+
Service Users
Mental Health Initiative
Community mental health originated organically from the work under ‘transform’ that included the participatory approaches for addressing gender-based violence among women and adolescents. Women experiencing different forms of violence, ostracization and social discrimination were attributable to gender-based violence in many instances.
Further on when the participatory approaches (Participatory Learning and Action) were used for adolescents to look at their mental health, violence and substance use, many adolescents could relate to mental health issues in their communities.
All earlier programs in Ekjut starting from 2005 and are ongoing aimed at addressing aspects of wellbeing at crucially vulnerable periods of the life cycle through a range of activities that addressed social determinants and predictors of mental health such as high maternal and newborn mortality and morbidity, issues of food security and a lack of safety net and entitlements. Ekjut’s vertical work in the mental health space actually started in 2018.
Community Based Rehabilitation (CBR)(2018)
Our community based, multi-disciplinary team provides treatment, rehabilitation and social support with participation of family members and community to enable persons with mental illness living in under-served areas of Jharkhand to engage in the recovery process which forms the core of this initiative. It works at 3 levels:
· Individual – Treatment through collaborative telepsychiatry (hub and spoke model), psychosocial counselling through home visits for persons with mental illness
· Family – Support group meetings for caregivers and persons with mental illness for sharing, peer learning and problem solving.
· Community – Facilitated participatory learning & action groups (Participatory Learning and Action meeting cycle) for entire community for building social networks, solidarity, common understanding, inclusion, non- discrimination and addressing gender-based violence (called ‘sukhu-dukhu’ or well-being meetings).
In the space of mental health Ekjut’s interventions during the vulnerable periods across the life cycle (from birth to adolescence and adulthood) with the partnering communities addressed the issues of perinatal mental health, nurturing care focusing on early childhood care and development, common mental health disorders among adolescent and distress prevention through linkages with entitlement.
This community intervention aims at reducing psychosocial distress among persons affected with mental illness (which includes both persons with mental illness and their caregivers) by improving access to affordable and quality psychosocial support. It includes:
a. Accessible, affordable, equitable and quality driven (WHO Quality Rights approach), culturally acceptable community based psychosocial intervention in underserved communities.
b. Identifying persons with mental illness and providing care, treatment and rehabilitation
c. Creating non-discriminatory, inclusive, supportive and enabling environment for persons with mental illness and promoting well-being in the community.
d. Promoting wellbeing in the larger community The program components include
1.Collaborative Tele-psychiatry +treatment
2. Door-step counselling
3. Support group meetings for service users and care givers
4. Participatory meetings for building solidarity and non- discrimination among neighborhood community about mental health
334 service users (People with severe psycho-social disabilities)
have been provided support in the period of 2019-2023.
5. Social contact program (Stories from persons with lived-in experiences)
6. Community-based rehabilitation of persons during their recovery phase.
The major strategies being followed in the initiative are
· Engaging in support group meetings for caregivers and persons with mental illness and community meetings with larger community through evidence-based community empowerment approach i.e. Participatory Learning and Action through wellbeing meetings.
· Building capacities of youths from village in psychosocial support to identify, support and refer persons with mental illness to appropriate centers. Equity and Inclusion:
Our initiative is inclusive as the program proactively seeks out the most marginalized people, i.e., those with severe mental illness belonging to indigenous community living in relatively inaccessible areas with lack of access to medical care for their treatment and rehabilitation. Engaging with the immediate caregivers is also a form of inclusion and participation enhancing and so is the work with the larger community for reducing discrimination and stigmatization. The Participatory Learning and Action approach is designed to be relevant, accessible and engaging for the poorest with a scope for sustainability.
Evaluation
Our internal evaluation using Cobweb diagram after 1 year of intervention suggested positive outcomes in the following domains of personal and social life of persons with mental illness. ( The providers ranked them on the 8 themes about their perception of how they progressed against a scale of 5; 5 being the best)
CHIME
We adapted the suitability of CHIME (C- Connectedness, H-Hope, I- Identity, M- Meaning in Life, E- Empowerment) recovery framework to understand the recovery and the journey of people with severe psychosocial disabilities (severe mental health issues) and was instituted keeping in mind the context, visual literacy and language. This evaluation and analysis provided an understanding of the pathways to recovery, but the service users were also able to appreciate their own path
to recovery. We have been using this framework with marginalized communities in our rural context in a spirit of co-learning that is beneficial for both service providers and service users.
Initiative is supported by CARING friends.
Mental Health Research: MADAD STUDY(Mobilising adolescents against Depression and Anxiety Disorders)(2022).
Ekjut has initiating a project “Community – Based Psychological Treatment for Adolescents with Anxiety and Depression In India” aiming to assess the feasibility, acceptability and cost of a stepped care model to improve access to psychological treatment for adolescents with anxiety and depression through non-specialist workers in community settings in underserved areas of India: rural Jharkhand (eastern India). The study participants are girls and boys aged 10-19 years in or out of school and residing in West Singhbhum. Our study partners are University College London, King’s College London, LSHTM, London and Sangath, Goa.
Initiative is supported by University College London.
Bridging the mental health care gap and addressing the social determinants of psychosocial distress.(2023)
The project is a co-location of several elements of evidence-based work that will help provide varying degrees of relief to the distressful situation among in Adivasi communities of West Singhbhum . In the district, an evidence-based structured community mobilization approach i.e. Participatory Learning and Action (PLA) had shown a significant reduction in neonatal mortality, maternal deaths, and postpartum depression.
During the last 20 years of our engagement with partnering communities, Ekjut has developed a better understanding of the predictors of distress. Predominant among them were their tribal status, asset-lessness, meager sustenance agriculture/wage labor when available, high child and infant death rates, post-partum depression, unmet need for family planning, lack of dietary diversity and adequacy, early marriages, domestic and gender-based violence and sorcery accusations. Some of these challenges are being addressed through engagement with the community through their participation in group meetings, counselling through home visits, social contact program, providing support to people with distress, appropriate referral when needed, and help to link them with their entitlements with the help of local administration and referrals. The program is meant to take a preventive approach to mental health issues across the lifecycle. The facilitators call themselves DukhuSukhu Sathis in this program.
Initiative is supported by Mariwala Health Foundation.
Promoting Adolescent Mental Health Through Participatory Adolescent Learning Groups – PAMPAL(Butterfly) (2024)
The project IMPROVING YOUNG PEOPLE’S MENTAL HEALTH will promote mental well-being among young people through structured participatory group meetings and address the mental health care gap through peer-led evidence-based intervention. This is to promote the mental health and well-being of young people through their participation in facilitated structured capacity building participatory group sessions and to address common mental disorders and related distress among identified young people through stepped care psychosocial interventions by peer facilitators.
Initiative is supported by Indira Foundation