Community Mental Health through Tele medicine · A mobile tele-psychiatry vehicle was built to...

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Community Mental Health through Tele‐medicine

An innovate strategy in the delivery of Mental Health Care

(SCARF Tele‐psychiatry in Pudukottai Program: STEPP)

Annual Report

Submitted by Schizophrenia Research Foundation

(Chennai)

To Tata Education Trust

February 2012

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Introduction & Background The Schizophrenia Research Foundation has been involved in the care and treatment of patients suffering from Chronic Mental Illness for the past twenty seven years. The services focus on rehabilitation, public education, research and community mental health (CMH). CMH encompasses family intervention and counselling, training of mental health professionals and community level workers (CLWs) and community outreach programmes.

SCARF greatly expanded its community outreach program following the August 2001 tragedy at Yerwadi, in Tami Nadu where 26 mentally ill persons were charred to death because they were kept chained at the religious treatment facility. This incident reinforced SCARF’s belief the need to educate people in the community about mental health. Studies from Tamil Nadu have revealed that there are substantial numbers of patients with schizophrenia, especially in rural communities, who remain never treated. The reasons for non-treatment include non-availability of psychiatric care services in their areas, difficulty in accessing the needed services due to the remoteness of their residence, the expenses and time spent to reach service providers, the cost of medicines, lack of awareness about treatment available, stigma and ignorance about mental illness.

In an effort to address these issues SCARF has harnessed the technology of Tele-Medicine. The main advantages of using telemedicine are that it optimizes scarce resources such as trained mental health professionals, maximizes geographical coverage and ensures access to specialists’ services and thereby enhance the quality of the service.

The present program supported by the Tata Education Trust proposal seeks support for the community mental health program of SCARF through Tele-Medicine to reach the rural population of the district of Pudukottai of Tamil Nadu.

The specific objectives of the program are

1. To provide mental health care to persons in remote areas in Tamil Nadu using the tele-medicine facility/network –i.e in four taluks of the Pudukottai district of Tamil nadu.

2. To liaise with existing local NGOs in the community to provide this service. This

would include training their staff/SHG members to, promote identification, initiate early treatment and referrals of persons with mental health problems.

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3. Strengthen the referral system for rehabilitation of the mentally disabled.

4. Create public awareness at the Community and Individual Level about mental

health problems, which will facilitate early identification and prompt treatment.

5. Empower and train the families and users in the psycho-social management of the illness, facilitate rehabilitation and reduce disability.

6. To create a standardized reporting format to enable periodic analyses to fine tune the program

7. To study the effectiveness of the use of “tele-psychiatry” in the delivery of mental health services to rural and remote areas of the state of Tamilnadu, which have limited or no mental health services. a) To study the prevalence of psychotic disorders in the community. b) To identify the profile of users and non-users of the tele-psychiatry services. c) To study the course & outcome of interventions provided through mobile tele-

psychiatry and compare this with a fixed line tele-psychiatry centre.

Activities undertaken under the project The project commenced on 1st April 2010 The activities completed during the first year (2010-2011) of the program are

1. Recruitment of staff 2. Training of recruited staff 3. Upgrading tele-psychiatry equipment at the central hub at SCARF, Chennai. 4. Identification of Local partner NGOs and training of their staff 5. Awareness creation in the program area 6. Starting two new fixed line tele-psychiatry clinics in the identified project area. 7. Mobile tele-psychiatry clinic – preparatory work 8. Integration of the Nagapattinam clinic with DMHP 9. Commissioning a computer program for medical records to enable regular

analysis to restructure program appropriately 10. Research : recruitment of staff, training, translating and piloting study

instruments, conducting pilot study, survey, quality control

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The activities undertaken for the current reporting year (2011-2012) are

1. Provision of psychiatric consultations through fixed line tele-psychiatry services 2. Conducting mobile tele-psychiatry clinics 3. Conducting family empowerment programs 4. Conducting awareness programs 5. Completion of survey 6. Follow-up of patients 7. Computerization of clinic records and pharmacy

1. Provision of psychiatric consultations through fixed line tele-psychiatry services Two sites, one each in Avudaiyarkovil and Thirumayam have been functional since 19th Oct 2010 and 29 Nov 2010 respectively. The Avudaiyarkovil taluk clinic is conducted once a week on Tuesdays while the Thirumayam tele-clinic is conducted on every Monday. The clinics at the peripheral units are handled by trained staff. They screen all patients attending the clinic with a modified screening tool, then register them at the clinic if they have psychotic symptoms. Others are referred to other appropriate sources. A brief history is taken and vitals such as blood pressure, height, weight, etc were also captured and communicated to the psychiatrist at SCARF Chennai. All records are maintained in a software that has been specifically designed for the program.

Medication as prescribed by the psychiatrist is dispensed by the team from the clinic pharmacy. The details are recorded in a drug card issued to the patient for their reference. The details are also maintained in the stock register at the respective sites. . The following medicines have been procured and stocked at the peripheral tele-psychiatry centres. S.No List of medicines procured for the program 1 Chlorpromazine 50 mg 2 Chlorpromazine 100 mg 3 Haloperidol 1.5 mg 4 Haloperidol 5 mg 5 Risperidone 2 mg 6 Olanzapine 5 mg 7 Trihexyphenidyl 2 mg 8 Nitrazepam 5 mg 9 Carbamazepine 200 mg 10 Amitryptiline 25 mg 11 Trifluperazine

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12 Inj. Flupenthixol 13 Inj.Phenergan 25 mg 14 Olanzapine (Mouth Dissolving) 5 mg 15 Clonazepam 0.5 mg 16 Fluoxetine 20 mg 17 Sertraline 50 mg 18 Quetiapine 50 mg 19 Disposable syringes & needles

Details of the two fixed line clinics (Cases & Number of tele-psychiatry clinics).

(For more details about the clinics conducted please see Annexure -I ) 2. Conducting mobile tele-psychiatry clinics

A mobile tele-psychiatry vehicle was built to order by M/S Ashok Leyland Ltd based on the design specifications given by SCARF. The custom made bus includes a sound proof and private consultation room with state of the art videoconferencing equipment to enable psychiatric consultation, computerized medical records facility and a computerized pharmacy. The bus also has a public address system and plasma screen which will enable it to conduct awareness and education programs in the villages. Other features include a ramp and wheel chair to enable disabled persons to also access care. It has its own generator and also has the facility to draw power from households if required.

