Sarbani Das Roy, through her organization, Iswar Sankalpa (God’s Resolution), is creating new roles for everyone in society, from school children, college youth, street vendors, police officials, to address India’s mental health by becoming active care givers.
The New Idea
Traditionally, it is believed that only mental healthcare professionals have a role to play in addressing the issue of mental illness. Sarbani believes that all one needs to be a caregiver to a homeless and destitute person with mental illness is empathy and basic humanity. By building relationships between people with mental illness and people in society, creating safe spaces and relationships for them to interact in, Sarbani is abolishing the stigma around mental illness, that has been the biggest roadblock in solving India’s mental health crisis.
She believes that everyone is naturally empathetic, so she finds those everyday citizens who are already showing empathy towards the homeless living with mental illness, by giving them food, water, or just saying kind words to them, celebrates them. She supports them to continue providing improved care by connecting them to psychiatrists who diagnose the mentally ill and prescribe medication that the citizen caregiver can give to the patient regularly. She also connects them to shelters, employment agencies and other services, so the caregiver can use these existing infrastructure to reintegrate the person with mental illness back into society, as they improve with the medication and are able to live a functional life. The joy and satisfaction one gets from able to support someone to recover and lead a full and functional life is what motivates them to continue to help more and more mentally ill homeless. She uses existing citizen caregivers to share their experience with others like them and recruit and convert others to do the same.
While the state wide government health programs and municipal governments are adopting and implementing Sarbani’s mode, Sarbani is not focusing on scaling her model, rather she is scaling her idea that everyone, irrespective of age, profession and resources, can play a part in solving India’s mental health crisis, only with their inherent empathy and humanity. She has positioned herself in mental health organization networks and conferences across Asia and using these platforms to influence the larger sector to see that anyone can play a role in addressing the issue of mental illness.
At least 60 million Indians suffer from mental disorders and only one in 10 people with mental illness have access to treatment. Even treatment for these 10% means only institutionalization. According to Krithi Sharma, researcher with Human Rights Watch, ‘Families feel forced to commit their relatives to institutions because there are so few alternatives in Indian communities.’ Because of the stigma associated with mental illness, India’s systems are designed to isolate people with mental illness in institutions so that everyday citizens never have to see or interact with them. For example, legally,
people with a mental disorder can be easily put into institutions by their relatives, by the police, without their consent due to Indian laws that date back to the Victorian era that don’t give the mentally ill the right to make their own decisions.
Institutionalization perpetuates the stigma against mental illness, because people in society only see the dysfunctional and homeless mentally ill who cannot afford or access any treatment, and those that might be able to lead socially integrated lives with the treatment they are receiving are away from society’s eyes in institutions
However, affordable and accessible mental health care without institutionalization seems practically impossible, because according to WHO backed study by the National Commission on Macroeconomics and Health (NCMH), India has only 3800 psychiatrists, 900 clinical psychologists, 850 psychiatric social workers and 1500 psychiatric nurses in the whole country to cater to these 60 million people living with mental illness. To be anywhere close to providing care to everyone who needs it, India needs 66,200 more psychiatrists and 269,750 nurses. This human resource gap is impossible to fill with enough trained professionals because there aren’t enough universities to train mental health care professional. India spends .06% of its health budget on mental healthcare, compared to developed and developing nations spend above 4% of their budgets.
The professional human development gap is being filled by everyday citizens in almost every other sector in India, for example, citizen journalists reporting real ground stories because there aren’t enough journalists to cover the entire geography, youth taking up charge to teach children slightly younger than themselves, in schools and communities where teacher absenteeism is high. However, in the field of mental illness, everyday citizens have not taken on the role of care givers, where we lack professionals to do so, because of the stigma around the issue, and the assumption is that one needs to have expertise and professional mental health training to do so.
Sarbani believes that to be a care giver to a person with mental illness one only needs to be empathetic and humane.
Sarbani started by identifying the people in society who anyway interact, as a part of their jobs, with the most marginalized section of the of mentally ill population-- the homeless. For instance, the police who arrest them and put them in lock-ups, or the municipal cleaners or neighbourhood food vendors who encounter them begging for food. Reversing this relationship on its head, Sarbani has brought a paradigm shift in their roles from perpetrators to care providers, by converting the lock-ups to safe spaces where the mentally ill are given medication and care or by having the food vendors administer medication prescribed by psychiatrists, who have observed and diagnosed the patient.
