A dedicated cadre to help with mental rehabilitation will fill out the healthcare picture.

Could the south of India see the repurposing of the Accredited Social Health Activists (ASHA) into a community health worker who is paid, not incentivised, and can provide support to persons discharged from a psychiatric facility? Or can a similar cadre be created to take up community mental healthcare?

In a conversation held recently, Vikram Patel, Paul Farmer Professor and Chair, Department of Global Health and Social Medicine, Harvard Medical School and R. Thara, vice chairperson, Schizophrenia Research Foundation (SCARF), explored the possibility of having a cadre similar to ASHAs to take community mental healthcare forward.

Noting that he had visited many District Mental Health Programme (DMHP) sites around the country, Dr. Patel said that DMHP was purely a medication programme. “There is nothing community-based, no peer support and no rehabilitation,” he said. There is no psychosocial intervention, added Dr. Thara.

Elaborating on community mental health, Dr. Thara said it meant involving the local community in every way; including all community stakeholders – teachers, doctors, panchayat leaders or tahsildars. “We have trained a number of community-level workers, mostly women. They have empathy, they have acceptance in the local community, and if you train them, they play an excellent role in early detection, in facilitating care and follow-up, and in delivering some psychosocial intervention. We have ASHAs, but you cannot overburden them, but we can have a similar cadre of health workers,” she said.

ASHAs conduct a rally organised to raise awareness among people on the importance of polio drops, in Vijayawada on February 29, 2024..
| Photo Credit:
K.V.S. Giri

SCARF started ‘Manam Inidhu’, a programme in which women from self-help groups were trained in the basic principles of mental health and counselling. If they came across persons with mild symptoms, they took them to a counsellor or to the DMHP, she said.

Dr. Patel observed: “The (Indian) government is among the first governments in the world to embrace the community health worker movement, and on a massive scale. It is an environment ready for a change. We could say that maternal, new born and child health (MNCH) issues, which dominated the ASHA movement, are no longer major concerns. Lets say Tamil Nadu does not need ASHAs for maternal and child health, Kerala does not need it, and Karnataka probably does not either. So, could the south of India see the repurposing of the ASHA into a community health worker who is paid, not incentivised….Could these States pioneer this kind of support such that every person who is discharged from a psychiatric facility – whether in the public or private sector – based on where they live, is allocated a local community health worker to support them?”

Dr. Thara said it was important to identify an existing cadre of women in the community – whatever name they go by in every State – and get them to do mental health work.

Agreeing that asking ASHAs to do more without taking something off their plate would not work, Dr. Patel said: “For now, let’s say someone like ASHA. The southern States are in the best place as the disease burden profile has almost moved to non communicable diseases. Therefore, the ASHA or frontline workers’ best place now is to manage chronic conditions.”

He suggested that State governments such as Tamil Nadu could develop skills, and certification courses associated with recognition so that the government can pay a specific monthly salary to support work like ASHAs do, a catchment area-based work. “This is the way of the future, a cross NCD community-based worker,” he said.