I. Hirstory

Seher is a service program of Bapu Trust, a psychotherapy program that provides counselling services with feminist sensitivities and sensibilities to deal with an emotional distress. Individuals with long standing depression, same-sex preference or orientation (5 gay men and 7 lesbian, transgender women seen in Seher Pune in the last 3 years), family problems (Marital and relational problems), dispute over child custody, traumatic life event (death of a significant other, sexual assault etc), severe mental illness, low on confidence and unemployed have been approaching Seher since its formation in 2004 in Pune and in 2005 in Mumbai. Support services provided by Seher are functioning with the help of skilled and well-trained counsellors.

Seher’s world-view and ideological understanding have evolved out of collective wisdom of last eight years of multifaceted activities, rigorous analysis and lively debates on mental health issues within Bapu Trust and with other mental health movements.

Bapu Trust was established under Bombay Public Trust Act in Pune in the year 1999. Basically Bapu shaped up in 2001 as research, resource and Advocacy centre. Its first project, Centre for Advocacy in Mental Health, its executive office was started in 2000. Till 2003 it focussed on Gender and Mental health project with clear advocacy positions on looking at mental health services. It critiqued biomedical-brain imbalances-symptom reduction approach for dealing with mental illnesses as the way of looking at overall mental health services. Existing mainstream approach has no understanding of psychological and social processes that go into personal sense of mental wellbeing. It was with an understanding that to be free is not merely to cast off one’s chains but to live in away that respects and enhances freedom of others that Bapu was established. The project foredoomed one of the social determinants of gender-how women’s reality and circumstances impact their mental health status. It also aimed to find answer to the mind-boggling question:

What are the alternatives that can be evolved in collaboration with users and survivors of mental health system?

Vision and Mission of Bapu Trust:

“We strive to change the structural, social, legal and policy environment, so that they remain just and fair to people with a psychosocial disability. We are struggling to restore the right to life and liberty of persons with a mental illness. We fight unfair, forced or abusive mental health interventions. We conduct research and train and monitor constituencies involved in policy or other vital decision making environments in mental health (e.g. judges). We work with people with psychosocial and psychiatric disabilities; so that they can get good quality mental health care and can live in an unbiased society, with knowledge, understanding, dignity, self-determination and self-respect.”

Genesis:

Dr. Bhargavi Davar, Founder and Managing Trustee of Bapu Trust has made a pioneering contribution in the promoting right based approach to mental health. Her childhood experiences shaped such a vision. As a mainstay of the institution, she has created an environment where hegemony of psychiatric approach to mental illness has been challenged by young professionals in the varied fields of health care, social work, women’s rights, social movement and human rights.

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Box: Bhargavi’s Vision

I was involved in women’s movement for number of years. I had several mental health problems. Just a political language of equality does not help someone, who is going thro’ personal psychological crisis. Also needed are additional knowledge and skills on healing. It is important to develop a space where political and therapeutic dimensions of mental health could be mixed. Amita and I started Bapu and at that time there was no intention of doing Clinical work. We aimed to do only rights and advocacy work in mental health. Demand for service was quite high, particularly women-centred services in mental health programme. We were clear that what we wanted do was not traditional psychiatric practice. We had met several victims of psychiatric services. Our concern for social justice and law background motivated us to challenge the foundation of mental practices in India. Later on we realised that mounting a critique is not enough. We need to promote values we believed in to apply in the field. “Patients choice” can not be an abstract concept. Mental health service has to be all the time negotiating Bapu’s overall values, which are political, development values. Then we started looking for someone with clear feminist politics and mental health skills. This person also needed to be someone who can work independently and engage with Bapu’s values. What is this advocacy framework? For them after they provide basic services, they append HR framework. We were also clearly looking for someone with core belief in non-medical intervention. She also needed to be comfortable with movements and campaigns. We checked out several self help groups. We wanted structured service programme.”

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Workshop in 2002- Bapu Trust decided to start a Self Help Group of women mental health seekers to understand and deal with structural psychological factors shaping women’s predicaments. During discussion sessions of the SHG the seed of Seher was sown. People who were in Bapu Trust had first hand experience of psychiatrist system. They felt that seekers of mental health had their own parallel story which was not congruent with psychiatric labels that were used to pigeonhole them.

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Box: Darshini’s Dilemma

When I joined Bapu, we felt necessity of starting SHG. First we thought of joining other Pune based SHGs working on schizophrenia and depression. I felt left out as I was not part of them. I was just an observer. I was in dilemma. In the SHG, most of them were middle-aged, I was young. A psychiatrist was facilitating the group. He was giving lectures on various psychological problems. It was like a class room lecture. I stared asking myself, how do you call it a SHG? I shared my doubts with the group. Bhargavi asked me,
“What are your expectations from SHG?”
I was not clear. Questions that bothered me were
What type of SHG should we have for women? For e.g. should it be a drop in centre where women can relax?
Should it be a speak-out centre where women can get democratic space?
What type of facilities should we provide for ‘User’ and ‘Carer’?
How can we avoid hierarchy between them?
To us “Users” are not consumer of our services but they are part of our team.

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Ketki was introduced to Bapu Trust by a Child therapist in Pune who was its Trustee and who had Clinical knowledge and sharpness on feminist understanding. In Ketki she saw someone who would understand social factors such as poverty, caste, etc and social movements and collective functioning. To her, initially, lot of things remained as ideas. Questions that bothered her were how does various types of identities impact what goes on within the person? How multiple identities get operationlised within individual’s inner process and how do you envisage mental health programmes?

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Box: Ketki’s Conviction

I was convinced that we needed a clinically sound programme. When I joined Bapu I was well-documented in history of user movement in psychiatry that has acquired a political identity within the mental health system, power relation between quasi mental health professionals and ‘patients’, coercion in treatment by “carer” and mental health professional, “odourless colourless liquid mixed in food and drinks”, goading by carers to patients for e.g. “Don’t sleep too much.”, “You must go out for a walk”, “What activities shall we do?” I have a research background. Moreover at NIMHANS I was trained in Clinical and counselling services. I asked what we should start. A Therapy centre or SHG? SHG is a MUST but services such as therapy, counselling also should be given as lot of women can benefit. Lot of us have taken help of professional psychotherapists. Most of the providers of mental health services have themselves been user. We opened services of Seher in April, 2004. We made brochure and poster of Seher. We met various organisations. As part of Seher inauguration, we had made personal diaries of women.

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Library and Documentation Centre:

Anant Bontadkar is very committed and proactive librarian who keeps in touch with all projects of Bapu and as per the suggestions of the staff and visitors acquires books, journals and documents on mental health and related issues/themes. He has prepared subject catalogue. Nearly 60-70 books are purchased in a month on different perspectives in psychiatry, psychotherapy, mental distress and disorders, lifestyle, knowledge and self help, women and mental health, child mental health, adolescent and youth, disability, elderly, Self Help Groups, sexuality, mental health theories, counseling, advocacy. At present, Bapu Trust has2662 books, 221 journals and newspaper clippings on 54 themes. Seher’s take on the library is quite enthusiastic. For action projects, library serves as a resource centre. It motives the activists to read. It is very difficult to find literature on mental health within the mainstream libraries. So it really helps the members and visitors to get valuable reading material on mental health. Seher members plan out reading. Seher members’ suggestions for library development are always welcomed by the Anant Bontadkar.

 II Values:

The Seher team had its moorings in different social movements, had lot of anger, unresolved emotions and trauma. Being a mental health organisation, the team had to be aware that before preaching to the world, they had to look at themselves and get convinced that love is important. One of the important thing that was established in the organisation as a value is non-violence.

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Box: Aparna’s Assertion

We have to be non-violent. It is an important value. We appreciated all the time the difference between assertion and aggression. When people have problems, they must communicate. Keeping transparent process for communication is very important. We encourage positive, constructive affirmation and feedback as they are extremely important so that the work goes further. We have spent lot of time, energy and money on how to create an organisation that is not punishing in its approach. We have forums which are explicitly set up for conflict resolution, T junctions- theme meetings on Bapu dilemma. I was part of Bapu Trust with Clinical understanding of mental distress and feminist understanding of psychiatric notion of mental health that starts with a premise that distress originates from within the individual-intra-psychic factors. E.g. cognitive therapy believes that distress results primarily from irrational thoughts. Psychoanalysis also attributes depression to inter-psychic factors. Feminist understanding of depression is rooted in socio-cultural and overall material reality under which patriarchy controls women’s sexuality, fertility and labour.

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Manisha and Aparna were approached for value clarification. Ketki had experience of working in hospital based interventions. Cognitive shifts were taking place in Seher team member’s psyche. Modules, concept notes, papers were prepared by Ketki, Aparna, Darshini for their own clarity on Feminist therapies. They called meeting of mental health professionals-doctors, activists, counsellors. As a result, half backed idea got crystallised and they also very enthusiastic response. Couple of psychiatrists and women’s group’s activists were extremely encouraging. Seher organised a 4-day workshop on “Women in Depression” that was conducted by Dr. Anisa Shah of NIMHANS.

Seher also conducted two day story telling workshop with Neelam Oswal. Deepa is a story writer. She wrote a story of Mrs. Agniohotri based on her personal experience. Ketki wrote story with mainstream clinical perspective that uses diagnostic labels such as “Crying spells”, “suicide ideation”, ‘low moods”, “fatigueability” so on and so forth….This workshop made the participants learn the impotant fact that A woman who narrates how she is subjectively experiencing various relationships gets essentialised and lexicalised into boxes.

Small attempt was tried and tested, from SHG to Seher. Why paradigm shift? Bridge for this was Bapu’s understanding of women’s emotional distress as “Women and Mental Health”.

“Apart from running a centre, you should go out to the community and think of running your own community health centre.”, averred Dr. Meera Sadgopal, a veteran feminist health activists and medical professional. She also gave a name “Women Overcoming Mental and Emotional Concerns” for this effort to signify that a person who experienced mental health problems runs community based mental health centre.

Septicism marked the perceptions of professioal psychiatrists’ about Seher’s efforts in the initial phase. How would so called anti-psychiatry group know, how to provide mental health services?

With formation of Seher we had to demarcate between “Friend versus therapist” and “Client versus therapist”. Till then, Bapu was primarily a research organisation and it believed that the services should be available to the members, those who had language of psychology and psychotherapy. Seher also had to negotiation between “universal sisterhood” and “individual concern and personal journey”. Seher acknowledges the therapeutic values of collective struggle.

Seher team in Pune and Mumbai is working in a very very resource poor, resource less system. It works in collaboration with the mainstream contacts in the Community, Sasson hospital, Beggar’s Home Reception Centre and Family Court.

 III Appointing an Advisory Board:

Seher decided to constitute an advisory of experts who were on the same wavelength in terms of intellectual integrity, sensitivity and critical faculty. The following panel was selected:

• Dr Bhushan Shukla has an experience in social science research as well as inbuilt understating of research- protocol documentation, feed back, and consent form.

• Dr. Bhargavi Davar, a feminist psychotherapist

• Anupama Keskar who has a personal experience of being “user” and an identity of sociologist

• Dr. Amita Dhanda, our Trustee and an expert on Law and Mental health

• Dr. Raghuram Raju Teacher of Philosophy and our initial first sounding board who regularly attended Bapu’s yearly meetings

• Lakshmi Rao

Initial Phase of Seher:

In the beginning period of Seher’s functioning , huge focus was given on peer learning and on the job training. The new-comers had to be oriented to professional work ethics. Human Resource performance guide was prepared. Need-based structured system was put in place. The leader was guiding and juniors were following. Programme guide, goals and objectives were prepared. Three months were devoted to self evaluation to examine allocation of people related time and personal growth. Indictors for target-based evaluation and monitoring system were evolved.

Issues that preoccupied us in this phase were modus operandi of case conferences, transparency ad accountability, realistic planning, barriers in service programmes while entering partnership with other kind of systems, element of predictability, planning- review mechanism and role directory, Performance guide system, indicators of growth, Improving, learning, quality job, professional development, reading time, training programmes, study circles HR system, issues of discipline, accountability, do we understand that within our team also there may be distress, leaves- medical leave, rejuvenation leave to relax, to prevent burnout……

Accountability at Seher

Accountability programme accommodates individual aspirations as well as Organisational Development. Three important concepts need to be explained here.

Role directory: Each profile has certain sub areas within which each profile needs to perform. All are professional by training.

Performance guide system: HR directory in which each designation, person’s role and work profile are mentioned. It is based on roles ascribed to particular designation.

Indicators to signify programme leader-development, implementation, and mentoring-people development, review mechanisms, need assessor, multiple levels at which these review mechanisms operate.

Fee structure:

There is flexibility in charging of fees for counselling services. For Seher, a person is the programme. All that you need to run a centre is basic infrastructure and a professional. It is not heavy in terms of infrastructure. To make organisation self sustaining nominal fee is charged from the client, Rs. 150/- for assessment and 125 for follow up.

