Mental health literacy in urban and rural communities in Kerala India: An interdisciplinary approach using applied theatre methodology

This highly collaborative international interdisciplinary partnership examines the applicability of the evidence based intervention of mental health literacy (MHL) for urban and rural communities through a multi-centre study in India using participatory theatre and media. We believe that our mutual sharing of research experiences, cultural identities and interdisciplinary exchanges will enable us to build our capacity for planning collaborative research of international significance. Our vision is to work towards the UN 2030 Agenda for Sustainable Development goals 3, 5, 8, and 10.The WHO estimates that mental and behavioural disorders account for about 12% of the global burden of diseases and this is likely to increase to 15% by 2020 . Our focus is in Kerala which has higher prevalence of mental ill-health (14.4%), suicidal risk (12.5%) and alcohol abuse than the rest of India. Thus there is a dire need to develop acceptable and affordable evidence based mental health interventions that are responsive to the local cultural and social contexts. Despite the high Human Development Index (HDI), stigma is widespread in Kerala and hence people with mental ill-health can internalise the public perceptions and become resistant to approach mental health facilities. Mental health literacy is proposed as an evidence based approach for enhancing tolerance, self-care, care for others and to reduce stigma. It is proposed that raising MHL can improve understanding about the risks to mental health, and methods of coping with these risks, thus promoting mental health for all.

This project will extend partnerships and develop new collaborations between UK and Indian academics & researchers, service users, families, theatre practitioners and NGOs. Our plan is to conduct a multi-centre study using a 'theatre for development' (TFD) model, adopting a participatory approach to engage and empower urban and rural communities through co-production and co-creation of culturally appropriate knowledge and practice in promoting MHL. We will use participatory co-research methodology embracing the principles of co-production and use theatre and media for research engagement and data collection. Our mode of practice and co-production will draw heavily upon the methodologies employed under TFD but we will also incorporate and extend the community storytelling approaches in partnership with local communities and theatre workers to pilot an approach that allows communities, policymakers and professionals working with mental health to explore mental health as an issue of social justice and to promote MHL. It will do this by creating an interrogative performance space that brings together local practices and attitudes, professional orthodoxies, policy-related data and the latest understanding of mental illness in a way that allows multiple stakeholders to collectively imagine possible solutions. This project will also include widespread public engagement with people in creating mental health literacy through active public engagement programmes.

The partnership will innovate and develop new knowledge by: (1) developing and promoting a culturally appropriate MHL programme (2) developing a participatory applied theatre model for promoting mental health literacy (3) co-producing a piece of applied theatre on MHL reflecting the lived experiences of urban and rural communities (4) public engagement of users, families and communities on talking about MHL and pathways of services. Our partnership will facilitate the development of lasting research partnerships combining knowledge of public mental health challenges with awareness of evidence based interventions and its cultural transferability, adding value to health humanities, mental health research and service development.

This project team consists of key individuals with a wealth of experience in interdisciplinary, funded research, publications and networking relevant to humanities, social sciences and healthcare. All the members have delivered a variety of high quality publications relevant to mental health, bringing together substantial experience of mental health policy, education, practice and humanities-based scholarship across narrative research, mental health promotion, community engagement, theatre performance. The team includes members with substantial brokering and knowledge transfer skills. The project will be strengthened by on-going support from mental health and drama research groups especially in terms of assisting exploitation activities.

This research will add a new international dimension to existing ESRC & AHRC funded projects. This programme of work incorporates a social sciences layer that seeks to advance transformative impacts in policy, provision and practice by grounding the outputs in culture and mental health literacy (MHL) programmes. It will link researchers in social, health, clinical sciences, arts and humanities across India and the UK and third and statutory sectors supporting people with mental health needs, in order to generate new forms of social and cultural connectedness that can facilitate MHL for health and wellbeing. This project has potentially wide impact on public engagement, mental health policy and academic research.

Policy-makers: This project brings together communities of arts, humanities, social and health science scholars, service users, volunteers and stakeholders from health, social care and education personnel in Britain and India, to respond to the psychological costs of mental ill-health. As such, it is anticipated that outputs in peer reviewed journals generated by this project will stimulate and inform public health debate, particularly as it relates to the development of policies that advance: a) less-centralised resources for responding to the mental health well-being agenda; b) more co-operative, open and permeable interfaces between diverse social actors and communities of practice in mental health.

Health, social care and education providers : The project will be of interest to health, humanities, social care, education, and performing arts organisations involved in mental health promotion work and the facilitation of more self-caring communities. The interdisciplinary approach and methodology aligns it with the emerging field of health humanities, in this case through a combination of performing arts and narrative work as well as sociology, psychology, psychiatry, nursing, and public health. It will afford knowledge dissemination benefits regarding the ways in which these fields animate one another. Our research findings may ultimately inform organisational culture and practices within India and UK and potentially suggest increased effectiveness of MHL for mental health and wellbeing.

Members of the public: Our planned public engagement will reach masses of people in India and the world. We envisage potential social benefits for users, families and the public more broadly, these emanating primarily from the impact of the research on public awareness in building MHL. It is envisaged that the project will generate public contribution to debate about ways to tackle societal challenges in mental health, and ways of achieving more egalitarian and inclusive connections between and within communities in mental studies and support. We aim to inform attitudes to and/or beliefs about the feasibility of applied theatre as a way of facilitating mutual support, being a possible solution to the limitations of biomedical and psychiatric approaches to date to improve mental health wellbeing of developing nations and to empower communities and individuals to deploy greater agency in their own health & well-being.