Mental health remains a neglected and ‘invisible’ segment within the broader domain of health. According the World Health Organization, there is a 75% treatment gap for mental, neurological and substance use disorders in Low and Middle Income Countries like India. Persons suffering from psycho-social disabilities live with stigma, and ‘voicelessness’ that is as destructive as the condition itself. Anjali addresses these critical gaps through a twofold strategy: one, to establish a positive and a rights-based approach to mental health within the mainstream health paradigm of India by humanizing existing public mental health institutions, and: two, setting up innovative community mental health programs through strategic partnerships with local governments.
While working within government hospitals to improve mental healthcare processes, Anjali also worked closely with the communities of the individuals who have lived in mental health institutes. Often, once treated medically individuals needed the support of their entire communities to be reintegrated fully. Moreover, given the inadequacy of public hospitals in meeting the demands of the more than 20 million Indians who live with acute psychosocial disorders, the need to provide a range of services at the level of the last mile community became increasingly critical for securing mental health for all. Thus, working through the full continuum – from hospital to families and communities- has given Anjali a vantage point to observe, experience and address the rough terrain for persons with psycho-social disabilities. It has also enabled Anjali to engage critically at different points in the lifecycles of their participants – from psychological breakdown to institutional care to recovery to rehabilitation to community integration to inclusion to wellness and finally, to rights and self-determination.
Janamanas, the community mental health program echoes Article 19 of United Nations Conventions of Rights of Persons with Disability (UNCRPD). Ratified by India in 2007, the UNCRPD recommends and states the rights of persons with psycho-social disabilities to live in communities with equal choices and opportunities. The program initiated in 2007, partners with local governments and communities to empower women as barefoot mental health care professionals. Partnership with local governing bodies ensures the program is sustainable and replicable across India. Janamanas was recognized as “Best Practice Model” in 2011 by the Government of India as part of urban governance.
Janamanas shifts the paradigm of care from institutions to the community, and partners with citizens to identify and train local individuals to become change agents in the field of mental health. It de-stigmatizes and ‘normalizes’ mental health care through easy access to information, counselling or Talk-listen-talk model and referral services that are provided by approachable and empathetic para-professionals who are known and trusted within the community. It creates a eco-system that promote mental well-being, empowers women from community with limited formal education to become champions of mental health care which helps move mental health care services away from the bio-medical domination.