completion of the course he will be deputed to Bijapura hospital.

7. Research
During the one year fellowship program one of the important components was
research. A small research study on the situations of PWMI in Bijapura and
Chikkaballapura was undertaken and this process helped in learning basic skills in
research like identifying the study area, framing interview schedule, objectives and
the methodology. This study helped in understanding the situation and strengthening
the partners, caregivers and the federations towards advocacy. The process also
resulted in networking with the district and the state officials with partners and
stakeholders. This process helped in planning the capacity building process for APD
team (BNI partner) at Bijapura, clarity on mental health care gaps and planning
advocacy strategies towards addressing those gaps and it is also a learning for BNI
and APD towards planning the stakeholders role and process of sustainability.

My research study
This comparative research study is done in Bijapura and Chikkaballapura. APD
(Association of people with disability) is implementing CBR program for disabled
including people with mental illness. APD is one of BNI partners and BNI is providing

technical support to APD to strengthen the mental health program in these two
districts. It is with this primary interest of strengthening the mental health program
this study was under taken. It is understood that APD will take the responsibility of
strengthening and sustaining the mental health program in these two districts.

Situational analysis of PWMI and their families - a sample study in
Chikkaballapura and Bijapura district
By
Gururaghavendra. C.E
Fellow – Community Health Learning Program – SOCHARA
Introduction
Mental health refers to our cognitive, emotional and social wellbeing - it is about how
we think, feel and behave. Mental health includes a person's ability to enjoy life - to
attain a balance between life activities and efforts to achieve psychological resilience.
Today, over a billion people in the world live with some form of disability. In the years
ahead, mental illness is going to be of concern as the prevalence of illness will rise due
to several factors including the vast ageing populations, higher risk of illness in older
people, increase in chronic health conditions, neo-liberalization policies that affect the
poor, inequitable development. This disability (mental illness) has a direct impact on
mental health that disables an individual from dealing with everyday life.
The need to empower people living with mental health problems is the need of the
hour and a collective effort must be made to remove the barriers, which prevent
people with mental health problems from participating in activities of their
communities, getting equal access to health care, education and employment.
Need of a comprehensive program and approach in mental health promotion and
rehabilitation
A comprehensive program and approach in mental health promotion and
rehabilitation at different levels is very much required - the individual level, the family
level, the local community level and at the level of the care provisioning system. As
per the WHO document ‘Integrating mental health into primary care, 2008 - chapter
1’ the service pyramid describes the comprehensive approach to address better health
outcomes.

WHO service pyramid
Tertiary and
secondary care
(specialist care)
Primary care
Community care
(outreach teams
and ambulatory
services)

Self care

(first level care by
health system)
Informal
community care
(NGO, village health
workers, solidarity
groups etc)

(active role
in own care)

Source: WHO document ‘Integrating mental health into primary care, 2008 - chapter
1’
The holistic approach of WHO as per the pyramid representation of both formal and
informal care provisioning is still not developed or it is not existing in India at the
moment. The reasons being inadequate infrastructure within the health systems. So
It is important to state that much of this care provisioning program is presently not
available and hopefully systems would be developed to fill this serious gap.
Basic Needs India is one of those resource organizations that believe in the psycho
social situations/factors affecting mental health is promoting a community based
approach in rehabilitating the PWMI and their families from last one decade and the
approach is called Community mental Health and Development. BNI is partnering
with other development organizations to integrate mental health in to CBR and the
development processes and one such initiative is with Association of People with
disability at Chikkaballapur and Bijapura districts.
This small sample study is intending to understand the situation of people with
mental illness and their families in the context of their psycho social needs including
mental health care services and impact of mental illness on families. This study also
focuses on the currently available public mental health care services. This study also
aims at comparing the needs, social and demographic situations services influencing
mental health.
Objectives of the study

•

To understand psycho social needs of People With Mental Illness in two
different districts of Karnataka (Chikkaballapura and Bijapura)

•

To understand the impact of mental illness on the individuals and families in
these districts

•

To understand the socio economic context and its linkages direct or indirect
on the Rehabilitation of People with Mental Illness specific to these two
districts.

•

To compare the available supports services to meet the needs of PWMI in these
two districts

Methodology for the study
•

Focus group discussions with PWMI and families - Two focus group
discussion with PWMI and their families, one each at Chikkaballapura and
Bijapura. At Bijapura 15 PWMI and 20 caregivers participated and 10 PWMI
and 10 caregivers at Chikkaballapura.

•

Case studies of PWMI - Four case studies of PWMI and their families, 2 at
Bijapura and 2 at Chikkaballapura. To understand the impact of mental illness
on the individuals and the families

•

Collecting the district profiles of the 2 districts

•

Interacting with public mental health service providers at the districts

Findings of the study
Psycho Social needs expressed by PWMI and carers
People with mental illness and caregivers expressed 4 significant needs during the
focus group discussions.
1. Treatment and health care needs: - at Bijapura there is no psychiatrist at the
district hospital so the group demanded regular posting of psychiatrist,,
regular supply of required psychiatry drugs and Counselling services. Apart
from health care needs they also felt the need for s. Day care centres for PWMI,
Respite care for caregivers and Facilities for destitute mentally ill. At
Chikkaballapura psychiatrist is appointed and consultation services at the
district hospital and medical camps at 4 Taluks are conducted. Group shared
that there is a gap in regular supply of medicines it needs to be addressed.
Though the social worker and psychologist is available as they are not trained
in counselling there is a gap in counselling services which needs to be taken
care.

