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Preliminary Matter VU Research Portal Homelessness and Mental Health Narasimhan, L. 2018 document version Publisher's PDF, also known as Version of record Link to publication in VU Research Portal citation for published version (APA) Narasimhan, L. (2018). Homelessness and Mental Health: Unpacking Mental Health Systems and Interventions to promote Recovery and Social Inclusion. General rights Copyright and moral rights for the publications made accessible in the public portal are retained by the authors and/or other copyright owners and it is a condition of accessing publications that users recognise and abide by the legal requirements associated with these rights. • Users may download and print one copy of any publication from the public portal for the purpose of private study or research. • You may not further distribute the material or use it for any profit-making activity or commercial gain • You may freely distribute the URL identifying the publication in the public portal ? Take down policy If you believe that this document breaches copyright please contact us providing details, and we will remove access to the work immediately and investigate your claim. E-mail address: [email protected] Download date: 25. Sep. 2021 Homelessness and Mental Health Unpacking Mental Health Systems and Interventions to promote Recovery and Social Inclusion Lakshmi Narasimhan August 2018 Members of the thesis committee: Prof. Dr Jacqueline Broerse Prof. Dr Dick Veltman Prof. Dr Pamela Wright Prof. Dr Marjolein Zweekhorst Dr Soumitra Pathare This research was carried out at The Banyan, India, a twenty-five year old non-profit working on issues of homelessness, mental health and poverty. Azim Premji Philanthropic Initiatives (APPI) funded the research that forms a part of Chapter 5. Grand Challenges Canada (GCC) invested in the trial of Home Again intervention, results of which form a part of this thesis in Chapter 8. Printed by: Lokavani Hallmark Press Private Ltd Cover design: Ashok Kumar Photo credit: Sathyanarayanan Suriyan © Lakshmi Narasimhan, Chennai, India, 2018 All rights reserved. No part of this work may be reproduced by print, photocopy or other any means without written permission of the author. VRIJE UNIVERSITEIT Homelessness and Mental Health Unpacking Mental Health Systems and Interventions to promote Recovery and Social Inclusion ACADEMISCH PROEFSCHRIFT ter verkrijging van de graad Doctor of Philosophy aan de Vrije Universiteit Amsterdam, op gezag van de rector magnificus prof.dr. V. Subramaniam, in het openbaar te verdedigen ten overstaan van de promotiecommissie van de Faculteit der Bètawetenschappen op maandag 19 november 2018 om 15.45 uur in de aula van de universiteit, De Boelelaan 1105 door Lakshmi Narasimhan geboren te Chennai, India promotor: prof.dr.J.F.G.Bunders-Aelen copromotor: dr.B.J.Regeer Table of Contents CHAPTER 1. INTRODUCTION ....................................................................................... 1 MENTAL HEALTH CARE IN INDIA .......................................................................................... 3 HOMELESSNESS AND MENTAL HEALTH .................................................................................. 4 CHAPTER 2. THEORETICAL CONCEPTS ......................................................................... 6 MENTAL HEALTH, HOMELESSNESS AND POVERTY: INTER-RELATIONS .......................................... 6 MARGINALISATION, SOCIAL EXCLUSION AND INCLUSION IN THE CONTEXT OF MENTAL HEALTH ...... 11 THE TRANSDISCIPLINARY PERSPECTIVE ON HEALTH SYSTEMS CHANGE ........................................ 14 CHAPTER 3. RESEARCH DESIGN ................................................................................. 22 RESEARCH APPROACH ...................................................................................................... 23 RESEARCH TEAMS ........................................................................................................... 28 VALIDITY ....................................................................................................................... 29 ETHICAL CONSIDERATIONS ................................................................................................ 30 OUTLINE OF THESIS ......................................................................................................... 31 CHAPTER 4. PERSISTENT, COMPLEX AND UNRESOLVED ISSUES IN THE INDIAN DISCOURSE ON MENTAL ILL HEALTH AND HOMELESSNESS ....................................... 32 ABSTRACT ..................................................................................................................... 32 INTRODUCTION ............................................................................................................... 32 THE POVERTY FACTOR ..................................................................................................... 34 THE ILL HEALTH AND MENTAL ILL HEALTH AND POVERTY NEXUS................................................. 37 HOMELESSNESS AND MENTAL ILLNESS ................................................................................. 39 DISABILITY AND HEALTH PROMOTION – A DEVELOPMENT AGENDA ............................................ 40 POVERTY ALLEVIATION: HOW SERIOUS IS SERIOUS? ................................................................ 41 WEAK AND INACCESSIBLE HEALTH SYSTEMS .......................................................................... 42 HUMAN RESOURCES: BETTER QUALITY AND MOTIVATED OR MORE IN NUMBER? .......................... 44 THE NATURE OF MENTAL ILL HEALTH ................................................................................... 49 REAL-WORLD DILEMMAS AND THE WAY FORWARD: THE OSTRICH SYNDROME .............................. 49 CONCLUSIONS ................................................................................................................ 53 CHAPTER 5. PREDICTORS OF HOMELESSNESS AMONG WOMEN WITH SERIOUS MENTAL DISORDERS ACCESSING OUTPATIENT CLINICS IN THE BANYAN, TAMIL NADU ................................................................................................................................. 56 ABSTRACT ..................................................................................................................... 56 BACKGROUND ................................................................................................................ 57 METHODS ..................................................................................................................... 59 RESULTS ........................................................................................................................ 62 DISCUSSION ................................................................................................................... 66 CHAPTER 6. RESPONSIVE MENTAL HEALTH SYSTEMS: A CONCEPTUAL FRAMEWORK EMERGING FROM THE BANYAN’S EXPERIENCE IN TAMIL NADU, INDIA .................... 70 ABSTRACT ..................................................................................................................... 70 INTRODUCTION ............................................................................................................... 70 METHODS ..................................................................................................................... 72 RESULTS ........................................................................................................................ 73 DISCUSSION ................................................................................................................... 81 CONCLUSIONS ................................................................................................................ 84 CHAPTER 7. HOMELESSNESS AND MENTAL HEALTH CARE: LESSONS FROM THE BANYAN’S EXPERIENCE IN CHENNAI, TAMIL NADU ................................................... 87 ABSTRACT ..................................................................................................................... 87 BACKGROUND ................................................................................................................ 88 THE BANYAN: A CONTINUUM OF CARE FOR HOMELESS PEOPLE WITH MENTAL ILLNESS .................. 90 REINTEGRATION AND AFTERCARE OUTCOMES OF THE EMERGENCY CARE AND RECOVERY CENTRE ... 93 LESSONS AND IMPLICATIONS FOR THE MENTAL HEALTH SECTOR .............................................. 101 CHAPTER 8. HOME AGAIN: EFFECTS OF A HOUSING WITH SUPPORTIVE SERVICES INTERVENTION FOR HOMELESS WOMEN WITH MENTAL ILLNESS IN INDIA ............ 107 ABSTRACT ................................................................................................................... 107 BACKGROUND .............................................................................................................. 107 STUDY INTERVENTION .................................................................................................... 109 METHODS ................................................................................................................... 110 RESULTS ...................................................................................................................... 114 DISCUSSION ................................................................................................................. 118 CONCLUSION ............................................................................................................... 123 CHAPTER 9. DISCUSSION AND CONCLUSIONS ......................................................... 125 VALIDITY ....................................................................................................................
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