13 April 2018
About Prashanth (or Daktre as he is fondly known) – Prashanth is an avid birder (avid – is an understatement) and somebody I go-to when I would like to discuss issues regarding mental health. While we bond over wildlife and conservation, he is also known for his humble and humanistic approach to problems. Underlying that casual exterior is a person who is well-versed with processes and pitfalls in public health systems, especially in Karnataka. Along with his team, he has been conducting mental health and public health clinics in and around Biligiri Rangana Betta (B R Hills) in Chamrajanagar district, Karnataka. In short, he is everybody’s friend, and everybody’s doctor.
We (Noah & I) had a quick chat with him just as he finished his weekly marathon and he managed to share some information while still being out-of-breath! (I exaggerated a bit!)
What are the best sources to get a comprehensive view of current scenario of mental health challenges and initiatives?
Too broad a question but there are good examples to consider. Vikram Patel runs Sangath (http://www.sangath.in/) in Goa. He is a strong advocate of using peers and community in mental health. Also, extension workers at ward levels (municipal wards). Has given numerous talks, including a TED talk on mental health. (TED talk: https://www.ted.com/talks/vikram_patel_mental_health_for_all_by_involving_all)
Schizophrenia Research Foundation (SCARF: http://www.scarfindia.org/) is another such organization that works predominantly in the schizophrenia community. Based in Chennai but is also active in Bangalore.
The Banyan (thebanyan.org, thebanyan.wordpress.com) – From their blog – “The Banyan has been filing an important gap in the system of mental health care in our country. The founders of the organisation proactively looked at the needs of people with severe mental health problems who are homeless by responding to a crisis on the streets of Chennai.”
Dr Kishore Kumar who now runs The Banyan is known to be a very dynamic and approachable person.
Could you broadly classify/categorize mental health issues in urban India as they relate to specific groups of people
Homelessness and people on the streets are particularly vulnerable. Kishore Kumar/The Banyan has worked extensively in this area. Almost 60% have diagnosable mental health problems, and sadly most of these people are invisible or slip through the nets. Slums/urban poor neighbourhoods also harbour high incidences of these cases. Substance abuse and domestic violence can also be linked to mental health issues. The elderly across classes/strata are another vulnerable group of people. Workplaces are often poor as well. In Bangalore, NIMHANS is the only place that remains accessible to all thereby putting an enormous pressure on the institute while most of these should be addressed at the ward or PHC level itself.
To you, where are the biggest barriers/gaps in people accessing care towards their mental health?
Barriers: Can be individuals, households, communities. It can also be lack of recognition of mental health. Services such as general physicians, doctors, nurses are often not empowered with information or resources and hence no awareness. Surprisingly, medical schools score very low on imparting good communication, ethics and empathy. Humanities is not a part of the curriculum in most/all medical schools. There are powerful institutional barriers to mental health and political engagement is often very poor. Media (English and vernacular) is also hugely to blame for sensationalizing or depicting mental health issues in a negative light. Schools are another place where it is important to inculcate the value of positive mental health in teenagers/adolescents but this is not happening. This could have a huge impact later on.
Who are the organizations or people doing interesting work in this space and looking to explore new ways if addressing the issues? (possible collaboration)
The Banyan, Chennai
SCARF, Chennai and Bangalore
R Srinivas Murthy (https://www.researchgate.net/scientific-contributions/38947128_R_Srinivasa_Murthy & http://www.indianjpsychiatry.org/article.asp?issn=0019-5545;year=2015;volume=57;issue=3;spage=315;epage=319;aulast=Wig ) – ex-NIMHANS & WHO-Mental Health, cancer survivor who now works almost exclusively with other cancer survivors. Believes that mental health must be community-driven.
Prashanth has indicated that he would be happy to facilitate correspondence or contact with any of the above mentioned people. He also strongly encourages that we go ahead and contact them and start a sustained discussion. He thinks a meaningful dialogue across disciplines is lacking and would be interested in participating in our meetings and foster collaborations. He is willing to experiment with/enable new methodologies or formats and host us (if needed) at their centre near B R Hills. We could potentially visit one of his rural mental health clinics.