2. Needs related education and livelihoods: at Chikkaballapura the group
expressed the needs more related to improve there already existing activities
like loans to improve their petty business like vegetable vending, mobile
accessory shop and to initiate self employment. Vocational training and
placement services for PWMI and Job opportunities for family members. At
Bijapura the needs expressed were more related to agricultural related
activities like putting bore wells in their land, loans to buy cattle and initiate
animal husbandry activities. Support to continue education of the children is
one of the significant need expressed at Bijapura..
3. Needs related to emotional support and family life: the statements given by
PWMI and caregivers are stated as it is - I want my wife back, I want to get out
of my fear/anxiety, I want peace, I want to get married. Though the situations
are different in two districts but the needs like counselling services, respite care
services, building family relationships are some important common needs
expressed by both the groups.
4. Social security: housing, disability ID card, concession bus and train pass,
disability, old age and widow pension, voter ID and Antyodaya card and
inclusion in to NREGA, were the other concerns.
Impact of mental illness on individuals and families – Based on the interactions
with PWMI and their family members/carers, at Bijapura and Chikkaballapura it was
evident that mental health problems not only affect the individual the family is also
greatly affected. The emotional burden and agony experienced by the individual and
family members is inexplicable. Based on the sharing by PWMI and their family
members impact of mental illness is categorized in to 3 main domains:
1. Emotional burden - Stress and frustration, unexplainable pain and agony,
insecurity feeling of worthlessness and hopelessness and suicidal thoughts
2. Impact on education - During the group discussions in both the districts it is
significant that substantial percentage of people affected with mental illness
discontinued their studies during adolescence because of illness. Discontinued
education, affected the knowledge and skills, affected the productivity of the
individual and family.
3. Economic burden – during the group discussions it was evident that the
individuals discontinued their education and earning members in the family
stopped earning because of illness, investment on education medicines is
causing economic burden on the families. Loss in the knowledge and skills in
turn leads to poverty. Lost opportunities of growth and development in
socioeconomic spheres.

4. Impact on family and social life - Affects the marriage, the family
relationships, family quarrels and separation, Stigma and marginalization,
human rights violation and destitution
Socio economic situations of PWMI and their families
Poverty: During the focus group discussions it was very evident among the people
who participated that majority of the families belong to below poverty line, landless
agricultural labourers, daily wage earners involved in construction work, domestic
work, workers at the market place and very few with 2 to 3 acres of land who are
growing maize, Ragi, Ground nuts cotton and dhal. Secondly if we look in to the
educational background of PWMI including carers very few are educated and
majority of them are non literates with no other trained skills. Thirdly majority of the
people participated belonged to backward or marginalized communities like Dalits
and Muslims. With all these inadequacies including financial burden they are
continuing their life journey.
Childhood experiences: During the 2 focus group discussions the childhood
experiences like inadequate family support and security, deprivation of basic needs
and individual experiences and lack of supportive environment was very evident.
Unhappy childhood experiences like sexual abuse, infatuation and other social
situations like deprivation of basic needs like education, food and clothing, single
parent, alcohol and family situations impacted the childhood of few PWMI who were
part of the focus group discussions. One girl currently 21 years old was sexually
abused by the neighbour twice at the age of 10 and 12 years. Two PWMI revealed very
strongly that love affair/failure or what we call it as infatuation during adolescent age
affected their education and resulted in discontinuation of studies. Gender:
Discussions with the PWMI and carers especially the female PWMI and carers gender
domination and related issues like physical abuse or harassment by the spouse, sexual
abuse during childhood or after marriage, deprivation of education as a female child,
economic burden, family pressures and stress like ill treatment by in laws demanding
dowry etc. affected the mental health among women. During the focus group
discussions 3 women with mental illness came out very strongly by stating I want
peace in my life and I would like to be free from stressful family life. They said
husbands were addicted to alcohol and even they had emotional problems resulting
in physical and sexual harassment and it was a daily routine ( repeated stress, abuse
and harassment which is not addressed, inadequate family support, patriarchy with
alcohol behaviour are together affecting mental health.
Caste: During the focus group discussion and case studies of PWMI 3 caregivers
expressed that they belong to Scheduled caste and it had lot of impact on their lives.
They said we are located out of the village called Dalit colonies, social life with other
caste groups are not encouraged. We are living in a small hut without any land and
our earnings, health and education of the children is affected. Social exclusion amidst

poverty is affecting the mental health of the population especially the Dalits and other
backward communities.
Stressful situations in the family – During the focus group discussions family
situations/stresses like alcohol addiction, extra marital relationships, husbands not
working and not able to take care for the family, economic burden, strained
relationships between the spouses and other family members, single parent, lack of
support from the family, separation of husband and wife etc. are some of the
predominant situations affecting mental health.

Similarities and differences in healthcare services in two districtsList of Health care services

Chikkaballapur
Bijapura a

Background
District Hospital started in

1886

250 bed facilities and constructed new building
in
Started Nursing College
Started general nursing training institute
Started Blood Bank

1976
1983
1994
1995

Alteration to old building and constructed one
ward
Started Karnataka State Drug Logistic
Management Store Room
Present Bed Availability
Started Yoga and Nature cure department
Started telemedicine unit
Available services at hospital
Started dialysis unit
24 hours emergency facility – Accident unit,
Emergency unit, Labor unit and Ambulance
facility
Machinery facilities – ultrasound, colour
doplar, TMT, x ray, C.R. operative microscope,
ventilator, ECG, cell counter, auto analyzer,
defibrillator
6 beds in dialysis unit
Ventilator facilities
24 hours blood bank
Yoga and nature care unit

1999

1959
100 beds information not
available on the year
no
no
2011
40 beds information not
available on the year