Name of taluk Start date of clinic

No. of clinics conducted

during current reporting year (2011-2012)

Total No. of clinics

conducted since start of

clinic

No. of new patients reg.


Total No. of patients

registered since start of

clinic Avudaiyarkovil 19 Oct 2010 53 72 96 154

Thirumayam 29 Nov 2010 52 66 89 132 Total 105 138 185 286

Patients being screened prior to being provided consultation in the mobile tele-psychiatry clinic .

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Mobile tele-psychiatry clinics were started on 12 May 2011at Gandarvakottai taluk. They are conducted twice a week on Tuesdays (earlier on Wednesdays) and Thursdays at two different locations in the taluk. Mobile clinics were started in Alangudi taluk on 17 Jun 2011. They are also conducted, twice a week on Wednesdays (earlier on Tuesdays) and Fridays at two places. Details of the Mobile clinics (cases & number)

(For more details about the clinics conducted please see Annexure -I )

Name of taluk Start date of clinic

No. of clinics conducted


Total No. of clinics

conducted since start of

clinic

No. of new patients reg.


Total No. of patients

registered since start of

clinic Gandharvakottai 12 May 2011 66 66 174 174

Alangudi 17 Jun 2011 56 56 140 140 Total 122 122 314 314

A patient collecting medicines from the on board pharmacy after attending the clinic

A mobile tele-psychiatry clinic in progress

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The reach of our mobile tele-psychiatry clinics have been restricted by the fact that we have as yet been unable to procure VSAT connectivity from ISRO. This has been due to an unexpected series of events starting with the launch failures of satellites on which we were to be provided the link and the subsequent changes at ISRO wherein the Antraix department (that deals with telemedicine) was transferred from Bangalore, ISRO HQ to Ahmedabad. This resulted in us having to restart the whole process with the Ahmedabad office of ISRO. We have been regularly following up this with them and are still awaiting a final response from ISRO. We have meanwhile started conducting the tele-clinics using 3G wireless broadband connections. As mentioned earlier this severely restricts the reach of our service as we are able to deliver these only where adequate signal strength is available. Despite these handicaps we have still managed to conduct 4 clinics a week at 4 different locations in the 2 taluks.

3. Conducting family empowerment programs (FEP) As part of the comprehensive psychiatric services that is being in Pudukottai district an integral element is the Family Empowerment component. These have been conducted in all the four taluks covered by the program. The topics of the FEP have primarily focused on educating the family members about the illness, regarding signs and symptoms, the general course of illness and outcome. The issues covered included the need for compliance to treatment and compliance management strategies and dealing with distressing symptoms such as violence, dis-inhibited behavior, etc. Various activities that could be done at home to improve negative symptoms and improve the functioning of patients were also discussed. During the reporting year 19 FEPs were organized across the 4 taluks where 250 family members of the patients attended. We have seen that the socially and educationally disadvantaged families of patients are more comfortable with one-on-one sessions rather than structured group sessions. As such a lot of FEP activities have been carried out during clinic visits and during the home visits conducted by the project team as part of their regular follow-up activity.

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Details of Family Education Programmes

Taluk Total Number of FEPs

conducted

No. of family members who attended

Total

Male Female

Avudaiyar Kovil 5 40 26 66 Thairumayam 4 24 49 73 Gandharvakottai 4 27 20 47 Alangudi 6 33 31 64 Total 19 124 126 250 (For more details about the FEPs , see Annexure II) 4. Conducting awareness programs Standardized information was disseminated in a structured manner to create the awareness about mental illness and available services. The techniques used for creating awareness included putting up skits, audio visual presentations, lectures, screening of films specially created for spreading awareness, putting up posters and distributing pamphlets The Mobile telemedicine vehicle which was designed keeping in mind its potential for awareness creation, and towards this end a large plasma TV screen has been installed with speakers and public address system. 114 awareness programs have been conducted using the bus wherein about 5500 people have attended the screening of awareness films. In all 202 awareness programs have been conducted till date and 16,243 individuals reached. Details of Awareness Programmes Awareness creation methods employed Name of Taluk Bus Street play Small Group

Meetings Total

No. programs (no. attendees’)



Total No. programs (Total No. attendees’)

Avudaiyar Kovil 10 (543) 6 (2663) 24 (1644) 40 (4850) Thairumayam 12 (556) 7 (1475) 22 (1342) 41 (3373) Gandharvakottai 57 (2645) 5 (644) 11 (1168) 73 (4457) Alangudi 35 (1739) 4 (1085) 9 (739) 48 (3563) Total 114 (5483) 22 (5867) 66 (4893) 202 (16243) (For more details see Annexure –III)

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An awareness film on mental health being screened using the telepsychiatry bus in a village in Pudukottai

An awareness program underway in a village in Pudukottai among NREGA scheme workers

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5.Completion of survey The two stage survey (screening visit by CLW and confirmatory visit by research assistant) was started on 11 Aug 2010 and completed in September 2011. This was much later than originally envisioned under the proposal. Several factors contributed to this, primarily the availability of suitable individuals. Retaining survey staff was also difficult and there was a fairly high turnover in the initial few months, leading to time being spent of fresh staff training. The fact that several of the villages were extremely remote with extremely limited access also resulted in longer time being taken to complete the survey. Other factors such as that the start of the start of the cultivation season also prolonged the survey as whole villages migrated at these times. Repeated visits were required for data to be completed. The change in TOR regarding this was sent to the TET. The screening, confirmation and quality control have been completed for both the research taluks. The data entry is also complete. The data is being cleaned at the moment and error estimations are currently underway and techniques such as capture-recapture method among others are also being used to verify the collected data. SURVEY DATA

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Please see Annexure IV for more details from the survey. 6.Follow-up of patients In the STEP program it was seen that about 80% of the patients/families had access to a cell phone, taking advantage of this a basic patient monitoring system was put in place where by they were reminded about their scheduled follow-up dates and any change in the clinic schedule. Updates regarding the same were also provided by SMS. Since their implementation we have seen our dropout rates reducing by over 50% in the course of three months. Taking advantage of some of the basic features available on most mobile phones we have programmed the phones of willing and interested family members to ring alarms and provide reminders regarding the time for medication and for follow-up visit dates. We are in the early stages of experimenting with strategy and are at present unclear about its success. We however feel that it has huge potential for ensuring compliance and regularity to treatment and follow-up. Apart from this patients are also being followed-up at home by the program team in conjunction with the local partner NGO when necessary. This has been primarily to ensure regularity to treatment and also per the directions of the treating psychiatrist who had issued specific instructions for follow-up. The story of Gomathy

SCARF first came across Gomathy when it was conducting its door to door survey as part of the present program. She was discovered in the cowshed of the family house where she had remained chained for the past 2 years.

