Objective: Mental disorders are a challenge among Internally Displaced People (IDPs). Training lay mental health workers (LMHWs) might offer an effective solution. Method: The study was conducted in a camp for IDPs in Malakal, South Sudan. LMHWs were trained based on WHO Mental Health Gap Action Programme (mh-GAP) guidelines to provide psychosocial interventions. Participants (n = 988) were randomised to either the intervention arm, receiving help from the trained lay mental health workers (LMHWs), or a waitlist control arm. A structured clinical interview, the Composite International Diagnostic Interview (CIDI), as well as the Brief Disability Questionnaire (BDQ), Impact Event Scale (IES) and the Alcohol Use Disorders Identification Test (AUDIT) were used for baseline and follow-up assessment. Results: A statistically significant intervention effect on PTSD severity was established (Cohen's d = -0.20, 95% CI = (-0.23, -0.17), p < 0.001). Additionally, significant effects on the prevalence of several CIDI diagnoses, including anxiety and depression (OR = 0.46, 95% CI = (0.33, 0.63) and OR = 0.62, 95% CI = (0.45, 0.84), respectively) were found. Disability and alcohol abuse were also reduced (Cohen's d = -0.30, 95% CI = (-0.38, -0.21) and d = -0.08, 95% CI = (-0.13, -0.02), respectively). The positive impact of treatment was found to be lower in the control group. Discussion: The lessons learned could potentially be used future programs.

Involving persons with lived experience in knowledge generation through participatory research (PR) has become increasingly important to challenge power structures in knowledge production and research. In the case of persons with lived experiences of mental illness, participatory research has gained popularity since the early 70 s, but there is little empirical work from countries like India on how PR can be implemented in psychiatric settings.This study focuses on exploring the way persons with lived experiences of mental illness can be engaged as peer researchers in a service utilisation audit of The Banyan’s inpatient, outpatient and inclusive living facilities. The audit was an attempt by The Banyan to co-opt clients as peer-researchers, thereby enhancing participatory approaches to care planning and provision. Notes and transcripts of research process activities (three meetings for training purposes), 180 interviews as part of the audit, as well as follow up Focus Group Discussions (n = 4) conducted with 18 peer researchers, were used to document their experiences and gather feedback on the training and research process.We foundthat, reflected against the lack of formal education in the past, the opportunity and support received to be part of a research endeavour, elicited a sense of pride, relief, and liberation in peer researchers. Additionally, actualising the role of an academic and researcher, and not just being passive responders to people in positions of intellectual and systemic power, engendered a sense of responsibility and accountability to peer researchers, and to the mental health system. Thirdly, supporting persons with experiences of mental illness in participatory research activities, especially in the context of low resource settings, requires specific consideration of practical conditions and adjustments needed to avoid tokenism. Finally, both peer- and staff researchers spoke about persisting hierarchies between them which deserve attention.We conclude that participatory research has a significant scope amongst clients from disadvantaged communities in low-resource settings. Respondents repeatedly expressed an urgency for persons with lived experience to contribute to mental health pedagogy, and, in so doing, disrupt archaic treatment approaches.. Experiences from this enquiry also call for a rethink on how training in research can be developed for individuals without formal education and with cognitive difficulties, with the help of auditory support systemssuch that key concepts are available and accessible, and long-term memory becomes less of a deterrent in the pursuit of knowledge and truth.

BACKGROUND:Patients with severe mental health issues who live in isolated rural areas are difficult to reach and treat. Providing effective treatment is difficult because mental health problems are complex and require specialized knowledge from a range of professionals. Task-sharing with lay mental health workers (LMHWs) has potential but requires proper training and supervision to be effective. This article reports on the challenges and facilitators experienced in empowering LMHWs in their role, with the help of a technology supported supervision group. The study sought to understand the functioning of the Empowering Supervisory Group (ESG) in the context of junior psychologists and LMHWs in rural India, and investigate how they experienced it by exploring challenges, lessons and empowerment. METHODS:Qualitative analysis of interviews with the 22 ESG participants and their supervisors. RESULTS:A total of three discrete phases of supervision were identified where supervisors responded to the changing needs of the group. This began with building trust at a baseline level, tackling issues with competence and autonomy and finally experiencing meaning and impact through self-determination. The experience of empowerment even in an online setting was very beneficial given the challenges of working in rural areas. CONCLUSION:Empowerment based supervision of LMHWs and junior psychologists online enables a level of engagement that positions them to engage in community mental health practices with greater independence and confidence.

