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 Table of Contents  
PERSPECTIVE
Year : 2019  |  Volume : 35  |  Issue : 4  |  Page : 224-226

Mental health and psychosocial support program for people of tribal origin in Wayanad: Institute of Mental Health and Neurosciences model


1 Department of Psychiatric Social Work, Institute of Mental Health and Neurosciences, Kozhikode, Kerala, India
2 Department of Psychiatry, Institute of Mental Health and Neurosciences, Kozhikode, Kerala, India

Date of Submission21-Nov-2018
Date of Decision16-Feb-2019
Date of Acceptance26-Apr-2019
Date of Web Publication15-Nov-2019

Correspondence Address:
Dr. Anvar Sadath
Department of Psychiatric Social Work, Institute of Mental Health and Neurosciences, Kozhikode - 673 008, Kerala
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijsp.ijsp_104_18

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  Abstract 


Mental health of people of tribal origin in Wayanad is a great cause of concern since there is limited accessibility of mental health services. Our pilot visits to the interior tribal colonies of Wayanad reveal many cases of untreated psychosis and high rates of substance abuse, especially alcohol and tobacco. To improve their mental health access and utilization, Institute of Mental Health and Neurosciences, Kozhikode, recently initiated a novel community mental health program in selected tribal colonies at Wayanad. This pilot program contains a situational analysis, training of grass root-level workers, awareness program, and mental health and psychosocial support services through a multidisciplinary mobile team.

Keywords: Community mental health, mobile mental health team, tribal mental health


How to cite this article:
Sadath A, Kumar S, Jose K, Ragesh G. Mental health and psychosocial support program for people of tribal origin in Wayanad: Institute of Mental Health and Neurosciences model. Indian J Soc Psychiatry 2019;35:224-6

How to cite this URL:
Sadath A, Kumar S, Jose K, Ragesh G. Mental health and psychosocial support program for people of tribal origin in Wayanad: Institute of Mental Health and Neurosciences model. Indian J Soc Psychiatry [serial online] 2019 [cited 2019 Dec 12];35:224-6. Available from: http://www.indjsp.org/text.asp?2019/35/4/224/271095



The people with tribal origin in Kerala commonly known as “Adivasis” are more marginalized and backward in socioeconomic and public health indicators as compared to other tribes in India.[1] Wayanad is one of the northern districts of Kerala state, with a population of 816,558. The scheduled tribe population in the district accounts for >18.5% of the total population of the district, while the state average of tribes is a meager 1.5%. Among the 484,839 of scheduled tribe population in the state, 151,443 are from Wayanad.[2] The tribes in Wayanad include various sects with Paniya (69,116), Kurichiya (25,266), Kuruma/Mullu Kuruma (20,983), Kattunayakan (17,051), and Adiya (11,196) constituting the majority.[2] Paniya outnumbers other groups. They were slaves of the nontribal landlords in the early periods; however, currently, most of them are casual agricultural laborers.[3] Kattupaniya, a subgroup of theirs, inhabits the forest region. The Paniyas are poorly educated, being the poorest and most marginalized group even compared to other tribes.[3],[4] Kurichiyas are one of the most developed tribes in Wayanad, most of them possess some land, and they do agriculture for livelihood. The Kuruma is another dominant tribe in Wayanad, and they do wood cutting and collection of minor forest product for livelihood. A subgroup of Kuruma, known as Mullu Kuruma, is presently cultivators and hunters. Kattunayakans are the primitive tribal group, also known as Thenkurumer, and they are experts in collecting honey and prefer to live in the forest. Adiya, as the name indicates, was the bonded laborer of landlords and majority of them are now agricultural workers.

The available mental health manpower and services in the district include a psychiatrist in the district hospital, District Mental Health Program (DMHP), one exclusive psychiatry hospital in private sector, and outpatient psychiatry services in some hospitals conducted by visiting psychiatrists from other districts. In addition, there are also a few residential facilities for chronically mentally ill persons and some old age homes and residential facilities for orphans and homeless persons which also have mentally ill persons as significant proportion of their inmates. The post of psychiatrist in the district hospital remains vacant for long durations. DMHP was available in the district since 2007 and Institute of Mental Health and Neurosciences (IMHANS), Kozhikode, was the nodal agency which was conducting the program until 2016. Mental health services relatively available to tribal population in Wayanad are largely limited to DMHP, which provides services at selected rural centers periodically. Even in these DMHP service points, only a small number of people with tribal origin are accessing help and also have high dropout from the services. The DMHP provides services through primary health centre/community health centre (PHCs/CHCs) and it helped to improve overall treatment utilization, while majority of the people with tribal origin live in remote areas or dense forest of Wayanad still have difficulties in accessing mental health services. Besides, they have poor help-seeking and healthcare utilization,[3] which may be due to poor knowledge about the illness and lack of acceptance to modern treatment. Our pilot visits to the interior tribal colonies of Wayanad revealed many cases of untreated psychosis and higher substance abuse, especially alcohol and chewable tobacco (used with betel leaf). The substance use is intertwined with their sociocultural belief system, tradition, and practices.[3],[5] To address the above issues, IMHANS initiated a novel mental health and psychosocial support program for the people with tribal origin in Wayanad, with support from Social Justice Department, Government of Kerala.

As align to the stated objectives of National Mental Health Programme, we initiated this program on pilot basis for 1 year. The project is likely to be extended with appropriate modification based on the pilot results. The objectives of the program include awareness generation on mental health and substance misuse, capacity building and training, and mental health service provision through constitution of a mobile mental health team. The mobile mental health team includes a psychiatric social worker (project director), a medical officer trained in mental health care, a social worker, and a mental health nurse. Psychiatrist services made available twice in a month and also have plan to facilitate telepsychiatry services, which is yet to be worked out.

