Promoting social inclusion for young people affected by psycho-social disability in India – a realist evaluation of a pilot intervention

ABSTRACT

India has 600 million young people, more than any other country in the world. Mental illness is the leading burden of disease for young people, and those affected experience restrictions in social participation that compromise recovery. The aim of this study was to assess the impact of a peer-led, community-based, participatory group intervention on social inclusion and mental health among 142 young people affected by psycho-social disability (PSD) in Dehradun district, Uttarakhand. Qualitative data were obtained via in-depth interviews and focus-group discussions. A realist evaluation identified contextual factors, mechanisms and outcomes to develop the programme theory. Group participants described intermediate outcomes including establishment of new peer friendship networks, increased community participation, greater self-efficacy (for young women particularly), and improved public image (for young men) that are likely to have contributed to the primary outcomes of greater (self-perceived) social inclusion and improved mental health (as assessed quantitatively). Mechanisms were identified that explain the link between intervention and outcomes. These findings demonstrate the effectiveness of a brief intervention to improve mental health and social inclusion for young people with PSD and are potentially relevant to programme implementers and policy-makers working with young people and promoting social inclusion, in other low- and middle-income settings.

KEYWORDS:

• India
• social inclusion
• realist
• evaluation
• mental health

Acknowledgements

Appreciation also to Dr Reeta Rao, Mrs. Madhu Singh and Mr Lawrence Singh and their teams as well as Jeet Bahadur, Samson Rana, Laxman Balan, Late Mr. Arun Sherring, Pooja Bhatt, Atul Goodwin Singh, Kakul Krishna and Neha Singh for their logistics support in implementation of the study and to Burans community workers who assisted in data collection for the research. We also thank the peer facilitators; Gurudass, Arjun, Maryam, Imrana, Asma, Pooja, Shobha, Neelam and Preeti and all the young people who participated in the research.

Disclosure statement

No potential conflict of interest was reported by the authors.

ORCID

Kaaren Mathias http://orcid.org/0000-0002-9607-9459

Nathan Grills http://orcid.org/0000-0003-1228-3047

Varadharajan Srinivasan http://orcid.org/0000-0001-7072-0431

Additional information

Funding

We gratefully acknowledge the support of the Disability Research Initiative, University of Melbourne, and the Australia India Institute Project in funding this research.