Conflict and displacement are gendered processes which impact women in refugee communities in various ways. The following case study, in a small refugee camp in Chennai, explores whether the design of a small refugee camp allows for increased mobility among women and a different position for female refugees in the community. Findings from a two-year long study, including participant observations, FGDs and interviews, show that Rohingya women gained social mobility by accessing schools, market places, health centers and the police station outside the camp. Through such interactions, women gained skills and knowledge which somewhat altered their position in the camp.

India has a significant number of people exposed to suicide. The traumatic effects of these experiences, and the healing process of suicide survivors are poorly understood. We investigated suicide survivors’ experiences and post-suicide healing. Interviews were conducted with suicide survivors who received different types of support—home visits before COVID-19 and telephonic outreach during lockdown. Two researchers used “active listening” and “human capacity for response” theory for deductive and inductive coding. Personal and socio-cultural factors affect recovery after suicide. Protective factors include religious or spiritual beliefs, as well as a sense of life purpose. Factors that hinder recovery include lack of social support, unmet need for compassionate understanding, insufficient acknowledgment of personal struggles, and social stigma. Interventions for suicide survivors should consider personal and cultural factors, including psychological and religious needs. Interventions should create safe environments that allow individuals to draw on personal and social resources for healing. Keywords suicide survivor , postvention , individual determinants , social determinants , cultural determinants

AbstractMany children worldwide interact with the justice system, which presents a host of legal and practical problems. The substantial power differentials in children’s interface with the criminal justice system are skewed towards professionals from the judicial, protection and mental health fields. Since legal and judicial systems tend to be particularly patriarchal, paternalistic and hierarchical, they are poorly equipped to grasp the need for democratic and more fluid interactions in order to include marginalized and vulnerable witnesses, such as children. Drawing on the work of SAMVAD (Support, Advocacy & Mental Health Interventions for children in Vulnerable circumstances and Distress) and discussing transdisciplinary methodologies, this chapter reviews SAMVADs’ attempts to address the complex problems of child protection and mental health and law—both with children, and in intersectoral collaboration between service providers and stakeholders from the domains of child mental health and law. It does so with the specific aim to elicit lessons on how to overcome systematic and structural barriers and power asymmetries to bringing stakeholders together in a process of knowledge co-creation.

Consistent listening to community voices throughout the life cycle of programs and interventions is increasingly recognized as a key to sustainable transformation of communities. Current listening approaches rely on the agency in the listener to listen at individual and mass levels. However, the absence of engagement of agency in the listened to limits its transformation potential to individual levels. SALT (Support/Appreciate/Listen/Team) based listening connects to the agency of the listened to at scale through home- and neighborhood-based conversations. Experiences of using SALT in drug de-addiction, a community development via a corporate social responsibility program, and a suicide survivor support program reveal three distinct characteristics of transformation at scale. These are as follows: (1) SALT is a mindset that listens to strengths, hopes, and concerns in people; (2) listening and agency building at scale is embedded in a process of home- and neighborhood-based reflective learning; and (3) empowerment of communities beyond geographic boundaries is possible through organic transfer and adaptation of organizational practices. Acknowledging the common humanity that underlies the listener and listened to opens doors for deep listening, mutual listening, and transformative listening in homes, neighborhoods, and institutions.

