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利用参与性剧院和媒体进行的多中心研究，审查了心理健康扫盲(MHL)循证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、文化特性和跨学科交流将使我们能够建设我们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年这一比例可能增加到15%。我们的重点是喀拉拉邦，那里的精神疾病患病率(14.4%)、自杀风险(12.5%)和酗酒发生率高于印度其他地区。因此，迫切需要根据当地的文化和社会背景，制定可接受和负担得起的、以证据为基础的心理健康干预措施。尽管人类发展指数(HDI)很高，但污名在喀拉拉邦很普遍，因此精神疾病患者可以内化公众的看法，变得抵制接近精神卫生机构。心理健康扫盲被提议作为一种基于证据的方法，以增强宽容、自我照顾、关心他人和减少耻辱。据认为，提高MHL可以提高对心理健康风险的了解，以及应对这些风险的方法，从而促进所有人的心理健康。该项目将扩大合作伙伴关系，并在英国和印度的学者&研究人员、服务用户、家庭、戏剧从业者和非政府组织之间发展新的合作。我们的计划是利用“剧院促进发展”(TFD)模式进行一项多中心研究，采用参与性方法，通过共同制作和共同创造文化上适当的知识和实践来促进MHL，并增强城乡社区的能力。我们将采用参与式共同研究方法，遵循共同制作的原则，并利用剧院和媒体进行研究、参与和收集数据。我们的实践模式和联合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戏剧工作者合作，纳入和推广社区讲故事方法，以试点一种方法，使社区、决策者和从事心理健康工作的专业人员能够将心理健康作为社会正义问题来探索，并促进MHL。它将通过创建一个质疑的绩效空间来实现这一点，该空间将当地的做法和态度、专业正统、与政策相关的数据和对精神疾病的最新理解汇集在一起，使多个利益攸关方能够集体想象可能的解决方案。该项目还将包括广泛的公众参与，让人们通过积极的公共参与方案创建心理健康扫盲。该伙伴关系将通过以下方式创新和发展新的知识：(1)制定和促进符合文化背景的多边人道主义方案；(2)开发参与性应用剧场模式，促进心理健康扫盲；(3)共同制作一部反映城乡社区生活经验的多边人道主义应用剧场；(4)让用户、家庭和社区公开参与讨论多边人道主义法和服务途径。我们的伙伴关系将促进发展持久的研究伙伴关系，将公共精神健康挑战的知识与对循证干预及其文化可传递性的认识结合起来，为健康人文、精神健康研究和服务开发增加价值。

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.