Profile of work at Seher:

Work of Seher is very different type and demands bounce back our thoughts through constant feedback from peers. Seher operates as community. Case presentation brings to the fore feeling about person whom we are counseling. Peer learning is the method most handy as our approach is not mastery or specialist driven.

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Box: Voluntarism, value based intervention and depathologisation

Ketan (23 years)’s parents came to Seher. For 4 years, they had organised treatment. On sly we have to mix medicine tea, food. Is not regular about his daily chores such s brushing his teeth, bathing, etc. At times he is violent. Mother told us that I can’t handle this child and he is not ready to come here. I paid visit to client’s house. He looked at me and left the room. When I told him that I had gone to visit him. He was irritated and told me that he did not want to speak to me. I spoke to him. I expressed my intention told that I was trying to bridge the gap between him and his parents. For which he needed to visit Seher. We don’t use drugs, injections. Main problem was undemocratic environment in the house. After our sessions with parents they stopped nagging him. Started respecting him. Seher is committed to Voluntarism, value based intervention and depathologisation. Client himself or herself approaches the centre-voluntary cases-We have shared belief that chemical therapy could be one of the many choices in mental health services, certainly not the only and need not be the first one. Even in normal circumstances, we go thro’ several highs and lows. Environment also has a lot to play in this continuum– It is very fluid. Person can have capacity, but can be very low. Seher opens up more opportunities for voluntary dialogue for care and treatment.

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Handling violence:

Dissatisfaction of members and clients is handled through discussion. The institutional programmes such as Seher’s Work at Family Court, Reception Centre of Beggar’s Home and Community Based organization Snehadeep Jankalyan Foundation in Kashewadi, Pune pose far many challenges. Government officials and people working in the institution must work in the community so that possibility of creative expression in their approach is ensured. Within Seher level of energy remains high and showdowns are less because of timely intervention. Power needs are sensed pretty early, there are regular discussions. People’s roles are clearly defined and cross ventilation across projects are encouraged.

At times, Seher does face troubles. Seher handles inter-personal problems with utmost sensitivity. In CAMH, we had 5 sessions before a person was asked to leave. Those who join the group, sometimes, individually develop their own programmes.

Two years ago, Bapu Trust moved from nice place to not o nice place. Three new people joined. They deconstructed Bapu Culture, leadership style and therapeutic values. There is covert message within the organization where it conveyed that no aggressive behaviour must be resist. It is an important organizational issue. No amount of psychologising can justify aggression. Hence, the members should avoid emotional language, passive aggression.

What do Seher members do for their own wellbeing?

Self preservation is an important art of living that every mental health worker must master. The members of Seher learn dancing from a professional dancer, go to Jim, do physical exercise and also going for therapy themselves.

Their expectations in terms of financial gains are less. “I can’t work at corporate sector where competition is the value. I want to work with cooperation principle.” told a newcomer.

Keeping disability framework in mind, we worked out responsibility for her. Between professional and personal life, sense of ability & disability play a very important role in determining individual’s choices. It is very crucial to identify ones own distress, work with ones own distress. One has to see that your unhappiness does not spill over- power, victim hood, and distress about unfulfilled dreams of any kind manifest, reflect in counseling. You have to decide Client-Counselor boundaries. Where can you meet your client? How much fees should be charged. What are gender dimensions involved?

“Our own likes and dislikes about our clients, question of ethics, marriage between psychological and clinical knowledge are the major concerns in our work. Individual stories of clients are central to my work with the goal of empowerment and healing. interventions are grounded in understanding of interpersonal, intra-psychic and social political understanding.” Responds Aparna.

When Seher counsels gay person, the therapy will not be on homo-phobia, therapy will be about nuanced understanding. For e.g. his relationship with his father. Understanding of person’s life-situation is understood while talking to him so as to make a person understand how to deal with his shame and how to accept his identity with pride and face his family?

While working with the mainstream institution at times Seher has to make compromises. But at the same time, the community work provides various experiences of happiness, joy and emotional enrichment. Seher has formed widow women’s group, single women’s group. Sometimes the team members experience clash of values. e.g. sexuality of 40 plus, sexuality of 25 year old, managing anger, every thing that women do to pamper themselves.

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Box: Centre for Advocacy and Mental Health: Puja and Maithreyi

Puja: I joined Bapu two years back. I was working in the area of children with learning difficulties. I have done Clinical psychology from Pune Vidyapeeth. I have worked on alternative mental health, Oral history archives of mental health experience, documentation work in the office. Art based therapies in Beggar Home. Ketki, Rushali and Kavita conducted sessions on art based therapy.
Maitreyi: I joined Bapu 9 month back as a coordinator for CAMH. I have done mass communication. I was working with NCAS on communication in the advocacy unit. I am concentrating on understanding issue of mental health and consolidation of CAMH, Aaina-a journal published by Bapu Trust, workshops, conducting interviews, create spaces that are more accessible to users to express their feeling, emotions depicting coping mechanisms, strong experiences of people with mental health system. We are providing space for discussion on life stories of people- introspection, look back at their own lives, how certain experiences shaped their decision ad course of life. I am working on software, designing software, communication material. I meet movement people who are working on gender, development and mental health issues. We are creating users space, a group of users who would be able to take leadership. Regarding reference from Seher to CAMH, we respect people who are users but don’t wont to identify with advocacy work. “We want only therapy.”
Services and advocacy are two separate spaces. Advocacy is outside therapeutic relationship. Hence we don’t exert pressure on user group to join the advocacy.
Alternative Mental Health (AMH): Self recovery is possible. Each one of us contributes to healing. AMH is one T junction for Seher, CAMH and JMAA. Vrushali did drama therapy sessions. Green therapy session. Many of us have tried Homeopathy.

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Seher organized two sessions on sexuality of single women with MASUM that highlighted various kinds of identities of women as mothers, working women, lovers, friends, sisters, sisters-in-law so on and so forth. Resolving multiple interests and competing demands thro’ capacity building and dealing with value dilemma as an uphill task. If these women face mental stress, what kind of mental health choices is made? How to ensure human values around various identity- gender, caste, religion, age? Instead of protest, at Seher there is spirit of dialogue as the members have accepted inevitability of dialogue. Dual process of service provision and advocacy has been interwoven into each programme of Seher that targets each system the members are working with. They try to deconstruct stereotypes related to Family regarding ‘good woman’, ‘bad woman’, ‘mad woman’, ‘wise woman’.

 IV Seher’s work at Beggar’s Home, Reception Centre, Pune

Introduction:

Under the partnership with Action Aid, interventions in beggars’ home reception centre, Pune were initiated in April 2005. Project was initiated with the capacity enhancement program with the staff of Beggars’ home reception centre about the awareness about the basic concepts of mental health & self. After written MOU with the Commissionerate of Women & Child development, psychosocial interventions were started in the month of Nov.05. Prior to that, team invested one month in understanding the system& its various procedures, roles of various staff, services provided within the institution & overall approach & attitude of staff working in these institutions. Study period helped in gaining insights into the system & its functioning, needs of the residents with the objective of pitching the interventions. On the basis of learnings during study period, interventions in beggars’ home started on 9^th Nov.05.

Since then, project had undergone many reflective reviews (within team as well as with external people like trustees’, funders) and subsequent changes in strategies of interventions.

Right to Dignity:

Psychosocial interventions in Beggars’ home, Pune
Beggars’ homes are custodial institutions established under Bombay Prevention of Beggary Act (BPBA), 1959. There are 14 beggars’ homes (some of them are reception centers and some of them are detention centers) in Maharashtra, which are being managed by Department of Women and Child Development. Under BPBA, beggary is an offence and person who found begging or suspected as beggar is arrested & brought to beggars’ home under this law. Though there are various provisions under the law to deal with such person, Seher team’s experience says that invariably people are being detained for the period of one to three years. Most of these people who get arrested are homeless people due to various reasons such as extreme poverty, migration, unemployment, violence, problems within family and interpersonal relationships, addiction & mental illness, social and natural disasters etc.

Objectives of the program:
1. To identify / assess people with Mental Health needs within the Beggars Home Reception Centre, Yerwada, Pune.
2. To provide mental health care and services to those who have Mental Health needs, during their period of stay in the Beggars Home Reception Centre, Yerwada, Pune.
3. To provide rehabilitative services to those who have been released from the Beggars Home Reception Centre, Yerwada, Pune, and reintegrated with their families / communities.
4. To design and implement recreational programs in the Beggars Home Reception Centre, Yerwada, Pune with the purpose of creating mental health enhancing environment in the institutions.
5. To conduct training and capacity building of the staff in the Beggars Home Reception Centre, Yerwada, Pune.
6. To initiate rights based work with respect to certified Institutions and Statutes related to certified institutions.
7. To facilitate communication and feedback mechanisms with / from the System.

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Box: One day in the Life of Seher Team at the Reception Centre of Beggar’s Home

Seema, Vidya and Amruta constitute Seher team for counseling at Beggar’s home.
They first of all meet Mrs. Ambika Garg (M.S.W.) and Dr. Anjali Patil (M.D., Gynaecologist) and discuss day-to-day matters regarding their clients. Then, they meet inmates at the Reception Centre from different language groups, temperamentally different men and women of varied age groups in the open space under the tree. Kantabai is crying as she wants to meet her son. Ramesh is autistic. Shanti is brooding and wears a forlorn look.
Mahesh is sobbing and saying, “I am not a beggar. I came from village to purchase agricultural equipments. I got down from the train and was moving out of the Pune station and 2 persons from the police van came and arrested me. Please help me get out of this place.”
Articulate Kisan howls, “How can they call me beggar? I was going to Sasson hospital to take anti-rabbis vaccination as I was beaten by a dog. This is nothing but violation of my human rights.”
Each one is vying for attention. All of them join the chorus and plead for release. _ The scenario is haunting. Everyone is sad and silent. The Seher team talks to them about drawings they made in previous session. Clients of tailoring unit tell them that during the week they stitched 24 shirts and half pants. Seher team talks about growth of plants they had nurtured…

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Understanding the Role of the Organization in Development of the Community:

Beggars’ homes house the most marginalized group of people. These are the people who live; wander on the streets due to various problems, which are of structural, interpersonal or emotional in nature. After doing the initial groundwork, Seher realized that within the Department of Women & Child, these institutions are the most neglected ones’. There are no monitoring mechanisms like visitors’ committee, monitoring bodies or even visitors to many of the remote homes in Maharashtra. Beggars’ on a whole is heterogeneous group consisting of old, disabled, mentally distressed & ill, mentally challenged people, women survivors of violence, people in addictions etc. There is a great stigma attached to ’being a beggar’. Beggars’ homes being the custodial institutions normally land up in being classification centres for assessing ’who is real beggar? And who is not?’ Though the law (BPBA) is not of criminal in nature, spirit of the Act criminalizes beggary and practices adopted by beggars’ homes reinforce this further. Unlike jails, this group doesn’t have access to legal mechanisms due to its invisibility & lack of priority by government, which worsens their condition further. Though the group is the most marginalized and vulnerable population, it is not perceived so by the govt., which gets reflected in the kind of services and urgency to provide these services. On the contrary, popular notions about this group are ’being lazy, irresponsible, unproductive and unwanted by the families & society at large’. Project team has been working with this group & trying to demonstrate to the officials of the beggars’ home that it is the intent, perspective, values & skills while working that matters most. Through this project, Seher has been able to reach one of the most marginalized groups of people i.e. people with mental distress/illness. Operating within the limitations of the nature of the institution (i.e. being a reception centre), project team could address the immediate issues of distress. They range from giving information about Beggars’ homes, the law, their rights such as contact with the outside world for their release, helping them to establish contact with their families (if they desire so), working with the families to understand the person in his/her context of distress/illness, demonstrating the system of creative mechanisms of networking & reintegration in the community/families, creating platform for the residents to share their emotional distress & seek support from others in a group etc. While implementing all this, one of the main objectives has been to develop mental health enhancing environment in the institutions.

Coverage of the programs:

Presently, Seher is involved in group sessions & individual sessions at the level of beggars’ home reception centre, capacity enhancement programs with the staff of beggars’ homes in Maharashtra in collaboration with Dept. of Women & Child Development & CAMH is actively contributing in advocacy initiatives with regards to Bombay Prevention of Beggary Act along with other stakeholders working in the area of homelessness.

Profile of the residents:

Residents of beggars’ home are mostly men. Number of women inmates is less due to less no. of arrests of women. Most of them are middle aged and old. Education level of the residents is on an average up to primary level. Socio economic status of the group can be classified as weaker sections. Though most of the residents come from Maharashtra, there are people other states like Karnataka, Tamilnadu, West Bengal too. Most of the inmates were into unorganized daily wage work of various kinds such as doing helping jobs with caterers, bigari work, working with food stalls, small hotels. However, there is smaller proportion of people who were without any gainful employment. They were either into begging or wandering on the streets. Most of the clients were married and separated from their families due to various reasons such as conflicts within the family, addiction (very high), death of the spouse and mental illness. There were clients who were single and wandering due to addictions and/or mental illness.

