This invited talk was delivered on the occasion of world mental health day. This session covered the power wheel, Maslow concept of needs, vulnerable community and their mental health status, and the session ended with a positive note of successful stories of community mental health care.

1. Dr. Rajeev Kumar
MSW (TISS, Mumbai), M.Phil., (CIP, Ranchi), Ph.D. (IIT Kharagpur)
E-mail: rajeev.iit.78@gmail.com
Delivering mental health services in an
unequal world

2. An unequal world
We live in a world, divided into multiple strata: caste creed
nationality, race, gender, political ideology and many more.
These strata are unequal in terms of resources, rights, and many
other privileges .
And this is the bone of all contentions.
There is struggle either to survive or to gain power
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3. Adapted from Sylvia Duckworth's wheel of
power
The root of an unequal world: Needs and
struggles
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4. Unequality of health in an unequal world
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5. Mental health and privilege status
Mental health is an inevitable component of over-all health and well-
being, and no component of health exist in isolation, and so as mental
health.
Regarding mental health care and treatment, there is a huge gap
between “haves and have not” (privileged and under privileged
communities).
I don’t mean to say, people of affluent classes don’t suffer from mental
health issues. They have their own needs, conflicts, and issues.
But in this session, our main focus on highlighting mental health issues
of underprivileged communities.
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6. Mental health in broader perspective
BPSS model (Sulmasy, 2002)
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7. Underprivileged communities and vulnerability to poor
mental health
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8. BPSS model and vulnerable communities
Vulnerable communities
and mental health issues
Responsible factors
Farmers suicide Economic system
Victims of terrorism
affected areas
Political unrest
Mental health of refuges International political
dispute
Mental health of hidden
population
Public policy
Victims of natural
disasters
Natural factors
Migration and mental
health
Economic system
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9. Farmers suicide: A neglected mental health
issue
Bomble & Lhungdim (2020)
conducted a study in farmers’
suicide prone area of Vidharbha
(Maharashtra) and found majority
of farmers were having symptoms
of mental distress, anxiety,
depression, somatic symptoms, and
insomnia.
The reasons for their mental
distress are low repay capability,
high debt, monsoon failure,
drought, lack of better price, and
exploitation by middlemen (Chetna,
2016)
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10. Farmers’ suicide in India
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11. Further on farmers suicide
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12. Relation between poverty and mental illness
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13. Political unrest and mental health
Ni et al. (2020) political unrest such as riot, insurgency, terrorism pose
reveres impact on mental health.
Especially females and people of lower socioeconomic status are
vulnerable to the poor mental health.
Comer et al. (2016) studied that youths who are exposed to terror
attacks and media content of terrorism often suffer from PTSD
symptoms.
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14. Kashmir terror scenario and mental health issues
(Dar & Deb, 2020)
The day to day situation in Kashmir :
curfew, strike, search operation,
crackdown are uncongenial to the
people of Kashmir.
A common people of Kashmir have
fear psychosis because of volatile
situation.
Especially women are raped and
widowed.
Many of them suffer constant
anxiety and depressive symptoms.
And available mental health
services are negligible.
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15. Mental health of Kashmiri women (Wani et al. 2016)
45% of people in Kashmir show symptoms of poor mental health.
A study conducted between widowed and half widowed women
(whose husbands are disappeared and not confirmed dead).
Because of uncertainty, half widowed women exhibit poorer mental
than clearly declared widowed women.
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16. Vulnerable youths of
Northeast states of India
(Kumar et al., 2017)
a sizeable number of youths in
northeast states (Manipur,
Mizoram, and Nagaland) whose
boundary shares with Myanmar
indulged in drug abuse and HIV
infection.
They show poor mental health
symptoms.
Because of cross-border human-
trafficking and drugs. Commercial
sex workers and drugs are easily
available and young people fall in
trap of drug abuse and unsafe sex
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17. Inside Maqboolpura - The Village Of Widows And Orphans
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18. Homeless population vulnerable to drug abuse
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19. Migration and mental
health
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20. Mass exodus of migrant workers during lockdown-1
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21. Migration and repercussion on health and mental health
 Most of HIV/AIDS infected people are
either migrant workers and long distance
truck drivers.
 Most of them are less educated. Because
of poor awareness, they indulge in
unsafe sex in their local sex network and
get infected (Kumar et al., 2017).
 Most of the HIV infected people
consume alcohol more often (Kumar et
al., 2020).
 Anxiety, depression, and suicidal
tendencies are the common symptoms
among people infected with HIV (Kumar
et al., 2021).
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22. From the studies we discussed, we can come up with a conclusion, how
the vulnerable communities fall in trap of high risk behavior which affect
their mental health, and form such vicious cycle.
