Case Study 1: PHC Workers Can Play a Major Role in Providing Mental Health Care

Mahadeva Murthy grew up in Komaranapura, one of the sub-centres within the area covered by the Gumballi PHC. His father worked for daily wages and often was not able to find work every day. With six children to feed and raise and with no land of his own in a largely agrarian part of Karnataka, Murthy’s father’s struggled to make ends meet. After a degree in arts in the early 1980s, there was a lot of pressure on Murthy to not continue with his studies, but contribute to the family’s meagre income. Introduced to Karuna Trust by a social worker, he was initially involved in their community-based leprosy elimination programme. He participated in door-to-door surveys, conducting community awareness generation meetings and using flip-charts, posters and awareness generation materials. Subsequently, as Karuna Trust expanded its activities to tuberculosis, he also began to participate in that programme. When the NIMHANS team and the medical officer at VGKK hospital were looking for health workers who could join their effort at detecting mental illnesses in the community, increase awareness on treatment of mental illnesses and refer such patients to the PHC, Murthy (among several other such non-professional health workers) was a natural choice. He attended a ten-day training at NIMHANS where he participated in lectures, watched patient education material and was shown several signs and symptoms of mental illnesses by the psychiatrists there. Subsequently, under the supervision of the medical officer at VGKK hospital, Murthy and several other health workers like him improved their listening skills and were able to help people in the community identify mental illnesses and take them to the PHC clinic for treatment. At the clinic, Murthy would talk to all the patients, make notes about the improvement/deterioration of various symptoms, chat with patient’s family members about their attitudes towards care for mentally ill, assess compliance to treatment and organise appointments for home visits and follow-up visits in cases where the medical officer identified such a need. Under the supervision provided by the psychiatrist (initially) and later taken over by the local doctor, Murthy today feels confident of being able to help people with mental illnesses. He looks back at his stint in various disease-control programmes including leprosy, tuberculosis, epilepsy and mental health and observes that mental health is the only one which really helped him form lasting relationships with patients and helped him improve his communication skills in general. He feels a sense of purpose today and is very satisfied with his decades of work in mental health. Not much has changed in terms of referral and availability of mental health care in most of the government PHCs, he notes as he has a lot of experience with patients from neighbouring PHC areas who were referred to their own PHCs for medicines returning to Gumballi citing nonavailability of these medicines and/or erratic supply. He also laments on the lack of a programme for mental health such as the ones for tuberculosis and leprosy, attributing the decrease in the prevalence of these diseases to the existence of national programmes specifically providing health workers for these purposes at PHCs.

Photo 4 Mahadeva Murthy