Mental health services are non-existent in rural areas in India, where 70% of population reside. According to a survey carried out by the World Health Organisation (WHO) in 2001, amongst persons in the age group 15-44, four out of five leading causes of living with disability are mental disorders.

The rural branch of The Richmond Fellowship Society (India), "Pragathi", which started in January 2004, is a community-based multidisciplinary rural mental health project in Siddlaghatta Taluk, Kolar district, Karnataka, an economically backward and consistently drought-prone area in Karnataka. The project expects to cover 243 villages with a total population of about 150, 000 and is being supported by the Trust under its Small Grant Programme, effective October 2005. Since then, over a period of one year, 536 new cases have been handled by the branch (249 males and 287 females) and over 4,000 follow-up patients have been treated (including patients with epilepsy).

Activities carried out under the Trust’s Grant:
The Trust’s support led to the appointment of staff, including Part Time Psychiatrist, Research Assistant, Part Time Data Entry Worker, Part Time Statistician and two Outreach Workers. Further, with the grant funds, the organisation was able to organize transport for the staff and patients. The staff appointed under the grant has devoted their time mainly towards the work related to the evaluation of the project. This included:

• Collecting demographic data of the patients, recording therapeutic, rehabilitative, educational, awareness programs and self help formation activities;
• Administering rating scales at agreed time intervals, to measure changes in psychiatric symptoms of the patients, degree of disability, family and economic burden;
• Carrying out awareness programs, organizing formation of self help groups and follow ups of default patients;
• Continuing activities related to establishing community mental health services; rehabilitation services to integrate mentally ill and mentally disabled persons back into their families and society; manpower development in the area of Psychosocial Rehabilitation and advocacy, promotion and prevention and dealing with the issues of stigma.
• Continuing the services already in operation, mainly concentrating on the patients included in the study

Services offered:
Monthly clinics were conducted on the last Sunday of a particular month for patients with mental health problems. Outpatient clinics are conducted by a team of Psychiatrists, Clinical Psychologists, Psychiatric Social Workers and student trainees with the help of local representatives from the community. The services and medication is free of charge. The assessment of rehabilitation needs is carried out for suitable patients using appropriate measuring instruments. Depending upon the individual needs of the patients, referrals are made for rehabilitation services based at Day hospital or community.

The Day Care Centre came into operation in October 2005. The Centre will be the central and focal point for coordinating rehabilitation and community cares services and educational programs for the patients and the community as a whole. The main purpose is to help patients to become as independent as possible, leading to better quality of life for themselves and less burden on the family. Planned program and training of individual patients, depending upon their needs, abilities and disabilities is carried out.

Community services:
The organisation aims to establish decentralized rural rehabilitation services through:

• Community outreach team - Creation of a local team to take mental health care to the doorstep of the needy. The team provides after care services and education and helps in setting up self-help and carer groups. Weekly visits to the villages are undertaken by the team, in addition to regular visits by the outreach workers;
• Formation of self-help groups as a means of social support;
• Enhancing community awareness about health and mental health problems through education, by organizing community participation programs at different villages. Consequently, the organisation managed to organize street plays, besides educational programs for various professional groups, voluntary organizations, village heads and school children;
• Educational programs for medical, paramedical, voluntary organizations, patients and carers;
• An enduring liaison that integrates mental health with primary health care; and
• Promoting community awareness of the rights and privileges of the mentally ill.

Some observations so far:

• Assessment of need – Mental health care is almost non-existing in Sidlaghatta Taluk. The patients who need the services have to travel to Bangalore (80 Kms) Kolar (50 Kms).
• About 80% of patients cannot afford minimum public transport charges and also the existing meager psychiatric services in urban areas cannot meet the demands.
• Increased awareness about the mental health problems in the community and services offered at monthly clinic is reflected in the steady increase in the number of new and old cases, especially male patients who are the main bread winners of the family
• The close vicinity of the monthly camp has helped many families in seeking treatment and to continue with follow up.
• Many families have been coming regularly for almost more then a year and are very happy with the degree of change in their clients’ behaviour and their abilities to take care of themselves and also being able to help in the regular routine family chores and responsibilities.
• The free medication provided has greatly helped in decreasing their financial burden and made it possible for them to bring their families for regular check up and hence the possibility of a good recovery and ability to reintegrate with the society.
• The response to community visits is welcoming and the clients discuss problems without being hindered by the thoughts of stigma. The volunteers are also keen to contribute to implement community services.
• Closer links have been established with the Government Health sector.

Click here to Enlarge

Click here to Enlarge