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Story Publication logo January 31, 2017

India's Community Approach to Depression Tackles Treatment Shortage


A guide for treatment of depression in India. Low-cost local solutions are working. Image by Joanne Silberner. India, 2016.

Mental illnesses take a huge toll on people in low and middle income countries, yet they're...

A guide for treatment of depression in India. Low-cost local solutions are working. Image by Joanne Silberner. India, 2016.
A guide for treatment of depression in India. Low-cost local solutions are working. Image by Joanne Silberner. India, 2016.

Around the world, millions of people with depression and anxiety have no access to psychiatric care. The problem is especially bad in India. There, about 90 percent of people who could benefit from treatment don't get it. A nonprofit has trained locals to fill the need. Joanne Silberner reports on how these lay counselors are making a difference.

JOANNE SILBERNER: Most days, Subhash Pednekar is out the office door by 9:30.

SUBHASH PEDNEKAR: I reach there by 10 o'clock, before 10 also by motorcycle.

SILBERNER: Today, he skips the motorbike, and we're in a car driving through Goa's monsoon rains. He's tall, good-looking and carefully dressed in a button-down shirt and pressed jeans. He looks like one of India's growing class of young tech workers, but he's not. Subhash is what's called a lay counselor. He doesn't have a degree in psychology. He's part of a pilot project in India aimed at making mental health care more available.

We arrive in a nearby village. His patient greets him with a big smile, her husband by her side. It's Mrs. Naik. She doesn't want her first name used because of stigma surrounding depression. She says life wasn't good before Subhash came on the scene.

MRS NAIK: (Through interpreter) There were many issues, emotional stress, some health issues.

SILBERNER: Mrs. Naik is in her mid-50s. She's raised four kids. I ask her what was causing the stress, and it's her husband who answers. He says money and paying for the kids' education. Then she interrupts and blames what she calls tensions.


MRS NAIK: (Through interpreter) I had sleeping problems. My hands and legs were cramping. I had too many thoughts on my mind, and I was feeling very tired.

SILBERNER: She went to the health center for a checkup and was referred to Subhash. He visited her seven times. Subhash works for a nonprofit organization called Sangath. It selects local people who've had at least 10 years of schooling to go through an intensive four-week training program followed by an internship.

Subhash had been taught to listen, to keep careful records and to suggest specific activities, much like cognitive behavioral therapy. Mrs. Naik was dubious at first but curious enough to try.

MRS NAIK: (Through interpreter) This is what they taught us. If you are feeling tired, then exercise. Don't think too much. Don't sit around. Do some small chores. Go for a walk.

SILBERNER: Subhash also suggested yoga and meditation. Mrs. Naik's husband was a constant presence. He made sure she kept up with therapy and took her on prescribed walks. She says he was a big help, and now she says her thoughts have changed.

MRS NAIK: (Through interpreter) Now I'm doing well. I'm doing really well.

SILBERNER: Before this job, Subhash knew nothing about depression. After college, he worked at a domestic call center. Then he saw an ad in the paper for the counseling, and his friends encouraged him. They liked his help.

PEDNEKAR: Whenever something's happening in the group, I used to give them good advice.

SILBERNER: Good advice - and now he's been a counselor at the health center near the town of Porvorim for several years. And it's not about the money.

PEDNEKAR: I am not looking at the salary, but I am really happy with the job. We're helping to the people.

SILBERNER: But you're making 10 percent, 15 percent, 20 percent less.


SILBERNER: He's seen a total of about 90 patients with depression, half of them also alcohol dependent. He's had a high success rate, though a few patients along the way dropped out - a woman whose husband wouldn't let her talk to him, a few people with alcoholism. Vikram Patel, a co-founder of Sangath, says one of the biggest challenges lay counselors face is the patients.

VIKRAM PATEL: They've never experienced counseling. They have no idea why a talking treatment should work.

SILBERNER: Patel says what makes an otherwise reluctant population willing to accept therapy is that it comes from local counselors who have a knowledge of local customs.

PATEL: They come from the same class. They come from the same community. They speak the same dialect. And so they have an identification with their patients.

SILBERNER: That's why Subhash knew he couldn't alienate Mrs. Naik's husband. He had to let him take part in the treatment. Rahul Sidhaye at the Public Health Foundation of India says this project, called Premium, is ready for scale-up.

RAHUL SIDHAYE: So projects like Premium - they come up with a proof of concept that this particular treatment works. Now as we move ahead, we need to actually see whether they work in the real world or not.

SILBERNER: Two recent studies in the journal Lancet show that patients who saw lay counselors did appreciably better than those who did not. China, Ethiopia, Nepal, Uganda and other countries are developing their own lay counselor programs. And Subhash Pednekar - he's happily on the job. For NPR News, I'm Joanne Silberner.


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