Providing Free Mental Healthcare to the Underprivileged in Kerala

Dr Manoj Kumar left his psychiatric practice in the UK and moved to India to provide mental health support to the lesser privileged community in Kerala. By adopting a unique model that engages the local community with the experts in the field, Dr Kumar has helped thousands of people in need. 

In a country like India where mental illness is still considered a taboo, a swooping 13 percent of the citizens are battling with some sort of mental illness. Around 66 percent of India’s population lives in villages with no access to basic health services. With the majority of mental illness healthcare centres saturated in urban areas, the country is doing a disservice to its citizens by letting a larger portion of the society suffer in silence. 

This disparity among the social classes motivated Dr. Manoj Kumar to leave his psychiatric practice in the UK and fly back to India to take care of the mental health of the rural populace. In 2008, he started the organization Mental Health Action Trust (MHAT) in Calicut, Kerala with the aim of providing a free, comprehensive, community-based, and cost-effective mental health care system for the economically backward groups of the society. 

According to Dr. Kumar: “Since the 17th century, madness was considered an illness with no proper medication. People were put in already overcrowded asylums where they became abusive until the medicine was developed in the 1960s. Still, in the present scenario as well, only institutional help won’t work. A paradigm shift of community psychiatry was much needed.”

Dr. Kumar started to get a broader understanding of psychology through his experiences while doing his Diploma in Psychological Medicine (DPM) at CMC Vellore. Dr. Kumar started seeing an uncomfortable pattern when it came to mental healthcare which was inaccessible, inefficient, inhumane in practice, and costly. These barriers were more apparent in the treatment of the lowest strata of society who don’t have access to basic healthcare.  

“Real psychiatry care is more than giving just medicines. People need proper support, counseling, rehabilitation, home care for the complete recovery. But most of the mental health care in India is still Institution-based and solely depends on the medication,” expressed Dr. Kumar on the problem of quality and reach of the treatment. 

To make complete mental illness care accessible to everyone, Dr. Kumar adopted the community model of mental health care by involving professionals and non-professional volunteers together. 

Engaging the local community

As MHAT adapts a community-based model, they find local partners in different communities willing to work and provide professional help to the underprivileged. They now have around 50 different centers with weekly clinics where medicines and all the other components are provided for better treatment. To reduce the cost of the entire procedure, they follow a treatment model of task-sharing. It is one of the famous concepts in the field of community healthcare. 

Dr. Manoj explained: “With over 1,000 volunteers now, they link us with each community at the grassroots level. The various needs of the suffering family are taken care of by our community team. In the method of task-sharing, the psychiatrists and clinical psychologists attend only the critical patients with complex issues. The organization simultaneously train and supervise young doctors to handle the recovery and rehabilitation process.”

It is essential to deal with mental health issues at different levels given a decentralized model like this. But before providing the relevant medication Dr. Kumar needs to scrutinize the patients and their disorders before directing them to healthcare workers. In this scenario, technology plays a crucial role in MHAT. 

“In the wake of the COVID-19 pandemic, we have adopted and adapted to this situation. Now everything is done through electronic means. With many video conferencing apps at play, I can easily the patients online and then decide what kind of medical treatment or therapy is required (also known as telepsychiatry). Our community workers carry out the video conferencing process for people who don’t have internet access,” shared Dr. Kumar. 

The problem in any psychiatric treatment is not identifying the disorder, but what to do after the identification. It should always be an amalgamation of medication and therapy for people to recover to their normal lives. 

Since MHAT is a charitable organization, it completely depends on individual contributions for fundraising for salaries and other finances required for the treatment. “For the patients, the treatment is completely free. If you wish to contribute, you can find the contact details at the MHAT website,” said Dr. Kumar. 

To demystify and decentralize the stigma associated with mental health, MHAT creates awareness through art exhibitions at their Headquarters in Calicut. They also a program, Talash, twice a month for the same. They have also started an initiative named “Friends of MHAT” where like-minded people can get involved and help in whichever way possible. 

Talking about his future plans, Dr. Kumar expressed, “We would like to provide services in other areas as well. The language might be a barrier but distance can never be. If a system is placed and local groups/communities agree to corporate with us, then mental healthcare can reach new pinnacles.”

Seeing the tribal communities from remote areas getting the proper mental healthcare they need, brings hope and motivation to Dr. Manoj Kumar. There is a sense of satisfaction within him that he is doing something great for the betterment of society and the country.  

Currently, Mental Health Action Trust is working across five districts in the state of Kerala in about 55 community groups taking care of over 4,000 patients. This community treatment model for mental healthcare has not only been applauded nationwide but has also earned Dr. Manoj Kumar a place among the prestigious Ashoka Fellows.