Gomathy chained in her cowshed

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When inquired about it the family reported that they had chained her for her own safety as she had a tendency to wander about and get lost. As all the family members worked as agriculture laborers and were out the whole day they were left with no other alternative. Further enquiries revealed that Gomathhy was 27 years old, educated up to 5th Standard and had been ill for the past 9 years since the age of 18. She was taken for magico-religious treatment during the early stages of her illness but it was discontinued as no improvement was seen. They had subsequently taken her to a psychiatrist in private practice. The family once again discontinued the treatment as they were not satisfied with the rate of improvement and also because they could not continue to bear the cost of the treatment. She was irregularly medicated for 6 years with all treatment ceasing in the last 3 years. When informed about the telepsychiatry program and the free treatment that could be availed of the family showed little interest. The program team visited them over the next 6 months and made repeated attempts convince the family to unchain Gomathy and start treatment but to no avail. Finally a neighbor who had been a classmate of Gomathy and been following these interactions stepped-in to help out. The team immediately got in touch with the psychiatrist who on making a provisional diagnosis on the available history prescribed her some antipsychotic. The neighbor agreed to take responsibility for seeing that Gomathy took her medication everyday. After four weeks of treatment the family could see some visible changes in her such as that there was a marked reduction her laughing and talking to self and improvement in her sleep and appetite. Following this her brother has now agreed to her continuing treatment and of ensuring that she takes her prescribed medication. The program team during its regular visits tries to engage Gomathy in conversation and encourage her family to involve her in household activities. Over a period of time the family now allows her to mop the floor, fetch water, etc. During this period she is unchained for a few hours each day. But she is back in chains when the family leaves for work. The project team is Pudukottai is making all efforts to speed up the process of removing the chains permanently and ensure a better life for Gomathy.

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7.Computerizing medical records to enable regular analysis to restructure program We have standardized all data to be collected at the central hub at SCARF Chennai as well at the peripheral units in Pudukottai at both the fixed line clinics as well as the mobile clinic. To enable the management of vast amounts of data SCARF had commissioned a customized software to capture the clinic data as well as other program specific data. This would enable regular analysis of data that would help fine tune the program . The computerization of the clinical records have been completed and the software program is now installed and being used in all the centers. Below are some screen shots of the software program.

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Outputs Outputs as per work plan submitted up to the point of reporting

Actual outputs as reported upto the point of reporting

Necessary project staff recruited

25 staff in various categories to be hired

31 staff were hired . The hiring of extra staff (adjusted within the available budget) and change in TOR approved by TET.

(a) One full time social worker with a background in psychiatric social work and experienced in community mental health was internally transferred from SCARF to the telemed program and was designated as the coordinator of the program.

(b) A psychiatric social worker with experience in conducting health surveys in rural areas was recruited as the research co-ordinator of the program.

(c) Two post graduate social workers were recruited as Research Assistants (RA).

(d) Two psychiatrists working in SCARF were deputed to serve on a part time basis on the program.

(e) A data manager well versed in statistical packages and managing vast amounts of data from multiple sources was also recruited.

(f) Three full-time field supervisors were deputed by the local partner NGOS to the project. However the salaries were scaled down to match the locally prevalent norms and as paid by the partner NGO. This provided the opportunity to recruit one additional field supervisor within the budget provision. An additional (fourth) field supervisor was recruited and directly appointed by SCARF. This facilitated each of the four taluks identified for

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the program to have its own field supervisor.

(g) Nineteen Community Level Workers (CLW) from the catchment area were identified and recruited with the help of the local partner NGOs. The CLWs are mostly female high school and college graduates who lived in the taluk that they were allotted to cover. It was possible to recruit more than the previously envisaged 12 CLWs as the salaries were pared down from the original budget based on the request from the local partner NGO.

(h) Telemobile manager, driver and assistant driver were also recruited for the telemedicine mobile unit.

Partnership with local established

Identification of a partner NGO in each of the four program taluks

SCARF identified and entered an MOU with Pudukottai Multipurpose Social Service Society (PMSSS) to partner in three taluks, Alangudi, Avudaiyarkovil and Thirumayam,. The other NGO that SCARF has signed an MOU with is the Rural Development Society (RDS) for Gandharvakottai Taluk .

Programme staff trained

Training of Community Level Workers for survey

All the staff were trained and oriented about the program. The project team trained the R.A’s on the instruments to be used in the survey (Psychiatric Personal History Schedule- modified, Indian Psychiatric Survey Schedule-modified, a demographic schedule and the Global Assessment of Functioning Scale) and were oriented to mental health problems over a period of one month. The CLWs were trained in the administration of the survey questionnaires (IPSS-mod and demographic schedule). They were trained to identify the mentally ill in the community and to refer them for treatment. The teaching methods employed were didactic lectures,

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showing short films, audiovisual presentations, role playing and observational visits at the SCARF OPD in Chennai. The CLWs were also given literature dealing with signs and symptoms of mental illness and other reference material.

Video-conferencing equipment purchased

Purchase of 3 Nos of Sony PCS 1P, External camera, ISDN connection, UPS

3 Nos of video conferencing equipment were purchased, external camera purchased, Static IP was decide upon as the connectivity technology to be used rather than ISDN. This change in TOR was approved by the TET.

Central hub at SCARF, Chennai up-graded

Installation of Sony PCS 1 system, sound & dust proofing of room.

The central hub at Chennai was upgraded with state of art video-conferencing equipment to enable tele-psychiatry consultation. The equipment is compatible with VSAT and broad band connectivity technologies and also ISDN. The up gradations at SCARF site, Chennai included sound proofing and dust proofing the central hub. The up-gradations have been completed satisfactorily.

