When Harvard Partners the Church

 Scaling Mental Health Support through Faith Communities: Insights from Dr. John Naslund

Discover how faith-based initiatives and community-led programs are transforming mental health outreach across diverse cultural settings, from India to Texas. Dr. John Naslund shares innovative strategies for leveraging existing community structures, digital tools, and evidence-based therapies to expand access and reduce stigma.  Find a sense of purpose and meaning 

In this episode:

• The origins and evolution of the Empower program for global mental health

• How faith communities serve as vital partners in mental health intervention and support

• The role of culturally adapted behavioral activation in resource-limited settings

• The launch and growth of the Congregational Collective in Texas

• Practical steps for integrating mental health training in churches and other faith groups

• Differences in scaling approaches between India and the US under health policy and community needs

• The importance of ongoing support, supervision, and community ownership in mental health initiatives

• Opportunities for Australia to adopt and adapt similar community-based mental health strategies

Timestamps:
00:00 - Introduction to Dr. John Naslund and his work in global mental health
01:20 - How community and faith sectors can help address mental health gaps
03:00 - The background and motivation behind the Empower psychosocial intervention
05:18 - Evidence base for psychosocial treatments and strategies for low-resource settings
07:06 - Digital tools supporting scalable mental health training
09:21 - The emergence and role of the Congregational Collective in Texas
11:15 - How behavioral activation fits into faith communities
13:05 - Training and deploying local church community members as mental health navigators
16:59 - Delivering brief behavioral activation sessions within faith settings
18:26 - Screenings, referrals, and managing serious cases in faith community programs
22:56 - The evolving perception and engagement with mental health in faith communities
27:32 - Feedback and shifts in faith community responses to mental health needs
30:30 - Cross-cultural origins and adaptations of behavioral activation programs
34:17 - The success of scaling mental health in India and implications for other countries
38:26 - Community-driven demand for mental health support in the US and beyond
41:14 - Final insights on expanding access through non-traditional settings
43:58 - Closing remarks and invitations for collaborations in Australia

Podcast Disclaimer:

Please be aware that the opinions and viewpoints shared on this podcast are personal to me and my guests, and do not represent the stance of any institution.  This podcast aims to present findings for open discussion and dialogue, inviting listeners to engage critically and draw their own conclusions. While the content serves informational purposes, it is not a substitute for professional advice. Thank you for joining me on this journey of exploration and conversation!

Transcript

SPEAKER_00 1:08

Hello, everybody. I have got Dr. John Naslund here with me today. John is an instructor of global health and social medicine. He holds expertise in psychiatric epidemiology, implementation science, and digital mental health. John's scholarship seeks to advance efforts aimed at improving the lives of individuals facing the challenges of mental illness worldwide. His work focuses on low resource settings with emphasis in India and the United States, covering three major areas: the training and building capacity of non-specialist providers, health promotion and addressing excess mortality in persons living with severe mental disorders, and digital platforms for peer-to-peer support and empowering individuals living with mental illness. I first heard John at the Common Table where he was presenting alongside another person, talking about how they brought a mental health solution into the community via the church, training our essentially everyday individuals to be part of the task force of uh resourcing and enabling people who are living with significant disadvantage and struggle. So I was really keen to speak with him and to share his work here with you. So welcome, John.

SPEAKER_01 2:25

Great. Well, thank you very much, Valerie. I I really uh yeah, I'm really excited to be here and really appreciate the invitation to be part of this podcast and the opportunity to talk more about uh some of the work that I'm that I'm doing.

SPEAKER_00 2:36

How did you get into this area, John? What led you here?

SPEAKER_01 2:41

So, in the well, I guess the the mental health work broadly, my it stems back from my my dissertation work um and a really keen interest around severe mental illness, which uh you mentioned in my bio. Um and then more recently, this work focused, I think maybe pertinent to your audience, is how did this intersection with faith communities come about in my work? And that's actually been more around keen interests of mine around how do we uh support the implementation and scale up of proven, evidence-based programs and interventions that can help address things like depression or anxiety in community settings. And one of the things that came about through that work was there was there was actually there was very keen interest among faith communities. They actually convened a meeting, uh, and I was invited to attend this meeting, and they expressed that there were severe sort of challenges within their congregations. This was cross-denomination, um, and it was really quite humbling and you know, in you know, incredible to hear their stories. And that's really where it was sort of like, well, we actually have some proven tools that may be beneficial, and there was sort of a synergy that came about through that and a key opportunity to address the real you know a significant unmet need by collaborating with faith communities.

