Case Study Highlights: The Banyan

When considering non-communicable diseases, what first comes to mind? Most likely, issues of heart disease and diabetes will spring up. But what about the often neglected but incredibly pervasive problem of mental illness?

According to the WHO’s 2011 Mental Health Atlas, neuropsychiatric disorders contribute to 13 percent of the global disease burden. Only 54 percent of 184 countries have community residential facilities, or group homes. Additionally, 23 percent of nations surveyed did not have a dedicated separate section for mental health policy outside of their general health policy.

This lack of government attention has created a need for innovation within the field of mental health care, which we at The Banyan aim to fill. For the past 19 years, The Banyan has been providing medical care, social interventions, vocational training and comprehensive mental health services to homeless women with mental health issues in Chennai, India. We are not the only organization to offer institutional care for those with a mental health problems, nor the only one to deal with the homeless, nor the only one to use medicines, but we are probably the only organization that combines all of these aspects, and many other social interventions too, within our work.

The Banyan strives to assist homeless women and reduce the stigma surrounding mental health problems that leads patients to avoid care. Our awareness and sensitization programs are geared towards building knowledge across local communities. Our Health Centre first started to offer psychiatric care around 5 years ago and only a handful of people attended the clinics. Now we have on average over 200 client visits every month, with more than 2000 registered clients. The local community has accepted that we are a place that you can turn to for help and have come to us.

Increased patient load often means increased cost. The Banyan works hard to keep costs low. We are funded on a donation basis and provide all care completely free. This means constantly looking at cost controls to bring down the costs per client. Keeping costs low serves not only the current institution, but also our desire to replicate.

We are conscious that if we want the public sector to take on more responsibility then we will need to build our models in ways that they can be sustained. For example, at a local Primary Health Centre (the first level of intervention in the public sector), there is a shortage of specialists, especially psychiatrists and psychiatric social workers. Our model therefore has to take this into account and we are working on how we can use non-specialists to deliver care, which would be sustainable in the public sector.

The key strategic aim of the whole program is to replicate. We have been successful with a number of organizations across India - in helping others to add mental health services to their existing work, in particular, Ashadeep in Assam, the Karuna Trust in Mysore and Missionaries of Charity in Kolkata and Ennore. All have adopted and adapted our approach, with our capacity building support, and are now successfully operating in their own areas.

We hope that through replication and further advocacy, more attention will be brought to issues of mental health. Through these actions, The Banyan can work to overcome the looming challenges of stigmatization and lack of awareness and provide much needed care to the neglected populations of those with mental health issues, not just in our local city of Chennai, but across all of India.

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