Background: The health challenges faced by the homeless are widely unaccounted for in the global south. In India, the lack of a primary healthcare sector in urban areas has led informal healthcare providers, such as Street Medicine, to step in. Methods: By compiling data collected by the Centre for Equity Studies’ Street Medicine teams from June 2016 to October 2018 (n =16,635), this study provides the first empirical assessment of the homeless disease burden in a global south country, while limited to only the people experiencing homelessness that the teams treat, hence being a burden of treatment. Our analysis quantifies this burden among those who seek care from Street Medicine teams and identifies variations in this burden’s distribution across demography and time. Results: The majority (n = 13,557; 81.5%) of Street Medicine cases can be attributed to 19 diagnoses or symptoms, which are mostly therapeutically-simple conditions. The distribution of disease seems to be affected by different configurations of three characteristics: demographics (age and sex), urban geography (where homeless reside), and season. Conclusion: The Street Medicine teams must reflect on the balance they wish to achieve by addressing the relatively common and mild conditions documented in the dataset, and more severe and established diseases within homeless communities. Rapid diagnostic tests for resource-constrained settings could be integrated into Street Medicine practice in order to strengthen the data on which resource allocation decisions are made and improve assessments of homeless disease burden.

Much research on child witnesses in child sexual abuse trials is focused on children’s performance in legal proceedings. Witness competency, that is predicated on the adversarial justice system’s principle of orality, is core to child witness testimony, and is determined at the pre-trial stage. However, this article highlights the need to consider child witness competency as a dynamic concept, that varies in response to the ecologies of the trial processes as they unfold. Set in a low-middle-income country, this qualitative study describes and analyzes trial processes through a child-inclusive lens, identifying barriers and facilitators to child witness competency. The results were mixed, yielding three major conclusions for consideration: (i) the importance attributed to physical infrastructure, and the creation of vulnerable deposition rooms; (ii) the role of judicial discretion in issues of child witness competency and (iii) role of intermediaries, with regard to enhancing child witness competencies.

Due to barriers in accessing and using healthcare services, a large proportion of the care homeless populations receive comes from informal providers. In Delhi, one such informal programme, called Street Medicine, provides healthcare outreach to homeless communities. Clinical practice guidelines are set to be developed for Street Medicine teams in India and form the object of this research. This study uses a social-ecological model to understand the barriers facing Street Medicine teams and the homeless as they attempt to address the latter's healthcare needs; coupling it with an analytical approach which situates these barriers as the issues within practice through which standardisation can take place. A qualitative inquiry, comprising three months of observations of Street Medicine outreach and interviews with over 30 key informants, was conducted between April and July 2018. The analysis identified novel barriers to addressing the needs of homeless individuals, which bely a deficit between the design of health and social care systems and the agency homeless individuals possess within this system to influence their health outcomes. These barriers - which include user-dependent technological inscriptions, collaborating with untargeted providers and the distinct health needs of homeless individuals - are the entry points for standardising, or opening up, Street Medicine practices .

Purpose After being forced to flee their respective home countries, Sri Lankan Tamils and Rohingya refugees resettled in the Indian state of Tamil Nadu. This study attempts to explore the extent to which the state has provided means for integration in the absence of refugee protection laws and citizenship. Design/methodology/approach A qualitative research approach was used, including in-depth interviews (IDIs) and focus group discussions (FGDs) with participants from both refugee groups between 2019 and early 2020. A representative sample of male and female Sri Lankan Tamils, living in or outside government camps, in urban and rural areas, was included (total number = 75). Similarly, a representative sample of the Rohingya refugee community was included for this study ( n = 44). Findings Despite constraints imposed by inadequate infrastructure, the study finds that Sri Lankan Tamils and Rohingyas both show to be progressively integrated in local society and have been capable of fulfilling some important basic livelihood needs, especially with regards to education. Some areas for improvement are identified as well, most urgently in terms of health and accommodation. Practical implications Other states in India, as well as in similar low-income countries (LICs), could learn from the current case study with regards to administering workable policies for small groups of refugees. Originality/value With minimal state facilitation and within the context of limited legal backing, refugee groups have somewhat managed to re-built their lives. This study identifies the threshold of requirements that make this achievement possible and suggests what more could be done to further advance the current state.

