We are happy to present our Annual Report (2005-2006). This is the first annual report printed by Bapu Trust, for wider dissemination. Therefore, the report has the additional objective, other than the routine one of activity reporting, of presenting our philosophies, perspectives and working logics, in other words, our politics in the mental health sector.

We mention these in the plural, because the Trust respects plurality and nurtures a diversity of world views, beliefs, opinions and professions, amongst its staff and working community. The Trust has created ample space to negotiate and dialogue on our politics and first principles within the Trust. However, all of us in the Trust are bound by a value centered, creative and life affirming vision for the Indian mental health sector. Bapu Trust has consistently delivered ideas, processes and outcomes which are driven by a user centered or user led politics in mental health. We have an abiding belief in the values of freedom, choice and liberty. Consequently we have not hesitated, whenever necessary, in assuming leadership positions to promote public policy informed with these values, even as we strive to be open and flexible in our argumentation, communications and negotiations. We therefore see leadership as an initiative to both persuade and be persuaded, to talk and to listen.

Bapu Trust has always articulated curiosities, queries as well as hard

challenges to the looming shadows of coercion and control, which dog people and programs in the mental health sector. We question the assumption in this regime of force, that personal well-being is something that other people can get for someone, and not something that one naturally owns as a matter of personal right, life and choice. The rather serious muscle flexing of Law in the sector is a further step in alienating people from their own selves, and the possibilities of their personal understanding and growth. Against this scenario, we strive to build knowledge and practice environments which affirm and respect the human self. Our Annual Report details the range of actions taken at Bapu in research, training and service development motivated by this belief.

We do not see mental health as a mere medical issue. We see “mental health” in all those sites where human disempowerments and deprivations happen- unequal development, social disasters, non-conforming personal, social or sexual identities, war and conflict, and other socio-economic political situations. Recovery and healing has to happen in these various sites in particular ways rather than as universally applicable acontextual cures.

Bapu Trust constantly flags off the limitations of bio-medicine, with the objective of pressing upon the creative potential of the mental health

sector to imagine or learn from alternative, even non-conventional healing paradigms, for example, faith healing. Our quarrel is not so much with medicine as a discipline, as we do appreciate that a person may have drugs or any other medical treatment, as a matter of personal choice. Rather, we ask for more responsibility, rigour and self discipline in mental health, so that personal choice can be exercised in real time by clients. It is the responsibility of the service systems to create an environment where personal choice can be exercised. Personal choice should be supported by the availability of full information, a range of therapeutic services, and respect for the client’s humanity. We therefore have a quarrel with the coercion, lack of transparency and the scarcity of humane values in the present mental health system. More proactively and as a way of demonstrating to the skeptics, that our expectations from clinical services are not purely theoretical or abstract, we have created service programs, detailed herein.

As with much “demonstration”, our programs and activities have the elements of play, experiment, curiosity and creativity in them, done to fuel the imagination of the sector. The processual aspects, then, of our work are thrilling and delightful, and the deliverables, satisfying. Writing more on the ethics of the organization, we look for congruence between what we ask from others, and what we ask from ourselves as a working community: accommodation with discipline, self-reflexivity as well as self control, thinking out of the box balanced with professionalism, and a firm value base built within a culture of dialogue and criticism. We bring these methods of working into the public sphere,

and have been delighted in the recent years, described herein, to engage a whole range of “mental health stake holders” in meaningful dialogue and constructive communications.

We want to tell the mental health world that we are a fledgling organization, with limited resources. Yet, we have been able to demonstrate the possibility of a world “without cages and chains” for persons with psychosocial disabilities. The vision and stamina of our people and programs can surely be replicated and upscaled by organizations and governments with better resources.

Breathing life into an Idea

“Bapu”, as an idea, was born around 1997. It was born at the Goa seaface, when two people, Amita and Bhargavi, had a long and intense conversation about the need for an organization, which will place at the core, understandings always considered as peripheral to mental health work. This organization would interrogate the political, legal, philosophical, sociological, gendered and other foundational issues of the mental health sciences and practices in India. The organization will actively build a politics of criticism and dialogue in the mental health sector in India, with a view to influence, persuade, or pressure for structural change. The two of us brought different academic and personal backgrounds to the “Bapu” idea. One, a teacher of law, had recently finished a Ph. D. critically examining the mental health laws in India. The other had been negotiating the tensions between believing in a rigorous philosophy of method in the human sciences and being a part of the women’s movement. A third friend joined in, Sujata Venkatraman, improbably, a geophysicist, pilot, dancer and martial artist from Houston. After many, many pages of intense sharing over the email, “Bapu”, a well formed conviction, was birthed …

Those were the years of infancy for Bapu, spent mostly in intense discussions, studying the community vocabularies and nurturing the infant organization. Erwadi has come and gone, showing once again the need for national advocacy in mental health, the need for “Bapu”, and a public platform for research, negotiations, dialogue and different kinds of political action.

