Innovating Mental health Services for tribal populations, Chhattisgarh

In an effort to make mental healthcare services more accessible for children residing in residential care institutes in Chhattisgarh, Unicef,  Manas Foundation and the Tribal Welfare Department of Chhattisgarh collaborated together to pilot a novel mental health project in the state of Chhattisgarh. The primary aim of the current project “Improving the lives of children residing in residential institutions of Chhattisgarh” focuses on capacity development and enhancement of stakeholders that are actively involved in working with children and young adults in Chhattisgarh. It’s a multi-tiered intervention that focuses on creating access points through the stakeholders in the communities while also setting up district level mental health services to cater to the need arising through the stakeholders. The intensity of this intervention amplifies further as the team also directly works with the beneficiaries that these stakeholders engage with. The first year is largely focused on the stage of building bonds and strengthening community-based stakeholders and interventions to identify and cater to the actual mental needs at the grassroots level.

The programme also includes components of creating IEC material which is aimed at creating a sense of wellbeing and aimed towards not just de-stigmatizing mental health care but also creating an awareness about the available services. These goals were crystallized in the form of the following outputs:

  1. Provide direct & accessible preventive  psycho-social care (PSS) & mental health (MH)services   through capacity development of Superintendents in identified 40 tribal residential institutions in demonstration model
  1. Workforce development of all counselors working under the ambit of ICPS (Integrated Child Protection Scheme) of Women & Child development department to provide effective psycho-social services in CCIs of Chhattisgarh.  ( All in Raipur, quarterly)
  1. Joint review procedures and advocacy with key officeholders at state and district level on psychosocial support ecosystem in tribal residential institutions and child care institutions (WCD) Participants: officials of tribal welfare department at State and identified four districts, officials from Collectorate of identified four districts (eg. District collector, Chief, development officer, District Education officer)
  1. Direct mental health services at the district level through specialist mental health unit in District mental health hospital in 4 districts
  1. Online capacity building training modules with the Para Legal Volunteers employed by the State Legal Services Authority, Chhattisgarh, on implementing mental health group work sessions with children in the community, a demonstration model
  1. Effective and efficient program implementation and management through empaneling team and administration support

Journey so far…

A four day training module was developed for the 40 superintendents working in the residential care institutions run by the Tribal Welfare department in the 4 districts of Dantewada, Sukma, Kanker and Narayanpur (10 institutions in each district). The training was delivered in the month of December 2020 virtually due to the restrictions related to the COVID 19 pandemic by the psychological experts from Manas Foundation. The purpose of the training was to build the capacities of the superintendents to have an accurate understanding of mental health, the stigma associated with talking about mental health, mental health concerns and how mental health concerns can affect our thoughts, behaviours and emotions. There was also a focus on the current socio-cultural context of these districts and how that might lead to the development of certain psychosocial stressors in the lives of children. The superintendents were further facilitated to identify emotional and behavioural red flags amongst children which might be indicative of a deeper mental health issue. The latter part of the training primarily focused on how we can document the psycho-social concerns of children by eliciting a client’s case history and conducting a mini mental status examination. Certain Dos and Dont’s of providing psychosocial support to children were shared with the participants along with highlighting the harm reduction model of support.

At the start of January a bimonthly engagement programme called Manthan was conceptualized as a tool to facilitate continuous interaction and refresher training sessions with the selected superintendents. As the name suggests, Manthan is a process of reflection through study aimed at creating tangible learning outcomes for superintendents and creating opportunities for them to practice the mental health know-how delivered during the quarterly training programme.

A total of 5 Manthan workshops addressing and revising different themes from the 1 st quarterly training have been implemented in Dantewada, Sukma and Narayanpur and Kanker. 1 manthan module is delivered separately in each district, therefore, a total of 20 manthans workshops have been delivered in total from the month of January to May .

All the Manthans organised for the superintendents of Kanker have been implemented online due to their difficulty with travelling to Kanker for the refresher training.

Manthan 1- Effects of stress on our Mental Health Implemented in the beginning of January 

Manthan 2- Identifying Risk factors and Red flags Implemented towards the end of January

Manthan 3- Identifying our own Strengths and Weaknesses Implemented in February

Manthan 4- Revising Mental status examination and case history taking Implemented in March

Manthan 5 – Impact of the second wave of COVID 19 on our mental health was implemented in the beginning of May

Manas Foundation has been conducting online capacity building training modules with the Para Legal Volunteers employed by the State Legal Services Authority, Chhattisgarh, on implementing mental health group work sessions with children in the age group of 6-12 years and 13-18 years. Through these online training sessions the volunteers are provided a space where they can learn about preventive and promotive psycho-social care.

The goal of these training sessions is to facilitate the PLVs to efficiently implement mental health group work sessions with the children residing in the communities they work with. 60 PLVs are selected to be part of these sessions and divided into 4 groups for the purpose of making our online training easier, interactive and more impactful. Three rounds of training have been conducted with all PLVs so far starting 24th July 2020, 22nd September 2020 and the latest one starting 31 st March 2021. 