Chief complaints reported by clients/ reasons for referral:

• Emotional distress, feelings of helplessness, anger, sadness due to the arrest.
• Somatic complaints
• Stigma of being kept in beggars’ home.
• Irrelevant talk, self talk
• Poverty of speech
• Depression, withdrawn
• Grandiose thoughts
• Constantly crying
• Hyperactive behaviour
• Disturbed behaviour

Clients (From Nov. 05 to June 08):

Total no. of clients	61
No. of women	18
No. of men	43

Group sessions in Beggars’ home:

Group sessions	No. of sessions	No. of participants
Arts based therapy sessions	31	On an average 23 (total)
Recreation sessions	14	On an average 15 (in one session)
Green therapy	8	5+ facilitator+Gardener
Bibliotherapy	8	On an average 8
Group sessions	19	On an average 25(in one session)
Outdoor sessions	15	On an average 15 in each session

Seher decided to conduct capacity enhancement programs with the group of caregivers & probation officers/medical officers/Superintendents of Beggars’ homes across Maharashtra as they are the people who are in close contact of residents (caretakers) & their role is that of the rehabilitation of the residents (probation officers). Either for working with residents for getting the necessary work done or for any rehabilitative efforts, development of understanding and perspective of mental health is very important. Before conducting these programs, needs assessment exercises had been conducted with the above-mentioned group & that of with the group of caregivers to prepare the module of the program. Main issues that came up during the discussion were mental health needs of the staff and need to have clarity about basic concepts of mental health & basic skills of working with people (we purposely focused on skills of working with people rather than working with those with severe mental distress as the proportion of people with severe mental illness is less compared to the vast population with distress). Our module covered these aspects and in addition to this, there was discussion on linkages between homelessness and mental distress/illness in an attempt to clarify some of the myths/stereotypes that participants had about residents in beggars’ homes. Participants appreciated the methodology, content and spirit of the program (as mentioned in the feedback given by participants). To understand the usefulness of the program Seher has sent an evaluation form to all the participants & follow up program with this group is planned in this year on the basis of their suggestions.

Capacity enhancement programs with beggars’ homes’ staff:

No. of programs	No of Participants	Profile of participants
8 (From April to July 2005)	On an average 15	Beggars’ home staff (from caretakers to medical officer/Probation officer)
2 (Nov. 06)	24	Probation officers, Medical officers & Superintendents of beggars’ homes in Maharashtra

Capacity enhancement programs for the group of caregivers have been planned in this year consisting of components of rejuvenation exercises, information pertaining to mental health concepts and basic skills of working with residents of beggars’ home. An attempt is be made to enhance the capacity of this group with the objective of replicating some of interventions Seher is doing presently. e.g. group sessions, outdoor activities etc. with the residents of beggars’ home.

Relationship of Bapu Trust & Dept. of Women & Child Development/Beggars’ home:

Dept. of Women & Child Development has been co-operative with Bapu Trust right from the beginning. However, neither officials of the department nor of beggars’ home expected Bapu to question their functioning & practices. When team members used to question certain practices, there was resistance & hostility from the officials. Seher team has taken initiative and showed openness in giving & receiving feedback to/from the system. Feedback mechanisms are being developed to encourage communication. In the quarterly reviews or meetings with the Department for renewal of MOU, it was stated by the Beggars’ home staff that they find the project relevant in terms of its innovative interventions, quality of time spent with the individuals, relationship with the residents (observed by caretakers also). However, in terms of impact, issue of being process oriented vs. outcome oriented (demanded by system in terms of number of clients, number of people referred for medication, number. of people who are rearrested for begging etc.) has always been discussed and negotiated. E.g. Seher team has always exercised great care in referrals to Psychiatry considering the factor of limited period of stay in reception centre. There are multiple factors which are being considered before this decision like how far the person is willing to exercise his/her consent for medication, dialogue with the psychiatrists about the profile of the group and issue of side effects of medication, possibilities of follow up, effects of relapse etc. Processes like this could be of lesser importance to setting like beggars’ home where sheer number is the only relevant factor. Referrals to alternative medical systems had been discouraged citing the audit reason. All these factors do play an important role in the pace of interventions while balancing it out with the required work with systems. Team members have been playing the dual role of carrying out psychosocial interventions at one level and continuous working through dialogue, negotiations, disagreements & at times, confrontations to ensure the efficacy of the program.

While project had attempted to address the problems of people with mental distress to a great extent & people with mental illness to some extent, special populations such as people with multiple disabilities or with mental retardation remained largely left out group from the interventions. Though conscious efforts have been made by the team to reach out to all, due to the level of disability and lack of requisite services, their issues largely remained unaddressed.

Assessing the Successes and Failures of the Programs:

Cost efficiency: While considering cost efficiency, costs of human and material resources are relevant. Working in institutional settings against the structural & attitudinal barriers posed by the system, issue of worker burnout assumes great importance. Organization has given serious thought over this issue and came up with strategies to deal with it. Initially, only two people used to be involved in the implementation of the activities, later on others in service team got involved in the work. At a given point of time, two workers visit beggars’ home who have either independent or joint tasks. This helps in creating support for the team members.

From individual to group approach:

Constant reflections & reviews have helped us in relooking at our strategies and interventions. e.g. when we realized that group sessions are being received well compared to individual ones’, we adopted it as one of the main interventions of working with people, building rapport & working on group processes for enlisting support of other group members. We have experienced that once people are comfortable with whom we are their discomfort of individual sessions lessened. While conducting individual sessions, Seher has reduced the duration of the session to 15-20 minutes from that of the standard one of 45 minutes-one hour as clients are more comfortable (with respect to attention, concentration & participation) with the same.

Most of the activities conducted in beggars’ home are cost effective. They don’t require many material resources but definitely require lot of energy, patience and positive attitude on the part of the counselor/facilitator. Whatever group activities had been conducted so far required things like brushes, paints, papers, newspapers and other small stationery & art/craft items. Group members are encouraged to demonstrate their skills or art while conducting these sessions. As most of it is of minimal cost, Seher discusses and negotiates with the officials of beggars’ home to bear the expenses. E.g. newspapers. After discussion and continuous follow up by Seher team, beggars’ home has now started subscription of daily newspapers. Recently organized ’funfair’ is a classic example of sharing the resources required for the event, an attempt to enhance mental health of residents. Bapu Trust has always tried to negotiate the resource sharing strategy with the systems with whom it is working, be it for training, group sessions or events. Due to our persistent efforts and response to the last program, Department of Women and Child Development has agreed to partner with Bapu in resource sharing for the next capacity enhancement programs.

Gender sensitivity

Continuous dialogue with staff and officials regarding observed difference in terms of how women look at arrest, it’s effect on mental health and amount distress experienced during the stay and amount of anxiety experienced regarding re-integration even after release has been discussed with B.H officials during review meetings, training program and on case to case basis. Seher team makes conscious efforts in making women comfortable in group sessions, outdoor sessions and individual sessions and providing art material, play material in the female barracks. Discussion on women’s issues and stressors in the group sessions and gender sensitive material selection are done without fail. In terms of Client level Impact, Seher has been able to provide an emotional space available in the custodial institutions. As a result, group serves supportive role with Seher counselors or without Seher counselors.

Conclusion

Seher team has visited different beggars home from Maharashtra to understand complexities of the need and kind of services and resource available in each setting. Seher team has made referrals to MIMH – for psychiatric evaluation, Homeopath and Shelter home. Seher has also raised the issue of the violations of the different acts and provisions, as a result of forceful confinement of ordinary citizens in institutions like Beggars Homes and done advocacy work about the human rights and constitutional violations in such institutions. At the same time Bapu’s collaboration with the government dept. of Women & Child Development has provided opportunity to make efforts at training, skill transfer and capacity enhancement sessions with the staff of the Reception Centre at Beggar’s Home, with Superintendent, Probation Officers and medical Officers from Maharashtra, With care-takers from Maharashtra- 6 programs ( No. of participants-110) in August and September 2007, With staff from B.H reception center, Pune. Seher has organized 8 Skill based trainings programmes involving fun games, play activity, group activity etc. It organized 3 programmes for Perspective building on HIV and 4 programmes on Addiction. It also succeeded in holding Movie screenings, “Raksha Bandhan” celebration with gender sensitive perspective, New Year and “Makar Sankranti” celebration.

Main strength of Seher intervention at Beggars’ Home is that user of the services has been at the center of the program. Participation voluntarism, excursing choices have always been at the center. Seher has adopted a cost effective strategy of group work to the setting. Through this program one can see subtle linkages between development and mental health.

For documentation of this work Referral form has been developed, Case register and Minutes of the meetings. Quarterly and monthly reports are prepared. Process Documentation of the capacity enhancement program, group sessions and outdoor sessions, Arts based therapy, green therapy

Sustainability of Seher’s work is ensured as some components have been taken over by the system. For e.g. Work on promotional level, referral to MIMH. Moreover B.H. is also taking initiative in working towards different needs of the population. E.g. Vocational training, inviting students, networking with other agencies etc.

Cost effectiveness is maintained as Infrastructure is provided by Beggar’s Home, Cost sharing during capacity enhancement program is done by both Seher and the Beggar’s Home.

Human resources with multiple skills and strong mental health and social perspective are required which might be difficult to get.

Seher has been able to make the System level impact in terms of Steady referrals of severe mentally ill, their Acceptance by officials and staff, Role clarity regarding Seher’s role and system’s role, Openness and willingness in discussing mental health and other issues ( Weather to involve mental hospital, vocational training planning), Greater initiative in organizing promotional activities (Resource generation, lead in planning and conducting-Dignity day, Fun-fair) and Superintendent conducting a session during care takers training program on Approach and value system.

This model is Replicable and could be used for other Beggars Home as well as other custodial institutions to some extend. Project has not dealt much with other issues of person with psychosocial disabilities like rehabilitation etc due to the limitation of the setting.

Team Movement for this work is at moderate level. This work is extremely exhausting and Burn out issues of the team members is a challenging because resistance of system and nature of work does not offer positive reinforcement. Transactions become difficult for those who have worked in the clinical structure. Rehabilitative services or advocacy related services have not being provided much by the project.

Regarding this project our Future Vision is to work towards presenting it in a model form and to reach out to other homes and to bring out Publications.

Seher’s learnings from this project have been to make efforts to bring personal narrations in group work, to enhance therapeutic value of group work (studying other group approaches, individual), to strengthen individual case work, to document individual case work and related data, to develop group work models for short stay residents and long stay resident and to arrive at T –junctions thro’ advocacy efforts to influence larger system.

 V. Seher’s Presence at the Family Courts:

Family Courts are special courts established to deal with matrimonial matters. Maharashtra has provision of family courts in four cities. These courts are specially established because matters related to marriages are different in nature as compared to the other civil and criminal matters. This therefore requires a sensitive treatment to legal issues.

Bapu Trust had conducted a two day state level mental health training workshop with family court marriage counsellors in 2005, upon the court’s invitation. This preliminary association later on paved a way for establishment of a psychological centre within Family Court Mumbai. Seher was initiated upon the invitation by the family court, Mumbai. Provision of such a centre was ensured by a Judgment by Justice A.P. Shah, of Mumbai High Court stating the importance of starting a psychotherapy centre for litigants within the Family Court premises. This judgment was a response to an unfortunate suicide by a litigant within the court during the litigation process.

The judgment clearly says that “the centre (Seher) will not engage in fact finding or will not play any investigative role. Seher will not submit any reports to the court with respect to is clients or will not part with any information that will affect the litigation process or client’s well being in any way. Seher will not provide legal advice. The centre will help the litigants deal with their stress.”

Bapu Trust started a psychological centre in the Family Court Mumbai in January 2006, with a vision of creating a space for metal health interventions within a legal system.

It is one of the pioneers in initiating mental health work in family court system as no such program exists in any other Family Court in India at the moment.

Rationale for the Centre:

Couples come to family court to take important decisions about their marital relationships. This journey from a private life to a public space like family court may not be an easy one for many couples. The issues dealt with at the family court, though of a legal nature, certainly have emotional undertones. It then becomes pertinent to have a healing space to deal with these emotions. Thus Seher’s work at the family court started in January 2006.

Seher’s primary objective through this intervention is to address the mental health concerns of litigants of the Family Court Mumbai. Seher intend to do this by providing psychotherapeutic services to individuals and couples in distress and thus promote their overall emotional wellbeing. We also aim to demonstrate a mental health service model in Family Court which can be replicated in other such settings.

While doing this, Seher team constituted by Aparna and Radhika also realize that their work cannot be limited to mere setting up of a Counselling Centre. The Family Court system needs to be sensitized to the mental health issues of litigants, so that a mental health perspective can be introduced to the overall functioning of the Family Court.

Law plays an overarching role in the mental health sector in India Besides the mental health law, which governs the mental health sector, civil laws including marriage laws have a section on unsoundness of mind which if proved positive results in nullifying the marriage. People with mental illness tend to lose their civil, political and economic rights and experience stigma and discrimination. Through Seher’s work with the court, the team aims to sensitize the system to the politics of diagnosis and to the mental health issues involved in laws that govern the Family Court. Thus Seher aims to help the system uphold dignity and rights of people with mental distress.

