Mariwala Health Initiative (MHI) is a personal philanthropy of Mr Harsh Mariwala who is the Chairperson of Marico Limited. It works exclusively on mental health and focuses on making mental health accessible to marginalised persons and communities by fostering an environment of accessible, affirmative, rights-based and user-centric mental health care. Currently, it has 38 projects with 33 partners across 20 states in India.
In this exclusive interview with TheCSRUniverse, Ms Priti Sridhar, Chief Executive Officer, Mariwala Health Initiative, talks extensively about her organisation's mental health initiatives, and also the need for CSR stakeholders to incorporate mental health components in their working. She also shares insights on how mental health intersects with development issues such as education, livelihoods, public health and social justice.
Scroll down to read the full interview:
Q: Please elaborate on MHI's current projects that address mental health issues, and their impact and scale.
A: Mariwala Health Initiative is the personal philanthropy of Harsh Mariwala and works only on mental health projects. We look at our work in 3 main areas - Grant making, Advocacy and Capacity building. In terms of grant making, we work on 38 projects with 33 partners across 20 states in India.
Typically, these projects work on accessibility to mental health support and services for marginalized communities. In advocacy, we have a MoU with the state of Bihar to implement mental healthcare in the state and have recently worked on advocacy for the National Suicide Prevention Strategy. We also realise that there is a need to have a more informed, practice-based conversation on mental health and suicide prevention and regularly create multiple Resource books. In terms of capacity building, we currently focus - Mental health of the LGBTQIA+ community and Suicide Prevention. We run the Queer Affirmative Counselling Practice (QACP) program that trains mental health practitioners to enable them to understand the unique stressors that the community experiences and similarly launched a short training on suicide prevention for social workers to provide crisis support. During the last year, our work has reached out to 228,692 people.
Q: What are the current mental health trends in India, especially post COVID? What are your observations on the impact of the pandemic on mental wellness?
A: The COVID-19 pandemic and its associated lockdowns have had long-time repercussions across society The dismantling of social support, inability to access goods and services such as public distribution systems, sexual and reproductive services, vaccinations and the fallouts of the pandemic such as job losses and pay cuts have had long lasting effects on mental health. There is enough research to show that COVID impacted the mental health of marginalised communities disproportionately – women experienced more domestic violence, school dropout numbers increased for children in both rural and urban areas, suicide amongst daily wage earners increased etc.
Q: What are your thoughts on the interconnectedness between the physical, economic, environmental and mental health of the affected communities?
A: The current narrative on mental health tends to be overtly biomedical with too much focus on the individual. This narrative pin mental health down to individual genetics, biology, environment and experiences. It is essential to consider social, environmental and economic factors that influence mental health. Mariwala Health Initiative (MHI) uses a psychosocial approach to mental health. Psychosocial means that the interventions are not just psychological (counselling) or any other individual focused therapy/solutions but are also social in nature.
A psychosocial approach to mental health care provision includes enhancing access to education, legal aid, public distribution systems, housing, healthcare and other social entitlements. A psychosocial approach to mental health moves away from addressing only the ‘treatment gap’ (which identifies the number of psychiatrists per 1 lakh people as a measurement of access to mental health care) to a holistic care approach--one that covers the overall needs of the individual.
Q: Mental health or any conversation around it is still fraught with challenges, which prevents affected people to openly seek treatment. How can CSR efforts turn this mindset around?
A: Rather than fund-based CSR efforts, corporates need to start looking internally on how they are dealing with persons who disclose about their mental health. How are hiring practices, onboarding policies, insurance benefits impacting people with mental health issues. There is a need to adopt a strong disability policy that includes psychosocial disability and has documented processes for seeking Reasonable Accommodation from supervisors. Persons with mental health issues face discrimination when it comes to livelihood and corporates need to work on this issue, not as CSR but as part of their work culture and practice.
Q: What measures has MHI taken to transform mindsets and raise awareness?
A: As Mariwala Health Initiative, we believe that only raising awareness about mental health or putting the onus on persons living with mental health issues is not enough. A recent survey by the National Institute of Mental Health and Neurosciences (NIMHANS) identified that there are 150 million people in India living with mental health issues, so there is enough awareness and demand for services, what is missing in all the conversations on mental health is availability of accessible services. This would mean services that provide quality care and are easy to access and affordable.
Therefore, apart from undertaking grants to NGOs that free mental health services, we work towards changing the narrative on mental health to a psychosocial issue and not just a biomedical issue. We also identified the gap regarding demonstration of community- based models of service delivery which are relevant in low resource countries like India. We therefore publish a yearly journal called ReFrame, that highlights and illustrates mental health as a psychosocial. This year, we will focus on the intersection of mental health and climate change.
