Co-creating Mental Health services that prevent a descent into Homelessness
Authors:   , Rajan Preetha 
Published: October 2023

Homelessness is a global issue exacerbated by poverty, forced migration, rapid urbanization, and lack of affordable housing. In India, around 1.8 million people were homeless in the 2011 Census, with many forced to sleep on the streets or in unofficial settlements. The link between homelessness, poverty, and mental illness is complex and uncertain. The increased risk of mental illness from poverty creates a greater risk of homelessness, with approximately 25% of homeless people experiencing serious mental health issues in India.

The Poverty, Mental Illness & Homelessness (PMIH) nexus is particularly relevant in India due to its large homeless population, high resource inequalities, and high prevalence of mental illness. This thesis aims to understand the factors influencing homelessness in the population attending the clinic and find ways to leverage them in improving services. It focusses on the experiential knowledge of diverse stakeholders, including primarily women with severe mental illness, and identify pathways otherwise left unseen. By addressing the research gap and focusing on the experiences of women with severe mental illness, the Banyan better solutions may be found to address the complexities of poverty, mental illness, and homelessness in India.

The interactive research approach and mixed methods are used to address the persistent problem of PMIH in outpatient clinics. The study focuses on understanding factors of homelessness among people with mental illness and the service needs and usage of those accessing outpatient facilities. It finds that 32.65% of women with mental illness accessing outpatient clinics reported experiencing homelessness, with low educational attainment and relational disruptions being associated with higher odds. Eliminating gender-based differences in education could be a crucial policy and practice direction to reduce homelessness risks among women with mental illness.

The study examines the lived experiences of women with mental health issues in Tamil Nadu who have been treated by The Banyan. Six themes related to protective factors against homelessness were identified: resilience emerging from trauma, treatment adherence, responsibility and purpose, family and relationships, spirituality, and employment and living space. 95% felt they were not at risk of becoming homeless, indicating hopefulness about future prospects. However, the majority struggled in terms of quality of life, highlighting the complex relationship between resilience and challenges.

In part 2, the study discusses the service needs of clients during the Covid-19 pandemic situation, emphasizing the need for expanding mental health interventions to include individuals with psychosocial disabilities. Social work practitioners play a crucial role in crisis intervention, providing clinical services and coordinating interdepartmental liasoning work. Key recommendations include involving trained community-level workers, involving non-government organizations, creating a single window system for all social protection measures, including mental illness as an eligibility category in disability social protection schemes, and continuing useful mechanisms implemented during the pandemic in the post-pandemic world.

In conclusion, this thesis emphasizes the integration of information and reflexive practice in preventing homelessness among vulnerable individuals, emphasizing the importance of social entitlement policies, greater flexibility in support and institutionalization of practices, and exploring the experiences of men and their narratives.