इस ब्लॉग को हिंदी में पढ़ने के लिए, यहाँ क्लिक करें।
Introduction
It is now well documented that while the COVID-19 pandemic has taken a terrible toll on the lives of millions of people the world over, historically marginalised communities have experienced disproportionate suffering. In addition to causing severe physical health challenges and laying bare the many cracks in our healthcare infrastructure, the pandemic also led to an increase in experiences of mental health challenges: from the uncertainty of stringent lockdowns and the fear of contracting the virus, to grief and loss, economic distress, learning losses for students and challenges related to providing and receiving social support.
In India, the second wave of the pandemic was even more severe than the first one, and organisations working with marginalised communities realised the need for mental health interventions at the level of the individual as well as groups. Since the pandemic had made it necessary for most interactions to transition online, several groups and organisations launched online mental health interventions, ranging from support groups to specialised care. In this blog, we will unpack two mental health interventions that can be categorised as Online Mental Health Communities (OMHCs)1. OMHCs can be thought of as “therapeutic, peer-to-peer space for users in times of crisis which have the possibility to increase self-efficacy when engaged with”1. Self-efficacy is the belief that people have in their abilities to cope with their challenges and accomplish their goals2. Therefore, self-efficacy is considered to be integral to human agency which can be understood as the capacity to act/ take action in a particular context3.
OMHCs can encompass online forums, social media groups, interactive blogs, and virtual meetings that offer a way for people to come together, either synchronously or asynchronously, and share and listen to experiences related to mental health and wellbeing. Apni Shala Foundation (Apni Shala) and Ummeed Child Development Center (Ummeed) were two social impact organisations that organised virtual meeting-based OMHCs during the second wave of the pandemic. Hence, we reached out to people who played a role in the design and/or facilitation of OMHCs at Apni Shala and Ummeed. Through this blog, our intention is to make visible the considerations and skills that went into designing and facilitating OMHCs and the possibilities that emerged because of them. Lastly, we will share a few thoughts on the way forward for OMHCs.
Apni Shala and Ummeed’s Mental Health Initiatives
We spoke to Rohit Kumar and Sangeeta Zombade, both members of the leadership team at Apni Shala. In our conversations with them, we spoke about the OMHCs organised for children, youth, caregivers, members from marginalised communities, and NGO staff. This blog focuses mainly on the OMHC for adults. Then, we reached out to Shahid Shaikh, a member of the Mental Health team at Ummeed, for his thoughts on the OMHC organised for caregivers of children with disabilities. In this blog, we will refer to Rohit, Sangeeta, and Shahid collectively as “representatives”.
Emerging Need
What immediately stood out in our conversations with the three representatives was that both organisations recognised the need to provide mental health support to the communities they were working with or connected to. Several people in these communities contracted the virus, experienced job loss, worked in the limited space at home, contended with severe economic distress, and took care of their children, some of them with developmental disabilities, amidst these multiple causes of distress. Children too had to contend with continued loss of learning and play, while lending a helping hand or two, at home.
Why OMHCs?
While designing the OMHCs, both Apni Shala and Ummeed worked to their organisational strengths of creating safe spaces for people to come together.
Apni Shala’s intention was to create an online space where people could come together, share their experiences, lend a non-judgmental ear, and process a range of emotions, all of which would become possible through the process of building community with each other. An aspect integral to this OMHC was the orientation towards listening and not problem-solving. Further, during the pandemic, Apni Shala had transitioned all its engagements with children and adults to virtual meeting platforms like Zoom and Hangouts. Hence the facilitators of the OMHCs had the skills to run these groups online.
In line with Ummeed’s philosophy of family-centered care, the Mental Health team focussed on working with caregivers of children with disabilities with a focus on building relationship skills and resilience. The intention was to support the wellbeing of caregivers and help them navigate their challenges and nurture the relationships with their child/ children. As one of the early adopters of the online training model, Ummeed’s facilitators were also technically equipped to run online groups.
Guided by the shared philosophy of Narrative Ideas and Practices4, the OMHCs organised by Apni Shala and Ummeed intended to make visible the expertise that the participants had about their own lives. This, they hoped, would in turn promote the participants’ agency in the navigation of challenges brought upon by the pandemic.
OMHCs: Activities and Themes
When catering to a diverse group of adults, the choice of activities and modalities becomes important. Apni Shala OMHCs included modalities such as writing, art, poetry, storytelling, and discussions to enable the participants to express themselves in diverse and/or preferred ways. Participants would engage in these modalities based on prompts around emotions, wellbeing, and relationships. In an effective use of the features of the virtual meeting platform, participants would also engage in small-group discussions. This was especially helpful for people who preferred to share their thoughts in smaller groups. Participants also engaged in mindfulness practices to help bring their focus to the present moment, as they may have joined the OMHCs right after work or while coping with a challenging situation. While this blog is focussing only on OMHCs for adults, the activities and modalities in the OMHCs for children and adolescents were also designed keeping in mind their interests and strengths.
