NGO grants offered by the Sir Dorabji Tata Trust

A world where healing is possible wit hout cages and chains…where people follow their hearts and ideas and receive care not treatment.

These catch phrases in the introduction of its website encapsulates the path-breaking approach of the Bapu Trust for Research on Mind and Discourse in Pune and its actions aimed at challenging the psychiatry-driven mental health system.

Managing director, Dr Bhargavi Davar’s childhood experiences shaped such a vision. The organization is named after her mother – a woman who developed deep spiritual yearnings, wore the clothes of a sanyasin and wrote beautiful Bhakti poetry in Tamil that was published and read widely. Labelled a schizophrenic by the orthodox family in which she was married into and abused, she would wander away only to be brought back forcibly in chains. She spent several years on the streets, or in traditional healing centres and was placed in hospitals where she received shock treatment or was kept in solitary confinement.

From a young age, Bhargavi, who later received a doctorate in philosophy of psychiatry from IIT, realized that there was a yawning gap in the country’s mental health policy that this gap needed to be addressed. She along wit h Amita Dhanda who had done extensive work on the unconstitutionality of the Mental Health Act initiated the effort to set up data and generate research, perspectives and other material on mental health. The research and academic studies needed space to develop and to operationalize the ideas into action. From this vision and direction, the Bapu Trust was born as an agency aimed at bringing about structural reform and policy. Its key dimension is its involvement of the social sciences wit h mental health.

One of the first funders of this ‘rebellion’ against the conventional medical approach to mental health was the Sir Dorabji Tata Trust which gave a three-year grant that enabled the institution to be set up. Thereafter, a grant of Rs 81 lakhs (spread over three financial years) was given to enable Bapu to develop its two arms – the research wing known as Centre for Advocacy in Mental Health (CAMH) and Seher (‘dawn’ in Urdu), the service wing.

An important feature of CAMH is that it is the only documentation centre that provides information not just on medical aspects of mental health, but also on community-based research on issues such as gender and mental health development and mental health and its links wit h socio-economic factors like homelessness, violence, conflicts and trauma.

Unlike mainstream information, the emphasis is on self-help and the values of autonomy, participation and dignity. Information is provided on subjects like natural healing for schizophrenia, foods that can help support medication for depression, the relationship between thyroid disorders and depression, etc.

The second important area – the community publications – is another innovative feature in a nation where very few resources are available to raise public awareness on mental health. Bapu Trust publications like Women and Mental Health …a beginning use positive illustrations instead of the stereotype stark images of disturbed persons and emotions. Wherever possible, case stories are used and a life approach instead of a symptoms-based one is adopted. The key note is one of offering hope.

The third area – that of research – provides unique linkages like social sciences and mental health, women’s issues and mental health, law policy , ethics and mental health.

CAMH’s 2003 mission report in which it worked wit h the Gujarat government and the IIM, Ahmedabad to understand the local needs in mental health directly impacted on policy wit h the Gujarat government using it as a draft for its mental health policy.

Another innovative research effort is to look at traditional healing systems, including those of tantriks and bhagats. Deepra Dandekar, who undertook the research in 22 centres in Maharashtra wit h 350 interviews, notes that different paradigms of body and health have yielded a broader understanding than the confining definitions provided by pathology. One important finding was that traditional healing centres had a different value system that allowed patients to admit and discharge themselves. It also permitted the users and family members to live together unlike medical institutions.

CAMH has taken up advocacy issues at many levels to bring about social change. Under soft advocacy it has undertaken academic training programs (funded by SDTT) to inspire the mental health sector wit h a gender perspective and it has given training to jail officers and those in charge of beggars’ homes in Maharashtra where inmates may be suffering from a variety of socio-psychological disorders. It has worked to sensitize the judiciary in Gujarat where there were several instances of men obtaining easy divorces by declaring their wives mentally ill.

Skill building for the future

For hard-core advocacy, it has taken on issues head-on wit h the main stakeholders in mental health – policy makers, non-medical professionals, institution authorities and various NGOs. It is working at the regional level to create a dialogue so that a charter of rights for persons wit h mental illness can be drawn up.

The documentation centre and library at the CAMH

Care and counselling with sensitivity

Since there are not many organizations that think similarly or have taken up a patient’s rights approach, the Bapu Trust has had to struggle wit h isolation ‘incapacity’. There has also been a lot of resistance from doctors and other mental health authorities because of the non-medical approach. “We have tried to dialogue wit h them and involve them in our efforts so that we don’t land up battling each other,” says Bhargavi.

Seher, set up in 2004 as a three-year project, grew out of the need to develop a holistic and alternative framework to the medicalized field of mental health. Program coordinator, Ketki Ranade who is an M.Phil. and who has worked as a psychiatric social worker wit h the National Institute of Mental Health and Neuro Sciences(NIMHANS), Bangalore explains how the service promotion primarily looks at social issues like violence against women. Services provided are individual psychotherapy, family therapy, group therapy and referral services.

One of its new approaches is carrying out training and capacity building activities on mental health wit h community-based organizations like Snehdeep Jankalyan Foundation. Health workers of Snehdeep functioning in the slums of Kasiwadi received education in evolving mental health components. Interestingly many of these workers who are single and face dual challenges were able to benefit from sessions in which they could consider their own mental and emotional health.

In yet another interesting initiative Seher functions in the family court in Mumbai and has undertaken training programs for marriage counsellors in Mumbai. In its second year, Seher has been looking into rights violations in jails, mental hospitals and the beggars’ homes. Training programs have been held wit h the staff in these institutions and there are counselling sessions for many of the inmates who have been picked up from the streets and have been leading isolated lives wit hout any support systems.

Since talking has not been too effective arts-based therapies have been initiated on an individual and group basis. These include drama therapy, paintings and drawing sessions or the play for peace in which games are explored as a method to break down barriers. For the first time in one such session the staff and inmates came together. One of the inmates confessed that she now looked forward to the days when the sessions are held, thereby illustrating how an unbiased society, sensitivity and skill-based treatment can empower a community to tackle its emotional distress and mental well being.