[#WHD2017 Blog Series] Inspiring Innovations: SAFE

This blog is part of our series celebrating World Health Day, this year themed “Depression: Let's Talk.” Hear what our community of innovators has to say about the ideas behind their Inspiring Innovations, and how they address depression across the globe.

Here, Abhijit Nadkarni and Urvita Bhatia at Sangath discuss their innovation: Supporting Addiction Affected Families Effectively (SAFE), which uses lay counsellors to support family members affected by a relative’s alcohol use in India.

Tell us about your country’s context and the circumstances that inspired your innovation.

Well over 100 million family members worldwide are estimated to be affected by the addictive behaviours (alcohol, drugs, etc.) of a relative. Although all affected family members (AFMs) may not suffer from a diagnosable mental health condition, the experiences of living with an addicted individual can make AFMs vulnerable to physical and mental ill-health: mood disorders, substance use disorders, trauma, stress-related conditions, and reduced quality of relationships in the family.

AFMs are particularly vulnerable to experiencing violence at the hands of their drinking relative, and this in turn is linked to depression, especially in spouses of heavy drinkers. In India, as the availability and resulting consumption of alcohol increases, so does the number of AFMs, with studies in India demonstrating the negative impact and high burden. These AFMs rarely come in contact with services to support them and consequently represent a silent group of sufferers. Additionally, in India, the situation gets more complex because of the lack of mental health services, and stigma associated with service use.

One way of increasing access to evidence-based support for AFMs is by overcoming barriers to help-seeking such as stigma, non-availability of culturally appropriate interventions, and shortage of mental health professionals. Our project, ‘Supporting Addiction affected Families Effectively (SAFE)’, aims to overcome such barriers and reduce the burden of living with a relative with alcohol-related problems.

What aspect of your project are you most excited about? How is the project innovative or unique?

Various components of our project make it an innovation that excites us:

  1. We are keeping an eye on long-term sustainability of program delivery, which is why we selected non-specialist health workers, technology to aid data collection, and feasible evaluation mechanisms, as well as making sure that our research is action-oriented and oriented towards public mental health and policy priorities in India.
  2. We are genuinely enthused by the question: does the adapted intervention for AFMs work? Once we answer this, our goal is to reach a point where we can confidently tell policy-makers ‘here is an evidence based intervention to support families of people with drinking problems, now let’s work toward implementation’.
  3. Our methodology: 1) The task-sharing method we are using is important for two reasons. First, it highlights an inexpensive approach to mental health care, by integrating a minimally trained workforce into community care. Second, it improves local communities, by training up a cohort of people who, whatever the results of this trial, will have enhanced interpersonal skills for the longer term. 2) The Community Based Participatory Research approach which allows for a range of community stakeholders to inform how we develop and implement our projects. Our eventual aim is to foster models of care that are grounded in both the context and the community, thereby creating interventions which are relevant and acceptable. 3) The emphasis on cultural adaptation by adopting systematic methodologies to understand, evaluate, and implement practices that are based on how the culture thinks and feels.

Have you noticed an impact ‘on the ground’? What is the best feedback you have received (from service users, team members, or otherwise)?

While we do have the numbers (i.e. statistical evidence) to support our work, we ascribe great emphasis to experiences of stakeholders involved in the intervention, for instance:

  • The woman who was beaten up severely by her husband abusing alcohol, who welcomed the counsellor to engage with her and saw that as a sign of hope.
  • The community health worker who had seen the burden of alcohol on families, who committed her time and support to expand the intervention’s impact in the community.
  • The counsellor who would see AFMs on a regular basis, who was satisfied with the knowledge of how the AFMs felt more confident and empowered after receiving counselling.

One such affected family member had the following to say about SAFE:

"What used to happen before was that whenever he (husband with drinking problems) said something I would retaliate and thus the arguments would escalate. Then Reshma (counsellor) helped me learn how to deal with such situations. I also managed to convince him to get treatment (for drinking problems) and his drinking reduced gradually as well."

What’s next?

This is the first initiative of its kind in India. After we build evidence for the acceptability, feasibility, and preliminary effectiveness, our efforts will focus on evaluating the impact of the intervention on clinical outcomes through a rigorous and well-informed randomized controlled trial.

Also, through our work we found that domestic violence was a huge and ‘silent’ problem in the local community. Testimonies from women we worked with highlighted the high burden of violence, and resultant emotional and social difficulties because of the absence or inaccessibility of quality support. The next steps are to examine the burden of domestic violence and to develop interventions and resources to support survivors of domestic violence.

What is the one message about depression you want people to take away from your innovation?

Once you choose help to help yourself, you open a door to a world of possibilities.

To read more about the Innovation, visit the case study page.

To see the other blogs in this series, visit our [#WHD2017 Blog Series].

Families and carers
Task sharing
Prevention and promotion
Treatment, care and rehabilitation
Depression/anxiety/stress-related disorders
Alcohol/drug use disorders
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