How stigma prevents people with mental illness from seeking professional help

Field workers describe ground realities 

Mongsentong Longkumer 
Dimapur | August 28

Ground realities pertaining to existing challenges in the mental health scenario in Nagaland State necessitate better understanding of the gaps and opportunities that can be filled by concerned authorities.   

The lens of field workers, who are at times the last-step process towards providing knowledge and creating awareness at the grassroots, thus, are crucial.

In particular, a project titled Community Mental Health Programme (CMHP), aimed at identifying mental health disorders among the general populace through physical home visitation, is illustrative. 

The on-going project, being implemented by Prodigals’ Home, a Dimapur-based Non-Governmental Organisation (NGO), covers the district of Chümoukedima, including its wards and localities.  

In a conversation with The Morung Express the organisation’s office located at 7th Mile, Chümoukedima, the field workers share their experiences.

Purpose of CMHP
The CMHP is focused on intervention in four major disorders - common mental disorder/illness (anxiety, depression etc), severe mental disorder/illness (schizophrenia, bi-polar, etc), intellectual disability and convulsive epilepsy. 

After enrollment/registration of persons into the programme, the patients are provided with free services including screening/diagnosis by a professional psychiatrist and clinical psychologist, psycho-education and counselling with their caregivers. The project has been supported by Azim Premji Foundation with technical support from Ashadeep Society, Guwahati. 

“It is for the people with less accessibility to care and medication for their mental health problems,” K Sani, the field coordinator of the team said.  

Over the span of 2 years, the project has covered over 52 wards and villages in Chümoukedima, including 100% door-to-door visitation in 27 villages and wards.

 During the process, they have identified over 661 individuals suffering from severe and common mental disorders, epilepsy, intellectual disability and persons with disability (PwD) and 341 have been enrolled into the project.

Several patients were also identified from districts such as Dimapur, Kohima and Mokokchung but the exact numbers were not known at present. 

During their visitations, it was found that severe mental disorders were the most common problems faced by the general populace. 

“Most of the patients are between the age-groups of 20-40 years,” team-member Sentimenla mentioned. 

COVID-19, scepticism & barriers 
Describing the early experiences during the pandemic, another team member Kedingunuo Sechu said that there was a great deal of scepticism at the initial stages of the project.

With COVID-19 pandemic setting in early 2020, their works initially began over the phone and later field work began from October, 2020 after the movement of people became less restrictive. 

She also noted that due to the pandemic, several people were not able to go to the hospitals for treatment, usually to Tezpur or at NEGRIMS, Shillong. 

“So as we came to visit them, they were grateful for the help provided.” 

At times, the team members were met with doubt and mistrust in some villages owing to lack of clarity and understanding on the part of the authorities and the people. 

 “Mistrust comes from the fact that we represent an NGO, maybe they fear that there is some ill-intention behind our visits. There were some villages who don’t even entertain visits by NGOs at all, regardless of the intention,” Sechu noted, attributing it to “their past experiences.” 

Sani also suggested that non-Naga communities were more receptive towards the services being provided and were more open to seeking professional help.

“Naga households had more scepticism towards what we were trying to provide to them...some exceptions do apply though,” he added.

Sentimenla also shared that one of the challenges they faced was “identifying mental disorders in the early stages as people usually don’t show signs until it becomes severe.” 

The team also observed that people who continued to take medication regularly improved tremendously and even continue to lead normal lives.

So far, the success rate is around 80% as per the team’s estimate. 

Rural and urban divide 
Most of the team members postulated the existence of class-divide between the well-off and the less-fortunate when it came to perceptions on mental health. 

“It was harder to interact with people in the urban areas,” Sani noted, adding that those in rural areas were more receptive as most people do not have the “option to seek for medical treatment.”

However, it was observed that schizophrenia and common mental disorders such as anxiety were more prevalent in the urban areas. 

 “For People residing in rural areas, transportation problems hinder their ability to get treatment on time, particularly for follow-up treatment,” remarked Nitoka H Aye, another team member. 

It was further informed that village councils do not take interest in such schemes because they do not see any monetary benefit from it. 

“What is in it for me? That is what they’re thinking. Although some have been very receptive to our initiative,” Sani mentioned.   

Existing stigma
Among the prevailing challenges was the also denial of the existence of patients in several villages, although the members had received inputs from ASHA and Anganwadi workers.

Besides, the concept of sin, prevalent in a Christian-dominated society, further complicated the scenario along with the notion of ‘generational curse or misfortune.’ 

“It is still very hard to penetrate into some of the areas as patients do not want to open up or share their problems due to the stigma associated with the illness,” Sentimenla said. 

“A common challenge we faced was in convincing people to come for follow up treatment. They fear the backlash or ridicule from neighbours or relatives,” another team member Tiarenla Walling, chipped in. 

Sechu also informed that village chairpersons were even reluctant to reveal that even some of their own family members were suffering from mental disorders and being ‘treated’ inside their house.

“At one church, the sister of a pastor was suffering from some mental disorder but not once did he mention to us about her, although an awareness programme was conducted at their church,” she added. 

Psycho education 
Meanwhile, Walling explained that all the members are trained in psycho-education, related to the know-how of giving awareness to the patients about the importance of taking medicine for their conditions. 

It included cases such as schizophrenia, where the care-giver is educated on what the illness, causes and management, along with suicide prevention.

 “So it is a whole form of education from all angles,” she added. 

Most individuals who are not properly made aware about psycho education do not get the correct information from their doctors because they do not know how to identify their own problems, the members maintained. 

“Since we are funded through a project with a limited time-frame, the funds will one-day dry up, and if that happens, then where will the patients go next?” Sani wondered. 

If they don’t get their medicines on time, it is back to square one. So their aim is to hand over this project over to the government in due course of time. 

“Yes, there is a DMHP but if the governments workers just simply sit inside their office without taking any proactive measures then it would be of no use,” he said. 

This is the first of a three-part series