SPEAKER_00 3:53

When you attended this meeting, what were you discerning their motivations were? Were they themselves seeing the burden of mental illness in their churches or their community?

SPEAKER_01 4:03

Yeah. So this was a meeting that was convened in 2022. Um and I at that time I was working as part of a um on a project where our focus was around training community health workers. This was in in Texas. This was a part of a statewide initiative to support access to mental health care. And it started with a focus on community health workers, sort of an extending the health system. But as the project evolved, it became increasingly clear that the individuals who are most interested in learning the content, like learning how to address depression, were actually representatives of various community organizations, with faith communities being one of them. And this meeting was convened with, it was, I guess, as I mentioned, it was cross-denomination. So we had representation from a wide range of different churches and serving varying, you know, demographic uh groups. And it was the leadership that actually had come together, and they they had identified this as a crisis in their congregation. So there were high rates of a death due to suicide, so that's been a real serious challenge. And then sort of this feeling of helplessness and not knowing how to respond to these concerns. And that was really it was sort of a moment where it became clear that actually we have some of these tools and we're trying to find the right places to make them available to people who they who could we could help. And there was a need uh identified among these faith communities.

SPEAKER_00 5:22

Which leads me to ask you uh empower? I've actually picked up a paper here this morning which I hadn't seen, but the title is Toward the Global Dissemination of Psychosocial Interventions. I love everything that Harvard does because every all everything it does seems to be global. Studies seem to be things that can be replicated in in different cultural and national contexts. Tell us a bit about what this empower and psychosocial interventions is.

SPEAKER_01 5:49

Yeah, so the empowered program is really um uh uh sort of the our our flagship program through our our through the lab that I I co-lead um in our departments. And uh I was one of the co-founders of this program. It started in about 2018, 2019. But really the goal here is not to we're not trying to reinvent sort of the actual evidence on how to treat something like depression or anxiety. Instead, our goal is to say, you know, there are proven interventions. We call them psychosocial interventions, sometimes they're called psychotherapy, there's other words for it. But basically, there's a global evidence base. And actually, there's a number of leading trials and projects that have come come from Australia. I know that, but really there's a global evidence base demonstrating the effectiveness of these, the clinical effectiveness, the cost effectiveness of these brief interventions across a wide range of different settings, and even settings that are unconventional. So there's work from rural India, from sub-Saharan Africa, so really from every corner of the globe, demonstrating that these programs are effective and can be delivered by almost anyone with the right training and the right support. The key challenge, which is really the key focus of my work, is that even though there's this incredible evidence base, very little delivery, very little uptake, very little use, especially in lower resource settings. So I do a lot of work uh with collaborators in India, but also in higher income countries like the United States, where we have huge gaps in access to mental health services. And so we need to think about how we can get programs like this into practice. And that's really the focus of Empower. We're we're um taking these programs, trying to simplify them to make them accessible to virtually anyone, and then using digital technology to support digital tools, basically to support training, to support quality assurance, the assessment of competencies, and then the actual implementation and delivery.

SPEAKER_00 7:40

Yeah, so one of the guests that we had on the podcast, Dr. Burr Johnson, he he kept using a phrase that really caught my um attention. And he said that in faith communities, he called them houses of uh worship. He said a lot of good is locked up in there. You know, it doesn't spill out or or we don't know how to spill that good that we have, that we know through through our faith, through our relationship with one another than with God Himself into the community. And I think that is a similar issue with mental health clusters as well. We can be quite siloed in our approach to coming out and being a part of helping the community. In fact, about two weeks ago, I attended a dinner in my health network. It's a segment in Sydney, that's how we're segmented. And it was about 200 doctors, psychologists, social workers, mental health nurses, health professionals coming together to try to figure out how do we actually work together and simplify things so that we don't make it so specialized, so expensive, and so hard for people to access this care. With the work if the congregational collective, that's the work with faith communities. Is that particularly in Texas, John?

