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proudly small / 45th st. gallen symposium / 7–8 may 2015
Ashwini Vanishree – Small is the new smart:
[F.O.C.U.S] formula to foster a forgotten cause
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SMALL IS THE NEW SMART:
[F.O.C.U.S] FORMULA TO FOSTER A FORGOTTEN CAUSE
Ashwini N. V is a top contributor of this year‘s St. Gallen Wings of Excellence Award. She studies at
Jain University, Bangalore, and attended the 45th St. Gallen Symposium as a Leader of Tomorrow.
Ashwini N. V (IN), PhD candidate in Psychology at Jain University
Ashwini Vanishree (IN) is a PhD candidate in psychology at Jain University, Bangalore. She is currently pursuing extensive research on the topic of women attempters of self-incineration, focusing
on the exploration of motives, the conceptualization of intrapersonal experiences and the effectiveness of self-empathy technique. Since 2012, she regularly publishes papers at confrences and
in renowned journals. Apart from her research, she serves as a co-ordinator of Kalarave, a psychological assessment and counselling centre at her university.
MIND CARE MATTERS
What would be the likely response of
scholars from various fields if they were
to be asked: ‘How do mental health
issues affect your domain?’ An economist
might cite with alarm a recent report
published by World Economic Forum and
Harvard School of Public Health which
estimates that mental illness along with
non-communicable diseases will cost
India $4.18 trillion in about next two
decades time.1 The cause for this degree
of loss to the coffers is a simple fact,
often overlooked even when visible in
plain sight, that mental illness will lead to
early retirement, distort expectations
from employment and retard work
output. On the other hand, an
educational psychologist might highlight
that non-completion of education is
consistently seen as a consequence of
development of mental disorders. This
applies to all nations irrespective of what
their economic statuses are.2
An epidemiologist might shift our
focus to a finding that indicates young
women with depression are more
vulnerable to adverse cardiovascular
effects.2 This consequence directly affects
the wellness quotient of an entire
ecosystem that these women with
depression have influence over and not to
forget the cost that comes with burden
of physical illnesses.3 A child care specialist on the other hand might note a study
from United Kingdom which estimated
that £230,000 could be the lifetime
savings if one child with conduct disorder
was to receive an early intervention. If it
is to be pointed out that there are 85,000
children in Canada estimated with
conduct disorder, it is not unimaginable
to picture how it tears the economic and
the social fabric of a nation.4
These studies are quoted to state a
simple truth that it does cost a lot if
governments of nations trivialize the
need for investing time, energy and
money on mind care of its people. It hurts
that economics must be quoted (as is the
trend) to make a point that human
species must invest to nurse their minds,
the very thing that has put them above
all species.
Mental illness discriminates none –
High, low and middle income nations. Yet,
one notices stark differences in patterns
of mental health investments among
high and low and middle income
countries (LAMIC). Mental health issues
are often forgotten and they don’t garner
the attention they deserve in most
LAMIC.
ROSE, THORN, BUD
77% of high income countries have
dedicated mental health legislations,
while only 39% of LAMIC have the same.
This indicates the gap between priorities
and possibilities of mental health
investments in these nations. There is
one psychiatrist or even lesser than that
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to serve over 200000 people for half of
the world’s people. It is noted that 0.05
psychiatrists are there per 100000 people
in low income nations, while it improves
to 0.54 psychiatrists in LAMIC and 8.59 in
higher income nations. This confirms the
mismatch between the need for and the
supply of mental service in most nations.
