Rehabilitation of mentally ill women

"These Places are easy to get into but Impossible to get out of": Women's Pathways to Psychiatric Institutions and Barriers to Community Reentry in India

In India, where institutional-based mental health care is common, gender and other intersecting marginalized identities along with absent familial support contribute to women's admission and prolonged confinement to psychiatric institutions. However, an intersectional analysis of factors that prevent women with limited familial support from returning to their communities is lacking. This article is based on narratives of eleven women residing at a halfway home in an urban city in India, awaiting return to their communities. We include descriptions and an intersectional analysis of women's pathways to psychiatric institutions, their experiences receiving institutional-based mental health care, and the challenges they face as they contemplate returning to their communities. This study adds to the minimal research examining women's gendered pathways to psychiatric institutions in India. Women's narratives highlight that gender and illness-related disadvantages coupled with economic adversity that led to the initial admission also serve as deterrents to reentering the community.

Eventful past, stagnant present, and hopeful future: A time order analysis of experiences of homeless women with chronic mental illness residing in shelter care homes

BACKGROUND

In developing countries like India, many women with mental illness are residing in shelter care homes (SCHs) without their wish. SCHs are residential facilities provided to the socially and economically backward women for free of cost. These facilities are funded by government or voluntary organizations.

AIM

To understand the living experiences of homeless women with chronic mental illness (HWCMI) admitted in SCHs.

METHOD

This article highlights learning from a qualitative study, 17 HWCMI participated in the research. Along with their past experiences, present life, and expectations in the future, other socio-demographic details also recorded. Qualitative data were analyzed using thematic analysis approach with the Atlas ti-8 software. Findings: Three main themes were emerged from the analysis such as 'Eventful past', 'Stagnant present', and 'Hopeful future'. The theme 'Eventful past' shows clear pathways to homelessness. 'Stagnant present' reflects upon trapped present life and their concerns and care-related aspects. The final theme, 'hopeful future', depicts strong hope in future and readiness for changing their living situations. The findings are discussed in the background of current trends in psychiatric rehabilitation and what is lacking in the Indian context.

CONCLUSION

This study attempts to unveil the gender-specific and person-centric explanations of experiences associated with the combination of homelessness and mental illness.

Need-based rehabilitation program for women with mental illness under long-term admission in a Tertiary Care Hospital: A feasibility study

BACKGROUND

In keeping with the rights perspective, the rehabilitation needs of the women under long-term admission (LTA) in 'closed wards' of Tertiary Care Hospitals (TCHs) are different, often unfulfilled, and need to be addressed.

METHODOLOGY

The study used a qualitative exploratory research design. In phase, I, the rehabilitation needs of Women with Mental Illness (WMI) were assessed. In phase II, a rehabilitation program was developed and implemented in the ward where WMI were admitted. In phase III, the feasibility of the implementation of the Rehabilitation Program was tested.

RESULTS

The needs expressed by WMI were personal, economic, vocational, social, emotional, educational, relationship, recreation, reintegration, and health needs. They also expressed needs related to their rights such as privacy, making personal choices, access to mobile phones, holding bank accounts, etc. The stakeholders felt that WMIs who get well should be segregated from people who are acutely ill and given access to interact with other groups of people. Based on the themes elicited, a rehabilitation program was developed and implemented through networking and liaising with various departments of the institute, other Government, Non-Governmental Organizations, volunteers, and corporates. The rehabilitation program was found to be feasible with systemic changes being brought about at the institutional level.

CONCLUSION

In keeping with a rights-based approach TCHs need to implement need-based rehabilitation programs for WMI under LTA to improve their living conditions and quality of life.

"The Day I Die Is The Day I Will Find My Peace": Narratives of Family, Marriage, and Violence Among Women Living With Serious Mental Illness in India

In India, there is limited research on the nature of familial relationships and domestic violence that women living with serious mental illness (SMI) experience. Using the self-in-relation theory and through 34 in-depth interviews, I explored narratives related to family, marriage, and violence in familial relationships among women living with SMI at a psychiatric institution in an urban city in India. These narratives are critical because they highlight how the presence of mental illness exacerbates the violence women experience. Informed by participants' narratives, I offer specific recommendations on creating gender-sensitive mental health care that is mindful of women's social realities.

