The Covid-19 pandemic has spurred widespread recognition of a spike in mental health problems. Yet it is the mental health needs of those who live in rural areas that are most important, for they are also the most ignored. Past experience has shown that access to mental healthcare in rural India is even more limited than it is in urban areas, and the problem is exacerbated in remote villages.
This shortcoming and its impact became very apparent during the implementation of a recent project on mental health in parts of Jharkhand and Bihar. The Nav Bharat Jagriti Kendra (NBJK), one of the most well-established voluntary organisations in this region, along with several partners, conducted detailed surveys of the mental health needs in far-off villages. These surveys have revealed several startling instances of the extent to which mental health patients are denied proper medical care, resulting in avoidable suffering for them and their families.
For example, Kishen [name changed], a patient in the Nalanda district of Bihar, was tied with iron chains at his home while his wife and children went in search of work.
Mithilesh [not her real name] of Santhal Pargana division in Jharkhand had a tendency to engage in self-harming behaviour and violence. She was denied any care at all and had to leave her family residence. She started living under a tree. Similar was the story of Gaya resident, Shiva, who took to roaming around aimlessly until members of his family would bring him back, but then keep him chained. He would often turn violent.
A Palamu, Jharkhand, resident could not withstand a family tragedy and would often become violent: her husband spent his money on quacks for her treatment, but obviously got no closer to a cure. In the process, he became indebted and lost his job. Similarly, Vasanth, a resident of Gaya, Bihar, lost his mental moorings and would indulge in socially embarrassing behaviour. His family would thrash him and leave him tied up in chains.
These instances provide a sense of the mental health crisis in rural India and the extreme distress that patients and their families go through. However, it is not all bleak. The good news is that access to the required medical care ensured that these men and women made very encouraging recoveries. Hundreds of other patients in very difficult circumstances got relief too, after the survey was followed up with mental health camps.
It was also heartening that those who made successful recoveries included people whose families, communities and neighbours contributed to their care. This was true for people who experienced mental crises following a major professional, business or emotional setback.
A Hazaribagh resident lost her mental balance after she and her two daughters were abandoned and evicted by her husband. She took to abusing and throwing stones at people, but when her daughters learned of a mental health camp near their village, they arranged for her treatment. As part of her recovery, the woman was involved in a micro-enterprise project in which she elected to start selling bangles for a livelihood. Thus, from a serious illness she could enter a very colourful world.
Thanks to the efforts of his mother and neighbours, a young man from Gaya sought treatment at a mental health camp where he responded well. Thereafter, with the economic assistance that is provided to people recovering from mental disorders, he purchased a pushcart and returned to making a living. When his condition improved, social activists reunited him with his wife and children. The recovered patient now devotes himself to care for people with mental health conditions and has already helped in the recovery of five people.
While these instances of recovery and rehabilitation of mental health patients are heart-warming, they also indicate the four factors that play a particularly important role in such successes.
One, the economically deprived households have genuine problems when it comes to taking patients to big hospitals, especially in distant cities where the only available mental healthcare facilities may be. In addition, there is a stigma attached to admitting a family member in a mental institute. Hence the NBJK and its sister organisations emphasised on holding health camps near villages in their project area and, supported by activists, visited households to tell them about the camps and facilitate their seeking care in them. In this way, more households could be persuaded to seek healthcare at regular intervals at the camps.
Two, this project focused on involving families and communities in recovery. As mental health experts always say, in rural India a community-based approach is more effective than setting up treatment centres at large hospitals.
Three—offering economic assistance to recovering patients is a useful provision, as a source of livelihood renews hope and keeps those in recovery busy.
Last: “caring for carers”. It is often forgotten that apart from patients, their carers, who have the main responsibility for looking after them, face tremendous stress, all the more in low-income households. As tested in the NBJK project, carers need opportunities to meet, share experiences, get organised in groups and also get livelihood support. This support proved invaluable when mental healthcare was provided in remote villages.
These are important lessons for those who provide mental healthcare in remote areas, which should definitely receive more attention, all the more in today’s troubled times.
[The names and identities of patients have been held back for.]
The writer is a freelance journalist who has been involved with several social movements. The views are personal.