Community Action Mental Health Program – CAMP Kumaon, Almora District, Uttarakhand

A community driven Manas initiative

Several of us in the Manas Team share a close personal association with Uttarakhand and its hardy folk. In its remote interiors, we have seen firsthand how poverty, lack of access to services, and lack of awareness of mental health all combine to impose a huge burden on the community. Over the years, many families have reached out to us with their mental health problems.

In early 2020, we decided to initiate a mental health service in this region, that would be led and driven by the community itself.  After gaining support from the village pradhans, CAMP Kumaon was conceptualizedin Ganoli village of District Almora. We recruited a motivated youth from within the village and trained him for 4 months in field work in mental health.

Services of CAMP Kumaon at village and block level

  1. MENTAL HEALTH SERVICES (Psychiatric, Counseling and Community services)
  2. TRAINING PROGRAMS FOR DOCTORS AND PARAMEDICAL STAFF
  3. VILLAGE HEALTH CAMP FOR WOMEN
  4. SUSTAINABLE EMPLOYMENT GENERATION
  5. RESEARCH AND PUBLICATIONS
  1. MENTAL HEALTH SERVICES

At village level:

In June 2020, we initiated our services at our centre in Ganoli village.

Door to door survey of the 5 villages in our catchment area was conducted. Our field staff and local volunteers reached out to all 334, households with stable population of1500 individuals. Family members were enumerated, our program was introduced to the community, and awareness was generated through IEC material and informal discussions.

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At block level:

In August 2020, we began providing mental health services at Community Health Centre (CHC) Dwarahat after receiving permission fromCMO Office, Almora.

The CHC serves both Dwarahat town, with a population of 15,000, and the whole block, with 205 villages and 70,000 population. It has 2 Primary Health Centers and 7 State Allopathic Dispensaries under its supervision.

Psychiatric, Counseling and Community services:

Psychiatry

Dr. Banerjee, Psychiatrist, visits CAMP Kumaon to conduct in-person OPD every month in Ganoli and in CHC Dwarahat on successive days. On these visits, he also interacts with the doctors at CHC to discuss the patients that they have referred.

An online OPD is conducted by him every week at both these locations.

Counseling

Our team of psychologists from Head Office are available online during all these OPDs to provide counseling services. The treatment offered is thus a combination of medical treatment and counseling, as per the persons’ need.

Community Outreach

Our field worker, being from within the community, personally knows most residents of the area. They freely reach out to him, and he is able to share psychoeducational inputs with them in Kumaoni. We are aware that barriers to access to services can undermine the best-planned community mental health programs. Our team understands this and makes extra efforts to ensure that our services reach the remotest home, and the poorest family.

NOTE: BRIDGEIT FEATURE WILL COME HERE

  1. TRAINING PROGRAMS FOR DOCTORS AND PARAMEDICAL STAFFANM Training, CHC Dwarahat

Date: 5 November 2020         Number of Participants: 25                            Duration: 60 minutes

The workshop was facilitated virtually by psychologists at Manas Foundation.

This was followed by a series of ice-breaking activities. These helped to form a rapport with the participants and also helped them to understand:

  • Individual factors (For example: coping) that impact mental health.
  • Aspects of mental health (physical, economic, environmental, and psychological) and relationship among these.

To understand the importance of focusing on mental health, ANM’s were shown a video

which focused on prevalence of mental health disorders. This also helped them understand

the seriousness of the problem at hand and the stigma attached around mental health.

Following this, myths related to mental illness were discussed with the ANM’s in detail.

  1. MEDICAL OFFICERS MEET, CHC Dwararhat

Date: 5 November 2020                     Number of Participants: 10                Duration: 60 minutes

The workshop was facilitated virtually by psychiatrist and clinical psychologist, CAMP

Kumaon, Manas Foundation. The session began with a note by Ms. Monica Kumar. The

discussion began by a case study where case of Ms. AN was discussed in detail. The case

presentation was moderated by Dr. Amiya Banerjee. At the end of the presentation, the patient and her father, who had consented to be present, were introduced to the Medical Officers. The MO’s interacted with them in detail.

The various take-aways from the conversation include:

• Collaboration between government health services and NGO’s with expertise in

grassroots level community mental health.

• Task shifting: Training and Supporting non-specialist physicians and paramedics to

deliver mental health care in the community.

  1. MEDICAL OFFICERS and COVID COUNSELORS TRAINING,

CMO OFFICE, ALMORA

Date: 26 May 2021                 Number of Participants: 20                Duration: 60 minutes

The presentation focused on understanding mental health and identifying mental illnesses through signs and symptoms. Members were encouraged to share their experiences and understanding of the topic.

