Numerous studies have indicated a rise in mental health issues for a substantial part of the population across the globe—nearly 1 billion people were living with mental disorders as of 2021. While the pandemic necessitated lockdowns, it also introduced isolation in people’s lives. For those vulnerable to forces of poverty, hunger, homelessness, and unemployment, the story was different altogether.
The varying context makes access to mental health facilities a difficult concept to engage with, especially in the case of marginalized communities. But interventions exist, and they are scaled when a positive impact is observed.
The question, then, is—
Every policy, program, or intervention aims to help people at an individual and structural level. A nationwide livelihood program will help women become entrepreneurs by giving them access to the required tools. It will also help society by empowering women in business, which impacts the way society perceives their role and importance, thereby bringing both personal and structural change.
Similarly, it is crucial for mental health interventions to address the issues at both personal and structural levels.
Psychotherapy, commonly known as talk therapy, is one of the most common tools to address mental health problems. Through conversations with a professional, patients learn to identify the triggers and work on creating better, healthier living patterns to overcome the anxiety induced by the stressors of everyday life. This is at the personal front of treatment.
At the structural level, awareness remains the most critical area enabling people to identify their problems. Despite the increasing normalization of conversations around mental health, especially post the COVID-19 pandemic, apprehensions around mental health continue to dominate the discourse, thereby discouraging people from seeking the help they require.
Secondly, structural barriers such as poverty and identity-based discrimination place people in stress-inducing situations. They also lack the resources to cope with their disadvantages precisely because of their disadvantages. For example, a systematic review of the literature found that the prevalence of depressed mood or anxiety was 2.5 times higher among young people ages 10 to 15 years with lower socioeconomic status than among youths with wealth, access, and status.
Let’s understand how with an example.
After the Civil War of 2009, Sri Lanka was recovering from the ruins inflicted due to the communal lines etched within the landscape. The country had been at war with itself for more than 25 years and left a ruinous ghost behind. People were grieving the loss of their loved ones, and the nation needed respite, which is why school-based interventions were set up to help young children improve their mental health.
The intervention was introduced in randomly selected schools and was based on similar models used in other war-inflicted countries, consisting of 15 sessions over a period of time using non-special personnel. Topics covered in the session included safety, stabilization, awareness and self-esteem, trauma, coping skills, reconnecting with the social context, and planning for the future.
The results showed improvements in some participants’ mental health and conduct behavior, including improvements in the ability to settle disputes in a non-violent way. On the personal front, these sessions helped students overcome their contextual stressors and enabled them to envision a better life. At the structural level, the younger generation was made aware of the consequences of conflict, furthering the cause for a peaceful and harmonic existence.
Whether or not a program can be scaled is dependent on a host of factors. The scope of this investigation is to enquire about scaling mental health interventions that need even more contextual precision. A study reviewed the effectiveness and scalability of such interventions and looked into the factors potentially influencing the scale-up of mental health interventions.
Scaling requires an increase in resources, which in this case, would be in the form of a qualified mental health workforce. This will help make mental health services accessible while also establishing them as a part of the mainstream health care systems available to the masses.
However, just like every other intervention, the aim is to make the system efficient and self-sufficient in due time, which requires transitioning from field experts to non-experts taking up the responsibilities. This can be facilitated through guidelines, templates, and manuals, providing common intervention frameworks.
In addition to digitizing the medium of intervention, these can prove helpful in the scaling process. Meanwhile, it is also important to maintain program fidelity to ensure that scale-up happens as intended. This happens through training provisions and knowledge transfer to provide skills for consistency.
Adapting to different contexts is one of the most crucial parts of any scaling project. Learnings from other countries facing conflict helped shape the program intervention in Sri Lanka, as discussed before. Similarly, within a transnational context, different geographies may require different sets of mental health services as part of the intervention, for which data becomes central to the aim for success.
Currently, mental health interventions and data are available for high-income nations, leaving a concerning gap of evidence on interventions in low- and middle-income countries. This is where the policy ecosystem can step in to advocate for this issue and further the cause of mental health services so that we may finally be able to access the care that everyone needs—be it physical or mental.
Aishwarya Bhatia, Sambodhi