Address of Correspondence: Dr. Rajeev Jayaram Paleri, Department of Mental Health Education, National Institute of Mental Health and Neurosciences (NIMHANS), Bengaluru, India
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Saini D, Paleri R J, K. S M, K L. NIMHANS Arogya Jagruti Kendra- A window to Educate Minds and Empower Communities. Journal of Mental Health Education. 2021;3(1):44-50
The purpose of this brief communication is to examine innovative ideas as a way forward in creating Mental Health Awareness. NIMHANS Arogya Jagruti Kendra (NAJK), an initiative by Department of Mental Health Education, NIMHANS was put forth to create awareness on the mental health & neurological disorders with the help of brochures short videos and direct interaction of mental health professionals with patients and caregivers. IEC materials include a range of products like: infographics, flyers, leaflets, brochures, short videos and direct interaction of mental health professionals with patients and caregivers. Theinitiative will foresee different ways to disseminate information about mental health and illness to the patients and caregivers attending Outpatient departments at the institute and to the public. The NAJK is a Learning Resource Centre where patients and caregivers can access various resources related to various disorders and health related information. Though it has its own strengths and challenges, the center looks forward to increasing the flow of patients and caregivers seeking access to information thereby meeting the objective of service deliverables.
Keywords: Mental Health Education, learning resource center, innovative ideas, mental illness, mental disorder, caregivers.
Mental health as defined by WHO is “a state of well-being in which the individual realizes his or her own abilities, can cope with the normal stresses of life, can work productively and fruitfully, and is able to make a contribution to his or her community. By this definition one realizes the importance of having a healthy mind and the ability to cope with daily life stressors. Globally the burden of Mental illness is 13.2%. (WHO, 2000) a. Health promotion is an approach in improving public health that requires active participation by the stakeholders. It may be understood as actions and advocacy to address the full range of potentially modifiable determinants of health, including actions that allow people to adopt and maintain healthy lives and those that create living conditions and environments that support health (WHO, 1998a) 1 . In India, many initiatives have been taken since the last decade to improve knowledge and increase awareness relating to mental illness. From traditional methods of print media to newer mobile technology based and Non-Specialist Mental Health Programs, each state has come up with newer initiatives to reach the target population. In the year 2014, the state of Gujarat, trained non-specialist community mental health workers for screening, tracking and providing mental health care in remote regions of Gujarat.2 They taught the people to use mobile phones and answer the self-report questionnaire developed by WHO. They customized and added questions for epilepsy and alcohol abuse to make it culturally appropriate and target the problem occurring in that area.
Information Education Communication (IEC) is the process of learning that empowers people to make decisions, modify behaviours and change social conditions.3 IEC materials include a range of products like: infographics, flyers, brochure, social media posts, television advertisements, audio spots for radio, posters, billboards or murals. The primary goal of the IEC program is to inspire and educate people about prevention, care and/or treatment of various health issues and for a better understanding of the same in a more comprehensive way.
The Ministry of Health & Family Welfare, Himachal Pradesh, developed 30 second audio spots to disseminate information regarding general health issues, mental health and substance use by broadcasting it on Radio channels. The spots were short, catchy and informative. The Department of Mental Health Education, NIMHANS started an innovative initiative in its OPD block which is called the NIMHANS Arogya Jagruti Kendra (NAJK). This learning resource center in the OPD allows the patients and caregivers to access varied health information related to mental health, neurological and neurosurgical disorders. It is a walk-in space and has different kinds of brochures, manuals and a digital display displaying educational videos for the visitors. The patients & caregivers can also interact with the students at NAJK who are trained by experts from a multidisciplinary team including Mental Health Education, Psychiatry, Clinical Psychology, Psychiatric Social Work, Neurology, Neurosurgery, Nursing and allied fields. This innovative initiative aims at strengthening the knowledge related to mental health & neurological conditions by integrating it into the OPD setting, and also disseminates information regarding specific disorders and well-being through a wide range of resources.
Observation and Experience
The department, in its academic pursuits, receives students from various backgrounds and trains them in the field of Mental Health Education during their tenure. One of the objectives of their training includes guiding patients and caregivers to access the resources at NAJK and to develop the same. In addition, they also learn to disseminate knowledge on various psychiatric, neurological and neurosurgical disorders among the people who visit the center.The concept of NAJK is innovative and exciting to explore as many hospitals that specialize in psychiatric illnesses do not have such spaces where visitors could gain information about disorders. For decades, it has been observed that the mentally ill have been treated very badly. It was believed that mental illness was caused by demonic possession, witchcraft, or an angry God (Szasz, 1960). For example, in medieval times, abnormal behaviors were viewed as a sign that a person was possessed by demons.4
On this background, we understand that there lies a strong connection between socio- cultural beliefs and mental health which plays a major role in the way mental health is perceived by people which further affect the treatment of Mental Health Disorders. Culture is an abstraction, reflecting the total way of life of a society. It is a precipitate of the group’s history and an expression of its adaptation to the physical environment. Culture is constantly in the process of change and it is transmitted from one generation to the next. All societies have it though their styles vary from one group to another.5 Over the years, there has been an initiative by the government and private organizations to spread awareness, information and facts related to Mental illnesses and health to bridge the gap between the orthodoxical perspective and scientific treatment.
