It took Ratna Chibber and her family more than a decade to comprehend what was happening to her younger brother Sushil. An engineering graduate, Sushil was finding it difficult to land a job. He would be rejected at every interview and his family did not know why. The symptoms went unnoticed for long until his unusual behaviour became hard to ignore. At times he would be a recluse and remain confined to his room. At other times, his random mumblings and sudden bursts of laughter would become a social embarrassment.

Chennai-based psychiatrist Dr Sarada Menon was the first to openly discuss Sushil's schizophrenia with Chibber. From there, Chibber's life changed.

In the 1990s, Chibber founded Aasha in Chennai. Aasha is a non-profit residential organisation run by caregivers of people with mental illnesses. Chibber wanted to change the way society regarded mentally-ill persons, including her brother. From making incense sticks and chocolates, Aasha, in 2001, opened a department store named Aatma Nirbhar, which is run by its residents. “Most of them were highly educated. With Aatma Nirbhar, for the first time in their lives, they began to see themselves as people who could contribute to society,” says Chibber. “They have regained their self-esteem.”

Chibber also runs a pigment-manufacturing company that employs and trains mentally-ill persons; many of them move on to mainstream jobs and are doing well. “Most people talk about awareness and bringing about a change, but they are clueless as to how,” says Chibber.

While it was her brother's condition that pushed Chibber, it was the lack of a residential mental health care institution in Maharashtra that urged Rony George to set up the Chaitanya Mental Health Care Centre in Pune in 1999. “I had finished my MSW in psychiatric care and was upset with the lack of such a facility. People had to travel to Bengaluru to avail help,” says George.

Chaitanya, where George and his team practice the concept of 'half-a-home', has six centres in Pune, Gurgaon, Goa and Kerala. “These residential centres are just like home,” explains George. The residents are encouraged to practice a 'democratic' way of life and go for a majority vote, be it the menu or a movie-outing.

Due to prolonged treatment and confinement, mentally-ill persons tend to lose out on their social skills, says George. Organising a mental health week and cultural talent fest where patients from various mental health care institutions participate are steps towards boosting their social skills.

Rehabilitation and research in disorders of the mind, especially schizophrenia, is the focus of the Schizophrenia Research Foundation (SCARF), a non-governmental organisation founded by Menon in Chennai in 1984. A Collaborating Centre of the World Health Organization for Mental Health Research and Training, SCARF also has community outreach programmes in urban slums and villages besides awareness programmes.

Psychiatric care is hard to come by in rural areas. To address this and ensure that more people have access to treatment, SCARF has initiated a tele-psychiatry programme in the villages of Pudukkottai district of Tamil Nadu, says Dr R. Mangala, consultant psychiatrist at SCARF. SCARF also works with the government for programmes and better health care facilities for the mentally ill, she says..

Dr Samir Parikh, director, mental health and behavioural sciences, Fortis Healthcare, Delhi, says even though there is better awareness about mental illness in the urban areas, the stigma continues to haunt patients. He narrates the instance of a young woman who had been suffering from mild depression and anxiety. When she told her prospective husband about her treatment, he called off the marriage. “I personally explained to the groom that the case was mild and medicines would be stopped in the next two-three weeks, but he refused to listen.”

Substance abuse is also a mental illness, says Pavan Kumar R., senior psychiatric social worker with the CADABAMS Rehabilitation Centre in Bengaluru. There exists a synergic relation between substance abuse and mental health; this cannot be denied, he says. And that is why CADABAMS focuses on dual diagnosis—the psychiatric complications of addiction.

There are persons with personality disorders (like compulsive disorder and excessive suspicion) who are able to function normally in society. Frustration, however, leads them to addiction. Addiction can trigger substance-induced psychosis. These are the kind of people CADABAMS tries to rehabilitate, says Kumar.

Besides attempting to bring about lifestyle changes in its residents, the team also focuses on creative therapy that uses art, drama and poetry.

Challenges

All organisations are unanimous about the biggest challenge they face: stigma. “There is lack of proper awareness. People still end up depending on black magic and planetary positions to treat mental illness,” says Mangala.

Caregivers' expectations are another major challenge. “Families come in with the hope that mental health illness is completely reversible," says Kumar. The truth, however, is that the possibility of relapse always exists. When families bring a person to these centres, they expect 100 per cent guarantee that the problem will be resolved.

“The moment they step out of a psychiatric care centre, they see it as a chance to stop medication,” says Mangala. The objective is to continue medication, she says, follow up and, at the same time, integrate themselves into mainstream life.