“Art is a kind of therapy that can bring out your feelings on paper”- a participant in Apni Shala’s OMHC
Ummeed’s OMHC invited the participants (caregivers) to engage in creating art, reading books, playing games and contributing to discussions around topics of shared interest such as the constructive use of technology. Some of the activities were such that the participants could engage in them with their children, for example, making rotis or playing with a dupatta. The OMHC also offered the participants the opportunity to reflect on and share their own journeys with each other, thereby helping build a sense of community. Another intention of the OMHC was to also create living documents of the participants’ know-hows, grounded in their ideas and lived experiences around mental health.
“Participants reported feeling safe after reading books, and said they would like to read more”– Shahid Shaikh, sharing an observation from Ummeed’s OMHC
OMHCs: Accessibility
Both Apni Shala and Ummeed were very intentional about the logistics of the OMHCs they organised. Firstly the day and time of the OMHCs had to be such that it would be convenient and/ or possible for the participants to join them. This led to 1.5 to 2-hour virtual meeting-based OMHCs being organised in the 3- 6 PM window during midweek and/or on weekends. In addition, the facilitation of the OMHCs was either bilingual (English and Hindi) or in one of English, Hindi and Marathi. Further, the use of visual aids (such as presentation slides) and the chat feature to communicate prompts in multiple languages, helped cater to the preferences of the participants.
Possibilities that Emerged
The participants of the OMHCs organised by Apni Shala and Ummeed engaged in a range of activities: emotional check-ins, art, poetry, reflection-based discussions in small and large groups, storytelling, and games. These activities and modalities helped them understand the challenging emotions and experiences that they were undergoing at the time.
“My emotion is named as HELPLESS HER. It’s dark in color. There’s a girl who is obese and she is having a bag by her side which is full of all the things she has to take every day in order to meet the expectations of the people she lives with. She is under a lot of pressure and is so scared of what is there for her in future.”– a participant in Apni Shala’s OMHC
In addition, these activities provided them with an opportunity to reflect on how they have already navigated some of their challenges and/ or what know-hows they could use to navigate upcoming challenges.
“Initially I used to get irritated when my child would use technology. But now I’ve understood that I need to understand why he is using technology and how I can support him. There is no point in just shouting at him, we need to have a conversation about it.”– Shahid Shaikh from Ummeed, sharing a participant’s reflection from their OMHC
While some participants shared their journeys and reflections with other participants in this space, others were intently listening to these experiences. That the nature and extent of participation were voluntary helped the participants experience emotional safety and comfort.
“Because these spaces [OMHCs] were confidential, participants experienced safety and shared their feelings without the fear of judgement. That people were bringing their life stories into this space, and our intention was to listen only, made this space very powerful.”- Sangeeta Zombade from Apni Shala, sharing her reflections from the OMHCs
In addition, engaging with each other’s lived experiences also helped them realise that they were not alone in this journey and helped build a sense of community and solidarity.
“We all are on the same page. In so many aspects. And we are all doing our best to channel our thoughts.” – a participant in Apni Shala’s OMHC
For caregivers of children with disabilities, Ummeed’s OMHC offered a way to participate in a wellbeing initiative from their homes without the stress of handing over caregiving responsibilities to someone else or travelling with their child during the pandemic.
“Such spaces for mental wellbeing do not exist at all for caregivers of children with disabilities. They are always thinking about their child and family. An online space helps them save on travel related expenses. Sometimes caregivers join this space while resting or lying down.” – Shahid Shaikh from Ummeed, sharing some observations from Ummeed’s OMHC
In terms of takeaways from the OMHCs, it was heartening to note that participants felt that they had engaged in a deeply meaningful process.
“I’ve found myself.”- a participant in Apni Shala’s OMHC
One of the hopes from the OMHCs that was seen to be realised was that the participants learnt some simple strategies and practices to help them navigate daily challenges.
“I’m leaving with a sense of comfort and hope I continue with a daily mindful practice”- a participant in Apni Shala’s OMHC
As a result of a continued engagement with the OMHC, the facilitators observed how participants were demonstrating an important shift in their mental health journey.
“I’m seeing a move from self-blame to compassion towards self ”– Shahid Shaikh from Ummeed, sharing an observation from Ummeed’s OMHC
Our thoughts on the Ways Forward for OMHCs
Our motivation to think about the way forward for virtual meeting-based OMHCs was based on the possibilities they created for the communities served by Apni Shala and Ummeed. When we initially read our notes from the interactions with the three representatives, we felt that the way forward looks bleak. Yes, more and more people have gone back to their daily routines which leave little to no time for self-care or recreation. Yes, ensuring that a healthy number of participants join the OMHCs takes up a lot of communication-related resources. And yes, sometimes balancing the need for OMHCs, risks related to participant turnout, and the funding available for these OMHCs becomes a major stumbling block.
