Barefoot Researchers in Mental Health?

The notion of “barefoot researchers” in mental health must sound preposterous. Yet, bear with me as I propose that very thing, especially for less-developed countries with poor infrastructure for psychiatric services and few doctorally-prepared researchers to assess the needs of their people. I have been thinking about the vast unmet needs across the globe since 2013, when this journal's theme for the year was “mental health across the globe.” Among the topics I considered in Volume 34 editorials were the mental health effects of the global phenomenon of urbanization; worldwide violence against girls and women; the pandemic of sex trafficking; atrocities in the workplace; deleterious effects of war; lack of adequate planning for dementia care; and virtual lack of psychiatric services in many developing countries. With regard to the latter topic, I focused on the African country of Liberia in an editorial in the May issue (Thomas, 2013). Liberia at that time had one psychiatrist. Less than one percent of the population had access to any psychiatric treatment. Yet, thousands of its people were suffering from post-traumatic stress disorder and other mental health consequences of its civil war. Stepping into the void, the Carter Center helmed by former American president Jimmy Carter and his wife Rosalynn had developed a training program to prepare psychiatric nurses, physician assistants, and community mental health workers who would deliver services within the Liberian primary healthcare system. The idea of community mental health workers stayed with me.

Liberia, of course, is only one of many countries sorely lacking psychiatric/mental healthcare providers. The World Health Organization, in its Global Mental Health Action Plan 2013–2020, called for intensive efforts by its 194 member states to increase the number of mental health providers, particularly in community settings (WHO, 2013). The document from WHO emphasized the need for increased mental health screening, data collection on vulnerable groups, and community interventions. Given the abysmal percentage of government budgets allocated to mental health (2.8% of health budgets at the time of the WHO report), it is unlikely that substantial increases in mental health screening, data collection, and community interventions have been achieved during the past three years.

Today, I return to the topic of lack of psychiatric services because I learned of a very innovative initiative taking place in the public health arena in India. I am wondering if the modus operandi of the initiative could be copied in the psychiatric/mental health arena. Key to the success of the initiative is the training of “barefoot researchers,” who are young people recruited from the urban slums (Atcheson, 2016). I assume that the adjective “barefoot” was borrowed from the label given to the village healthcare workers trained to provide basic medical and preventive care in rural areas in China back in the 1960s; they were called “barefoot” because they were like the farmers who worked that way in the rice paddies. Rural residents respected the advice of their peers, and the World Health Organization regarded the “barefoot doctor” movement in China as quite successful (see Fang, 2012, for more details).

The “barefoot researchers” in India are focusing on population access to clean drinking water. In India, 75% of people do not have access to drinking water in their homes; in one slum, 0.1% of the residents have such access (Atcheson, 2016). In this situation, women and girls must spend an inordinate amount of time obtaining water for the household, limiting their ability to attend school or work. Alternatively, slum residents must buy water from the price-gouging “water mafia.” The “barefoot researchers” will collect precise data in a Mumbai slum about contaminated or nonfunctioning water taps; water reliability, quality, and quantity; and costs of obtaining water from the “water mafia.”

An organization called Partners for Urban Knowledge, Action, and Research (PUKAR) developed the concept of “barefoot researchers” and has trained more than 3,000 of them. More than 300 research projects were conducted before the above-described water survey that will provide slum residents in India with the data they need to advocate for access to clean water (Atcheson, 2016). Here is how PUKAR's program works: young people are recruited from the community and trained about research ethics, methodology, and tools of data collection, including techniques of interviewing, mapping, and photographing. Because they are residents of the community, their neighbors trust them. They are paid for their work, which enables many of the barefoot researchers to continue their education. When data collection is completed, the young people act as community organizers in lobbying the government for improved services.

I found the concept of “barefoot researchers” amazing, and I began to think of ways that young people in other countries could begin to collect some of the data that WHO (2013) said it needed.

Initial mental health screening and casefinding could be conducted by such workers, and then communities could be galvanized to lobby for the needed mental healthcare services. Data empowers communities to speak out. As the founder of PUKAR claims, “Anyone can be a researcher. It doesn't only have to be the MDs and the PhDs…. Common people not only can do research—they need to do it” (cited in Atcheson, 2016, p. 2). I invite responses to the proposal of “barefoot researchers” in mental health, and I await your articles or letters to the editor.

Declaration of Interest: The author reports no conflict of interest. The author alone is responsible for the content and writing of this paper.