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

Lead Research Organisation: De Montfort University
Department Name: School of Nursing and Midwifery

Abstract

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.

Planned Impact

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.

Publications

10 25 50
 
Title Applied theatre shows in urabn and rural communities 
Description Eight pieces of applied theatre ( 20 minutes each) was created based on the interview narratives from patients and carer participants. This was shown in eight different localities ( 4 urban and 4 rural areas) in four districts in Kerala 
Type Of Art Performance (Music, Dance, Drama, etc) 
Year Produced 2019 
Impact Public awareness of mental health issues and the need for mental health literacy Patient/ carer taking responsibilities for own health and access to health services ( Rural/ tribal community - Attappadi, Kerala) 
URL https://m.facebook.com/story.php?story_fbid=2716741158413936&id=100002342352169
 
Description Mental health narratives of patients and their family carers in Kerala India - access to and use of a range of health care pathways- allopathic medicine, Homeopathic and Ayurvedic systems
Narratives of patient and family perspective on mental health service access and support
Exploitation Route Use of data sets, narratives and community engagement theatre performances
Sectors Healthcare

URL http://mehelp-india.org/
 
Description Applied theatre developed from narrative interviews were used to engage with patients and family carers and NGO organisations. Patients/ carers from rural settings reported attitude and behaviour change - for mental health service access and use of interventions. Public awareness of mental health literacy - through engagement with print, visual and social media.
First Year Of Impact 2019
Sector Communities and Social Services/Policy,Healthcare
Impact Types Cultural,Societal,Policy & public services

 
Title Applied theatre engagement 
Description Eight Applied theatre performances created from the interview narratives- and used for engagement with mental health users and their families in 4 rural and 4 urban localities in four districts in Kerala 
Type Of Material Database/Collection of data 
Year Produced 2019 
Provided To Others? Yes  
Impact None to report at this stage 
URL https://dmu.figshare.com/
 
Title Narrative data sets 
Description 192 Narrative interview data sets transcribed and translated to English - from urban and rural communities in four districts in Kerala, India 
Type Of Material Database/Collection of data 
Year Produced 2019 
Provided To Others? Yes  
Impact None to report in this period 
URL https://dmu.figshare.com/
 
Description Perinatal mental health literacy India project application 
Organisation University College London
Country United Kingdom 
Sector Academic/University 
PI Contribution Myself and DMU research team are collaborating with Professor Monica Lakhanpaul from UCL for a MRC GCRF call garnet application on neonatal and maternal health study in India ( application for a multicentre study in 3 Indian states on perinatal mental health literacy). Myself and my research team are key UK partners in this collaboration in developing the application.
Collaborator Contribution Involvement in new grant application and link with new UK and India research partners
Impact A grant application to be submitted on 24 April 2019. Outcome: Unsuccessful
Start Year 2019
 
Description Perspectives of slum dwelling internal migrant women on gender based violence: An interdisciplinary approach using street theatre methodology 
Organisation Institute of Health Management, Pachod
Country India 
Sector Charity/Non Profit 
PI Contribution Submitted a collaborative research grant application to the British Academy call on Dignity Heritage and Violence call in 2019 - on Perspectives of slum dwelling internal migrant women on gender based violence: An interdisciplinary approach using street theatre methodology
Collaborator Contribution Research collaboration, Co-applicants, Access to community
Impact None
Start Year 2019
 
Description Perspectives of slum dwelling internal migrant women on gender based violence: An interdisciplinary approach using street theatre methodology 
Organisation Tata Institute of Social Sciences
Country India 
Sector Academic/University 
PI Contribution Submitted a collaborative research grant application to the British Academy call on Dignity Heritage and Violence call in 2019 - on Perspectives of slum dwelling internal migrant women on gender based violence: An interdisciplinary approach using street theatre methodology
Collaborator Contribution Research collaboration, Co-applicants, Access to community
Impact None
Start Year 2019
 
Description Young people with Autism and transition 
Organisation National Institute of Mental Health and Neurosciences
Country India 
Sector Hospitals 
PI Contribution Grant application to MRC on Interventions to Support Autistic Adolescents and their Families in India: An interdisciplinary approach using multi-media methodology
Collaborator Contribution Main Co-Investigator in India
Impact Grant application unsuccessful
Start Year 2019
 
Description Community engagement 
Form Of Engagement Activity Participation in an activity, workshop or similar
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Study participants or study members
Results and Impact Applied theatre show and discussion with patients and carers, community members in 8 localities ( 4 urban and 4 rural ) in four districts in Kerala. Applied theatre show developed from interview narratives of patients and carers for engagement and discussion
Year(s) Of Engagement Activity 2019
 
Description Engagement with Universities and Colleges 
Form Of Engagement Activity A talk or presentation
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Other audiences
Results and Impact Invited presentation to Psychology postgraduate / research students at one university Centre ( University of Calicut) and two University colleges (U.C. College Alwye, and Providence Women's College, Calicut ( Kerala) - on 3, 10 and 11 February 2019.
Discussions with students about mobilising mental health literacy activities in Kerala
Year(s) Of Engagement Activity 2019
 
Description Interview and publication in a National Newspaper in India 
Form Of Engagement Activity Participation in an open day or visit at my research institution
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact This was an interview and article in the Deccan Herald national daily newspaper in India (Kerala edition).
Year(s) Of Engagement Activity 2019
URL https://www.deccanchronicle.com/lifestyle/health-and-wellbeing/201118/mental-health-via-theatre.html
 
Description Media News on mental health 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach National
Primary Audience Public/other audiences
Results and Impact Applied theatre community engagement in Calicut, Kerala -Play and discussions with patients/ carers/ public - TV news
Year(s) Of Engagement Activity 2019
URL http://mehelp-india.org/blog-post/mehelp-on-janam-tv-kerala/
 
Description Press Interview Media publication 
Form Of Engagement Activity Engagement focused website, blog or social media channel
Part Of Official Scheme? No
Geographic Reach International
Primary Audience Public/other audiences
Results and Impact Media interview by online news media in South India - thenewsminute.com
Year(s) Of Engagement Activity 2019
URL https://www.thenewsminute.com/article/uk-india-collective-using-theatre-create-mental-health-awarene...
 
Description Press Interview and Print media publication 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Public/other audiences
Results and Impact TV news publication by Mathrubhumi TV in Kerala - on community engagement through applied theatre ( engagement activity at Calicut, Kerala)
Year(s) Of Engagement Activity 2019
URL https://www.bing.com/videos/search?q=Mathrubhumi+TV+news+on+mental+health+&view=detail&mid=2B33DBA6A...
 
Description Project Press Release 
Form Of Engagement Activity A press release, press conference or response to a media enquiry/interview
Part Of Official Scheme? No
Geographic Reach Regional
Primary Audience Media (as a channel to the public)
Results and Impact Press release about MeHeLP India project at the Cochin Press Club in Kerala
Year(s) Of Engagement Activity 2018