Profile of Women with Mental Illness Admitted in Shelter Care Homes; A Co-relational Description of Changing Sociocultural Scenario in India

Background:

The prevalent explanations of gender and mental illness in the Indian social structure often highlighted in terms of traditions and gender-colored norms which is confirmed with the patriarchal framework. The combination of women and diagnosis of mental illness disturbs the prescribed gender expectations which accelerate the family abandonment, and many women lead their life in shelter care homes after psychiatric hospitalization. The aim of the study is to assess the sociodemographic characteristics of the residents admitted in shelter care homes and understand the co-relational aspects of changing sociocultural scenario.

Subjects and Methods:

Recruited 50 women residents living in 14 centers both the governmental and nongovernmental shelter care homes in Bengaluru, Karnataka. Utilized sociodemographic datasheet to assess the sociodemographic variables and retrospective file review to elicit commonalities among the sample.

Results:

The current study reveals that majority (74%) belongs to the nuclear family, lived in a rented house before institutionalization (46%). The reason for stay in shelter care home reported to be family abandonment and rejection (72%) and majority of the residents experiencing chronic homelessness (92%) are unmarried/separated (82%) and majority revealed none of the family members ever visited them in shelter care homes (66%).

Conclusion:

It is imperative to understand the connection between sociodemographic details of the women admitted in shelter care homes and the rapid changes occurring in the sociocultural structure for comprehensive understanding of mental illness-homelessness-institutionalization nexus.

Women with Mental Illness - An Overview of Sociocultural Factors Influencing Family Rejection and Subsequent Institutionalization in India

BACKGROUND

Family abandonment and rejection resulting in homelessness are detrimental to women diagnosed with mental illness in India. A majority of the literature related to homelessness holds a western background, and women's homelessness in relation to mental illness is relatively unexplored in the Indian context. This review was conducted to understand the sociocultural factors influencing family rejection and to synthesize the living situation of institutionalized women with mental illness in India.

METHODS

Literature search in electronic databases (PubMed, Google Scholar), carried out using appropriate keywords, and a manual search in the library catalog.

RESULTS

As per the selection criteria, 19 reports, including original research articles and conceptual papers, were included and reviewed.

CONCLUSION

There is a shortage of methodologically sound research in understanding the connection of mental illness-women homelessness-and the institutionalization scenario. This review highlights the necessity of shifting focus from institutionalization to innovative psychiatric rehabilitation strategies using the Mental Healthcare Act, 2017.

Homelessness and severe mental illness in low- and middle-income countries: scoping review

BACKGROUND

Despite being a global problem, little is known about the relationship between severe mental illness (SMI) and homelessness in low- and middle-income countries (LMICs). Homeless people with SMI are an especially vulnerable population and face myriad health and social problems. In LMICs, low rates of treatment for mental illness, as well as differing family support systems and cultural responses to mental illness, may affect the causes and consequences of homelessness in people with SMI.

AIMS

To conduct a systematic, scoping review addressing the question: what is known about the co-occurrence of homelessness and SMI among adults living in LMICs?

METHOD

We conducted an electronic search, a manual search and we consulted with experts. Two reviewers screened titles and abstracts, assessed publications for eligibility and appraised study quality.

RESULTS

Of the 49 included publications, quality was generally low: they were characterised by poor or unclear methodology and reporting of results. A total of 7 publications presented the prevalence of SMI among homeless people; 12 presented the prevalence of homelessness among those with SMI. Only five publications described interventions for this population; only one included an evaluation component.

