MAANASI - A Sustained, Innovative, Integrated Mental Healthcare Model in South India

Authors

  • Geetha Jayaram Johns Hopkins University, Departments of Psychiatry, & Bloomberg School of Public Health, Meyer 109, Johns Hopkins Hospital, Baltimore, MD 21287
  • Ramakrishna Goud St. John's Medical College, Bengaluru
  • Suhas Chandran Department of Psychiatry, St. John's Medical College, Bengaluru
  • Johnson Pradeep Department of Psychiatry, St. John's Medical College, Bengaluru

DOI:

https://doi.org/10.5463/dcid.v30i2.851

Keywords:

global mental health, psychiatric care, integrated care, rural mental health, community health care workers, caseworkers

Abstract

Studies in low and middle-income countries (LMICs) point to a significant association of common mental disorders with female gender, low education, and poverty. Depression and anxiety are frequently complicated by lack of disease awareness and non-adherence, the absence of care and provider resources, low value given to mental health by policy-makers, stigma, and discrimination towards the mentally ill. This paper aims to show that female village leaders/ community health and outreach workers (CHWs) can be used to overcome the lack of psychiatric resources for treatment of common mental disorders in rural areas.

A multidisciplinary team was set up to evaluate and treat potential clients in the villages. A program of care delivery was planned, developed and implemented by: (a) targeting indigent women in the region; (b) integrating mental health care with primary care; (c) making care affordable and accessible by training local women as CHWs with ongoing continued supervision; and (d) sustaining the program long-term.   Indigenous CHWs served as a link between the centre and the community. They received hands-on training, ongoing supervision, and an abridged but focused training module to identify common mental disorders, help treatment compliance, networking, illness literacy and community support by outreach workers. They used assessment tools translated into the local language, and conducted focus groups and client training programs. As a result, mental healthcare was provided to clients from as many as 150 villages in South India. Currently the services are utilized on a regular basis by about 50 villages around the central project site.

The current active caseload of registered clients is 1930.  Empowerment of treated clients is the final outcome, assisting them in self-employment. Rural mental healthcare must be culturally congruent, and must integrate primary care and local CHWs for success. Training, supervision, ongoing teaching of CHWs, on-site resident medical officers, research and outreach are essential to continued success over two decades.

Author Biographies

Geetha Jayaram, Johns Hopkins University, Departments of Psychiatry, & Bloomberg School of Public Health, Meyer 109, Johns Hopkins Hospital, Baltimore, MD 21287

Dr. Geetha Jayaram is a senior faculty member of the Departments of Medicine, Public Health and Nursing at the Johns Hopkins University in Baltimore, Maryland, USA. She is a community psychiatrist, program builder, researcher and clinician. She is the Founder of the Maanasi project. 

 

Ramakrishna Goud, St. John's Medical College, Bengaluru

Dr. Ramakrishna Goud is Professor and Chair of the Department of Community Medicine at St John's Medical College Hospital, St John's National Academy of Health Sciences, Bangalore, India. He is the Director of Maanasi on the ground, responsible for overall supervision of the project.

 

Suhas Chandran, Department of Psychiatry, St. John's Medical College, Bengaluru

 

Dr. Suhas Chandran is an Assistant Professor in Psychiatry at St John's Medical College Hospital, St John's National Academy of Health Sciences, Bangalore, India. His areas of interest include community psychiatry, child and adolescent psychiatry among others. He has been associated with the Maanasi project since more than a year and visits the rural mental health clinic on a weekly basis.   

 

Johnson Pradeep, Department of Psychiatry, St. John's Medical College, Bengaluru

Dr. Pradeep Johnson is Associate Professor and the Lead Psychiatrist who consults for the Maanasi program. He is responsible for education of the residents and Community Health Workers as well. He supervises and teaches residents in psychiatry. 

 

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Published

2019-10-04

How to Cite

1.
Jayaram G, Goud R, Chandran S, Pradeep J. MAANASI - A Sustained, Innovative, Integrated Mental Healthcare Model in South India. DCIDJ [Internet]. 2019 Oct. 4 [cited 2024 Jul. 16];30(2):104-13. Available from: https://dcidj.uog.edu.et/index.php/up-j-dcbrid/article/view/335

Issue

Section

Experiential Accounts