Mental Health <http://truguj.org/programmes/mental-health> [image:
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*Background*

The general view of mental illnesses is that their treatment requires
institutional care. TRU, however, has been successfully applying its
experience with community health activities to the field of psychiatry.
Since 2004, 65% of mentally ill patients who reported to TRU have have been
rehabilitated. This success rate prompted the training of CHC and PHC staff
on the TRU model. Furthermore, the model was applied in Halol and
Jambughoda blocks, where TRU set up the infrastructure and imparted
training to ASHA workers.


  *Approach*

TRU established psychiatric OPDs at three locations in Halol and Jambughoda
blocks, in addition to the OPD that had already been set up in Shivrajpur.
A total of 236 villages and 1,90,000 people were surveyed, and
approximately 80 ASHA workers and 8 PHCs participated in the mental health
initiatives. Patients who had been off medication owing to various
constraints were actively sought and offered follow up care and counseling.
The aim was to understand why people went off medication and at what stage
they considered themselves mentally fit to resume work. In addition,
through surveys, an attempt was made to understand the triggers of mental
illnesses. Most importantly, TRU conducted various programs to train ASHA
workers to impart mental health initiatives.


 *Response*

   -

   In all 646 patients attended the new OPDs.
   -

   More than 2000 patient visits were recorded at the new OPDs
   -

   TRU followed up on 457 of the 646 patients that attended the OPDs


Trust for Reaching the Unreached
Organization: Trust for Reaching the Unreached (TRU) (http://truguj.org)
Team Member:
Asti Bhatt ([email protected])

A new approach to handle mental illnesses among the marginalized
communities in India has been implemented
as a pilot project in the Panchmahals district of Gujarat state in India.
The approach aims for a near total
rehabilitation of mentally ill patients. This involves personal, social,
and economical rehabilitation. It enables
patients to take care of themselves in terms of their personal hygiene,
helps them rehabilitate in their own
families, makes them socially participative in their communities, and helps
them rejoin their livelihoods according
to their skill sets prior to suffering a mental illness. This approach is
made possible by integrating mental health
into a general community based health care model working with health
workers from the community itself.

The issues related to mental health are widespread in communities under
constant stress. Patients suffering from
mental illnesses often have no more choice than to go to a folk healer, and
often get mistreated by the
community. Women, especially, often suffer greater pain and sexual
harassment as a consequence of their illness.
There is currently an extreme shortage of psychiatric services, including
community minded and patient oriented
health care professionals, psychiatric nurses and social workers. This is
the problem we seek to address.
Non‐community‐based psychiatric care is often based on medicines and one
time solutions, rather than on
constant care and requisite follow‐up. To this purpose, the people trained
as mental health community workers
are those who are trained in general health care services, are part of the
communities themselves and are
equipped to maintain a long term relationship with the patients. This makes
the task of relationship‐building with
the patients' families easier leading to increased chances of
rehabilitation of the patient. To assist these workers,
aids in the form of booklets, pictures and other literature are also
developed, along with regular trainings.

The target population for the pilot project is a set of tribal and dalit
(backward caste) communities of Panchmahals
district in Gujarat state of India. However, we envisage upon successful
completion of this pilot program, that this
community based approach can be scaled up to serve the mental health needs
of marginalized communities in all
of rural India.

Mental health patients include both men & women from various tribal and
dalit hierarchies in the region. A rather
unique approach towards inclusivity is that the mental health community
workers establish communication with
traditional folk healers (instead of discouraging their involvement) and
encourage them to send patients to the
community health workers thus ensuring that these patients receive the
psychiatric care they require.
Teaching aides for community health workers and teachers have been
developed through this pilot project, which
can be easily translated in other languages in order to implement this
approach on a pan‐Indian scale. A
community based approach needs to be introduced in people's consciousness
through continuous communication
with not only patients and their families, but also with communities at
large through creative means.

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