  • The first training round involved building a rapport with the volunteers as well as laying a foundation for the collective work ahead. 
  • The second training involved introducing the process of implementing psychosocial group work sessions with the children along with demonstrating an activity for the same with the PLVs. In the second session the PLVs were also assisted in identifying emotional and behavioral red flags in children as they continue to work with children on their psychosocial care. 
  • The third session revised the concepts learnt in the previous sessions along with introducing the topic of child sexual abuse to the PLVs. It focused on understanding child sexual abuse from the lens of the POCSO act and learning to identify the different mental health indicators of child sexual abuse that one can watch out for. The last session also focused on how to conduct a “Safe Touch” workshop with children in communities or school set ups.

The fourth series of sessions with the PLVs are scheduled for May-June 2020, on the basis of approvals and permissions from the departments.

Manas Foundation collaborated with UNICEF and and Nehru Yuva Kendra Sangathan to promote positive mental health and well being amongst the volunteers and officials of NYKS during the second wave of the COVID 19 pandemic. This was done via conducting 2 webinars on the topic of “Psychosocial care in the time of COVID” . The themes of the webinars included fostering a foundational understanding of mental health, a discussion around the stigma and lack of awareness around mental health, using examples to illustrate how a mental health stressor can affect our thoughts, emotions and behaviors. There was also a psycho-educative component of understanding how stress associated with the pandemic can lead to feelings of loneliness, hopelessness, helplessness, loss of motivation, depressed mood, anxiety or even self deprecating thoughts and behaviors. The second half of the webinar focused on sharing the model of mental health first aid that can be utilized by the officials or the volunteers to help others during this time of crisis and some research based strategies that they can personally adopt to cope with the stress of the pandemic.

  • The first webinar was conducted with approximately 150 officials of NYKS on the 21st of May 2021
  • The second webinar was conducted with approximately 150 volunteers working with NYKS on the 25th May 2021

A working collaboration with the DMHP

Dantewada

An awareness program on suicide prevention was conducted on 23/01/2021 in a village called Podum under the DMHP.

Mental Health Camp along with the DMHP was organised in the district Jail of Dantewada

A two day training was organized under the ambit of the District Mental Health Program (DMHP) for primary health care physicians on identifying and treating different psychiatric disorders. The training was conducted by the district nodal officer for DMHP, the psychiatrist at the district hospital and the Manas Counselor.

Following the marked increase in COVID cases in the district, it was decided that teachers would be recruited for telephonic covid counseling. Under the district mental health program (DMHP), an online training session was organized for teachers and there were 30 participants. Focus of the training session was on providing a brief overview of mental health and helping the participants understand how COVID can impact mental health. The participants were also familiarized with the National Mental Health Program protocol for online counseling.

Clinical psychologist from Manas foundation (Ms Parvathy Nair) is coordinating daily with teachers for covid counselling. Calls are coordinated on a daily basis according to the list provided. Ms Parvathy provides mental health first aid to anyone who may show signs of psychological distress during these calls. This is done under the ambit of the DMHP.

In the district, feedback is also taken daily from those COVID patients in different covid care centres in the district. This is also coordinated by the clinical psychologist from Manas foundation and is done on a daily basis.

Kanker

Provision of counselling services to those infected with COVID 19 and screening for symptoms of depression anxiety and insomnia by Manas Foundation’s clinical psychologist Ms. Barsha. Since April 6th she has counselled more than 400 patients residing at home or in the COVID centre. Daily report is provided to the mental health nodal officer regarding the number of sessions conducted.

As per the order of the mental health  nodal officer, a one hour online training session was conducted by Ms. Barsha and the  psychiatric nurse (Kanker District Hospital) on covid counseling for counselors  working in different zones of  the Kanker District. All the procedures regarding covid counseling were explained to them thoroughly during the training

As per the order given by the deputy commissioner a 10 minute long video was made by Ms. Barsha and the psychiatric nurse of the Kanker District Hospital on mental health issues experienced during the pandemic and coping strategies for covid patients.

Ms. Barsha is consulting with patients from OPD on a daily basis and providing them counseling services, but due to lockdown, the number of patients has decreased. The process of counseling involves taking the case history  and conducting a mental status examination, arriving at a probable diagnosis and  providing psychoeducation about the diagnosis to the client and their family.  For further therapy sessions, an appointment is provided to the clients. Sometimes counseling is also provided to IPD patients having substance dependence and those who attempt suicide.

Ongoing Research:

EVALUATING EXISTING SYSTEMIC CAPACITY AND NEED OF PSYCHOSOCIAL CARE FOR BOYS AND

GIRLS IN CONFLICT SITUATIONS.

 WITH FOCUS ON ESTABLISHING ROBUST, SUSTAINABLE PSYCHOSOCIAL SUPPORT SYSTEMS WHILE INCORPORATING GENDER NUANCES.

The research is being conducted in four districts of Chhattisgarh (Kanker, Narayanpur, Dantewada, Sukma). The objective of the study is to understand the existing systems in place that work with children affected by violence and evaluate the need for psychosocial care while including a gender lens.

Various stakeholders working with children such as superintendents of hostels, teachers, doctors/nurses working in the district hospital, officials from the tribal welfare department, and representatives from the district management will be interviewed. Using a mixed-methodology approach, a questionnaire has been developed and translated into Hindi.

Findings from the study will help direct and focus the work done by Manas Foundation in Chhattisgarh, ensuring that fundamental psychosocial needs of the children are fulfilled.

Read more about Research at Manas

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