Community based mental health initiative

Weaving the Colors : Suman Doloi

Enrollment: Suman Doloi was enrolled with CMHP when a field worker was informed about her by the local Asha, reporting complaints of occasional crying spells, self-muttering, self-smiling, wandersome behavior and increased irritability. Though her parents had already sought treatment for her, but due to financial and physical constraints, they weren’t able to continue medication- thus leading into repeated relapse.

History & Intervention: A decade ago, Suman was one of those quite and docile girls of her neighborhood who is loved by all, and her story of life was smooth until one fine day in April, 2006, she had a sudden onset of fever and then few days later, her mood started to be unexplainably elated, along with decreased sleep and appetite and increased religious ideation. Her parents, suddenly in a helpless consign, resorted to faith healing. The symptoms persisted infrequently, and suddenly everything escalated into severe catatonic symptoms; post which she was rushed to the district government hospital. With medication, her psychiatric status stabilized but within a few more months, another severe episode struck. She was taken to Gauhati Medical College and Hospital and thereby her treatment started again. But infrequent lapses in medication sustained- how far do ageing parents go in providing every possible treatment for their dear daughter? Suman’s parents however left no stone unturned.

When she was identified by the CMHP field worker, she already had a diagnosis of Chronic Schizophrenia and to fight it, her parents had drained themselves of almost all financial and emotional resources they had gathered in their lifetime. The difficulties of commuting to the capital city with often derailed conditions of Suman, and the long hours of wait to access doctors took a toll on them in more ways than can be measured from a distance. After enrolling with CMHP, her family which is primarily engaged in cultivation has been relieved of these pains in ways not fathomable to our coveted lives. She has also been forwarded livelihood support, whereby her weaving skills were let to bloom by providing her with thread to weave clothes.

Suman’s psychopathology has substantially improved, and beyond that has her occupational engagement. For her parents, to see their daughter no more succumb to irrational fears and disconnection with reality is perhaps one of the few joys they today cherish. And for Suman, life is again adding colors- like one of those colorful clothes she delightfully weaves!

Fighting Every Odd, Evening Out every Pain

Enrollment: On 8th of April, 2013 a field worker was informed by the neighborhood Anganwadi Worker about this one person named Ajit Debnath who has persistently for many years been showing symptoms of psychiatric illness that included aggressiveness, hesitant speech, decreased sleep, impaired judgment, restlessness and diminished self care abilities.

History & Intervention: A one room house that is home to Parul Bala Debnath, husband Ajit Debnath and their two sons doesn’t give out the finest impression when someone walks in for the first time. Rather, in the silent darkness that engulfs it, a woman’s every day fight comes into light. On the right is a bed where a man in his 40s sits cross-legged and stares at us, probably wondering, probably not.

Ajit Debnath was hale and hearty almost 20-25 years ago, and engaged himself in simple trading activities. Though he couldn’t climb the ladder of formal education beyond 10th grade, he earned sustainably enough through his business and life was uncomplicated. But the serenity didn’t sustain long enough and he was soon hit and robbed by dacoits at midnight while he was returning from another village. His friend managed to escaped, but the dacoits didn’t let him loose until they robbed him off of all that he had- including the stability of his mind. They had hit his head hard but nothing unexpected was seen in his behavior until then. Few months later when he traversed through that same road where he was robbed, he got extremely anxious and cried in panic. Situations never settled to normalcy after that. He would throw away things of the house, wander around in an apathetic mood, continuously mutter to self, hoard things that others have discarded and spend days and nights sleeplessly. Thinking that some evil spirits have cast their spell on him, his family members resorted to faith healing. But as they saw him deteriorating further, in 2003 his siblings came together and took him to LGBRIMH, Tezpur. In the meantime, someone suggested to his mother that if he could be married, maybe the illness would cure itself! Accordingly, Ajit married Parul Bala 16 years back, and as she reports, she knew nothing about his mental status.

On their first night, Ajit inappropriately danced around in the room naked.

A scared and traumatized Parul sat there, shocked at what life had suddenly come to.

Rest of the years continued with Parul’s struggle with her in-laws’ family whom she accused of deceiving her into the marriage, their refusal to let her go to her maternal home fearing she would not come back and in the midst, the fluctuating status of Ajit. His treatment was continued sometimes from LGBRIMH, and sometimes from GMCH, Guwahati. But due to inconsistency of medications and poor compliance, the symptoms have persisted. Over time the economic conditions took a toll, and due to his often unmanageable state that caused difficulties for other family members, they were separated out of the main household.

Parul stood as the head of her family, fighting through her husband’s illness every day and raising two sons whom she hopes shall someday make everything seem worth it. Her elder son stays at her maternal home currently and she works as a cook at a local primary school and runs the family with whatever little she earns. After being enrolled with CMHP, her financial burden of continuing her husband’s treatment has eased to great extents, and with supportive care from the field worker, Parul today has someone to share her emotional pain with. In order to enhance Ajit’s behavioural activation, in the form of livelihood support, he was provided with ducks which he could look after and make profit out of selling their eggs. The same has been continuing successfully.