Mobile tele-psychiatry van

Purchase and custom build a van for tele-psychiatry

A customized van for telepsychiatry purposes was built and delivered by M/S Ashok Leyland.

Medicines purchased and stocked at the clinics in Pudukottai district

Purchase of medication for patients visiting tele-psychiatry clinics in pudukottai

List of medicines procured for the program: Chlorpromazine 50 mg, Chlorpromazine 100 mg, Haloperidol 1.5 mg, Haloperidol 5 mg, Risperidone 2 mg, Olanzapine 5 mg, Trihexyphenidyl 2 mg, Nitrazepam 5 mg, Carbamazepine 200 mg, Amitryptiline 25 mg, TF –Plus, Inj.Prolinate, Inj.Phenerghan 25 mg, Olanzapine (Mouth Dissolving) 5 mg, Clonazepam 0.5 mg, Fluoxetine 20 mg, Sertraline 50 mg, Quetiapine 50 mg, syringes & disposable needles

Tele-psychiatry clinics-Fixed line clinics started

Start of fixed line clinics in Avudaiyarkovil and Thirumayam taluks.

2 fixed-line clinics started in the two taluks. Avudaiyarkovil clinic started on 19 Oct 2010 and Thirumayam clinic on 29 Nov 2010

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Mobile Tele-psychiatry clinics started.

Start of mobile clinics in two taluks in Oct 2010. To be operational 4 days a week.

Start if mobile tele-psychiatry clinics in Gandharvakottai taluk on 12 May 2011and in Alangudi taluk on 17 Jun 2011. Mobile clinics conducted in 2 different locations in the two taluks and is operational Tuesday to Friday. The mobile clinics were started later than planned as there were unexpected delays in completing the customization of the bus. The lack of availability of VSAT connectivity also delayed the implementation.

Beneficiaries of the program

3000 beneficiaries to receive treatment

600 patients have utilized the tele-psychiatry services across the 6 clinics in the 4 taluks. This number is far fewer than the original estimate. The reasons for the short fall are the following :

(a) The reach of the mobile clinics have been restricted by the fact that VSAT connectivity is yet to be granted and we are using 3G wireless broadband connection at present. The coverage of which is restricted in the rural pockets.

(b) The delay in the start of the mobile services in 2 taluks by 5 months has also lead to fewer patients being registered.

(c) Our survey also indicates that we had probably overestimated the prevalence of Psychotic disorders at 1% (which was based on available literature). The real picture is closer to less than 0.5% (from unadjusted raw data of the survey).

(d) This is also borne out by the fact that 58% of the identified patients in Thirumayam have visited the clinic and about 88% of the patients identified through the survey in Gandarvakottai have utilized the mobile tele-psychiatry clinic services.

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Family Empowerment Programmes (FEP) conducted

66 programs to be conducted in year 2

19 FEP programs have been conducted in Year 2 of the program. 5 in Avudaiyar Kovil, 4 in Thairumayam, 4 in Gandharvakottai and 6 in Alangudi. 250 caregivers participated in the FEP. Fewer family programs have been conducted than planned for two treasons (a) the mobile clinics were started later than originally envisioned for reasons already spelled out earlier (b) fewer patients have been enrolled in the program than anticipated. The reasons for these have also been given. Apart from this we have also seen that the less educated families of patients are more comfortable with one-on-one sessions rather than structured group sessions. As such a lot of FEP activities are carried out as an across the table activity during clinic visits and during the home visits conducted by the project team as part of their regular follow-up activity.

Awareness Programmes conducted

16 programs reaching at least 8000 individuals to be done by year 2

202 awareness programs have been conducted with 16,243 being covered across the 4 taluks of the district.

Research -Conducting survey

To study the prevalence of psychotic disorders in the community

The number of identified cases in the two taluks here survey was conducted is 421.

Research -Estimating reach of services

To estimate the reach and coverage of service mobile vs fixed line

The rough estimate of the reach of the fixed line clinic is 58%* and for the mobile tele-psychiatry clinic is 88%*. (* preliminary results based on raw data)

Dr. R. Thara Date: 29 Feb 2011 Director, SCARF

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Annexure – I

Dates of Telepsychiatry Clinics conducted (with no. conducted)

Month Fixed Tele-Psychiatry Mobile Tele-Psychiatry Avudaiyar Kovil Thirumayam Gandharvakottai Alangudi

Oct – 10 19,25 (2) Nov – 10 2,9,16,23,30 (5) 29 (1) Dec – 10 7,14,21,28 (4) 6,13,20,27 (4) Jan – 11 4,11,18,25 (4) 3,10,17,24,31 (5) Feb - 11 1,8,15,22 (4) 7,14,21,28 (4) Mar – 11 1,8,15,22,29 (5) 7,14,21,28 (4) Apr – 11 5,12,19,26 (4) 4,11,18,25 (4) May – 11 3,10,17,24,31 (5) 2,9,16,23,30 (5) 12,19,26 (3) Jun – 11 7,14,21,28 (4) 6,13,20,27 (4) 2,9,16,23,30 (5) 17,24 (2) Jul – 11 5,12,19,26 (4) 4,11,18,25 (4) 7,14,21,28 (4) 1,8,15,22,29 (5)

Aug – 11 2,9,16,23,30 (5) 1,8,22,29 (4) 4,11,18,25 (4) 5,12,19,26 (4) Sep – 11 6,13,20,27 (4) 5,12,19,26 (4) 7,8,14,15,21,22,28,29

(8) 2,9,16,23,30 (5)

Oct – 11 4,11,18,25 (4) 3,10,17,24,31 (5) 5,6,12,13,19,20,26,27 (8)

7,17,21,28 (4)

Nov – 11 1,8,15,22,29 (5) 7,14,21,18 (4) 2,3,9,10,16,17,23, 24,30 (9)

1,4,8,11,15,18,22,25,29 (9)

Dec – 11 6,13,20,27 (4) 5,12,19,26,28 (5) 1,7,8,14,15,21,22, 28,29 (9)

2,6,9,13,16,20,23,27, 30 (9)

Jan – 12 3,10,17,24,31 (5) 2,9,16,23,30 (5) 4,5,11,12,18,19,25,26 (8)