Hence Seher conducts capacity building workshops for the marriage counsellors, Judges, lawyers and other family court staff, to help them to integrate a sensitive mental health perspective into their work.

Understanding the Role of the Organization in Development of the Community

Addressing the marginalization:

Marginalization with respect to a legal set up such as family court needs to be defined in a different way. This marginalization exists at various levels. Marriage is considered to be a developmental task one automatically achieves at a certain age in our society. People after a certain age are expected to get married. In fact there is a tremendous pressure to do so. Failure to abide by this norm may result in stigma and discretion as well as deprive a person of certain rights that only a married person can enjoy. On one hand, youngsters are forced to marry, while on the other there is no preparation involved for entering into such a unique intimate relationship at the societal level. Society exerts pressure not only to marry, but also to sustain the marriage, no matter what happens. Since marriage and the relational issues involved in the same, are considered to be a private issue, it is expected that no one talks about it outside. Globalization, fast pace of life and modernization impacts people’s support systems negatively, leaving individuals lonely in their struggles to cope with life. Coming to a formal structure such as court, is often the last resort adopted by couples to settle the matter or solve a problem. There is a high level of stigma attached to coming to the court, as it may be perceived as an individual’s failure to sustain what is so sacred and upheld as normal by the society. All this obviously, including the process of litigation itself, adds to the existing interpersonal stresses that the spouses bring to the court. Thus the population visiting family court reflects the community’s need for mental health services.

Another level of marginalization exists for people with mental illness. It is a well known fact that people with a label of mental illness have to face a lot of stigma and discrimination in general in our society. People with mental illness tend to lose their civil, political and economic rights. Mental health diagnosis in a legal set up might further exacerbate some of these effects as law plays an overarching role in the mental health sector. Besides the mental health law, which governs the mental health sector, civil laws including marriage laws have a section on unsoundness of mind which if proved positive results in nullifying the marriage. A mental health diagnosis can also result in denial of certain other rights. E.g. it can lead to divorce, denial to child custody etc. Women are the worst affected of the lot as the research shows that most of the petitions of unsoundness of mind are filed by men against women.

The project has been able to reach out many such cases, where diagnosis of mental illness is involved or stigma due to the break up of marriage is experienced resulting in high levels of mental distress. The project data shows that the center has catered to the needs of people coming from lower socio economic classes. The center has also to a great extent been able to reach out to women with experiences of violence.

But the center needs to make active plans to reach out to some other vulnerable groups such as Muslim women.

View of government/other agencies with regard to the project’s relevance and impact:

The court is aware of the fact that couples who come to family court to take important decisions about their marital relationships may find this journey from a private life to a public space difficult and stressful. The issues dealt with at the family court, though of a legal nature, certainly have emotional undertones. These issues if unresolved affect their self esteem, work out put, relationships, life philosophies, future plans and relationships and most importantly, sense of well being. It is important to deal with these emotional issues as well. Provision of a marriage counsellor, is unique to the Family Court Act. To some extent, presence of marriage counsellors, may serve as an emotional first aid to the litigants. But many of these emotional and interactional issues need deeper exploration and different handling. Given the dearth of mental health services even in a metropolitan city such as Mumbai, people have no space to voice some of these private issues. Therefore the court perceived a need fro an on campus, free of cost psychological service.

Along with a perceived need for a psychological centre, the A. P. Shah judgment mentioned earlier, proved to be one of the most conducive factors for initiating a psychological centre within the family court set up. Seher’s presence was preceded by another psychological centre which had to be closed down for some unfortunate reasons. However the court was familiar with accessing services of an on campus psychological centre. Presence of the then principal Judge, Mrs Joshi, who believed that litigants should be offered these services along with marriage counsellors who reiterated this view helped establish and sustain the centre.

Regular ongoing strategies such as monthly capacity enhancement sessions, bimonthly review meetings and other formal and informal communications with the marriage counsellors and also with the Judges( especially the principal judge) have helped covey some of our perspectives. All this has resulted in the centre being visualized as an important and valuable service by Mumbai and other Family courts in Maharashtra. This is also reflected in the regular and sustained inflow of referrals to the centre since its inception period.

Overall the project has succeeded in creating a model for mental health services in a legal set up and also opened up possibilities of replication at other family courts in Maharashtra. This is reflected in the fact that we have already received an invitation by Pune family Court to start in house training program for their marriage counsellors.

Assessing Project Planning and Implementation

AAI statutory exercises and plans and budget:

Yearly statutory exercises of AAI (P&B, ARRP) have been completed as per the set timeline by the team. For the last year’s P& B exercise, project team prepared the plans and budget (initially discussed in small teams & later with the seniors in the organization & Project officer of AAI for their feedback and inputs before presenting it to AAI) in a participatory manner. Preparing plans and budget gave an opportunity to the team members to review the work done, planning the year ahead by doing realistic assessment of field situation & working out budget accordingly. During P&B exercise too, project team members presented the overview of the work done, plans & budget for the same.

Coverage of the Program

Work with Clients

Client profile: Seher extends its services to litigants accessing services of family court during the litigation period.

Number of clients: 97

Total number of sessions must have been approximately more than 170 (including individual and joint sessions)

Demographic Details of Clients-

• Age- The age ranges from 19 to 67. Most clients are between the ages 25-45
• Gender- Most individual clients referred to Seher are women. But we encourage the counsellors to make couple referrals than individual referrals.
• Education- many of the clients have been educated up to X to XII std. and a few being graduates and post graduates.
• Occupation- Many of the clients are into service sector, employed with government or private jobs. Some of them have their own businesses ranging from small scale ones to well established ones. Some clientele also belongs to the service industry. Many women clients are home makers with a few exceptions who fall into categories mentioned above. Some men have been unemployed in the recent past.
• Socio economic class: most of the clients referred to Seher belong lower or middle class.

Sources of referral: All referrals are rooted through the marriage counsellors. Most referrals are also made by the 14 marriage counsellors while some are made by the Judge and some are self-referrals (where people read or get to know about Seher services and approach Seher by themselves)

Reasons for referral:

o Suicidal Ideation and Suicidal threats –
o Marriage counsellors perceiving a ‘personality problem’
o Crying often and seeming depressed
o Presence of a psychiatric illness or symptoms of an illness. For example, some might be referred for ‘suffering from schizophrenia’ and some might be referred for ‘continuously talking irrelevant things’.
o Addiction to substances – mainly alcohol
o Violence between the couple- physical, emotional and/or verbal. Mostly violence by husband towards wife
o Suspiciousness directed by husband towards wife
o To facilitate decision making in either spouse or the couple together.
o To facilitate grieving over imminent divorce or separation.
o To explore for reconciliation, to see if reconciliation is advisable
o Physiological ailments that may be caused by stress
o Helping one spouse cope with the decisions of the other, especially when both spouses want contradictory things.
o Deal with the emotional upheavals accompanying the litigation, such as stress, anxiety, anger towards the legal system.
o Husband not giving money at home/ paying maintenance regularly
o Spouse having “affairs”
o Aggressive behaviours/ emotional outbursts
o Mostly men complain that the woman has not been able to fulfil her duties as a “homemaker/ wife/ mother/ daughter-in-law”
o Fights over wining the child and therefore attempts to triangulate the child.
o Incompatibility in cultural practices, lifestyles, attitudes and overall life philosophies.
o The non-litigant spouse expects the litigant spouse to reconsider/ review his/ her decision of the litigation.
o The other spouse is heavily influenced by his/ her parents/ family and has no mind of his/ her own.
o Sexual incompatibility
o Initially felt that they are compatible to each other but as time passes, the incompatibilities become glaring.
o Domination by one of the spouses.
o Interference by respective family members.

Work with the System

Staff Trained

As mentioned earlier, Seher besides service provision also engages in close interaction with the court system to help the system integrate mental health in their overall functioning. Capacity enhancement sessions beginning with marriage counsellors and later expanding to other stake holders in the court, is one of the important strategy to further this goal.

Marriage counsellors were identified as the important stake holders for this integration. Seher in its day to day functioning has to work in close association with the marriage counsellors. All the client referrals are made by or rooted through the marriage counsellors. Seher also exchanges some feedback (keeping the confidentiality codes in mind) about these clients with the marriage counsellors. Thus they are Seher’s primary link with the court.

Mumbai family court has 7 courts and 14 marriage counsellors. They are all masters in social work and have an average experience of 9 to 10 years of working in Family court. Counselling by marriage counsellor is a mandatory feature in the family court. The marriage counsellors help the couple sort out their legal and other issues in an amicable fashion, before the actual hearing and also during the litigation process. They deal with clients’ emotional and psychological concerns day in and day out. In spite of being in such a pivotal role, many of the marriage counsellors have not received any formal training in counselling. Whatever inputs they might have received during their MA become obsolete over a period of time. Besides, a government job, poses a lot of restrictions on opportunities for their professional growth. Over the years they might gain experience legal aspects of counselling, but there is no way of receiving any inputs on mental health aspects of counselling. Therefore Seher decided to conduct once a month, half day capacity enhancement sessions with the 14 marriage counsellors. These trainings are intended to help the counsellors learn key concepts and skills related to mental health and counselling. These capacity enhancement sessions held once a month with marriage counsellors are welcomed by them as it provides an opportunity for continuous learning for them and also for updating their knowledge.

During the preparatory phase, Seher assessed mental health training needs of the marriage counsellors and prepared a list of possible training topics. Ever since the beginning of these trainings, Seher is in a constant dialogue with the counsellors to make these trainings relevant to their needs.

It is also important to state here that the Mumbai High Court has given permission to the marriage counsellors to be exempted from their daily work during the training period. Following are the details of the trainings conducted so far:

Sr. No	Date	Topic of the Session	Resource Persons
1.	29.03.06	Mental Illness: Moving beyond Diagnosis	Ketki, Bapu Trust(Pune)
2.	28.04.06	Mental Illness: Understanding the complexity of Illness, Health, diagnosis and treatment.	Dr. Shubhangi Parkar (HOD, KEM Hospital)
3.	28.06.06	Family Therapy	Dr. Srilatha Juvva (Professor at TISS)
4.	31.7.06	Family Therapy	Dr. Srilatha Juvva (PhD in family Therapy Faculty with TISS)
5.	26.9.06	Rational Emotive behaviour Therapy	Dr Anuradha Sowani, Faculty, Psychology Dept, University of Mumbai
6.	October 31st 2006	Rational emotive behaviour Therapy	Aparna Joshi
7.	November 2006	Rational emotive behaviour Therapy	Aparna Joshi
8	December 17th 2006	Enhancing counsellors mental well being (this was a full day session at Yusuf Meherally Centre, Tara, near Panvel	Asha Pillai and Anand Chabukswar from the WCCL foundation
8.	30th January 2007	Grief Counselling	Gitika Talwar
9.	30th March 2007	Narrative Therapy	Aparna Joshi
10.	28th June	Narrative therapy	Aparna Joshi

Extent to which the staff are able to mainstream mental health interventions in their day to day work

To assess the impact of these trainings and Seher’s overall functioning within Family Court, we prepared a 6 paged questionnaire at the end of the first year and requested the counsellors to fill the same. This was because counsellors had the maximum opportunity to interact with us and observe our work through out the year. The questionnaire asked a number of questions about various aspects of Seher’s functioning, namely quality of work with clients, communication with the court system, review meetings, trainings, IEC etc. We had asked some questions that helped us answer the question in relation to the mental health integration into their day to day work. These were some of the answers provided.

Examples of how you have used content from the training sessions or reading materials in your own work.

Response from counsellors	Frequency
Sessions have helped discern rational thoughts from irrational ones and dispute the irrational thoughts	6
Improved questioning and interviewing skills	2
Help build knowledge and skills	2
Understanding clients’ personality quickly	1
Helped change clients’ attitudes	1
Helped make conscious efforts to review our counselling process	1
Helped referral work	1
RET and FT sessions were found to be most useful	1
Blank	2

How did you incorporate mental health work into your own work before Seher started at Family Court?

Response	Frequency
Referred cases to Government hospitals such as Nair and KEM	4
Referred to Manoshakti	4
Counsel till a limit, then refer	1
Refer to private mental health agencies or outside agencies – psychiatrist, psychologist, NGO’s	6
Applied own skills of Counselling	1
Blank	4

Following Seher’s introduction into the system, do you feel that there is a greater possibility of incorporating mental health work into your current work? Please give examples of ways in which that has happened.