The department of Mental Health Education tries to bridge this gap by creating simple, easily understandable content in the areas of psychiatric, neurological and neurosurgical disorders. With various IEC Materials out for display at the entrance of the NAJK, the public is drawn to have a look at the materials for more information about the disorder they would like to know about or even about ways to maintain a good mental well-being. Posters and short videos are displayed on digital signage at the entrance of the OPD block and waiting areas to educate and expand the visitors’ knowledge regarding disorders and healthy lifestyle. The department has taken various steps including distributing flyers to other Outpatient Departments, for the doctors to guide their patients or caregivers to the NAJK for further information about mental health topics.
The turnout of patients and caregivers in NAJK over the last 3 months has been tremendous. Ona day to day basis, the fellows interact with patients and caregivers who visit to NAJK and it was disheartening to realize people have no or very little information regarding the problems they are going through and it draws our attention towards the bridging the gap between trying to create awareness using IEC material and how many people actually receive it. This has been supported in a study by Thakur et al that lack of information is the major barrier to the effective access to services. Adding to the lack of information is the inappropriate usage of funds provided by the Government. The funds are underutilized or used for conventional information material such as print advertisements. A majority of the IEC materials available at the district level is not relevant as per the local needs and requirements. The focus should be to develop local context-specific IEC materials. IEC materials need to be adapted at the state and district levels, and reproduced considering the sociocultural context and need, and then be disseminated in the community, especially hard-to-reach areas.6 The curiosity of the visitors often draws them to the NAJK to interact, know more about their problems and pick up brochures. Patients and caregivers provide feedback where they suggest improvements in the NAJK and request for other relevant topics on whichIEC material can be created. A lot of patients through the feedback form have expressed a need for starting discussion groups for family and Self-help groups for patients, as they feel that talking to others who can understand what it is like to deal with a mental illness and caring for them would prove to be of great help. Self-help groups for mental health problems are the most prevalent form of self-help. There are several thousand groups in Australia, the U.K., the U.S. However, in India where there are less trained mental health professionals, SHGs prove to be essential and beneficial for both rural and urban populations. Under the “ManamInidhu” an initiative by Tamil Nadu Corporation for Development of Women, SchizophreniaResearch Foundation (SCARF) and the Institute of Mental Health, members of self-help groups (SHGs) across Tamil Nadu will be trained as mental health counsellors.7 NAJK as an initiative, helps to reach out to more audience, understand the nuances of how mental illness is perceived by the population, the treatment gap that persists, the need to fill in through educating the masses, and normalizing discussing and talking about Mental illness.
There has been a very slow progress in understanding mental health and its importance when compared to physical health. With the arrival of the Pandemic, COVID- 19, people have begun to understand the importance of Mental Health and seeking treatment for all mental disorders. The NAJK is crucial in drawing people into the world of knowledge and thereby spreading awareness among the people about Mental Health which is further crucial in obtaining the right treatment at the right time, thereby helping to reduce stigma related to mental health disorders and treatment gap, which are the two main causes of global burden of mental health disorders. This is achieved through effective dissemination of booklets and brochures. It also helps the people in identifying mental health disorders, seeking necessary treatment, self- help and improving mental well-being. The NAJK also invites emails from people to seek out information from various other authentic sources.
Strengths and Limitations
The location of the NAJK near the entrance proves to be of very crucial strength as it draws in the attention of a majority of people who enter the OPD as they are passing by to their respective departments. The availability of various IEC materials and its display on standees calls in people to read and collect the IEC Materials to improve their knowledge on Mental Health and its well-being. The NAJK also conducts theme based programs by initiating exhibitions, public awareness programs, development of IEC materials and undertaking unique campaigns to generate awareness.
Despite all the strengths, the NAJK has got scope for improvement. Most of the patients and caregivers come from different parts ofIndia and from neighboring countries. The waiting time for consultation deprives the caregivers of visiting the center for accessing the resources. This can be addressed by the trainees and volunteers reaching out to them in the waiting hallsand making help accessible. Development of newer IEC materials in multiple languages according to needs can be enforced with interaction with patients and caregivers. Implementing these in the coming months can strengthen the services of NAJK and educate and empower the persons seeking services at the hospital.
The NIMHANS Arogya Jagruti Kendra, a learning resource center to disseminate awareness about mental health, its disorders and well-being, is an innovative strategy brought into action for patients and caregivers coming to the OPD. The NAJK can be further strengthened by being provided with space in key locations within the specific Outpatient Departments, thereby improving dissemination of awareness on mental health and neurological disorders.The NAJK plays a key role in answering the queries of its visitors and thus, improving mental health literacy and reducing mental health stigma. The innovative approach of NAJK started by NIMHANS, not only makes mental health services more accessible and affordable but also empowering in nature by encouraging patients and caregivers in early detection, prevention of mental health illness, appropriate treatment referral to existing primary healthcare services.
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