3,6,10,13,17,20,24,27,31 (9)

Feb - 12 7,14,21,28 (4) 6,13,20,27 (4) 2,7,9,14,16,21,23,28 (8) 1,3,8,10,15,17,22,24, 29 (9)

72 Clinics 66 Clinics 66 Clinics 56 Clinics Total 260

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Annexure II

Family Education Programme (April 2011 to February 2012)

Avudaiyar kovil Taluk

# Venue Date No. of members attended

Staff present Male Female Total

1 SCARF-PMSSS field office, Avudaiyar Kovil

12.7.11 12 7 19 Mr.D.Kotteswara Rao & Ms.T.Gunaselvi


23.08.11 4 7 11 Mr.D.Kotteswara Rao & Ms.T.Gunaselvi


16.12.11 8 3 11 Mr.Thangam & Ms.T.Gunaselvi

4 SCARF-PMSSS field office, Avuadaiyar Kovil

24.01.12 8 2 10 Mr.Thangam Ms.T.Gunaselvi

5 SCARF-PMSSS field office, Avuadaiyar Kovil

14.02.12 8 7 15 Mr.Thangam Ms.T.Gunaselvi

Total 40 26 66

Thirumayam Taluk

#

Venue Date No. of members attended


1 SCARF-PMSSS field office, Thirumayam

24.6.11 5 10 15 Mr.D.Kotteswara Rao & Ms.G.Kiruba


08.08.11 10 20 30 Mr.D.Kotteswara Rao, Ms.G.Guna selvi


23.1.12 5 10 15 Mr.Thangam Ms.G.Kiruba


20.2.12 4 9 13 Ms.G.Kiruba Ms.Jothy

Total 24 49 73

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Gandharvakottai Taluk

#

Venue Date No. of members attended


1 Gandharvakottai 17.11.11 8 7 15 Mr.Thangam & Ms.S.Karthick

2 Gandharvakottai 29.12.11 3 4 7 Mr.Thangam & Ms.Bama

3 Kallakottai 11.1.12 8 2 10 Mr.Thangam & Mr.S.Sendhil Kumar

4 Gandharvakottai 26.1.12 8 7 15 Mr.Thangam Mr. K.Vasu

Total 27 20 47

Alangudi Taluk

# Name of the Village /Target Population Date

No. of people attended Staff present Male Female Total

1 Alangudi 14.09.11 3 5 8 Karthick,Vasu 2 Alangudi 19.10.11 5 6 11 Mr.Thangam &

Mr.K.Vasu 3 Vadakadu 18.11.11 4 3 7 Mr.Thangam &

Mr.Sendhil 4 Vadakadu 16.12.11 5 4 9 Mr.Thangam &

Mr.K.Vasu 5 Alangudi 25.01.12 6 7 13 Mr.Thangam &

Mr.Sekar 6 Vadakadu 22.02.12 10 6 16 Mr.Thangam &

Mr Karthick Total 33 31 64

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Annexure III

Awareness Programme Report (April 2011 to February 2012)

