Program Design: Seher Comprehensive Urban mental health program
The Vision of the program is to create emotionally sustainable communities. The vision is based on the social entrepreneurial idea that it is possible to transact on positive emotions, especially love, support and care, in communities: pooling, sharing, transferring, distributing, conserving, skilling, etc.
The strategy to create emotionally sustainable communities is by providing comprehensive mental health services, with all components covered: prevention, promotion and curative services.
At core, the program is designed in two tiers, ‘non-formal care’, and ‘formal care’.
Non-formal care is the community-based foundation on which formal care is built up. Non-formal care includes a range of specific psychosocial services, including home visitors service, peer support and support counselling services, enabling neighbourhood community care system, family counselling, inclusion and stigma reduction.
Formal care includes a range of specific medical and psychosocial services, including comprehensive medical care, social care and rehabilitation, psychotherapies, arts based and body based therapies, and group therapies.
The periphery of the program design is covered by liaison and partnership building, awareness, research, capacity building, advocacy and organisational / team development.
This photo story covers main aspects of the Seher UMH program.
Our Location : Kashewadi and Lohiyanagar Wasti, Inner city area of Pune.
Pune has 550 slums at the last count, and upto 45% of Pune people are living in the slums. Kashewadi and Lohiyanagar Wasti are two of the oldest and largest slums, with total population of around 55000 people. The Vastis are old, established, safe, with good social capital and low level of migration. The basic infrastructure and socio economic needs are being met for the people living in these areas. Various services both private and public are available in the vastis and can be approached for support.
A view of the working areas and people
Awareness activities include
– Corner meetings
– Household surveys which also help us to identify clients from door to door
– Poster Exhibitions, awareness in schools, colleges, hospitals, NGOs and other institutions in our working areas
– Mass awareness programs in community areas attracting 150 or more people
– Interactions and exchanges with a variety of key resource people in the community, such as anganwadi teachers, police, RCV workers, etc.
Corner Meetings: These meetings are more intimate, happen in groups and are done with 8 to 10 participants. Field workers have created a flip chart covering over 50 topics that are of relevance to mental health, well being, illness and disabilities. In the project period, out reach has been to over 5000 men and women; through approximately 920 corner meetings @ 16 meetings per month per field worker.
Often times, these meetings happen in people’s homes, or in the sidewalks or clearing spaces in between the kohlis.
Poster Exhibitions appeal more to men, it appears, and are put up in busy market areas of the vastis, such as nearby a dargah, vegetable market, mandir, auto stand, etc. They attract between 50-100 people, and are done about twice a month.
Awareness programs have been done in schools, colleges, and NGO spaces, attracting around 50 people at one time. Around a 100 awareness meetings were done during the project period, reaching out to approximately 2700 people.
Awareness meetings were done in key institutions in the area, such as Poona College, SnehDeep Jankalyan Foundation, Khadak Police Station, Sonawane hospital, Kamla Nehru Hospital, St. Hilda’s School, etc. Staff at Sonawane hospital, nursing students and staff at Sonawane and Kamla Nehru, local doctors, students, teachers, health workers, social workers, anganwadi teachers, police men, RCV workers of UCD system, etc. have attended these programs. Depending on expectations and needs expressed by particular group, team covers a range of topics. Positive mental health and promotional activities are favoured by communities for these larger meetings. Sharing about Seher work in the areas is shared, and referral promoted.
Special mention of work with Alcoholics Anonymous, which, under the leadership of Ram Bhau of Kashewadi Wasti, led to the formation of two AA groups in our working areas. One of them continues to work, and there is regular referral.
Mass communication events are organized around significant days, such as Erwadi Memorial Day, Mental health Week, etc. The local Mandals invite us to share our work during Ganesh festival Durga festival, etc. On those days, we screen our film, ‘Aadhar’, and interact with communities.
