“Villagers ostracise people with mental illness. They don’t even know it’s a medical condition. As community workers, we need to explain these things to them as we would to children,” says P Manjula, a community mental health worker from Periya Nemmeli. “‘Is this man often angry?’, ‘does his mood fluctuate often?’ we would ask them, and then explain possible reasons and the kind of help the person needs,” she says.It requires a lot of patience, but now the villagers are willingly bringing the patients for treatment, and the stigma is slowly waning, she says.Across Tamil Nadu, women with little formal training are being recruited as community mental health workers, helping identify people with such conditions, tackling stigma and connecting families to treatment. Through programmes run by The Banyan and Schizophrenia Research Foundation (SCARF), they are taking mental health care to villages and undeserved communities, often navigating social barriers of their own, while challenging beliefs that label people with mental illness as ‘possessed’. While The Banyan trains community workers to identify people who need care and connect them with services, SCARF runs its own community outreach programme to improve mental health awareness and early intervention.When Suriya Baskaran, one of the community workers, visits families in Kannakudi village in Trichy to identify people with mental illness, she is often faced with a question: “Which street do you belong to?” Villagers ask this to determine her caste. “Sometimes, when I visit houses to identify families with cases of mental illness (MI), they offer me a cup of tea before asking my caste. But I remind myself why I am there. I explain what MI is, how it can manifest in different ways and affect a person’s behaviour. They become less hostile,” says the 38-year-old.Suriya joined The Banyan’s community outreach programme, ‘Nalam’, in 2024 after completing a six-month certificate course through the Banyan Academy of Leadership in Mental Health (BALM).Once a homemaker, she now works across four panchayats, helping families understand mental health conditions and accompanying them to hospitals and therapy sessions. She has also helped more than 150 people obtain unique disability IDs (UDID), connecting them with support and services they might otherwise struggle to access.For Suriya, the work also means learning to navigate social barriers. “When I found out that members of the Irular community in my area lacked identity documents, I approached the district collector’s office and filed a petition to help them obtain them. This intervention helped the community exercise their right to vote,” she says. “Seeing them benefit from my work makes me forget the hostility, discrimination and difficulties,” she says.For Amutha S from Kovalam, becoming a community mental health worker changed how she saw herself. Before joining the organisation, she worked at a publishing house, binding books to earn a living. Her husband, a plumber, would keep shouting at her: “You’re at home lazing around all day, doing nothing” and not give her any money. “But I was doing all the household chores, cooking and looking after the kids. My labour was never considered work; which is why I started doing odd jobs,” she says.She was initially told the field worker position involved extensive travel and physical work, but she took it up nonetheless. Her responsibilities now include checking whether patients are taking their medication, experiencing side effects and attending counselling sessions, as well as helping them access disability cards and accompanying them to govt offices and hospitals.Being sought out by people in her community for help has been a significant change, she says. “Nowadays, people come and ask for my help. I have become important in my community, and am happy about that,” she says.The initiative began in 2018 and was rolled out in phases across Tamil Nadu. Koteswara Rao, assistant director at SCARF, says the organisation initially selected four key people from each of the state’s 38 districts to explain the programme and help reach members of self-help groups. Formal qualifications are not the primary consideration when selecting community workers, often called ‘barefoot counsellors’.“Even a Class X qualification is enough. What matters most is their willingness to approach people and raise awareness about mental health, early warning signs of mental illnesses, and the dos and don’ts when supporting someone experiencing psychological distress,” he says.The programme has also expanded to include substance dependence, particularly among young people. In 2025, SCARF incorporated alcohol and drug dependence into its training, teaching community workers to recognise warning signs and refer people for treatment.The Tamil Nadu govt established or renovated de-addiction centres at 25 locations in 2025. “Community workers can refer people requiring treatment to these centres and medical colleges. SCARF has continued training workers in mental health and addiction, with refresher sessions planned to help them respond to emerging needs,” says Koteswara.The growing presence of women in these programmes is significant not only for the communities they serve but also for the workers themselves. Preetha Krishnadas of The Banyan says the organisation did not specifically design its programme for women; but most of those who came forward in Tamil Nadu happened to be women.“A reason, I think, is that caregiving comes to them organically. Women may also find it easier to gain access to households and build relationships with families, as they are often the primary caregivers themselves,” she says. Also, men may have access to more employment options and thus be less likely to consider community-based social work as their first career choice.However, sociologist Pratham Parekh says caregiving is ‘enforced’ on girls through a process called socialisation, a lifelong process through which individuals learn and internalise the norms, values, and behaviours of society. “Even India’s Accredited Social Health Activist (ASHA) programme offers a different institutional setting in which women’s community-based labour has become integral to the delivery of public health services.”
