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Unshackling the mind

Started in Goa in 1996, Sangath has become one of the most influential health NGOs garnering local, national and international recognition.

Published on December 19, 2020 at 2:37 pm

Updated on March 20, 2021 at 06:48 am

Sangath team members.
By Pinaki R. Mitra
Started in Goa in 1996, Sangath has become one of the most influential health NGOs garnering local, national and international recognition.

Sangath is a not-for-profit organisation committed to improving health across the life span by empowering existing community resources. It took its first steps as a small NGO in Goa in 1996, with the limited ambition of providing a child guidance service. The areas of health Sangath chose to focus on were not-so-fashionable in the mid-1990s. Many people had asked Sangath’s founders whether child development and mental health could be considered as socially relevant causes for an Indian NGO. In those initial years, several people had suggested that Sangath should shift its focus to more critical health problems that were plaguing India’s population. But within Sangath, people not only showed patience and tenacity of purpose but also recognised the value of science in demonstrating why Sangath’s chosen domains were critical issues that needed to be addressed.


Sangath school health promotion programme.

The core problem
A report by the World Health Organisation (WHO) states that 7.5% of the Indian population suffers from some form of mental disorder. Mental illnesses constitute one-sixth of all health-related disorders and India accounted for nearly 15% of the global mental, neurological and substance abuse disorder burden. The treatment gap, which is defined as the prevalence of mental illnesses and the proportion of patients that get treatment, is over 70% in India. WHO also predicts that by 2020, roughly 20% of India will suffer from mental illnesses. As per ‘Global Burden of Disease’ report, mental disorders account for 13% of total DALYs (Disability Adjusted Life Years), with Depression being the leading cause (Source: National Mental Health Survey of India, 2015-16). Moreover, persons with mental disorders are also known to be associated with a wide range of societal problems, if their illness is unrecognised or is inappropriately managed.
An even more troubling fact is that there is an extreme shortage of mental health workers like psychologists, psychiatrists and trained nurses in India. For example, there are only 3 psychiatrists per million people in India, while the corresponding figures for the USA and China are 105 and 22 psychiatrists, respectively. Moreover, a huge majority of the mental health professionals are located in urban areas. Hence, the shortage of trained mental health specialists in rural India is more severe.

Counsellor team-building exercise in progress.
Task-sharing approach
In resource-poor settings or low-income countries, the task-sharing or task-shifting strategy has often been proven to be beneficial, especially in the management of some chronic conditions like AIDS. In a task-sharing strategy, usually the community or lay health workers provide ‘front-line care’ (with oversight from primary healthcare practitioners and specialists), instead of physicians and trained nurses. This strategy appears particularly attractive in low-income countries, where the number of physicians and trained nurses are simply inadequate. Sangath was one of the first institutions in the developing world to train and utilise the services of laypeople to deliver research evidence-based psychosocial interventions for mental health problems. The institution’s primary goal has always been to continuously innovate solutions to improve access to interventions or treatments so that the treatment gap for mental disorders is significantly reduced.
Today, Sangath’s task-sharing model of care has won plaudits around the world, and this model has also been applied in other developing countries. Some of the main features of Sangath’s model are:
• Designing interventions based on global evidence of effectiveness and local evidence of cultural acceptability
• Involving diverse stakeholders, in particular people affected by the target mental health problems, in shaping the content and delivery of the treatments.
• Recruiting and training available human resources from the local communities to deliver mental health interventions. They can be lay counsellors or ASHA workers, but can also be teachers or parents, in the case of childhood disorders.
• Embedding the interventions in established healthcare platforms, most commonly those run by the government and the private sector, to ensure scalability.
• Disseminating the findings in a variety of ways, ranging from scientific papers to audio-visuals and social media.
• Simplifying the messages to convey mental health issues, and trying to replace psychiatric labels which may cause shame or misunderstanding.
Programmes at a glance
Children at a school-based intervention programme.

Sangath’s work spans across various domains in mental health and well-being, for example, designing interventions for children with neuro-developmental disabilities, sensitising school managements and teachers on various aspects of child development and learning, promoting the mental health of adolescents and young people, designing treatments for alcohol addictions, innovating effective psychosocial treatments for depression in adults, designing strategies to prevent depression in late life, promoting the mental health of people living with HIV, and spreading mental health awareness through youth-friendly activities like street plays, “Mann Melas” (mind fairs), and through Sangath’s “It’s OK to Talk” online campaign.
Some of Sangath’s significant achievements include the development of HAP and CAP. HAP (Healthy Activity Programme) is an extremely useful counselling treatment for helping people overcome moderate to severe Depression. CAP (Counselling for Alcohol Problems) is a psychological treatment for harmful and dependent drinking, based upon successful methods used in the West and the experiences of working with patients in India.
An integral part of much of Sangath’s work is the use of information and communication technologies, examples of which can be seen in interventions like (i) assessment of children for ASD (Autism spectrum disorder) through portable eye-tracking technology, (ii) a self-help app designed like a game, which is part of an intervention for school-going adolescents, or (iii) using telepsychiatry for patients identified with mental health problems in government primary health care centres.
Sangath’s training programmes like Leadership in Mental Health (LMH) course are designed to develop leadership capacity in the context of the emerging global mental health movement. Today, LMH is widely viewed as one of the most important short programmes in the world in the mental health domain, especially from the public health perspective.

A child playing with Sangath mobile app.
Partnerships and collaborations
Almost all of Sangath’s projects are collaborative in nature and in partnership with reputed national and international organisations and stakeholders. Sangath’s past and current partner institutions include Harvard University, London School of Hygiene and Tropical Medicine, King’s College London, MacArthur Foundation, Grand Challenges Canada, Wellcome Trust, All India Institute of Medical Sciences (AIIMS), Public Health Foundation of India, Governments of Goa, Delhi and Madhya Pradesh, National Institute of Mental Health (USA), and World Health Organisation (WHO). Sangath is also a member of the ”Movement for Global Mental Health”, a virtual network of individuals and organisations.
The journey continues
Sangath’s work in the mental health domain has been recognised by several governmental and other institutions. Sangath was awarded the MacArthur Foundation’s International Prize for Creative and Effective Institutions in 2008. Sangath also received the WHO Public Health Champion award in 2016, for its contribution to public health in India. Sangath’s co-founder and Harvard Medical School Professor Dr Vikram Patel has received numerous accolades in recognition of his groundbreaking work in mental health. In April 2015, he was listed as one of the world’s 100 most influential people by TIME magazine.
Today, Sangath is widely viewed as one of the most influential organisations in the global mental health sector. And yet, Sangath’s vision to make high-quality mental health care accessible and affordable for all remains unfulfilled. Till Sangath achieves its core mission of eliminating the mental health treatment gap, this journey based upon the strengths of community resources and innovation is unlikely to pause.

 

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