Vidarbha shows the way to check suicides

Print edition : March 17, 2017

A GRASS-ROOTS mental health programme in rural Vidarbha called VISHRAM (the Vidarbha Stress and Health ProgRAM) has enabled a dramatic reduction in the treatment gap for depression in that region, according to a study by the Public Health Foundation of India (PHFI). The study was published in Lancet Psychiatry.

VISHRAM was designed to address the mental health risk factors for suicide (i.e., depression and alcohol use disorders) in a predominantly rural population of 1,00,555 people in 30 villages in the Amravati district of Vidarbha region, the epicentre of farmer suicides. According to a 2015 study VISHRAM conducted, 5.2 per cent of the people interviewed had thought of taking their life in the previous 12 months. Of these, nearly half (45.3 per cent) also had depression. The PHFI study is an evaluation of the VISHRAM programme, which was implemented over 18 months by two non-governmental organisation (Prakriti, with technical support from Sangath). Surveys were done at the start and the end of the programme. The evaluation at the end found that (a) the prevalence of depression fell from 14.6 per cent to 11.3 per cent; (b) the proportion of people with depression who sought care rose from 4.3 per cent to 27.2 per cent; (c) treatment access was equitably increased across caste, gender and social class; (d) the prevalence of suicidal thoughts in the previous 12 months fell from 5.2 per cent to 2.5 per cent; and (e) a range of mental health literacy indicators showed significant improvement.

As a part of VISHRAM, existing front-line workers such as accredited social health activists (ASHAs) worked at the community level to raise mental health literacy and provide psychological first aid and lay counsellors provided psychological treatment in the community and at primary health centres. Psychiatrists from the government’s District Mental Health Programme and the private sector provided medication for serious mental disorders at the primary health centres and the rural hospital. VISHRAM underlines the importance of care for depression and the concomitant reduction in suicidal behaviour.

Global burden

According to the PHFI, one-third of the global burden of mental illness falls on India and China, more than all high-income countries combined. Yet, in both countries less than 1 per cent of the national health care budget is allocated to mental health care. The recent National Mental Health Survey in India shows that about 90 per cent of people with depression had not received any care in the previous 12 months; VISHRAM shows how this treatment gap can be reduced.

VISHRAM is led by the psychiatrist Prof. Vikram Patel. “VISHRAM offers a model for the scaling up of community mental health care in India through a partnership between communities and front-line workers, lay counsellors and mental health practitioners from the private and government sectors. In particular, it offers a template for reducing suicides in Vidarbha,” he said. “It is now critically important to translate this knowledge into real-world practice by scaling up VISHRAM intervention through the National Mental Health Programme across the country,” observed Rahul Shidhaye, associate professor at the PHFI and the lead author of the PHFI study.

R. Ramachandran

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