Abstract
Young people experiencing mental ill-health are often excluded from peer networks, family events, education, marriage and employment. We evaluated a community-based, peer-led intervention guided by the Nae Disha (new pathways) program, targeting young people affected by mental ill-health in Uttarakhand, India. A total of 11 groups involving 142 young people (30 male, 112 female) and 8 peer facilitators participated, most of whom were enrolled in a community mental health program. The impact of the intervention on participation, mental health, and social strengths and difficulties was measured at baseline and endline using validated instruments. The proportion experiencing significant social isolation reduced from 20.6 to 5.9% (p < 0.001), and those classified in the ‘abnormal’ range of the social difficulties measure halved from 42.6 to 21.3% (p < 0.001). These findings clearly demonstrate that perceptions of social inclusion and mental health of young people affected by mental illness can be significantly strengthened through participation in this low-resource intervention.
Similar content being viewed by others
References
Atilola, O., Balhara, Y. P. S., Stevanovic, D., Avicenna, M., & Kandemir, H. (2013). Self-reported mental health problems among adolescents in developing countries: Results from an international pilot sample. Journal of Developmental and Behavioural Paediatrics, 34(2), 129–137.
Barry, M. M., Clarke, A. M., Jenkins, R., & Patel, V. (2013). A systematic review of effectiveness of mental health promotion interventions for young people in low and middle income countries. BMC Public Health, 13, 835. https://doi.org/10.1186/1471-2458-13-835.
Baumgartner, J. N., & Burns, J. K. (2014). Measuring social isolation—A key outcome in global mental health. International Journal of Epidemiology, 43(2), 354–364.
Census of India. (2011). Age structure and marital status. Retrieved 09/06/2019, from https://censusindia.gov.in/Census_And_You/age_structure_and_marital_status.aspx.
Cohen, A., Raja, S., Underhill, C., Yaro, B. P., Dokungu, A. Y., DeSilva, M., et al. (2012). Sitting with others: Mental health self-help groups in northern Ghana. International Journal of Mental Health Systems, 6(1), 1. https://doi.org/10.1186/1752-4458-6-1.
Das, J., Do, Q. T., Friedman, J., McKenzie, D., & Scott, K. (2007). Mental health and poverty in developing countries: Revisiting the relationship. Social Science and Medicine, 65(3), 467–480.
Das, J. K., Salam, R. A., Lassi, Z. S., Khan, M. N., Mahmood, W., Patel, V., et al. (2016). Interventions for adolescent mental health: An overview of systematic reviews. Journal of Adolescent Health, 59, S49–S60.
Duffy, R. M., & Kelly, B. D. (2019). India’s Mental Healthcare Act 2017: Content, context, controversy. International Journal of Law and Psychiatry, 62, 169–178.
Emmanuel Hospital Association. (2016), Nae Disha II—A manual to build youth mental health and resilience. New Delhi: Emmanuel Hospital Association. Retrieved 09/06/2019, from https://projectburans.wixsite.com/burans/manuals.
Fernandes, A. C., Hayes, R. D., & Patel, V. (2013). Abuse and other correlates of common mental disorders in youth: A cross-sectional study in Goa, India. Social Psychiatry and Psychiatric Epidemiology, 48(4), 515–523.
Goldberg, D. P., Gater, R., Sartorious, N., Ustun, T. B., Piccinelli, M., Gureje, O., et al. (1997). The validity of two versions of the GHQ in the WHO study of mental illness in general health care. Psychological Medicine, 27, 191–197.
Goodman, R. (2001). Psychometric properties of the Strengths and Difficulties Questionnaire. Journal of American Academy of Child and Adolescent Psychiatry, 40(11), 1337–1345.
Jaisoorya, T. S., Geetha, D., Beena, K. V., Beena, M., Ellangovan, K., & Thennarasu, K. (2017). Prevalence and correlates of psychological distress in adolescent students from India. East Asian Archives of Psychiatry, 27(2), 56–62.
Jha, K. K., Singh, S. K., Nirala, S. K., Kumat, C., Kumar, P., & Aggrawal, N. (2017). Prevalence of depression among school-going adolescents in an urban area of Bihar, India. Indian Journal of Psychological Medicine, 39(3), 287–292.
Joshi, R., Alim, M., Maulik, P. K., & Norton, R. (2017). A contemporary picture of the burden of death and disability in Indian adolescents: Data from the Global Burden of Disease Studies. International Journal of Epidemiology, 46(6), 2036–2043.
Kumar, V., & Talwar, R. (2014). Determinants of psychological stress and suicidal behaviour in Indian adolescents: A literature review. Journal of the Indian Association for Child and Adolescent Mental Health, 10(1), 47–68.
Leventhal, K. S., DeMaria, L. M., Gillham, J. E., Andre, G., Peadbody, J., & Leventhal, S. M. (2016). A psychosocial resilience curriculum provides the ‘missing piece’ to boost adolescent physical health: A randomised controlled trial of Girls First India. Social Science and Medicine, 161, 37–46.
Malhotra, S., & Patra, B. N. (2014). Prevalence of child and adolescent psychiatric disorders in India: A systematic review and meta-analysis. Child and Adolescent Psychiatry and Mental Health. https://doi.org/10.1186/1753-2000-8-22.