Our Vision

In Bapu, we want to see a world, where emotional well-being is experienced in a holistic manner, as an experience of “total wellness”. Bapu dreams of therapeutic environments in the world, where every person can reach into and use their own capacity to make choices, heal themselves, recover and move on. Such environments will also be rich in love, warmth and nurturance, and will enable people’s higher aspirations for growth, pleasure, joy and creativity, using compassionate, non-violent, non-hazardous and playful means. Bapu partakes of a world of healing environments, based on a philosophy of care, freedom and fairness.

Our Mission

We create, pilot and monitor programs and interventions that enable self-respect among persons with psycho-social disabilities. Such programs aim to connect with people’s aspirations and potential, and promote their positive mental health. We work towards enhancing and promoting the emotional well-being of persons in vulnerable positions (women, poor) and other communities in need. We create innovative preventive programs in the community, so that the burden of psychological distress in the community is reduced. We create activities that are aimed at changing the structural, social, legal and policy environment, so that they remain just and fair to people with a psycho-social disability. We work with people with psycho-social and psychiatric disabilities, so that they can get good quality mental health care and can live in an unbiased society, with knowledge,

understanding, dignity, self-determination and self-respect. We fight unfair, forced or abusive mental health interventions.

Trustees

Professor Amita Dhanda, NALSAR, Hyderabad

Dr. Bhargavi Davar, Pune

Ms. Lakshmi Rameshwar Rao, Spark-India, Hyderabad

Professor A Raghurama Raju, University of Hyderabad, Hyderabad

Who is “Bapu”?

“Bapu” does not have any party, political or religious affiliations, even though we like the intimate resonances of the name with the well known political teacher and practitioner of ahimsa. “Bapu” is the personal name

From our Archives

Institution

By Ciera Sky Louise

CAMH: A resource center of Bapu Trust

We started our library, documentation service and archives, as a part of the Center for Advocacy in Mental Health, in the year 2001. When we started, we had a completely disorganized and assorted set of books and reports donated by various people. Aparna Waikar’s personal vision, hard work and drive, along with Darshana Bansode’s dedication and quiet efficiency, has presently made it into a well-organized and stocked community resource center in mental health. We made our own home grown library catalogue through a listing, pile sorting and categorizing method in the year 2000. CAMH is widely used by teachers, researchers, students, lawyers, counselors, mental health professionals, activists, development workers and trainers working in the mental health or related areas. The objective of the resource center is to collect and present conceptual, social scientific, non-medical and medical, therapeutic, historical, policy and legal information in mental health. There were 303 additions of books, reports, and documents in the year 2005-06, taking our collection to over 2181 books, documents and papers on various subjects. We also have a report and newspaper documentation section.

a) List of subjects
	Arts based therapies and alternative mental health
	Colonialism, social sciences and psychiatry
	Community health, mental health and people’s movements
	Culture and healing
	Ethics in social sciences, medicine, health care and mental health care
	Gay, lesbian issues in mental health, and other vulnerable groups
	History of science, medicine and psychiatry
	Human biology, nutrition and mental health

	Law, psychology and psychiatry
	General medicine, brain sciences, integrated medicine, endocrinology and psychiatry
	Philosophical psychology and general psychology
	Culture and healing
	Philosophy of science, social science, medicine and psychiatry
	Policy studies in mental health
	Psychotherapies and counseling
	Research and methodology
	User empowerment, user rights and mental health advocacy
	User perspectives in mental health
	Gender, women and mental health

Our collection is aimed towards enhancing self-help opportunities of users of mental health services. It also aims to develop new skills or visions in the field of non-medical interventions (e.g. family therapy). In order to aid research, we maintain a large collection of reprints and journal articles on various topics related to social sciences, methodology, policy, user studies, psychiatry and mental health. Through contributions from friends and well-wishers, we have a very small, but precious collection of archival materials in mental health- old newsprints of ex-patients’ movement, photographs, audio-visual data, books and documents, stories, case papers of landmark cases, etc. We have a good collection of videos, films, documentaries, and other audio-visual resource materials, which are of use during our awareness and training programs.

