Exploring Community Mental Health Systems - A Participatory Health Needs and Assets Assessment in the Yamuna Valley, North India.

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dc.contributor.authorRawat M
dc.contributor.authorThompson A
dc.contributor.authorGaitonde R
dc.contributor.authorJain S
dc.contributor.authorMathias, Kaaren
dc.date.accessioned2022-03-09T02:44:51Z
dc.date.available2022-03-09T02:44:51Z
dc.date.issued2020en
dc.date.updated2022-01-20T00:59:18Z
dc.description.abstractBackground: In India and global mental health, a key component of the care gap for people with mental health problems is poor system engagement with the contexts and priorities of community members. This study aimed to explore the nature of community mental health systems by conducting a participatory community assessment of the assets and needs for mental health in Uttarkashi, a remote district in North India. Methods: The data collection and analysis process were emergent, iterative, dialogic and participatory. Transcripts of 28 in-depth interviews (IDIs) with key informants such as traditional healers, people with lived experience and doctors at the government health centres (CHCs), as well as 10 participatory rural appraisal (PRA) meetings with 120 people in community and public health systems, were thematically analysed. The 753 codes were grouped into 93 categories and ultimately nine themes and three meta-themes (place, people, practices), paying attention to equity. Results: Yamuna valley was described as both 'blessed' and limited by geography, with bountiful natural resources enhancing mental health, yet remoteness limiting access to care. The people described strong norms of social support, yet hierarchical with entrenched exclusions related to caste and gender, and social conformity that limited social accountability of services. Care practices were porous, pluralist and fragmented, with operational primary care services that acknowledged traditional care providers, and trusted resources for mental health such as traditional healers (malis) and government health workers (accredited social health activists. ASHAs). Yet care was often absent or limited by being experienced as disrespectful or of low quality. Conclusion: Findings support the value of participatory methods, and policy actions that address power relations as well as social determinants within community and public health systems. To improve mental health in this remote setting and other South Asian rural locations, community and public health systems must dialogue with the local context, assets and priorities and be socially accountable.en
dc.identifier.citationMathias K, Rawat M, Thompson A, Gaitonde R, Jain S (2020). Exploring Community Mental Health Systems - A Participatory Health Needs and Assets Assessment in the Yamuna Valley, North India.. International journal of health policy and management.en
dc.identifier.doihttp://doi.org/10.34172/ijhpm.2020.222
dc.identifier.issn2322-5939
dc.identifier.urihttps://hdl.handle.net/10092/103447
dc.languageeng
dc.language.isoenen
dc.publisherMaad Rayan Publishing Companyen
dc.rightsAll rights reserved unless otherwise stateden
dc.rights.urihttp://hdl.handle.net/10092/17651en
dc.subjectCommunityen
dc.subjectHealth Systemsen
dc.subjectIndiaen
dc.subjectMental Healthen
dc.subjectNeeds Assessmenten
dc.subjectParticipatoryen
dc.subject.anzsrcFields of Research::42 - Health sciences::4203 - Health services and systems::420313 - Mental health servicesen
dc.subject.anzsrcFields of Research::42 - Health sciences::4203 - Health services and systems::420321 - Rural and remote health servicesen
dc.subject.anzsrcFields of Research::42 - Health sciences::4203 - Health services and systems::420311 - Health systemsen
dc.subject.anzsrcFields of Research::42 - Health sciences::4206 - Public health::420602 - Health equityen
dc.subject.anzsrcFields of Research::44 - Human society::4410 - Sociology::441011 - Sociology of healthen
dc.titleExploring Community Mental Health Systems - A Participatory Health Needs and Assets Assessment in the Yamuna Valley, North India.en
dc.typeJournal Articleen
uc.collegeCollege of Education, Health and Human Development
uc.departmentSchool of Health Sciences
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