Community efforts to reframe the landscape of mental health

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As my first week in Mumbai nears an end, I remain astounded and humbled by the willingness of two clinicians to let me into their workspace and home on my very first day. They spent several hours with me, sharing aspects of their everyday worlds and teaching me a great deal about culture and mental health. One clinician, Dr. X, is a professor and psychologist; the other, Dr. Y, is a gynecologist. Given that my research is on postpartum depression, I couldn’t have asked for a better blend of care-providers to learn from.

[To offer some background, I came to Mumbai, Maharashtra, India, to study the prevalence, risk factors, and perceptions of postpartum depression among marginalized populations, particularly within the context of Indian culture. Underway at Sion Hospital, this project is conducted under the remote supervision of my professor Dr. Mellissa Withers at the University of Southern California. To carry it out, we have partnered with MINDS Foundation, a grassroots non-profit that aims to provide free mental health services, and conduct research to better understand and develop aptly-tailored mental health interventions. I plan to write about my research experiences with MINDS in the blogs that will follow. Within these experiences, I have no doubt that my time in Mumbai will be full of new valuable relationships, both within Sion’s maternity ward and beyond. Thus, I plan to share the stories of many of the people I meet, but will use pseudonyms throughout my narratives to protect their identities.]

My interactions with Drs. X and Y weren’t part of the summer plans I had made on the plane, but the timing of our arrival allowed for some downtime to explore other mental health initiatives in Mumbai. Through a family friend, one of my peers arranged a visit to a schizophrenia center and a gynecologist. Although the time we spent with them didn’t directly contribute to our research data, it was the most formative experience we had that week for the plans we did lay out.

Our afternoon was filled with unstructured and informal, yet fulfilling conversations with the two female care providers. Dr. X, the psychologist and professor, belonged to an initiative for people with schizophrenia, known as the Tridal Foundation. Named after a bilwa leaf, the foundation works to rehabilitate and find employment for individuals living with schizophrenia. The trifoliate-shaped bilwa leaf is known to possess antipsychotic medicinal properties, the three parts of the leaf stands for the three essential prongs of rehabilitation – the patient; caregivers such as family members and mental health professionals; and the community.

Trifoliate-shaped bel or bilwa leaf. Not my image.

Plutchik’s Eight Primary Emotions! Found this hung up in the foundation.

Bus used by the foundation to transport clients and increase accessibility to services.

Dr. Y, on the other hand, was a gynecologist at a private hospital. She spoke a great deal about postpartum depression, sharing stories of mothers reluctant to take care of their newborns, and even fathers experiencing postpartum depression. Prior to her current practice at a private medical facility, she worked at a free government hospital, and highlighted the stark contrast between the two. Physicians at government hospitals see up to a hundred patients a day, and resort to assigning two or three patients to a bed. There was little time to assess their mental health. On the other hand, at her private medical facility, she is able to spend at least 10 minutes with each patient.

Out of all the insight we gained from our conversations with Drs. X and Y, the most striking was the emphasis they placed on the community. We discussed how a community’s attributes can serve as both determinants and consequences of mental health. According to Dr. X…

“At the end of the day, the community will have to accept them. There is a lot of stigma. Without that acceptance, the progress will not have growth. The patients that come in cannot go out and look for a job because they must work on their social skills, […] people tease them and make fun of them […] and they have even more difficulty adjusting.”

And in the words of Dr. Y: “The worst disease a woman can have is poverty.”

When conceptualizing a “community” that shapes mental health, they weren’t merely referring to a unified body of people, but also the socioeconomic environment within which they reside.

This is the understanding I want to employ at the core of any community-based research I pursue in the future. The landscape of mental health is shaped by economic and social factors – including prejudice and stigma. We cannot make strides in erasing the burden of mental illness until we confront the taboos that surround it. This stigma and its consequences do not stop at the individual level. They instead seep into the cracks of what is legal, economic, and institutional. And this idea is applicable globally. We know that suicide is can be criminalized; job discrimination and unemployment yields economic costs; and institutional discrimination reduces access to adequate care and resources.

The Tridal Foundation’s approach to mental health intervention facilitates economic, social, and cultural participation by combining rehabilitation services with employment opportunities. The clients we met work for four hours a day, Monday to Friday, making chidava, laddu, dry chutney, and seasonal foods; making Diwali decorations; and stitching reusable grocery bags with recycled cloth. Not only does this carry therapeutic value, but also fosters social integration. Work like this is also very important for people with mental health problems because it provides income, social status, and a sense of achievement and means of structuring one’s time.

Rangoli (Diwali decor) created by a Tridal client.

There is a pressing need for more opportunities such as those provided by Tridal, mainly to address the disadvantage and exclusion that mental illness brings. I’m unsure what more of these initiatives might look like, but maybe my summer research will hint at some answers.