SPEAKER_01 8:53

It is, yeah. So the Congregational Collective actually came about. So that meeting in 2022 I mentioned was hosted in in uh uh in San Antonio. And one of the conveners for the meeting um is Becca Bruni, who and she's now the the um executive director of the congregational collective. The congregational collective was was established, I believe, in 2023 or 2024. So it ha came about actually after securing funding, was one of sort of one of the outcomes from that that uh initial meeting. And what's been really exciting about the the Congregational Collective is that it's essentially bringing together congregations from around San Antonio, and the goal is to expand even beyond that one one setting, but really around a focus of building up capacity and strengthening and supporting these congregations in a in a model where they work together. So it's very, very, very collaborative, but around addressing mental health concerns. So this has been and so part of this has involved um, you know, basic training around recognizing, identifying mental health concerns, how to work together, you know, as congregations, how to connect people with services that they may need. And one of the one of the key offerings is well, our our role, so the Harvard Medical School team role, is around how do we bring empower, the empower program, into these congregations. So some of the some of the participating churches have elected to kind of take their training a step further by doing the empower training, which involves training and how to deliver uh behavioral activation, which is a brief psychotherapy for depression and anxiety, but training members of their congregations to learn and master those skills with our support around how to implement this. And um, essentially, rather than simply referring outside the church, making that a place where there's someone who could learn those skills and respond to someone who has depressive symptoms right there in the church in a setting where there's trust, where there it can be done in a place of comfort, and then also with the kind of support. So it's not just uh I guess the other piece by having this collaboration is that this is a proven approach that we're now moving into the church. So it's also grounded in science, but then also really leverages the strengths and the values of the faith community to make it work well.

SPEAKER_00 11:02

So take us through a typical collaboration between yourselves within power and a local church. What does that typically look like?

SPEAKER_01 11:11

Yeah. No, that's a great that's a great question. So so many of the churches that are part of the congregational collective, they they're quite incredibly diverse in in terms of size and in terms of their geographic location, in terms of the race and ethnicity of their congregants, the neighborhoods that they serve, uh, the types of, you know, the the variation and socioeconomic groups that are served. So really some of them are in many very low resource parts of the city, others are in, you know, more high-resource areas. Really, in these congregations, we so my my team, we ex we provide access to the our training platform. So we have a program, the empower platform. It's all it's all a virtual training. We all we do in-person meetings as well, but we we first give access to this training and we really make that open to any anybody in in the participating churches who might be interested in doing this training.

SPEAKER_00 11:58

Yeah, really particular qualifications.

SPEAKER_01 12:00

No, there's no restrictions on who can do it. Except that they have to either speak English or Spanish, because we have it in both English and Spanish. That's really it's really the requirement. So, really the goal is to try to actually think creatively about who can who can learn this content. So they don't have to have a background in healthcare or men or mental health. We have people from all kinds of different backgrounds. You know, they had some of them are you know maybe retired, others are still you know working part-time, and then they're doing this. But they're really doing it because they're a member of the congregation. They're the either they're part of their their church community. Um so they can do this training, and then we recognize that it's a you know, like a significant time demand. I I don't want to oversimplify it. There's a lot of content to learn. And even though we make the content approachable, anyone can learn it. But then to go for to the next step of actually, you know, mastering and using that content requires more time investment. So we recognize that not everyone who learns the content is gonna say, yes, uh, this is for me and I want to move on. Um but for those who do, then we we work closely also with clinical partners. So we we partner with the University of Texas Health Sciences Center in San Antonio. We work with their clinical, so licensed clinicians, so psychologists and licensed clinical social workers. Um, and we work with them to then support any of these trainees in really using those skills. So, really, how do you then find someone in your congregation who has depressive symptoms? How do you then begin delivering the program? So it's a brief, and I'll just speak briefly what it's a brief intervention. Um, so it's called behavioral activation, and it's um it so there's a cognitive behavioral therapy or CBT is very well known. And behavioral activation is actually a component of CBT. It's a simplified component that actually shows similar, if not even superior, outcomes to CBT, but it's a little bit easier to learn and master. And it and what also is really valuable about this program, and that's been helpful through our learning, is it's it actually is very much complementary with different belief systems, with different faiths. Um, and that's partly why it's worked so well in so many different settings around the globe, whether it's in rural India or now in in San Antonio in faith communities, it really aligns, it's complementary to most people's belief systems. So what uh we have then found actually with working with the churches is that we're actually trying to learn from them how do we frame this so that this, you know, this program, when we bring it to a church, that it it really is complementary to your faith. It's not, it actually doesn't, if anything, it might actually help you re engage more with your faith. It might help you practice activities that are supportive of your faith, because it really focuses around skills. Think of it as sort of like a it's a skills training in some ways, um, around how to engage in activities that are meaningful, um, to identify your values and to practice that. And that helps then overcome the symptoms of depression.

