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  • (a) It was found that some patients could not come to the clinic for follow-up due to practical difficulties like bringing an acutely psychotic patient by public transport, an elderly caregiver and economic difficulties. The clinic team led by the doctor and sometimes the visiting psychiatrist visited the house of the patient on a regular basis to provide treatment. Such involvement and sustained effort from the clinic and the positive outcome it brought out reinforced the faith of the community in treatment.
  • (b) Some very severe cases, which could not be managed at the clinic, were even referred or even transported to NIMHANS for further management.

Rehabilitation efforts

  • (a) Rehabilitation was the most challenging component of the care provided even though it is an integral part of mental health care. Community-based rehabilitation requires convergence and intersectoral coordination between a variety of actors at the village, taluka and district level. In a limited way, rehabilitation opportunities were explored and provided for some patients within Karuna Trust.
  • (b) Families were helped and empowered in getting linkages with existing social welfare schemes of the government to mitigate distress secondary to dysfunction in the individual leading to economic difficulties. Although the schemes are limited in their scope and difficult to access

anchoring the mental health programme at Gumballi. The projects that benefited from these insights include Association for Health and Welfare in the Nilgiris (ASHWINI), Tamil Nadu, The Banyan, a voluntary organization working for homeless mentally ill women in Chennai as well as its initiative for the Tsunami-affected community in costal Tamil Nadu, Paripurnata, a voluntary organization established in the year 1991 with the vision of bringing hope and wholeness in the lives of mentally ill women, and The Richmond Fellowship Society (India) Bangalore which has developed a community-care model in rural Karnataka.

for the most affected and vulnerable, they are often the only available source of support for many families that are severely affected socioeconomically by a member suffering from mental illness.

  • (c) Volunteers were identified in some of the villages in the catchment area and trained to support the families caring for persons with severe mental health problems. They often discussed with the health worker many issues like discontinuation of medication, not keeping follow-up contacts, specific difficulties encountered by the families and crisis situations. Many of the volunteers advocated for employment for the affected person in the village or with any other potential employers in the neighbourhood.
  • (d) Support groups of people and families with mental illness were also initiated to share their experiences every month. This activity typically lasted for about 45 minutes before the consultation or reviews occurred.
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