A Bapu Poster made in August of 2001, commemorating Erwadi Victims
Erwadi Tragedy of 2001 elicited nation-wide shock and response from Human Rights Institutions, Supreme Court, and civil society. Bapu Trust along with Schizophrenia Awareness Association were among the first to respond, and eventually signature the day as the ‘Erwadi memorial day’, which till date, is being remembered by the two organizations. During the project period, we organized poster making exhibitions in colleges, screenings of Aadhar film, and other local engagements. Gurudatt Kundapurkar of SAA reads out a pledge every year, which we all avow, finishing with lighting of candles. The event attracts the Pune city folks, press, and other key resource people within education system. We feel it is important to bring our news to young people of the city.
Some training events require special mention, those done at Sonawane hospital and Kamla Nehru Hospital for the doctors, paramedical and nursing staff.
Seher program provides a range of comprehensive medical, psychosocial, recovery based support systems and therapeutic interventions, as part of non formal as well as formal care. Some of them are presented through these photographs.
For Comprehensive medical care, we partnered with Kamla Nehru Hospital and their PHC, Sonawane Hospital. We made referrals to a variety of hospitals, including Maharashtra Institute of Mental Health, and KEM Hospital. Kamla Nehru and other hospitals in Pune provided general health care to our clients.
Psychosocial methods are mixed, working with both individuals and groups, using Arts based therapies, cognitive behavioural techniques, breath practices and visualisation, nutritional inputs, Building social capital of clients and circles of care, group therapies (specific), family counselling, linking people to local resources, and social security.
Individual counselling and client work
The bulk of our clients, in the full spectrum of mental health problems, are referred for individual counselling at our centers in Lohiyanagar and Kashewadi. Several are given support counselling by grassroots staff. During the project period, approximately 630 people, largely women, have benefitted from our services. Around 385 have obtained various social benefits and entitlements; another 70 have obtained disability certificates.
However, these sessions and clients are not presented through photographs, due to reasons of privacy.
Home visits are a key element to the success of our program, and in the project period, upto 5400 home visits were made.
Assessments We use standard ‘scales’ for assessments such as Self Reporting Questionnaire, WHO-QOL, BPRS, and a variety of psychological testing tools. These however are supported by in-house group assessment, ABT assessments, etc. We have an intake form that covers a wide scope of a person’s life and history, as well as preference / belief in any particular system of healing. Some pictures herewith…
Assessments Techniques such as mandala, body mapping, drawing a tree, a house, etc. help in making assessments of the client’s ‘being’ at the point of o
We have found that mandala drawings and body maps convey much more than words a person’s self experiences and relationship with the world and others. Simply put, in all three renderings above, core ‘self’ experience is missing, suggestive of de-personalisation, suicidal ideation, boredom, depression.
Arts Based Therapies certified by the World Center for Creative Learning Foundation (www.wcclf.org) has skilled some of us in integrating various art forms (rhythm, body & movement, breath practice, visualisation, art and colour, theatre) to use with ‘special needs’ groups. These interventions have a tight therapeutic structure and are part of the formal care system.
I am a tree: Care Giver Burnout
These evocative pictures were drawn by caregivers of children with mental disabilities, suggestive of high level of burn out. In one tree, the trunk is split in the middle into two, drawn in red; In another, there are no leaves, tiny objects being all red; in the third, there is no colour!
1. Any Body Can Dance …
Based on the fact that the brain moves when the body moves (within a structure based on therapeutic objectives)
2. Colour in every breath: Breathing practice with straw
Sitting meditations or breath practice is difficult for young people and people who are having higher level of psychosocial need. Using some activity to nculcate practice helps.
3. If not words, use a drum or a percussion
With high support needs clients, who find it difficult to express themselves in words, rhythm helps to restore a sense of reality, and self expression. Those with auditory hallucinations are particularly supported by drumming and rhythm. This is a skilled activity, requiring training, as all interventions here described, are!
