*December 13, 2010*

*Joanne Silberner*

[image: Children light candles in India]

*Children light candles to observe India's first National Mental Health
Awareness Day, in New Delhi on Aug. 6.*

When stacked up against HIV/AIDS, malaria and other fast-moving, deadly
diseases, mental illnesses don’t score as
high<http://www.npr.org/blogs/health/2010/06/10/127741091/mental-health-and-the-developing-world>
with
governments and philanthropies. One reason: the perception that tackling
mental illness is too complicated and too costly.

Now an intriguing
study<http://www.thelancet.com/journals/lancet/article/PIIS0140-6736(10)61508-5/abstract>
in
the online version of the medical journal *The Lancet* suggests that it’s
not that hard to tackle some mental conditions. And what may help most of
all are therapists with minimal training.
Mental illnesses exact a heavy toll in developing countries, where they can
make it even harder for people to provide for themselves and their families,
as the World Health Organization found in an
analysis<http://www.who.int/whr/2001/en/>
.

In India, there is only 1
psychiatrist<http://www.npr.org/templates/story/story.php?storyId=126143778>
for
every 400,000 people, according to the Indian government. *The Lancet*study
involved about 2,600 people in the state of Goa with common mental illnesses
such as anxiety or depression. About half were assigned case managers who
had taken a two-month training course in mental health counseling.

All of the patients in the study got whatever routine care was provided by
private doctors or public clinics. And half of them had 6 to 12 meetings
with the lay therapists. The therapists talked with them about their
illnesses and problems, taught them coping mechanisms such as breathing
exercises, and in some cases offered psychotherapy.

In the public health clinics, 66 percent of the people who talked to the lay
therapists recovered after six months, compared to 43 percent of people who
got the standard care. The researchers call this "modest evidence of a
beneficial effect" of using lay counselors.

The approach, however, isn’t perfect –  it turns out lay therapists are
better at treating anxiety than depression. And at private clinics, where
the standard of care was presumably higher to begin with, having a lay
therapist around didn’t help much.

Still, experts in the field say the approach suggests a new way to reduce
the global burden of mental illness. The lead author of the study, Vikram
Patel <http://www.lshtm.ac.uk/people/patel.vikram> of the London School of
Hygiene and Tropical Medicine, says the hope is that NGOs and governments
will consider the model as "an affordable and feasible framework" for
improving standard primary health care.


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[image: Rey Carr
(ReyCarr)]<http://www.npr.org/templates/community/persona.php?uid=5452243>

Rey Carr 
(ReyCarr)<http://www.npr.org/templates/community/persona.php?uid=5452243>
 wrote:

The results for lay therapists are similar in North America although the
terms used to describe the lay therapists are different: peer counsellors,
peer support workers, or peer helpers.

[image: saju mannarath
(saju)]<http://www.npr.org/templates/community/persona.php?uid=6619311>

saju mannarath 
(saju)<http://www.npr.org/templates/community/persona.php?uid=6619311>
 wrote:

This study once again reiterates the role the community plays in the
betterment of a person with mental illness - whether a lay person outside
the family or the family itself. Unfortunately, even the recent draft Mental
Health Care Act, 2010 of India does not give due focus on the role of
community in 'treating' the 'ill'.

[image: Heather Whistler
(HeatherWhistler)]<http://www.npr.org/templates/community/persona.php?uid=6072849>

Heather Whistler
(HeatherWhistler)<http://www.npr.org/templates/community/persona.php?uid=6072849>
 wrote:

I've found tremendous benefit from "lay therapy" in the form of a Twelve
Step sponsor, so I can absolutely see how this type of movement would have a
big impact. For serious mental illness like schizophrenia or bipolar
disorder, however, psychiatry is usually necessary.

I also agree with Saju re: the role of community, and I actually wrote about
it not too long ago on my blog: http://tinyurl.com/2fcjjea

[image: April Wolff
(jaocobreese)]<http://www.npr.org/templates/community/persona.php?uid=3142355>

April Wolff 
(jaocobreese)<http://www.npr.org/templates/community/persona.php?uid=3142355>
 wrote:

I cannot emphasize enough how important this story is, to counter the ever
spreadiing conception that mental illness, particularly schizophrenia and
psychosis in general = homicidality. Especially sicce Fort Hood, the terms
are used interchangably. (Though I don't know all the details, I've seen
little evidence in the media that the perpetrator was psychotic.)
Statistically, there is only a small increase in violence over the general
population, almost all in Parnoid Schizophrenia. Most people can identify
with anxiety and depression, having experienced them in a subclinical form.
But fear of, and stigma towards all major mental illness, bipolar disorder
and schizophrenica, especially, are escalating and the word "psychotic" is
used widely in the media as a slur. Rosallyn Carter, who's worked diligently
on this issue for 39 years, says it's geting worse. "Reinstitutionaliztion"
leads to the mentally ill being imprisoned, where they are preyed on, since
the big "snake pits" were closed and the community mental health facilities
Kennedy favored, never were funded.

http://www.npr.org/blogs/health/2010/12/14/132031411/lay-therapists-in-india-can-make-a-difference-in-mental-illness
 <http://www.npr.org/templates/community/persona.php?uid=6352149>
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<http://www.npr.org/templates/community/persona.php?uid=6352149>
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<http://www.npr.org/templates/community/persona.php?uid=6352149>
<http://www.npr.org/templates/community/persona.php?uid=6352149>
   <http://twitter.com/NPRHealth>
 <http://twitter.com/NPRHealth>
 <http://twitter.com/NPRHealth>
 <http://twitter.com/NPRHealth>
 <http://twitter.com/NPRHealth>

<http://www.npr.org/blogs/health/2010/12/14/132031411/lay-therapists-in-india-can-make-a-difference-in-mental-illness>
 Anupam Nath/AP

Children light candles to observe India's first National Mental Health
Awareness Day, in New Delhi on Aug. 6.
<http://www.npr.org/blogs/health/2010/12/14/132031411/lay-therapists-in-india-can-make-a-difference-in-mental-illness>
close<http://www.npr.org/blogs/health/2010/12/14/132031411/lay-therapists-in-india-can-make-a-difference-in-mental-illness>

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