What's New

RECASTING CARE MODELS FOR MENTAL ILLNESS AND HOMELESSNESS

Syllabus:

GS 2:

• Welfare Schemes for Vulnerable Sections of the population by the Centre and States and the Performance of these Schemes;

• Government Policies and Interventions for Development in various sectors.

Why in the News?

The article highlights recent policy shifts and collaborative efforts in India to address the complex needs of homeless persons with mental illness (HPMI). These initiatives aim to provide more inclusive, localized care, challenging traditional institutional models and promoting agency, choice, and community integration for HPMIs.

Source: Medium

Context and Overview:

• Socio-Normative Representations: Homeless persons living with a mental illness (HPMI) are often viewed as refuge seekers, leading to rescue missions focused on institutionalizing them in shelters or mental hospitals, often against their will.
• Limiting Perspectives: As professionals, our past focus was on providing shelter and treatment, overlooking the importance of agency, choice, and creating spaces that respect individuals’ preferences.
• Social Order Constraints: While maintaining social order is important, it can sometimes limit innovative responses, forcing adherence to dominant narratives that may not align with the lived experiences of HPMIs.
• Cultural Nuances: Understanding that there are diverse ways to experience safety and freedom, which may not align with conventional norms, is crucial in addressing the needs of HPMIs.
• Agency and Place-Making: It is essential to prioritize the agency and choices of HPMIs, recognizing their right to shape their own living environments and social circles.

Challenging Notions and Integration Efforts

• Engagement with Experts: Collaborating with lived experience experts can challenge traditional notions of care, highlighting the importance of self-curated support networks among homeless individuals.
• Complex Narratives: Addressing the oppression, scarcity, and abuse faced by HPMIs requires more than simplistic solutions, demanding a nuanced approach that respects their complex realities.
• Successful Collaborations: Noteworthy efforts, such as those in Tamil Nadu, demonstrate the potential of integrating emergency care and recovery centers within district hospitals to provide immediate, localized care.
• Rupturing Dominance: This approach challenges the dominance of large asylum-style institutions, promoting smaller, more personalized care units that ensure better medical attention and personal care.
• Global Challenges: Overcrowding, limited staff, and poor personal attention in care institutions are global issues that necessitate transformative approaches in care models.

Institutional Space Issues

• Long-Term Needs: About 37% of people in state psychiatric facilities have long-term needs, with a median stay of six years, often due to police or judicial intervention.
• Supreme Court Mandate: In 2017, the Supreme Court mandated rehabilitative measures for HPMIs, but community re-entry pathways remain limited and institutional, perpetuating custodial existence.
• Cure and Discharge: The criteria for being “cured” and ready for discharge are often rigid, limiting HPMIs’ participation in community life and perpetuating social distancing.
• Housing Initiatives: Programs like Housing First and Tarasha offer comprehensive care, demonstrating the feasibility of integrating HPMIs into society through innovative housing solutions.
• Hostel-Like Facilities: For those transitioning from hospitals, co-living facilities that enhance social capital and security are preferable to traditional rehabilitation homes.

Reframing Support Measures

• Radical Shift Needed: Social protection for HPMIs requires a shift from paternalistic interventions to strategies that empower and support their independence and agency.
• Disability Allowance: A monthly disability allowance, though modest, can provide critical financial support for HPMIs, addressing basic needs and promoting economic inclusion.
• Financial Inclusion: Ensuring access to documentation and banking services for HPMIs is crucial for their financial empowerment and inclusion in the economic system.
• Holistic Approaches: Complementing financial support with efforts to address structural issues like discrimination, violence, and deprivation is essential for the well-being of HPMIs.
• District Mental Health Integration: Strengthening social care and post-discharge support within the District Mental Health Programme is vital for sustained engagement and improved outcomes for HPMIs.

Advancing Economic Justice

• Systemic Barriers: Confronting systemic barriers and elevating marginalized voices are key to advancing economic justice and inclusion for HPMIs.
• Workforce Participation: Thoughtful facilitation of workforce participation can empower HPMIs, offering them meaningful engagement and a sense of community and purpose.
• Social Cooperatives: Social cooperatives, where individuals collaboratively exchange labor, provide a promising model for inclusive economic participation and community building.
• Affirmative Action: Implementing affirmative action policies to spur socio-economic, cultural, and political inclusion is crucial for the holistic development of HPMIs.
• Policy Initiatives: Tamil Nadu is set to release a policy integrating many of these approaches, showcasing a commitment to pragmatic and inclusive care models for HPMIs.

Key Challenges

• Socio-Normative Representations: Homeless persons with mental illness (HPMI) are often viewed as needing rescue, leading to coercive institutionalization that disregards their agency and choices.
• Traditional Care Models: Conventional approaches prioritize shelter and treatment over individual preferences and the creation of personalized living environments.
• Social Order Constraints: Emphasis on social order limits innovative responses and forces adherence to dominant narratives, neglecting the lived experiences of HPMIs.
• Rigid Institutional Criteria: Long-term stays in psychiatric facilities due to strict discharge criteria perpetuate custodial existence and hinder community reintegration.
• Overcrowded Institutions: Overcrowding, limited staff, and poor personal attention in care institutions degrade the quality of care, necessitating smaller, personalized care units.
• Systemic Barriers: Discrimination, violence, segregation, and deprivation pose significant challenges to the well-being and inclusion of HPMIs.

Way Forward

• Empower Agency and Choice: Involve HPMIs in decision-making, respect their preferences for living environments, and prioritize their agency and choices.
• Innovative Care Models: Develop smaller, localized care units that challenge the dominance of large asylum-style institutions and provide immediate, personalized care.
• Community Integration: Implement programs like Housing First and Tarasha for comprehensive care and support community integration through innovative housing solutions.
• Reframe Support Measures: Shift from paternalistic interventions to strategies focused on liberation, including financial support and ensuring access to documentation and banking services.
• Address Structural Issues: Tackle discrimination, violence, segregation, and deprivation to ensure holistic well-being for HPMIs.
• Economic Inclusion: Promote workforce participation through social cooperatives and affirmative action policies that foster socio-economic, cultural, and political inclusion.
• Adaptive Governance: Develop dynamic leadership and governance systems to address complex issues in the care of HPMIs and implement comprehensive policies like those being developed in Tamil Nadu.

Conclusion

A multifaceted approach to care for HPMIs advocates for their agency and inclusion, moving beyond traditional institutionalization. Emphasizing personal choice, innovative housing solutions, and comprehensive social support can better address their needs and promote their rightful place in society.

Source:The Hindu

Mains Practice Question:

Discuss the challenges faced by homeless persons with mental illness (HPMI) in India. Evaluate the recent policy initiatives and collaborative efforts aimed at improving their care and integration into the community. What further measures can be taken to enhance their agency and social inclusion?

Associated Article:

https://universalinstitutions.com/mental-health-and-the-floundering-informal-worker/