SPEAKER_00 14:48

And can you just speak a little bit about what sorts of activities are in the behavioral activation component?

SPEAKER_01 14:54

Yeah, yeah. So the behavioral activation typically is delivered in six to eight sessions. So one-on-one. It can be done like this, it can be done virtually over or over the phone, or it can be done in person. It's really at the, you know, it's usually based on preference. So it could be done in the church directly or in the participant, you know, in an individual's home or in another location where they feel comfortable, or over the phone, as I mentioned. So and it usually involves walking through, identifying values, things that are important to you, and then making sort of a plan to engage in different activities. So it's it's really around sort of the core concept is really that if you engage in activities that you care about and track it and do it in sort of so there's homework, there's like, you know, you have to follow the steps, then it can really help you overcome the the depression, uh the de symptoms of depression. So it's done in a structured way. And part of what makes it work so well is that it's it's so structured that anyone who uses it, whether it's being delivered within a church in San Antonio or in Boston or wherever, you can do make sure it's done the same way in every single place, which is one of the reasons why it works so well.

SPEAKER_00 16:04

Right. So a church says we'd love to do as part of the congregational collective, they send some people to be trained. And then they are in partnership with the clinical oversight or overseers through this program. Say they finish the training. What happens now in terms of the church getting people from the community? How does that look like?

SPEAKER_01 16:29

Yeah, no, that's that's a great question. And that's something we're um we're still working on. So right now it's it's in the context of uh um you know implementations. We're actually trying to better understand how to do this. Because I don't, I actually I don't think there's one correct way to do that right now. So we've been training members of congregations of churches. We call use the word navigator, they're called a navigator. And basically, for some of them, they are you know, people are either being sent to them within their congregation because they are not doing well. Um then they do a brief screener. So they they do uh there's a short questionnaire to kind of ask about your how are you feeling. And you know, it starts with uh either it's a two-item questionnaire, it's called the the patient health questionnaire, it's a PHQ is the acronym. It has two questions. If you endorse any kind of concerns on one of the two questions, or both, one or then you do a longer version. It's a nine item. So it's only nine questions, but that's the first step is identifying um you know people who have symptoms. And then symptoms of depression is not, so I also want to make very clear it's not we're not diagnosing. This is not a diag that we're not doing, you know, we're not trying to find mental illness and you know disorders. What we're doing is we're finding symptoms. And then we are training members of congregations to then respond to those symptoms. So if they find someone who has, you know, depressive symptoms that are would be considered a concern, then they can begin delivering the behavioral activation program to them uh and scheduling sessions and then setting that up. So that that's that's been, you know, and we're exploring different ways to find people in the in the congregations. I know, and it varies by church. One church, for instance, is putting advertisements up. You know, they're putting, you know, like signs and you know, everywhere you, you know, things around mental health awareness. Other churches we've worked with are a little more cautious. They're not sure they want to really advertise mental health like that way. They're, you know, they're a little bit more worried about stigma. So I think the answer is really we're learning, and I think it might be different in each church or each setting. And I think that flexibility is actually one of the strengths because in some cases it's a referral from someone who's concerned. In others, it might be just finding someone and asking the questions and identifying it. Other instances it might be, like I said, you might see an advertisement and then reach out. So I don't think there's there's not one way to do this, but I think the shared goal is really trying to uh, you know, essentially find people who likely would not have gone to seek help if it weren't for this capacity now uh within their church.

SPEAKER_00 18:54

And so once it's rolled out in the church, my imagination is that most people gather at a church on Sunday. If we're training people from church who have regular jobs, how are they delivering this service? And what does that look like? Are they doing the behavioral activities with the person as in their walking with them? Like once it's identified and they go, okay, well, here's a plan for you. Seems like, you know, you your your values align towards spending time with family. Um, here is some thoughts about that. Are they doing it with them? How does that work?