(Though a question regarding integration of mental health was asked, the counsellors seem to have processed it as the need for a mental health service in Family Court)

Response	Frequency
Yes, earlier referrals were made outside but follow up was difficult, now it is easy and so is communication with Seher counsellors regarding the same. Referral and feedback is easier	3
It is helpful and has vast scope in our work	1
Vast scope at macro-micro level	1
Seher can increase availabilities or service to clients through workshops	1
Stress management centre	1
Training marriage counsellors periodically, lectures and discussions organized by Seher, made us more knowledgeable	4
Gender oriented mental health approach	1
Clients need to go to Seher more regularly or practical result not achieved	1
Interacting with counsellor help think differently on issue of mental health	1
Yes, many ways	2
Clients come disturbed, confused, violent, excited, and adamant. Due to Seher they handle problems patiently and with stable mind they take decision	2
Understanding problems of litigants in better way	1
Problematic clients are helped	1
Blank	2

Currently Seher feels that it has succeeded in creating a language around mental health of clients as well as self and demonstrate the need and feasibility of mental health services in family court settings. In short Seher has succeeded in creating a model mental health project within the court structure which has a high reliability value given its rigorous documentation, regular review mechanisms and innovative thinking. Marriage counsellors have got used to the concept of a psychological centre and accessing services of the same. Even Judges are now aware of such a centre they can refer their clients to. The rates of self referrals have increased over a period of time, showing that clients themselves are interested in accessing services of psychologists. They are looking for an emotional space within a formal legal structure as family courts.

ASSESSING THE SUCCESSES AND FAILURES OF THE PROGRAMS:

Cost efficiency: We visualize two kinds of costs involved in any project. One kind of cost involved is monetary cost. Besides the salaries, travel and training costs involved, the project does not demand much of monetary resources. The program is housed by the family court that takes care of basic amenities/ requirements such as space, table, chairs, storage space etc. Mumbai Family Court has offered a spacious, well lit and ventilated room to Seher for its functioning. Court has also made available their phone services. The court has also extended services of a peon who brings referral forms from the marriage counsellors, does Xeroxing when required, helps exchange messages and also maintains the place. Trainings with marriage counsellors are held within the court premise, leading to zero costs for the venue.

On one occasion, the counsellors themselves tried to raise funds for a full day session outside the court premises. There is a constant effort to assess the efficacy of each session and the entire training program to know how it is impacting the system. Seher has come up with a new strategy to maximize this impact and create an on the job learning opportunity to integrate mental health inputs for marriage counsellors. This involves organizing regular case conferences (once a month), where counsellors will discuss their cases and also have a platform to apply the newly learn strategies.

Another kind of costs involved is in terms of skills and knowledge of trained professionals who run the center. So conservation of these human resources and energies is a big challenge to cost efficiency. Being in people oriented profession and dealing with difficult emotions and problem stories day in day out also leads to burn out issues. So cost efficiency also involves addressing these issues. Projects are reviewed at regular intervals to look out for energy leakages. Innovative strategies are adopted to maximize the inputs keeping in mind the conservation of human resources and well-being. At the micro level, these include strategies in relation to the way services are delivered to clients, analysis of how sessions with clients are structured, analysis of what works and what does not work in a given set up. To cite an example, Sheer counsellors constructed their initial sessions where clients were encouraged to narrate history of their entire marital journey. Over a period of time, however, this was replaced by briefer and more here and now strategies. Also the centre insisted on joint sessions for the couples, given the theoretical orientation followed and given the games people play to triangulate the therapist into their power struggles. However it was soon realized that this strategy might increase drop out rates for the couples may not want to see the other spouse given the adversarial context of Family court. So we started holding both joint and individual sessions. Newer therapies and techniques are applied to help the couples better.

At the programmatic level, a dual strategy of service provision and work with the larger system is a cost efficient strategy. This ensures that a context is created for the service provision. Bimonthly or quarterly review meetings with the marriage counsellors have helped us ensure a regular in flow of clients without which the services can not function. Issues of drop out have been addressed through these meetings resulting in joint strategizing to avoid the same. Even at a client level, an informal dialogue with counsellors helps us ensure that both Seher and marriage counsellors are putting their efforts in the same direction and the legal and emotional interventions compliment each other.

The list of resource persons invited for training sessions conducted in family court involves a good mix of outside and in house expertise. This also helps us save costs. Program persons across different projects in Bapu are also invited as resource persons for these training programs. Learnings from other programs are put to use across programs. For example learnings of both Family Court and Beggar’s home have been exchanged.

Assessment of structures and groups which are supposed to sustain the development inertia and Enabling Environment:

The Family court program began a year and half ago. The program was planned in such a way that it can be handed over to the system at some point. That was the reason the program was not envisioned to be a mere service provision, as per the original offer of the court. Strategies to impact the system were an in built component of the program. Several trainings have been undertaken up till now and many others are planned to move forward in this direction. There are also plans to upgrade the project and not just run it in Mumbai Family Court.

Marriage counsellors as mentioned earlier are the first and the important agents in addressing clients’ emotional needs within the court system. They act as emotional first aids for clients. Amongst the various duties they perform, their primary role is to assist and advise the parties (that is couples) regarding the settlement of the subject matter of dispute. The counsellors are also supposed to help the parties in arriving at reconciliation. Thus their current role lies on a threshold of legal and emotional terrains. That is why Seher feels the need for mental health integration into marriage counsellors existing work. Seher does not believe in old and traditional models of integration, whereby workers are trained to identify mental distress or illness and merely refer the client to another agency. We believe that this model is reductionist and undermines people’s capacities. Instead we believe in complimentarity of helping professionals’ roles.

To achieve the same, Seher aims to help them consciously develop a language and perspective around people’s emotional and psychological needs and enlarge the scope of their work that deals with emotions.

While doing so, Seher is aware of the fact that marriage counsellors have their primary legal mandates which may put constraints on their time and resources expended to deal with clients emotions. Therefore services of a psychological expert will still be required to deal with the distress and illness aspects of people’s mental health. Thus marriage counsellors and psychologist’s services will compliment each other.

Successes of the Program:
• Good rapport with court counsellors and the Principal Judge resulting in great acceptance of centre.
• Well worked out communication systems
• Obtained a space for the centre, administrative support from the Court and drafted a Memorandum of Understanding
• Steady inflow of referrals
• Regular and detailed documentation
• Capacity Enhancement sessions have been well attended, they appear to have helped raise our credibility as an organization and increases the transparency of our own functioning as mental health professionals
• Review meetings have been well-attended. They have helped increase transparency and enable better communication between Seher and Family Court, thus helping avoid potential deadlocks.
• Project is going according to original plan
• After the IEC materials were put up, we have seen an increase in the number of queries.
• We have been able to create a mental health space for clients as well as the system.

Client and System related Challenges and Strategies

Client-related challenges and strategies

Marriage Counsellors make a referral to Seher after having sought a written consent from the clients. However many a times the consent sought is” pseudo consent” in actuality as the clients are not adequately informed about the nature of work and services at Seher. It is also at times not specified that the services are of voluntary and not mandatory nature.

Through our preliminary conversations with the referred clients, we tell them about our service being voluntary. An overview of our work is discussed and it is clarified that the sessions/ information that clients disclose in sessions will have no bearing on their legal procedures. They are also told that no report (written or verbal) is sent to the court by Seher.

Then on the consent is revisited as now the clients are clearer about what role Seher can play in their current circumstances.

People who come to Seher come with varied notions of counselling and what could be achieved through it. Many a times they are looking for legal answers and not at exploring emotional or relational issues. They are carrying with them fatigue due to the relationship issues at hand as well as of having approached number of options to deal with those issues and then reaching family court almost as a last resort. This leads to a gap between clients’ expectations from Seher and what Seher can actually provide. This plays on the association of the clients and Seher manifesting in lower number of sessions or even dropping out of sessions.

We constantly keep negotiating with the system to refer clients as early as possible (after they have come to the court). We also explore if our working days can coincide with the clients court dates. Presence of Seher is evident through the IEC material to help self-referral. On the spot referrals by the marriage counsellors are also welcomed for clients who are in the court on Seher days and might need to be referred for the first time.

The fact that Seher functions in the court premises and has litigants as clients, many a times clients are resistant or anxious to the level of disclosure that you want to engage in during their therapy sessions. This resistance also comes from constant pressures on the clients from their lawyers and family members. This is after Seher constantly clarifies that processes or things discussed at Seher will have no implication on the litigation process...

Many times who come to Seher appear to have chronicity in their issues/ problems, as well as their interpersonal dynamics. They often come with conflicting goals that pose barriers in arriving at common agendas and decision in sessions.

We attempt to arrive at goals that the couple has in common and work on the contradictory goals at a later point. We also express our own dilemma clearly to the clients and ask them how they would like to deal with the inherent contradictions they are expressing.

Clients failure at previous attempts over solving their ‘problems’ as well as multiple sessions with marriage counsellors could make many clients less amenable for change. Hopelessness sets in and faith in formal counselling setup like Seher lowers.

Seher explains itself to be different from other helping agencies by being unbiased, third party, neutral facilitators whose primary commitment is to helping them understand their relationships better and help them reach a decision if desired. We clarify we do not have any stakes in their relationships unlike family members who might have been mediators in past.

There are many instances during sessions where either one or both partners try to triangulate the therapist to prove themselves to be right and the other wrong. Do not forget that we work in a court where it is all about being able to prove or not able to prove. A lot of power play goes into sessions trying to align the therapist on each of the couple’s side.

Reiterating of being a neutral unbiased agency helps minimize these “proving the point” processes.

Seher thus has to constantly, untiringly engage in reviewing and restrategizing to engage clients in constructive therapy sessions and processes.

System related Challenges and Strategies-

There is a possibility of limitations with respect to the extent to which the system will integrate mental health into their current work. Even if the integration takes place, the concern remains as to how one can ensure that the system will also adopt the perspective and the attitude of the mental health work that is being done currently.

When Seher started its work at the court, the court was familiar with the concept of such a service being pertinent due to the judgment, a proactive principal judge and also because a psychological centre was functioning at the court previously. However, the exit of that centre was not on good terms with the court as it had been found that there were some unethical practices going on. Therefore, the initial work of Seher had to deconstruct those previous notions that the stakeholders in the system had towards such a centre.

This was done by being as transparent with the system as possible by constantly communicating formally regarding the processes at Seher, its value base, its practices.

Another challenge came in the form of demarcation of roles with respect to Seher’s functioning and that of marriage counsellors. Marriage counsellors in family court are trained social workers in Maharashtra. Most of them are in service for a long period. Many of them initially were apprehensive about Seher’s encroachment upon their role, since there is a great possibility of overlap in these two roles. They were also concerned about the fact that a referral to a psychological centre can be interpreted as their failure in their respective job.

However much of it was sorted out in the preparatory phase, which preceded the actual inauguration of the centre. Seher held several meetings with the marriage counsellors and the principal judge to demarcate counsellors’ role from that of Seher’s work.

This has of course not come without constant challenges. Initially, the court and its stakeholders expected the centre to play the role of a mental health expert which included functions such as dispensing a diagnosis, conducting psychological tests, assessing client’s personality etc. The concept of mental health was limited to mental illness and so was the role of a mental health expert. This was an expectation affirmed by experiences with the previous centre that regularly administered psychological tests to its clients and offered a diagnosis based on the same. In spite of Justice A.P Shah’s Judgment which clearly mentions that the centre is supposed to help the litigants deal with their stress and not play any investigative role, some marriage counsellors believed that the centre must provide reports that will contain some analysis or information about the mental status of the individuals referred. The idea somewhere was that this information will help the court in some way. Seher had to time and again remind the Court of the centre’s role, and reiterate the values guiding our services. Seher had to clarify that we do not believe in diagnosis and had to discuss the labelling and stigmatizing effects of a diagnosis at various occasions. Initially it was difficult to convince them that mental health is not equivalent to mental illness and also that therapy can function outside diagnostic framework. This had to be done carefully keeping two things in mind. Firstly, we wanted to convey that a mental health service can function without some of these so called expert tools and yet deliver credible and quality services. And secondly constantly negotiate Seher’s commitment to client well being without jeopardizing relationship with the court.

Seher has also experienced some apprehensions by a few stakeholders like Shirastedars in undergoing mental health trainings. This so happened as they were unclear about how they were expected to place these trainings in their work and it worried them that it might just lead to some added work burden.

To work around this, Seher has communicated with different stakeholders to understand where the Seher trainings could be pitched with respect to their function and role. Planning and conducting needs assessment sessions has opened up space for dialogue.

The patriarchal values that the society we live in also get reflected in the court and its expectations from Seher. To elucidate- A set of stereotypes that we grapple with constantly with are gender stereotypes. A client is viewed as a good or a bad client by the system depending on many parameters one being how well or badly has a person incorporated the gender stereotypes in herself/ himself respectively.

‘To aid reconciliation’ has been a consistent reason for referral. The “success” of work done with clients is seen within these stereotypical parameters thus if a couple reconciles, the reconciliation becomes the success of the court, marriage counsellors as well as of Seher.

We have, at number of instances clarified and still reiterate that we do not believe in any essentialism (thus also no stereotypes), even if it means essentializing successes and institutions like marriage. There cannot be fixed indicators for success and would greatly depend on case to case and person to person basis and what she/ he expected as therapy outcomes.

