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The dynamics of a recovery oriented mental health approach in northern India

PI: Dr S Jain

Funder: ESRC Impact Accelerator Award

Co-Investigator: Dr Kaaren Mathias, Burans Project, Emmanuel Hospital Association, Dehradun, India.

Summary of Project

Set in rural and urban communities of the state of Uttarakhand in north India, this project will co-develop a culturally relevant visual tool for recovery with community members with psycho-social disability. This initiative builds on ethnographic research on mental health in the global south and uses this to enhance existing research, develop a case study and policy brief. The project will strengthen locally relevant knowledge, skills and practice in mental health recovery among community leaders, mental health practitioners and policy makers, ultimately improving mental health services in the populous Hindi speaking region of north India.

Background: Bayetti, C., Jadhav, S. S., & Jain, S. (2016). The re-covering self: a critique of the recovery-based approach in India's mental health care. Disability and the Global South3(1), 889-909.

Abstract: This paper critiques recent initiatives for deploying the Recovery Model in the Indian sub-continent. It traces the history and growth of the model, and questions its applicability for mental health care in the Indian sub-continent. The authors argue that mental health professionals in this region are at the crossroads of a familiar past: either to uncritically import and apply a Euro-American 'recovery' model or reconfigure its fundamental premise such that it is embraced by the majority Indian population. The paper proposes a fundamental re-thinking of existing culturally incongruent 'Recovery Models' before application in India’s public mental health and clinic settings. More crucially, policy makers, clinicians and researchers need to reconsider the local validity of what constitutes 'recovery' for the very people who place their trust in State mental health services. This critical reappraisal, together with essential culturally-sensitive research, is germane to prevent yet again the deployment of culture-blind programmes and practices. Addressing these uncontested issues has profound implications for public mental health in the Global South.

Outputs: Policy Brie

Film 1: Co-production process of the recovery tool

Film 2: Outcomes of the recovery tool 

Mathias, K., Pillai, P., Gaitonde, R., Shelly, K., & Jain, S. (2019). Co-production of a pictorial recovery tool for people with psycho-social disability informed by a participatory action research approach—a qualitative study set in India. Health promotion international. 

Open access version

Abstract: Mental health problems are recognized as a leading cause of disability and have seen increased allocations of resources and services globally. There is a growing call for solutions supporting global mental health and recovery to be locally relevant and built on the knowledge and skills of people with mental health problems, particularly in low-income countries. Set in Dehradun district, North India, this study aimed to describe first, the process of co-production of a visual tool to support recovery for people affected by psycho-social disability; second, the key outputs developed and third, critical reflection on the process and outputs. The developmental process consisted of participatory action research and qualitative methods conducted by a team of action researchers and an experts by experience (EBE) group of community members. The team generated eight domains for recovery under three meta-domains of normalcy, belonging and contributing and the ensuing recovery tool developed pictures of activities for each domain. Challenges to using a participatory and emancipatory process were addressed by working with a mentor experienced in participatory methods, and by allocating time to concurrent critical reflection on power relationships. Findings underline the important contribution of an EBE group demonstrating their sophisticated and locally valid constructions of recovery and the need for an honest and critically reflective process in all co-productive initiatives. This study generated local conversations around recovery that helped knowledge flow from bottom-to-top and proposes that the grass-root experiences of participants in a disadvantaged environment are needed for meaningful social and health policy responses.

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