THE ORIGIN STORY
My earliest recollection of Obsessive Compulsive Disorder (OCD) was when I was 13 years old standing face to face with myself in the bathroom mirror. I would wash my hands for 30-40 minutes several times a day until they would crack and bleed. They began to resemble the leathery exterior of a football. My handwashing would go on day after day, weeks at a time as I was lurking for the ‘just right’ feeling. As a little boy, I was baptized Eastern Orthodox Christian and would pray nightly. On a perfect day, my prayer would last 5 minutes. On any other day it would last 45 minutes. If a bad or immoral thought found me, I would have no choice but to start from the beginning for fear of god striking me down. Most recently, my experience with OCD masquerades cruelty as honesty. I think I’m doing the right thing by being honest with my thoughts, but it comes off hurtful – even malicious – to the person receiving them.
My greatest antidote was engaging in the very difficult and worthwhile work of Exposure & Response Prevention (ERP) Therapy and Acceptance & Commitment Therapy (ACT). I’d much rather subject myself to feelings of apprehension, fear, even danger by my own doing rather than being at the mercy of my mind.
In contrast, I often say that the only silver-lining to me having OCD is the fact that I live in the United States. When you look at the rest of the world, the numbers are grim. Nearly half a billion people live with a mental illness. 300 million people live with depression. And, I’m convinced that both of these estimates are radically conservative because of a lack of screening mechanisms. There is an astonishing 90% treatment gap in low-income countries. Rooting down into Uganda, there are 30 psychiatrists for a population of 43 million people. Uganda ranks 4th in Africa for suicide and 17th in the world. The country allots a mere 1% of their healthcare budget to mental healthcare.
Access to resources, friends and family, and other supports have made my journey with OCD manageable, but still difficult. And if I think about countries like Uganda with far limited resources, I’m disheartened. Finemind was born from a single email to global mental health guru, Vikram Patel. Our correspondence and my concern for the global mental health landscape catalyzed an incredible journey. In late 2016, I crowdfunded the monies to travel to Goa, India, in order to attend the Leadership in Mental Health course. There I rubbed elbows with some of the frontrunners in the field and learned about the MANAS program.
The program was set up in Goa, India, between 2005 and 2010, to develop and evaluate a model for delivering treatments in primary care settings. The essence of the MANAS model was to facilitate the shift for mental health care from specialists to lay people within a primary care team, and thus improve the coverage and efficiency of treatments for common mental disorders.
The MANAS program serves as the backbone to Finemind. We utilize an approach called task sharing. The few available mental health specialists are reallocated to provide oversight, facilitation, and supervision, while healthcare workers with less experience are empowered to provide the day-to-day supports.
Inspired by my visit to Goa, I called my friend Kenny, a Ugandan Doctor and Founder of Esuubi Community Outreach Ministry to discuss the potential impact and traction of the MANAS model in Uganda. He shared my the excitement. That was enough. While I’d been there several times prior to volunteer for different organizations, in the summer of 2017, I traveled to Uganda to pilot our work. My network of friends supported Finemind’s humble beginnings. I was hellbent on seeing this vision live in Uganda and struggled with prioritizing my mental health in lieu of assembling a sustainable mission and impact. I owe the world to my family, friends, supporters, and partner for continuing to believe in me and mental health for all.
Today, Finemind is doing critically important work to support the mental well-being of internally displaced persons and refugees. In true cliché, we are just getting started.
– Pavel Reppo