‘ManasRang’: Description and Stakeholder Evaluation of an Expressive Arts Based Group Psychosocial Intervention in Indian Setting

Recovery-oriented psychosocial interventions for people living with long-term Mental, Neurological and Substance use (MNS) disorders (PLMNSD) with enduring psychosocial disabilities and their carers in India are limited. To address this gap, we developed the multi-component, expressive art-based group therapy—ManasRang (‘colors of the mind’) to create an enriching, joyful and enabling group milieu to facilitate recovery. ManasRang was delivered as weekly group-based sessions between February 2016-October 2017 for 70 PLMNSD [Schizophrenia (n = 44); Psychosis- not otherwise specified (n = 6); Unipolar Depression (n = 5); Bipolar mood disorder (n = 4); Alcohol and substance use disorder (n = 3); Intellectual Disability (n = 2); Obsessive–compulsive Disorder (n = 2); Anxiety, epilepsy, adjustment disorder (n = 1 each)] and 18 of their carers in Pune, India. A nested qualitative study was conducted with twenty purposively selected PLMNSDs, six carers and five of their treating psychiatrists. In-depth interview (IDI) and Focus Group discussion guides exploring a set of themes were systematically developed and used to record the interviews. English transcripts of the interviews were imported into NVivo®9.2 and analyzed using grounded theory approach. All PLMNSD and their carers found the weekly group meetings to be stimulating, engaging, interactive, and conducted in an equitable and respectful manner while providing opportunities for self-expression. The intervention was perceived as being helpful in dealing with symptoms, improving communication and other social skills, family interactions, and in securing employment. ManasRang improved carers’ understanding of MNS conditions and provided hope and emotional support. Participants also reported improvements in their self-confidence, communication skills, and work performance. Some logistical and financial challenges were identified to improve access to and the sustainability of ManasRang. Given the dearth of recovery-oriented interventions in India and other LMICs, it is encouraging that the ManasRang intervention was acceptable and perceived as beneficial by PLMNSDs and carers. The results also indicate a set of potential dimensions to measure effectiveness in more rigorous subsequent evaluation.