1st Feb , 2017

Hitha Maureen
M2016MH011

Our country has a rich heritage of faith healing in many of its temples , Dargahs and other
worship places, which is increasingly been overshadowed by the new clinical models. The fact
that there is so much potential in the union of faith healing and modern clinical practice , to
reach out to heavily traditional and religious communities in the far corners of the country.
Religion has existed from time immemorial as the ‘Opium of the masses’ (Marx), God and
religion is seen as a symbol of hope for the future and also becomes an escape from the mortal
hardships of this world. Faith also often helps people in attributing problems of their body to
something bigger and beyond them.
The Dawa-dua project is one such an attempt to provide medicine and prayer for treatment in
our country.Another example from the south is of the Gunaseelam Vishnu temple, in
tiruchirappalli district (Tamil Nadu) is a testimony to the coexistence of modern and traditional
mental health systems.

‘The calming melody of the nadaswaram interspersed with the beat of the mridangam rose from the
sanctum sanctorum of ​Vishnu in the famous temple dedicated to the Hindu god in Gunaseelam, a village
in Tiruchirappalli district of Tamil Nadu. ​A visibly disturbed woman, perhaps diagnosed with psychosis,
was speaking to herself or to the voices she heard. She seemed agitated by the auditory hallucinations,
somewhat angry at what they had to say, and yet, strangely comforted by her environment.
Another woman seemed rather sad and withdrawn, displaying a “negative effect” – a classic symptom of
depression. Her attention focused sharply on a picture of a god that she believed had the power to heal.
Meanwhile a young man was pacing up and down the courtyard, as his father looked on, hopeful that the
visit to this shrine would help’.

This temple also has a mental health rehabilitation centre attached to the temple that is visited
by psychiatrists. The deity of the temple is also believed to have healing powers. Hordes of
people visit the temple in the hope to be cured, and the temple+the rehab centre together
provide a space of mental health care that most people can access and afford ( compared to
other private care facilities). The temple and its community thus provides a therapeutic
environment to the devotees who find solace and faith in the deity and have a strong conviction
about recovery.

The time to move towards a holistic approach in mental health care has come, a need to
incorporate traditional practices, respecting the socio-cultural contexts and the wholesome
understanding the individual’s history before prescribing medicines. In our country, people with
severe and common mental disorders typically go to primary health clinics or District and
Psychiatric hospitals (or private care)that offer anti-psychotics, mood stabilisers,
anti-depressants as the first line of depressants. The government’s District mental health
programme (DMHP) conveniently resorts to a one-size-fits-all treatment method, without any
respect for the context/ social setting of the people. This would mean the need for ​DMHP to
diversify and adapt ​according to the community.

A case study: ​Radha (name changed), a tribal woman who comes from the Irular community in
Tamil Nadu, whose culture does not have many of the stereotypical gender roles that exists in
the mainstream society, the women and men both drink and the instances of Wife and husband
beating is equally common. And She experienced a deep sense of inadequacy due to her
inability to fulfill her social role as a mother after she was unable to conceive a child. She had
several physical and verbal altercations with her mother-in-law and alcoholic husband. To
worsen things, the floods last year destroyed all of her family’s property, spiraling them further
into poverty.
Radha’s sleep and eating patterns changed. She experienced a sense of hopelessness, fatigue
and fear – classic symptoms of depression and perhaps, trauma. Her mood dipped over a
period of two years, with the loss of her thatched hut in the floods, perhaps, making her
depression more intense.

It’s important to understand whether the symptoms were due to psychological distress or an
outcome of her social context ( events in her life)? The stressors she experienced are certainly
multidimensional. The poverty due to sudden destruction of property, unable to conceive, living
in a community that is far removed from the developed world etc all are contributing to her
distress.
(According to Maslow’s hierarchy,self actualization can only be achieved when the lower levels
of food, safety, affection etc are completely fulfilled). For a case like Radha’s it's essential to
understand the social setting, tribal culture,oppression and deprivation she experiences that is
contributing to her mental ill health etc, such a case can't be just clinically labelled as
‘depression’ and pushed away by the prescription of drugs. Isn't it time to look beyond the
psychological view and look for the sociological causes?. A proper DMHP intervention in
Radha’s case would have to look into various aspects of her life to understand the real problem,
instead of taking a medical approach by just prescribing drugs, which may even convince
Radha that she is the ultimate cause of all her distress and not her circumstances/social
conditions.