The prognosis of Ajit’s psychiatric health has been poor, but more than that it is the story of Parul- a woman who has decided to fight all odds and even out things for her family. A woman who hasn’t given up, no matter what life has put her through. Ajit may not be healed in miraculous ways, yet Parul who walked into the marriage without any knowledge of his illness has devoted her life to his care, and in such relentless love, maybe her world of solace exists.

Iridescent hope in yarn of illness: Ranjita Devi

Enrollment: Ranjita Devi, 46 years old, was enrolled with CMHP, Sipajhar in September, 2013, after having suffered from Chronic Schizophrenia for more than a decade and seeking treatment that failed to ensure continued drug compliance. A mother of three sons, the illness progressed in an insidious manner and the severity of her irritability, aggressiveness, confabulated speech, and sleeplessness gradually escalated to unmanageable levels. Her husband immediately sought treatment, and even when there were episodes of remission, medicines would be discontinued and she would suffer a relapse.

History & Intervention: Unlike most other cases, the challenge in regard to Ranjita and her caregivers was not unavailability of treatment sources or stigma; rather it was solely confined in poor drug compliance and continuation. 15 years ago when Ranjita first showed unmanageable symptoms of sleeplessness, irritability and aggressiveness, her husband immediately took her to a private practitioner in Guwahati. With medication, as symptoms subsided she discontinued the drugs and in no time, the symptoms resurfaced. In the next two relapse episodes she also required hospitalization in LGBRIMH, Tezpur for 3 months. However after almost 2 years of continued drug compliance she relapsed and that is when the CMHP intervention stepped into their lives. For her husband who was relentlessly putting in efforts to manage both the household and his wife, CMHP stood as the last flicker of faith.

With continued supervision and visits of the field worker, it was ensured that she didn’t discontinue her drugs. Soon she was back to her usual self and got engaged in household work, weaving and gardening. However, as in previous episodes, she stopped medicine intake and this time deceived her husband saying that she is regularly taking them. A major relapse followed where she would wander around, verbally abuse and engage in instrumental aggression against others. Her husband then consulted the CMHP Psychiatrist and hospitalized her in LGBRIMH, Tezpur for 2 months.

Currently her mental illness is in remission and drug intake is strictly monitored by her caregivers. Belonging to an agriculture-based financially poor background, CMHP has come forth as the only spinal support in Ranjita’s treatment. Her caregiver’s were provided with specialized caregiver’s training such that her husband and three sons can adequately take care of her, and provide the necessities in the most efficient manner. Also, to involve Ranjita in a financially productive and behaviorally activating engagement, she was provided with a variety of seeds for the kitchen gardening that she seemed to enjoy so much. Her husband and son equally share household responsibilities with her, and though the father remains as the decision maker of the family, his love and affection towards his wife is what the highest priority remains.

Light of the Dawn: Reba Kanta Nath

Enrollment: 43 years old Reba Kanta Nath was enrolled with CMHP Sipajhar in July, 2013 after having suffered mental illness for almost 20 years with symptoms of excessive and irrelevant talking, sleeplessness, inappropriate social behavior and increased irritability. The eldest among three siblings, Reba had no family history of psychiatric illness and for his parents; these symptoms were far beyond their idea of sickness and health.

History & Intervention: In his early 20s when Reba was pursuing graduation, he fell for a woman in his neighborhood and as the love bloomed into commitment, they married one another and stepped into the realities of life. In the meantime Reba started teaching in a school and their conjugal life blessed them with a son. The happiness remained short-lived however. Reba’s marriage suddenly hit a rough patch following some family issues and soon thereafter his wife started living in her maternal home with their son. The shock and pain of separation led Reba to spend hours continuously brooding over the situations, and he left his job. Eventually a range of psychiatric symptoms, as mentioned above, started showing up. His parents sought faith healing initially, but seeing no drastic improvement, they took him to LGBRIMH, Tezpur. He continued medication for 2 years and seeing substantial improvement, discontinued the drugs. For the next 10 years, he remained off medications, with the symptoms infrequently resurfacing and sometimes being difficult to manage.

As the CMHP intervention started, the accessibility of doctors and continuous availability and intake of medicines soon helped raising the lost spirits in Reba Kanta Nath. Through awareness programmes in the villages and caregiver’s training, Reba’s family and immediate society was taken into the team of providing him care through all possible magnitude- medically, socially and emotionally. His mother, brother and sister-in-law provide him with constant care and share the responsibilities accordingly. However, a sustainable intervention plan also needed behavioral activation and financial stability, and for the same, Reba was provided with desks, benches, and blackboard and chalks so that he could tutor students at home and earns a decent and respectful living. For Reba, this is another beginning. Pain, hope and happiness are a share of everyone’s tale- some fight battles for life; some however see the light of the dawn.