Responsive mental health systems to address the poverty, homelessness and mental illness nexus: The Banyan experience from India

Abstract

Background Mental health has gained prominence as a global public health priority. However, a substantial treatment gap persists in many low- and middle-income countries. Within this scenario, the nexus between homelessness, poverty and mental illness represents a particularly complex issue. This article presents the experience of The Banyan, a 25 years old non-profit organisation providing mental health care to people living in poverty in Tamil Nadu, India. Case presentation The case study describes the evolution of The Banyan using a timeline narrative. By applying an action learning framework, the organisation’s evolution through four lifecycles, strategy and the key elements underlying mental health system responses are identified and presented. ‘User centred’ and ‘service integration’ emerge as the main dimensions of The Banyan’s responsive health system. Relating to these two attributes, a typology of services is derived, indicating the responsiveness of mental health systems in addressing complex problems. The role of the organisational culture and the expressed values during the transition is considered. Conclusions The case study serves as an example of how responsive mental health systems may be constructed with both a user centred and a service integration focus.

“If somebody could just understand what I am going through, it would make all the difference”: Conceptualizations of trauma in homeless populations experiencing severe mental illness

“…Using a maximum variation purposive sampling technique, 26 participants (20 women and six men) were recruited from Kanchipuram and Chennai districts in Tamil Nadu, through The Banyan – a mental health NGO that provides services to over 2,500 homeless persons and approximately one million individuals experiencing mental health needs across India (Narasimhan, Gopikumar, Jayakumar, Bunders, & Regeer, 2019).…”

Homelessness, housing instability and mental health: making the connections

“…In Chennai, India, a visionary nonprofit known as The Banyan has pioneered a culturally and socially innovative approach, 'Home Again', to help homeless persons with severe mental illness recover their lives and live independently or return to their family homes. 25 In West Africa, advocates for AIDS and leprosy patients have turned their talents and expertise to developing programmes for persons with mental illness that are inclusive, rehabilitative and rights based. 23 Zimbabwe's 'Friendship Bench' programme, which situates attention to mental health within ongoing community activities, has been replicated worldwide.…”

Supported Housing as a recovery option for long-stay patients with severe mental illness in a psychiatric hospital in South India: Learning from an innovative de-hospitalization process

“…These projects enable people to lead a normal and somewhat independent life, with support, ultimately aimed at rehabilitation and social reintegration [24]. Supported housing projects are user-centred, and place a strong emphasis on the residents' independence, freedom of choice, independent life skills, individualized services, and ultimately community integration [26,27]. Several studies have shown that homeless people with mental disorders who take part in a supported housing initiative show greater housing stability, make less use of shelters, are less often admitted and stay for less time in hospital, are less often imprisoned, and less substance abuse [27].…”

“…Supported housing projects are user-centred, and place a strong emphasis on the residents' independence, freedom of choice, independent life skills, individualized services, and ultimately community integration [26,27]. Several studies have shown that homeless people with mental disorders who take part in a supported housing initiative show greater housing stability, make less use of shelters, are less often admitted and stay for less time in hospital, are less often imprisoned, and less substance abuse [27]. Since this model is not often described in the context of India, this study aims to understand how moving towards SH may support people with severe SMI.…”

“…Most importantly, therefore, to allow health systems to reform positively, this study shows that not the intervention itself is the lesson, but the adaptability of a mental health institution to find solutions in the particular context of this intervention. To reform the health system for the better, perhaps we should look beyond the diffusion of SH as intervention per se, and find ways to continuously adapt to the needs (user centred) by innovative practices through integrating services [27].…”