SPEAKER_01 19:29

Yeah, so they don't, um, to my knowledge, they don't necessarily do the activities directly with the person they find. But what they do is they schedule follow-up, you know, the follow-up appointments or visits or however sessions, uh follow-up sessions. And that's really to monitor progress. So it's not like a, you know, there is follow-up, right? So we need so each session, they so every time there's a session, they collect a measure of depressive symptoms to see how they're doing. That's also really important because sometimes, you know, sometimes there's more serious things that can come up, or someone may not get better, that that can also happen. And we need to know that because if that happens, then there is also there is the opportunity for referral. So that's been actually one of the, I should have mentioned too, one of the key things is this is not a um program that is, you know, in isolation of the health system. That's that's certainly not not my goal. Um, and certainly not we don't want to try to put all of mental health care on onto the shoulders of churches. That's not the goal. The idea is to find people who probably would never have gone in to get help. But if there is a really serious case, we need to make sure that there's a a pathway to refer them to care. And that's already been one of the early successes, actually. We've identified some people who've been in pretty significant distress and they've been referred to a clinic that they never they didn't even know existed or they didn't, they wouldn't have felt comfortable going. But because someone in their church who they trust said, Yeah, I think you really need to go to this clinic, they've actually gone. And and that's been so that's one of the early successes, and we're really pleased with that. And that again, it's one of these things where there's a great deal of stigma in these communities. Um, and then also it there's, you know, it's it's not easy to seek help for a mental health issue. But if someone you trust is bringing this forward, um, there's opportunities to do that. So they don't necessarily, yeah. So back to the navigators, they don't necessarily do the session, you know, all the activities outside of the sessions, but they do schedule regular sessions to monitor progress, symptoms, and hopefully supporting someone as they get better.

SPEAKER_00 21:29

And okay, I think I understand. Um we currently have in a program called the Mental Health First Aid Training, which means that we can train people in the congregation to respond to signs and symptoms of a disorder or a mental illness early. But then once once that happens, it's then then refer on. But this then perhaps provides a next step, almost like a uh initiating one of the first, I suppose it's transdiagnostic. Behavioral activation is great and helpful across a range of illnesses, mental illnesses. So someone can then go, oh, we flagged or we've found, or this person has, you know, revealed to us they're actually really struggling. You can then talk to a navigator within the church, even. So you can initiate a referral. So the next step could be a navigator who's able to give that first level assistance and support through empower.

SPEAKER_01 22:36

And exactly.

unknown 22:38

Yeah.

SPEAKER_01 22:39

You're exactly. And I just want to mention that actually the many of the churches we met with, like so that meeting, that original meeting with the various congregations, many of them had done something like mental health first aid. And there is certainly value in learning, but I learning that content. But I think one of the challenges is that it's right, it's refer on. It's very, very basic understanding. And what was echoed across, yeah, almost every congregation that we met with in that meeting was that that was not enough. They needed More skills, more tools, basically. What are some of the other things they can do? And then that's when we said, well, hey, we actually I we have a program through our lab that this might actually help meet that need. And then there was that's where the kind of the synergy came about. Because yeah, behavioral activation is is essentially a you know, for many people, if you pay for psychotherapy or you go to a licensed clinician, you'll receive something like this. You would receive so now we're moving that capacity into um into a church.

SPEAKER_00 23:38

Yeah. Who are these navigators? They sound like superheroes. Like life is already complicated and busy and exhausting. And here they are stepping up and saying, No, I I want to be trained in this. I'm assuming they're not getting paid for it either. Who are these people?

SPEAKER_01 23:52

Yeah, no, it's a great question. And they come from all different, you know, different backgrounds, all different prior professions. Why some have been have had sort of leadership roles in their church, but they maybe have stepped back. So they, you know, they they were either, you know, a pastor, and then now they're they're they're so they have a connection to their church. Others are not like that at all. They do work in their church, but they uh, you know, they came from other professions. We've got uh you know people who are former um, you know, worked were former service members in the military or Air Force, and then now they're doing this. Or we have another we have one navigator who's taken this uh really has taken this to heart and is actually now going back to school to become a licensed clinical social worker. So is almost taking this to now become a clinician, which is pretty remarkable. You know, he did all the training. I mean, it's I think it's an incredible success story that not only has he done the training, but he's now gonna make this sort of a career shift and because he's you know compelled to do this within his his church. So I think the one thing that they all share in common is that there's a deep commitment to helping, just supporting their church and addressing the crises that they're they've been witnessing.