Avudaiyar kovil Taluk


Methodology No. of people attended

Staff present Bus Street play

Small Group Meeting

Male Female Total

1 Avudaiyar kovil (S.H.G)

20.4.11 yes 22 22 Ms.T.Guna selvi & Ms.Selvarani

2 Kampan Nager) (S.H.G)

11.6.11 yes 25 25 Ms.T.Gunaselvi & Ms.Selvarani

3 Amaradakki(school) 22.7.11 yes 200 150 350 Cultural Team of SCARF

4 Perunavalur 22.7.11 yes 32 16 48 Ms.S.Sendhil Kumar & Mr.K.Vasu

5 Avaudaiyaur kovil (school)

22.7.11 yes 250 100 350 Cultural Team of SCARF

6 Avuadaiyur kovil (school)


7 Avaudaiyur kovil (school)


8 Okkur (school) 10.8.11 yes 230 230 460 Cultural Team of SCARF

9 Karur (school) 10.8.11 yes 350 250 600 Cultural Team of SCARF

10 Kasiya madam (S.H.G)

25.8.11 yes 13 13 Ms.T. Guna selvi & Ms.Selvarani

11 Karur (S.H.G) 7.9.11 yes 12 12 Ms.T. Guna selvi & Ms.Selvarani

12 Manal mal kudi (S.H.G)

22.9.11 yes 15 85 100 Ms.T. Guna selvi & Ms.Selvarani

13 Kulathur(S.H.G) 15.9.11 yes 15 15 Ms.T. Guna selvi & Ms.Selvarani

14 Okkur( 100 days 29.9.11 yes 10 35 45 Ms.T. Guna

STEPP – Feb 2012

23

workers) selvi & Ms.Selvarani

15 Aranthangi kottai (S.H.G)

20.10.11 yes 22 22 Ms.T. Guna selvi & Ms.Selvarani

16 Aranthangi 3.11.11 yes 24 24 Ms.T. Guna selvi & Ms.Selvarani

17 Balavarsan panjayathu 9.11.11 yes 2 22 24 Ms.T. Guna selvi & Ms.Selvarani

18 Palladthi vayal 16.11.11 yes 28 28 Ms.T. Guna selvi & Ms.Selvarani

19 Amaradakki 9.12.11 Yes 38 17 55 Ms.S.Sendhil Kumar & Mr.K.Vasu

20 Avudaiyar kovil 9.12.11 Yes 25 25 Ms.S.Sendhil Kumar & Mr.K.Vasu

21 Naallikudi 15.12.11 Yes 22 50 72 Ms.T. Guna selvi & Ms.Selvarani

22 Virudhanvayal 16.12.11 Yes 60 140 200 Ms.T. Guna selvi & Ms.Selvarani

23 Yembal (100 days workers)

17.12.11 Yes 24 76 100 Ms.T. Guna selvi & Ms.Selvarani

24 Irumbammadu 28.12.11 Yes 76 35 111 Ms.T. Guna selvi & Ms.Selvarani

25 Kasukudi 5.1.12 Yes 1 27 28 Ms.T. Guna selvi & Ms.Selvarani

26 Thirubunavasl 19.1.12 Yes 14 71 85 Ms.T. Guna selvi & Ms.Selvarani

27 Mimisal 20.1.12 Yes 120 30 150 Ms.S.Sendhil Kumar & Mr.K.Vasu

28 Mimisal (north) 20.1.12 Yes 75 8 83 Ms.S.Sendhil Kumar & Mr.K.Vasu

29 Pranthani 20.1.12 Yes 8 4 12 Ms.S.Sendhil

STEPP – Feb 2012

24

Kumar & Mr.K.Vasu

30 Thirubunavasl(100 days workers)


31 Seeyathur 25.1.12 Yes 20 128 148 Ms.T. Guna selvi & Ms.Selvarani

32 Union panchayat office (AV Koil)


33 Vilanur 3.2.12 Yes 15 10 25 Ms.S.Sendhil Kumar & Mr.K.Vasu

34 Ponpethi 3.2.12 Yes 20 4 24 Ms.S.Sendhil Kumar & Mr.K.Vasu

35 Avudaiyar kovil 4.2.12 Yes 5 64 69 Ms.T. Guna selvi & Ms.Selvarani

36 Avudaiyar Kovil 8.2.12 Yes 5 60 65 Ms.T. Guna selvi & Ms.Selvarani

37 Velvarai 15.2.12 Yes 25 126 151 Ms.T. Guna selvi & Ms.Selvarani

38 Puthambur 16.2.12 Yes 18 116 134 Ms.T. Guna selvi & Ms.Selvarani

39 Yahilnuthimangalam 24.2.12 yes 55 25 80 Ms.T. Guna selvi & Ms.Selvarani

40 Paranthamanur 24.2.12 Yes 26 14 40 Ms.T. Guna selvi & Ms.Selvarani

Total 10 6 24 2260 2590 4850

STEPP – Feb 2012

25

Thirumayam Taluk

# Name of the Village /Target Population

Date Methodology

No. of people attended

Staff present Bus Stree

t play Meeting Mal

e Female Tota

l 1 Panayapatti(public) 24.6.11 yes 40 20 60 Cultural Team

of SCARF 2 Panayapatti(public) 24.6.11 yes 40 20 60 Cultural Team

of SCARF 3 Konpet(school) 13.7.11 yes 150 150 300 Cultural Team

of SCARF 4 Aahanur(school) 15.7.11 yes 50 75 125 Cultural Team

of SCARF 5 Melur(public) 15.7.11 yes 21 13 34 Mr.Sendhil

Kumar & Mr.K.Vasu

6 Savariyapuram(public) 9.8.11 yes 30 30 Mr.D.KRao, Ms.Kiruba

7 Pulivalam(teacher training institute)


8 Nachanthupatti(school)


9 Kottur(public) 29.7.11 yes 11 23 34 Cultural Team of SCARF

10 Nachanthupatti(public people)






13 Manavalankari(100 days worker)

9.9.11 Yes 150 150 Ms.G.Kiruba &Ms Stella

14 Kottur(100 days worker)

15.9.11 Yes 150 150 Ms.G.Kiruba & Ms Stella

15 Thirumayam(S.H.G) 17.9.11 Yes 40 40 Ms.G.Kiruba & Ms Stella

16 Manapatti(100 days workers)

24.9.11 Yes 200 200 Mr.Thangam & Ms Stella

17 Pariyur(S.H.G) 7.10.11 Yes 75 75 Ms.Jothy & Ms.Stella

STEPP – Feb 2012

26

18 Thirumayam(Resso-N.G.O- S.H.G)

5.11.11 Yes 20 20 Ms.G.Kiruba & Ms.Jothy

19 Konapot( public people)

10.11.11 Yes 15 15 Ms.Jothy & Ms.Stella

20 Sagampatti(100 days workers)

12.11.11 Yes 60 60 Ms.Jothy & Ms. Stella

21 Parayampatti(village people)

14.11.11 Yes 18 18 Ms.G.Kiruba & Ms Jothy

22 Vellipatti(S.H.M) 15.11.11 Yes 20 20 Ms.Stella & Ms Jothy

23 Thirumayam(S.H.M) 15.11.11 Yes 25 25 Ms.Stella & Ms.Jothy

24 Pallivasal 28.11.11 yes 20 5 25 Mr.Sendhil,Ms.Gunaselvi & Ms.G.Kiruba

25 Lenavilakku 12.12.11 yes 49 31 80 Mr.Sendhil & Mr.Sekar

26 Panayapatti 3.12.11 Yes 30 30 Ms.Kiruba & Ms. Jothy

27 Perunthurai 9.12.11 Yes 14 50 64 Ms.Jothy & Ms.Stella

28 Verachilai 27.12.11 Yes 23 4 27 Mr.Thangam & Mr.Sekar

29 Pallivasal 27.12.11 Yes 3 45 48 Ms.Stella 30 Iyyanar Puram 5.1.12 Yes 15 113 128 Ms.Stella 31 Manavalankarai 7.1.12 Yes 20 15 35 Ms.G.Kiruba

& Ms. Jothy 32 Periayakalluvayal 19.1.12 Yes 13 13 Ms.Stella 33 Samathuvapuram 20.1.12 Yes 49 49 Ms.Stella 34 Thirumayam (Nursing

Students) 23.1.12 Yes 60 60 Mr.Thangam

35 V Kottaiyur 27.1.12 Yes 9 80 89 Ms.Stella & Ms Jothy

36 Aadhanur 15.2.12 Yes 35 32 67 Ms. Jothy 37 Aranmanaipatti 15.2.12 Yes 14 34 48 Ms.Jothy 38 Maruthakudipatti 17.2.12 Yes 2 31 33 Ms.Stella &