2004
400
2008
2008

no
140
no
no

2009

yes

yes
available

yes

yes
available
6
yes
available
yes
available
yes
available

yes
6
no
yes
no

AC operation theatres
special and general wards
ICTC and ART units
Immunization facility
Telemedicine unit
OPD for all units
Janani suraksha, Madilu, Thayi bagya,
Suvarna Arogya Chaithanya and Yasaswini
schemes
Lab facility
Provides Medical certificate, Disability
certificate, and First Aid certificate. For
disabled – corrective surgeries, audio gram,
NRC – neuro rehabilitation centre, neo natal
intensive care.
Community awareness on national
programs: Display boards, pamphlets, TV
programs, radio programs, paper add etc on
dialysis, HIV, Tuberculosis, immunization etc
Other information’s
in patients per month
OPD per day
Common health problems - Gynaecological
and general health problems
Staffs: 18 doctors, 67 nurses, 62 group – D
workers, 25 admin staffs, clinical psychologist
1, psychiatric social workers 2, total 213 staff.
Details of user fee
Outpatient registration :
In patient registration :
In patient ward charges – general per day :
rupees
2 bed special room :
Fistula surgery :
Piles surgery :
Appendix :
X ray :
ECG :
Ultra sound services:
Free for BPL card holders

yes
available
yes
available
yes
available
yes
available
yes
available
yes
available
yes
available
yes
available

yes
no
yes
yes
no
yes

yes
yes

yes
available

yes

yes
available

yes

1000
700

1000
700

available

yes

available

Exact information is
not available

2
10

5
10

5
75
400
250
500
50
50
50
available

20
no
no
no
500
50
50
50
yes

List of doctors / specialists
Psychiatrist
Medical department – Dr. Vittala Rao
Surgeries specialist – Dr. Jadav
Orthopedic specialist – Dr. Gujjala
Gynecologist – Dr. Vijaya Biradar
Pediatrician – Dr. Renuka Patil
Anastasia – Dr. D.C.Upase
Eye specialist – Dr. Meenakshi
ENT – Dr. Nazeea
Dialysis – Dr. Prakash .D
Skin Specialist – Dr. Mallikargun
Dentist – Dr. Dakshayini
ART specialist – Dr. R. D. Totada
Programs under DHO
District malaria program/ officer –
District leprosy prevention and control
program/ officer –
District Glaucoma prevention and control
program/ officer
District Tuberculosis control program/ officer
District disease surveillance program/officer –
research
District maternal health and family welfare
program/ officer
District RCH program/officer ( reproductive
and child)
District AIDS prevention and control
program/ officer
District program managers – NRHM
District Health Education program/ officer –
IEC (Awareness materials, implementing and
monitoring)
Coverage under DHO
PHC’s
CHC’s
Taluk Hospitals
Schemes and services:
Vajpeyi Arogya Scheme – especially for heart,
kidney services
Suvarna Arogya Yojana – Congenital
Anamalies – heart related problems
Madilu schemes
Every Tuesday and Friday – 12:30 pm to
1:10pm radio program

available
available
available
available
available
available
available
available
available
available
available
available
available

yes
yes
yes
yes
no
yes
yes
yes
yes
no
no
yes
yes

available

yes

available

yes

available
available

yes
yes

available

yes

available

yes

available

yes

available
available

yes
yes

available

yes

64
9
4

54
2
5

available

yes

available
available

yes
yes

available

no

Based on the above data both the districts have some similarities and differences
in providing health care services.
Some significant Similarities
In both the district inpatient and outpatient services in various disciplines are
available. Laboratory services and equipments in general are the same, user fee
including registration and any other charges like x-ray, blood test or any other charges
are similar. National programs under the DHO and the health schemes are included
in both the districts.
Differences in health care facilities:
Some of the significant differences in the health care services between the two district
hospitals:
Chikkaballapura hospital does not include some of the significant services like
Nursing College and training institute, Yoga training institute and Nature cure
department, Telemedicine unit, facilities of surgeries like Fistula and piles and
Dialysis including ventilator services. Gynaecology and skin specialist posts are
vacant or not posted. Whereas Bijapura District hospital contains all these facilities
and the services are available and the system is functioning fairly good.
In relation to the hospital management and hygiene Bijapura District hospital is
ranked 7 in the country and 1st in the state of Karnataka under the Survey done by
central health department. In Chikkaballapura the hospital management including
hygiene is very poor. Over all maintenance of wards, premises including the doctor’s
rooms and the kitchen are poorly managed.
In relation to psychiatric care services Bijapura district hospital does not have a full
time psychiatrist, at the moment Dr. Saraswathi psychiatrist Bagalkot district hospital
is visiting two days in a month. Whereas Chikkaballapura district hospital has regular
psychiatrist posted Dr. Kishore. Apart from OPD and inpatient services medical
camps at all the Taluks of the district is organized and PWMI are getting treatment at
the Taluka level. (Bagepalli, Sidlagatta, Gauribidanur and Chintamani Taluks.
Outcomes of the meeting with District and state authorities to understand the
available supports services to meet the needs of PWMI
The purpose of meeting with concerned department officials was to compare the
available supports/programs to meet the needs of PWMI. Plan was to meet DHO’s,
DDWO’s District surgeons and if possible D.C’s of the concerned districts and state
health Department officials.

