Knowledge

Focus groups with community members held at the outset of the project identified that some people understood seizure and severe mental distress as being caused by an evil spirit or by ‘black magic’. Other community members considered severe mental distress as a stress reaction to life events or as an illness. A total of 35 community MHVs were selected by their communities and worked in their respective panchayat (administrative unit of around 2000 people) with the aim to build awareness and knowledge about mental health in the community. A further 140 adolescent PEs were selected as the community members with most available time who could then train other adolescents and community members. All volunteers were trained in basic knowledge and skills for mental health promotion such as in rights-based approaches, stress management, and communication skills. The intervention was delivered through regular awareness and larger group meetings held in different communities by MHVs and PEs, and through smaller meetings with groups that focussed on skill and capacity building. There was a significant increase in biomedical mental health-related knowledge and skills, such as the ability to identify and differentiate common and severe mental distress, particularly among the 175 community volunteers. Caregivers reported increased skills in areas such as reflective listening and problem-solving. Peer educators reported increased confidence to speak out in schools and community gatherings, particularly in areas related to rights, health, and relationships. Increased knowledge seems likely to have led to an increase in the number of people seeking biomedical care. At the start of the project, to our knowledge, there were only a handful of community members accessing biomedical mental health services (all attending a private psychiatrist 70 km away in the district capital Saharanpur). By the end of March 2015, community volunteers and staff working with SHIFA had identified and provided social and psychological support, treatment or referral to 150 people with common mental distress, 70 people with severe mental distress, 35 people with a seizure disorders, and 13 people with intellectual disability (Kamal 2015). Around one-third of these people regularly attended the SHIFA primary mental care clinic held fortnightly. There were also reports of increased attendance for support with mental distress by local pharmacists, traditional healers, and local doctors. Workshops held by project staff with religious leaders, traditional healers, and local doctors focussed on building their knowledge and skills in active listening and encouraging referral of people with seizure disorders and severe mental disorders to the biomedical health clinic while their clients continued to also access their services.

 
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