 Founder and Managing Trustee, The Banyan With globalisation, mental health became an important area of concern and 10 to 12 per cent of India’s population need some form of help. For this, we had only psychiatrists with a highly clinical approach to mental illness. But mental health is more than a clinical issue. It is also a social construct. There are different socio-economic, political, familial and psychological processes that cause mental illness. The Banyan began in 1993 as a humanistic response to the needs of homeless women with mental health issues, an invisible group, among the most marginalized population. The Banyan is a registered not-for-profit organisation in Chennai, offering comprehensive mental health solutions for persons with mental illness, living in homelessness and poverty in community and institutional settings. The Banyan’s in-depth investigation over two decades into the intersections between homelessness, mental ill-health, poverty and the resulting distress has led to the development of an adaptive mental health systems framework with the ability to respond effectively to an individual’s needs along the path to recovery. Today, The Banyan has reached out to over 7000 people across eight urban and rural locations offering a spectrum of care. Recognizing the complexity and embeddedness of the problems in the mental health sector, The Banyan pioneers innovative approaches at the individual, community and governance levels catering to 50 villages in the Thiruporur block, Kanchipuram district and nine wards in the Chennai district, with a total catchment population of over 4,50,000 individuals. The Banyan’s different mental health care services and solutions operate across four key verticals:
The Mental Health and Social Action Laboratory (MHSAL), the primary space within BALM, aims to understand, apply and test new ways to address issues in the mental health sector. BALM’s research and The Banyan’s service are inextricably linked as both follow a transdisciplinary approach and engage with users through participatory development practice on the field to innovate service models that are capable of handling critical challenges in the mental health sector. The Banyan and BALM are strongly engaged in advocacy and recommendations on livelihood options, alternate living spaces and social care needs for persons with disabilities based on empirical and grassroots evidence that have now been adopted by state and national governments. In response to the need for human resources imbued with core values, knowledge and skills to address mental health issues from a development perspective, BALM, in a collaboration with the Tata Institute of Social Sciences (TISS), and Vrije Universiteit (VU), Amsterdam, offers the Master’s degree programmes in social work in mental health, MA (Applied Psychology) and MA in management policy analysis and entrepreneurship in health and mental health. Thematic Areas of Engagement Across Projects Clinical Care Clinical care services are delivered by a multidisciplinary team of experts including psychiatrist, psychologist, social worker, counsellor, occupational therapist, general physician and vocational trainer. The services include emergency care, medical and psychiatric services including pharmacotherapy, hospitalisation and specialist referrals, psychological assessments, dynamic and eclectic counselling approaches, and social work practice: individual case management, and reintegration, rehabilitation and aftercare. Social Care According to the WHO, persons with disabilities in poverty are among the poorest and most marginalized communities. The evidence of social determinants affecting mental health exists in plenty. Social phenomena such as homelessness, poverty and insufficient social support systems expose individuals to adverse experiences that can trigger mental health issues and also determine the extent of success in management of recovery. Work participation, quality of familial relationships and community linkages, discrimination on the basis of gender, age, caste and poverty affect the quality of mental health outcomes. Hence there is a critical need to cultivate multi-dimensional and multi-pronged approaches to address these issues simultaneously at the individual, family and community levels. The Banyan has instituted several social care programmes fundamental to improving wellness across the social fabric such as assistance for housing and facilitating access to government social entitlements, support for children of parents living with mental illness, day care, and skill development, livelihood and entrepreneurship programmes. These schemes, designed along the wellness and development paradigm, focus on building self-reliance and independence thereby combating poverty and improving mental health outcomes. This in turn fosters resilience and results in healthier and stronger communities. Stakeholder Engagement and Advocacy Engagement between the social and health systems: To ensure seamless mental health service delivery, that augments existing government services, The Banyan has forged partnerships with several government agencies such as the State Department for the Welfare of the Differently Abled, the State Health Department, the Corporation of Chennai, the State Central Prisons Department and the Tamil Nadu Police Department (Mental Health Helpline) to co-locate mental health clinics, offer counselling programmes and ease referral pathways to clinics. Sharing of manuals and protocols for replication of models: The Banyan Model of care has been successfully adapted and replicated across in two different states in India by the Karuna Trust in Karnataka and Ashadeep in Assam. Additionally the organisation has shared its approaches and protocols with several other NGOs in the country. The Banyan’s Projects : Addressing Key Challenges in the Sector Adaikalam – Transit Care Centre (TCC) : Addressing the compound issues and multiple deprivations experienced by women affected by homelessness and mental illness through a comprehensive range of emergency and transit care services, with the fundamental goal of restoring dignity, safety and rights. Services offered enable clients to make an informed choice on future course of life through reunion with family, employment, or referral to The Banyan’s Community Living Project (CLP) or Shared Housing Programme. Rural Mental Health Programme (RMHP) : Following a functional mental health systems design to address unique rural geographies and emerging barriers to care such as poverty through a wellness oriented multi-dimensional, multi-tiered package of care for alleviating distress, and promoting mental health and wellness through positive help seeking behaviours thereby reducing the treatment gap. Urban Mental Health Programme (UMHP) : Addressing poverty and other urban barriers to mental health and wellness through co-location in diverse, inclusive urban spaces ranging from a renowned college to a local public health setup; and integration with social and therapeutic services at functional access points. Clustered Group Homes (CGH) : Addressing the complex long term care needs faced by clients requiring continued physical/psychological and economic, long term support in a dignified setting that is an amalgamation of community and institution features, where they are part of a new family with a cottage to call their own. Shared Housing/Alternative Living Spaces : Providing an exit pathway from institutionalised care services by promoting independent living, kinship and autonomy, through shared housing accommodations in rural and urban settings with tiered clinical and social care services, linked to a nodal health centre, addressing the needs of individuals in institutional spaces for extended periods of time. This is a novel approach that is yielding remarkable results but is as yet untried in the Indian context. Open Shelter for Homeless Men with Psychosocial Disabilities : Testing the notion of an open, localised, community-owned mental health care delivery system as a sustainable, cost effective model with significant therapeutic benefits, thereby breaking down barriers reducing stigma, and creating inclusive communities. Some Achievements in Statistical Terms