I was able to meet the DHO, District Surgeon and D.C of Bijapura District. In
Chikkaballapura I was able to meet only the District Psychiatrist and the district
surgeon, as on the day of my visit Chief Minister Siddaramaiah visited
Chikkaballapura to inaugurate the newly constructed D.C’s office and all the district
officials were busy. At the state level I interacted with members of Mental Health Task
Force, Deputy Director of Health and Family Welfare in charge of mental health
services and Secretary State Mental Health Authority. Meeting with these officials
resulted in the recognition of the need for psychiatric care services at Bijapura, D.C
Mr. Shivayogi directed the DHO to take immediate steps to depute one psychiatrist at
the district hospital and till then making temporary arrangements for treatment by
negotiating with BLDE Medical college to post psychiatrist once a month and
directing Dr. Saraswathi to visit once a week instead of once in two weeks. The need
was brought to the notice of Task force and the deputy director. Dr. Gunde Rao the
deputy director mental health service has assured to post one psychiatrist within six
months time.
At Bijapura
At Bijapura Association of people with disability (APD) has identified around 300
PWMI and they are implementing community mental health program – community
based rehabilitation for PWMI with the support of BNI. Unfortunately at Bijapura
district hospital regular psychiatrist is not appointed. Dr. Saraswathi psychiatrist
working at Bagalkot district is visiting Bijapura hospital fortnightly and providing
treatment services. Some times because of her other responsibilities she is not able to
visit regularly which is resulting in gaps in treatment and care services at Bijapura.
After the focus group discussion the caregivers and PWMI felt the need for meeting
Deputy Commissioner Mr. Shivayogi to address the issue. On the same day along
with the representatives of the caregivers group we met the Deputy Commissioner.
He was very positive and he admitted that he is also aware that the treatment services
for mental health problems not available in the district. Immediately he directed the
DHO to look in to the matter and he asked DHO to negotiate with Dr. Saraswathi
(psychiatrist working at Bagalkot district hospital) to visit ones in a week instead of
ones in fortnight to treat PWMI at Bijapura. Secondly he also directed him and the
caregivers group to identify alternative (psychiatrist from BLDE hospital if willing
and retired psychiatrist Dr. Saleem) sources in the district so that the health care
services for PWMI can be regularized.
Meeting with the District surgeon at Bijapura
Provided the details about the health care services available at the district hospital and
DHO explain the program under his supervision and implementation. (Presentation
available attached as annexure). Both of them admitted the need for psychiatric care
services and also the challenge of getting a psychiatrist at the district level.

At Chikkaballapura
Dr. Kishore from Chikkaballapur explained the services under his jurisdiction like
daily OPD and an average of 10 to 15 new and 10 follow up cases, monthly camps at
Sidlagatta, Chintamani and Bagepalli. Indenting and supply of medicines regularly at
the hospital and the camps. He also expressed some of the challenges like himself
posted for causality duty, general OPD other than psychiatry when ever required,
social worker and clinical psychologists not equipped with counselling skills and not
even one assistant to support the other work in the department.
Meeting with Mental health Task Force and State Mental Health Authority – the
same situation was brought to the notice during the Mental Health Task Force meeting
and the suggestions were:
a) Expansion of DMHP to more districts and waiting for the response from
central Government. Chikkaballapura is covered under DMHP and
Bijapura district will be supported by the neighbouring district Bagalkot
team which is proposed under DMHP. Phase wise expansion of DMHP to
all the districts in the state by 2019.
b) Training Clinical psychologists and social workers on basic counselling
c) Circular to all the DHO’s to buy the medicines including psychiatry drugs
under unrestricted money when ever required
d) District disabled welfare officer Bangalore Urban informed that under the
directorate of Women, child and senior citizens development has initiated
Manasa Kendras in five districts and has a plan to start in all the districts.
Recommendations from the study
Psychiatric health care services
•

•
•
•

•
•

To start comprehensive psychiatric units in all district hospitals
comprising of a psychiatrist, clinical psychologist, psychiatric social
worker and psychiatric nurse
To provide 10 beds exclusively for inpatients in psychiatry ward.
The psychiatrists in district hospitals and in the medical colleges to
visit Taluks in each district on a specified day at least once in a month.
To provide continuous supply of free medicines to be purchased
through drugs and logistics department or direct purchase from the
DHOs office.
Counseling services by professional counselor in each of the district
hospitals
To include psychiatric emergencies under 108 ambulance services for
transportation of mentally ill

•
•

Suicide helpline to be handled by specifically trained counselors.
To implement DMHP programs as per the prescribed norms.

Community programs
•
•
•
•
•
•
•
•
•
•
•
•

Community awareness on mental illness
Building PWMI and caregivers support groups
Inclusion of PWMI and carers in to community groups
To start vocational training centers for PWMI
To create livelihood opportunities for stabilized mentally ill and family
members
Social entitlements for PWMI and families
NGOs to be encouraged to include mental health program
Extensive use of media both print and visual media and distribution of
pamphlets highlighting the need for positive mental health outlook
Ayush workers, ANMs, VRW’s MRW’s and program officers to be
involved in the program
To start psycho-social rehabilitation centers at District level
To start day care center for the mentally disabled
Initiating respite care services for carers of PWMI

Recommendations for BNI and partners
Partner APD (Association of people with disability)
o Regular family visits, referrals for treatment and follow up–
educating the family on illness, treatment and care for PWMI
o Individual rehabilitation plans including carers plans based on
felt needs and supporting the families accordingly
o Social inclusion – including the stabilized PWMI and carers in to
different community support groups, enabling the PWMI to
take up productive work within and outside the family and
encouraging PWMI to participate in family and community
activities
o Promoting carers support groups and linking these groups to
other disability, women and health movements
o Inputs to carers and representatives of the DPO’s, and other
community groups on psychosocial skills
o Sensitizing the local governance, ASHA, VRW, MRW,
Angawadi workers and ANM’s on Needs of PWMI and families
and facilitating support
o Community awareness on mental illness and community based
rehabilitation

o Identifying vocational training and livelihood options
Government and non Government and include PWMI and
family members
o Orientation on entitlements and enabling PWMI and families to
access the same
o Inputs on mental health promotion and prevention of mental
health problems like life skill education, psycho social skills etc.
o Promoting the network of stakeholders at Taluka and district
level towards advocacy
BNI
•
•
•
•
•
•