Outpatient mental health facilities are
drastically less in low income nations
than in high income nations. These
figures are not quoted to compare and
shame nations not investing enough in
mental health, but to acknowledge that
some really can’t invest in mental health
even when they want to because of the
tyranny of other crises. Roses are few and
far between, thorns aplenty, but the buds
should inspire and call for intentional
nourishment. An example of such a
promise is that there is an increase in
mental health human resource from
2005 to 2011 and increase in the number
of countries with dedicated mental
health policies and legislations.5 The
kingdom of Bhutan at the eastern end of
the Himalayas uses Gross National
Happiness as an indicator of quality of
life than an economic indicator. This is
another example of small, but inspiration
progresses made in LAMIC.6
The situation demands that we
evaluate the strategies used in LAMIC to
promote mental health. It is in this
context that [F.O.C.U.S] formula is
proposed to foster mental health
promotion in LAMIC. [F.O.C.US] formula is
an outcome of my intention to challenge
some of the tokenistic ‘grand’ projects of
mental health promotion, debate the
greatness of ‘high’ profiles of mental
health
professionals,
dare
the
authenticity of ‘universal’ diagnoses,
reassess the ‘ubiquitous’ dearth of
resources
and
reconceptualise
approaches to develop preventive
measures in mental health field in LAMIC.
[F.O.C.U.S] FORMULA
[F.O.C.U.S] formula is one idea constituted by a set of inter-related microstrategies which have the potential to
catalyse fostering of mental health care
in LAMIC. The acronym FOCUS is within
bracket to reiterate that it is one idea and
there are dots in between alphabets to
convey that the hypothesised positive
outcome is going to be the product of
each strategy that the alphabets stand
for.
reach is national.
Consider the results of a simple semistructured interview that the researcher
conducted with the family members of
few patients admitted at National
Institute of Mental Health and Neurosciences (NIMHANS) in Bangalore, the
silicon hub in India. It is recognised as an
institute for national importance in India.
It is a multidisciplinary institute for
patient care and academic pursuit.7 In
one such case, the family members
reported that a patient from Yadgir (A dry
‘Flourish’ centres instead of
‘national’ institutes for mental health
Micro centres
Outsourcing psychotherapeutic skills
to smaller groups
Micro communities
Culture specific conceptualization of
illness and treatment
Micro perspective
Unostentations philanthropy for
mental health fund
Micro funding
‘Skill-ing’ individuals the right way
Micro skills
1. ‘FLOURISH’ MIND CARE CENTRES
INSTEAD OF ‘NATIONAL’ INSTITUTES FOR
MENTAL HEALTH:
This strategy aims to suggest the
benefits of decentralization of resources
from ‘national’ institutes of mental
health to micro mind care centres called
‘Flourish’ centres. In most LAMIC,
governments invest lots of money and
man power in one or two tokenistic
‘national’ institutes in their capitals or in
one of the metropolitan cities. I say
tokenistic because these centres are like
‘grand show pieces’, they get a lot of
attention but their utility is not as grand
as the word ‘national’ sounds. An
institution cannot become ‘national’
because it is the only one in the country;
instead it becomes ‘national’ when its
district -495 kilometers from Bangalore)
as brought to NIMHANS and was told he
requires hospitalization after being
diagnosed with paranoid schizophrenia.
The family had to sell two of their cattle
to buy tickets and rent a hotel for stay.
Now, with the need for hospitalization,
the remaining livestock had to go, which
was their only source of income. This is
just an example to show how ‘national’
institutions may not work for ‘Flourish’
centres instead of ‘national’ institutes for
mental health care services as it requires
people in need come to big cities. Let
there be national boards at the level of
policy making if need be and if the love
for bigger banners is too difficult to let
go. When it is the matter of people
seeking direct mental health service, it is
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apt to have micro-centres in each zone.
Instead of having 1000 mental health
professionals in one national centre, have
5-8 in each zone. I have used the phrase
‘Flourish’ centre’ to also highlight the
need for moving from ‘illness to health’
perspective to ‘illness-health-wellness’
perspective.
Thus,
the
first
recommendation is to establish ‘micro
mental health’ centres called ‘Flourish’
centres.
