An Evaluation of Psychosocial Rehabilitation Facilities for Homeless Mentally Ill in India

Abstract

Homelessness due to chronic mental illness has become a major burden for most of the resource poor countries. The Kerala State in India has witnessed the efforts from the faith based organizations and religiously oriented families in the care and rehabilitation of the homeless mentally ill. This paper explores the processes used by these facilities for the care and rehabilitation of homeless mentally ill. Data were collected from the chief functionary of rehabilitation facilities, persons with mental illness residing in the rehabilitation centers, and volunteer care providers using interview schedules for the study of rehabilitation processes and profile of chief functionary and care providers. Otehre tools were, WHO QoL to measure the quality of life and level of functioning scale and Global Assessment of Functioning Scale for measuring the functioning. The care providers' orientation to mental illness was assessed using Orientation to Mental Illness Scale (Prabhu, 1983). 65% of the centers displayed above average patient care services whereas 25% had poor overall quality of patient care services. The residents showed moderate level of quality of life in the area of physical health, psychological health, social relationships and high level of quality of life in the * Asst Professor of Social Work, Rajagiri School of Social Sciences, Kerala; anishkrk@gmail.com. Anish K R ISSN 0975-329X2 domain of environment. The research has also identified several gaps in functioning of the facilities.

Clinical and psychosocial profile of persons with mental illness living in non-hospital residential facilities in a district in Kerala, India: A cross-sectional survey

“…Forty percent of the residents in this study were brought in with the help of police/volunteers. The same pattern is noted in other studies: in non-governmental psychosocial rehab facilities, the majority of admissions were by police and social agencies/public (Anish, 2013) and among long-stay patients in mental hospitals, 55.4% were referred by police or magistrates ‘indicating a possible history of homelessness’ (Lakshmi Narasimhan et al, 2019). However, in the case of ‘governmental welfare homes’ residents were admitted as transferred from ‘mental hospital’ (Ravindren & Kurian, 2021).…”

“…However, the pattern noted in centres in another study showed a differing picture, with 71% having moderate disability and levels of functioning low in dimensions of community living and interpersonal relationship (Anish, 2013). Mild to moderate levels of disability is reported in 85% of residents of government welfare home and in 77.4% of long-stay patients in mental hospitals (Lakshmi Narasimhan et al, 2019; Ravindren & Kurian, 2021).…”

“…A recent paper from a Chennai-based NGO has traced the development of a continuum of care for homeless people with mental illness (Narasimhan et al, 2020), while another study from Bangalore has looked at the profile of mentally ill women residing in shelter homes (Moorkath et al, 2020). Two studies from Kerala have looked at the profile of residents in residential facilities – one studied the level of functioning and quality of life of residents in non-governmental ‘psychosocial rehabilitation facilities for homeless mentally ill’ (Anish, 2013), while the other looked at residents of three governmental ‘welfare homes for homeless persons with mental illness’ (Ravindren & Kurian, 2021). A report from Kerala described the process of rehabilitation in a residential facility that also facilitated supported housing; however, it did not cover the profile of the residents (Pfizer & Kavitha, 2019), while another recent study from Chennai reported on a pilot project for ‘supported housing’ (Padmakar et al, 2020).…”

Intersectoral and multisectoral approaches to enable recovery for people with severe mental illness in low- and middle-income countries: A scoping review

“…Also, the clubhouse model for psychosocial rehabilitation was reported in China (Chen et al, 2020 ), one case describing linkages with a supported employment programme in surrounding communities (World Health Organization, 2021 ). Supported housing, especially focusing on those experiencing poverty and homelessness, was described in India, (Anish, 2013 ; Padmakar et al, 2020 ; World Health Organization, 2021 ) and Brazil (Acebal et al, 2021 ). In some instances, mental health teams performed various services, for instance facilitating residential training and placement according to individual preferences and needs – an example is a Recovery Oriented Services (ROSeS) team in India facilitating placement at a rural development centre for an individual who was interested in agriculture and animal husbandry (Vijayan, 2021 ).…”

Residential Rehabilitation Facilities for Persons with Mental Illness: Current Status and Future Directions Based on a Survey from Kollam District of Kerala

“…A study from Kerala had observed that centers had one room per 13 residents and one toilet per 12 residents. 26 The formal rules for psychosocial rehab homes also categorically say that each dormitory can accommodate 25 inmates. Each person can get a living space of 60 square feet, and there shall be one bathroom and one toilet for every eight male and six female inmates.…”