•

•
•

Building the partner team capacities (APD) on identification, treatment
and follow up care through family visits
Supporting the partner(APD) to develop individual rehabilitation
plans and executing
Skills in building carers groups and linking them with other groups
Skills in community awareness strategies
Training on psychosocial skills including mental health promotion
Inputs on social entitlements and concerned legislations and
Government programs like DMHP, NRHM, State mental health
authority and mental health rules etc.
Facilitating sensitization and training programs to local governance
including Taluka, district and state officials of the concerned
departments
Facilitating stakeholders networks
Training on advocacy strategies and planning and executing advocacy
processes

Academic level
•
•
•

•

To educate teachers in high school and universities in stress
management skills and life skills
Starting counseling centers in all the establishments, education
business and industry
To start life skills education for students in high school, graduation,
syllabus and teaching aids and training material to be designed by
qualified mental health professionals
To train teachers of biology, sociology and psychology as special
educator in teaching providing sex education

•

Including Psychiatry as a paper in MBBS course for medical students

Conclusion:
The study on situational analysis of PWMI and families in Bijapura and
Chikkaballapura highlights the psychosocial needs of PWMI and carers, impact of
mental illness on the individuals and families and also the gaps in the health care
service provisioning. This document will guide Basic Needs India and APD to
strategically plan the mental health program in these two district towards meeting the
needs of PWMI and their families, also strengthens the process of discussions with the
Government health care provisioning system in highlighting the gaps and demanding
the concerned authorities for the same.

Annexure
Case studies
Case Study of Saraswathi
Individual history
Name: Saraswathi
Age:
28 years
Gender:
Female
Caste:
Achari (general)
Education: Studied up to 8th standard
location:
Chikkaballapura
Husband’s name: Shivanandachari
Diagnosis: Severe depression
Background
Saraswathi aged 28 years was identified by Association of people with disability at
Chikkaballapura. She came in contact with APD staff during the orientation program
on mental illness for women self help group organized by APD. On 21 st September
she was part of the focus group discussion facilitated by Guru to understand the
psycho social needs of PWMI and their family members. She came alone and no
caregivers accompanied her, when she was asked she replied I am mentally disturbed
and I am the caregiver for myself. Further in the process of focus group discussion in
relation to the needs she expressed I want peace of mind. The strong statements like I
am the affected person as well as the caregiver and I need peace of mind triggered
Guru to do the case study of Saraswathi. After the focus group discussion with her
permission the case study was accomplished.
Family Background

Saraswathi is 28 years old, she was born at Chikkaballapura. Her father was a
blacksmith; she is the eldest and 4 younger sisters and a brother. Mother is a home
maker. With great difficulty her father was able to support the family as the earnings
were very meagre. At present he is aged and not able to do the blacksmith work as it
requires lot of physical energy. He managed to organize marriage for 3 daughters and
2 more daughters’ life needs to be settled and her younger brother is still studying in
school. Mother is the daily wage earner and only the bread winner for the family.
Life after marriage
Saraswathi was very much interested in studies and she was regular to the school.
Her life time aim was to become a teacher. She said though there was no
encouragement from my parents for the education especially towards the daughters’
education, but I had hopes that I will continue studies come what may. But the days
were not so as I expected. When I completed my 8th standard my parents were very
keen to organize my marriage, and it happened immediately and I never expected
that I have to discontinue my studies and get married and lead the married life.
During the summer holidays my marriage was fixed and I was just 14 years old and
I never realized it is a child marriage. Immediately after the marriage my in laws
asked me to discontinue my studies and she said I never imagined that I have to
discontinue studies which shattered my dreams completely. At this stage for about
5 minutes she was not able to speak and tears dropped from her eyes automatically.
After few minutes she took a long breath and continued her sharing.
She said immediately after the marriage shocking news for me was that my husband
is an alcoholic. On the day one he came drunk and I was able to sense that he is drunk
and his behaviour was different and it was not digestible for me and I was struggling
to adjust with him. The pity is nor my parents were aware or my in laws never shared
that he is addicted to alcohol and before marriage if by any chance I was aware about
his addiction I would have opposed the marriage strongly, but what to do man
proposes and god disposes. With all these unpreparedness and unwillingness I had
to adjust to my husband and to his family. With all these problems after one and half
years of marriage I delivered a girl child. Unexpectedly after the birth of the daughter
my husband stopped consuming alcohol for few years and I was really happy and I
felt it was a miracle and we both lived happily. Though he was working in a private
sector he was not regular to job and he was more dependent on the parents
economically. So another problem in my life was husband was not regular to job and
he was not earning. Looking at his irresponsible behaviour parents got separated
themselves and asked us to lead life independently.
Two years later I delivered a male child and life was very challenging as the earning
was not enough. Unfortunately by that time because of financial problems my
husband had started his habit of drinking again.
Life in Bangalore city