The library came out with a special publication in 2004 listing all the material housed in the library. Some events where the library and documentation center displayed its publications are the Gender and Mental Health course (2005) and the JMAA capacity building workshop (March 2006). Our library is a member of Pune-Net, which is a network of libraries

Bringing out user centered, life experiential, gender sensitive, and empowering mental health materials is a core competency of Bapu Trust. We have the view that our publications must reflect community perceptions, experiences and practices in mental health. Materials created at our Center emphasize lives of liberty and dignity, and contribute to the realm of non-medical approaches to personal well-being and recovery. We self-consciously address methodology issues, in the process of building up a publication. Doing needs assessments, research, participatory workshops and group discussions, training sessions, collecting case studies and ethnographies, interviews, organizing resource person interactions, and field visits have been used as methodologies for our publications. Our publications are usually peer reviewed and field tested. Our publications are especially meant for community and NGO use, giving a framework for understanding as

Aaina

Jayasree Kalathil created Aaina, an advocacy newsletter, in the year 1999, for Bapu Trust. It was our very first activity and is now in its successful sixth year. It was a voluntary activity started as we felt that there was a need for a newsletter, which frontally addressed critical debates and controversies, in the mental health sector. There was a felt need to make visible the policy, legal and practice related gaps and the human rights violations. We also wanted Aaina to reflect the views of users and survivors of psychiatry. Aaina would reflect innovative non-medical experiments and ideas in service delivery.

Excepting one year, when we brought out only two, we have brought out three issues every year. Aaina reaches out to around 400 individuals, libraries, resource centers, NGOs, service providers and policy makers all over India. Aaina is now visible as an opinion-making and opinion-leading newsletter, with a consistent message of user leadership and empowerment, good practice, policy, legal and social reform, in the mental health care sector in India. We do bring international, national and regional human rights concerns into the newsletter. At present, Gitika and Radhika help in editing Aaina, while Shraddha, Yogita, Anant, Atul and Sandeep maintain the regularity in disseminating every issue, updating mailing lists, etc. Anil Rohra of Geminarts has been reliably involved in the layout and production.

Abhivyakti - A mental health newsletter in Marathi

Abhivyakti, as the title connotes, aspires to be a forum for self-expression. The inadequacy of information on mental health in Marathi has been evident for some time now. Abhivyakti, started at CAMH by Aparna and Darshana, aims to address this gap. With an aim of reaching out to the

The Oral Histories Archive is a small, but growing collection of people’s stories, testimonies, poems and fiction, audio-visuals, personal narratives, case papers, photographs, letters, movement newsletters, campaign materials, audio-visual material and other artefacts about emotional well-being and ill-health. The archive stands as evidence of the profound experiences of users / survivors with mental ill health and our experiences with the mental health service delivery system in India and elsewhere in the world.

Initially, when we started talking to people about an oral history archive of stories from persons subjected to psychological distress and to inhuman, degrading treatments, we had to face many questions. How can such persons share their stories? Will they remember anything? Can they talk rationally? Oh, well, they are too dangerous to talk to! Will their stories be aesthetic enough? Etc.

The marginalization of persons with a psychosocial disability from the mainstream human rights movements and intellectual currents was evident in such queries. There was also little recognition of the fact that often the users’ entire personhood has been robbed off by many years of using brain damaging, health compromising, violent, and harmful psychiatric treatments. The memories of those who are surviving or have survived many “doses” of shock, with or without anesthesia, has been damaged to such a degree, that telling their story becomes difficult for them.

Our sisters and brothers inside lock ups, solitary cells and isolation wards, tied or chained to their cots, have sordid stories to tell about rights violations. Few of us, users and survivors of psychiatry, have lived to tell the tale of lives lived inside custodial institutions, and if we have survived, it has been at great cost to our creativity, skills and abilities.

We share this invaluable collection with the community through our library and documentation center. We hope that these activities will help mobilize user / survivor workshops in India and create sharing groups to take our activism forward.

1. A three-day Film Festival, designed by Deepra Dandekar and Madhura Lohokare, called “Reel madness” was organized in December 2004. Open Space partnered in this workshop with Bapu Trust. The film festival explored various issues surrounding mental health and institutions, both modern and traditional, each of the three days dealing with a separate concern.

