When we began our work as a mental health advocacy agency, we were reluctant to start service provision, until it dawned on us that, in India, we have to actually advocate for ‘community mental health’. What is taken as a given within the disability sector, was a ‘new and innovative idea’ within the mental health system: The overarching paradigms within the mental health system were the mental institutions and the allied ‘safe custody’ institutions. We did try to work within institutional settings (the beggars’ homes; the family court system) for 4-5 years; and found that we could not fundamentally challenge the oppressive laws determining these systems (Beggary prevention act; the Marriage and Divorce Act). That seemed to be possible only through the courts.
Like people who work in the health movement in the country, we knew that social inequality, gender, poverty and marginality caused mental distress, disturbance and disability. Being led by the visions (and no doubt the delusions) of the user survivor movement, we were ‘challenged’ enough to imagine newer forms of services, based on principles of community, networks and care. We decided not to provide services within institutional settings; rather, we would focus more on advancing user led services, peer support systems, wellbeing based practices, and community mental health care in an authentic sense. The arrival of the UNCRPD in 2008 only strengthened our efforts to search out, support or partner with more holistic networks of care within the community (‘The Red Door’, ‘Circle of Care’, etc.).
We also figured out that if communities should own their own choices and practices in keeping well, our services should break down the barricade between ‘expert’ and ‘client’. Our earlier experience in community mental health showed that mental health professionals, however liberal, were reluctant to give up that role. It took us a while to figure out who is the main enabler in a community based mental health service: those who lived in the community themselves! We upturned our service pyramid and rebuilt our urban mental health program.
In doing these experiments, we were able to question many myths and to expand possibilities of practice. For example, there is a myth that community workers cannot be taught Cognitive Behavioural Therapy or other ‘higher’ treatment modalities. There is another one, that talk therapy can cure many issues, and where there were limitations, the only other option was medication. This is not true: a variety of body based practices can help in communicating with people who will not talk. The most vicious one that we have encountered in our own practice, was that ‘psychotic people’ only needed to take their medicines. We have found a variety of actions to take with families, with neighbours, and with our clients in dealing with extreme states, and we are still learning. Nutrition, life style changes, peace building and ‘emotional ramping’ (i.e. building positive emotional environments within families and neighbourhoods) have become a part of our community mental health program.