Projects

Good mental health is recognised as an integral part of a person’s wellbeing and development embedded in all aspects of life, their beliefs, faith, culture, environment, spirituality, work, housing, education, family and community respect.
Our aim is to spread public awareness on mental health literacy in urban and rural India. Our work focuses on lived expertise stories of people with mental health problems and their families to promote public understanding about living with mental illness, help seeking and support for promoting mental health and wellbeing.
The Mental Health Literacy project is part of a larger project on mental health literacy in India funded by the UK Research Councils, to explore the role of applied theatre and creative arts in enhancing mental health literacy. The larger project involved a multidisciplinary team comprising mental health specialists, cross cultural scholars and dramatists and used narrative interviews with local people to help design plays and films which were then used to prompt further discussion.
The study took place in Kerala, a southern state in India with the highest Human Development Index (HDI) of 0.79 in the country. The state has the highest literacy rates among all Indian states at 98.9% and a life expectancy of 74 years which is among the highest in the country. The majority of the population are of the Hindu faith with significant Muslim and Christian minorities. Despite the health advances in Kerala, 14.4% of population aged 18 and above experience mental ill-health once in their lifetime, with 12.5% of individuals with suicidal risk. This is the highest of all the states of India and is almost twice the national rate of 6.4% (National Institute of mental Health and Neurosciences, 2017). This elevated rate is attributed to the high number of people suffering from depression in the state (Shaji et al., 2017). Mental health experts link the rise of depression to Kerala’s fast socioeconomic transformations (Halliburton, 2009). These have coincided with decline of the joint family system, discrepancy between high standards of education and low employment, and labour migration to the Gulf States, resulting in ‘gulf depression’ of these migrants and of the women left behind. Moreover, the gap between high expectations, and often harsh socioeconomic realities, the heavy consumption of alcohol, and pressure exerted on children by the school system, also reportedly contribute to depression (Halliburton, 2009).
The sample was constructed to include four different districts that consist of villages with farming communities, tribal colonies with low-income levels and living standards and towns and cities with higher income and living standards. The participants were recruited from eight different locations across Kerala, including Rural and Urban areas; Ernakulam, Chottanikkara (Rural) and Edappally (Urban); Palakkad (Rural and Tribal); Malappuram (Urban and Rural); Calicut (Urban and Rural). The Ernakulam district is the fastest developing region in Kerala gaining national and international level importance in business, trade, technology, education, health and tourism. Edapally, the urban site is a hub of leading business centres, educational institutions, health care centres as well as religious institutions. Chottanikkara, the rural site is located 16kms from the main town and is home to the famous Chottanikkara temple. In Palakkad district, Elappully is a rural area near the Kerala–Tamil Nadu border with a mix of Tamil Nadu and Kerala cultures. The second site in Palakkad, Attappadi, is a hilly area with reserved forests. It is one of the least developed and least literate places in Kerala. The majority of the population in Attappadi are from tribal communities. Calicut the third district is also an economical hub of Kerala with centuries of history in trade through the Indian Ocean. Payyoli is a rural coastal area situated 36kms from the central town of Calicut. Malappuram is the third-largest district of Kerala by area and the third biggest contributor to the GDP of Kerala. Over 70% of the population are of Islamic faith. Ponnani, the urban area is a major fishing centre. Vailathur is a rural village area located on the border of Malappuram and Thrissur districts.
Our emphasis is on formulating knowledge in new, creative and accessible ways, through use of creative methodologies and media engagement as an intervention to enable knowledge to be used in genuinely empowering and emancipatory ways by the public and services in urban and rural India.