Ms Jothy 39 Bramanapatti 17.02.12 Yes 3 22 25 Ms.Stella &

Ms.Jothy 40 Aranmanai patti 22.2.12 Yes 20 17 37 Mr.Thangam

& Ms Jothy 41 Nallipatti 22.2.12 Yes 22 27 49 Mr.Thangam

&Ms.Jothy Total 12 7 22 1061 2312 3373

STEPP – Feb 2012

27

Gandharvakottai Taluk


Methodology No. of people attended

Staff present Bus Street play

Small Group Meeting

Male Female Total

1 Thatchangurichi 12-05-11 Yes - -

20 05 25 Rao,senthil,vasu, Karthic,sekar

2 Thatchangurichi 12-05-11 Yes - -

20 10 30 Rao,senthil,vasu, Karthic,sekar

3 Rasappatty 14-05-11 Yes - -

25 23 48 Saravanan,senthil,vasu,Karthic,sekar

4 Gandharvakottai 16-05-11 Yes - - 27 12 39 Senthil,vasu, Karthic,sekar

5 Kattunaval 17-05-11 Yes - - 10 20 30 Senthil,vasu, Karthic,sekar

6 Gnadharvakkottai 17-05-11 Yes - - 45 27 72 Senthil,vasu, Karthic,sekar

7 Kulathoornayakar patty

18-05-11 Yes - - 35 05 40 Senthil,vasu, Karthic,sekar

8 Kallakkottai 19-05-11 Yes - - 15 25 40 Senthil,vasu, Karthic,sekar

9 Kallakkottai 19-05-11 Yes - - 20 35 55 Senthil,vasu, Karthic,sekar

10 Kothagampatty 20-05-11 Yes - - 25 45 70 Senthil,vasu,sekar

11 Old gandharvakottai 23-05-11 Yes - - 13 12 25 Senthil,vasu,sekar

12 Pisanathoor 25-05-11 Yes - - 30 15 45 Senthil,vasu,sekar

13 M.S.A.Nursing Institute G.K.T

01-08-11 - yes - 15 25 40 Cultural Team of SCARF

14 Arul Mary Mt.High.School

01-08-11 - yes - 75 55 130 Cultural Team of SCARF

15 Govt.Boys.High.sec, School

01-08-11 - yes - 230 - 230 Cultural Team of SCARF

16

Oldgandharvakkottai 01-08-11 Yes - - 29 18 47 Vasu,sekar,karthic

17 B.S.S.Nursing Institute 02-08-11 - - - 28 28 Thangam,Kart

STEPP – Feb 2012

28

G.K.T hick 18 Meikudippatty 03-08-11 Yes - - 06 15 21 Senthil,vasu,

19 Vempanpatty 11-08-11 Yes - - 18 26 44 Senthil,vasu

20 Govt.High School

Pudhunagar 16-08-11 - yes - 120 90 210 Cultural Team

of SCARF 21 Valarpirai S.H.G

Oldgandharvakkottai 16-08-11 - yes - 10 24 34 Cultural Team

of SCARF 22 Malligalnatham 18-08-11 Yes - - 15 13 28 Vasu,Karthick23 Pandhuvakkottai 24-08-11 Yes - - 28 10 38 Senthil,Vasu,

sekar 24 Punalkulam 14-09-11 Yes - - 16 19 35 Senthil,

Thangam 25 Thurusuppatti 20-09-11 Yes

- - 18 12 30 Senthil, Thangam

26 Thurusuppatti 20-09-11 Yes - - 21 44 65 Senthil, Thangam

27 Manjapettai 22-09-11 Yes - - 24 38 62 Senthil, Karthick

28 Manjapettai 22-09-11 Yes - - 22 15 37 Senthil, Karthick

29 Kothagam 26-09-11 Yes - - 20 50 70 Senthil, Karthick

30 Solagampatty 03-10-11 Yes - - 15 10 25 Karthick, Thangam

31 Gomapauram 06-10-11 Yes - -

20 15 35 Senthil, Thangam, Sekar

32 Gomapuram 06-10-11 Yes - -


33 Veladipatty 11-10-11 Yes - -


34 Vellalaviduthi 11-10-11 Yes - -


35 Manganoor 18-10-11 Yes - -


36 Solagampatty 19-10-11 Yes - -


STEPP – Feb 2012

29

37 Solagampatty 19-10-11 Yes - -


38 Ariyanipatty 09-11-11 Yes - - 20 10 30 Karthick, Senthil

39 Thethuvasalpatty 10-11-11 Yes - - 27 08 35 Senthil, Karthick

40 Thethuvasalpatty 10-11-11 Yes - - 15 15 30 Senthil, Karthick

41

Pandhuvakkottai 15-11-11 - - Yes 07 21 28 Mis.Bama

42 Nadupatty 17-11-11 - - Yes 09 08 17 Mis.Bama, Sivaranjani

43 MHREGP-workers Gandharvakkottai

18-11-11 - - Yes 03 32 35 Mis.Bama, Sivaranjani

44 MHREGP-workers Gomapauram

22-11-11 - - Yes 01 23 24 Bama,T hangam

45 Ghandarvakottai 01-12-11 Yes 200 200 Thangam 46 kallakottai 01-12-11 Yes 266 210 476 Thangam 47 Thachankuruchi 05-12-11 Yes 125 75 200 Thangam 48 Mulliapatti

Marunguruni 07-12-11 Yes 65 20 85 Rao,Thangam

,kavitha 49 Nadupatti 10-12-11 Yes 25 25 Bama 50 Parukai vidhuthi 12-12-11 Yes 19 19 Bama 51 Valavampatti 19-12-11 Yes 19 26 45 Karthi 52 Andi kollappampatti

and thuvar 20-12-11 Yes 75 17 92 Sekar,Vasu,

senthil 53 vallavampatti 22-12-11 Yes 4 24 28 Thangam,

Bama 54 Thiruvonam 28-12-11 Yes 115 25 140 Thangam,

Vasu 55 Athanakottai 09-01-12 Yes 96 24 120 Thangam 56 Ghandarvakottai 11-01-12 Yes 45 8 53 Karthi,senthil,

vasu,sekar 57 Mattangal 12-01-12 Yes 25 13 38 Thangam 58 Mohanoor 18-01-12 Yes 30 12 42 Thangam 59 Komapuram 19-01-12 Yes 80 60 140 Thangam 60 Perungalur 23-01-12 Yes 40 7 47 Thangam 61 Sothupalai 25-01-12 Yes 35 10 45 Karthi 62 Kendayampatti 27-01-12 Yes 25 14 39 Senthi,sekar,

kavitha 63 Kolavaipatti 27-01-12 Yes 15 18 33 Senthil,

sekar,kavitha 64 Peruchi Vanniampatti 31-01-12 Yes 25 18 43 Pandian,

STEPP – Feb 2012

30

Thangam 65 Amma pudupatti 02-02-12 Yes 22 15 37 Senthil 66 Periyakottai 07-02-12 Yes 15 28 43 Senthil 67 Namburanpatti 09-02-12 Yes 7 13 20 Thangam 68 Periyakottai 09-02-12 Yes 32 15 47 Thangam 69 Saveyriarpatti 14-02-12 Yes 25 20 45 Senthil,Sekar 70 Manaipatti 16-02-12 Yes 20 35 55 Sekar, Senthil 71 Nerpukai 16-02-12 Yes 22 24 46 Sekar,Senthil 72 Vandianpatti 21-02-12 Yes 27 35 62 Sekar,Vasu 73 Chozhavanpatti 23-02-12 Yes 18 12 30 Senthil,

