A sense of depletion invades the room as 26-year-old Greek Australian mental health strategist Mietta Kyrios reflects on her current surroundings in India’s Indira Naga slum, seven hours from Mumbai.

“For the past 10 years, 10 farmer-related suicides have been reported per day in rural India’s area of Jamkhed. And when you align this with the attitudes of state leaders, for example, when a Maharastran minister once said ‘it’s not so much a mental health problem as it is a fashion trend for all these farmers to be killing themselves’, a dire cycle presents itself. There’s just no understanding, no support …”

In the Western society in which she was raised, mass stigmatisation against suicide has been omitted from the collective consciousness. Mietta’s Australian culture, in the majority, is free from superstitions and social taboos surrounding mental health. It has widely-praised avenues for support; its sufferers don’t have to have their mental integrity questioned by authorities nor their struggles suppressed under wider societal shame or secrecy.

But for the 30,000 people who consume her research placement at the Comprehensive Rural Health Project (CRHP) in western India’s rural Jamkhed, sadly this is an everyday reality.

Kyrios began her career in social welfare when a burning curiosity concerning the pitfalls of Western intervention brought her to a halt.

“Both my parents are health professionals, so I was raised around conversations about people’s welfare and I always looked at doing human rights from a different angle. But then being at university in Melbourne, in this very Australian, western perspective of health – something just wasn’t right.”

For Kyrios, this uncertainty was buried in a western tendency to pathologise life events.

“We don’t look at someone as a whole person to see what’s going on in their life. And this had me thinking about broader determinants of health – why are all of these mental health issues so prevalent in minorities that experience poverty or violence, or in women or people with disabilities – what’s going on with these double vulnerabilities here and why aren’t we doing more to protect people?”

In an endeavour to advance research in this exact field, she took a six-month volunteer placement in January with the CRHP in Jamkhed to write a report for the International Association of Applied Psychology about developing mental health strategies in rural India. Through a community-centred focus, she works with the CRHP to demonstrate how communities can sustainably manage their own psychological wellbeing. The CRHP, started in 1970 by two Indian doctors to bring health care to the poorest of the poor, has proved itself a front-runner in community empowerment for over 40 years under the idea of appropriate levels of care. With a relentless focus on community-centred intervention, the CRHP has changed the lives of Jamkhed’s men, women and children who areheavily affected by poverty.

According to Kyrios, the critical malaria phase of public health in rural Asia is nearing a close. On a large scale, what is a big problem and in total boom are the non-communicable diseases such as hypertension, diabetes and mental illness.

“Mental health has taken a huge hit in Jamkhed because we have a rural farming population and no water, which is devastating. Suicides in the farming population are the men’s hot button health issue. And then there’s no support from wider society.”

Jamkhed’s women and kids also face dire issues; ones that are heavily embedded in gender inequality and disempowerment. Kyrios says that the women of Jamkhed do “around 70 per cent of manual labour on farms with no access to adequate nutrition, water or care” and this is aligned with “a lot of superstition around pregnancy, menstruation and sexual health for women”.

And it is here, in the female sector of Jamkhed, that the CRHP relentlessly commits to empowerment. Its untiring pursuit towards gender equality is shown in the CRHP training and sustainability of their 51 Village Health Workers (VHW), local female village members who are the point of contact for health and welfare issues at a community level.

They administer information about sanitation and nutrition, monitor things like blood pressure and sugar levels, deliver babies and monitor the nutrition and school attendance of village children.

Selected by the communities themselves, VHWs are integral to Jamkhed because they are women who would otherwise not have been afforded the opportunity for employment due to widowhood, or the effects of poverty and the caste system.

“Having female VHWs has a big impact on a village because it helps empower all the women. We see the VHWs demonstrate to community members how women can be leaders, and that women can be respected as experts in their field. It also helps break down the caste system,” Kyrios reflects.

However, even in the powerful face of successive VHWs, in Jamkhed, and rural India alike, the progress of women’s empowerment has been slow.

Ultimately, superstitions around womanhood heavily impose on a VHW’s ability to work.

“I have heard stories about VHWs who have done all their health training and are sent back to their village to begin work, only to still be rejected. No one would touch them. No one would go near them – nothing. What would eventually have to happen for her to be accepted would be through years, no joking, years of observation – of seeing the VHWs children living healthy lives without malaria or disease etc. – it had to be through this observation that people would then approach her.”

In the face of ingrained behaviour, the CRHP’s pursuit for gender equality reminds us that eradicating gender disparities (anywhere in the world) requires a shift in intergenerational behaviour and attitude; a process that relies on all members of the community.

“All the programs here are long-term – they wouldn’t run if they only had a shelf life of two or three years. With something like changing the role of women in society, which moves at a glacial pace globally (not just developing countries!) you need to have that multi-level, multi-age group and long-term approach which the CRHP has.”

And perhaps the most critical thing of all about the CRHP, and certainly what tied Kyrios to their cause, is their 40-years of success in taking the time to use local staff to empower local people; eradicating typical top down charity models. Educational sessions and health check-ups are for locals, by locals, around what locals have said they want and what locals have expressed is a problem in their community, something that Kyrios regards as the most important aspect of their model of care.

“If the CRHP disappeared tomorrow, this place would still run – and that’s the important thing. In my previous experiences, I was quite uncomfortable with power dynamics in philanthropy, that real top down charity model. This is not how to work in a foreign community. It’s not about me being a clinician for people – it’s about me helping this community empower themselves so they are the clinicians, they are the teachers and they are the consumers of good health.

“I am just here to liaise between the community and the western bodies that bring the funding. But here, where those dynamics don’t exist, the community trusts in us – they trust it’s not all smoke and mirrors and white people’s bullshit.”