The program began in 2005, hiring 12 recent high school or college graduates who lacked medical backgrounds. Six “health assistants” received a week of training, and six “health counselors” had three months of training. The workers — paid the equivalent of $100 to $200 a month, significantly less than Indian psychiatrists — were sent to the six clinics.
Five days a week, the assistants screen almost every patient who arrives at the door. Pregnant women, minors and emergency cases are excluded. The screening is created for the program. It includes questions about physical symptoms, as well as emotional problems.
A patient meeting the criteria for mental illness is immediately sent to the health counselor, who provides a straightforward explanation of depression and anxiety and offers a range of treatments like talk therapy, yoga and, in conjunction with a doctor, antidepressant medication. Patients return every few weeks for follow-ups.
The screening and first consultation typically take a half-hour. In the old system, the few patients with diagnoses of depression were referred to a psychiatrist at one of two state mental hospitals. Dr. Patel said many patients failed to show up for appointments because they could not afford to take time from work or pay for transportation.
Most are also apparently wary of visiting a mental hospital. In India, the stigma of mental illness remains strong. To minimize the problem, health workers avoid using the words “mental illness,” “depression” or “anxiety” with patients, relying on more commonly used words like “strain” and “tension.”
The patients “are happy to talk,” Dr. Sudipto Chatterjee, a psychiatrist at Sangath, said, “as long as you stay away from the idea of mental illness.”
Dr. Chatterjee helped draw up the program and oversees the screeners and counselors. He said they not only diagnosed as well as doctors but were generally better listeners, partly because they have more time.
Psychiatrists usually “have five minutes to see a patient,” Dr. Chatterjee said.
In a society where many people have no place to share their worries, the effects of therapy can be striking. On a recent Saturday morning at the Siolim clinic, Ms. Upadhye, the health counselor, sat in her closet-size plywood-wall office, trying to stay cool under a negligible breeze from a tiny plastic fan, when a psychiatric patient arrived for a return visit.
A housemaid in her 50s who wore large glasses, bright bangles on her wrists and a light blue sari, the patient had originally reported physical problems like headache, insomnia and pains but had been given a diagnosis of depression. As Ms. Upadhye listened, the woman let loose a flood of words.
Speaking in Konkani, the predominant Goan language, she told the counselor that she was not getting along with her four children, especially her son, who had recently beaten her up in a drunken rage. She said she had no one to talk to. Holding tightly to her handkerchief, she began to cry.
Within minutes, she began to relax. Her expression loosened.
“I feel better when I tell my problems to somebody else,” she said.
Ms. Upadhye ended by reminding the woman to keep taking her antidepressant medicine and to check in regularly.
After the session, Ms. Upadhye reflected that just listening to her patients made a big difference.
“I feel like I’m doing something, just giving them time to ventilate,” she said. “They can tell their problems, they can share their feelings.”By DAVID KOHN
Five days a week, the assistants screen almost every patient who arrives at the door. Pregnant women, minors and emergency cases are excluded. The screening is created for the program. It includes questions about physical symptoms, as well as emotional problems.
A patient meeting the criteria for mental illness is immediately sent to the health counselor, who provides a straightforward explanation of depression and anxiety and offers a range of treatments like talk therapy, yoga and, in conjunction with a doctor, antidepressant medication. Patients return every few weeks for follow-ups.
The screening and first consultation typically take a half-hour. In the old system, the few patients with diagnoses of depression were referred to a psychiatrist at one of two state mental hospitals. Dr. Patel said many patients failed to show up for appointments because they could not afford to take time from work or pay for transportation.
Most are also apparently wary of visiting a mental hospital. In India, the stigma of mental illness remains strong. To minimize the problem, health workers avoid using the words “mental illness,” “depression” or “anxiety” with patients, relying on more commonly used words like “strain” and “tension.”
The patients “are happy to talk,” Dr. Sudipto Chatterjee, a psychiatrist at Sangath, said, “as long as you stay away from the idea of mental illness.”
Dr. Chatterjee helped draw up the program and oversees the screeners and counselors. He said they not only diagnosed as well as doctors but were generally better listeners, partly because they have more time.
Psychiatrists usually “have five minutes to see a patient,” Dr. Chatterjee said.
In a society where many people have no place to share their worries, the effects of therapy can be striking. On a recent Saturday morning at the Siolim clinic, Ms. Upadhye, the health counselor, sat in her closet-size plywood-wall office, trying to stay cool under a negligible breeze from a tiny plastic fan, when a psychiatric patient arrived for a return visit.
A housemaid in her 50s who wore large glasses, bright bangles on her wrists and a light blue sari, the patient had originally reported physical problems like headache, insomnia and pains but had been given a diagnosis of depression. As Ms. Upadhye listened, the woman let loose a flood of words.
Speaking in Konkani, the predominant Goan language, she told the counselor that she was not getting along with her four children, especially her son, who had recently beaten her up in a drunken rage. She said she had no one to talk to. Holding tightly to her handkerchief, she began to cry.
Within minutes, she began to relax. Her expression loosened.
“I feel better when I tell my problems to somebody else,” she said.
Ms. Upadhye ended by reminding the woman to keep taking her antidepressant medicine and to check in regularly.
After the session, Ms. Upadhye reflected that just listening to her patients made a big difference.
“I feel like I’m doing something, just giving them time to ventilate,” she said. “They can tell their problems, they can share their feelings.”By DAVID KOHN
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