Every Infant Matters- Mental health

The COVID-19 crisis had led to an unprecedented surge in mental issues such as depression and anxiety. Children from disadvantaged backgrounds such as slums are the worst affected due to isolation, loss of family income, lack of schooling and many other reasons. Parents of such children in turn are unable to cope with the pressure. We shall hire and train local people as Community Health Workers (CHWs) to identify mental health issues among disadvantaged slum children, and reduce stigma and discrimination. Through our technology based solution, we will identify those who need help,  provide counselling, treatment, and long term support, including psychosocial support to families to cope with at-risk child. Together we shall do advocacy with the government to include mental health in its advisory for tackling the COVID-19 crisis. Mental health is inextricably linked to physical health, thus our solution will build resilient individuals and communities if scaled globally.

One-third of the world's population and 60% of urban populations in the least developed countries live in slums. Millions are children. Slums are areas of social and health deprivation to children due to extreme poverty, overcrowding, poor water and sanitation, substandard housing, limited access to health and education, insecurity, unstable incomes and other hardships ( Children's health in slum settings - PubMed (nih.gov)). While the number of people residing in urban India is on the rise, equally alarming is the rise in the number of the urban poor. At 76 million, the burgeoning size of the urban poor cannot be ignored. UNICEF’s State of the World’s Children 2012 report states, “The children living in around 49,000 slums in India are invisible. Covid has exacerbated mental issues amongst slum children. Boredom and loneliness lead to aggression and /or depression. Siblings fight. Kids get restless. Living 24/7 in close, unsanitary conditions, families become dysfunctional. Parents lash out at their kids, and kids clash with parents. Alcoholism is a chronic problem. More than 53% slum children show evidence of mental issues and need help not just in India but also globally.

Every Infant Matters has carried out a pilot in the slums of Delhi. We developed a low cost technology application which uses validated, standard questionnaires used and accepted worldwide to detect mental health. We trained and built capacities of people from local communities as CHWs, and empowered them to conduct first level intervention. The technology solution helped them carry out screening for mental health issues among slum children. We identified children/parents who need help, and provide psychological intervention which consists of early diagnosis and identification, comprehensive psychiatric evaluation; psychological assessments, screening tests, treatment plan specific to individual needs, use of behavior therapy to facilitate adaption of productive behaviours, group-based training for cognitive and social skills enhancement, and follow-up counseling sessions for continued care.

We serve slum children who are amongst the most vulnerable. They are trapped within the confines of poverty. Slums typically lack proper sanitation, safe drinking water, garbage collection; there is usually a severe shortage of space inside the houses where the children live, and no public spaces dedicated to their use. Often these children have no childhood. Some have no homes, they are forced to live on the street and work as beggars, exploited in every way possible. They face brutality, starvation, sickness. We begin our work by engaging with slum children and their families to understand their needs. We hire and engage local people as community health workers (CHWs). These people belong to the slum they serve. They live in the same neighbourhood, they eat the same food, they worship in the same manner. They are best equipped to navigate the informal geography of slums where there is no road number or house number. CHWs go door to door to engage in conversation with the families and the children to understand the challenges that they are facing. Mental health is one of the biggest challenge. When there is no money for food, when jobs are scarce, then parents have only one aim, to somehow earn their daily bread. Parents have therefore very little quality time for the children. Also, parents suffer mental illnesses. They have an all-pervading fear of Covid, sometimes they are accompanying feelings of guilt, anger and resentment. Negativity spills over from parents to children. We have seen parents hitting their children and neglecting them in every way. There is no one to address the concerns and needs of children. This is why our solution is an immediate and urgent need. Our CHWs meet slum families and get all kinds of reports. Very often parents tell them directly about how children are behaving. The comments can be as “my child is always hitting other children” or “my child is banging his head against the wall” or “my child has not eaten food or slept for several days”. These are all indications of mental illnesses and give some idea of what is going on. CHWs then screen children with the help of a standard  questionnaire that is posed to the children.  This questionnaire clearly identifies those children whose mental health is not up to the mark. While there are many children who have clinical depression, they are many more children with borderline mental issues, who exhibit early signs of depression or aggression that can be captured by the questionnaire. Thus our solution helps in diagnosis. Once we have diagnosed, the next step is to provide psychosocial support and even medical treatment if required, which is done by a team of psychologists and psychiatrists working in close tandem with local communities.

Our solution aligns with MIT Solve, that seeks to identify inclusive technologies to protect the most vulnerable. We serve marginalised slum children who are ‘left behind’ when it comes to health. When there is no food on the table, and parents have lost their jobs and livelihood, there is no-one to address the issue of mental health. We identify those suffering from loneliness, stress, anxiety, depression, and other mental impacts. Our beneficiaries include internally displaced migrants who come to cities in search of jobs. We equip last-mile healthcare providers with the tools to detect mental illnesses and respond effectively .

We are in the pilot stage of development. The technology application has been prepared by OneKeyCare Ventures, which is the technology partner. The pilot has been implemented by Every Infant Matters, a not-for-profit company incorporated in India.  Every Infant Matters has hired and trained four local people who belong to the slums themselves, as Community Health Workers (CHWs). CHWs were given comprehensive training on mental health, Covid, and how to use the technology application. All training was carried out in a culturally appropriate manner. CHWs began serving the community in four separate slums of New Delhi. The total population of the slums is approximately 20,000 people. CHWs go door to door to educate people on the issue of mental health and Covid, and have screened 1000 children so far. CHWs get direct or indirect evidence of loneliness, depression, or anxiety, this can be detected by the app.

Our solution is innovative as it integrates science, technology, social and business innovation comprehensively. We integrate a scientific solution with the social empowerment of disadvantaged people, utilizing best business practices and technology while engaging local communities. Our scaling model integrates with other stakeholders including governments and civil society and also with policymakers to provide a comprehensive pathway to scale.

We shall use technology for screening  children for mental health issues, data collection, and analysis and adherence, and hand over the technology to key persons within disadvantaged communities. Utilizing local people as CHWs is an innovation itself, as they understand the psyche of our end users and are best equipped to develop a rapport with them and to navigate the informal geography of slum areas where there are no road numbers or house numbers. We believe in the best of business practices and shall apply these in the NGO space as always. By integrating technology with business principles and utilizing local people, we shall carry out a project that embodies the principle of integrated innovation.