Given how few specialists are available, many organizations are increasingly relying on community health workers. SCARF trains local women to do a broad survey of mental health issues in the community, and refer those that need treatment to the clinic. Their outreach workers also conduct home visits for distant, long-term patients. Sangath completed a similar training in Goa, where women were given six weeks of training on how to recognize and help issues such as depression and alcohol abuse.

According to Vandana Gopikumar, founder of the Banyan and member of the Indian Mental Health Policy Group, low-level health workers could drive the expansion of mental health services in India. "The non-specialized workforce is the workforce that needs to be built up," Gopikumar says. "What is therapy? Therapy is really a kind person who is speaking sweetly with you and trying to solve your problems."

SCARF outreach worker Kruba Gunasekaran is from a village eight hours from Pudukottai. After completing a month-long training, she now has a roster of patients in the surrounding villages she visits every other week. "I try to spread some awareness and get the patient to the clinic," she says.

People are more receptive to Gunasekaran than they might be to a licensed doctor from the city, especially when discussing sensitive subjects. "In some families, we get really attached," she says. "People share a lot of personal stories with me. They talk to me like family."

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Despite rejecting a specialist-based system, some worry the mental health movement in India still imitates the West in other ways, to a fault: by using Western definitions to diagnose disorders, and psychiatric drugs to treat them. These definitions and treatments may not be universally applicable for the unique population and conditions on the other side of the world.

"[Medication] is an easy option. Who wants to solve the psychological problems and the cultural issues?" says Dr. K.S. Jacob of Christian Medical College in Vellore. Jacob has written extensively on the "medicalization" of public health in India, the result, he says, of pharmaceutical interests and Western influence.

Much of the treatment given through rural outreach programs now is the prescribing and supplying of medicine. Check-ups with outreach workers or specialists are often a conversation about whether that medicine is working. "Home visits are important to explain why taking medication is important," says Kavitha, a community outreach worker with the Banyan.

Many programs aim to provide more counseling and other services, the way some urban-based programs do. But time is limited for both outreach workers and the patients they serve. "We should be more like a wellbeing center," Gopikumar says of the rural Banyan clinic. "But our [rural patients] don't have time for yoga and meditation... They don't have the luxury to take time to get well."