Referral rate at most times is high; however there are patches like the summer and Diwali vacations where the referral rate drops low. Initially the referrals made by the marriage counsellors were individual referrals. However it was effectively communicated to them, that sending one person will only lead to greater stigma and marginalization of that person. Couple referrals were encouraged, which also in the beginning became “pseudo couple referrals” as the marriage counsellor would tell one of the client that she/ he was just being sent along, else the other partner was in need of Seher service. Thus people who came in with such couple referrals were resistant to explore their own feelings and interactional patterns in the relationship as they had already been told that nothing was wrong with them.

We have consistently communicated to the counsellors the reason as to why we ask for a couple referrals. One reason being to prevent marginalization of either one of the partners and also importantly we find that the interactional patterns between the partners need to be explored to a greater extent in this context.

What Changes Has The Project Brought To The Life Of People:

The centre has primarily provided a space for emotional healing within a formal legal structure such as court. Seher is a space where clients can ventilate their feelings, talk about issues that concern them, explore their future plans, grieve over the losses, confront some of the unhealthy relational patterns and develop newer ideas and ways of being. They can do all this without being sacred of any legal implications. They do not have to worry about how this will impact their case or about somebody utilizing this material against them in any. They can also talk about the stress induced by the litigation process.

Here is a glimpse of the processes and interaction involved in the kind of work Seher does at the family Court.

This Couple,’ A’ was referred to Seher as the Judge thought the wife needed psychological interventions for some “mental problems”. Informally Seher got to know that the Judge made this impression on the basis of irrational demands the wife made of husband, which included large maintenance amount, a house and child custody. The husband obviously was aware about the reason for referral and believed that the counselor would locate the so called mental problem within the wife and convince the wife to change her mind. One of the primary strategies adopted therefore was to defocus wife as the problem bearer and focus on the interactional nature of the problem. The interventions were a combination of joint and individual sessions that helped the spouses express their individual concerns and also feelings associated with the same. The sessions also provided the couple an expression of emotions behind their actions and communications. These sessions through a detailed assessment of the history of marital life, helped the couple voice their expectations and discomforts in the marriage. These sessions traced the history of various marital stages up to the point of separation. The counselor helped the couple look at the interactional nature of their relationship. The counselor also helped the couple establish ground rules of communication within the sessions, adopting an,’ I ’ framework rather than a, ’ You’ framework. There was a detailed discussion about what are the strengths of their relationship and what is it they still like about each other. As the therapy progressed wife changed her mind and decided to accept husband’s offer of staying together, but on a condition of staying separate from his natal family. This was an important juncture as both the spouses arrived at a mutual goal. The counselor besides helping the couple express needs and emotions behind these communications also helped devise problem solving strategies.

As time passed, they both would express a wish to be together, but would resist possibility of changing or taking a decision themselves. Phrases like,’ counselor is the captain of the ship and therefore will take a decision for us" capture the pattern. Ultimately, when the counselor presented this contradiction the couple agreed with what was happening, but the couple expressed the fact that they will not be able to follow up and will depend upon the court to decide for their marriage. The couple did not follow up after this session. However a few days later, the marriage counselor informed Seher that the couple had made up their mind and had started staying together.

Project’s attempts to create a mark in the field of mental health and advocacy:

As mentioned earlier Bapu Trust is mental health advocacy organization. Service programs run by the Trust imbibe the advocacy spirit of the organization, family court program being no exception to the same. Through out this report we have tried to detail advocacy positions translated at the service delivery level. The psychological centre run by Bapu Trust in the family court is not like any other psychological centre. To its core stands, Bapu’s philosophy of user centricity. All the values governing the service follow from this central position. The program has also initiated systemic interventions to destigmatize mental illness

The program has successfully demonstrated that legal and formal institutions can and need to integrate mental health into their functioning. This is because people approaching those institutions have emotional and psychological needs which if not fulfilled, make these services incomplete. After all one can not compartmentalize human beings. It has also demonstrated the feasibility and utility of such services. These services are more effective if provided on campus than referring clients to outside mental health agencies. Clients find it convenient due to practical and emotional reasons to access these services when they are provided on campus.

Various stakeholders in the institutions whether they are aware or not are dealing with mental health issues of clients day in and day out. The fact that they deal with human experiences and emotions and are trying to help people, necessitates some knowledge of mental health. Gaining this kind of knowledge might help them respond more effectively to people’s mental health and other needs. Having an on campus psychological centre will further aid the process of responding to mental health needs of the client.

Seher has maintained rigorous documentation and adopted a studied and reflexive approach while implementing this project. The documentation involves details about necessary preparations to run this kind of a project, values governing the project, processes involved in implementation, learnings, data, insights etc. This makes the project replicable and implementable at other cites. Thus we have made a mark of demonstrating a model mental health project in a legal institution as family court.

As far as the larger level advocacy is concerned, Bapu has future plans to advocate for such centres to be an essential feature of every family court.

Understanding the Quality of the Program through the Following Parameters

Organization’s approach to Programs- Rights of the marginalized:

Bapu Trust works for advocating rights of the mentally ill, through its various local national and international level campaigns, activities and publications. As we all know label of mental illness in our society leads to rights violation and stigma. The organization, therefore adopts a rights based approach in all its programs, including services. Many a times marginalization experienced by people with mental illness is further complicated by other forms of marginalization resulting from caste, class, gender, sexual identity etc. Seher at family court is sensitive to various forms of marginalization that people experience and builds service strategies that are more inclusive and that respect the diversity rather than forcing a monolithic understanding of people’s realities.

Bapu service programs are known to imbibe a spirit of within them. All our services are respectful of people’s rights and especially rights of the mentally ill. ‘Users’ are at the centre of our services. In every set up we are clear about our primary commitment to client well-being. At times this may conflict with the larger set up we work with, Family Court being no exception to the same. However we have time and again made this commitment clear and fought for it. We consciously adopt practices such as not offering diagnosis or any such label which can limit people’s rich descriptions of identities, adopting a strength approach rather than a deficit approach, maintaining high level of voluntarism and participation, respecting confidentiality, offering choice at every point, respecting clients’ decisions, etc.

Community participation & leadership:

There two kinds of communities that Seher works with namely client community and the court system. As far the client system is concerned, Seher invested a one month study period studying the system, documents, functioning of the earlier psychological centre and also gaining knowledge about mental health needs of the clients who visit the court. The services provided by the centre are voluntary and aim at maximizing participation in every way during the therapy process. However the client system is not currently involved in program planning and evaluation. Seher tends to seek informal feedback from the clients about the quality of its services and their level of satisfaction. However no formal mechanisms have been instituted as yet. This is primarily because of a couple of reasons. The first and the foremost reason being the high drop out rates and the floating nature of the client population within family court. Secondly, it is difficult to establish such procedures in the first year of centre’s functioning as one is gauging the client response and learning ways to address it. Last reason for the same has to do with the high level of emotional intensity and urgency of decision making that people harp upon, which makes evaluation and planning processes difficult to incorporate

As far as the court system is concerned, the level of participation at least by marriage counsellors in planning, reviews mechanisms, trainings, problem solving is consistently high. They have been more or less consistent in making referrals to the centre. All of Seher’s programs with marriage counsellors utilize participatory methods. Out of the 14 marriage counsellors, some have been more active in dialoguing with Seher and in incorporating mental health into their work. The former Principal Judge was active in establishing Seher within the court and ensuring required support for its functioning. The new Principal Judge has also shown great enthusiasm about Centre’s services, approach and future plans. However, response from other judges has always been marginal. This highlights the fact that the leadership and support of the Principal Judge is important for centres like Seher.

Building network & alliances:

Seher has always been aware of the multiple needs with which people approach the centre. So the centre provides referral services along with therapeutic services to its clients. These services include services of mental health professionals or centres as well as services of NGOs providing shelter, legal support, counselling services for women facing violence, vocational training, child guidance, de-addiction facilities etc. This information is also useful for the court in making necessary referrals.

Strong gender perspective: clarity, understanding and belief on feminist perspectives:

The centre extends its services to couples as well as women and men individually. Seher’s practices are informed by feminist values of non hierarchy, choice, equity-based and freedom for both genders. Seher believes that gender roles prescribed by the society can be limiting for both men and women. They can limit the ways people want to exist and the choices they wish to make. Therefore as therapists we aim to provide space for people to explore different ways of being in a non violent framework.

However sometimes it becomes a great challenge for the counsellors to apply their feminist understanding to especially couple situations. This is because many of the men and women come to the centre with internalized gender roles and norms and expectations. Almost all disputes have some or the other reference to the other spouse having failed to do what is expected of a man or a woman in our society. These norms are oppressive for both men and women. However given the gender and the power hierarchies in our society we observe that women are often the targets of violence. So one of the clearest examples where feminist perspective is utilized with urgency is with respect to violence. We have observed during our practice that marriage counsellors’ may not be sensitive or even aware of the violence faced by one of the spouses. Many a time violent resistance by wife is perceived as being violent and is therefore termed as mutual couple violence. Referral; notes sent by marriage counsellors’ reflect many of the gender biases that are prevalent in society. Concepts of good victims and bad victims or who deserves help or who is right or wrong in a given case are constantly at play.

Another challenge posed by the court system is in terms of pressure to keep the marriages intact under all circumstances. Family Courts function on a basic premise that marriages are sacrosanct and have to be mended anyhow. Reconciliation is the key word. Successes or failures are measured in terms of how many couples have been reconciled. This pressurizes men and women to be in bad, defunct marriages and continue the same patterns including performance of stereotypical gender roles. Nowhere is the scope to challenge these. We have seen women facing violence being forced to reconcile and then the case written off as successful.

All this poses great challenges to how Seher counsellors function. Seher counsellors mostly adopt a neutral stand required as couple therapists, with only one exception, namely violence. Seher counsellors consciously explore and assess history of violence in every case. Through out our work, we make it clear to both spouses that violence under no circumstances is justifiable and they can engage in non violent ways of problem solving. Seher Counsellors establish clear ground rules both during the sessions and during the therapy period that violence and abuse of any kind will not be entertained. Abuse is not only defined in physical terms, but also in emotional, economic, and sexual terms. The counsellor tries to actively engage in discussions about effects of violence on both spouses. It is most difficult to do so with the perpetrators (who are men in most cases) who may agree with the ill effects of violence and yet justify that there is no other way to approach the problem. All the myths related to violence, such as she asked for it, she can’t understand my point in any other way, it is the alcohol or stresses etc are put to use to justify violence. One of the clients clearly told us during the session, that it is okay in his community to kill a wife and one should not feel bad about it. Both the therapists working with Seher are women. Thus the gender of the counsellors is also sometimes perceived as a threat or a barrier in communicating one’s story or perspective. In such sessions, Seher eventually ends up conducting individual sessions with the wife and helping her in her process of empowerment and healing. Seher consciously helps the women challenge the internalized gender stereotypes. It is also a well known fact that often women internalize the same patriarchal or power beliefs that they wish to fight against. Challenging these beliefs and promoting a sense of equality is a difficult task. Seher also believes that violence can not be dealt with in a violent way. Every person who faces violence has a right to resist and this resistance can not be termed as violence. But Seher does not promote a spirit of violence to self and others.

Another important issue where one sees clear gender differences is the issue of mental illness. Many of us may be aware of the fact that most of the divorce petitions where mental illness is cited as a ground are filed by men against women. A diagnosis of mental illness means different things for women than men. There is a greater stigma involved and greater possibility of desertion or being taken away child custody or other rights. We must also be aware that many times women are offered a diagnosis on the basis of their so called gender non conforming behaviours. Therefore it is important to keep these dynamics in mind, especially given the court set up. Confidentiality becomes a value of prime importance, given the possibility of labelling and further victimization. One also has to keep in mind the circumstances in which the mental distress has originated and offer healing opportunities for women.

However Seher is also aware of the fact that these same gender stereotypes can be oppressive for men as well. Men have to live under extreme pressures to perform, provide and compete, which may really stress them out. There is a tremendous pressure to conform to the masculine stereotypes. Sometimes these pressures can come from society, community, family members, and sometimes by wives. They need support to deconstruct these and live the way they want. So it aims at challenging any essentialist understanding of human beings including gender.

Seher through its therapy tries to help the spouses develop communication, dialogue and problem solving strategies which are based on mutuality and give and take.

As far as trainings with the marriage counsellors are concerned, gender component is woven through contents of the session, examples chosen or through challenging gender stereotypes and finally through the choice of themes such as violence and mental health, sexuality etc. Discussing individual cases with the marriage counsellors also serves a great value in transferring Seher’s gender understanding.

Diversifying resource base:

As mentioned earlier, the program is housed by the family court that takes care of basic amenities/ requirements such as space, table, chairs, storage space, telephone facility and basic administrative support etc. Trainings with marriage counsellors are held within the court premise, leading to zero costs for the venue.
For residential or outside court trainings which may involve greater costs, Seher always insists on sharing these costs. For example Seher had planned a sate level Judges training last year which could not materialize for some technical reasons. However we spoke a language of partnership, in which the court was supposed to bare the cost of travel and stay and the rest of the costs were to be borne by Seher. We have future plans now to advocate with legal authorities that such a psychological centre be made an essential service in each family court and are sponsored by the court.

