An exploration of mental health and resilience narratives of migrant workers in India using community theatre methodology

这一高度创新、跨学科和协作的全球公共卫生伙伴关系旨在利用戏剧讲故事的做法，探讨印度浦那境内移徙者的心理健康挑战和恢复能力的机会。我们的重点是共同创造心理健康和复原力知识，通过社区剧场参与贫民窟移民，提高对心理健康的认识和支持。该项目旨在发展英国和印度学术研究人员、社区戏剧团体、移民社区、政府机构和公共卫生非政府组织之间的伙伴关系。我们的愿景是努力实现联合国可持续发展议程：改变我们的世界：2030年可持续发展议程目标3、5和10（良好健康和福祉、性别平等和减少不平等）。全世界估计有4.5亿人患有精神障碍，其中约75%的人生活在发展中国家，在这些国家，不安全、文盲、贫困和暴力加剧了精神疾病的流行。社会上普遍存在对精神健康的无知，这往往导致侵犯人权和对精神病患者的污名化。身体健康问题和成瘾也与精神健康问题有关。在低收入和中等收入国家（LMIC），国内移民是一个非常重要的问题。农村地区农业萎缩、工业化和城市化进程加快导致越来越多的国内移民到城市寻求生计。我们的合作研究将在印度马哈拉施特拉邦的浦那进行。之所以选择这个地点，是因为我们在这个领域的学术和非政府组织的联系和伙伴关系。根据2011年印度人口普查数据，在浦那，城市贫困人口占总人口的50%，约有564个贫民窟。心理健康干预通常仍以以缺陷为基础的理论和实践模式为主。传统上，许多人类服务机构的重点是努力更好地了解生物/心理或环境风险因素，这些因素增加了发生或维持危险行为的可能性，以及对预防的潜在影响。以个体的缺陷、问题或病态为基础的干预往往会把专业人员的注意力引向对这个人的一种看法。支持恢复能力需要从基于缺陷的心理健康理论和实践模式转变。我们的目的是研究戏剧实践所提供的机会，为被边缘化的移民社区探索和发展个人和社区层面的复原力，这些移民社区在健康和福祉方面的公共卫生支持很少，难以满足他们的基本需求。迄今为止，关于印度境内移徙者心理健康的叙述往往侧重于心理困扰、焦虑和抑郁的普遍情况；但关于贫民窟移民居民的适应力，我们缺乏证据。移民带来的心理困扰和经历确实可能是精神障碍患病率较高的一个风险因素，但缺乏关于移民如何在逆境中调解风险并为积极生活构建复原力的知识，这是一个不为人知的故事。戏剧的一个关键优势是它有能力发展叙事，捕捉并有力地传达健康经历的整个范围——不仅探索人们生活中的危机，还询问和回答“什么是美？”（美可以是意义和韧性的关键来源）。随着移徙社区精神疾病负担的日益加重，这一国际研究伙伴关系为共同创造关于内部移徙贫民窟居民复原力的知识和理解增加了一个新的层面，以制定适当的公共卫生支持和干预模式。

This highly innovative, interdisciplinary and collaborative global public health partnership aims to explore the mental health challenges and opportunities for resilience for internal migrants in Pune, India using theatre storytelling practices. Our focus is on co-creation of mental health and resilience knowledge for raising mental health awareness and support through community theatre engagement with migrant slum dwellers. This project aims to develop partnerships between UK and India academic researchers, community theatre groups, migrant communities, government agencies and public health NGOs. Our vision is to work towards the UN sustainable development agenda: Transforming our world: the 2030 Agenda for Sustainable Development goals 3, 5, and 10 (Good health and wellbeing, Gender equality, and Reduced Inequalities). There are an estimated 450 million people worldwide with mental disorders and about 75% of them live in developing countries, where insecurity, illiteracy, poverty, and violence increase the prevalence of mental illness. There is the widespread ignorance within society about mental health, which often results in human rights abuses and stigma against people with mental illness. Physical health problems and addictions are also associated with mental health problems. Internal migration is a matter of great importance in Low and Middle Income Countries (LMIC). Shrinking agriculture in rural areas and industrialisation and increasing urbanisation leads to ever increasing numbers of internal migrants seeking livelihoods in the cities. Our collaborative research will be in Pune in the state of Maharashtra, India. The rationale for this location is due to our academic and NGO contacts and partnerships within this area. In Pune the urban poor make up fifty per cent of the population with about 564 slums as per the Indian census data in 2011. Mental health interventions are still typically dominated by deficit-based models of theory and practice. Traditionally, many of the human service agencies have focused on trying to better understand the biological/psychological or environmental risk factors that increase the likelihood of the development or maintenance of at risk behaviour and the potential implications for prevention. Interventions that are based on the deficit, problems, or pathologies of individuals tend to direct the attention of professionals to only one view of the person. Supporting resilience requires a shift away from deficit-based models of mental health theory and practice. Our aim is to examine the opportunities presented by theatre practice for exploring and developing resilience at both personal and community level for migrant communities who are marginalised and struggling to meet their basic needs with very little public health support for health and wellbeing. Mental health narratives of internal migrants in India have hitherto tended to focus on the prevalence of psychological distress, anxiety and depression; but we have scant evidence about the resilience of migrant slum dwellers. The psychological distress and experiences as a result of migration can indeed be a risk factor for higher prevalence of mental disorders, but the lack of knowledge on how migrants mediate risk in the midst of adversities and construct resilience for positive living is an untold story.A key strength of theatre is its capacity to develop narratives capturing, but also powerfully communicating, the whole spectrum of health experiences - exploring not only the crises in people's lives but also asking and answering 'what is the beautiful?' in people's lives (beauty can be a key source of meaning and resilience).With the growing burden of mental ill health among migrant communities this international research partnership adds a new dimension to the co-creation of knowledge and understanding of resilience of internal migrant slum dwellers for developing appropriate public health support and intervention models.