KAAREN MATHIAS wants to put mental health "in the hands of the people". In this interview, she tells us how her and the Uttarakhand Cluster are working to do just that… Tell us about your work. I’m the Mental Health Programme Manager for the Emmanuel Health Association (EHA). But I also lead the Burans project – a Cluster project run by twenty of us, geared towards community mental health. How does it work? We support patients through psychosocial approaches, counselling, support groups, livelihood and social inclusion actions. We also work with communities to build skills and knowledge in mental health. And we give training and encouragement to government to deliver more effective mental health services – we’ve trained over one thousand government community health workers to date. Give us an example of the challenges you’re addressing. Epilepsy is a big issue here. It’s often seen as a mental illness, which can mean there’s no treatment or management, and so it leads to premature deaths. We launched a pilot project in 2017 to train twenty government doctors on managing epilepsy in their health centres, and we worked hard to ensure the government would supply medicines for them too. It’s taken a lot of tenacity but a few of these doctors are now managing epilepsy in primary care. Now we want to expand this to other areas. How do Cluster member organisations work together in this project? We each do the different things we’re good at. EHA is good at healthcare and community development, so we lead and provide technical guidance. OPEN is good at working with government and building their capacity, so they help forge these relationships. And AKS Hope has a really strong approach in education and community health projects – particularly in rural Muslim areas – so their credibility in communities helps us build these relationships. Do other Cluster members benefit from this mental health expertise as well? Yes, we’ve run training for the Cluster to help members get experience and technical expertise to run their own mental health programmes. For example, the AKS Hope team now has an inclusive disability project that includes quite a lot of work around mental health. It’s really good to see our partner organisations grow! Why is mental health work important in your region? There are quite high rates of depression, and people often don't know where to seek help. So we need to help people understand what mental illness is, so that they don’t just think they’ve been cursed or have an evil spirit. And we need more community-based support and mental health professionals. In Uttarakhand, we have seven government psychiatrists in a state of 10 million people, so clearly mental health has to be in the hands of the people, and we need to find ways to promote mental health independent of the few mental health professionals. How did you first get involved in the Cluster? EHA was a founding member so we’ve been here from the start. I remember thinking it sounded like a wonderful opportunity for learning and growing together and really building community. I realised that by working with Cluster members they could help a community mental health project develop, whilst developing all of our skills too. What Cluster achievement makes you most proud? I’m proud of our high level of community engagement and participation. For example, our teams have identified about 980 people with a psych-social disability in different areas and they’ve said: “we want to be part of your programme, we want to support you with rehabilitation and livelihood skills”. It’s really great – building these relationships. Tell us some other benefits of being in the Cluster. There’s a strong level of personal friendship and support that we all really value. We go to each other’s weddings and all were sadly at our team member Arun’s funeral together last year too. I’ve just had knee surgery and team members have been checking in on me. I think India is good at this kind of thing – the personal and the professional are quite entangled here, largely in positive ways. What are some of the challenges the Cluster faces? Sometimes, we have keen and engaged people and there’s momentum and energy. At other times, it’s hard: there are slumps in energy and engagement. The challenge for us is to make clear that the attitude should not always be “what can I get out of this”. Rather, “what can I put into this”. What are your hopes for the future of the Cluster? I’d like to get more things happening on community mental health in all the programmes. But funding is a challenge. We all spend too much of our time finding funding – I might spend a third of my time just applying for grants in order to stay afloat. So I guess my hope is for more stable funding and initiatives in community mental health across all our Cluster members.
Thanks for all the work you're doing, Kaaren!
You can learn more about community mental health in our podcast.