Karthi Total 57 5 11 2507 1950 4457

Alangudi Taluk


Methodology No. of people attended Staff present Bus Street

play Small Group Meetings

Male Female Total

1 Pudukkottaividuthi 25.07.11 Yes - - 41 23 64 Karthick,Vasu2 Pudukkottaividuthi 26.07.11

Yes - - 38 19 57 Senthil,

KartthickThangam

3 Vallathirakkottai 27.07.11 Yes - -

43 12 55 Thangam Rao, Vasu Senthil,

4

Venkidakulam 28.07.11 Yes - - 27 23 50 Senthil, Vasu

5 Golayankadu 28.07.11 Yes - - 31 17 48 Senthil, Vasu 6 Alangudi 04.08.11 Yes - - 38 18 56 Senthil, Vasu,

Sekar 7 Vadakadu 05.08.11 -

Yes - 120 105 225 Cultural Team of SCARF

8 Vettanviduthi 05.08.11 - Yes - 210 180 390 Cultural Team of SCARF

9 Mangadu 08.08.11 - Yes - 130 90 220 Cultural Team of SCARF

10 Senthangudi 08.08.11 -- Yes - 140 110 250 Cultural Team of SCARF

11

K.Rasiyamangalam 08.08.11 Yes - -

22 28 50 Thangam, Vasu, Sekar Karthick,

STEPP – Feb 2012

31

12 Thiruvarangulam 19.8.11 Yes - - 20 - 20 Thangam, Vasu, Sekar

13 Vamban 4 Road 19.08.11 Yes - - 40 - 40 Thangam, Vasu, Sekar

14 Melakkottai 26.08.11 Yes - - 10 18 28 Senthil, Vasu 15 Kuppakkudi 26.08.11 Yes - - 19 29 48 Senthil, Vasu 16 Melathoor 02.09.11 Yes - - 16 22 38 Senthil, Vasu,

Sekar 17 Pullanviduthi 16.09.11 Yes - - 15 33 48 Senthil, Vasu

Thangam 18 Vadakadu 16.09.11 Yes - - 38 - 38 Senthil ,Vasu,

Thangam 19

Kothamangalam 30.09.11 Yes - - 65 15 80 Senthil, Vasu Thangam

20 Kothamangalam 30.09.11 Yes - - 75 10 85 Senthil, Vasu Thangam

21 Mangadu 07.10.11 Yes - - 45 10 55 Senthil, Vasu, Sekar

22 Avanamkaikatti 15.11.11 Yes - - 40 15 55 Senthil, Sekar 23 Keeramangalam 15.11.11 Yes - - 30 17 47 Senthil, Sekar 24

Pallathividuthi 22.11.11 Yes - - 15 20 35 Senthil, Sekar

25 Ntp tuition centre 27.11.11 - - Yes 120 80 200 Thangam, sendhil

26 United paramedical college

28.11.11 - - Yes 60 60 Thangam, sekar

27 Regional nursing college

1.12.11 - - Yes 70 70 Thangam, sekar

28 Kasimpudupettai 6.12.11 Yes - - 28 15 43 Thangam, vasu

29 Anaivayal 6.12.11 Yes - - 7 22 29 Thangam 30 Kalibullah nagar 100

days workers 15.12.11 - - Yes 25 25 Kavitha

31 Kummamkulam 23.12.11 Yes 38 24 62 Sendil, vasu 32 Sammachividudhi 03.1.12 Yes 55 10 65 Sekar, vasu 33 Alangudi regional iti 5.1.12 Yes 80 45 125 Thangam 34 Varapur 10.1.12 Yes 105 90 195 Vasu, sekar,

senthil 35 alangudi 21.1.12 yes 37 37 Thangam,seka

r 36 manjanviduthi 21.1.12 yes 60 40 100 Thangam,seka

r 37 Kallalankudi 24.1.12 Yes 25 5 30 Senthil, vasu,

sekar

STEPP – Feb 2012

32

38 manjanviduthi 25.1.12 yes 60 40 100 Thangam,sekar

39 kennayanpatti 27.1.12 Yes 15 18 33 Senthil, vasu, sekar

40 mazhayur 27.1.12 Yes 25 12 37 Senthil, vasu, sekar

41 T.kolavaipatti 27.1.12 Yes 25 14 39 Senthil, vasu, sekar

42 keezhathur 1.2.12 Yes 9 21 30 Senthil, vasu, sekar

43 peeradipatti 8.2.12 Yes 5 18 23 Senthil, kavitha

44 kovilpatti 8.2.12 Yes 27 8 35 Senthil, kavitha

45 pachukottai 10.2.12 Yes 22 25 47 Kavitha, vasu, thangam

46 Nambanpatti 17.2.12 Yes 15 27 42 Senthil, vasu, kavitha

47 Nambanpatti 17.2.12 Yes 10 22 32 Senthil, vasu, kavitha

48 Mangadu 21.2.12 yes 22 22 Senthil, sekar Total 35 4 9 1999 1564 3563

STEPP – Feb 2012

33

Annexure IV

Research

QC of survey data

Name of Taluk Total villages surveyed

Total No. of Households surveyed

No. of individuals with Common Mental Disorders identified during survey

No of individuals with Psychoses identified during survey

Thirumayam 260 17023 817 225 Gandarvakottai 125 18115 731 196 Total 385 35138 1548 421

QC – Door to Door Survey

Gandarvakottai

• Total No. of families surveyed = 18115

• QC completed = 1375

7.6%

Thirumayam

• Total No. of families surveyed = 17023

• QC completed = 1068

6.3%

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