Q: According to your observations and experience, which are the most affected communities in terms of mental well-being?
A: Mental Health is psychosocial and intersectional; this means that a person’s social experiences and ecosystem affect their mental health. People having marginalized social identities experience discrimination and their access to social determinants like housing, employment, education, nutrition etc are affected and that results in poor mental health. Communities or groups marginalized by religion, caste, gender, sexuality, ability, economic status is the most affected in terms of mental well-being.
Q: How do you identify the communities for your projects?
A: We approach funding through a social justice lens and our grant making centres communities with marginalized identities. We prioritize organizations in marginalized geographies, look for leaders from marginalized communities and ensure that our funding goes to those organizations who have limited access to foreign and corporate funding.
Q: How are you using technology led solutions (such as online counseling and AI/mental health apps) to address the needs of affected communities?
A: When we talk about technology and mental health, we forget that the telephone too is a technology that has been delivering mental health support for many years. It is simple to use, affordable, accessible to marginalized groups (especially women & children) and is able to maintain anonymity. Using mental health apps or AI is not something we have been able to support primarily due to the need for a smartphone (therefore not affordable), using English as a language (not accessible to many) and the fact that conversations can be tracked by family members (therefore limited confidentiality). The other problem with Apps/ AI is that the reliability has not been tested and these are not validated by mental health professionals. There is also usually no referral system for social components of the issue ie the approach is not psycho social.
Q: You have highlighted the need to initiate community-led solutions to address the challenges of mental health. Please elaborate on this perspective, and the kind of partnerships that need to be forged to facilitate meaningful impact.
A: In MHI’s experience of funding community-based mental health services, we have learnt that mental health support for marginalized communities involves understanding the unique stressors that the community experiences, having people from the community design and lead interventions accordingly. This is important as people from the community have a deep understanding of the context and have similar lived experiences. Examples of mental health interventions for marginalised groups could therefore take the form of crisis support (eg for LGBTQIA+ community members who are forced to leave their homes);capacity building of youth leaders so that they can provide peer support; leadership programs for young persons from Dalit and Adivasi communities so that they can counter systemic challenges and express themselves in safe space providing legal support to victims of serious crimes so that they are able to access monetary and psychosocial support; supporting persons with disabilities to access disability certificates / pensions/ cash transfers etc. In all of these examples, linking social benefits and support is central to providing responsive mental health services, in addition to talk therapy. A true partnership is where community-based organizations are viewed as the expert in the community needs and funders support this journey by the grassroot organizations / collectives
Q: What kind of support do your partners extend, to expedite your efforts?
A: In our grant making work, our partners work on-ground, closely with communities to implement projects. Two of our partners include iCALL, which is a psychosocial helpline that offers free phone and email counselling services run by trained counsellors and therapists in 10 languages and Centre for Mental Health Law and Policy (CMHLP) that implements Atmiyata, a community-based project in Mehsana, Gujarat to reduce the mental healthcare gap in rural communities through community volunteers. We also partner with other organizations in our advocacy and knowledge creation work to bring in lived experience and subject matter expertise.
Q: What changes would you like to see at the policy making level for a holistic approach and solution to the issue of mental health?
A: In our view, mental health needs to be given a priority within the government by firstly providing adequate budgetary allocations, and secondly, providing services not just through the primary health center but also integrating mental health service delivery within the existing health programs. Strong referral systems are important for social benefits to deliver the impact of reaching communities and effectively addressing their mental health. For instance, the recently released National Suicide Prevention Strategy recommends an intersectoral approach, wherein ministries collaborate not only amongst themselves but also with civil society organisations, academia, media to work cohesively on suicide prevention. This is the kind of collaborative action mental health needs.
Q: What are your suggestions and advice to other social sector stakeholders, especially Corporates, on integrating mental health with their CSR goals?
A: Whatever your CSR goals are, it is possible to incorporate mental health components in your work. Our resource, Mental Health Matters, highlights how mental health intersects with development issues such as education, livelihoods, public health and social justice. For instance, integrating mental health programs in school settings, where teachers and lay counsellors are trained to provide care so that children receive care through the week rather than waiting for a weekly individual session, has proven to be effective in low-resource settings. Livelihood is another thematic area where mental health support can be foregrounded- by providing psychosocial support to participants to boost their functionality or by pre-empting mental health concerns.