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23. A ray of hope: Some success story of
community mental health programme in India
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24. Before we embark on community mental health, we need
to break these vicious cycles, which are our barriers.
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25. Dava-Dua Project in Gujrat
Dava-Dua project in Gujarat is an example
of a combination of “magical-religious
ailment” and “modern psychiatric
interventions” for the treatment of
mental illness.
The project provides psychiatric
treatment for those who are visiting a
Mira Datar Dargah of Unava (one of the
Taluka of Sabakantha District) for a cure,
making psychiatric services not only
accessible but also advocating fair
treatment of psychiatric patients by
sensitizing and training faith healers.
(Pandya et al., 2019)
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26. Mobile technology-based programs
Systematic Medical Appraisal, Referral and Treatment (SMART) mental health project in
Andhra Pradesh
The George Institute for Global
Health's SMART Mental Health
program—a digital mental
health application for screening,
management, referral and
treatment of depression, stress
and suicidal risk in rural patients
through primary health center in
Andhra Pradesh revealed
positive treatment outcomes
https://www.georgeinstitute.org.in/projects/smart-mental-health-cluster-randomized-controlled-trial
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27. NIMHANS ECHO model
• Tele-psychiatry and mobile
telepsychiatry for reaching out to
vulnerable communities for the early
detection and treatment of psychosis
is an effective approach to reduce
treatment gaps.
• Tele-mentoring based on NIMHANS
ECHO model for consultation, training,
and education is effective not only for
building the capacity of mental health
professionals but also conducting
regular review meetings with district
mental health programme staff.
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29. References
Bomble, P., & Lhungdim, H. (2020). Mental health status of Farmers in Maharashtra, India: A study from farmer suicide prone area of Vidarbha
region. Clinical epidemiology and global health, 8(3), 684-688.
Brenes, G. A., Danhauer, S. C., Lyles, M. F., Hogan, P. E., & Miller, M. E. (2015). Barriers to mental health treatment in rural older adults. The American
Journal of Geriatric Psychiatry, 23(11), 1172-1178.
Chethana, B. (2016). Determinants of Farmers’ Suicide in India-A State Level Analysis. Research Journal of Humanities and Social Sciences, 7(3), 193-
197.
Comer, J. S., Bry, L. J., Poznanski, B., & Golik, A. M. (2016). Children’s mental health in the context of terrorist attacks, ongoing threats, and possibilities
of future terrorism. Current psychiatry reports, 18(9), 1-8.
Dar, A. A., & Deb, S. (2020). The volatile situation in Kashmir and its impact on the mental health of common people. In Upholding Justice (pp. 152-
168). Routledge India.
Housen, T., Ara, S., Shah, A., Shah, S., Lenglet, A., & Pintaldi, G. (2019). Dua Ti Dawa Ti: understanding psychological distress in the ten districts of the
Kashmir Valley and community mental health service needs. Conflict and health, 13(1), 1-11.
Kumar, R., Suar, D., & Singh, S. K. (2017). Regional differences, socio-demographics, and hidden population of HIV/AIDS in India. AIDS Care, 29(2), 204–
208. https://doi.org/10.1080/09540121.2016.1211605
Kumar, R., Suar, D., & Singh, S.K. (2021). Biopsychosocial-spiritual model: Predictors of medication adherence, coping, and resilience in HIV/AIDS.
Journal of Health and Religion (first revision submitted). Springer Nature Publication.
Kumar, R., Suar, D., Singh, S. K., & Bhattacharya, S. D. (2020). Why do AIDS Sufferers on Antiretroviral Therapy Die Early?—Evidence from Jharkhand in
India. In Race, Ethnicity, Gender and Other Social Characteristics as Factors in Health and Health Care Disparities. Emerald Publishing Limited. pp. 199-
216. https://doi.org/10.1108/S0275-495920200000038015
Ni, M. Y., Kim, Y., McDowell, I., Wong, S., Qiu, H., Wong, I. O., ... & Leung, G. M. (2020). Mental health during and after protests, riots and revolutions:
a systematic review. Australian & New Zealand Journal of Psychiatry, 54(3), 232-243.
Pandya, A., Shah, K., Chauhan, A., & Saha, S. (2020). Innovative mental health initiatives in India: A scope for strengthening primary healthcare
services. Journal of family medicine and primary care, 9(2), 502
Wani, M. A., Mir, M. S., Sankar, R., Khan, Z. Z., & Rakshantha, P. (2016). Impact of prolonged deprivation on mental health of widows and half-widows
in Kashmir Valley. Mental Health: A Journey from illness to wellness, 211-220.
https://www.ruralhealthinfo.org/toolkits/mental-health/1/barriers
https://www.indiatimes.com/news/india/the-story-of-maqboolpura-the-village-of-widows-and-orphans-punjabdrugcrisis-256499.html
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