Atmiyata

In India, close to 14.3% of our population, i.e., 197 million people live with some form of a mental health condition.

The National Mental Health Survey (2016) shows that there exists a large mental health care gap wherein 76-85% of people with mental health conditions in need of mental health care and treatment cannot access the necessary care. This is primarily due to both, demand and supply-related factors.

Demand-related factors: These include stigma, discrimination as well as other structural and social barriers that make it difficult for people to access mental health care.

Supply-related factors: These include the lack of specialised professionals, poor quality of available services, high costs, services that are inaccessible as they are located far away, and a purely bio-medical approach that does not take into account socio-cultural factors that influence an individual’s mental health.

This mental health care gap is particularly large in rural areas as many individuals are trapped in a cycle of poverty, social isolation, ill-health, disability, and social exclusion.

While there are evidence-based interventions that involve non-specialised health workers to deliver psycho-social interventions, there are few scalable models to reduce this significant mental health care gap.

Atmiyata is a low cost, high impact, sustainable and scalable intervention that complements the public mental health system. It aims to reduce the care gap for people with mental health conditions in India.

The Atmiyata intervention employs a stepped care approach, using community-based volunteers knowns as Champions, who are identified, trained, and mentored to:

1. Provide psychosocial support: Champions provide 4-6 counselling sessions using evidence-based techniques to those with common mental health conditions such as depression and anxiety.
2. Make referrals: Refer persons with severe mental health conditions to public mental health services when required.
3. Facilitate access to social benefits: Enable access to social care benefits such as pension, disability support, etc. to increase financial stability.
4. Build awareness: Raise community awareness by using the Atmiyata App to show films based on social determinants of mental health to a small group of 3-4 community members.

Built on the tenets of empathy and volunteerism, Atmiyata equips communities to meet their own mental health and social care needs.

Atmiyata aims to assist people with common mental health conditions lead productive and healthy lives, breaking the vicious cycle of poverty and mental ill-health. It strives to create a shift in the mental health systems in low-middle-income contexts through its community-led approach.

As a mental health intervention, Atmiyata seeks to reduce the treatment and psychosocial care gap for both common and severe mental health conditions, improve access to benefits and quality of life, and reduce levels of disability.

The effectiveness of the Atmiyata intervention has been evaluated through a Stepped Wedge Cluster Randomised Controlled Trial (SW-CRCT) with a nested economic evaluation from 2017–19. The SW-CRCT results showed that:

1. Persons with common mental health conditions receiving the Atmiyata intervention are 3 times more likely to show reduction in symptoms of depression and anxiety, with a sustained effect.
2. The Atmiyata intervention is effective in reducing symptoms of depression and anxiety, improving quality of life and social participation.
3. Champions (trained community-volunteers) are skilled to identify persons with common mental health conditions with an accuracy of 58%, which improves over time.

To read the detailed results of the evaluation, please click here.

Our preliminary results show that Atmiyata is also an economically viable model with a return of $9.35 on every $1 invested, we will soon publish the results of the economic evaluation.

2013 – 2015: Atmiyata was piloted as a proof-of-concept study in 41 villages of Nashik district, Maharashtra, covering a rural adult population of 14,000.

2016 – 2019: Atmiyata was transitioned to scale across 530 villages in Mehsana district, Gujarat, covering a rural adult population of 0.8 million.

2019 – ongoing: In addition to Mehsana, Atmiyata is being implemented at scale across 1219 villages in Patan and Sabarkantha districts of Gujarat, covering a rural adult population of 1.7 million. The project is being implemented in collaboration with the Department of Health & Family Welfare, Government of Gujarat. We are also in the process on conducting a pilot study to address gender-based violence by building on the existing Atmiyata model, in Mehsana.

2021 – ongoing: We have partnered with Ambuja Cement Foundation to extend Atmiyata’s reach across 101 villages in Maharashtra, Chhattisgarh, Uttarakhand & Himachal Pradesh, covering a rural adult population of 0.1 million.

2022 – ongoing: We have entered into a partnership with Hasiru Dala, a social impact organisation working with waste pickers, to pilot the Atmiyata intervention in 8 blocks of Bangalore’s urban slums, covering an adult population of 22,800.

By June 2024, we aim to be present in 1890 villages across 7 districts and 5 states in India, with support from 2500 community volunteers (Atmiyata Champions), covering a total rural adult population of 2.6 million.

Impact in Mehsana, Gujarat

From 2018 to Aug 2023, Atmiyata has reached: 54,946 persons with common mental health conditions, 4,488 persons with severe mental health conditions, linked 11,998 end-users with to social benefits. The Atmiyata films aimed at creating awareness have been viewed by 86,883 individuals.

The Atmiyata intervention has also been adapted into an online course. The course aims to equip individuals with the skills to use evidence-based counselling techniques to identify, reach out, and support persons in distress. To know more about The Atmiyata Course, click here.

Future directions

Our strategic focus is to: 

• Implement the Atmiyata programme at scale, through replication and adaptation in new contexts
• Develop and evaluate innovations to better address community mental health and social care needs
• Collaborate and partner with community-based organisations to integrate Atmiyata within their existing programs/ portfolio

Co-leads

Kaustubh Joag, Centre for Mental Health Law & Policy, ILS, Pune

Jasmine Kalha, Centre for Mental Health Law & Policy, ILS, Pune

Funded by

Grand Challenges Canada

Mariwala Health Initiative

Azim Premji Foundation

Partners

Dept. of Health and Family Welfare, Govt. of Gujarat

Hasiru Dala, Bangalore

Ambuja Cement Foundation