Nightingale of Mental Health The Banyan, founded in Chennai in 1993 by Vandana Gopikumar and Vaishnavi Jayakumar, has not been another NGO. Borne out of a strong conviction and an irresistible desire to change the way mentally ill persons, particularly women, are treated, rather ill-treated in India, The Banyan has been a phenomenally transformative mental health movement in India. Mental hospitals in the country are torture centres as a rule. The exceptions are a few. Many mentally ill women, brutally abused, both physically and sexually, neglected by everybody, eating out of stinking garbage bins competing with street dogs, and with no place to call a home, wandering here and there in Chennai streets, were common sights till some years ago. But The Banyan changed that scenario. Vandana and Vaishnavi, two young college students, came across one such half-naked, homeless woman in total distress in the middle of the road on way to their college. Unlike the other indifferent onlookers, Vandana and Vaishnavi rushed to protect the woman’s modesty, to give her bath and food, and to find a shelter. At this time they were in for a surprise as no shelter facilities were available in Chennai. That made them to involve themselves in this effort and that was the genesis of The Banyan. Vandana qualified herself in social work at the Madras School of Social Work. The Banyan believes that institutionalisation is not the proper way to go ahead in caring for the mentally ill. It has developed four critical areas of work: emergency and therapeutic services for persons with mental health problems ; inclusive ecosystems for persons with mental health issues; health and mental health systems ; and NALAM: social inclusion, skills development and well-being. The Banyan took more than two decades to develop a model that addresses comprehensively the needs of homeless people with mental illness and to arrive at mental health designs that take into account diverse needs, including long-term care. Focussing on the goals of personal recovery and self-reliance, The Banyan Model is aimed at promoting exits from institutionalised care to an environment of choice and social mobility enabling to build an ecosystem of social mixing, promotion of capabilities and inclusive development. The Banyan Model, thus, contributes to mental healthcare globally. In order to address the structural barriers of mental distress beyond the contrived orbit of psychiatric medicine, The Banyan created an academic centre The Banyan Academy of Leadership in Mental Health (BALM). BALM has been working on developing standard operating protocols and knowledge dissemination with other stakeholders to help improve the quality of care for the mentally ill. Not only this, development of competent human resources has been another focus of BALM. The collaboration between The Banyan/BALM and the Tata Institute of Social Sciences has led to the starting of three Master’s degree programmes through three centres or schools besides a Diploma programme for community health workers. The three centres concentrate on Health and Mental Health Policy Research, Inclusive Development and Social Innovation, and Mental Health and Marginality. Vrije Universiteit, Amsterdam ; the Harvard School of Public Health and the Global Psychiatry Department at the Massachusetts General Hospital, Boston are the other collaborating institutions with BALM. In about a short span of two decades Dr. Vandana Gopikumar has led The Banyan to great heights in mental health therapy, education, research and policy. Dr. Vandana’s professional and personal achievements are highly impressive at this young age. She is Supreme Court-appointed Special Commissioner (Homelessness); Member of Mental Health Policy Group of the government of India; Member of the Advisory Board of the Movement for Global Mental Health ; and Faculty in the London School of Hygiene and Tropical Medicine. Her appointment as Professor in Social Work Practice by the Tata Institute of Social Sciences is a rare academic recognition of Vandana’s credentials. Dr. Vandana is the recipient of many awards such as Jindal Award (2012), WHO Award (2012), India NGO Award (2008), NIQR-Lucas TVS Award (2007), Sat Paul Mittal Award (2007), G.D. Birla International Award (2005), and Stree Shakthi Puraskar Award (Ministry of Women and Child Development, 2003). Some human beings are born with a mission. Florence Nightingale was one such human being. As I shared the MSSW classroom in discussing research methodology with Vandana like the other young persons more than two decades ago I never had an inkling of the great life mission of Vandana. Of the different vulnerable sections of any population in any society, the mentally ill and more so the mentally ill poor women , are the worst victims of abuse and neglect. What Vandana and Vaishnavi have initiated for this invisible section of human beings is a movement for restoration of their dignity and worth as human beings. To me, Vandana is another Florence Nightingale. Women in Mental Asylums Live in Inhuman Conditions A study conducted by the National Commission for Women and the NIMHANS find that unhygienic, overcrowded wards with shortage of psychiatrists and support personnel are some of the hallmarks of the government mental hospitals in the country. In one hospital, women were kept in prison-like environment. They were not allowed to step out and even had to use the toilets under the gaze of the staff. In another hospital there were no sheets or mattresses for the patients. In one institution 150 women have to share just 4 bathrooms. In one hospital sanitary napkins were just thrown out the windows; there was no hygienic disposal. It was also found that families gave wrong addresses and dumped the women patients in the mental hospitals. The chairperson of NCW observed : “Women in mental institutions had been consigned to the bottom of the heap as far as attention or care was concerned”. This is the harsh reality in the 21st century India. - Dr. T.K. Nair Former Principal, MSSW Ramesha M.H. |
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