Mansik Saundarya Program in partnership with Ramakrishna Mission Home of Service, Varanasi Mirzapur and Sonbhadra Districts, Uttar Pradesh.

Background

Ramakrishna Mission (RKM) has been providing health care services through its village medical camps in 9 villages spread over 7 blocks of Mirzapur and Sonbhadra districts since 2006.  These villages range from 40 to 130 km from RKM, Varanasi. The total population covered is around 70,000, with most people engaged in agriculture, and 40% of the population being Below Poverty Line.

The journey of the mental health program

  1. Integration of mental health services with ongoing primary health programs: 2013 – 2017
  2. The sustained phase: 2017 onwards, with the introduction of telemedicine and telepsychiatry.
  3. The Mansik Soundarya Program in partnership with Manas: 2021 onwards
  1. Integration of mental health services with ongoing primary health programs: 2013 – 2017

Mental health services were integrated into the community-based primary health programs of (RKM) as part of the Jan Man Swasthya Pariyojana (JMSP) in 2013. At that time, no psychiatric facility existed in the area in the government or private sector. Psychiatric patients had to go to Allahabad or Buxar (50-120 km) for treatment.

The mental health services were integrated into the 3-tier primary care system, with:

  • the physician being available in-person in the Mobile Medical Units (MMU) or available virtually at the Telemedicine Units (TMU)
  • the Community Health Workers (CHW) providing door-to-door coverage.
  • the Middle Level Team (MLT) working as ‘physician substitutes’ and trainers of CHWs.

The program focused on the treatment needs of people with Common Mental disorders (CMD), Severe Mental Disorders (SMD) and convulsive epilepsy. The program was delivered with JMSP support for three and a half years till June 2017, when funding ended.

  1. The sustained phase: 2017 onwards

Mental health services continue to be delivered through the MMU’s and TMU’s till date in a sustainable manner. Our paper on sustainable community mental health presents a detailed review of the program, highlighting our model of integrated care.

In 2018, Telemedicine and telepsychiatry were added to the program. Our unique model of telepsychiatry has been presented in our paper on ‘integrated tele-mental health’.

Dr. Amiya Banerjee has been the Mentor and Consultant psychiatrist for the mental health services at RKM from the inception of the mental health program in 2013. He is responsible for:

  1. Onsite, hands-on training the middle-level team and the doctors.
  2. Treatment and clinical monitoring of patients.
  3. Developing booklets, manuals, and videos for training.
  4. Conceptualizing research design and data analysis for scientific publication of results and insights gained from the program.
  1. 2020: A crisis, and a new beginning – the Mansik Soundarya Program

The year 2020 had a terrible impact on our program. Just as we were coping with the pandemic, we lost our leader and guide, Sw. Varishthanandaji, to a sudden illness.

Sw. Divyasukhanandji was entrusted by the Ramakrishna Mission with the responsibility to take forward the program. Under his guidance, integrated health services have again come on track. The mental health component has been named the Mansik Soundarya Program.

In January 2021, Manas was honored to be entrusted with the responsibility of taking this mental health program forward as a partner of Ramakrishna Mission Home of Service, Varanasi.

July 2021: Program review by Dr Banerjee While telemedicine and telepsychiatry continued throughout 2021 in the midst of the second wave of the pandemic, Dr Banerjee visited RKM Varanasi to review and restructure the program in consultation with Sw. Divyasukhanandji. He also visited the program sites at villages Patewar and Gaura, where he reviewed the treatment of patients and delivered hands-on training for the mental health team.

PUBLICATIONS AND REPORTS:

(NOTE: all land on respective item in research section)

1.     Telepsychiatry in integrated care: A retrospective comparative study from Uttar Pradesh.
2.     Sustainable community mental health services: a description and review of an integrated care model in Uttar Pradesh, India l
3.     The Role of Belief Systems and Shared Culture on Mental Health
4.     Models of Psychiatry: Science and Mythology of understanding mental disorder

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

IMPACT OF THE PROGRAM

  1. Patient related outcomes

JMSP period and first two years of sustained period (2017-18 and 2018-19)

 CMD patientsSMD patients
JMSP period (Nov 2013 – Jun 2017)288166
1st year sustained period (Jun 2107 – May 2018)168126
2nd year sustained period (Jun 2108 – May 2019)292137  

3rd and 4th year sustained period

 CMD patientsSMD patients
3r year (April ‘19 – March ‘20)273138
4th year (April ‘20 – March ‘21)114135
  1. Program related outcomes:
  2. Program adaptation occurred through the introduction of telemedicine and shift to electronic health records.
  3. Program fidelity was maintained over most activities.
  4. The primary care doctors demonstrated competence in the desired level of diagnostic and pharmacotherapeutic skills.
  5. The Middle Level Team could not only retain their knowledge and skills but could pass it on to the newcomers.
  6. The organization invested in creating training manuals, flip charts, pamphlets, and videos to further sustain and scale the program.

Going forward..

While the program is continuing to deliver effective services in this sustained manner, gaining external funding support will help us build in other important activities:

  • Developing linkages with the Government agencies and programs like the DMHP program, District Hospital and PHC/CHC infrastructure, Education Department etc.
  • Increasing the intensity and scope of our mental health interventions based on our psychosocial model of community mental health care.
  • Developing programs for rehabilitation of patients
  • Further contributing to the knowledge base of community mental health in LAMIC settings through ongoing research and publications.

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