Reference
Scroll article :​ ‘‘​How centres of faith can help provide better mental healthcare in India’’
Dated:​ Sep 17, 2016 · 02:30 pm
Source​: https://scroll.in
8th Feb , 2017 
Hitha Maureen 
M2016MH011 
 
The Trieste model is multidimensional,The approaches taken are as follows: holistic 
approach: the focus is on the individual and not the disorder, all are ‘users’ and not 
patient, ecological approach: the focus is on social inclusion by giving importance to 
the person’s social context, Legal approach: civil rights of an individual. Trieste model 
believes in the idea of deinstitutionalization that means an individual controls one’s 
own route to recovery And most importantly their guiding principle is ‘freedom first’ 
in every sense- a conscious decision to not lock people up, always ‘open’ doors and 
deinstitutionalization is not complete without the reintegration of the people back 
into the community, the principle of reciprocity that involves creating equal 
relationships of exchange between the client and the professional, idea of personal 
autonomy and good care. What I would like to pick out from the trieste model is the 
increased emphasis on the ​Outpatient care and community support along with the 
strong emphasis on ‘freedom first’,​ which seems relevant in our country context with 
a huge population and the need to move away from institutionalisation.  
There is this idea I had during my undergraduate years when I developed a strong 
liking to psychology , the idea of mobile psychiatric services, which according to me 
at that point was the ultimate solution to reach out to the people in remote areas of 
our country with adequate mental health care. Now this idea seems pretty naive and 
unrealistic, but I figured it can be reused with a little tweaking. A network of mobile 
mental health services in collaboration with the DMHP with access to remote areas of 
our country. The mobile mental health services with clinically(and in community 
mental health) trained staff , who are aware of the socio-cultural context of the 
community they are headed to and are sensitised to the social conditions that 
individuals experience in the community. The dual role of the mobile mental health 
services is to give outpatient care and identify two/three stakeholders from the 
community as volunteers (train them and keep them in the loop for follow up on 
individual caseworks), additional support network creation of caregivers,clients and 
other citizens (all together, to encourage inclusion and give clients a sense of 
autonomy and empowerment). The mobile mental health care services would 
periodically visit the communities (say every six months), and this idea is feasible for 
places where establishing infrastructure is not currently possible. This is just a idea 
that still hasn’t evolved (needs proper ideation and feasibility check and pilot testing) 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
 
15th Feb , 2017 
Hitha Maureen 
M2016MH011 

Disaster mental health ​ makes mental health workers work with individuals and whole
communities in the field rather than in an office.This is similar to conceptualization of
community mental health.What seemed really interesting about Disaster mental health is
that it had a strong sociological standpoint and medical/psychiatric standpoint. From a
sociological standpoint, disaster mental health looks at all kinds of support that people
rely upon in their day- to-day living, in order to bring people to normalcy it's more
important to restore their social conditions to the prior-to-the-disaster-state. In a medical
point of view, intervention will be aimed at identifying and treating pathological
reactions among people post disaster, trying to identify cases of PTSD, depression,
anxiety, distress etc. Disaster mental health probably evolved from both the perspectives
or was influenced by both as it evolved.
I tried ​to understand the responses​ that ​a mental health worker​ should ideally have while
handling a post-disaster scenario in terms of interacting with people/community members
through the ​WHO’s psychological first aid (PFA) ​. It was interesting to note that the PFA
could be used by anyone to deal with a disaster scenario , it need not be a mental health
professional. The PFA constantly emphasised on the need to listen to the people, to not
pressurise them to talk, and helping them address their basic concerns like food, water,
shelter, and most importantly information. Information becomes a vital resource at such
times, information about social support and services, it becomes necessary to arm
yourself with adequate information while approaching people in such situations.
PFA encourages the need to collect stories (without pressurising)of
individual/community to understand the people’s post-disaster reactions. You cannot
forcefully help people but can make yourself easily available for people who will need
your help.Also it’s essential to help responsibly! While helping it’s essential to keep
people’s rights, dignity and safety in mind, its also important to be mindful of the
cultural context that the person belongs to, and very very very importantly be aware of
other emergency response measures for food, shelter, child protection services etc ( this is
vital information they really need). The three basic action principles of the PFA is ​look,
listen and link .
Look
»​Check for safety.
»​Check for people with obvious urgent basic needs.
»​Check for people with serious distress reactions.
Listen
»​Approach people who may need support.
»​Ask about people’s needs and concerns.
»​Listen to people, and help them to feel calm.
Link
»​Help people address basic needs and access services.
»​Help people cope with problems.
»​Give information.
»​Connect people with loved ones and social support.
It would be interesting to analyse situations in post disaster contexts and try an
application exercise to understand how Look,Link and listen , possibly works. And why
don’t we really have a workshop to get a better understanding of Disaster mental health?
If it happens, count me in. And in the post exam period, visits and sessions would be
great, I’m sure dates can be worked out amongst us , so that we are all available on that
date.