“I can’t leave him. But, I need to sleep at least one night peacefully in my life without anxieties,” she says.She is the primary earner in her family but there are few jobs for her in her village, Kothakottai, situated in Alangudi Taluk of Tamil Nadu’s Pudukottai district. It is an arid region where agriculture depends largely on rainfall. This means that farm work is erratic – one day, Nallammal would be cleaning the field, the next she would be plucking chillies or pounding tamarind, sometimes she reaps greens.Eight hours of hard work earns her just Rs 170. Women farm workers earn no more than Rs 200 in this region, half what the men can demand. If Thamizhselvan needs hospitalisation or medicines, she has to borrow from her neighbours. This has left her family in a state of constant precarity. The family also bears the stigma of mental illness and the isolation this brings, as we detail later.The caregiver burden for mental health is all consuming – it is physical, psychological, emotional, social, and financial, show our interviews with women. Chronic stress, declining personal well-being, exhaustion, and low energy experienced by spouses are often referred to as spousal caregiver fatigue. And this fatigue can last years given the failure of early detection of mental illness.Till three years ago, Nallammal had no help from any quarter, not even from her own or her husband’s family. Nallammal’s entire life is planned around Thamizhselvan’s needs – adapting, calculating, overextended, overexploited, and of course, uncompensated because carework is assumed of a wife. Seventeen years of marriage have deepened Nallammal’s time poverty.It was her encounter with WORD (Women’s Organisation and Rural Development), an NGO that works in partnership with Carers Worldwide India to support unpaid carers, that lifted her and her family out of precarity. WORD has been working in around 80 villages of Pudukottai district spread over Thiruvarangulam and Pudukottai to provide support to carers of persons with mental health issues. It offers monetary support to carers and also guides them on how they can access mental health care at government hospitals.When Nallammal became a part of the network, she got a loan of Rs 5000 to buy goats for her husband to rear. The network of support also gave her the courage to take on better-paying work as a catering assistant at weddings outside the village.We found in our interviews with women across Pudukottai that carework was not just physically and emotionally exhausting but it also drained families of precious resources. They have to pay for medicines, transportation and hospitalisation costs. This often meant the loss of a month’s salary leading to a debt trap.The crisis we found is worsened by inadequacy of the public mental healthcare network. Carers complained about the frequent shortages of medicines and psychiatrists at government hospitals that force them to seek out expensive alternatives. The one disability scheme the government runs has been digitised and it now faces access and awareness issues. We discuss these issues in detail later in this article.Double whammy