Our preliminary discussions with Kerala Schools Leaders Associations (Kerala Registered School Managers Association KRSMA and Sahodaya Association), State wide & District Educational Officers, and Panchayat/Municipality highlight that it is important to focus on the mental health needs of teenagers due to the high prevalence of mental distress and mental disorders in this group and address the challenges they face during this developmental phase and the risk factors they are exposed to.
So we tried to explore on the mental health issues of adolescence students and the importance of treating mental health issues among students in India, with a focus on the state of Kerala by engaging school leaders like head teachers, principals, school managers of different schools together in different districts of Kerala.
The school leaders’ engagement programme was conducted 27 February 2023 to 5 March 2023. This aimed at a state-wide engagement with policy leads – School leaders, Educational Officers, and Local Government Educational leads (of Panchayats and Municipalities) for developing a sustainable mental health literacy programme (mental health championship programme) in Kerala Schools. Workshops were organised in the five different districts of Kerala namely Palakkad, Malappuram, Kozhikode, Kannur, and Kasaragod.
These workshops were conducted to answer the following questions.
How can we best facilitate a mental health championship programme in Schools in Kerala?
How can we develop a sustainable youth-led mental health championship programme in Kerala Schools (both state and private schools)?
How can we best integrate the mental health literacy programme into the school curriculum?
The discussion held in the different districts delves into the mental health perspectives of educators and students in Kerala, with a particular focus on adolescents, who undergo significant physical, emotional, and cognitive changes. There were three major facets of this issue. Firstly, it sheds light on the vulnerability and risk factors that can contribute to mental health challenges in students. These factors include the pervasive influence of media, especially social media, which, while fostering connectivity, can also be a source of anxiety, isolation, and low self-esteem. Substance use among students is another concern, with its associations with increased stress, anxiety, and depression. Additionally, a notable risk factor is the lack of informal education, as the development of life skills and emotional regulation is crucial for effective stress management. Furthermore, reduced self-esteem can hinder students’ confidence and decision-making abilities, while emotional suppression due to a lack of outlets for emotional expression can lead to stress and anxiety. Issues with education infrastructure, such as inadequate classroom conditions and teaching methods, further exacerbate these challenges. Lastly, constant peer comparison contributes to feelings of inadequacy and anxiety among students. The discussion uncovers the lack of mental health literacy within the school community, where mental health stigma and confidentiality issues hinder students from seeking the support they require. This underscores the importance of enhancing mental health awareness, open conversations, and ensuring the protection of students’ confidentiality when seeking help. Discussion emphasizes critical strategies for promoting mental health in schools. This includes the implementation of universal school-based counseling, offering support to all students regardless of whether they have diagnosed mental health conditions. Moreover, increasing access to professional mental health support addresses resource shortages and reduces the stigma around seeking help. Educating teachers and parents about mental health through mental health literacy training fosters a supportive network. Promoting mental health awareness through peer support enables students to support one another effectively. Incorporating mental health education into textbooks and courses provides students with the knowledge they need. Lastly, collaborative mental health support between teachers and parents ensures a coordinated approach to student mental health.
In conclusion, these discussions held among school leaders underscore the vital need to prioritize mental health in schools, especially during the crucial adolescent phase. It highlights the various risk factors faced by students and advocates for comprehensive mental health promotion strategies to create a nurturing, inclusive school environment where students feel empowered to seek help when necessary.

Context

The rational for our focus in Kerala is based on the higher prevalence of mental ill-health (14.4%), suicide (12.5%) and alcohol abuse in the state. Evidence show that one in every five students in the 12-19 age group in Kerala suffer from psychological distress, based on various studies from across the state. Children and young people are also vulnerable to being bullied, sexually assaulted and to the widespread use of psychoactive substances. The World Mental Health Report 2022 (WHO) highlight the need to transform our attitudes, actions and approaches to promote and protect mental health and to provide and care for those in need. Despite the high literacy rate in Kerala, mental health stigma is toxic in the State.

Method

Our Mental health championship programme will engage with selected students and teachers in schools and colleges with a 12-week learning programme using creative methdology for learning engagement. Our mental health champions (students and teachers) will engage with other students, and teachers using peer-learning model through a mental health and wellbeing forum set up in schools and colleges. This will be a rolling programme where senior students and teachers will engage with junior students and the wider teaching and support staff, this creating a whole school approach for developing mental health literacy, and behaviour change for wellbeing and resilience. Our pilot programme in selected schools and colleges will be conducted systematically using pre and post-bassline measurements of mental health literacy and substance abuse awareness, with monitoring of attitude and behaviour changes at regular intervals over a period of twelve months from the start of the programme. Our MH championship programme will have international engagement with Indian and UK based academics and mental health experts. We will conduct evaluations with teachers and mental health champions (group and individual meetings as appropriate) to explore teachers’ and students’ perspectives, roles in the school, their work, and to explore key strengths / risks/ needs and any further support needs. We will follow ethical and safeguarding polices and measures for working with students and teachers with the necessary approvals (with parents) and regular feedback to school heads/ leaders.
Outcome
The key outcome of MeHeLP MH championship programme is the creation of knowledgeable students and teachers on mental health literacy (including substance abuse awareness), equipped with the ability for promoting self and others mental health, well-being and resilience. MeHeLP MH championship programme provides added value to the educational ethos of the schools and colleges in developing socially responsible citizens with sound knowledge of mental health and wellbeing in their life journey.

Impact

Our MH championship programme will have a lasting impact on the school/ college environment by creating an interrogative space that brings together student/ teacher/ support staff attitudes, in the understanding of mental health and wellbeing in a way that allows schools and colleges to collectively imagine possible solutions for eliminating mental health stigma and promote help seeking and support. Our MH Championship programme will facilitate the development of fearless mental health and wellbeing dialogues and, explore novel initiatives for improving the education, health and living conditions of many in Kerala.