When these unlikely allies see the patients recovering, cleaned up, being rehabilitated with jobs and leading integrated lives in society, the satisfaction that they get makes them continue to play the caregiver role for the mentally ill-. In addition to sustaining their current relationships, they seek out more mentally ill homeless to help them recover, and spread the message to others like them to do the same. For example, the police officials conduct sessions with school children on how they can identify and help homeless mentally ill, thus setting off a chain of people becoming problem solvers.
Sarbani has advocated for existing public infrastructure and systems to cater to the homeless mentally ill. The city municipality used to think mental health is a state or national health issue, but she convinced them that mental health was their issue, because homelessness is a local municipal issue. Every municipal ward has a medical officer, who only diagnoses and treats physical illness from the local community primary healthcare center (PHC). Sarbani has trained them and the nurses at the PHCs to do preliminary mental health diagnosis. This coupled with a psychiatrist visit once a week, then once every 2 weeks, who works with the more severe patients, and continuously upskills the medical officer and nurses, converts the existing PHC system to one that can cater to mental illness as well. By working with the community influencers in low-income communities, like the local municipal officers, teachers, SME business owners, Sarbani has converted them to allies, who bring people with mental illness to the PHC. By doing this, just in 1 year, the existing PHC system was able to identify and treat 2500 patients in the city of Kolkata.
These community changemakers have formed committees in their neighbourhoods, where they meet regularly and discuss issues that the people with mental illness are facing. Since, they are thought leaders in the community, they are able to help solve most of these problems. For eg.: if a family is abusing their relative with mental illness or not accepting them, the Municipal Counselor, the community health workers go and speaks to the family and convince them to accept and integrate their family member. Over time these committees have come up with and run various program on their own that Sarbani had no role in orchestrating, eg.: in one community they organized and ran a door-to-door sensitization drive about mental illness. This shows that the change leaders Sarbani has cultivated in everyday citizens in communities are spurred by satisfaction they are getting from seeing people with mental illness recover and become integrated with society.
Sarbani has so far built caregiving relationships between 2800 people living with mental illness and unlikely caregivers. She is scaling her model in rural areas through the National Rural Health Mission, and in urban slums through the Municipal Health Care system, who have both recognized the success of her work and partnered with her to adopt her model. She is also using national platforms, like policy advocacy groups, networks of mental health care organisations, closely working with all Ashoka Fellows in the space, to influence all the relevant thought leaders about the critical need for involving everyone in mental health care, and not just professionals.
Going forward, Sarbani is focusing her efforts on creating as many interaction points as possible for people with mental illness and common citizens, by having café, book stores and other human-interaction heavy businesses being run by people living with mental illness and putting together large scale cultural performances attended by pop culture influencers of the city. By doing this, Sarbani is bringing a massive cultural shift in society- normalizing the so far stigmatized mentally ill and making them a part of everyday life.
When Sarbani was very young, her mother was diagnosed with cancer. She was sent to live with her uncle, and only visited her mother during summer holidays. She wasn't with her mother when she passed away. Even as a 50 year old adult she is still haunted by the desire to see her mother once, or at least be with her during her last moments.
Drawn to study the human mind and behavior from her childhood experience, Sarbani studied the unique combination of Business and Psychology. In 1999, she started her own practice, where she merged these two disciplines in her own unique methodology to do business development for companies, and used the profits to give psychological counseling services to those who could not afford it, like adolescents in orphanages, girls at risk of early marriage in slum communities.
Although Sarbani had commonly observed the mentally ill homeless or roaming in her home city, Kolkata, she was surprised to see a mentally ill homeless man right outside Missionaries of the Charity, Mother Teresa’s care facility for the homeless, living in the garbage vat. She talked to the nuns at Missionaries of Charity asking why they hadn’t taken him in. They told her the man was “mad” and violent and they didn’t know how to take care of him. Observing him for longer, Sarbani realized that he had paranoid schizophrenia in a few days he would die of dehydration. She was kept awake at night by the thought that no one even knew where his family was, so even his dead body would be unclaimed. She thought of her life long loss of not being able to stay with her mother, and was plagued by what this man’s family members were going through because they were no facilities to treat him, or at this point, find him.
Fueled by her personal childhood loss, Sarbani started Iswar Sankalpa in 2007, so that mental illness didn’t cause loss of family, relationships and society in people. After struggling to build an affordable mental health care system for people from low income communities for 4 years, Sarbani realized that India would never be equipped with enough mental health professionals to meet the needs of the number of patients, and that if she is to tackle this critical problem, everyone in society has to play their part in becoming care givers to people living with mental illness.