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Psychosocial Support Groups for North Indian Women

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Psychosocial Support Groups for North Indian Women PSYCHOSOCIAL SUPPORT GROUPS FOR NORTH INDIAN WOMEN “HOW CAN WE SHARE WHEN WE DON’T GO OUT?” PSYCHOSOCIAL SUPPORT GROUPS FOR NORTH INDIAN WOMEN By NICOLA S. GAILITS, B.A. A Thesis Submitted to the School of Graduate Studies in Partial Fulfillment of the Requirements for the Degree Master of Science (Global Health) McMaster University © Copyright by Nicola Gailits, January 2017 i McMaster University MASTER OF SCIENCE (2015) Hamilton, Ontario (Global Health) TITLE: “How Can We Share When We Don’t Go Out?” Psychosocial Support Groups For North Indian Women AUTHOR: Nicola Gailits, B.A. (McMaster University) SUPERVISORS: Dr. Lisa Schwartz and Dr. Elysée Nouvet NUMBER OF PAGES: 112 ii ABSTRACT Background: Although major depression is one of the leading causes of premature death and disability in India, there is little infrastructure to provide mental health services in the rural North Indian state of Uttarakhand. The worldwide burden of depression is 50% higher in women than men, however Indian women experience the double burden of gender disadvantage and poverty which restricts their autonomy and access to social support, and increases their risk for common mental disorders (CMDs). In this low resource setting, community mental health (CMH) models of care may offer the best approach to supporting women with CMDs. Objective: This study partnered with a local NGO in Uttarakhand to examine the factors influencing women’s participation in psychosocial support groups (PSSGs), and the groups’ impact on the women and their communities. PSSGs had been set up in the communities for a minimum of 6 months Methodology: Focused ethnographic research was conducted over three months in 2016, involving ten focus group discussions (FGDs) with seven unique PSSGs, representing a total of 43 women. FGDs were conducted with PSSGs that had been active a minimum of 6 months. They included both persons with psychosocial disability and their caregivers, primarily divided into separate PSSGs. FGDs were conducted across three different sites, with predominantly Muslim and Hindu populations. Additionally, eight key informant interviews were conducted with community health workers and mental health professionals. Data was translated and transcribed from Hindi to English. Results: The principal barrier to PSSG participation was gender inequality, more specifically, women not being granted permission to leave the home to participate. In terms of impact, the women explained how learning and talking about their own depression and anxiety increased their knowledge and improved their mental health. PSSGs created safe social spaces for women to talk, which increased women’s confidence to speak freely in their community. As a result of the PSSGs, women felt that they had reimagined their roles as community members, shifting from the role of receiver of help to provider. Communities were impacted by the PSSGs as women shared their mental health (MH) knowledge widely, and referred and accompanied community members to MH services. Discussion: These findings are significant because women in PSSGs were able to work together to improve their MH in the context of high gender inequality and mental health stigma. Greater ability to speak out and act collectively may empower women to contribute to household and community decisions, and participate economically, advancing their health and social interests. This research demonstrates how PSSGs can benefit not only the women involved but their community and its mental health. It highlights the importance of understanding models for CMH services that build on local resources and can serve as a model for other underserved communities. iii ACKNOWLEDGEMENTS From the very beginning, this thesis has been a team effort. Beginning with the initial literature searches, Laura Banfield provided essential searching help to ensure I had the best background on my topic. Once I was on the ground, the entire team of Project Burans staff members supported this research. This includes all the community health workers and project officers at all three sites. Particularly, the staff members at Mussoorie’s site, including Atul, Rani, Shalini, Kamla, and Samita dedicated their time and energy into showing me their work, and inviting me into their support groups. One person in particular, my friend and colleague, Pooja Pillai, made everything possible. Not only did she personally facilitate all the focus group discussions, she put up with each particular procedure I wanted in place, including wanting to debrief in 45-degree heat before lunch. Her comedic wit and charm made the focus groups an enjoyable experience for all those participating. Dr. Kaaren Mathias, my supervisor while collecting data, provided support from my project from the beginning. Inviting me to work with her staff members, she mentored me in areas of qualitative research and analysis, and invited me into her wonderful home and family. Lastly, without Prerana Singh, I would have had a tremendously difficult time translating my interviews. Her persistence and attention to detail was incredible. Back in Canada, my committee members at McMaster University were unwavering in their support for my project. From the outset, my co-supervisors, Dr. Elysée Nouvet and Dr. Lisa Schwartz, stood behind my aspiration to engage in community-based mental health research. I had not previously been trained in anthropology, and Elysée’s enthusiasm and instruction enabled me to complete an ethnographic study. Her insight throughout the analysis stages truly transformed this study. Dr. Lisa Schwartz welcomed me into her office from the very first day of my MSc. Her incredible guidance supported me throughout the entire process. Her philosophical and qualitative guidance were crucial, and her ethical lens provided critical feedback, particularly working with vulnerable populations. Sending myself off to a rural part of the Himalayas was an incredibly challenging experience. I am not sure how I would have made it through without the support of my family, particularly my mom. Her continuous mental support through phone calls, emails, Whatsapp messages, and any other communication possible, gave me strength in difficult times and helped me to stay safe. Lastly, I want to acknowledge my partner Vanessa. She stood by me throughout this project as a constant source of support and laugher. iv TABLES OF CONTENTS INTRODUCTION and BACKGROUND....................................................................................1 Summary: Study Rationale...................................................................................................1 Summary: Study Purpose ....................................................................................................2 Definitions............................................................................................................................2 Indian Women’s Mental Health: A Special Case.................................................................3 The Solution: Global Scale Up of Western Medicine? .......................................................4 Indian Mental Health Policy Context ..................................................................................6 Community Mental Health ..................................................................................................8 Psychosocial Support Groups In The Literature.................................................................11 Depression: Cross Cultural Variations...............................................................................15 INTERVENTION AND COMMUNITY CONTEXT...............................................................17 Project Burans.....................................................................................................................17 Intervention: Psychosocial Support Groups.......................................................................17 Study Population And Site Contextual Features................................................................20 Community Context...........................................................................................................23 Community Mental Health Context...................................................................................25 METHODOLOGY.......................................................................................................................30 Research Methodology and Approach...............................................................................30 Recruitment........................................................................................................................33 Data Collection...................................................................................................................34 Data Analysis .....................................................................................................................43 Rigour ................................................................................................................................44 Ethical Considerations........................................................................................................46 RESULTS......................................................................................................................................49 Part 1: Going Out: Women’s Freedom of Movement........................................................49 Part 2: Successful Support Group Qualities.......................................................................59
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