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FINAL REPORT Award Period: July 1, 2018 – June 30, 2019

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FINAL REPORT Award Period: July 1, 2018 – June 30, 2019 FINAL REPORT Award Period: July 1, 2018 – June 30, 2019 BU Global Programs & BU Foundation-India Seed Fund 1. PROJECT TITLE: Capacity-building in mental health research on serious mental illness in Tamil Nadu, India and Boston, USA 2. ABSTRACT: Through the support of the BU Global Programs – BU Foundation-India (BUFI), The Banyan/TISS- BALM and the BUSM Department of Psychiatry engaged in institutional exchanges and a comparative research project that aimed to build capacity for mental health research. Findings from the comparative research project will inform the design and development of a model of care that can be scaled up to a health systems level to ensure more effective and accessible mental health care is provided to vulnerable patient populations in India and in the U.S. 3. COLLABORATORS (individuals and institutions – please include all local stakeholders who have collaborated on this project during the award period): Dr. Vandana Gopikumar, Professor, School of Social Work, Tata Institute of Social Sciences (TISS) and Co-Founder of The Banyan and the Banyan Academy of Leadership in Mental Health (BALM) Ms. Smriti Vallath, Faculty, TISS-BALM; Clinical Psychologist at The Banyan Ms. Mrinalini Ravi, Faculty TISS-BALM Ms. Tanya Joseph, Head of Monitoring and Evaluation Services, TISS-BALM Ms. Archana Padmakar, Faculty, TISS-BALM Ms. Kamala Easwaran, The Banyan Dr. David C. Henderson, Professor and Chair, Department of Psychiatry, Boston University School of Medicine (BUSM) and Boston Medical Center (BMC) Dr. Christina P.C. Borba, Associate Professor and Director of Research, Department of Psychiatry, BUSM and BMC Senait Ghebrehiwet, Global Program Manager, Department of Psychiatry, BMC 1 Tithi Baul, Biostatistician, BMC Clinical Data Warehouse (CDW), BUSM 4. PROJECT RATIONALE: Within the health sphere and global policy, mental illnesses remain a public health challenge. In both the USA and India, care protocols remain only satisfactory in catering to the mental health needs and overall well-being of individuals living with serious mental illnesses (SMIs). TISS-BALM was founded with the vision of enhancing human resources working for marginalized communities within the Indian context. Consequently, TISS-BALM focuses on transdisciplinary research in order to impact service models and public health approaches to care. As the primary teaching affiliate for BUSM, BMC shares a similar vision of providing accessible health services to all in need of care regardless of status or ability to pay. Through collaborations between BUSM Department of Psychiatry in Boston and The Banyan/TISS-BALM in Chennai, this project aimed to compare health care models between the two study settings in order to identify possible gaps in care and determine best practices that will help advance mental health care delivery systems in the two countries. 5. PROJECT GOALS: The purpose of this seed fund was to enable both partners to cultivate long-term institutional collaborations in order to conduct evidence-based mental health research that informs the development of sustainable health systems level changes. Through this collaboration, we continue to enhance the research capacities of staff in transdisciplinary research as well as clinical practice in low resource settings within the Indian and American contexts. Training to individuals at various levels (i.e., medical residents, psychiatrists, psychologists, social workers, etc.) is provided with the vision of enhancing research expertise within a practice framework that will contribute to the long- term improvement of mental health outcomes in India and the U.S. During the project period, TISS-BALM and the BUSM Department of Psychiatry aimed to increase the research capacity of the partnering institutions by: 1) promoting institutional exchanges; and 2) conducting a comparative research project. Findings from the comparative research project will inform the design and development of a model of care that can be scaled up to a health systems level to ensure more effective and accessible mental health care is provided to vulnerable patient populations in India and in the U.S. 2 6. DESCRIPTION OF WORK COMPLETED DURING SEED FUND PERIOD: Institutional Exchange In January 2019, The Banyan Academy of Leadership in Mental Health (BALM), Kanchipuram and the Tata Institute of Social Sciences (TISS), Mumbai, India hosted the 2nd International Conference on Mental Health and Inclusive Development from 6-8 January 2019. The team – Ms. Mrinalini Ravi, Faculty TISS-BALM, Lead, Centre for Homelessness and Social Vulnerabilities and Ms. Smriti Vallath, Faculty TISS- BALM, Program Manager and Clinical Psychologist, led