June 2020 | 751 words | 3-minute read
Anxiety, depression or other mental health conditions are subjects most of us still don’t like to talk about.
“Mental health remains a neglected part of global efforts to improve health,” according to The WHO Special Initiative for Mental Health (2019-2023): Universal Health Coverage for Mental Health publication, which states that “more than 80 percent of people experiencing mental health conditions, including individuals experiencing neurological and substance use disorders, are without any form of quality, affordable mental health care.”
In large sections of our society, it is still considered taboo to talk about emotional and mental health needs because of the social stigma attached to it. Take the case of 40-year-old Arjun Patil (name changed) who lives in a suburb of Nagpur city in Maharashtra and works as a daily wage earner. He had been suffering from epilepsy and showed signs of depression, with symptoms including feeling of worthlessness, irritability, sleep disturbances and harbouring suicidal thoughts. It was only after an attempted suicide on his part that his family realised that his mental condition was serious and decided to seek clinical help.
In another case, a 38-year-old resident of Gadchiroli town in central Maharashtra suffered from severe obsessive-compulsive disorder and sought medical attention; the families of both the patients found private treatment cost-prohibitive.
In India, an estimated 150 million people — about 10.6 percent of the population — suffer from a mental disorder that needs active intervention, according to a 2016 survey published by the National Institute of Mental Health and Neuro Sciences, Bengaluru. The large disease burden notwithstanding, mental health remains a neglected aspect of healthcare along with woefully inadequate mental healthcare services in India.
Investment in mental healthcare
It is here that the Tata Trusts decided to step in through Udaan, a special initiative to reform and transform mental healthcare in India.
Towards this, the Tata Trusts signed a Memorandum of Understanding with the Government of Maharashtra on March 31, 2016, to develop the Regional Mental Hospital, Nagpur (RMHN), as a centre of excellence for providing the highest quality of care to people suffering from mental illness.
"Udaan is not a project, but a mental health initiative of Tata Trusts," says Tasneem Raja, lead, Mental Health, Tata Trusts. It currently has three large programmes under it, and Tata Trusts is the lead technical partner for them. These include reforming the Regional Mental Hospital, Nagpur, and developing it as a centre of excellence; implementing the District Mental Health Programme for Nagpur district and developing it as a scalable model for the state; as well as creating a Technical Support unit for mental health in partnership with the state government, adds Raja.
Udaan's journey
Udaan thus is a journey to transform the quality of care provided in psychiatric institutions. In the first two years, it focused on undertaking several activities at RMHN to develop it as a centre of excellence that would serve as a model for other psychiatric institutions seeking reform.
Udaan thus is a journey to transform the quality of care provided in psychiatric institutions. In the first two years, it focused on undertaking several activities at RMHN to develop it as a centre of excellence that would serve as a model for other psychiatric institutions seeking reform.
Integrating care
Envisaging a linkage between institutional reform and community mental health programmes, the Tata Trusts’ Udaan team took on the challenge to integrate mental health services at the community level in Nagpur district.
The development and integration of mental health into the community domain required work at multiple levels. It needed work at the community level, with the public health system, and in the area of capacity building of various cadres involved in the delivery of mental health services. The ensuing programmes were developed to address these critical elements and build feasible and evidence-based models.
In the offing
In 2019 — the initiative's third year — Udaan is collaborating with the Maharashtra government in designing and implementing the District Mental Health Programme to deliver mental healthcare services across the state. This partnership could create a replicable model for community-based mental healthcare services in India. "The programmes, however, have a journey to traverse before we achieve replicability and scale," emphasises Raja.
Udaan has a participatory framework for reform in which the key stakeholders constitute the core pillars with the Tata Trusts’ Udaan team acting as a catalyst and guide. "The journey so far has been rewarding but extremely challenging," opines Raja.
—Esther Cabral