2. A photo-exhibition was organized in January 2006 at the Balagandharv Kaladalan, in Pune, called “Faith healing: Going beyond medicine”, portraying Mr V Karthik’s photographs of various healing rituals from Maharashtra and the south of India and highlighting the relevance of traditional healing for recovery.

In these years, we have received the support of various journals, newsletters and the newspapers, to make our work public. It is a practice for everyone in the Trust to write features or other articles for the media, including those that speak for the social development sector, such as Jivhala, Infochange, and ARROW. Articles have been written in various media instruments, including theme articles for the edit page of the Times of India. Our ECT campaign was carried into the ezine of Tehelka, among other media. Our programs, events and campaigns, have been regularly covered in all the major newspapers, both English and Marathi.

and corrected before planning a psychiatric treatment.

AMH as a concept and activity began in the year 2003, following the participation of Bhargavi Davar at the first “Non-Drug approaches in mental health” Conference, organized by the Safe Harbor Project in Los Angeles. This conference emphasized the point, at the basis of AMH, that physical medicine must form the basis of psychological treatments. Upto 54 medical conditions were misdiagnosed as “mental illness”, leading to severe health and mental health compromises for clients. Deepra, Shraddha, Madhura, Puja, Radhika and others took the initiative forward in the last year.

In the last year, we have established non-medical healing as a cross cutting value and practice in Bapu. The traditional healing research project, described below, only strengthened our belief in non-medical healing. The AMH approach to mental health is reflected in all our activities and programs. Ketki, Kavita and Vrushali were trained intensively in specific Arts Based Therapies (ABT) interventions in the last year. Puja was involved in extensive documentation of ABT work. A vast collection of evidence base and theoretical materials on AMH have been added in the last year, and continue to be added to our resource center. AMH is very much encouraged and financially supported as a part of the self care activities of staff at all levels.

ABT / AMH activities have brought in notions of “spirituality” into the organization as a therapeutic and self development value, as much of these ABT practices are based on a philosophy or on spirituality. In operational terms, for us, “spirituality” links to well-being and not to religion. It refers to

• Session by Dr. Pradeep Sethia - Homeopathy and Mental Health
• Session by Dr. Vijaya Sathe - Acupuncture and Acupressure
• Session by Chandrakala Samant - Reiki
• Session by Dr. Vijaya Sathe - Nutrition
• Session by Bina Bakshi - Hypnotherapy

Various resource materials were collected for the library on Nutrition and Homeopathy.

Individuals or couples/families undergoing distress due to marital/family conflicts, those who have survived childhood trauma, people diagnosed with common mental health difficulties such as anxiety, depression, and psychosomatic illnesses

Seher is also run as a sexual-minority friendly service with regular clients from the Lesbian Gay Bisexual Transgender (LGBT) community seeking help

Working class women and families in the community, as part of the community mental health program run in collaboration with Snehadeep Jan Kalyan Foundation in Kashewadi slum, Pune

Wandering and homeless people in distress at the Beggars’ Home Reception Center, Beggars Home, Yerwada, Pune

Litigants undergoing the trauma of divorce / separation, child custody at the Family Court, Mumbai

A multi-disciplinary team of social workers, counselors, psychologists and alternative mental health practitioners is involved in service provision at Seher. Seher focuses not merely on tertiary care or symptom relief, but through all its activities, attempts to prevent psychological distress and promote positive mental health.

Seher started as a modest, center-based work in Pune. In the last year, a Seher center was started in Mumbai as well. Services have been expanded to include institutional work, other than individual therapeutic work. As a concept as well as a program, it originated from two main forces: First, the vision of Bapu Trust which always believed in and advocated for creating a recovery oriented, therapeutic, nurturing and enhancing environment for those suffering from mental distress / mental illness, along with providing quality mental health care. Also feminist values - with an emphasis on the need to reconstruct women’s distress and psychiatric diagnosis in the context of structural oppression alongside the values of fairness, care, nurturance and healing - informed most of the work at Bapu, including Seher. The second force was that, the dismal state of mental health services in our country, both in public and private sector, warranted a deliberate response. The existing services, apart from being sparse, are primarily biomedical in nature, with an exclusive reliance on pharmacological approaches. Medical interventions, in addition to being intrusive, are very limited in their approach, as they focus merely on symptom reduction, and do not consider the psychological, social, economic, cultural and spiritual realities of people’s lives. Mental disability, on the other hand, does not occur in a vacuum, but rather within a larger life context, including all dimensions of life and consciousness. The existing mental health services often do not address these dimensions and fail to respond to their unique mental health needs. Hierarchical client-provider relationship, client non

participation, lack of quality standards in mental health practice, lack of multi-disciplinary approach to mental health, absence of a discourse around ethical mental health practice, and a restricted view about human consciousness, are some of the other concerns that seriously plague the mental health sector. Seher was created as an attempt to demonstrate an alternative model of mental health service delivery.