Mathias, K., Kermode, M., San Sebastian, M., Davar, B., & Goicolea, I. (2018a). Asymmetrical burden—Experiences of male and female caregivers of people with mental disorders in rural North India. Transcultural Psychiatry. https://doi.org/10.1177/1363461518792728.
Mathias, K., Pandey, A., Armstrong, G., Diksha, P., & Kermode, M. (2018b). Outcomes of a brief mental health and resilience pilot intervention for young women in an urban slum in Dehradun, North India: A quasi-experimental study. International Journal of Mental Health Systems, 12, 47. https://doi.org/10.1186/s13033-018-0226-y.
Mathias, K., Singh, P., Butcher, N., Grills, N., Srinivasan, V., & Kermode, M. (2019). Promoting social inclusion for young people affected by psychosocial disability in India—A realist evaluation of a pilot intervention. Global Public Health. https://doi.org/10.1080/17441692.2019.1616798.
Ministry of Health and Family Welfare, MHFW, Government of India. (2014, October). New Pathways New Hope: National Mental Health Policy of India. Retrieved 09/06/2019, from https://www.nhp.gov.in/sites/default/files/pdf/national%20mental%20health%20policy%20of%20india%202014.pdf.
Murthy, R. S. (2017). National Mental Health Survey of India 2015–2016: Prevalence, patterns and outcomes. Indian Journal of Psychiatry, 59(1), 21–26.
Nakimuli-Mpungu, E., Wamala, K., Okello, J., Alderman, S., Odokonyero, R., Musisi, S., et al. (2014). Outcomes, feasibility and acceptability of a group support psycho-therapeutic intervention for depressed HIV affected Ugandan adults: A pilot study. Journal of Affective Disorders, 166, 144–150.
Nath, Y., Paris, J., Thombs, B., & Kirmayer, L. (2011). Prevalence and social determinants of suicidal behaviours among college youth in India. International Journal of Social Psychiatry, 58(4), 393–399.
NHM (National Health Mission), MHFW, Government of India. (2014). Rashtriya Kishor Swasthya Karyakram. Retrieved 09/06/2019, from https://vikaspedia.in/health/nrhm/national-health-programmes-1/rashtriya-bal-swasthya-karyakram-rbsk.
Patel, V., Pereira, J., & Mann, A. H. (1998). Somatic and psychological models of common mental disorder in primary care in India. Psychological Medicine, 28(1), 135–143.
Patton, G. C., Coffey, C., Romaniuk, H., Mackinnon, A., Carlin, J. B., Degenhardt, L., et al. (2010). The prognosis of common mental disorders in adolescents: A 14-year prospective cohort study. The Lancet, 383(9926), 1404–1411.
Pillai, A., Andrews, T., & Patel, V. (2009). Violence, psychological stress and the risk of suicidal behaviour in young people. International Journal of Epidemiology, 38(2), 459–469.
Russell, P. S., Mammen, P., Nair, M. K. C., Russell, S., & Shankar, S. R. (2012). Priority mental health disorders of children and adolescents in primary-care and adolescent mental health policy, program and service model. Indian Journal of Paediatrics, 79(Suppl 1), S19–S26.
Smith Fawzi, M. C., Eustache, E., Oswald, C., Louis, E., Surkan, P. J., Scanlan, F., et al. (2012). Psychosocial support intervention for HIV affected families in Haiti: Implications for programs and policies for orphans and vulnerable children. Social Science and Medicine, 74(10), 1494–1503.
Stevelink, S., Terwee, C. B., Banstola, N., & Van Brakel, W. H. (2013). Testing the psychometric properties of the Participation Scale in Eastern Nepal. Quality of Life Research, 22(1), 137–144.
van Brakel, W. H., Anderson, A. M., Mutatkar, R. K., Bakirtzief, Z., Nicholls, P. G., Raju, M. S., et al. (2006). The Participation Scale: Measuring a key concept in public health. Disability and Rehabilitation, 28(4), 193–203.
Ware, N. C., Hopper, K., Tugenberg, T., Dickey, B., & Fisher, D. (2007). Connectedness and citizenship: Redefining social integration. Psychiatric Services, 58(4), 469–474.
Acknowledgements
This project was funded through a Grant from the Hallmark Disability Research Initiative at the University of Melbourne. We acknowledge the substantial contribution made by the Project Burans Team (including Jeet Bahadur, Pooja Pillai, Samson Rana); Emmanuel Hospital Association; Community Health Global Network (Uttarakhand Cluster); participating organizations (AKS-HOPE and OPEN); the Project Advisory Group; the peer facilitators and all group participants.
Author information
Authors and Affiliations
Corresponding author
Ethics declarations
Conflict of interest
The authors declare that there is no conflict of interest.
Additional information
Publisher's Note
Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.
Rights and permissions
About this article
Cite this article
Kermode, M., Grills, N., Singh, P. et al. Improving Social Inclusion for Young People Affected by Mental Illness in Uttarakhand, India. Community Ment Health J 57, 136–143 (2021). https://doi.org/10.1007/s10597-020-00623-6
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10597-020-00623-6