Dr Kaaren Mathias is a public health physician who has spent 15 years in India working in community health and development. Dr Mathias completed her PhD with Umea Universitet in Sweden in 2016, where her work focused on youth resilience, community participation, social inclusion, gender, equity, and health system strengthening in North India.
Dr Mathias is also the founder-director of the community mental health project, Burans, which works with disadvantaged communities in Uttarakhand, India, to promote mental health and wellbeing by building on their strengths and resources. She and Her team has developed various interventions, such as Nae Disha, Nae Umeed, Swasthya Labh Saadan, that have been adopted and scaled with different government and non-profit groups.
Dr Mathias is married to Jeph, an NRI from Mangalore, and they have four children aged 14 to 23 years.
Currently, Dr Mathias is working as a senior lecturer in the Faculty of Health at the University of Canterbury in Christchurch.
In an interview with Indian Weekender, Dr Mathias talked about her experiences and insights gained from working in India and her thoughts on mental health in India and New Zealand. She believes there is a huge opportunity for mental health professionals in New Zealand to learn from India's community-based care model, while India can learn from New Zealand's approach to peer support and participation of people with lived experiences in mental healthcare delivery, design, and evaluation.
What inspired you to focus your research in India, and what did you discover during your 15 years there?
I did my research in India because while living and working in Uttar Pradesh and Uttarakhand, I saw vast amounts of need, particularly in the area of community mental health. I was also surprised to find that there were almost no research studies set in Hindi-speaking North India. The research I came across mainly described the problems of mental health and distress but few solutions were proposed.
Dr Mathias in Uttarakhand village
So I resolved to do two things – first, look for what was working in community mental health promotion and interventions and describe how that was done to lead to improved mental health in the region and second, to focus my efforts on Hindi-speaking North India where there were fewer resources, fewest non-profit organisations and where often the government health services were less functional. My focus was mainly on Uttar Pradesh and Uttarakhand while acknowledging that Haryana, Delhi, Bihar, Chhattisgarh and Jharkhand were all examples that had few resources for mental health.
Do share some key insights and lessons you learned in India.
I observed significant strengths in mental health in North India, where people with mental health problems are often cared for by their families and included socially, for example in village melas (festivals) or religious ceremonies in ways that are not commonly seen in New Zealand. In contrast, many people with mental health problems in New Zealand often live away from their families and struggle with social isolation.
I also noticed that people in rural India are very supportive of their families and communities. For example, one woman with significant postnatal depression received support from her neighbours, who looked after her children, took them to school, and helped with daily tasks. Dr Mathias believes that these community-based approaches to mental health care could provide valuable insights for mental health professionals in New Zealand.
How do cultural and other factors influence community and mental health in India, and how does this compare to New Zealand?
Culture plays a significant role in shaping how communities perceive and access mental health services. In India, religious and cultural beliefs can greatly influence how individuals understand mental health problems. This can have a major impact on the success of mental health interventions. For example, some Indian communities believe that seizures from epilepsy might be due to the weather or due to having a curse. So we discussed and talked with those families. Many were grateful to find that they could considerably improve their symptoms once they accessed medical care.
Similarly, cultural factors can influence access to mental health services in New Zealand. Many individuals have reported feeling disrespected or not getting the care they need or want when seeking mental health treatment. This has led to a growing desire for greater autonomy and involvement in treatment decisions. This trend reflects a larger movement towards patient-centered care, where individuals are empowered to take an active role in their own care and which is something that I would love to see in the care offered by doctors in India.
Tell us about any successful interventions or programs you have developed or implemented in India that could be adapted to New Zealand.
Some of the successful interventions we developed and implemented in India are relevant for use in New Zealand. One such program is the youth resilience program, which was implemented among young people in schools and communities in India. This group-based intervention had great outcomes, with young people reporting improved mental health, resilience, and self-belief. I believe similar programs can be useful for implementing with young people in New Zealand, in various settings, including inside and outside of schools.
Another program developed in India focused on supporting carers' mental health. This program was particularly relevant for India, where carers are often isolated and have few resources and support. This programme has benefited caregivers of people with psycho-social disabilities in India. But it would be less helpful in New Zealand because much more support is available here.
The third program we developed in India, Swasthya Labh Saadhana, used a recovery approach co-produced with people with lived experiences of mental distress. This program explored different domains, including community participation, family responsibilities, and belonging to a religious or faith community, which are often not included in western constructs of recovery.
While New Zealand shares much cultural history with Euro-America where most recovery tools originate, we also have a unique context and this is especially true for people in te ao Maori (the Maori world). I believe that co-producing a recovery tool for New Zealand would be a wonderful undertaking, that could meet this unique place. However, the biggest learning from this program was the importance of including people with lived experience of mental health problems in the design and delivery of mental healthcare.
How can community/mental health professionals in New Zealand learn from the experiences and insights of health professionals in India and vice versa?
There is a huge learning opportunity for mental health professionals in New Zealand to learn from in India. One of the biggest learning for mental health professionals in New Zealand will be to consider how mental health services can be more community-based. At the moment, the majority of the mental health budget in New Zealand goes towards services delivered in secondary and primary care settings, while very little is allocated to supporting people living life as they want to live it. New Zealand can learn from India, which has had to use a community-based care model due to a shortage of psychiatrists.
On the other hand, India can learn from New Zealand in the area of peer support and the participation of people with lived experience in designing, delivering, and evaluating mental healthcare. New Zealand is doing moderately well in this aspect and can provide leadership to India on the value of peer support and the importance of involving people with lived experience in all facets of mental healthcare.
What are you currently doing, and what are your future plans?
My current role as a senior lecturer in the Faculty of Health at the University of Canterbury involves ongoing research and supporting my team in India by engaging with them regularly.
I am also really interested and engaged in community mental health research in New Zealand. I am working on a project exploring how people with lived experience can strengthen mental healthcare delivery in Canterbury and West Coast. This has been informed from my work in India which suggests that locally developed mental healthcare with input from local people is more relevant, acceptable, and of better quality. I am also excited to continue to work in the area of community mental health and particularly through participatory approaches with individuals who have lived experience in both India and New Zealand.