The objectives of the Seher program are:
	To offer a need based, cafeteria of mental health interventions to individuals and families in distress, especially to those who are vulnerable and marginalized
	To prevent distress and promote the psychological well-being of users, carers, and the community at large
	To create awareness and enhance the capacity of various stakeholders on mental health, as a way of preventing mental illness, and also empowering communities to take on their daily life struggles
	To demonstrate non-medical, psychosocial and value-based approaches to mental health interventions, which are rights compliant

The program started at the Pune center with numerous intense discussions, value clarification exercises and goal setting, and has now progressed to a stage where concrete protocols have been developed. What Bapu holds as a vision and philosophy in mental health has been consistently converted into a practiceable clinical program through Seher. Ketki Ranade has doggedly and diligently engaged with the political values and principles propagated by Bapu Trust, negotiated service requirements with advocacy pressures, and brought clarity as well as quality to the range of clinical behaviours, and decision making in the Seher team.

In these years, a definitive identity of Seher has emerged through a process of program development, which negotiates clinical realities with the value base, that forms the foundation of all Bapu’s work. The values that form the core of Seher’s work are that of equity, autonomy, sharing of power, user empowerment and the value of non-medical mental health approaches. The work involves identifying and working on individual stressors, meanings of the same for the individual, and interactional patterns between individuals and systems. Planning for mental hygiene in future is an important and integral part of a mental health service. This plays a significant role in enhancing an individual’s sense of control over her/his life, thus putting the client at the center of Seher service planning and implementation. Self-determination of clients through their full participation in therapeutic interventions with least intrusive forms of treatments forms an abiding part of practice. The relationship between client and counselor/therapist is nonhierarchical and based on principles of informed consent, respecting diversity, and confidentiality. Our broad based referrals further indicate our acceptance of multi-disciplinarity in mental health work.

Seher says “No” to

	Unnecessary and unwarranted forms of interventions including unnecessary medication and ECT
	Abuse and hierarchy in a therapeutic relationship
	Taking decisions on the client’s behalf
	Discrimination on the basis of class, caste, gender, sexual orientation or any other marginalized identity
	And to medical diagnosis and the disempowerment that it brings.

	program remains tied to current knowledge. It also encourages staff to take steps to enhance their own psychological well-being and prevention of burn out.
	The Seher program is well documented. The documentation involves case details, details of processes involved in visioning, developing, running programs, curriculum building, trainings or any other activities, reviews, etc. carried out as part of the program. This would help for demonstration purposes and in replicating the project at other sites or in other contexts.
	Seher is an advocacy statement of Bapu Trust on value-based mental health service. Constant efforts are made to negotiate and operationalize the advocacy elements that inform Seher’s services. All our programs are interconnected with the ideology that is shared by the organization and also the larger vision for mental health that Bapu adheres to.

a) Seher center-based services (Pune and Mumbai)
Individuals or couples/families undergoing distress due to various stressors such as marital/family conflicts, surviving childhood trauma, diagnosed with common mental disorders such as anxiety, depression, psychosomatic illnesses etc. visit the Seher center, both at Pune and Mumbai. Both these Seher branches are run as a sexual-minority friendly service with regular clients from the LGBT community seeking help. Clients at Seher have to seek a prior appointment and are provided services at a nominal charge. Services provided here include:

Assessment of the clients intra-psychic, interpersonal and social realities

Followed by the assessment, based on client needs, suitable psychotherapy services are provided:

- Individual psychotherapy
- Family therapy
- Group therapy

Referral services (clinical and non-clinical)

Clinical referrals include referrals to general practitioners, dieticians, gynaecologists, psychiatrists, or other health providers. Non-clinical referrals include referrals to NGOs, self-help/user groups for emotional support, legal aid, shelter, vocational training, and employment services.

Seher (Pune) center-based clients between
May 2004-March 2006

Seher (Mumbai) center-based clients between
December 2005-March 2006

A program development meeting with Ketki Ranade on 19th August 2006 threw up her reflective view of Seher’s center based work.