Looking at the situation I decided to go to Bangalore so that I can find some job and
manage the family. With great difficulty I convinced my husband and we migrated to
Bangalore. Few months after migrating I joined as a helper in a garments factory. But
one of the learnings after joining garments was to develop skill in tailoring so that I
can earn more and sustain my family. After the work during evening times I joined
tailoring classes and learnt tailoring. This skill brought lot of changes in my earnings
and my life. Saraswathi was able to earn 12 to 14 thousands a month and even the
mangers recognized her skill and they were very happy to continue her in their
production unit and she was awarded the Best women in 2004.
But looking at my growth and earning capacity my husband developed inferiority and
he started giving more torture and he also developed suspicion on me and his alcohol
consumption became more chronic. On the one hand our financial problems got
addressed but the family problems increased. I was really down and decided to
commit suicide at two situations. Once he called my parents to Bangalore and he
picked up the quarrel and in front of me he physically assaulted my parents like
anything without any reason. Even with this he was not satisfied and he went to our
native place and he repeated the same with my parents. I was really shocked and
humiliated that unnecessarily my parents and tortured. She could not resist the pain
and sorrow at this stage and tears flowed like anything though her eyes. She said even
after this kind of torture and humiliation I decided to live because it is my
responsibility to support my daughter and the son to grow up and lead peaceful life.
With that hopes and aim I living otherwise she said.
The causes for my mental health problem
When we asked are you aware of the situations leading to your mental health
problems, she said yes and she also mentioned few situations for her emotional
disturbance.
1.
2.
3.
4.

Dowry harassment by in laws
Behavior of her husband
Unhappy married life
One of her close friends committed suicide because of similar problems at home
and which influenced her a lot

Impact on the family
Continuing further we focused on the impact of family situations and her illness on
the family. She was able to focus specifically how it is affecting her and the family. She
said now I recognize that I am emotionally disturbed and I am not able to concentrate
on my work, I discontinued my work. I have developed unexplained fear and I have
started suspecting the men. Not able to sit in one place for few hours, agitation and
frustration, and hopelessness. I am not able to concentrate on my children, their
education and my financial situation is bad. I also recognize that my husband is also

having emotional difficulties. But he is not in a position to accept. She said I am not
able to digest any difficult situation even if it is in the movies, I start crying. I also feel
that my husband is planning to kill me. I am taking treatment at Chikkaballapura
district hospital.
The case study process was concluded with the below mentioned suggestions
1.
2.
3.
4.

Regular treatment
Undergo counseling by Dr. Kishore psychiatrist or at APD
Motivating her husband to go for treatment
Future of the children

Case steady of Vinodh
Individual history
Name:
Age:
Gender:

Vinodh
19 years
male

Education: 10th pass
location:
Chikkaballapura
Marital status: unmarried
Occupation: He was a cleaner in the bus
Diagnosis: Bipolar affective disorder
Family history
Vinodh is 19 years old and he is the only son. He is from a village from Gudibanda
Taluk, Chikkaballapura district. His father was a farmer and mother sarojamma home
maker. They have 2 acres of land and because of inadequate rainfall they are not able
to cultivate regularly and they were forced to work in others fields and any daily wage
work for their livelihood. Though his father earns 200 to 250 rupees per day, majority
of his earnings will be spent on alcohol. So mother was dependent on Vinodh’s
earnings. Till 10th standard he studied in Gudibanda Taluk and though he was
interested in continuing studies the family economic situation did not permit him to
continue his studies. So he joined as a bus cleaner in one of the travels at
Chikkaballapura. He has two maternal aunts and one of the maternal uncle lives in
Devanahalli near Bangalore. Currently he was the bread winner of the family. He
belongs to a scheduled caste community.
His mother said during his childhood he was intelligent and he was very fond of his
friends. Even today he has 15 friends from his village. He was a very active and
energetic boy and he was ready to sacrifice his life for his friends. But from his

childhood he was not interested in studies much and the family situation also forced
him to join the work. After completing his 10th standard for about 2 years he was
working in a poultry farm, later he joined as a cleaner. He was very enthusiastic and
regular for his work and he enjoyed the work what he was doing.
History of illness
We met Vinodh on the day one when he was admitted at the district hospital
Chikkaballapura. On the day we met Dr. Kishore Psychiatrist Chikkaballapura. After
interacting with him regarding the facilities and services at the district hospital we
also shared we are planning to do few case studies, he suggested us to interact with
Vinodh as he is admitted on the same day and Dr. Kishore said it will be helpful to
him also in understanding the case in depth. With his suggestion we met Vinodh in
the psychiatry general ward.
We introduced ourselves and we also shared with his mother the purpose of
interaction and documentation. Without any hesitation she agreed to share about her
son. She said really I am shocked to hear that my son is admitted in the hospital and
even now I am not clear what kind of health problems my son is having. But I heard
that at his work place 2 days back he had some quarrels with the co workers and he
was beaten up and in turn Vinodh ganged up with few friends and he took revenge
on the other gang. The opposite gang launched police complaint and he was arrested
by the police and he was tortured and later he was released on bail. Immediately
Vinodh developed fear and he left the work place and he was wandering on the streets
of market place crying, abusing people and laughing without reason.
Looking at his strange behaviour the known people escorted him and admitted him
to the hospital and informed me that your son is not feeling well and admitted at the
district hospital.
At this stage we were not very clear what happened to Vinodh and why he developed
illness. At this stage we felt it is worth interacting with Vinodh directly. Though he
looking very fearful and murmuring to self we decided to motivate him to share his
journey just before he developed illness. While interacting with Vinodh his mother
was coming in between and was trying to stop the flow of discussion. At this stage we
felt mother is aware of the situation, but she is not feeling comfortable to share
especially about the police complaint and she was trying to stop Vinodh also. But
luckily two ladies came and joined the discussion and later we understood that one
lady was his maternal aunt and the other person the neighbor and close friend of the
family and both of them said nothing to hide and they encouraged Vinodh to share
the truth.
With the encouragement of his aunt Vinodh shared the story behind his illness. He
said after joining the private travels as cleaner he came in contact with few friends and
they became very close and they ganged up during the journey they never used to