SPEAKER_00 25:03

What sorts of shifts and changes have you seen in the churches themselves as they participate? Because I mean, this is, you know, I know as a mental health clinician, um, my mom used to say to me, You must be so burdened and tired listening to terrible stories all day. And I'm like, actually, no, the most inspiring time I have is with my clients. You know, the government gives me grief with all the compliance stuff I have to deal with. But clients are one of the pure delights of my world. What have you seen it feed back into the faith communities?

SPEAKER_01 25:36

Yeah, that's a that's a great question. Uh and that's again, that's actually part of the because so we have a research project embedded in this to really try to understand first of making sure this is working, because that's really key. You know, we want to make sure that what is being delivered is is achieving, we want to make sure that people are getting better. I mean, there's that there's no question there. But also there's another piece too to explore the perceptions of the you know, the faith leaders and the broader clergy. I think one of the key things is that what has certainly I've observed in the you know uh since starting this this project is that there's uh been a real, I think, increase in awareness around mental health issues. The conversation's happening a lot more. And I think I think it's interesting that first, you know, because now it's been since, well, 2024 is when you know our team really was started working on this project. But in the last two years, I think initially there was maybe people were there's a little hesitancy, you know. Some of the churches were signing on they because they knew this was like, yeah, they they could see this was a concern, but they weren't really sure about it. Now it's sort of like, oh yeah, no, they're all in, like they're much more invested because I think they are hearing either either they're hearing from their own congregations about the value of you know trying to address these concerns, or they're seeing firsthand that this is having you know an impact in terms of it's changing the conversation. I think that's a big piece. You know, this it's now something that there's less stigma is there. I don't I don't want to, you know, pretend it's not, but there's certainly a shift in people talking about this. I was recently in a meeting where, you know, I was uh I was I was visiting a a church um uh gathering uh in San Antonio and they where they were describing the launch of a new program focused on families, so thinking of mental health and families. I I mean it was incredibly inspiring because this was coming about engaging about nine or so different congregations with a focus on on supporting families with mental health being central to that. And I thought this is really but that what I thought was so exciting there is that this isn't this wasn't you know something that I put forward or our team brought, you know, it wasn't from you know academia in any way. This was driven by the churches taking the content that we've provided and adapting it. So that that I mean I I think seeing things like that is really exciting. So the church is taking the mental health training content that we've provided and then adapting it and using it in ways that they see as beneficial. So that that's one example. And I think that's really exciting because it means they're taking ownership, they're using it. That's the whole point. That's why you know the empower is not gonna just it's not gonna work if it just lives at Harvard Medical School. It has to be in the any communities really, but where it can be used and owned and you know, adapted in ways that could be beneficial.

SPEAKER_00 28:15

Yeah. So I took my AI note taker to the common table gathering in Houston and it generated, you know, all these what you might call it, summaries for me. And what I've been doing is I've been sharing the link with various groups of people. So um I have a team of psychologists uh in my practice, uh, you know, sharing it with them. But I did take it to one in-person uh gathering. And these are the it's called the Pastors to Pastors Network. These are people who are, you know, support chaplains or mentors, or over here, pastoral supervision is a huge thing who are gathering to talk about well, how do we actually support pastors better? And um, so one of the things that I shared was about empower and uh the congregational collective work. And one person looked at it and I can see why they said this. And they said, Oh, this is a really westernized view of how to address mental health issues. And I I said, Well, actually, there's work that's um did it originate the what empower is actually in India? Is that correct, John?

SPEAKER_01 29:15

Yeah, that's right. Yeah, yeah. It's it's well, it's a little it's a bit more convoluted. The behavioral activation originated in Western countries for sure. But then it was adapted and delivered in in rural India, and that was a trial done about well, it was that work started about 20 years ago. And I and I think, or even more so now, yeah, 20 to 30 years ago, really. And there was pioneering work around taking, you know, Western models grounded in the psychological sciences, you know, from you know, ivory tower settings, mostly you know, white researchers developed these things and adapted it for the context in rural India. Similar work in parallel has taken place in Sub-Saharan Africa. Very similar models have been and and have had very, very high success. The Empower program actually took the work from India and adapted it back to the U.S.

SPEAKER_02 30:01

Yeah.

SPEAKER_01 30:03

Where is it? Yeah, is it a is it a program from India or is it but so it we we but we did cultural adaptation for the US, but essentially took the exact program um that was used in India.