Some points that the participants brought up during the discussion were:

● the mental state of a person can be inferred from how he behaves with family and in society.

● Lack of awareness regarding the importance of mental health. Many people do not

realize that there are aspects of health other than physical health.

● Social stigma attached to mental health.

  1. VILLAGE HEALTH CAMP FOR WOMEN
  2. Date: 29 January, 2021

Dr. Neelam Banerjee, Gynecologist, conducted a health camp for women at CAMP Kumaon, Village Ganoli. 36 women from the village registered with our field worker for the camp. Awareness was generated by explaining the gynecological issues faced by women at different ages.  Their concerns were heard, and medicines were disbursed to those in need.

  1. SUSTAINABLE EMPLOYMENT GENERATION

Empowering youth and women through sustainable employment and income generation is important to foster positive mental health in the community. The natural beauty of this region, and the intimate bond that people here share with nature, led us to encourage families here to develop homestay tourism.

QR homestay (www. qrhomestay.com) opened its doors to guests in early 2021. It is owned and managed by local families.

NOTE: Naveen ji has all photos for this.

  1. RESEARCH AND PUBLICATIONS

This region and its people have unique social and cultural features that warrant systematic study. Along with providing services, CAMP Kumaon is invested in research on mental health and its overlaps with social issues like gender and migration. Our structured assessments and robust information management systems facilitate data collection and analysis.

Three research projects have been conducted:

  1. MENTAL HEALTH IMPACT OF THE CoVID-19 PANDEMIC on REVERSE MIGRANT WORKERS IN UTTARAKHAND – A CROSS-SECTIONAL STUDY

(Lands in: Main 5: publications)

Accepted for publication in the Indian Journal of Social Psychology

The announcement of a nationwide lockdown in India in March 2020 in response to the CoVID-19 pandemic led to an exodus of migrant workers back to their homes. With the passage of several months, these reverse migrants eventually reached their homes and re-entered their own communities.

In our 5 villages too, around 500 young men returned from the cities as reverse migrants. This study assessed the impact of the later phase of the CoVID-19 pandemic and lockdown on these reverse migrants, and compared this impact with the local residents, who have never migrated.

Our results were different from what the literature on the subject suggested but did not surprise us.

No significant depression or anxiety was found in the reverse migrants group. These findings can be attributed to factors such as social support from the community members, engagement in work and the use of approach-based coping mechanisms.

  1. Why the willingness to return to the city? A study from Uttarakhand on ‘Reversal of Reverse Migration’ 

(Lands in: Main 5: publications)

Submitted for publication.

Migration has been a pattern in the hills of Uttarakhand for decades. This region has seen men migrating to the cities in order to earn a livelihood for them and their families, but the pandemic forced them to reverse migrate to their homes.

A year into the pandemic and deteriorating finances, the reverse migration was reversing in Kumaon, Uttarakhand. This study included a semi structured interview with men from our previous study who moved back to cities in search of jobs.

An analysis of the interview showed that despite having a social and financial security at their homes these men move back to cities for only one reason: EMPLOYMENT.  The research also highlighted a few themes that focus on their lives in the city and hometown as well as how migration is the only means of survival for these men in Uttarakhand.

  1. Comparative study on Impact of male migration on autonomy of women of Kumaon and Dausa

(Lands in: Main 5: publications)

Data collection ongoing

Studies on migration confirm that most of the migrants are men who migrate to cities due to rampant unemployment in search of a livelihood and those who are left behind, are women. With the onset of the pandemic, the past two years saw migration and reverse migration in these areas.

While the Mental health team was conducting the above research on the reverse migrant men of the area, our Gender Justice Team raised an important question: Do women gain and practice autonomy when male members are absent from their families because of migration?

 In this study we compare the impact of male migration between the women of rural areas of Kumaon, Uttarakhand and semi urban areas of Dausa. Through a preliminary questionnaire we have identified those women who have had male migration from their families in Kumaon. As we move ahead, we aim to map women’s autonomy via studying variables like internalized misogyny, their quality life and self-financial efficacy to gauge the same.

Read more about Research at Manas: (lands in Main 5, Research section)

Impact of the program

Number of OPDs conducted:

 In-person OPD, GanoliIn-person OPD, CHC DwarahatOnline OPDPatient contacts by PsychiatristPatient contacts by Psychologist
2020 – 6 months7524543
2021 – 6 months7721834

Patients under our care:

 New patients registeredPatients with psychosisPatients with other disordersPatients on counselingPatients who have recovered
2020 – 6 months5424303
2021 – 6 months29623410

Future directions

Within one year, this program has demonstrated the effectiveness of our psychosocial model in delivering mental health services and enhancing capacities at village and block level.

With the support of external funding, this program can readily be scaled up to a District and State level program.

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