India

Nothing About Us, Without Us - Voices from the Global South

28th-29th November 2015

The Movement for Global Mental Health (MGMH), in partnership with The Banyan, The Banyan Academy of Leadership in Mental Health (BALM), The Public Health Foundation of India (PHFI) and Tata Institute of Social Sciences (TISS) are delighted to announce the fourth Global Mental Health Summit to be held at the TISS Campus in Mumbai, India on the 28th and 29th of November 2015.

The Global Mental Health Summit is a biennial conclave of people passionate about mental health from across the world, who come together to share experiences, discuss problems related to access to care, and set programmatic and policy targets that address issues of mental health care delivery in low resource settings.

The focus of this year’s Global Health Summit, themed “Nothing About Us, Without Us”, will be driven mainly by persons living with mental health issues from different social, cultural and educational ecosystems. The aim is to bring to the forefront voices of individuals from marginalized backgrounds, those who are rarely represented in discussions related to the mental health agenda. Some of these individuals would include clients from The Banyan belonging to different rural and urban pockets in India, and people whose lives have been impacted by mental health issues, from across the world, who may or may not be users of mental health services. At a time when institutional and community care, the biopsychosocial model of mental health care, and notions of human rights are undergoing a paradigm shift, it becomes critical for voices of those in the margins experiencing complex realities to be heard, and interventions planned in accordance with their multidimensional needs.

Please find the agenda attached.

Vikram Patel talks on the dark side of mental institutions

Sangath is a non-governmental, not-for-profit organisation committed to improving health across the lifespan by empowering existing community resources to provide appropriate physical, psychological and social therapies. Its primary focus areas include child development, adolescent and youth health, and mental health and chronic disease.

REGISTRATION IS NOW OPEN FOR SANGATH'S GLOBALLY RECOGNIZED 'LEADERSHIP IN MENTAL HEALTH' COURSE, TAKING PLACE IN GOA, INDIA FROM 30 OCTOBER - 17 NOVEMBER 2017. Email: lmh@sangath.in

PANAJI: Eminent psychiatrist and co-founder of Goa based mental health research institute Sangath, Dr Vikram Patel has been awarded the 2016 Pardes Humanitarian Prize in Mental Health by the New York based Brain & Behaviour Research Foundation for his transformative work in advancing mental health care in resource-poor counties.


The 2016 Pardes Humanitarian Prize in Mental Health annually recognizes individuals who have contributed to mental health and who have improved the lives of people suffering from mental illness. The prize's honorarium of $3,00,000 will be presented to the awardees on Friday, October 28, in New York City.


Patel who will be attending the award ceremony along with his wife says he is honored and humbled and will accept the award on behalf of the millions struggling with mental illness, majority of whom live in the developing world and have limited access to appropriate mental health care. "I pledge to redouble my efforts to address the burden of mental health problems globally, especially amongst those who are socially disadvantaged or living in low resource settings," he says.


In 2015 Patel was recognized by Time magazine as one of the 100 most influential people in the world and he has been addressing the void of mental health care in developing countries as well as the grave shortage of psychologists and psychiatrists. A vocal advocate for the development of mental health services in these countries, he promotes practical solutions to improving mental health care by teaching ordinary people to deliver front-line mental health care to make up for the lack of care for people with mental illness.



Charles F Reynolds has been awarded for his pioneering work in geriatric psychiatry and the prevention and treatment of late-life depression and the late Senator Edward M Kennedy has been given an honorary tribute for his powerful and unwavering commitment to advocating on behalf of people with mental illness.

What are the mental health issues faced by the youth?
Young people can face a range of mental health problems. Most mental disorders begin before the age of 24, although they are often first detected later in life. Poor mental health is strongly related to other health and development concerns from early childhood onwards, notably child neglect and abuse, low educational attainment and a variety of stress points at home, in school or the community. The most common mental health problems that come up in this age group are emotional distress characterised by anxiety and depression and behavioural disorders such as attention-deficit/hyperactivity disorder and disruptive behaviour. Mental health problems and high social pressure can lead to self-harm, a leading cause for mortality in young Indian.