This study aimed to address gaps in understanding of the lived experiences of caregivers of persons with mental illness in low-income countries. It was conducted among caregivers of persons with mental illness making use of a free non-governmental clinic in and around Chennai, India. The study adopted a qualitative methodology, with semi-structured interviews and life history exercises (n = 29) and six focus group discussions with caregivers (n = 21) and mental health professionals and community-based workers (n = 39). The experiences of caregivers were analyzed in the framework of “The Banyan model of caregiving,” which identifies six phases. Major themes in caregivers’ experience were: embarrassment and losing honor; fear; awareness; stigma and social exclusion; and reduced social interaction and loneliness. Posttraumatic growth considered as the result of caregiver experiences was found to consist mainly of personal growth and focusing on positive life experiences. Lost opportunities particular to the context of Tamil Nadu were described as the inability to get married, obtaining less education than desired, and loss of employment. Siblings faced lower levels of burden, while elderly mothers experienced especially high levels of burden and lack of happiness in life. Caregiver gains were identified as greater compassion for other people with disabilities, resulting in a desire to help others, as well as increased personal strength and confidence. Understanding the nuances of the caregiving experiences over time can provide a framework to devise more fine-tuned support structures that aim to prevent reductions in social interaction and lost opportunities, and improve a sense of meaning, in order to assist caregivers to continue providing care for their relatives with mental illness in a context with scarce mental health resources.

Background The stigmatization of mental health problems is a primary barrier for young people to approach mental health services when they suspect they might have such problems. Nevertheless, the internet has become a common platform on which they are likely to seek information on mental health. As such, this study aimed to explore responses from secondary school students in Can Tho city regarding suckhoetre.vn website. This website provided information on health and mental health, and this study assessed the potential relevance, appeal, accessibility, usefulness, and sustainability of the website. Methods A cross-sectional study included 643 secondary school students in Can Tho city selected by cluster sampling. Two weeks after the students were introduced to the website, they were invited to evaluate it using an anonymous questionnaire. The Chi-squared test was used to assess the significance of differences in the distribution of selected students’ sociodemographic characteristics. Results Most (98.6%) participants visited the website in the two-week period, 74% once or twice a week, the others more often, up to once a day. Their activities included reading information (85.8%), seeking help (17.7%), sharing information (15.5%), giving advice to others (11.0%), and chatting or giving comments (9.8%). Most students rated the website very highly in terms of appeal, relevance, accessibility, and usefulness, and wanted to have access to the website in the future. These findings are positive signals to pursue the possible use of a website on mental health for secondary school students to help raise awareness and support good mental health among adolescents in Can Tho city and beyond. Conclusion A website designed to provide information to secondary school students appeared to be a promising way to provide access to information on the topic of mental health. The website should be maintained and introduced widely to students, teachers and parents, with regular evaluation of the effectiveness of this website.

BACKGROUND:Homelessness has multifaceted and damaging effects on women with mental illness. This makes it imperative to identify and address the factors leading to homelessness among women with mental illness in order to inform policy on providing relevant services for this vulnerable population.METHOD:A cross-sectional survey was conducted among 346 women in active contact with one of four outpatient clinics at The Banyan, a non-profit organization in the Indian state of Tamil Nadu. A semi-structured instrument and modified version of the List of Threatening Experiences Questionnaire was used for data collection. Multivariate logistic regression analysis was used to examine predictive variables for homelessness among women with mental illness.RESULT:32.65% of participants reported a history of homelessness. Less than 5 years of schooling (OR = 2.914, 95% CI = 1.027-8.269, P < 0.05) and disrupted relationships (OR = 1.807, 95% CI = 1.23-2.655, P < 0.01) were associated with a greater likelihood of women with mental illness to experience homelessness.CONCLUSION:In the study cohort, this was explained mainly by factors rooted in gender-based disadvantage. Further practice and research are needed to develop interventions that address issues with a sociological basis to mental illness and prevent these predictive factors.

Persons with mental health issues are among the most under-represented populations in rights discourse, and more so those from the Global South, who have been further subjugated by the intersections of poverty, patriarchy, and systemic isolation wrought by colonial and outmoded psychiatric treatments. The issue is worse still for women with mental illness in the Global South, many of whom are driven to the extreme margins, including but not limited to chronic homelessness. Through an enquiry into the lives of these women, and their experiences of exclusion, homelessness, and involuntary commitment, this chapter aims to deconstruct traditionally accepted notions of human rights and recalibrate a service paradigm that can mould itself to fit the diverse needs of an ultra-vulnerable population over a strong foundation of liberty, access to choice, and commitment to diversity. The study is set in The Banyan, a Chennai (India)-based not-for-profit organisation, focussed on humanitarian, equity, and justice-centric responses to the needs of homeless women with mental health issues.

