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Home > News > Big Story > How the pandemic derailed rehabilitation of the mentally ill

How the pandemic derailed rehabilitation of the mentally ill

Efforts to rehabilitate residents recovering from mental illnesses slow down as halfway homes face a staff and fund crunch

Representational image.
Representational image. (Unsplash)

At Pune’s Chaitanya Mental Health Care Centre, which runs a halfway home and day-care centre, a majority of the residents used to work at the centre’s café and gift shop till the lockdown in March. Three of them were also training to be yoga instructors. Then the shop and café closed and exams were suspended.

“The residents were naturally quite upset because their work brought them some income. We plan to gradually open it. It’s a small community where we have a geriatric group with co-morbidities as well. So we have to take all precautions while opening up,” says Sushupati Rony, director of the centre. Through the pandemic, the centre has been home to 20 residents who are being treated for schizophrenia, bipolar disorder or other chronic and non-chronic mental illnesses. Nearly 80% of the residents, Rony adds, usually go back home after a few months, requiring only follow-up consultations.

Halfway homes are safe places for mentally ill persons to recover and get support, training and rehabilitation—and help other mentally ill people recover in a community setting. Besides a supportive environment, these homes offer social skills and vocational training courses, encouraging residents to take up paid work.

Since March, though, these homes have found it difficult to continue their programmes in the face of pandemic protocols and a fund and staff crunch. In a setback they may take a long time to recover from, many of their residents have lost their jobs and financial independence—and their already shaky sense of self-confidence.

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At the Trichy halfway home of The Banyan, an NGO working with mentally ill persons, some of the 34 women residents lost their livelihoods after the lockdown. The few who held day jobs worked as caretakers for senior citizens living in and around the community. Others used to made beads, paper bags or take up tailoring work, say the centre’s managers, Amali Margaret and Jacquelin Sahayarani, both of whom have been through the programme themselves. Residents who have no family to return to or are abandoned live in shared housing that mimics a family environment.

According to an October report in The Lancet, mental health conditions accounted for about 13% of the global burden of disease before the covid-19 outbreak, and a big spike is expected due to the pandemic. In 2018, The Hans Foundation, which funds non-profits in the areas of health, education, disability and livelihood, came out with the National Strategy For Inclusive And Community-Based Living For Persons With Mental Health Issues report, which surveyed 13,610 people. The organisation, based in Gurugram, Haryana, found that 93.5% of patients never left the institution they were admitted in, and 86.5% had never had a visitor. The survey was done in partnership with the Union ministries of health and family welfare, and social justice and empowerment, National Institute of Mental Health and Neuro-Sciences, Tata Institute of Social Sciences, and NGOs.

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Women residents at The Banyan's Homeagain home at Thiruporur town in Tamil Nadu.
Women residents at The Banyan's Homeagain home at Thiruporur town in Tamil Nadu. (The Banyan)

At Pune’s Chaitanya Mental Health Care Centre, which runs a halfway home and day-care centre, a majority of the residents used to work at the centre’s café and gift shop till the lockdown in March. Three of them were also training to be yoga instructors. Then the shop and café closed and exams were suspended.

“The residents were naturally quite upset because their work brought them some income. We plan to gradually open it. It’s a small community where we have a geriatric group with co-morbidities as well. So we have to take all precautions while opening up,” says Sushupati Rony, director of the centre. Through the pandemic, the centre has been home to 20 residents who are being treated for schizophrenia, bipolar disorder or other chronic and non-chronic mental illnesses. Nearly 80% of the residents, Rony adds, usually go back home after a few months, requiring only follow-up consultations.

Halfway homes are safe places for mentally ill persons to recover and get support, training and rehabilitation—and help other mentally ill people recover in a community setting. Besides a supportive environment, these homes offer social skills and vocational training courses, encouraging residents to take up paid work.

ADVERTISEMENT

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Since March, though, these homes have found it difficult to continue their programmes in the face of pandemic protocols and a fund and staff crunch. In a setback they may take a long time to recover from, many of their residents have lost their jobs and financial independence—and their already shaky sense of self-confidence.

At the Trichy halfway home of The Banyan, an NGO working with mentally ill persons, some of the 34 women residents lost their livelihoods after the lockdown. The few who held day jobs worked as caretakers for senior citizens living in and around the community. Others used to made beads, paper bags or take up tailoring work, say the centre’s managers, Amali Margaret and Jacquelin Sahayarani, both of whom have been through the programme themselves. Residents who have no family to return to or are abandoned live in shared housing that mimics a family environment.

According to an October report in The Lancet, mental health conditions accounted for about 13% of the global burden of disease before the covid-19 outbreak, and a big spike is expected due to the pandemic. In 2018, The Hans Foundation, which funds non-profits in the areas of health, education, disability and livelihood, came out with the National Strategy For Inclusive And Community-Based Living For Persons With Mental Health Issues report, which surveyed 13,610 people. The organisation, based in Gurugram, Haryana, found that 93.5% of patients never left the institution they were admitted in, and 86.5% had never had a visitor. The survey was done in partnership with the Union ministries of health and family welfare, and social justice and empowerment, National Institute of Mental Health and Neuro-Sciences, Tata Institute of Social Sciences, and NGOs.

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At Paripurnata, a halfway home in Kolkata that offers psychosocial rehabilitation for mentally ill women, caretakers have been asked to stay at the centre and work in shifts. The centre is home to 31 women, most of them from economically weaker families. “Since most of our staff use local trains to commute, we were badly affected by the lockdown. Now, they take turns to stay for one or two months and then take a few weeks off,” says Prabir Basu, the centre’s secretary. Occupational therapists and other instructors have not been able to visit. “Most use the local trains, which were suspended for eight months. Even after services restarted, people are afraid to travel,” says Basu. Needless to say, the pace of rehabilitation has slowed.

The concern is echoed by Rangashri Kishore, dean of library services at Krea University, Andhra Pradesh, who has co-founded halfway homes in Delhi and Mumbai with The Richmond Fellowship Society, an international network of mental health rehabilitation services. It has been a challenge, she says, to get full-time staff at the 20-bed capacity Delhi centre, which currently has 12 residents.

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Employers also need to provide a supportive environment, says S. Kalyanasundaram, adviser and former CEO at The Richmond Fellowship Society, Bengaluru. The society runs halfway homes (ASHA), long-stay homes (Jyothi), and day-care centres (Chetana) in Bengaluru and Delhi. Currently, the halfway home, where residents stay between 18-24 months, has 21 people, including nine women.

Halted by the pandemic, The Hans Foundation and The Banyan are now moving ahead with plans to roll out a “Home Again” community-based rehabilitation programme in the four southern states, Madhya Pradesh, Delhi, Bihar and West Bengal in April. These homes will be rented from the community and located within the community, in an effort to get it to participate in the rehabilitation of residents. The Banyan will begin training for 15 NGOs this month.

Kishore, who cares for a brother with schizophrenia, believes it’s a challenge for people with chronic mental illness to hold on to a routine for long durations. “This is why community-based living is helpful. Other people are not always sensitive to the condition or understand the medical requirements. They often convince the patient to stop their medication as they think the patient is cured,” says Kishore.

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In Trichy, Margaret says, the community did step in to help during the pandemic. Sahayarani, a trained nurse, says: “There was a time people wouldn’t take us seriously even after we recovered. They didn’t want to associate with us or employ us. Now, over time, they see our work and our commitment and we are respected.”

Hopefully, that sentiment will spread to other cities.

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