MILESH HAMLAI

Target Population:
India,

Milesh Hamlai is creating a new system of community-based rehabilitation for the mentally ill, by employing religious faith healers as the key influencers in communities to access psychiatric services for them. 

This profile below was prepared when Milesh Hamlai was elected to the Ashoka Fellowship in 2013.

INTRODUCTION

Milesh Hamlai is creating a new system of community-based rehabilitation for the mentally ill, by employing religious faith healers as the key influencers in communities to access psychiatric services for them. 




THE NEW IDEA

It is common practice for families in India to bring mentally ill family members to religious places such as temples and dargahs, for faith healing. This practice is often done in closed compounds, and excluded from modern mental health systems. Milesh turns faith healers into allies and includes them as key stakeholders in community mental health care.

Milesh brings two unusual stakeholders together—government district mental hospitals and religious faith healers—to provide psychiatric, therapeutic, and medical services to the mentally ill. He trains faith healers to perform the primary diagnosis of mental illness and modern and humane methods of treatment. Milesh also engages the government district mental hospital to set up a clinic on the premises of the temple or mosque to provide free care and services. In addition, Milesh works with various stakeholders in the community, such as teachers and the families of the mentally ill; training them to identify and support the mentally ill through treatment, for a comprehensive community-based rehabilitation program.

Milesh is increasing access for the mentally ill to psychiatric treatment, and through the training and awareness of faith healers, he is also ending abuse of the mentally ill often perpetrated by religious priests in the name of faith healing. Milesh is working to end traditional religious practices of mental health treatment, such as chaining and whipping, and is reducing superstitious beliefs among families. 




THE PROBLEM

There is a strong system of taboo and superstition placed on mental illness throughout India, which is often viewed as possession by spirits or another supernatural affliction. As a result, mental illness is not understood as a medical condition and the mentally ill are commonly taken to religious institutions and religious leaders for faith healing. There are at least one thousand individual faith healers in the state of Gujarat and around ten strongly identifiable religious institutions that see approximately 17,000 to 20,000 patients each year. Faith healers, in the name of ritualistic healing, routinely abuse the mentally ill. Common superstitions such as “holy water” in the religious institutions or oil from lamps, has the power to cure mental disease. Ritualistic healing also includes caning and beatings to “drive away the evil spirit possessing the body.” During the day, patients may be tied to trees with thick ropes. At night, they can be tied to their beds with iron chains.

An incident on August 6, 2001, at a dargah (religious institution for Muslims) in Erwadi, Tamil Nadu, exposed gross violations of human rights. The dargah caught fire and while most people escaped, 28 mentally ill patients chained inside burned to death. As a result, the Supreme Court ordered chaining of the mentally ill be banned and any institution caring for the mentally ill formally register with the government district hospital for the mentally ill. In spite of this legal order, families continue to take their family members to faith healers, and they are abused, with no access to psychiatric therapy, medication, or a chance for medically-sanctioned treatment. 

An effort was made in the past by the Ahmedabad District Mental Health Hospital to access the Mira Datar Dargah, famous for faith healing, as a center to provide psychiatric support to patients. However, hospital authorities did not engage the faith healers but tried to eliminate them from the system. This angered the healers, garnered distrust between them, and led to the dargah banning the hospital from its premises. 




THE STRATEGY

Milesh’s own brother suffers from mental illness and as a result, he personally understands the deep-seated taboos that exist around mental illness. He recognizes the role of faith healers in mental health in India, and is making them responsible stakeholders—providing adequate mental healthcare to patients, referring them to accessible and affordable psychiatric care systems, and stopping all abuses performed on them. Through Milesh’s Dava Dua (Medicine and Prayer) program for the mentally ill, he brings the government district mental hospitals, faith healers, and the families of the mentally ill to a common platform, to ensure their proper treatment and care. 

Milesh first partnered with a district mental hospital in Ahmedabad to access mentally ill patients and provide them with government psychiatric support and free medication at the Mira Datar Dargah, a popular institution for faith healing treatments of the mentally ill, around 100 kilometers from the hospital. With backing from the superintendent of the hospital, Milesh approached the Mujawars (Muslim priests) at the Mira Datar Dargah, to allow him to set up a mental health clinic on their premises. After months of refusal to cooperate, fearing their own business of faith healing would be taken by a psychiatric clinic; Milesh finally convinced the board of the dargah to permit him to operate the clinic when he promised treatment would only be given to those who hadn’t been cured by faith healing. The families of the mujawars had a high number of mentally ill members due to marriages within the same family for over 500 years.

