Improving Mental Health Literacy in Rural Pune
It was the inauguration of the first-ever Mental Health Outreach OPD (clinic) in Wanewadi village of Baramati block, almost 100 kilometers away from the district headquarter of Pune. Dr. Amar Shinde, a Senior psychiatrist and chairperson of the Jagruti Public Charitable Trust, was delivering his inaugural speech on the ‘Manojagruti’ initiative in Pune. As I skimmed through the gathering, I noticed Baba Gadhve (name changed), stationed in a corner of the hall, restless, murmuring, and fidgety. His wife, Latabai, was battling to calm him down. Baba seemed disoriented, with an unkempt beard and stinky clothes, and his rapid movements disturbed the rest of the gathering.
The irony of the situation called for action. After all, it was a meeting to promote mental health and care in rural Pune. Some of my fellow psychiatrists decided to approach the couple. They were escorted to the adjacent room and offered help. It turned out that Baba was a homeless nomad—he wandered throughout the village, ate whatever he could find, mumbled round-the-clock, and found refuge on the streets. He has not received treatment in the last ten years because his family could not afford it.
Our team assessed his mental and physical health and prescribed a few initial medications. The whole process helped calm Latabhai. It was satisfying to see her leave with Baba—less stressed, calm, and poised.
Mental Health
Mental health is crucial to overall health. About 6-7% of the Indian population grapples with mental disorders, a statistic that also extends to Maharashtra. Studies show that young adults between 15-29 years old are prone to suicidal attempts, underscoring the urgency of addressing mental health.
Rural areas reported a lower prevalence of mental issues compared to urban settings. Possible reasons could be a lack of awareness of mental illness, poor availability of mental health and rehab facilities, and a treatment gap. Only 10 to 20% of people in rural areas who need mental health support actually attempt to get it. This disparity is caused by things like a lack of health professionals, access to services, and social stigma. Dr. Amar Shinde envisioned establishing outreach services to bridge this significant treatment gap. His approach seeks to extend care to those who are unable to travel to urban centers by providing treatment in locations that are accessible to them.
Dr. Amar Shinde is a renowned psychiatrist who heads the Jagruti Rehabilitation Centers across the nation. The institution started with just 10 beds way back in 2008 and has now expanded to 600 beds in six different cities across the country. Jagruti is the pioneer in dementia care in the state of Maharashtra. In 2014, Dr. Amar took the initiative to establish the Jagruti Public Charitable Trust, primarily aimed at promoting awareness and extending the reach of mental health services beyond the four walls of urban facilities into the community.
Manojagruti is a big step forward for the Jagruti Trust to promote essential mental health education. This program was launched in Parinche village of the Purandar block and Wanewadi village of the Baramati block.
Dr. Amar says,
“An individual's mental well-being can have a ripple effect on their family, friends, and neighbors. By fostering a culture of mental health awareness and support, we can strengthen the social fabric and promote a sense of empathy and understanding within these communities. Recognizing this, Manojagruti has launched a Mental Health Literacy Campaign. The focus is to reduce the treatment gap while society is well aware of mental health matters, recognizes needs, and tries to seek it timely’’.
Manosathi—Your New Friend
This program is based in Parinche, a remote village 50 kilometers from Pune, nestled behind the Purandar fort. The village is significant because of the late Dr. Nosheer Antia, who oversaw the Foundation for Research in Community Health (FRCH) for nearly three decades in this locality. Hence, the local community is vocal about their healthcare needs.
The program involves training six experienced female health workers as Manosathis. Their primary role is to make a list of people with mental illness in their area, map their treatment histories, and guide them to the Manojagruti charitable OPD. The villagers have helped endorse this OPD service, held in a Grampanchayat hall once a month.
Manosathis are also expected to conduct bi-weekly home visits to ensure treatment adherence. To tell you about our progress—the Manosathis have already identified 41 patients afflicted by mental disorders in Parinche and neighboring villages, covering a population of 20,000. The ongoing process aims to add patients with epilepsy and chronic substance abuse to this list.
The biggest challenge is dealing with patients and families who have remained silent and confined within the house for years. The team is trying to streamline home visits to initiate treatment for them.
Wanewadi village, whose prosperity is linked to a cooperative sugar factory, represents a different scenario. While private clinics have thrived in this community, the approach of the people to their health needs has been limited. Amid this backdrop, introducing the Manojagruti Mental Health Literacy Campaign and appointing Manosathis was an uphill struggle. Despite education sessions, the OPD turnout was poor. To address this issue, the Manojagruti team decided to align with government health workers, specifically ASHAs, to help reach out better in the community, schools, and junior colleges for basic mental health literacy.
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Elderly Care and Dementia Treatment
There is a small conventional hall right in the center of Wanewadi village where a group of senior citizens frequently convene. This assembly, known as the Virangula group, has been supportive and helpful with our outreach programs and has lent out the hall space for mental health outreach OPD. Interactions with the group revealed that several members displayed early signs of dementia. Many people expressed a desire for evaluation and care following a session on dementia awareness. Dr. Amar Shinde examined them and determined that three of the elderly patients had early-stage Alzheimer's dementia. These elderly patients, who are in their 80s, are being treated by Dr. Amar Shinde to halt further memory loss. The Manojagruti has effectively been able to educate these elders about the connection between aging and memory loss.
A Way Forward
Looking ahead, Manojagruti is in the early stages of spreading awareness about mental health in rural India. The District Mental Health Project (DMHP) of the government aims to provide care at the block level, but accessibility remains an issue. In areas where regular psychiatric outreach is lacking, facilities such as Manojagruti's frontline staff and telemedicine programs, delivered through Health and Wellness Centers, can improve access. There are thousands, like Baba Gadhve and 'Latabais,' who lack access to mental health care due to transportation and financial difficulties. It is critical to create an informed and compassionate society to support initiatives such as Manojagruti.