The project has started functioning since June 2018, and it has been implemented in different phases at selected tribal colonies in Wayanad. First, we conducted a detailed situational analysis using field survey and qualitative methodology. As part of this study, we have conducted four focus group discussions with tribal promoters, 14 in-depth interviews with tribes of substance abuse, and four key informant interviews with the Tribal Mooppans (chief of the tribe). Further, we have conducted a household sample survey among 2400 adult tribes. As there are inadequate data on mental health and substance misuse of the tribal population, this study helps us in understanding the service needs and determining and finalizing the treatment components of our program. Barriers of treatment access and utilization of their mental health services are also measured in the survey.

Second, we initiated mental health training programs for the grass root workers including tribal promoters, mentor teachers, paralegal volunteers, committed social workers, and ASHA workers in tribal-dominant areas. Training was also provided to the tribal extension officers in Wayanad. The training intended to impart essential knowledge and skills in identifying and referring the potential cases of mental illness, substance misuse, and child abuse. The training programs also provided knowledge on basic counseling and psychosocial support. Such training for nonspecialist community health workers is helpful to improve help-seeking,[6] address the shortage, and inequitable distribution of mental health workforce in low- and middle-income countries.[7] We have completed training for all the tribal promoters (375 persons), tribal extension officers (15 persons), committed social workers (15 persons), and paralegal volunteers (60 persons) in Wayanad.

Third, we recognize the importance of increasing mental health awareness and reducing stigma as an integral part of the tribal mental health program. Available limited evidence supports high levels of stigma, myths, and misconception about mental illness among tribes,[8] which are associated with lower treatment utilization,[9],[10] and mental health awareness campaigns yielded positive outcome.[11] We have initiated small-group, tribal colony-based mental health and substance abuse awareness campaigns on selected tribal villages in Wayanad. Further, we have planned mental health campaigns at schools in tribal areas and tribal hostels for addressing child and adolescence mental health substance abuse issues.

Fourth, we initiated psychiatric consultation services in a few tribal colonies located at interior places or dense forest. The services are providing as home based to address the accessibility issues and treatment barriers. The trained grass root workers and tribal leaders are extending the necessary support. A psychiatrist's service is made available twice in a month, who initiates treatment for the new cases identified. Follow-up care is provided by the medical officer and team. We have identified around 50 cases of untreated psychosis/treatment dropout, in which we already initiated pharmacological intervention for half of them. We just initiated these services, and necessary modification will be made based on our experience, feedback, and evaluation.

Finally, we understand the importance of a partnership care model, especially when implementing a phase-specific complex community mental health program for the indigenous tribal population. Thus, the program implemented with support of district health services, district mental health team, integrated tribal development project, district legal aid services, district administration, exercise and police department, education department, forest department, and nongovernmental organizations working for the tribes in Wayanad.

The program is initiated with effective implementing mechanism including documentation, monitoring, and evaluation of the project. The project may continue with support from Social Justice Department for 3–4 years. Later, we will ensure financial support from Panchayat Raj Institutions at identified service points.

Financial support and sponsorship

The project is funded by Social Justice Department, Government of Kerala.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Narayana D, Haddad S, Mohindra KS, Aravind S. General Profile of Kottathara Panchayat, Unpublished Report. Centre for Development Studies, Université de Montréal; 2005.  Back to cited text no. 1
    
2.
Census of India. Provisional Population Totals-India Data Sheet. Office of the Registrar G2eneral Census Commissioner, India. 2011 ed. Delhi: Indian Census Bureau; 2011.  Back to cited text no. 2
    
3.
Mohindra K, Narayana D, Harikrishnadas C, Anushreedha S, Haddad S. Paniya voices: A Participatory poverty and health assessment among a marginalized South Indian tribal population. BMC Public Health 2010;10:149.  Back to cited text no. 3
    
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Mohindra K, Haddad S, Narayana D, Aravind S. Health Profile of Kottathara Panchayat. Montreal: Université de Montréal; 2005.  Back to cited text no. 4
    
5.
Mohindra KS, Narayana D, Anushreedha SS, Haddad S. Alcohol use and its consequences in South India: Views from a marginalised tribal population. Drug Alcohol Depend 2011;117:70-3.  Back to cited text no. 5
    
6.
Armstrong G, Kermode M, Raja S, Suja S, Chandra P, Jorm AF. A mental health training program for community health workers in India: Impact on knowledge and attitudes. Int J Ment Health Syst 2011;5:17.  Back to cited text no. 6
    
7.
Patel V. The future of psychiatry in low- and middle-income countries. Psychol Med 2009;39:1759-62.  Back to cited text no. 7
    
8.
Sadath A, Uthaman S, Kumar TS. Mental health in tribes: A case report. Indian J Soc Psychiatry 2018;34:187-8.  Back to cited text no. 8
  [Full text]  
9.
Kulesza M, Pedersen E, Corrigan P, Marshall G. Help-seeking stigma and mental health treatment seeking among young adult veterans. Mil Behav Health 2015;3:230-9.  Back to cited text no. 9
    
10.
Sadath A, Muralidhar D, Varambally S, Jose JP, Gangadhar BN. Caregiving and help seeking in first episode psychosis: A qualitative study. J Psychosoc Rehabil Ment Health 2014;1:47-53.  Back to cited text no. 10
    
11.
Srivastava K, Chatterjee K, Bhat PS. Mental health awareness: The Indian scenario. Ind Psychiatry J 2016;25:131-4.  Back to cited text no. 11
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