Creating safety nets – building community mental health partnerships in Kerala

Kalyani* is a mother of three living with her daughter, and granddaughter. Although she is 80 years old, Kalyani still holds the responsibility of taking care of her family. Her daughter experiences paranoid delusions, and due to the severity of her illness, is unable to work, or help with household chores, her husband left many years ago unwittingly consigning Kalyani with the onus of caring for her mentally ill daughter.

Through a spell of bad luck, Kalyani’s grand daughter, Seeta*, met with a head injury that led her to develop psychotic symptoms, similar to her mother. Her delusions became so bad that she believed that if she even opened her eyes, she would die. Kalyani, at the age of 80, stepped up and found treatment for her granddaughter at a private facility. However, this facility was very far away  from their home, and expensive. The monthly injections that Seeta received did wonders for her symptoms, but cost more than Kalyani could afford. After losing support from her other son, she had to resort to begging. She wished that there was an option that was closer to her home and more affordable for her family.

When a team from The Banyan arrived at Kalyani’s home in February to explain how a new and free outpatient clinic, run in collaboration  with The Ottapalam Welfare Trust and Mehac Foundation was to be available only a few minutes away from her home,

“Just yesterday, I went to the Vishnu temple nearby to pray that I would find the money for my grand daughter’s next doctor’s visit, and here you are today, telling me that I can now access services in my own neighbourhood, you must be Vishnu” said Kalyani.

“No, no, I’m not Vishnu. I’m from The Banyan!” said our programme manager, Salih who heads the Kerala Chapter.

Kalyani felt that things were finally looking up.

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The Banyan making a field visit to the home of Kalyani and Seeta.

The Banyan initiated its presence in Kerala in early 2017 when the scale up of the Home Again approach began. Shortly thereafter, we began engaging with the Government of Kerala to  facilitate exit options for individuals who were well but living in State run mental health centres, because they had nowhere else to go. Now, The Banyan has a full-fledged chapter operating in Kerala, with its headquarters in Malappuram.

The Ottapallam Welfare Trust (OWT) is an organisation in the Pallakad district of Kerala that has been offering palliative care and health care (focus on general health, oncology, and eye care)  services for marginalised individuals for 17 years. Recently, they noticed that in the communities they were serving there was a dire need for mental health care and since The Banyan had now established its Kerala Chapter, they reached out to form a partnership.

The Banyan has always focused on providing comprehensive mental health solutions for marginalised populations,  and for the past decade, addressing social causation of mental illness has been one of our main priorities. So when we were contacted by OWT to form a partnership through which we could collaboratively offer outpatient mental health services – we jumped at the offer.  

Through a collaboration with OWT and The Mehac Foundation (an organisation that has provided community mental health services for those who have limited access to healthcare), we have now been offering outpatient clinics and home based care for individuals who are experiencing multidimensional and complex difficulties due to mental illness and poverty.

This community mental health programme is largely led by the palliative care volunteers that are the backbone of the OWT. Many of these volunteers are retired, highly educated individuals who have worked in a variety of careers, and have chosen to spend the rest of their life providing help for those in need.


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Group discussion with palliative care volunteers

The Banyan team, consisting of a psychiatrist, a nurse and two social workers, conduct bi-monthly training sessions on integrated mental health care for these volunteers. These volunteers then identify potential clients in the area who would benefit from outpatient mental health services. The Banyan team then conducts a home visit, for these outpatient clinics are reserved for those who are experiencing multidimensional vulnerabilities in combination with a mental health issue. Each month the volunteers, nurse and psychiatrist conduct about 10 home visits, to make sure that the needs of the families are being met, and facilitating both clinical and social care.

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Field visit

For a families experiencing severe economic difficulties, having multiple members with mental illness, and no support except from an aged caregiver, the initiation of these clinics has been a invaluable. Seeta now visits these outpatient clinics regularly, and although her mother is still a little hesitant, she too has come to the clinics a couple of times.

This outpatient programme now has 15 active clients, and as the programme grows we aim to start a day-care centre as well as a diploma course in community mental health for those who are interested.

If you are located in Kerala and are interested in volunteering your time to support this project please contact Salih at

*names have been changed to maintain confidentiality


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