How can one deal with relationships, academics, peer pressure, family issues?
* Share your feelings and problems with family and friends, this can help reduce the sense of loneliness when in distress
* Participate in sports, exercise, school activities or hobbies. Staying busy helps one focus on positive activities rather than negative feelings or behaviour
* Try relaxation and meditation exercises, such as those used in some yoga techniques
* Do not resort to substances like tobacco or alcohol to help feel better; they may help in the short-term but will cause long-term damage
* Try to understand why you are feeling low; is there a problem which you need to address but have been avoiding? Are you misinterpreting a situation and reading it in a negative way?
* There is no shame in seeking professional help

How to identify if one is suffering from mental disorders?
The theme for this year’s Word Mental Health Day is ‘psychological first aid’, which aims to increase awareness of basic mental health first aid. To promote an environment of calm, hope and help people with acute mental health problems. It is important for all of us to have a basic knowledge of common mental health symptoms, some of which are listed below:

* Prolonged feelings of anxiety or tension
* Prolonged feelings of sadness, loss of interest or irritability
* Social withdrawal such as from friends
* Changes in eating or sleeping habits
* Growing inability to cope with daily problems and activities such as studies
* Suicidal thoughts
* Numerous unexplained physical complaints like headaches and tiredness

Guidelines for students, teachers and parents

Some of the things that parents, peers and teachers need to do:

* Encourage a zero-tolerance policy on violence in schools and home
* Look out for young people who may be isolated or bullied or whose school attendance or grades suddenly dip; these may all be signs of mental health problems
* Encourage young people with emotional or behavioural concerns to talk about their feelings. Try to understand why. Listen, don’t lecture
* If it seems that the situation may be serious, encourage the young person to seek counselling help and share their concerns with key adults in the youth’s life — family, friends and teachers
* Pay attention to talk about suicide. Ask direct questions and don’t be afraid of frank discussions

Why is it important to engage young people in mental health dialogue?
The guiding principle of engaging adolescents is an acknowledgment of their central role as agents of change and their right to information and services, with voices that are unique and complement scientific perspectives. To this end, one must create a platform for a genuine dialogue between young people and key stakeholders around mental health, to build adolescent capacities to address mental health problems and to identify strategies to address the stigma associated with mental health and increase adolescent knowledge of services and awareness of their rights.

Is technology to be held responsible for the mental stress on young minds?
It could be in some instances, for example if the young person becomes totally absorbed in the internet and loses contact with friends/families/other activities, or due to cyber-bullying. However, technology can also offer exciting opportunities for young people to access mental health care through a variety of online help sites and self-help apps.

Gender is a critical element of mental health. Where women are concerned, WHO statisticssay depressive disorders account for close to 41.9 percent of the disability from neuropsychiatric disorders. At 29.3 percent, the occurrence among men is considerably lower.

As per the WHO, depression, organic brain syndromes, and dementias mostly afflict older adults. Women form the majority of these adults.

Prof Vikram Patel, Co-director, Centre for Chronic Conditions and Injuries at the Public Health Foundation of India, says, “Gender is a profoundly important determinant of women’s mental health as the disadvantages faced by women, from birth through old age, lead to a range of stressors such as domestic violence, which are important risk factors for depression.”

Violence and sexual abuse

WHO research shows that a lifetime prevalence rate of violence against women ranges from 16–50 percent, for at least one in five women suffer rape or attempted rape in their lifetime. In the context of India, we see rape, sexual harassment, and child molestation cases across both rural and urban areas. According to the National Crime Records Bureau, a total of 36,735 rape cases were reported in 2014; the conviction rate was 28.0 percent. For the 3,37,922 crimes against women reported in 2014, the conviction rate was 22.3 percent. Victim-blaming and low conviction rates mean women suffer through the trauma and are marked for life.

Domestic abuse

Dr Rahul Shidhaye Research Scientist, Public Health Foundation of India, says that compared to the West, India has some cultural and social factors that are important triggers for mental ailments, stress, and depression among women. However, he points out that one needs to take into account effective country-specific prevention and intervention strategies because of the socio-economic and cultural differences that exist between India and the West.

women-2

Culture is heterogeneous and in the rural context he says, “A recent phenomenon that adds to higher depression among women is the strong preference for a male child. Population control measures and the ability to determine the sex of a child has increased the pressure on women to deliver a male child the first time round.”

With government policies regarding the number of children allowed per family, women have to go thorough abortion, are forced to abandon their children, and often face domestic abuse — both physical and verbal — for failing to deliver a male child.