allow the other private buses to overtake their bus. If somebody tried to overtake their
bus they used to literally fight with the bus drivers. It was fun but at the same time a
kind of craze and also we wanted more collection to our travels, it was really a
competition between the few private travels. At the same time influenced by friends I
became addicted to Gutka, cigarette and alcohol. We used to have week end parties.
Another turn in my life was I fell in love with one girl during my routine travel. She
was from Devanahalli and her name was Nalinakshi. I was not aware that one more
driver was also interested in her and we had fights each other few times. These kinds
of quarrels resulted in police warnings also. But one fine day somebody gave a love
letter to her in my name and the girl belonged to a economically well to do family and
from a upper caste, he came and blasted me saying I was never interested in you and
how a person like you can imagine that I will agree for your rubbish interest. At that
stage I felt that it is better to stop. But when I realized that I am going in a wrong way
it was too late. The girl’s family gave a police complaint and they paid money and
influenced and it resulted in arrest and they treated me with the third degree and now
I am really afraid to go out of the house. Two days back this incident happened and I
don’t know what happened to me I developed extreme fear and I started running on
roads. Finally I landed up in the hospital.
Currently I am having the symptoms of excess fear, anxiety, talking to self and feel
like running away from place and visual hallucinations of somebody trying to kill me.
Impact on the family
Continuing further we also discussed with Vinodh and his mother how the situation
is impacting the family. Responding to the question Vinodh replied saying I lost my
job, no earnings. This situation is also impacting my relationships with my friends and
my family members. I am also filing hopelessness and worthlessness. His mother
sarojamma was shocked hearing responses from Vinodh. She said he is the only son
and family had lot of hopes but in one go all our expectations are shattered. All the
family members are feeling depressed. People in and around our family are filing he
is possessed by evil spirits. Even we are confused whether it is an illness or possession,
family is in total confusion. He was the bread winner in the family and now our family
income also affected. We are also afraid that police may crate farther problems, they
demand many or possibilities putting case against Vinodh. Responding to the anxiety
expressed by sarojamma and Vinodh guru suggested to continue treatment, both
Vinodh and sarojamma to undergo counselling and also take certificate from the
treating doctor so that they can submit the same to avoid further problems and
complications. Also to keep in touch with APD for further support and guidelines.
With this action plan interaction with Vinodh and family members was concluded.

Case Study of Nagappa
Name:
Nagappa s/o Dowlath
Age:
34 years
Gender: male
Caste:
Scheduled caste
Education: p u c
location: Bijapura
Type of illness: Mania
Individual and family Information
Nagappa aged 34 year is from remote village from Bijapura Taluk, Bijapura District.
Parents of Nagappa are agricultural labourers. Both the parents are aged; they have
three children, two sons and a daughter. Eldest son is married and living separately
daughter also married and living in a neighbouring village. Nagappa is the only
person who is educated in the family. Nagappa developed mental illness at the age of
20, from last 10 years he is suffering from mental illness, he is not working and
earning. His brother addicted to alcohol and he is not supporting the family
financially. Mother is the earning person, even at the age of 70 plus is working at the
agricultural fields and feeding the family. Government of Karnataka has given two
acres of land to the family, but they are not able to cultivate anything because of lack
of support within the family.
History of illness – when, how and why mental illness, perception of the family on
mental illness, tried out treatment modalities
After collecting the information about individual and information guru asked
Boramma (Nagappa mother) to share about the causes for Nagappas illness and her
understanding on the situation. Responding to the question she started sharing the
whole story. She said I am poor family, we belong to scheduled caste. My marriage
was child marriage; my husband was daily wage labourer. He is addicted to alcohol
and has a wife I have under gone lot of problems and I have struggled throughout my
life. More than happiness I have experienced pain and sorrow in my life. My husband
never interested in educating children because of financial problems we found very
difficult to send our children to school. But Nagappa was very much interested in
studies. As a mother I felt responsible that at least I should educate the last child of
the family. I set him to school, with lot of positive encouragement from the mother he
studied well and completed 10th standard. I was very happy when he passed 10th
standard and I encouraged him to continue the studies. He joined PUC at Bijapura
Taluk, as there is no college in our village. Out of small earnings I supported him to
take room in one of the hostels and continue the studies. Though it was a great
financial burden (food, accommodation and fees) I supported my son to continue his
studies.

