Community mental health and concepts of mental illness in the Sundarban Delta of West Bengal, India

The Sundarban Delta of West Bengal is a remote, rural region with poor infrastructure and until recently without designated mental health services or a community mental health programme. To inform development of such a programme for the region, and to complement epidemiological study of rates of suicide, nonfatal deliberate self-harm, and specific psychiatric disorders, cultural epidemiological research was undertaken. This research aimed to clarify the nature of broadly conceived mental health problems in the community (not just professionally defined psychiatric disorders) and local concepts of mental illness, clarifying specific features, perceived causes, and help seeking for these problems. Findings from ethnographic study of three villages of two Sundarban blocks (Sagar and Gosaba) are presented and discussed, focusing on particular stresses and supports in the community, local priority of mental health concerns, and concepts of mental illness. This first phase of research has been followed by a cultural epidemiological survey in phase 2, studying mental-illness-related experience, meaning, and behaviour among (1) patients coming for treatment with selected mental disorders, (2) patients admitted after surviving an episode of deliberate self-harm, (3) non-affected laypersons in the community, and (4) health care providers with diverse orientations and credentials serving the community. As important as they are, psychiatric epidemiological data alone are insufficient to clarify the nature of needs and to specify the character of services. This research shows how cultural epidemiology informs policy and action, and how similar research in other settings may contribute to the mental health of populations.