2. OUTSOURCING
PSYCHOTHERAPEUTIC SKILLS TO SMALLER
COMMUNITIES:
The field workers involved in forming
self-help groups for micro-financing in
India and other South Asian countries
often note that women with depression
and other anxiety issues often make
great progress because of the therapeutic
quality of group interaction. This casual
observation of social workers holds the
key to an idea using which we could form
therapeutic micro-communities in rural
areas and places where there are no
mental health professionals. A school of
thought called person-centred therapy in
the field of counselling states that when
individuals provided with facilitative
conditions of empathy, genuineness and
unconditional positive regard8 will
recover from emotional distress. Hence, I
propose an idea to train these microcommunities with these facilitative
conditions, so that members from these
groups rely on one other for emotional
support.
3. CULTURE SPECIFIC
CONCEPTUALIZATION OF ILLNESS AND
TREATMENT :
Watters (2010) published an article in
New York Times titled ‘The Americanization of Mental Illness’ which points
out to the sad reality that many LAMIC
nations have accepted ‘Diagnostic and
Statistical Manual of Mental Disorder’
published by American Psychiatric
Association as their own9 . It leads to a
dangerous situation of conceptualizing
diagnosis and treatment of clients
without keeping in mind the influence of
the ethos of specific cultures. A global
vision to the mental health cause is
welcome, but popularizing a global
perspective on diagnosis for illnesses
which invariably have indigenous roots
will distort our understanding of
patients. We can draw enough inspiration
from United States of America for the
rigorous research undertaken before
publishing diagnostic manual, but not let
the magnitude of work overwhelm us to
such an extent that LAMIC start imitating
and blindly following the same
diagnostic manuals. There cannot be
universal perspectives on diagnosis and
treatment plans when there are sociocultural factors influencing the psyche
and its problems. We need micro
perspectives on symptoms that are
culture specific so that conceptualization
of diagnosis and treatment can become
socio-culturally relevant.
4. UNOSTENTATIOUS PHILANTHROPY
FOR MENTAL HEALTH FUND:
Inspired by Mahatma Gandhi’s
‘austerity drive’ during the freedom
struggle movement in India, I propose
what I call ‘Unostentatious philanthropy’
to raise funds for the cause of mental
health. This is based on one of the small
experiments conducted by me in a school
with 15-17 year old students and adults
in a company. They were informed about
an NGO which works with children who
are mentally retarded. They were
requested to keep the following requests
in mind: “Do not donate money. Instead,
let’s say you want to buy a new pen and
you already have one. You remember the
cause. If you wish to, give the money that
you saved up by not buying the new pen
unnecessarily, however small it is. Please
donate what you save up without
spending on those things that are not
necessary” The results astonished
everyone. Even though the money came
in small, sporadic form, we had built the
spirit of unassuming micro-funding for
mental health cause which was
sustainable unlike grand donations
which end after one time.
5. ‘SKILL-ING’ INDIVIDUALS THE RIGHT
WAY:
“Take care of the pennies and the
pounds will take care of themselves” says
an old adage. Similarly, teach micro-skills
to individuals, mental health will be
taken care automatically. Imagine, we
teach children alphabets, numericals,
history and so on. But who has ever
taught us emotional literacy. The root
cause of most mental disorders is lack of
emotional regulation and management.
But even before we focus on emotional
regulation and management, we must
focus on emotional awareness. This can
be taught as a microskill that everyone
must learn in varying degree keeping in
mind the age of the child. We could be
using concentric circles model of
teaching children the micro-skill of
emotional awareness. Concentric circle
model method of teaching means micro
skills of emotional regulation are
introduced to children every year in
schools by increasing the radius of the
topic as the child ages. This has the
potential to be an excellent preventive
strategy. Each one of these micro
strategies which constitute [F.O.C.U.S]
formula might pose challenges in their
execution which should be dealt keeping
in mind the socio-cultural context. With
small but smart strategies as presented
in [F.O.C.U.S] formula, I hypothesise we
could make incremental progress in
facilitating promotion of mental health in
lower and middle income countries.
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REFERENCES
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