“When we started out, only people with severe mental health problems would come to us, especially when families found it impossible to care for them. They would be suffering from depression with grave suicidal tendencies, alcholism, or schizophrenia and psychosis. Very rarely did persons with mild forms of emotional disorders come to us. But today, young women walk into my clinic by themselves and seek care for mental health, which in my opinion, is great,” said Dr Thara Rangaswamy, co-founder of Schizophrenia Research Centre (SCARF), a mental health care centre and NGO based in Chennai.
Thara co-founded SCARF in 1984 with Dr Sarada Menon, one of the country’s first women psychiatrists. During its 40 years of service, the clinic has treated thousands of patients for mental health issues ranging from schizophrenia to depression and anxiety disorders. TNM caught up with Dr Thara Rangaswamy to understand how SCARF came into existence and the gradually evolving perceptions of mental health care in the country.
According to Thara, when Sarada Menon retired in 1984 as the director of the Institute of Mental Health in Chennai, she was unhappy with the plight of rehabilitative care for mental health disorders in Tamil Nadu and wanted to do something about it. It was this thought that became the inspiration behind SCARF. Sarada approached Thara, who was working on a research programme on schizophrenia then. The duo, along with Dr Rajkumar, a psychiatry professor at Madras Medical College, came together to create SCARF. “The credibility of Dr Sarada and Dr Rajkumar helped us secure a board of management. Eventually, we hired psychologists and psychiatrists to work with us part time. We put down objectives for the organisation and I wrote the constitution and the bye-laws for SCARF,” said Thara.
Setting up a mental health care centre in the 1980s was no mean task. Apart from providing care and rehabilitation, the founders of SCARF had to work to destigmatise mental health disorders and normalise seeking care. Thara recalled how the public was sceptical about schizophrenia, its diagnosis, and treatment. She said, “One major challenge we faced was that people would equate all mental illnesses with depression. The view that mental illnesses were incurable and there was no point in investing in curing them was also widespread. There were also some groups of people who relied on traditional healers for mental health care and thought disorders were ‘black magic’.”
As SCARF grew gradually, people’s perceptions around mental health began changing as well. Now, the health care centre has a team of 11 full time psychologists and over 120 staff. It has 135 beds for in-patients. Additionally, SCARF has an exclusive “first episode psychosis clinic” where young and middle aged people can seek treatment after they experience their first episode of psychosis. There is also a youth mental health clinic for people below the age of 25 and a dementia and elderly care clinic for those over the age of 60.
The dementia care facilities available at SCARF include an outpatient clinic, a day clinic and an in-patient clinic, said consultant psychiatrist and assistant director Dr Sridhar Vaitheswaran. “In the outpatient clinic, we can diagnose, discuss treatment, and start a plan to treat dementia. The treatment plan for dementia is person-centric and has to be tailor-made for each person. We also have a day hospital where patients can receive non-drug intervention and treatment. We also offer interventions for behavioural problems in dementia and other issues people with dementia might be facing. There is also an in-patient clinic for more severe behavioural problems,” Sridhar said.
He stressed on the importance of support groups for caregivers of persons with dementia. “Caregivers of these patients also undergo a lot of stress so there is a support group for them as well. This group used to meet regularly before the pandemic but it has shifted to WhatsApp now. We also have interventions for caregivers that look at creating awareness about dementia and help manage their stress,” he said.
Thara strongly believes in involving the community for better mental health care practices. To facilitate this, the clinic has set up outreach programmes in some of Tamil Nadu’s districts. Thara said, “The outreach programmes were started in 1990 in Tiruppur, Kancheepuram, and Pudukottai. In Pudukkottai, we pioneered the mobile psychiatry unit, which was a bus that would visit villages to pick up clients and patients. Similarly, we held outreach programmes in Nagapattinam and Cuddalore after they were hit by the tsunami.”
She also said, “There are different stakeholders like the spiritual leaders, panchayat leaders, school teachers, and village leaders, among others. All of them have to be sensitised to mental health issues. Otherwise a community mental health programme will not take off or sustain. SCARF is also involved in social rehabilitation in these districts where our staff help patients find jobs, help their children with school admissions, and so on.”
Dr R Padmavati, the director of SCARF, said that working with patients in need of mental health care has been a satisfying and fulfilling career. Having worked with SCARF since 1990, she said, “My work was mostly concerned with data collection and research but I have also worked with patients and their families to help them heal holistically. Seeing patients respond to the treatment and get a good outcome helps us continue doing the work we do.”
While SCARF has been working tirelessly to destigmatise the shame around mental illnesses and seeking care, both Thara and Padma are of the opinion that there is a long way to go. Thara said, “Women still take longer than men to get a mental illness diagnosis. I have seen several parents express concern about their daughters’ marriageability if word of them receiving psychiatric treatment got out.”
Thara also spoke about how several patients’ families perceive mental illnesses. “Only children with mental illnesses seem to receive any type of sympathy. At the same time, there are other parents who question why a mentally ill person does not act ‘abnormal’ all the time. The patient’s families' still fail to understand that a mentally ill patient need not exhibit symptoms all the time.”
In Padma’s view, there are very few clinics that provide the comprehensive care that SCARF is able to offer. She said, “The prevalence of mental health disorders has not changed much in the last decade. At SCARF, we have almost 10 new patients every week. Some of these patients may have gone anywhere between 2.5 to three years without treatment before coming to us.”
Society’s attitude towards mentally ill people continues to be concerning, Padma said. “People with mental illness are called derogatory names and there are unfair perceptions around their behaviour. Even when they are gainfully employed, their employers might not pay them what they are paying the others. While the attitude towards seeking treatment is gradually changing for the better, the same cannot be said about the attitude towards mentally ill people themselves.”
That patients of SCARF are able to regain their mental health after receiving treatment stands testament to the type of work the centre has been doing for decades. Hemanth (name changed), a former patient who was diagnosed with bipolar disorder in 2012, told TNM how SCARF had not only helped treat his illness but also helped with his career. “After I got my diagnosis, I could not focus on my career as an Human Resources (HR) professional in the IT sector. I found myself blanking out often, quitting my job, quickly joining another company, only to leave again in a week or two. I began making impulsive decisions that took a hit on my personal and professional life. In 2018, I tried starting my own business venture but it did not work out due to the pandemic. It was difficult to find jobs during that period. I began consulting a psychologist at the time of my diagnosis and she suggested I seek help at SCARF,” Hemanth said.
He added that SCARF has helped greatly with his condition and career prospects. He said, “I am able to manage my condition and the treatment has helped me get back on track professionally as well. In 2023, I began my training at the vocational training centre in SCARF where I was taught several skills that would help me build a career. I tried to go back to my career in HR but that did not work out. That was when my psychologist told me about an opening for a supervisor in a vocational training project SCARF was collaborating with. I was qualified for the role and have been working there since September 2023. SCARF not only helped me at my most vulnerable time, but also helped me with my career prospects, for which I am grateful.”