Atmiyata is an innovative, evidence-based, high impact, community-led model to reduce the mental health and social care gap in rural communities.
Mental health conditions are a substantial public health burden in India, affecting close to 150 million people. The latest data from 2016 shows that depressive and anxiety disorders, collectively referred to as ‘common mental disorders’, contribute 33.8% and 19% respectively to ‘disability adjusted life years’ lost to illness, leading to increased mortality and increased socioeconomic cost, especially for marginalized groups. Further, data shows 85% of Indians with mental health conditions receive no treatment for their condition. This gap in mental health care is a complex phenomenon associated with factors of both demand (stigma, discrimination) and supply (lack of mental health care professionals).
While models for mental health care involving lay-health worker have proven to be effective in controlled trials, there is limited evidence on the effectiveness and scalability of these models in rural communities in low- and middle-income countries. Atmiyata aims to bridge the mental health care gap by using a psychosocial model delivered through community volunteers to identify and support persons with distress.
How are we addressing the issue?
Atmiyata involves two-tiers of community volunteers for identification and support to people in distress and with symptoms of common mental conditions. The first tier consists of community volunteers called Atmiyata Mitras who are from different caste and religion-based sections of the village, trained to identify persons in mental distress.
The second tier consists of Atmiyata Champions, who are important community members (e.g. former teachers, community leaders) with leadership and communication skills and are well-known and approachable in their village. Champions are trained to identify and provide structured counseling to persons with significant mental distress, including the ones referred by Mitras.
Given the social barriers based on caste, gender and religion, the identification and support by Champions and Mitras ensure equitable reach and improves coverage of the intervention across the entire village.
The Champions are trained: (i) to identify persons with CMD and provide evidence-based 4–6 mental health support sessions; (ii) to raise community awareness on social issues by ‘narrow-casting’ four films; 10-min films dubbed in Gujarati on commonly experienced social issues in the community such as unemployment, family conflict, domestic violence, and alcohol-use. Films are developed to build community mental health awareness and were not designed for training purposes or for intervention delivery related to counselling or symptom reduction. The films are shown to community members in the village where the Champions reside, typically in small groups of 3 to 4 people and at a public space in the village, such as a temple or a farm or the Champion’s house; Champions also (iii) make referrals of persons with severe mental disorders to mental health services offered within the public health system when required, and (iv) enable access to social benefits for persons with mental health problems, such as government schemes for paid work opportunities.
What is the potential impact?
Atmiyata is an acceptable, feasible intervention that enables the community to address their own mental health and social care needs. It is a large rural community-led intervention that systematically evaluated its impact in real life settings, at scale. The results will be available under the publications as soon as it is published.
During Covid-19, Atmiyata’s training sessions were adapted and offered to volunteers of various organizations working on peer support, livelihood and public health organisations to increase psychosocial support across communities.
Atmiyata is featured in WHO’s list of 30 best practices for community-led interventions (under review). It was nominated for the SKOCH Award 2019.
Atmiyata aims to scale-up the intervention across geographies and location to maximize the mental health and social care impact in rural communities.
Where have we reached?
From piloting the intervention across 40 villages in a district in Nasik, the intervention was scaled up to cover an entire rural district in Mehsana, Gujarat. As of March 2020, the intervention had reached out to 525 villages, covering 0.8 million adult population. The intervention continues to expand its reach and coverage, especially to reach out to marginalised and vulnerable communities.
As of March 2020, the community volunteers have reached out to 16580 people with common mental health conditions by providing 4-6 mental health support sessions. In addition, 2541 people with severe mental health conditions have been linked to public mental health services, 1491 families were linked to social benefits and welfare schemes, and 62042 people viewed Atmiyata’s films.
In 2019, the intervention expanded its reach by collaborating with a partner to cover 71 villages, covering one lakh adult population in Ahmednagar district, Maharashtra.