Rhythm is used to return to reality. Drumming seems to affect the auditory system, which is also the root of auditory hallucinations.
4. Kitchen is where mental health is cooked for self and family
We did a ‘food visit’ in the wastis to find out what varieties of grains, proteins, and fats; vegetables, fruits and dairy products are available there. A list of 300 items surfaced! Except for oils and fats, there is no shortage of foods. However, people eat very few items in their daily diets. We did not explore the reasons. But whatever they may be, the money they spend on food can be spent on healthy nutrition, rather than on baked products and oils (which is hugely consumed). We emphasize role of proteins, multi grains, pulses, eggs, and omega 3 oils (jawas is widely available) in daily diet. We also track consumption especially in case of people with high support need. We provide illustrations of holistic nutrition, providing nutritional information to our group clients and sometimes individual clients. Many clients go to Sonawane OPD for malnutrition check.
Singhdana, bananas, bangda fish, til, jawas, undae, gawankur … natural anti depressants
5. Meditations and visualisations
A variety of meditations are used. Sitting meditations (Anapana) has been found difficult for most clients. Dynamic, active, walking, meditations are enjoyed more. Meditating with visualisation has had beneficial effects and is also enjoyed, practised. Anger management techniques regularly include a variety of dynamic, cathartic as well as mindfulness based meditations. These are skilled techniques used specifically in sessions based on therapeutic objectives.
These techniques are also used to build faith and hope in one’s own well being. For example, in the picture o the right, one group member is reinforcing the faith and hope in recovery of another member, by visualizing ‘healing showers’.
Many of these techniques (e.g. relaxation exercises as shown below) are done in the community itself, using a hall or a home offered in kindness by someone.
Opening the senses: Use of light, colour, smell, touch, etc. the 6 senses, helps in experiencing well being, as the 3rd picture on the right (above) shows. Other than these, theatre and role plays, interactive games, art, collage, etc. are used in session.
6. Building social capital
Rhythm, colour, movement, and drama can build a sense of connection and group experience of well being. These help in community development around the theme of recovery, connection and well being. Several activities are introduced in individual sessions and group sessions, to inculcate self care.
A large number of our clients have medium to high level of depression, and for them, such collective spaces help in building support within their own families and communities. We have ‘client reunions’, and other such common events when people from across all segments of our services come together for some activities. We encourage our group clients to take up a number of activities, such as running, physical exercise, joining the gym, any recreational activities, spiritual groups if they are so inclined, etc.
7. Circles of care
In cases of high support needs, we try to develop a neighbourhood support system, and a ‘circle of care’. If families do not co-operate, it becomes difficult to establish such care system. We work with primary care giver(s) maybe one person or two in the family, extended family, who are concerned about client. Sometimes a client reaches critical stage only then family gives support. In full spectrum of disabilities, we involve community in decision making, so that they own the process of care giving. In group sessions, we run modules on ‘circle of care’. Pictures below…
Especially among families and care givers of persons with disabilities, such exercises and discussions help in beating the sense of loneliness and isolation, and cultivate a culture of ‘asking for help’, depending on neighbour, etc. In these activities, people find out that there is a wide range of personal, social, and other support systems that they can fall back upon, including Seher team, in case of need.
8. Transforming communities for inclusion
In case of high support need clients, we often have to do corner meetings on the humanity embedded in all human beings, and other stigma reduction activities.
We do intervene with arbitration and negotiation methods where family / neighbourhood conflict is high. Family conflict, and tumult in neighbourhoods being highest cause of stress among families, especially those with persons with disabilities, we take out street play with message of peace, care and inclusion. A ‘play for peace’ training helped grassroots staff to take the message of inclusion and co-operation to our working areas. A street play, a campaign on ‘peace practice’, some amateur videos, and other such have helped in spreading the message of inclusion.
Finally, a number of videos have been created which are regularly used in our work in communities, and for awareness and dissemination.
Bapu Trust team (2010-2012)