by Prof. Vandana Gopikumar, Faculty TISS and Co-Founder of The Banyan and BALM, and Mrs. Madhuri Menon, Dean TISS-BALM – was involved in the planning and execution of the conference since August 2018. The conference focused on discussions related to inclusive living options for persons living with mental illness experiencing long-term care needs. The conference brought together mental health clinicians, policy makers, activists, and researchers from various parts of India and the world. Speakers from various international and national schools and organizations, including faculty from TISS, were critical in discussing challenges to strengthen service delivery systems and to encourage the development of models of care that drive social inclusion for individuals with SMI. Through the support of the BU Global Programs – BU Foundation-India (BUFI) award, four members Pictured (L to R): Mr. Indu Prakash Singh (City Makers International), Prof. Sanjeev Jain (NIMHANS, Bangalore), Dr. KV Kishore Kumar (Faculty, TISS-BALM, Director, The Banyan), Dr. David Henderson (BUSM/BMC), Dr. Chitra Venkatesh (MEHAC Foundation), Ms. Tasqeen Macchiwala (Azim Premji Philanthropic Initiatives), Prof. Anirudh Kala (Mind Plus) 3 of the BUSM Dept. of Psychiatry research team attended the conference. Dr. David Henderson, Chair, BUSM Dept. of Psychiatry and BMC, discussed the need for long-term care within mental health systems, especially in low- and middle-income countries (LMICs). In addition, the BUSM psychiatry research team visited The Banyan’s Emergency Care and Recovery Center (ECRC), which facilitated better understanding of the mental health scenario and research needs. In March 2019, a representative of The Banyan’s research team, Ms. Vallath, traveled to Boston to visit the BUSM Dept. of Psychiatry. During her month-long stay, Ms. Vallath participated in a wide range of research and practice-related activities, including weekly psychiatry grand rounds, didactics with our global mental health postdoctoral fellows, and meetings with clinical and research faculty in the department. In addition to attending lectures on global mental health, Ms. Vallath had the opportunity to shadow Dr. Henderson in the outpatient psychiatry clinic and received training and mentorship from both him and Dr. Christina Borba in qualitative and quantitative research methods. These skills Pictured (L to R): Dr. Christina Borba, contributed to significant advancements in her Ms. Smriti Vallath, Dr. David Henderson doctoral work, including research articles to be submitted for publication in the coming months. Comparative Research Project During the project period, the collaborating institutions (TISS, The Banyan/BALM, and the BUSM Dept. of Psychiatry) initiated a comparative research study to examine the health and mental health experiences of homeless individuals with serious mental illness (SMI) served at The Banyan in Chennai, India and BMC in Boston, USA. The Banyan’s research team (including Ms. Tanya Joseph, Head, Monitoring and Evaluation services, TISS-BALM, Ms. Archana Padmakar, Faculty at TISS-BALM and Ms. Smriti Vallath; supervised by Prof. Gopikumar and Dr. Narasimhan, Faculty at BALM-TISS) and the BMC research team (including Ms. Tithi Baul, Biostatistician and Ms. Senait Ghebrehiwet, Global Program Manager, BUSM Dept. of Psychiatry; supervised by Drs. Henderson and Borba) prepared datasets which were representative of homeless individuals with SMI in India and the U.S. The teams worked collaboratively through site visits and regular meetings to complete the cleaning and management of qualitative and quantitative data pulled from patients’ medical records. Analyses were conducted to compare sociodemographic characteristics and health outcomes between study samples from both settings, as described below. Methods Study settings The Banyan is a not-for-profit organization that works with marginalized communities, especially homeless persons experiencing severe mental illnesses. In the field for 25 years, The Banyan has extended reach to over 1 million persons across India. Approximately 95% of persons accessing The Banyan’s services are from rural backgrounds, speak various dialects and most often are diagnosed with psychotic spectrum conditions. Intellectual disability is a common co-occurrence, which often 4 plays a role in individual care plans developed for service-users. The Banyan and TISS-BALM have pioneered care protocols for this population by bringing the affected individual into care, offering basic needs (such as food, water, shelter, and clothing), providing mental and physical health care rooted in a biopsychosocial, user-centric framework, and connecting patients to rehabilitation services. This model of care has been replicated by local government agencies across the state of Tamil Nadu. This process is
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