The Banyan - RIST collaboration began with a MOU in September 2018, with RIST extending support towards initiating the Centre for Mental Health and Inclusive Development (CMHID). About 18% of people with mental health conditions in psychiatric facilities across the world, live there for a year or more. In India, 37% of people in state-run psychiatric facilities face long-term institutionalization with little or no options to reclaim their rightful space in society. Besides burdening the tertiary care system, the continued living of people within the confines of an acute care facility compromises on their right to live lives of their choosing like any other citizen and marginalizes by sequestering them to a gaze that only sees them in ‘sick’ roles and festers social exclusion of people with mental illness.
In this context, the collaboration seeks to scale up initiatives that attempt to reformulate tertiary mental health care and support definitive, sustainable pathways for community inclusion of people with mental health issues. The values and principles that underpin this collaboration between The Banyan and RIST are those of promoting social justice and inclusion, fostering personal recovery and promotion of individual capabilities.
The primary approach being supported, Home Again (HA), is a housing with supportive services approach that offers people living with mental illness the opportunity to live in rented, shared homes in the community with bespoke supports delivered through personal assistants for health, socialization, economic transactions, work, leisure and pursuits with personal meaning. People come together to form affinity groups and live in homes in a community, creating a shared space of comfort, that mimics a familial environment. Along with housing, the intervention features allied supportive services including social care support and facilitation (opportunities for a diverse range of work, facilitation of government welfare entitlements, problem solving, socialization support, leisure and recreation), access to healthcare, case management (detailed biopsychosocial assessments and personalized care plans), and onsite personal assistance.
The RIST grant is applied to the following areas:
1. Expansion and Penetration of Home Again to enhance the contextual application of Home Again in diverse contexts and build demonstrable evidence for advocacy for statewide adoption
2. Capacity Building for Scale-up of Reintegration-Aftercare/Home Again in other parts of India
3. Aftercare packages for households with people with mental illness to prevent re-entry into institutions and homelessness
4. Service User Leadership in Mental Health Sector
1. Over 200 people with mental illness, histories of long-term institutionalization have transitioned from psychiatric facilities and now lives as part of 45 homes spread across neighborhoods in Tamil Nadu, Kerala and Maharashtra that are supported by Home Again (HA)
2. Home Again (HA) established in Maharashtra in collaboration with the Government of Maharashtra; Andhra Pradesh government has accepted proposal for Home Again to address needs of people living long-term at the Government Hospital at Vishakhapatnam, with funding allocations by state
3. 25% of Home Again staff are service users, majority also with histories of homelessness. Sonal Adlakhiya, a user survivor and primary care-giver for three other family members who are service users supported to lead the Home Again demonstration site in Maharashtra.
Narratives of confinement have the potential for being replaced by people with mental health issues occupying their rightful space in society and leading the way as agents of care and recovery. This may result in shifts in how mental health is perceived and care is sought and delivered.
A national-level movement for HA-like inclusive living options for long-stay cohorts in state mental hospitals has the potential to contribute to social justice and human rights, alter stigmatizing notions of mental ill-health and change the landscape of mental health care in the country.