WHEN SHIVASHARANAIAH first started showing signs of a mental breakdown a few years ago, the 43-year-old commerce graduate’s employers at a chartered accountancy firm in Bengaluru sent him back to his village in Karnataka’s Davangere district.
At Kalledevarapura village, which he had once escaped in search of a better life, Shivasharanaiah turned dishevelled and unkempt, roaming the streets, speaking English to himself or writing on the walls. His family tried everything that other villagers suggested — local healers, religious centres and hospitals. They had almost given up hope when, two years ago, they heard that the local primary health centre (PHC) had psychiatrists visiting under a public-private initiative to take modern mental healthcare to people in the villages of Davangere.
Consultations resulted in a diagnosis that Shivasharanaiah was suffering from schizophrenia. Prescribed medication, he has over the last year achieved a semblance of normalcy — enough for his mother Anupama to say, “I have got my son back.”
Says Anupama, “He would roam around unshaven and dirty, speak only in English. We went everywhere but there was no treatment. In the end, the treatment was available in our own backyard PHC. He is almost normal now and listens to us. It is a huge relief.”
In Davangere, where the mostly dry and arid taluks are plagued by poverty, superstition, debt and alcoholism, a quiet revolution in mental healthcare is taking place thanks to the coming together of various stakeholders ranging from the state government to NGOs and private donors. Today, the district is the first in Karnataka where mental healthcare is being provided in all PHCs in all taluks on a large scale. Hundreds of government health workers trained by local NGOs now identify families with people suffering from severe mental illnesses and advise them about modern care at bi-weekly camps conducted at PHCs by psychiatrists visiting from institutions such as the National Institute of Mental Health and Neurosciences (Nimhans).
NGOs such as the Association for People with Disabilities (APD), with financial support from actor Deepika Padukone’s The Live Love Laugh Foundation, and free psychiatric medication provided by the Infosys Foundation backed by the NGO Chitta Sanjeevini have taken big strides in changing cultural attitudes.
Speaking to The Indian Express, Padukone says “multiple stakeholders in the field (are) doing amazing work” in Davangere. “One person getting better is creating a ripple effect. A person who was psychotic for 10 years is today a lot better with medication and this has a ripple effect. For me, to see this in actuality was a revelation… The fears are many — fear of losing your job, fear of isolation, fear of what people are going to say. So we will hopefully get to a place where we are rid of all these fears, doubts and stigma. That is ideally where I want us to be,’’ she says.
Says A L Janardhan, assistant director at APD, “One of the biggest challenges in providing modern mental health care in the rural setting is the cultural one. People tend to first turn to local quacks and religion. The general tendency is to view mental illness through the eyes of superstition and to link it with spirits and ghosts or sorcery. The programme has impacted 892 individuals with mental illness so far and as many as 217 new individuals requiring treatment have been identified in the last year.”
A PhD scholar from Nimhans, James Joseph, who has been studying mental health rehabilitation in Davangere over the last couple of years for his thesis, says a gradual change is happening in the region with word spreading about the treatment being provided at the local PHCs. “We had a patient who had been taken to a local healer a few years ago. The healer had applied some medication on his head, which resulted in burns on his scalp. After we heard about him, we approached the family and they agreed… There has been a visible change in his behaviour,’’ says Joseph.
Dr T Sivakumar, an associate professor for psychiatry at Nimhans who consults twice a month at a PHC in Jagalur, says training local doctors and healthcare workers in rural areas involves “a process of building a relationship with the community and becoming trustworthy”.
While the state government has started a rural mental healthcare programme, “Mano Chaitanya’’, through consultations at PHCs across the state on “Super Tuesdays’’, the initiative has not taken off in other regions due to a lack of awareness among people and cultural constraints, say APD officials.
“Our neighbours used to fight with us if my wife who was unwell and wandered into their property. They said her mental illness would spread. People do not take kindly to those with mental health problems,’’ says the husband of a woman who has undergone treatment at a PHC in Davangere.
Says psychiatrist Dr Shyam Bhat, a trustee with The Live Love Laugh Foundation, “What is happening in Davangere is a start. There is a lot of change in society that is still required.’’