Janamanas was launched in November 2007, as one of Anjali’s definitive steps towards de-institutionalisation, community care and demanding every citizen’s right to mental health/wellness. It is a collaborative project with the State Government Department of Municipal Affairs, to work in 3 peri-urban municipalities, with the most neglected, marginalized and economically backward section of the population using available Government infrastructures. Anjali has conducted a baseline survey at all these municipalities to bring out prevalence of mental health problems, danger signals, possible reasons, lack of available services and high level of gender based violence and discrimination, before launching this programme. Janamanas had worked with 108 women associated discriminated by their gender, class, caste and lack of formal education. 50 women emerged as forward line of leaders who are now running the kiosks established in their communities. The rest are working as primary mental health workers supporting the kiosks as outreach persons.
Assess: Mental health is a severely neglected area in India. It is often associated only with mental illness and lack of perspective makes the situation worse as community and even the family refuses to accept persons with mental problems and abandons her/him due to fear of stigma, relapses and the perceived economic burden. Through our hospital based rehabilitation programme we had interacted with several such families and individuals from peri-urban and industrial areas and conducted a survey to chart out causes of prevalence of mental health problems in those areas. In this process, status of women, subjected to multiple discriminations came into account along with a range of other contexts like class, caste, religion etc. This programme was thus conceived to address the needs and concerns expressed by the community, designed on the basis of the survey findings which were collated, analysed and documented to be shared and used by all.
Plan: The community was involved through baseline surveys and a series of FGDs with all the key stakeholders conducted before launching the programme. Anjali aims to secure large-scale systemic changes in the mental health field by building community eco-systems for mental health care & well-being, particularly women and adolescents for they are worst affected and ending stigma, violation and discrimination associated with mental health. Key objectives and strategies: • Partnerships with local, state and national government to humanize mental hospitals and systems. • Integrate mental health into the rights and gender discourse in the country through trainings and advocacy with families, local communities, local self-government • Develop community based organizations and women leaders of local governance systems into mental health champions to ensure community care and women’s involvement in community development • Identify the gendered face of mental illness and address the patriarchal paradigms within the communities and families
Act: Janamanas has: • Created therapeutic spaces and communities to safeguard and protect the interest and rights of persons with psychosocial disabilities • Mapped health facilities (especially mental health facilities) and infrastructure conducting ground-up research of the prevalence of mental health disorders in the communities (since no organized data exists so far) • Trained and launched women who are below the poverty line and who are members of urban self-help group members as barefoot professionals • Developed employment opportunities for women as primary mental health workers and barefoot professionals • Setting up mental health kiosks at 3 municipality areas managed and run by trained community women
Mass awareness campaign, focus group discussions, daylong workshops, public programmes involving celebrities, film shows, motivating community key persons (political leaders, administrators, teachers, youth group leaders and women in particular), involving stakeholders from all levels, usage of IEC materials – these are strategies used for community mobilization.
Evaluate: Monitoring indicators with timeline, developed with key stakeholders and objectives in the centre, are used to evaluate the effort. The programme being a collaborative effort, the Municipality Administration became one of the key stakeholders, whereas the women trainees were the other. Objective for the first group was basically to ensure buy-in and full partnership for the kiosk and to accept mental health as a health rights issue. For the second group the objectives were to equip participants with information and training to ensure full professional execution of their job as kiosk as well as to bring in a change in their own mindset vis-à-vis mental health and their own potential as full citizen.
We had taken small step at a time and continued to include changes in our training curriculum, which was tailor made for each group and took up innovative, effective ways to negotiate and convince the Administration.
Sustain: Program Buy-in by the Municipality Administrative System is our main sustenance strategy. Keeping Anjali as the consultant cum monitoring agent consultants the exit plan has been planned and implemented in the municipalities. Inclusion of Mental health in the Draft Development Plan of the State Government is part of this exit plan and an orientation cum perspective building series of workshops are executed with the government authorities to ensure quality control and smooth operation of the programme using existing government infrastructure. Involving the community at all stages of decision making is also important for its sustenance.
The initiative though unique is simple to replicate and sustain. It essentially requires a committed group dedicated to ensuring positive mental health in the community. In terms of resources the project is based on a cost effective model where focus is on onus sharing by the state, the community and women workers at large.
Janamanas has integrated marginalized groups such as those with mental health problems within mainstream society with confidence to interact and negotiate with families, neighborhoods, local elected representatives, doctors, other caregivers and the government and judiciary at large. The programme has also built civic engagement of municipality citizens with mental health. This large volunteer base, created through trainings, has shifted from stances of violence and fear to serving as care-givers and friends of persons who are mentally unwell. Women, who are our primary target to bring in this huge shift in the community, themselves went through attitudinal change and are now have taken up importance positions in their families, communities and even in the municipal administrative system.