The psychiatric clinic initially functioned twice a week, from 2 to 4 pm. Milesh chose the time when the mujawars had lunch; to not interrupt their work and gain their trust and support. With the clinic on the Dargah premise, Milesh trained the mujawars to do primary diagnoses of mental illness and instructed them to refer patients to the clinic. He designed the training curriculum with the mujawars. Milesh’s training included awareness on the rights of the mentally ill, and the legalities of violating them. This training urged the mujawars to direct mentally ill patients from the dargah to the psychiatric clinic for diagnosis and treatment, while it also ended the abuse of the mentally ill by faith healers. 

Three psychiatrists from the district mental hospital treat patients at the clinic on a rotational basis, and medicine is also supplied by the government hospital; making the psychiatric services accessible and free for patients and their families. Since most patients are from remote rural India, and are poor with little education, being able to offer services free of charge is very important. 

As patients come to the dargah from all across the country, Milesh networks with mental health organizations, governmental and non-governmental across the country. Once patients are accessed, diagnosed, and given medication at the clinic in the dargah, Milesh refers them to a mental healthcare facility (in network) close to their home, and transfers their case, so they may continue to receive care without traveling to the dargah. This network is crucial to the care of the mentally ill and their continued wellbeing, because most mental illnesses are chronic and need medication and treatment for life. 

Milesh engages the entire village community to provide training to the mentally ill. He trains teachers to do early detection of students with learning disabilities, and organizes family members into village level committees to create awareness about mental illness in the village. Milesh also educates patient family members about the rights of the mentally ill. Clinical psychologists facilitate these sessions, and discuss how families can best care for their mentally ill members, while encouraging the sharing of experiences so families gain support from each other to deal with the stress of being a caregiver. 

The Dava Dua clinic founded within the Dargah premise nine years ago, now operates seven days a week, and has moved slightly outside the Dargah, as Milesh realized many non-Muslim patients were hesitant to use the clinic because it was inside a Muslim religious institution. In the past nine years, the Dava Dua clinic has treated 18,000+ patients with mental illness, including repeated cases and follow-ups. 

Milesh is replicating his model in religious institutions in Baroda and Hyderabad. With patients as his main source, Milesh has also built a database of a thousand Bhuvas (individually practicing faith healers) across Gujarat. He is bringing the bhuvas together to train them to refer patients to the Dava Dua clinic or government mental health facilities. To convince the bhuvas to cooperate, Milesh is using the mujawars in the Mira Datar Dargah, who are convinced about the importance of his program, to talk to the bhuvas, who respect the mujawars immensely, and will get on board the Dava Dua program when asked by the mujawars. Milesh is training bhuvas on mental health and to refer patients for medical treatment. 




THE PERSON

Milesh is the eldest of three brothers. He feels that growing up during a financial crisis, often not having even basic things, meant he never had anything to lose. Milesh believes his childhood experiences made him a survivor, and able to take risks without the fear of loss. Being the eldest, among his cousins as well, Milesh cared for his younger siblings and cousins as a parent. He did everything—from bathing and clothing them to helping them with their homework. Milesh showed so much responsibility in caring for his siblings, although he was only two years older than some, that his parents and aunts and uncles trusted him; and left them in his care when traveling for work for long periods of time. 

When Milesh was 21, he married against his parent’s wishes and went to Mumbai to make a living. He worked as a delivery man for a small mechanical parts manufacturer for Rs. 500 (US$10) a month. To supplement this income Milesh taught himself how the visa process for various countries worked, and did the paperwork for visa applicants for Rs. 100 (US$2). 

While Milesh worked, he learned that his younger brother had run away from home (1995). Milesh tracked his brother down and took him to a psychiatrist, where his brother was diagnosed with schizophrenia. From the psychiatrist Milesh realized his brother had been suffering from schizophrenia for many years, but his parents had never sought medical help due to a lack of awareness. Milesh continued to help his brother with treatment over the years, but his parent’s refused to recognize that his brother had mental illness and took him to various faith healers. In such institutions, his brother’s condition worsened and he was beaten. 

While Milesh was visiting different psychiatrists and mental health facilities to get help for his brother, he became more acquainted with the gaps in the mental healthcare space, and realized his parent’s reaction to seek help from faith healers rather than medical practitioners was a common practice.