CONCLUSIONS

Evidence shows an association between homelessness and SMI in LMICs, however there is little information on the complex relationship and direction of causality between the phenomena. Existing programmes should undergo rigorous evaluation to identify key aspects required for individuals to achieve sustainable recovery. Respect for human rights should be paramount when conducting research with this population.

DECLARATION OF INTEREST

None.

A structured review of psychiatric rehabilitation for individuals living with severe mental illness within three regions of the Asia-Pacific: Implications for practice and policy

INTRODUCTION

Psychiatric rehabilitation can provide and support recovery-oriented care by assisting individuals living with severe mental illness to lead full lives. Despite a well-established evidence-base, implementation and access to these interventions in clinical practice for people with severe mental illness in the Asia-Pacific region is low. We therefore aimed to evaluate prominent themes impacting on clinical practice, policy, and the implementation of psychiatric rehabilitation across the Asia-Pacific region.

METHODS

A comprehensive review of relevant literature on psychiatric rehabilitation of three regions within the Asia-Pacific was conducted using a structured search of PubMed and other databases. Eligible articles were selected which focussed on how psychiatric rehabilitation is defined and implemented across the Asia-Pacific region, as well as the associated successes and challenges. Common themes were generated.

RESULTS

Six themes emerged: the impact of policy, legislation, and human rights; access difficulties; the important role of family; the significance of culture, religion, and spiritual beliefs; the widespread impact of stigma; and the indigenous models of excellence being developed.

DISCUSSION

Consideration of the six themes and their implications should help raise awareness of the issues involved in the provision of psychiatric rehabilitation in the Asia-Pacific region and may improve outcomes for people living with severe mental illness. Suggested strategies include: developing a shared understanding of psychiatric rehabilitation; establishing quality legislation that's well implemented; adapting evidence-based models to develop culturally appropriate services; implementing stigma reduction and empowerment-based interventions; and, ensuring coordinated action among all stakeholders, combined with effective leadership.

Lives without Roots: Institutionalized Homeless Women with Chronic Mental Illness

The spiral phenomenon of homelessness and mental ill-health are major growing epidemic in both developed and developing countries. Viewing from a socio-economic-political dimension, homelessness and mental ill-health cause detrimental effects on the individuals' lives as well as the nation-building process. The condition of women seems to be complex, as the gender perspectives are often described in terms of patriarchy and powerlessness. The bi-directionality of mental illness and homelessness creates a vicious cycle, and many women seem to end up in shelter care homes. The scenario of homeless women with chronic mental illness reflects the lack of community-based rehabilitation efforts and gender-sensitive policy level initiatives.

Clinical outcome and rehabilitation of homeless mentally ill patients admitted in mental health institute of South India: "Know the Unknown" project

OBJECTIVES

Homeless Mentally Ill (HMI) patients represent a unique global problem and pose a challenge in treatment, management and rehabilitation services. There is sparse data on HMI patients in India. The objective of this paper is to study the clinical outcome and rehabilitation of HMI patients.

METHODS

We performed a retrospective chart review of 'HMI' patients from 1st January 2002 to 31st December 2015, who were admitted under Department of Psychiatry at National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India. Clinical outcomes were analysed by descriptive statistics and predictors of family reintegration were analysed by logistic regression model.

RESULTS

Seventy-eight HMI (unknown) patients were admitted in fourteen years period. 64(82%) were improved at discharge, 40(51.3%) were reintegrated to the family; 15(19.2%) were sent to state home for women, and 17(21.8%) were sent to Non-Governmental Organization (NGO)/Rehabilitation Centre and 6 (7.8%) required multispecialty care in general hospital or absconded from the hospital during inpatient care. The logistic regression model showed that mental retardation (B=-2.204, P=0.002) was negatively correlated with family reintegration and clinical improvement at discharge (B=2.373, P=<0.001) was positively correlated with family reintegration.

CONCLUSIONS

In our study majority of HMI patients improved at the time of discharge. Family reintegration was possible in about half of HMI patients after treatment. Mental retardation and clinical improvement are important predictors of family reintegration of HMI patients.