SPEAKER_00 30:15

I'm I'm just absolutely thrilled and fascinated by that. One of the things I discovered, um, I commenced a PhD program, which is very painful for me at the moment, but I started to see that post-c the pandemic, it's actually developing countries that have an academic community started to say, we can't go through this again or we can't feel this helpless again. So, you know, in the leadership and organizational uh studies that came out after COVID, it was things like how do we make sure that workplace well-being is taken care of? How do we make sure that our leadership is ethical and attuned to the mental health needs of workplaces? So I'd already have been seen that we can't actually assume that that some of the struggle and solutions is only coming from the Western world. Actually, developing countries are wrestling with issues as well. So I'm thrilled to hear that it started from India and we're learning actually how to do that. What generated that research in India? Was it you, John? Is it is it because you've got links there?

SPEAKER_01 31:20

Yeah, so I I've been I've now been working in India for well, close to 10 years, but I started working with an organization there called Sungath. And one of the real pioneers of this work is Professor Vikram Patel, who I've he was he's a mentor of mine and he's the chair of my department. And he, along with colleagues through an organization called Sungath. So it's uh it's an NGO, so a non-governmental organization in started in Goa in India. And that was really the organization and and and um uh Vikram Patel's work that really started this in India about and that's now about 25 or so years ago, yeah, mid-90s, I would say. And then when I started working with Sungath, we were actually expanding to a different part of India. So uh my work has been entirely in a place called Madhya Pradesh, which is like in the center of India, working in a city called Bhopal. And there's a hub there, a research hub for Sungath, and and I've really been working with them primarily. And the focus was less around does this model of behavioral activation work, but instead, how do we support the scale up? You know, basically bring it to scale. How do we support scalable training programs for community health workers? Uh, how do we do this in rural settings? Um, and working in one of the most under-resourced parts of the country. So that's really been the focus. Uh, so I'm I'm not a I'm not a clinician. My background is really more focused on epidemiology and how do we support implementation. So basically, how do we get things that we know work into practice? That sort of sums it up. And that has been um tremendously uh successful collaboration. Our team in India is actually they're so much further ahead than our work in the United States in terms of achieving scale. It's almost it's inspiring for for us because they're now they've expanded to multiple districts in this in central India that I mentioned, and they've trained thousands and thousands of community health workers, you know, reached thousands of patients, tens of thousands of sessions of behavioral activation have been delivered. I mean, it's really um it's what we're aspiring to try to achieve with our with our work in in uh in Texas and other parts of the United States.

SPEAKER_00 33:22

I mean, in your and Texas, they're they're rather different. How do you see what is how does this work? Why does it work at scale in India and then now in Texas?

SPEAKER_01 33:34

Well, uh, you know, that's it's um there in some respects the well in India, I think some of the reasons why it's worked very well is that there's been a real policy imperative to make it work. So I I'd actually say it's it's very, very different than the United States in that sense. I mean, they share many similarities for you know for the wrong reasons in terms of you know high burden of mental illness and many challenges with you know access and so on. But in India, that's been very exciting in the last few years because the government has been rolling out a basically national reforms around the health system and rolling out this, you know, they're basically trying to work towards universal health coverage and in in you know in the rural and remote and underserved parts of the country. And within that is rolling out non-communicable disease care programs, so comprehensive primary care services, and it includes uh mental health care. So that that's actually been that's sort of been what's really helped as sort of the uh you know the starting point, because if you have this you know policy documentation, uh they also have the Mental Health Care Act in India, it makes it sort of, you know, now there's an imperative to make this work. Of course, there's huge implementation challenges, but at least you get this sort of top-down sort of shift towards making this happen. So there is that's one one advantage, I would say, in that work. The United States is a lot different. And our health system is much more complicated. And it is actually, I would say, a little different here. It's driven less by health policy and by health systems and more by community need. And I think that's I think the Congregational Collective is a prime example of that. That this is now actually more of a bottom-up. This is coming because people are in crisis. And the same is true in India, absolutely. There is there is certainly growing, you know, recognition at the community level, but it just helps you have this sort of synergy with the policy and then the community need. Whereas in the United States, it's the demand, I'd say, and the opportunities are now coming about because I'd say in some respects the situation has become so difficult and so challenging, people are saying we need to take matters into our own hands, learn these skills, and do this ourselves. And I'm seeing that not just in faith communities, but I mentioned earlier we had this, you know, program to scale up depression care across um Texas. And some of the very most successful examples had nothing to do with the health system. So we partnered with veteran-serving organizations. You know, so they were working, they serve, you know, uh veterans in different parts of the state. They see this kind of high levels of distress on a you know regular basis. They took, they did the training and have since successfully applied this in their programs. Similar with the YWCA, so Young Women's Christian Association, they offer sort of uh support services, residential facility uh for women who are typically uh victims of uh domestic violence or have experienced homelessness. So, not a traditional healthcare provider. They've used this content and then have applied it in their in their facilities. So I think that to me is very exciting because it means people are there's a motivation. And I'd say that absolutely is the case with these these churches. They they see this, what's happening, and they are now taking an intrinsic motivation to learn the content and to address these needs in their communities. And I think that's uh I think it's very exciting actually. And I and I I think this is where we need to bring mental health care is outside of clinics, outside of the formal system, and where people can actually get the help and and in a trusted way.