Alcoholism

Alcoholism among male members of the family is another cause for increased stress and abuse among women, especially in low-income groups. The women not only face abuse but also are left to fend for themselves and support their families. There are thousands of women in urban India working in our houses as cooks, maids, and cleaners who carry this emotional and mental burden with them.

Challenges for working women

Dr Rahul makes an interesting point when he says that workplace processes and programmes have not been designed to accommodate the challenges women face. Whether it is PMS, pregnancy, or childbirth and return to work, women are often supposed to ignore their bodily functions and needs.. “Look at the sanitary napkin advertisements — they show that women can achieve whatever they want even on the days they probably need to give more attention to the needs of their bodies.”

Society and the workplace have made no adjustments to factor in the challenges women face. “While most women are celebrated when they come back to work after three months, what we are ignoring is the pressure and stress it puts on them to manage their career, work, and home.” Delaying pregnancy for career advancements also leads to physiological stress, causing health issues such as hormonal imbalances, cysts, etc.

“Physiologically, a lot of women experience postpartum depression, which, if treated with gentle love and care will pass. Unfortunately, this isn’t the case in many instances. The husband doesn’t quite get it. Another physiological reason is PMS. Too much fun has been made of it and too little importance is attached to it. As a psychotherapist, I have found that insensitivity towards these seemingly silly issues has long-lasting mental consequences,” shares psychotherapist and DeBox Founder Cheelu Chandran.

Interventions: from awareness to action

Cheelu says, “ Psychologically, women have a way of blaming themselves first for almost anything that happens in their households and/or work. It is so subliminal that they aren’t even aware of it. Apart from this, many women don’t even realise that they are in abusive relationships/environments, whether from their husbands, in-laws, or bosses. The grin-and-bear-it attitude that has been drilled into our heads, and phrases like the ‘weaker sex’ make us more vulnerable to depression. Emotionally we are so much stronger intrinsically and naturally, primarily because of our capacity to bear children. But this inner strength is taken for granted and mistaken for,‘Oh we can dump it on her, she can take anything.’”

According to Cheelu, the first step has to be awareness. “Women need to be made more aware to tap into their feelings and identify depression. The movement has to go from covert to overt.”

Alternative approaches: from higher purpose to good sleep

Given that sex and gender make women vulnerable to mental disorders, stress, and depression, psychological and psychiatric help is essential, but there are other alternative interventions that women can look at.

“Depression never really goes away, as I have seen in my own and others’ experience. It gets replaced with finding a higher and better purpose in life, but it does lurk in one corner and raises its head from time to time. The idea is to embrace that fact and not associate it with mental well-being. Depression is not a mental disease or disorder; it is a state of mind and an indicator that some suppressed emotion needs expression and/or an unfavourable situation needs changing. Kindness and forgiving and unconditionally loving yourself through this phase every time it comes up, will lift it. The moon waxes and wanes, the sea has low tides and high tides, so do we.”

Dr Rahul suggests a regular exercise regime; half an hour every day as exercise releases endorphins or happy hormones. According to him, sleep and a routine is must. “Our body has been designed to be productive in the morning and go slow during the evening.”

good night’s sleep refreshes and gives the body and mind the much-deserved rest.Arianna Huffington, who has launched sleep revolution, claims, “Sleep is a small miracle that lets you see the world anew with fresh eyes and reinvigorated spirit. I became an all-out sleep evangelist after my collapse from sleep deprivation… Let sleep be the big idea that shapes 2016.”

There is no doubt that gender makes women more vulnerable to depression, stress, and other kinds of mental disorders. However, it has to be accepted that social and cultural pressures are not going to ease anytime soon, and that workplace pressure to stay on top of the game is only going to tighten the noose. Women, therefore, have to take their wellness in their own hands and work towards a healthy lifestyle that can help keep mental disorders at bay.

A mental health stall at a Durga Puja pandal? It worked much better than you’d think

Susan Sontag wrote in her seminal work Illness as Metaphor (1978): “Everyone who is born holds dual citizenship, in the kingdom of the well and in the kingdom of the sick. Although we all prefer to use only the good passport, sooner or later each of us is obliged, at least for a spell, to identify ourselves as citizens of that other place.” Perhaps it is inhabiting that other place that brings out the most humane side of our existence — of learning to appreciate the perspective, the vulnerability that illness sometimes confronts us with.