Exposure to violence, vulnerability due to lack of shelter, alienation due to stigma, the experiences of severe mental illness (SMI) and subsequent institutionalization, make homeless persons with SMI uniquely susceptible to trauma exposure and subsequent mental health consequences. This study aims to contribute to the development of culturally sensitive interventions for identifying and treating trauma in a population of homeless persons with SMI in Tamil Nadu, India by understanding the manifestations of trauma and its associated consequences in this population. Free-listing exercises followed by in-depth interviews were conducted with a convenience sample of 26 user-survivors who have experienced homelessness or were at risk of homelessness, and suffered from SMI. Topics explored included events considered to be traumatic, pathways to trauma, associated emotional, physical and social complaints, and coping strategies. Results indicate discrepancies in classification of traumatic events between user-survivors and the Diagnostic and Statistical Manual of Mental Disorders. Traumatic experiences, particularly relating to social relationships and poverty, mentioned by user-survivors did not match traditional conceptualizations of trauma. Positive coping strategies for trauma included being mentally strong, knowledge and awareness, whereas the main negative coping strategy is avoidance. User-survivors attributed their experiences of homelessness and SMI to past traumas. Differing views of trauma between user-survivors and mental health professionals can lead to misdiagnosis and under-recognition of trauma in this population of homeless persons with SMI.

Health Technology Assessment focuses on equal appraisal of health technologies introduced into the market. This has made regulators and the governance of innovation reactive and dependent on the initiatives innovators take for technology development, thus making it supply driven. The policy makers’ role has become one of appraising technologies that are already developed rather than guiding the development agenda. This severely limits the possibility to ensure that health technologies sufficiently address major issues such as burden of disease, trade deficit and health inequalities. It places governments outside of the actor arena that co-shapes technologies in the early stages, restricting the involvement to facilitating scale up or not. It makes it hard to achieve health technology governance practices that maximally contribute to ensure technological developments that actually address public concerns. What is the potential of frameworks for changing this dynamics and how can evidence shape technology development agenda’s without falling into the traps of regulator lock-in or social engineering? The methodology presented in this study takes first but important steps towards an evidence based framework for priority setting to guide innovations, particularly in health and social sectors

The objectives of the study were to explore the experiences of school health officers in identifying and managing mental health problems of secondary school students and to gather recommendations from the school officers for improving the effectiveness of mental health care in secondary schools in Can Tho City, Vietnam. We conducted a qualitative study based on in-depth interviews using a semi-structured guideline with 15 school health officers at 15 secondary schools in Can Tho City, Vietnam. Data were analyzed using content-driven analysis to identify recurring themes. The school health officers reported that stress, depression, suicidal ideation, and sexual orientation issues were the most commonly encountered mental health problems among their students. The officers worked with a limited range of interventions for helping these students, such as giving non-narcotic analgesics or advising students to take a short break at school or to go home. Most of them felt that their training was insufficient to deal with mental health problems in an optimal way. They recommended further training to improve their knowledge and skills in recognizing and managing mental health problems in students. They also considered a university-sponsored mental health website a good source of information on mental health care for students. School health officers reported that they did not feel well equipped to manage mental health problems because of insufficient training, lack confidence, and absence of an appropriate network for advice and referral. Updated policies and programs are needed for initial training and refresher courses, which will strengthen the role of school health officers as first line support for secondary school students with mental health problems.

PURPOSE A multiphase model for experiences of family members of persons with mental illness that considers both positive and negative aspects is proposed. DESIGN AND METHODS Mixed methods (semistructured interviews, life history timelines, focus group discussions, and the Experience of Caregiving Inventory) were used with caregivers accessing outpatient services of a nongovernmental organization in urban and rural locations around Chennai, India. FINDINGS Based on our results, we constructed a multiphase model, which we named The Banyan model of caregiver experiences. The phases are (1) manifestation of symptoms, (2) seeking help, (3) helplessness and attribution, (4) relative control and insight, (5) loss and worries, and (6) finding new meaning. PRACTICAL IMPLICATIONS Our multiphase model allows us to identify in more detail the needs of caregivers at various stages.