SPEAKER_00 36:55

Yeah. So has empowered landed in Australia?

SPEAKER_01 36:59

I don't think so yet. No. We have certainly have collaborators in Australia, but I don't think empower has landed in Australia yet.

SPEAKER_00 37:06

Can empower land in Australia?

SPEAKER_01 37:08

So yeah, I think there'd be great opportunity. I know Australia is really one of the leaders in certainly in youth mental health, there's some of the programs that have been really among the top. I know that anytime we're looking at what are some of the best examples, Australia is usually one of the you know leading places around the globe. But I I I think it would be yeah, it would be very exciting to to explore opportunities for empower in in communities in Australia.

SPEAKER_00 37:30

Aaron Powell Well, if you have a message to leave with us, John, as we wrap up, just from your observation of how faith communities have responded, what would you what would you say to us here in Australia as we start to think about, as we listen, listen to this conversation? What would you like to leave with us?

SPEAKER_01 37:48

Yeah, no, that I mean one of the things that I I think is really, I mean, to me is actually one of the most exciting things is to, again, just sort of back to that idea of getting mental health care outside of clinic settings. And my work is not the goal is not to replace clinicians, and it's not it at all. We're not trying to, you know, we're not trying to compete. But we know that the health system and licensed clinicians are, well, one thing, specialist mental health providers are in such short supply, uh, that's a global, you know, anywhere. And really we we won't be able to train enough to meet need, but I also don't think we need to. I I think the specialists can really serve an incredibly important role in seeing the most severe cases, responding to complex needs. So what that means is we have to shift our attention to uh finding other people who can respond. And and I think that's where I'm most excited is that we we can think kind of creatively and outside the box. Like, you know, there's so many different people who can learn these skills. As I mentioned in the congregations, all the people we've trained are all kinds of different backgrounds. And I think even beyond churches, there's so many opportunities to respond to someone in distress before it turns into a serious crisis. You know, there's ways we can do this earlier in community settings, in comfortable and trusted areas. And I think that's really what I encourage anyone to think about is really thinking, kind of thinking creatively, outside the box about who is the right person to respond to a mental health need. And then how do we make sure that we can support them, train them, and then offer the support to make sure they can do it well. And I would say that's just one of the other key key pieces in this work is that training someone to respond to depression, the training's not actually too difficult. What requires a lot of care and attention is after you've trained someone, how do you make sure they have that ongoing support? A few reasons. One, it's not easy uh responding to mental health needs. You're seeing someone who's in distress. You know, it can be really stressful on your own. So you need, you need someone to, you need, you need your own support, actually. So and then also this idea of ongoing support or supervision can be really helpful to make sure that if you run into something challenging, how do you navigate that? So there's this need for ongoing support. So I I think that's another key piece is that yes, we can find people in the community, we can train them, but then we need to make sure that we can support them in doing this well. So I think those are you know sort of key takeaways. I think this can work very well in these communities. It's just thinking how to make sure the right, you know, you find the right people and then the right support and infrastructures there to make it work.

SPEAKER_00 40:19

Yeah. And um, to any of our listeners, if this has inspired you, please do reach out, send me an email, and maybe we can start a conversation about how we might be able to see this in Australia. Thank you so much, John, for your time this morning. I've really enjoyed it and appreciated it.

SPEAKER_01 40:34

Yeah, well, thank you so much, Valerie. Really appreciate the invitation and thank you again.