As I took a good long look at a mental health-themed stall at the Durga Puja pandal in CR Park, a south Delhi colony, interactive games and surveys in full flow, these thoughts returned. The stall was set up by the Public Health Foundation of India (Knowledge to Action), as part of its PRIDE project to spread mental health awareness (and help suffering children), supported by Wellcome Trust/ DBT India Alliance. On the eve of World Mental Health Day (October 10), they came up with the idea of analysing how 75 per cent of the country’s youth (source: PHFI) are battling with mental illnesses everyday.

At first glance, a Durga Puja pandal might seem like an odd place for such a stall. But people flocked around the eager young PHFI folk all day. Who were these people asking pointed questions about their children’s mood swings and tantrums? Why were they looking like passengers without “good passports”, marooned at the airport of no return?

Sweta Pal, communication officer at PHFI, said: “The performances over the last two days generated a lot of positive feedback. People came to us with serious problems and what-to-do questions. Parents were worried about their kids’ stress levels. A lot of people brought back friends and spouses to “prove” to them that their anxieties and worries are “normal”. Mostly there was a lot of curiosity about why we weren’t selling anything.”

After a conversation with project coordinator Pattie Gonsalves, I got to participate in two jar games, which statistically explained how problems of stress, mental peace, fitness, food are interlinked. (One sought to locate the reason behind most stress-ridden situations, the other provides us with reasons that uplift moods). Towards the end of Navami (the ninth day of Durga Puja), it was discovered that the jar containing office/work-related stress was the fullest — a telling statement about the pressures related to our economic system.

Among the many sets of parents who visited the stall, there was one who wanted to know if their son waspaagal (insane). The only thing one can really say about this encounter is that it was good of the parents to ask this question in front of professionals; one hopes their misconceptions were swiftly dispelled.

It is rather troubling that the term ‘mental’ in mental health is understood as a pejorative. It shows that as a culture, we do not have the sensitive nomenclature for patients with mental illness.

It is necessary, therefore, for the relevant information to be disseminated in a thorough but wholly accessible manner. That’s where In the Life of Ravi and Asha comes in.

Ravi and Asha is a mini-comic that was distributed free at the PHFI stall. It’s about two people who have known each other since childhood, but are realising that their bond is turning into what is called a fair-weather friendship, with no outlet for the more disturbing aspects of their lives.

Once they realise this, they open up and tell each other everything. Asha’s father has a drinking problem, for instance, and there’s verbal abuse involved. Ravi has, of late, become listless and remains disinterested in everything, with no appetite, literal or metaphorical. His friends ignore his worries but we are shown that this is the onset of clinical depression. When the kids try to seek help from a teacher, he dismisses them summarily: “What do you have to worry about? You go to a good school and have a good home! Your generation is just lazy and ungrateful!”

Of course, this is a mini-comic, that too an instructional one, so the resolutions are neat and clean, no loose ends. But I feel that Ravi and Asha should be required reading, especially for the 11-15 age group. This is the age when children start being afraid of ridicule. Often, social ridicule is gendered to make matters worse. When I was in school, teachers would always reserve their rudest tones (and harshest punishments) for boisterous girls who had already attained puberty. For every out-of-the-box question they would ask, they would be disciplined by nasty remarks on their uniform, innerwear and so on. Even if their stress was genuine and had potentially serious repercussions, they were discouraged from talking about it.

Ravi and Asha is an attempt to change the way we address mental well-being. It does a good job in showing us some widespread myths about mental illness — and how we can counter them.

The efficacy of comics as an instructional medium has been well-documented. W Sones, in his famous 1944 essay ‘The comics and instructional method’, discusses how the medium of comics created a rare visual interest among students compared to textual learning. His studies also revealed that low- and average-IQ children found the graphic medium especially helpful.

Once we step into the shoes of the mentally ill, we realise the privilege that comes with being passengers from the kingdom of the well. From describing depression as a “character flaw” to tagging the sick as “psycho” and “dangerous”, we have been a rogue kingdom, it has to be said. One hopes that projects like this one will reach out to a large number of young people, and mental health truly becomes a priority for all of us. To quote from the comic itself, “There is no shame in asking for help. Mental health is, after all, as important, and must be taken as seriously as physical health.”

Rini Barman is a Delhi-based writer and researcher