India's Mental Healthcare Crisis: Beyond Rehabilitation, Employment and Social Integration Key

At Kimaya Café, nestled in the heart of Pune, the day unfolds with a rhythm of its own. Shilpa, 42, skillfully prepares Vada, a traditional Indian snack, while Nilesh returns, arms laden with groceries and vegetables, ready to serve the customers who have settled in the welcoming space outside the café. Amid the daily hustle and bustle of commuters at the nearby bus stop, Shilpa and Nilesh perform their duties with remarkable discipline. To an onlooker, their seamless operation hides a deeper story: both have been coping with severe mental health conditions, such as schizophrenia and bipolar disorder for over a decade now. In fact, all five individuals behind the café's operations share similar battles. 

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The inception of Kimaya traces back to Parivartan, a social organisation founded by the late Dr. Narendra Dabholkar, a renowned anti-superstition activist from Maharashtra. Since 1991, the organisation has been supporting individuals with mental healthcare related challenges, guiding them through the stages of disease identification, support, treatment, and ultimately, rehabilitation. "As we approach the stage of rehabilitation, it becomes evident that securing employment is a monumental barrier for our patients. Those who do find work often struggle to maintain their positions due to various challenges, including stress, or face termination from their employers,” states Reshma Kachare, a coordinator and psychologist with Parivartan. 

The counselors at the organisation were well aware that for individuals largely recovered from their mental health challenges, securing employment was not just beneficial but crucial for their continued recovery. This understanding led to an innovative approach: creating employment opportunities directly for those in recovery. Recognising the potential in this idea, Parivartan began by setting up snack stalls at short-term events like exhibitions and theater festivals, which were managed with remarkable capability by individuals undergoing treatment for mental health issues. This success laid the groundwork for a more ambitious project.

In January 2022, the decision was made to establish Kimaya Café, a name chosen for its connotation of 'magic,' aiming to offer more than just snacks, tea, water bottles, and packaged goods. The initiative was as much about creating a supportive employment environment as it was about running a café. To identify individuals best suited for this venture, Parivartan conducted assessments focusing on communication skills and interest in café work. The selected candidates underwent comprehensive training covering everything from snack preparation and food arrangement to maintaining cleanliness and washing utensils.

Nilesh Panase, a 39-year-old graduate battles bipolar disorder | Photo courtesy: Varsha Torgalkar 

Ultimately, the café's day-to-day operations were entrusted to Shilpa Dharmande, Lalit Deshmukh, Nilesh Panase, Yogita Bajirao, and Chandrakiran Parundkar. This initiative has indeed offered a new lease of life to many grappling with mental health challenges. However, it also brings to light a pressing issue: the lack of similar opportunities for individuals in India who are either navigating through mental health issues or are on the path to recovery from such conditions.

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India's Mental Healthcare Dilemma: A Stark Gap in Care and Professional Support

In India, an estimated 60-70 million people grapple with a range of mental health conditions, from common to severe. This figure starkly contrasts with the availability of mental health professionals in the country; there are merely 0.75 psychiatrists for every 100,000 people, a fraction of the World Health Organisation's recommended ratio of three psychiatrists per 100,000 population. Additionally, according to government data, there are only 3,372 clinical psychologists across the nation, pointing to a significant gap in the mental healthcare infrastructure.

How Work Environment Positively Affects People with Mental Health Challenges 

The transformative impact of a supportive work environment on individuals with mental health challenges is vividly illustrated through the experiences of those working at Kimaya. Nilesh Panase, a 39-year-old graduate battling bipolar disorder, found a new lease of life when he started working. His responsibilities range from grocery shopping to serving customers, and his stable work environment has evolved into a form of therapy for him. Despite initial challenges with tasks like accounting, he has not only improved but thrived, learning to navigate both positive and challenging customer interactions with grace.

“A few customers intentionally come and ask for cigarettes and tobacco. But I have learnt to say no politely. There are many people who are curious about our organisation and what we do. There are groups of friends and college students who celebrate their monthly get-togethers at the café. We get both kinds of experiences - good and bad,” explains Nilesh,

Shilpa Dharmande has been battling schizophrenia for over two decades now | Photo courtesy: Varsha Torgalkar 

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Similarly, 42-year-old Shilpa Dharmande, has undergone a remarkable transformation since she began working from January 2022. Struggling with schizophrenia for two decades, Shilpa's previous life was marked by isolation and silence. However, her role at the café has catalysed a profound change, enabling her to engage with customers and find joy in these interactions. This newfound confidence is not just evident in her social interactions but has also spilled over into other aspects of her life, including her commute to work. Where once she would only travel by taxi, she now confidently takes the bus.

The combined efforts of the five-member team who divide tasks such as taking orders, serving, and managing finances during busy periods shows their capacity to not only contribute significantly to their café's operational success but also find therapeutic value in their work. "We do accounts every two weeks. We are there to solve any problems the patients might encounter," Reshma explains. 

The importance of professional supervision in such initiatives cannot be overstated, as Dr. Shama Rathod, Deputy Director of the Regional Mental Hospital in Pune, points out. According to Dr. Rathod, it's challenging for individuals with severe mental health conditions to maintain employment in a sustainable manner. "Patients generally find themselves in menial roles, such as agricultural labourers, security guards, or domestic helpers, and struggle to secure more intellectually demanding positions," she observes. This situation is further complicated by the lack of provisions for livelihood rehabilitation in the Mental Healthcare Act 2017, an oversight that fails to address the crucial aspect of integrating mentally challenged individuals into the workforce.

In India, the disparity in employment opportunities for individuals with Severe Mental Illnesses (SMI), such as schizophrenia and bipolar disorder, is stark compared to developed countries, where the workforce is more inclusive of people with SMI. Experts highlight that the stigma surrounding mental illness presents the most significant obstacle for those in recovery seeking employment. Beyond the challenge of unemployment for those with SMI, there exists an additional hurdle for employed individuals who lack access to mental healthcare. The Deloitte Mental Health Survey 2022 reveals that 80% of the Indian workforce experiences mental health issues. However, studies have indicated that 73% of employers do not include mental healthcare services in their employee health benefit packages.

While the current situation is concerning, there is room for optimism if policy interventions at the governmental level are implemented. Effective policies could bridge the gap in mental healthcare access and employment opportunities for people with SMI. By fostering a more inclusive workforce and ensuring comprehensive health benefits that cover mental healthcare, the government can significantly mitigate the challenges faced by individuals with SMI. Such measures would not only address the stigma associated with mental health but also promote a healthier, more productive workforce. This approach requires a concerted effort from policymakers, healthcare providers, and employers to create an ecosystem that supports mental health rehabilitation and integration into society.

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