Challenges and sustainability of Indian mental health: evaluating volunteer-based community mental health clinics with a complex adaptive system framework

Purpose: This study aims to evaluate how a community psychiatry model, referred to as the Mental Health Action Trust (MHAT) in India, provides decentralized care and comprehensive services to people with severe mental illness living in poverty. Using the complex adaptive system (CAS) framework, the authors aim to understand the factors that contribute to the diverse outcomes of the MHAT community mental health programme as observed in four different locations. Design/methodology/approach: Four MHAT clinics were purposively chosen from two districts in Kerala. A comparative case study methodology was used to document each clinic’s MHAT services and activities, as found during field visits and interviews with staff members and volunteers. Findings: The study shows that all four clinics met the basic aim of providing free, quality mental health care to the poorest populations, although not all aspects of the comprehensive model could be equally provided. Alignment with the MHAT vision, appropriate leadership, the relationship with partners and their level of community engagement determined the varied success between clinics. Originality/value: The current study evaluation stresses that community ownership is crucial. Careful attention must be paid to the characteristics of selected partners, including their leadership styles and ability to garner resources.