However, a closer look of our interactions with the three representatives revealed some possibilities and hopes we could hold onto.
Incorporating OMHCs in our existing work
Given that allocating additional time and resources for organising dedicated OMHCs can be challenging, a possible way forward includes organising OMHCs with a reduced frequency and/or figuring out ways in which the objectives of the OMHC can be met as part of the regular engagements with various stakeholders and communities. In the context of Apni Shala’s work in public schools, this could mean that teacher engagements and caregiver engagements, which are currently happening via online group meetings, become a possible avenue to work towards the objectives of an OMHC.
With the increased adoption of messaging apps during the pandemic, they too can help meet the objectives of OMHCs outlined in this blog, in the form of an asynchronous OMHC. With engagements with several stakeholders now moving offline, there is also an opportunity to organise online-offline hybrid Mental Health Communities. The possibilities that mental health organisations have created during the pandemic with the help of internet-based platforms, can continue to be leveraged even after the pandemic.
OMHCs for Mental Health Advocacy
Since the core objective of the OMHC is the care and wellbeing of the participants, organising OMHCs on an on-going basis can play a critical role in destigmatising mental health challenges, and in normalising seeking care for mental health. Since these OMHCs work on promoting self-awareness and agency in the participants, the hope is also that the participants will recognise their mental health needs and seek specialised mental healthcare, if required.
The complex emotions and challenges that people have experienced during the lockdowns have also impacted how they express their feelings and whether or not they choose to express their feelings. In this context, it becomes important that OMHCs where one can participate by either listening or sharing and where one can share their thoughts and feelings without fear, hesitation, judgement, and consideration for tone or language, are available to people. In the context of Ummeed, the hope is that continuing to offer OMHCs for caregivers will help advocate for their mental wellbeing and slowly build a culture where caregivers’ wellbeing becomes more intentional in the provision of healthcare for their children.
OMHCs for Mental Health and Social Justice
It is important to note that while OMHCs can serve certain members of marginalised and/ or underserved communities, they will continue to exclude individuals and groups whose access to smartphones and internet data may either be absent or sporadic. Further, communities that have been marginalised historically on the basis of gender, caste, sexuality, disability and income/ class are also likely to experience exclusion from OMHCs.
Through engagement with mental health communities, one understands how individual mental health is connected to families and communities. Similarly, from a social justice perspective, one can see how systemic marginalisation at the level of family and community links back to individual mental health. In other words, mental healthcare and social justice are closely intertwined, and that justice in mental healthcare cannot be achieved without social justice. Lastly, the possibilities that have been discussed in this blog help make visible how the intentions, design, guiding philosophies and facilitation practices of intervention can affirm the fundamental human rights to “dignity, respect, development, and participation”5, thereby fulfilling the potential of mental health work to be “social rather than individual, revolutionary rather than repressive, and contextual rather than colonial”6.
This blog was not intended to be a critical analysis of the effectiveness or impact of OMHCs. The objective of this blog was to provide a vivid description of the OMHCs organised by Apni Shala and Ummeed, in terms of their intentions, considerations, guiding philosophies, practices and possibilities (those that emerged and those that can potentially emerge). We hope that this blog supports mental health workers, educators and social workers as they design and implement initiatives for the wellbeing of the diverse groups they work with.
References:
- “Online mental health communities, self-efficacy and transition to further support” by Julie Prescott, Amy Leigh Rathbone, Terry Hanley
- “What is Self-Efficacy Theory in Psychology?” by Courtney E. Ackerman
- “Agency (Philosophy)”
- Narrative Practices India
- “Where Social Justice Meets Mental Health” by Deepa Pawar
- “Psychotherapy Practices in India” by Ritika Chokhani
With gratitude to: Shahid Shaikh (Ummeed), Rohit Kumar and Sangeeta Zombade (Apni Shala); Apni Shala’s facilitators and partners in organising the OMHCs (called “Communities of Wellbeing”)- ATMA, The Yellow Umbrella, Narrative Practices India, Catalysts for Social Action
Disclaimer: Both the authors are full-time employees of the Apni Shala Foundation.
About the Authors:
Abhijeet Dhurve has a Master’s in Social Work specialising in community organization and development practice from the Tata Institute of Social Sciences. Having been involved in social work since 2011, he currently works at Apni Shala Foundation as a Programme Lead managing public school partnerships. When Abhijeet is not working, he is busy playing cricket or traveling to places.
Niranjanraj Ramasundaram has an MA in Development Studies specialising in power, participation and social change. With a work experience of 6+ years in the start-up and social sectors, he is currently working at Apni Shala Foundation as an SEL Facilitator and a member of the Fundraising team. Niranjan is fond of music, writing, and taking care of cats and dogs.
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