Transparency and Accountability at all levels – this is introspection of both Action Aid’s role and partner’s role in community

At the family court level, Seher was established after a series of dialogue with the court authorities and a month long study period. Seher drafted a memorandum of understanding, which clearly spells out all the terms of references and also ways in which Seher will function. This was prepared in consultation with the Principal Judge and marriage counsellors.

The centre maintains necessary documentation for the court, such as a register containing basic information about client profile and a file in which all the referral forms are entered. Other client related information is kept confidential (in the best interests of the client) and this is clearly communicated to the court. The centre submits a quarterly progress report to the court detailing the work undertaken. It holds periodic review meetings with the marriage counsellors which involve transfer of information and addressing difficulties if any and finding strategies for the same. Seher has held a couple of meeting with all the judges to discuss centre’s work.

At Action-aid level, we are regular and active with the necessary review, budgeting planning and monitoring processes. We are also well compliant with the financial and other program related requirements. We try to keep ourselves informed and participate in larger-level Action-Aid activities and initiatives.

Way Ahead:

The project has definitely to an extent succeeded in creating a healing space for people with mental distress and illness in a legal set up. It has also attempted through its work to destigmatise mental illness.

The current strategies of training and review mechanisms employed by Seher have definitely helped to create a mental health discourse within counsellors’ work. Seher has plans to dialogue with other key stakeholders within Mumbai Family Court, such as Bar Council, and other court staff. We also have plans to extend our trainings to the state level whereby we can take mental health to both the marriage counsellors and Judges across the state and the national level.

However while we do all this, we are aware of the fact that these strategies are not adequate in themselves. Seher agrees that an attitudinal and skill-based integration is much required to sustain the development inertia. However, this is a necessary and not a sufficient condition to respond most effectively to the mental health needs of the clients approaching legal institutions such as family courts. Something else is required for the same.

Currently these services though perceived as needed, are regarded as “value-additive” services. But they need to be treated as essential services. To further this goal Seher plans to undertake advocacy activities to demand for on campus psychological services as an “essential Service” of every family court.

The journey of last one and a half year has only deepened our conviction in the direction we are moving in.

Conclusion

Interventions in Family Court were initiated in January 2006. The strength of the intervention, like other Bapu initiatives, is its perspective of creating space for psychosocial work with couples within the legal system. Such interventions are acutely needed considering the rising rates of divorce on one hand and unavailability of quality services in the field of mental health.

In the one year that Bapu has worked in the Family Court, it has significantly influenced marriage counsellors’ perspective on marital relationships, counselling and evaluating success on the basis of ‘case’ outcomes.

The challenge now is to review the Family Court Act and influence policy changes based on the findings. Bapu’s work of capacity enhancement of marriage counsellors and judges in Mumbai and Maharashtra needs to be taken forward. The challenge lies once again in institutionalizing such services without compromising on the quality of interventions.

 VI. Community Mental health work with Snehdeep Jankalyan Foundation (SJF):

Seher’s community based work in the urban slum of Kashewadi and Vadarvasti in Pune started in March 2004. SJF has been working for issues concerning health and education through Community Based organisers for past 24 years. When Seher decided to work with SJF, first of all it organized training programme for Need assessment on mental health with focus on Self, Mind, Mental health, Communication skills, Counseling, etc. Seher started with quasi OPD to play a supportive role in terms of mental health counseling. It is open once a week in the afternoon at Snehadeep office. The health workers of Snehaddep are now equipped with positive mental health approach, single women and mental health, self care, self recovery, dealing with burn out. The CBOs provide an experiential input. Seher also interacts with parents for case management. Alcoholism/ addiction, poverty and domestic violence are major causes for mental problems. Seher organizes sessions for CBOs for case presentation and also to deal with their day-to-day stressors in a deeper way.

Adolescents are full of anger. Some of them are earning and learning. Four of them managed to get admission in an Engineering college but don’t have money. They get frustrated and become aggressive. Along with counseling, Seher also does developmental work such as organizing scholarship programme. Students and youth from Kashewadi and Vadarvasti refuse to socialize with outside world as they fear stigma of being in the slum. “We can not go to someone’s house as we will have to invite them. And if we do so, they will find out that we live in the slum.”

During last four years, between March 2004 to March 08, Seher provided counseling to 128
Clients and had 138 sessions. The Case work involved intervention, dealing with problems
with intervention and emerge with a plan for cases. Seher provided support to Cases of Severe
mental disorders, Common Mental Disorders, Cases of mentally retarded children and adults,
Case of school droop outs. Seher organized Supervisor Training on Need assessment,
Domestic Violence and Couple therapy. Their capacity was enhanced to handle individual
Case work Group work, Awareness program, Corner meeting. They reviewed of previous
training, discussed field workers role in mental health area (client and Family, community),
What is Seizure? Child Mental health, mentally retardation children and family problem and
Sexuality.

Case discussions with field workers dealt with questions such as Reason of referring client to Seher, nature of mental health work they were doing with client and follow-up plan for field worker.

Group work with single women involved Need assessment of single women group such as feeling alone and responsible for children’s future, mixed responses of the community, feeling of burnout, lot of worries about future, feeling anxious, fear, Feeling of sadness and isolation, sense of loss and Psychosomatic symptoms.

Objectives of Group work was to give a space where single women can forget about their tension at list for some time, Group bonding , Having fun, Ventilation of feeling, Time for self, Space for self expression, Reduce stress, Relax themselves and gain an optimist attitude towards their own lives.

Seher team organised session with the group on self, Painting , Group bonding, Story telling session by Renu Gavaskar, Relaxation, Anger management , Yoga , Picnic, celebrate friendship and Sexuality.

Seher organized awareness programs that involved Street play, Poster exhibition and Story telling.

The idea of corner meeting is to have meeting in the community with small group. The meetings happen in all 4 community in which Snehdeep is working. In these meetings mental health and family relationships are discussed in the review process and case conferences are organize.

• Seher service team and Snehdeep’s grass root level work has made both display Openness to learn new things. Snehdeep’s experienced field worker team has integrated mental health issue in their project. There is role clarity about complementary work done by both. As a result, linkages with development issues and mental health issue are made. Seher has adopted a systemic approach in work and not biomedical model.

Process documentation and critical analysis of community mental health work needs to be done so that this work can be converted into a module. Most of the clients in this effort are women. To popularise gender sensitive approach in counseling, training, group work and IEC material is of utmost importance. Seher tries to have sessions with man whenever it is possible. It is a major challenge to find out how to expand this work with other organization and how to integrate advocacy work? Seher’s approach is Cost Effectiveness as the networking with community based organization requires minimum resources. Infrastructure is used from Snehdeep and even the training cost is shared by Snehdeep.

Impact- client level

Seher’s intervention in the communities has made a space available for talk about emotion and feeling, relationship, ventilation of suppressed stress and visibility in the thinking of self. Seher team wants to work with the communities on long term basic as positive outcome seen in most of the client. This has ensured Seher’s integration in the communities.

Impact- system level

Impact of Seher’s approach can be seen in Snehdeep’s acceptance and willingness to learn about mental health. Snehdeep has given more space for mental health work in their overall work. Now, more mental health language is used by Snehdeep team which is also in touch with other mental health professionals. We are collectively seeking alternatives for mental health treatment. Our approach strives for rehabilitation of our client at a community level. Our capacity building programmes have brought empowering results for CBOs as well as the communities. We are also working towards prevention level mental health strategies.

Replicability

For replicability of this community based mental health work what is required is basic level mental health training for which not very qualified people are needed. This model can be easily followed by other community based organizations.

Future Plan

Seher would like to institutionalize training for counselor and community workers by making community mental health module of 16 sessions with paradigm shift from “Illness driven approach” to “Feminist Approach” as it is articulated by the poem by Marsha Forest:

“Inclusion is trend,
Such as democracy,
Freedom and justice for all.
All means all,
No buts about it.
Inclusion is opposite of exclusion.
Inclusion is no to boycott.
Inclusion is a battle cry.
Challenge to the parents,
Child’s cry for his/her existence…
For welcome, for embrace,
To be remembered fondly…for award
For gift of love…like surprise,
Like treasure.
Inclusion means clean game,
General knowledge, courtesy, hard work.
Inclusion is great in its simplicity,
And surprising in its complexity.
Instead of investing in jails, mental asylums, hospitals, refugee camps,
To canalise resources for creating true homes,
True life, true human beings…
For humanising life.

 VII Jan Manasik Arogya Abhiyan (JMAA)

JMAA started as a people’s movement in mental health in September 2005 with the partnership of Action Aid India. It is a platform built in order to engage various stakeholders on the vital issue of the “right to mental health care”. The problems of persons with a psychiatric disability are different from other vulnerable groups (e.g. health care patients) and needs to be addressed as an independent area of activism.

JMAA has been successful in starting a dialogue on rights of persons with mental illness and issues related to quality of care. It has forged partnerships with NGOs in Mumbai and Pune and has had regular meetings to sensitize members and discuss priority issues. It has created a space within the Jana Swasthya Abhiyan to mainstream issues related to mental illness. This provides an opportunity to integrate health and mental health issues and magnify stakeholders’ voice and concerns. JMAA’s work complements Bapu’s work on advocacy at National and international levels. The current challenge is to strengthen the user perspective and user participation in the movement. Working through conflicting perspectives and priorities of partner organizations will pose a challenge.

Maharashtra has no people’s platform on mental health, as exist in some of the other states. As a result we, who are service providers, users and consumers of mental health services in different ways, have become isolated. There does not exist any process of bringing the critical issues of mental health into the public or policy domain. Through JMAA we aim to build region-wise work in Maharashtra, where people working in mental health or related issues come together to work towards a common cause.

Persons labeled with a “mental illness” are the most marginalized in society. They are treated as people without histories and as voiceless people. There has to be a space for their mobilization and political participation in decisions made about their lives, health and well being. JMAA is founded on principles of “self-determination” of persons with a psychosocial disability.

Role of the Organization in development of the community:

Bapu Trust initiated the process of a people’s movement, which led to many organizations coming together. During the initial meetings, various organizations, groups and individuals discussed the need for another movement and reached a consensus about starting a campaign, which would focus on the issues of self-determination of the user.

Since the partners of JMAA came from different backgrounds and experiences, Bapu Trust as a convenor organization, worked on building a common understanding of mental health during the past two years. There was a need felt for building awareness and capacity building among the partners on rights of mentally ill, the existing services related to mental health, and the legal issues related to mental health and this objective was addressed through all activities and events of JMAA. JMAA is also envisaged as a space to mobilise users of mental health services in the State of Maharashtra.

A lot of efforts have been made in order to develop a democratic process within JMAA as well as its position and ideology in mental health. Initial meetings with partners involved needs assessment and obtaining the interest of people in the movement. There has been continuous dialogue within the group about the identity and values of the campaign. Effective strategies for successful integration of mental health agendas into much larger campaigns like JSA have been planned and developed. When, how and why to dialogue with the government has been a self-conscious thought process. We have maintained detailed documentation of the meetings, activities and events related to JMAA in order to create advocacy documents for the state. This has also helped us in establishing dialogue with the state.

Project Planning and Implementation:

Bapu team worked towards the plans and budget for JMAA for both the years. But these plans were made based on the brainstorming activities with JMAA partners at the preliminary meetings. These plans were then incorporated in the plans and budget for JMAA. There was high involvement of the partners in determining what the role of JMAA would be, what would be the strategies and to fulfill these strategies what activities would the campaign undertake.

At the onset, a capacity building of Bapu staff in the areas of Mental Health Act, Persons with Disabilities Act (PWDA), and mental health activism in India took place. Ration Kriti Samiti (RKS) and RSCD (Mahila Rajyasatta Andolan) shared their experiences with the Bapu team on building people’s movement, identifying partners, creating people friendly literature and arriving at common minimum understanding while building alliances. There have been regular internal meetings as well within the Bapu team to review, plan, follow up and maintain detailed documentation of all the proceedings related to JMAA.

