Coping with complexity in a wellbeing oriented, task-shared, community mental health setting, Kerala, India - PhDData

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Coping with complexity in a wellbeing oriented, task-shared, community mental health setting, Kerala, India

The thesis was published by Pallikkuth, Rekha, in December 2022, VU University Amsterdam.

Abstract:

The Complex Adaptive System (CAS) model was employed to evaluate and explore the reality around Mental Health Action Trust(MHAT) community clinics in Kerala, which offer a rich empirical and experimental pool of data collection, exactly because it aims to serve the communities in a most efficient and effective manner. The research was set up as to offer solutions to persistent problems in Community mental health, such as e.g. issues of collaboration and communication within a system of partners, the knowledge, skills and confidence of Lay Mental Health Workers (LMHWs) and how to train or supervise them, as well as the question of incorporate technology. The totality of this thesis pertained to the importance of complexity experienced by LMHWs conducting wellbeing-oriented community mental health interventions in low resource settings in India. In addressing this topic, it covers both practical questions of types of complexity particular to the Indian context, and the more theoretical questions of applying complex systems analysis and integrating social development in mental health care. This thesis points to the need that in order to meet the practical needs arising from communities and the LMHWs that serve them, approaches need to be reconfigured to accommodate not only the full scope of the pursuit of wellbeing, but how that pursuit must include a dialogue between more prescriptive structuring and attention to the constantly evolving realities emerging from within health organizations. Where more holistic approaches to mental wellbeing are essential to tackle emerging problems in global mental health, they also create unique challenges for LMHWs relating to their shifting roles, such that they must be empowered through training and supervision to become complexity leaders, capable of making context-responsive, independent decisions. Operationalizing this process through use of theoretical models related to empowerment and self-efficacy proved effective. Tensions and conflict arising within the process from the way these external and internal stimuli affect the system appear to be mitigated by a deepening of interconnection through for instance the experience sharing that is facilitated by peer support. The research on which this thesis is based shows that many of the challenges within the organization can be attributed to the ways in which different agents in the system are responding to transitions with insecurity such that emergent behavior is negative. Yet, those challenges also indicate the directions for growth as targeted and dynamic input can shift the self-organization of the organization into new directions. Finally, this research demonstrates that LMHWs can be empowered to productively self-organize and interact with other actors in the complex adaptive system of mental health in mutually beneficial ways. This was accomplished through visible changes in knowledge, attitude and practices in training as well as increasing self-efficacy through peer supervision and online supervision that enabled self-determination through flexible, strength-based supervision. Technology proved an effective way to extend limited human resources. Working with complex systems requires case-by-case flexibility and constant adaptation not just for mental health interventions but also for supervision. Support of LMHWs must be iterative in nature and leverage the potential of technology to extend limited resources.



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