With all this support he failed in 2nd PUC. He came back home, he looked very silent
not talking to people, not interested his studies and was very much afraid to go out of
the house. Looking at the changes in the behaviour of Nagappa people in around felt
somebody has done black magic to him, few said he will spirits have possessed him.
Has a mother I also believed the same and we took him to faith healers. Later he
became very violent and started abusing and beating family members and people
around and illness became more and chronic.
This situation continued for few months and finally we were forced to lock him in a
room. Few later somebody in village said it is an illness and he suggested us to go to
Dharawad institute of mental health. We approached the hospital few times for
treatment and we say significant changes in Nagappa. But we could not continue the
treatment because of our financial condition. Illness became worst and situation
continued. One and half years back we came in contact with Bhagirathi of APD. Since
then is on treatment regularly and condition is better. Now my perception on the
illness is changed. Now understand that it is an illness which is treatable, but still I am
not clear why this illness to Nagappa. Even today I strongly believe that his studies
have resulted in mental illness (studying more result in mental illness)
At this stage guru asked Nagappa about his views on his mother’s belief about his
illness especially her views on studies resulting in mental illness. Few seconds
Nagappa was silent and was laughing to self and said the reason for my illness is love
failure not my studies. He said when I was studying in 2nd PUC I was in love with one
girl, but I did not express my love to that girl because she belonged to upper caste and
from a economically sound back ground. But I suffered within and developed illness;
I was able to concentrate my studies and discontinued my studies. Knowing the real
cause for her son’s illness. Boramma was shattered and tears started pouring from her
eyes. For about five minutes she was crying and said from last ten years I believed
that my son suffered from mental illness because of his studies. But today I came to
know that he developed illness because of his love failure. My life time struggles and
efforts are sacrificed to one girl by my son. I am not able to digest the truth and I am
really emotionally disturbed, automatically tears were pouring from our eyes.
To divert her attention guru asked Boramma how she feeling now about her son. She
said I am not angry about my son but I am disappointed that our dreams did not come
true.
Current situation including treatment
Continuing farther guru asked Boramma and Nagappa to share about the current
situation. Both of them said Nagappa is on regular treatment is taking medicines
regularly, his symptoms have come down. He is sleeping well and relating to people
in the family and outside family. Now he is showing interest in studies and also wants
to work.

Impact of mental illness on the individual and the family
Discussion continued further on the impact of mental illness on Nagappa and his
family. Responding the question both of them replied saying illness affected his
education, his ability to work and support the family, family dreams got shattered and
it affected the family financially, emotion ally and socially. His mother said Nagappa
is interested in marriage, but we are not able to organize and encourage because of his
illness. At present nobody in the family are in a position to earn, at this age I am
working and supporting the family. In one way we are handicapped said Boramma.
Interview was concluded with the action plan:
1.
2.
3.
4.

continuing treatment regularly
Applying for disability id card and pension
Vocational training- exploring options
Keeping in touch with APD for ongoing support and guidelines

Case Study of Saira Bhanu
Name:
Saira Bhanu D/o Hasan
Age:
23 years
Gender: female
Caste:
Muslim
Education: 7th standard
Marital status: single
Diagnosis: Schizophrenia
location: Bijapura
Individual and family information
Saira Bhanu is 23 years old studied up to 7th standard belongs to a traditional Muslim
family. She is from Bijapura town father is expired, mother is the care taker. She has
two younger brothers and a sister; she is eldest in the family. Mother is working a
domestic worker, both the brothers studying and younger sister is married. Mother is
suffering from neurological problem; Saira Bhanu is suffering from schizophrenia
from last five years.
Her paternal uncles are living in Bijapura, they are economically sound but they are
least bothered about Saira Bhanu family. Literally after the death of her father, uncles
chased Saira Bhanu her family out and they have grabbed the property.
Currently they are living in a small room provided by her maternal grandmother.
History of illness – when how and why mental illness, perception of the family on
mental illness, tried out treatment modalities

After the brief introduction about the family guru asked Sulthana, mother of Saira
Bhanu to share about their life story. Sulthana started sharing from her child hood.
She said when I was 13 years I got married, that was the age I was supposed to study,
play and enjoy the child hood. Has a child I got married and at my in laws place I was
a domestic worker and they never accepted me as their daughter in law. All the at
home was designated to me and I was a donkey in the family. Apart from donkeys
work they used to abuse and physically harass me every day. My husband was a
chronic alcoholic and he never use to care for me. my in lows never informed my
parents about his behaviour and they also ditched me and my family saying he is
working in government sector. He died because of lever failure. Immediately after his
death they chased us out and they have not given any property sheer which belongs
to my husband. We were on road for few months, later I went and approached my
family for support and protection. My brothers and parents washed away their hands
by saying once the marriage is over our responsibilities are completed. I was really
shacked and confused how to withstand the situation. At this stage I also developed
neurological health problems. Shattered with difficult situations and I decide to end
my life and tried to commit suicide twice also I developed mental illness. I am aware
that I am mentally ill but I am not taking treatment and I am managing without
treatment. Later I realized the responsibility of 4 children and I decide to live and
continue my life.
After sharing about her life journey she then started shearing about her daughter Saira
Bhanu. She said when she was at the age of 8 one of the neighbours abused her
sexually when nobody was there at home. Though aware of the situation I was not
able to do anything. The same incident occurred for the 2nd time when she was 12
years old. Again I was not able to anything because my poverty, ignorance and lack
of support from the family because 2nd indent my daughter developed illness. Till
recently I was not aware that she has developed illness. She remand silent, preferred
to be alone, discounted her studies crying without reason and developed suicidal
thoughts.
APD staff visited our family last one and half years back and suggested me to take
Saira Bhanu for treatment now her symptoms have come down and she manage
herself and she also supports me in my house hold work.
Currently Saira Bhanu feels that she should get married and live with her husband
happily but her illness and our finical situation is not permitting as to organize her
marriage.
Impact on the family
Based on the desiccations with sultana it was evident that the impact on the family
was huge –

1. It affected of the education, child hood and growth and development of Saira
Bhanu
2. Emotional disturbance in the family
3. Economic burden
4. Lack of security
5. Hopelessness and worthlessness
Future direction
Interview with Sulthana and Saira Bhanu was concluded by drawing their
attention towards future thoughts and goals. Sulthana expressed the need like
disability ID card and pension for Saira Bhanu, vocational training and job
placement for her elder son and house to live. Guru suggested her to keep in
touch with APD (Bhagirathi Assistant Coordinator – mental health program)
as it requires lot of efforts and support to achieve the expressed needs.

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