Mental health literacy in urban and rural communities in Kerala India: An interdisciplinary approach using applied theatre methodology

这一高度协作的国际跨学科伙伴关系通过在印度开展的一项利用参与式剧场和媒体的多中心研究，审查了基于证据的精神卫生扫盲干预在城市和农村社区的适用性。我们相信，我们相互分享研究经验、文化认同和跨学科交流，将使我们能够建立规划具有国际意义的合作研究的能力。我们的愿景是努力实现联合国2030年可持续发展议程目标3、5、8和10。世界卫生组织估计，精神和行为障碍约占全球疾病负担的12%，到2020年可能会增加到15%。我们的重点是喀拉拉邦，该地区的精神疾病患病率（14.4%）、自杀风险（12.5%）和酗酒率高于印度其他地区。因此，迫切需要制定符合当地文化和社会背景的可接受和负担得起的循证精神卫生干预措施。尽管喀拉拉邦的人类发展指数（HDI）很高，但耻辱在喀拉拉邦普遍存在，因此患有精神疾病的人可能会内化公众的看法，并对前往精神卫生机构产生抵制。建议将精神卫生素养作为一种基于证据的方法，以增强宽容、自我保健、照顾他人和减少耻辱感。建议提高MHL可以提高对心理健康风险的认识，以及应对这些风险的方法，从而促进所有人的心理健康。该项目将扩大英国和印度学者和研究人员、服务用户、家庭、戏剧从业者和非政府组织之间的伙伴关系，并发展新的合作关系。我们的计划是利用“发展剧场”（TFD）模式开展一项多中心研究，采用参与式方法，通过共同生产和共同创造与文化相适应的知识和实践来促进妇幼保健，让城市和农村社区参与进来，并赋予他们权力。我们将采用包括合作制作原则的参与式共同研究方法，并利用剧院和媒体进行研究参与和数据收集。我们的实践模式和合作制作将在很大程度上借鉴TFD所采用的方法，但我们也将与当地社区和剧院工作人员合作，纳入和扩展社区讲故事的方法，以试点一种方法，使社区、政策制定者和从事精神卫生工作的专业人员能够将精神卫生作为一个社会正义问题加以探讨，并促进妇幼保健。它将通过创建一个疑问性的表演空间来实现这一目标，该空间将当地的实践和态度、专业的正统观念、政策相关数据和对精神疾病的最新理解结合在一起，使多个利益相关者能够共同想象可能的解决方案。该项目还将包括通过积极的公众参与规划，让公众广泛参与，促进精神卫生知识普及。该伙伴关系将通过以下方式创新和发展新知识：(1)制定和促进文化上适当的妇幼保健方案；(2)制定参与式应用戏剧模式，以促进心理健康素养；(3)共同制作一部反映城乡社区生活经验的妇幼保健应用戏剧；(4)让用户、家庭和社区参与讨论妇幼保健和服务途径。我们的伙伴关系将促进发展持久的研究伙伴关系，将对公共精神卫生挑战的了解与对循证干预措施及其文化可转移性的认识结合起来，为卫生人文学科、精神卫生研究和服务发展增加价值。

This highly collaborative international interdisciplinary partnership examines the applicability of the evidence based intervention of mental health literacy (MHL) for urban and rural communities through a multi-centre study in India using participatory theatre and media. We believe that our mutual sharing of research experiences, cultural identities and interdisciplinary exchanges will enable us to build our capacity for planning collaborative research of international significance. Our vision is to work towards the UN 2030 Agenda for Sustainable Development goals 3, 5, 8, and 10.The WHO estimates that mental and behavioural disorders account for about 12% of the global burden of diseases and this is likely to increase to 15% by 2020 . Our focus is in Kerala which has higher prevalence of mental ill-health (14.4%), suicidal risk (12.5%) and alcohol abuse than the rest of India. Thus there is a dire need to develop acceptable and affordable evidence based mental health interventions that are responsive to the local cultural and social contexts. Despite the high Human Development Index (HDI), stigma is widespread in Kerala and hence people with mental ill-health can internalise the public perceptions and become resistant to approach mental health facilities. Mental health literacy is proposed as an evidence based approach for enhancing tolerance, self-care, care for others and to reduce stigma. It is proposed that raising MHL can improve understanding about the risks to mental health, and methods of coping with these risks, thus promoting mental health for all. This project will extend partnerships and develop new collaborations between UK and Indian academics & researchers, service users, families, theatre practitioners and NGOs. Our plan is to conduct a multi-centre study using a 'theatre for development' (TFD) model, adopting a participatory approach to engage and empower urban and rural communities through co-production and co-creation of culturally appropriate knowledge and practice in promoting MHL. We will use participatory co-research methodology embracing the principles of co-production and use theatre and media for research engagement and data collection. Our mode of practice and co-production will draw heavily upon the methodologies employed under TFD but we will also incorporate and extend the community storytelling approaches in partnership with local communities and theatre workers to pilot an approach that allows communities, policymakers and professionals working with mental health to explore mental health as an issue of social justice and to promote MHL. It will do this by creating an interrogative performance space that brings together local practices and attitudes, professional orthodoxies, policy-related data and the latest understanding of mental illness in a way that allows multiple stakeholders to collectively imagine possible solutions. This project will also include widespread public engagement with people in creating mental health literacy through active public engagement programmes. The partnership will innovate and develop new knowledge by: (1) developing and promoting a culturally appropriate MHL programme (2) developing a participatory applied theatre model for promoting mental health literacy (3) co-producing a piece of applied theatre on MHL reflecting the lived experiences of urban and rural communities (4) public engagement of users, families and communities on talking about MHL and pathways of services. Our partnership will facilitate the development of lasting research partnerships combining knowledge of public mental health challenges with awareness of evidence based interventions and its cultural transferability, adding value to health humanities, mental health research and service development.