Activity Table for JMAA for 2005 - 2007

Sr.No.	Date	Venue	No. of people attended	Purpose of the meeting / programmes / events
1.	13th Dec, 05	Bapu Trust, Pune	35	To discuss need for such Abhiyan/platform in the mental health sector.
2.	16th Dec, 05	Kshitij Mental Health Care Centre, Mumbai	20	To discuss need for such Abhiyan/platform in the mental health sector.
3.	27th Dec, 05	YWCA, Andheri	63	Coalition meet of Pune and Mumbai members to discuss strategies for future
4.	20th Jan, 06	Apanalaya, Mumbai	17	Feed back on concept note, to finalise areas for capacity building and to discuss responsibilities
5.	23rd Jan, 06	Shahid Bhagat Singh Hall, Pune	18	Feed back on concept note, to finalise areas for capacity building and to discuss responsibilities
6.	20th & 21st Feb, 06	J.P.Naik Centre , Pune	46	Capacity building workshop of Pune & Mumbai group
7.	24th Apr, 06	Bapu Office, Thane	8	Objectives and strategies of the IEC core group were discussed
8.	18th May, 06	Bapu Office, Thane	4	IEC meeting to brainstorm and plan IEC material
9.	20th Jul, 06	Yerwada Mental Hospital	21	Visit to the mental hospital (Pune JMAA partners)
10.	14th Jul, 06	Thane Mental Hospital	17	Visit to the mental hospital (Mumbai JMAA partners)
11.	6th Aug, 06	Bal Gandharva Hall, Pune	110	Erwadi Memorial Day – Photo exhibition and panel discussions
12.	6th Oct, 06	SAA - Kamla Nehru Hospital	12	To discuss observations and suggestions for mental hospital visit report
13.	6th Oct, 06	Samaritans Office, Mumbai	10	To discuss 6th August event and mental hospital visit report
14.	30th Dec, 06	YMCA, Pune	19	JMAA Review meeting for dilemmas, strategies and future plans
15.	21-23 Feb, 06	Mumbai		Participation in the state health assembly
16.	13th Mar, 07	CYDA, Pune	8	To discuss charter of demands and planning for NHA
17.	23-25 Mar, 07	Bhopal	7	Participation in the National Health Assembly
18.	29th May, 07	CYDA, Pune	8	To discuss plans for meeting with DHS
19.	12th Jun, 07	Directorate of Health Services, Mumbai	13	Meeting with Dr. Doke

Strengths:

As Bapu did not have much capacity and experience in running campaigns, one important strategy was to build our own capacities and we developed activities around this.

Process of arriving at common minimum understanding of mental health led to gaining consensus on issues of creating awareness about mental health and right to quality mental health care.

Initiative and voluntarism from partners with respect to spaces for meetings, cooperation and openness to travel to other places without asking for reimbursement and resource persons offering free consultations for the awareness workshops, which proved to be cost effective ways of managing the campaign. These were not just cost effective means but also showed the partners commitment and ownership towards the campaign and the cause.

Integration with other already well established campaigns like JSA has created a space for putting forth the mental health agenda to the government. This space has also aided in mainstreaming issues of mental health in the larger health scenario.

A Charter of Demands was prepared by JMAA, which was put presented at the State as well as the National Health Assembly of the JSA. This also forms a good advocacy document, which can be used for developing a mental health policy at the state level and also forms a good template for the national mental health policy.

Two core groups were formed where one group will work towards creating awareness material and the other group would be involved in research activities. The IEC group brought out posters to raise awareness about mental health and also about stigma attached to mental illness. There was also high initiative from the research group to understand the quality of existing services in Pune city.

The dialogue processes have been more successful with the government and other campaigns through the platform politics of JMAA rather than as an individual organization.

JMAA is a local level campaign for the rights of persons with mental illness supporting and complementing Bapu’s other national and international level campaigns.

JMAA because of its diverse activities (research to advocacy) can provide field data for supporting Bapu’s other campaigns.

Limitations:

Across the forum there has been strong need for initiating quality mental health services voiced by the partners but as a campaign we cannot start services and it is difficult to negotiate this with the partners.

The government officials have shown an apathetic and indifferent attitude towards the issue and thus keeping the dialogue with the government sustained has been challenging.

The values of the campaign and values of some organizations who are partners of JMAA sometimes clash. Some of their activities at an organizational level are conflicting with the stands they take at the campaign. In such cases, the dilemma about inclusion remains.

While focusing on mental health as a broad issue, sometimes we may run the risk of not addressing many cross-sectional issues like gender, child rights, etc.

Due to the intense stigma attached to mental illness, many users do not come out with their issues even though JMAA has been portrayed as a user space. Thus, the work of the campaign so far has been limited to creating awareness about the issue even after two years of establishment of the Jan Manasik Arogya Abhiyan.

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Box: Prashant

I joined Bapu in January, 2007. I was in CEHAT, Pune. I am M.S.W. from Karve Institute of Social Work. Through JMAA we are establishing Interlinkages among pressure groups/ Stake holders- service providers, care givers, users, parents. Our clients are from different backgrounds. They come for our film festivals and rally. Seher and JMAA are interlinked. All
Seher members and Seher’s clients actively participate in JMAA. We organize Awareness Rally during Mental Health Week in August-Yervadi Din. We commemorate International Mental Health Day on 10^th October. Our goal is to promote right based approach that we are pre-testing in community. Testimonies of rights violation can be presented at Jansunvai (People’s Court) at JSA.

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Changes the project has brought to the life of people:

Many of the organizations that are JMAA partners do not work in core mental health issues. They may work on women’s issues or youth issues or other health issues. But the campaign has led to not just awareness about mental health issues but also an integration of these issues in their respective work. A mental health vocabulary has been incorporated in their everyday work.

Management and Sustainability of the project:

Cost effective strategies like active contributions by the partner organizations will help the campaign sustain as well as lead to more participation in the campaign.

The structure of the campaign is such that the leadership roles will change and thus lead to greater involvement of other partners.

Active involvement with national campaigns like JSA and the Bill of Rights Campaign to mainstream mental health agendas into other movements and also to say that mental health is a cross cutting issue.

Forming of a working group and constitution of JMAA, which in turn expands ownership towards the campaign.

 VIII. Interventions with Other Custodial Institutions such as Jail and Mental Hospital

Right to Life:

Capacity enhancement program with Jail officers:

Being the custodial institution where rights of persons with psychosocial disability are at stake, Bapu Trust had initiated the capacity enhancement program with newly recruited jailors along with Jail officers’ training school, Pune. Jailors are in a key position with respect to both having power of decision making and contact with the prisoners, Bapu decided to work with this group to begin with.

Three capacity enhancement programmes with jailors were organized in which on an average 55 participants were present in each. Some of the topics covered during the program are concept of mind, mental health, continuum of distress, and informative sessions on common and severe mental disorders, self care etc. Last program, which Bapu had conducted, was with in-service jailors working in various prisons in & around Mumbai. Needs assessment exercise followed before the module building. Prison dept. is sufficiently motivated to conduct such programs, which is reflected by sharing the cost of the program and assuring co-operation in future too with similar kind of programs.

Women’s Rights: Working In Mental Hospital, Yerwada

Activities under this component are placed under the theme of women’s rights as we are planning to work mainly with the women in long stay, chronic ward of the mental hospital, Yerwada. This is also necessary as, often; women are being dumped by their family members in the hospital, and continue to languish there for years in spite of recovery. In this scenario, interventions with the component of rights interwoven in it assume importance.

Proposal that has been submitted to Health dept. has components of linkages of service and advocacy in the program.

It has following components-
• AMH interventions with the long stay & recovered women residents in mental hospital.
• Capacity enhancement programs with the staff of mental hospital.
• Workshops on ’Good practices in Institutional care’ with the staff of mental hospitals in Maharashtra.

AMH interventions with women in long stay and chronic ward of mental hospital

Using various alternative therapies such as green therapy, arts based therapies would be carried out. These are people friendly, non-intrusive and creative therapies wherein the focus is upon the ‘wellness’ and not on ‘illness’ per se. We are planning to conduct 50 sessions in a span of one year with the group of women.

Capacity enhancement sessions with the mental hospital staff will be conducted. These sessions will be started in the second half of the year as our experience with beggars’ home says that it takes a while to study and understand the system, people, programs and services in the process of establishing service. We will be spending first six months for this purpose. During this period, we will also make the assessment of the training needs of the mental hospital staff such as social workers, psychiatric nurses etc. and start the sessions in the next six months. We are hoping that we will get permission in the beginning of the year.

Good Practices Workshop with the Mental hospitals across Maharashtra on theme of ‘Institutional Care’

Maharashtra has 4 regional mental hospitals. Bapu Trust now has the experience of conducting similar kind of workshops with the stakeholders in the field of mental health in Gujarat. This will enable us in planning & conducting workshops in Good Practices in the context of Institutional Care with these hospitals. The objective of the workshop will be to standardize care in the Mental Health system and to initiate dialogue on systems reform.

Currently team members have paid visits to the hospital and had discussions with the residents and staff keeping the participatory approach in planning the program. Shortly, we will be able to initiate interventions in mental hospital, Yerawada.

 IX Efforts at Staff Development:

Seher makes concerted efforts for staff development. The team organizes human resource sessions, recreational activities, lunch, workshops as group activities. It provides social security Benefits through group Mediclaim and the preminum is paid by the organization. PPF or Provident Fund is also provided to the staff. At Bapu Staff Development is Individual centric with stress on Personal growth.

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Box: Amrita

Actually I have joined Bapu Trust 4 months back. Right from my college day, I knew about the organisation. I had read several articles .While I was doing my P.G.; I felt that I wanted to use my knowledge for those who needed the services but could not get one. I find 4 points about Bapu Trust very important:
1. In the Clinical set up, the emphasis is on how to establish rapport with community. Darshna’s work thought me this.
2. Bapu gives lot of space for reading and proactively shows importance of critical reflection.
3. Community training is imparted in simple language by Seema, Radhika. They know how to touch heads and hearts of trainees.
4. We are given writing skills that include structured documentation and preparation of training material.
I feel I need to learn a lot. I feel I will get lot of experience in this organisation. I see my future in this organisation. My identity, self perception gets extended while working in Seher. My expectations about my work got fulfilled in Bapu.

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Mentoring process of Seher is guided by ethos of cooperation. Bapu culture encourages reading and analysis. Collective thinking, collective wisdom and writing skills get developed.

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Box: Vidya

When I joined Bapu Trust 6 months back, I wanted to get out of “Clinical” approach. I am trained as psychiatric social worker. I felt that what I was searching I got. By working in Beggar’s Home, I realised that you can’t preplan you work. You have to decide your approach according to situation.
While working in the government structure, you need special skills. Proper communication is very important and you can not make loose statements or else the repercussions can be very damaging. Interacting with DWCD system, we have to be very professional.
In my earlier job, while doing training, I had worked in a secure environment. In my field work of M.S.W., there was a teacher to guide me. Here I conduct counseling with responsibility. E.g. I will counsel that person keeping into consideration her context not my personal context.
I have written in Abhvyakti. Even in report writing, I have improved. My verbal skills have developed a great deal.
While working in institutions, right based approach is so important. Even in small matters, individual’s rights are very important, I understood. E.g. While working in hospital setting, when relatives tell that the patient should be given medicine. Nobody bothers whether the patient wants medicine or not. We must seek alternatives to biomedical approach.

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 X Future Visioning and Plans:

Most of Seher projects have arrived to a stage where active documentation is in process. The projects are established, where they can be replicated, they can be expanded. With respect to each project Seher has decided to expand the scope. Approach of knowledge building is for replication. We are geared towards consolidation of our activities. Next couple of years will focus on dissemination of our learnings, insights, challenges…Our biggest strength is to operationalise our mental health value framework, notion, social and individual perspective. Our documentation will not only go to the systems but to the larger field. To develop training programmes, reader friendly material- knowledge centre, dissemination centre, writing for other forums, platforms. Experiences getting across-services in mental health are very few. Hence there is need for mental health- core programmes which are a must as knowledge does not happen in vacuum.

Seher will continue supervisory, consultative and monitoring role in the Family Court and The Beggars Home. Along with this Seher will come out with advocacy material- Publications, posters and wider dissemination of creative expressions- poems, paintings, stories and songs.

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Box: Bhargavi

Over the years, Seher has evolved as a programme, of course is self-consciously non-medical. Its objective is mental wellbeing through non-medical preventive promotion work. Seher has made major qualitative contribution in India for mental health sector as a whole. Also thro’ this process, our belief in being able to apply core Human Rights values about patient choice has turned into a conviction.. Having been able to mix political action with therapeutic work, we have also collected new knowledge which can be transferred to wide ranging constituency. It is a mature programme. Now we are looking at how this can be presented as good practice model for a range of people –mental health professionals, women’s movement, development sector, government agencies, policy makers, general civil society-family members and clients. People in Seher have high capacities for training people in different constituencies as primary care givers. We are looking forward for various strategic opportunities. We are thinking of institutionalizing our mental health values and practices into various sites where we are working, into governance. The programmes are also giving us lot of advocacy data. Ground level data that can influence policy. We want to explore relationship of Spirituality and Mental Health and Role of spirituality in mental health.

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During last 4 years, Seher has succeeded in bringing visibility to mental health issues from the rights perspective. Its work is recognized and valued at local, state, national and international levels. The Board of Trustees and team leaders function as experts at various fora, providing leadership even outside the organization.

Seher’s work within institutions has demonstrated the efficacy of rights based interventions and influenced perspectives of programme planners and policy makers. However, much of this work is of recent origin. In order to make a big difference, this work needs to be consolidated.

Private practitioners are missing out on social aspects, developmental counselling misses out on psychological aspect, and Seher centre brings social aspect as well as psychological aspect centre-stage.

Seher has proved that intertwining development into mental health and mental health into development is possible. Seher has consciously avoided integration of mental health with mental health trap of biological essentialism and RCH machinery. Seher has brought legitimacy for role of non-medical intervention in mental health discourse.