Shantmanas

History

Shant Manas was begun in 2007 by Dr Cahn Vasudevan, a retired Consultant Psychiatrist and Psychotherapist from the UK. His was a simple idea of 'putting back' some of his skills and experience into a small rural community of the country of his origin and making mental health services accessible to a section of people who previously had no such service available to them. Shant Manas began as a small clinical project in 4 villages. Since its inception it has expanded its field of care to 14 villages, with a combined estimated population of about 80,000. It is staffed by three full-time mental health social workers (supported by supervision from 2 sessional psychiatrists) overseeing the psychiatric and social care of 220 service users, with around 50 of them in being in active treatment, as of in May 2015. As well as the treatment of psychiatric disorders, Shant Manas aims to provide education on mental health to the local population, reducing stigma and myths surrounding mental health. Due to its success the service continues to expand as demand and awareness of mental health increases. The main body of clinical and social work at Shant Manas is to do with all forms of mental illness and their consequences, but in a very limited sense with difficulties relating to alcohol addiction or learning difficulties.

Mental health beliefs in the locality

The Shant Manas catchment area covers a rural population, with many informal workers often living in poor economic conditions. As such there is little or no awareness regarding mental health and illness, there are no local services and access to free, urban government treatment is limited or not possible, with no consistent follow-up after treatment. Mental health compounds economic difficulty by keeping able people out of work, creating a negative impact on their families also (in a community in which most households have one wage earner). Many communities retain the idea that mental health is a product of ‘possession’ or have other mythological roots, and significant stigma is still attached to mental health issues. Because of these beliefs many sufferers (or their families) seek alternative forms of treatment and do not access conventional healthcare. The behaviour of those mentally ill often could trigger in others different emotions such as fear, anger, disgust, etc. which might then lead to a response of hostility or even aggression by neighbors or villagers who do not understand their condition. Such stigma also creates social limitations on a sufferer’s family and their place in the community, affecting deeper levels of rural society: for instance, a mental illness can force the entire family into the fringes of the community and affect the prospects of a sufferer’s relatives.

The Shant Manas Approach

Shant Manas is community based, relying on word-of-mouth and family referrals for service users to access care. Its approaches to care are:

1. The 'doorstep' approach – Staff visit the villages regularly to identify and approach new service users, as well as new cases being brought to light by word-of-mouth and family members.
2. An initial assessment, in the home, is done and rapport is built with the service user. Shant Manas involves the family and community at every stage of treatment and all assessments are done in the company of anybody who wishes to attend.
3. The new service user is referred to a psychiatric consultant, who advises on any diagnosis or medication queries.
4. The Shant Manas team formulates a personalized care plan for the service user, including treatment, talking therapy, rehabilitation and education for them and the family.
5. Medication for acute issues is given if required.
6. Follow-up visits are planned. For acutely ill service users this is once a day, reducing to at least once a week for the entire caseload. All follow-up visits are done in the service user’s home and in the presence of his/her family. Counseling is also given regarding how to cope with the diagnosis and the team ensures any queries the family have are answered. This includes sleep issues, medication, and how to recognize deterioration and relapse.
7. For those recovering, the team aids service users financially, by seeking employment and motivating families to do the same.
8. Shant Manas always maintains close links with the village panchayat leaders (governing body), school heads and local health workers for mutual support and easier identification of new service users.
9. Shant Manas runs mental health awareness programs in the villages, for the wider community. Through these awareness can be boosted regarding mental health and stigma sufferers may be enduring can be eased. These programs are also run in local schools with the same objectives but for the younger generation, with the aim of improving awareness in the years to come.

Villages served by Shantmanas

Shantmanas currently services the communities of: Thuvariman, Keelamathur, Melamathur, Kodimangalam, Melakkal, Katapulli Nagar, Depethar Santhai, Kachirairuppu, Keelamatayan, Thenkarai, Oothukuli, Narayanapuram, T. Pudur, Mullipallam, Achampathu, Sholavandan and Nagamalai.

Pablo’s Group

Initiated in 2014 by Dr Pablo Curras, a Canadian psychiatrist volunteering with Shant Manas, Pablo’s Group is a meeting for service users and their carers or families. It is focused on boosting the self-confidence and social skills of service users (who, due to their conditions, may have been ostracized or have little social contact). Although the session is a free structure its core themes are psycho-social education, friendship and communication, and games or activities during the group are aimed at building upon any or all of these. It also teaches relaxation and exercise regimes such as simple yoga routines. The group, held once every three weeks, has an attendance of around 10-15 people (both service users and their families), and has received positive feedback from those accessing it.

Student placements

Placement work is crucial for the Indian social work syllabus and Shant Manas is actively involved in healthcare education. It accepts a wide variety of local students and international volunteers. Social work and nursing students from local Universities in Madurai opt for placements with Shant Manas and a variety of healthcare professionals, including doctors, nurses and social workers from overseas have volunteered. The organization’s novel approach to home-based care offers a different insight into home-based care and students and volunteers alike are able to influence treatment and healthcare plans. The opportunity for students to improve their own skills is also available – students are encouraged to formulate their own assessments and give presentations on case studies. A quarterly mental health seminar for local students is also given at the Shant Manas site as an educational tool and synergist alongside the Indian social work syllabus.