VU Research Portal Understanding the Mental ill Health - Poverty - Homelessness Nexus in India: Gopikumar, V. 2014 document version Publisher's PDF, also known as Version of record Link to publication in VU Research Portal citation for published version (APA) Gopikumar, V. (2014). Understanding the Mental ill Health - Poverty - Homelessness Nexus in India: Strategies that promote distress alleviation and social inclusion. Lokavani Southern Printers Pvt. Ltd. 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Oct. 2021 Understanding the Mental Ill Health-Poverty-Homelessness Nexus in India Strategies that promote distress alleviation and social inclusion Vandana Gopikumar August 2014 The Banyan, Chennai, India Published by Lokavani Hallmark Press Pvt. Ltd. Visual concept and cover design by Ashok Kumar Photography by Arun Titan © Vandana Gopikumar, Chennai, India, 2014 All rights reserved. No part of this work may be reproduced by print, photocopy or any other means without written permission of the author. VRIJE UNIVERSITEIT Understanding the Mental Ill Health-Poverty-Homelessness Nexus in India Strategies that promote distress alleviation and social inclusion ACADEMISCH PROEFSCHRIFT ter verkrijging van de graad Doctor aan de Vrije Universiteit Amsterdam, op gezag van de rector magnificus Prof. Dr. F.A. van der Duyn Schouten, in het openbaar te verdedigen ten overstaan van de promotiecommissie van de Faculteit der Aard- en Levenswetenschappen op maandag december 1, 2014 om 9.45 uur in de aula van de universiteit, De Boelelaan 1105 door Vandana Gopikumar geboren te Chennai, India promotor: Prof. Dr. J.F.G. Bunders-Aelen co-promotor: Prof. Dr. S. Parasuraman To the resilience, grittiness, creativity and potential that I see – at The Banyan and elsewhere – amidst poverty, distress and pain… About the Cover This thesis is an inquiry into the distress experienced by homeless persons with mental illness and strategies used in promoting personal recovery. Bala, who stands tall on the cover, is a resident of The Banyan who was rendered homeless and suffered mental ill health, and yet found the strength to smile again! She speaks eloquently and courageously of her journey and is an inspiration to many others who experience similar pain. Table of Contents Account .......................................................................................................... 9 Chapter 1: Introduction ................................................................................ 12 Chapter 2: Theoretical Concepts ................................................................... 21 Chapter 3: Research Design .......................................................................... 45 Part 1: Setting the scene: Persistent and complex problems in the mental ill health-poverty-homelessness nexus .................................................. 57 Chapter 4: Persistent, complex and unresolved issues in the Indian discourse on mental ill health and homelessness ......................................................... 59 Chapter 5: The chicken and egg situation: Systemic deterrents to fixing persistent problems of homelessness and mental ill health in India ............. 83 Part 2: Responding to challenges through innovation and cultivation of values amongst human resources ........................................................ 105 Chapter 6: Responsive mental health systems: A conceptual framework emerging from The Banyan’s experience in Tamil Nadu, India .................... 107 Chapter 7: Enabling access to mental health care: Perspectives from The Banyan experience in India ......................................................................... 123 Chapter 8: The role of non-governmental organisations in community mental health care ................................................................................................. 133 Chapter 9: Mimicking family as a therapeutic strategy in promoting recovery from mental illness and building human-resource capabilities .................... 155 Part 3: Understanding the diversity in the human rights conceptualization within the mental health discourse: Voices of the Indian mental health service user ......................................................................................... 171 Chapter 10: Human rights in the context of mental health: Perspectives from service users of The Banyan in India ........................................................... 173 Chapter 11: Mental illness, care, and the Bill: A simplistic interpretation .... 191 Part 4: Aligning strategies with diverse sectors and stakeholders: the role of policy, responsible business and education ...................................... 203 Chapter 12: Comment on ‘The Mental Health Act 1987: Quo Vadimus?’ ..... 205 Chapter 13: Challenges of teaching clinically applied anthropology and cultural psychiatry in India: An evolving partnership between a UK University and an Indian NGO ..................................................................................... 211 Chapter 14: Making business sense of corporate social responsibility ......... 231 Chapter 15: Conclusions ............................................................................. 246 Appendix .................................................................................................... 258 Summary .................................................................................................... 264 Samenvatting ............................................................................................. 271 Acknowledgements .................................................................................... 278 Account Chapters 1-3 introduce the main themes and theoretical concepts of this thesis. Part 1 of the thesis probes deeper into the problems of mental ill health, poverty and homeless in India, while Part 2 captures innovative responses to address the distress, as a result of this nexus. Part 3 attempts to interrogate the understanding of human rights within this context in Chapters 10 and 11. Part 4 discusses the need for alignment with external stakeholders in Chapters 12-14. Chapters 4-14 are based on eleven articles that have been published or submitted to peer reviewed journals. Part 1 – Setting the scene: Persistent and complex problems in the homelessness-mental ill health-poverty nexus Chapter 4 Gopikumar V., Narasimhan L., Easwaran K., Bunders J., Parasuraman S. (under review) Persistent, complex and unresolved issues in the Indian discourse on mental ill health and homelessness Chapter 5 Gopikumar V., Narasimhan L., Ravi M., Bunders J., (under review) The chicken and egg situation: systemic deterrents to fixing persistent problems of homelessness and mental ill health in India Part 2 – Responding to challenges through meaningful innovation and cultivation of values amongst human resources Chapter 6 Gopikumar V., Narasimhan L., Regeer B., Jayakumar V., Bunders J., (accepted) Responsive mental health systems: a conceptual framework emerging from The Banyan's experience in Tamil Nadu, India. Indian Journal of Social Work Chapter 7 Gopikumar V., Jayakumar V., Narasimhan L., (2013). Enabling access to mental health care: perspectives from The Banyan experience in India. Commonwealth Health Partnerships 9 Chapter 8 Gopikumar V., Negi E., & Dijkxhoorn M., (2010). The role of non-governmental organizations in community mental health care. Community Mental Health in India, 148- 153. Chapter 9 Gopikumar V., Easwaran K., Ravi M., Jude N., Bunders J., (under review) Mimicking family as a therapeutic strategy in promoting recovery from mental illness and building human- resource capabilities. Part 3 – Understanding the diversity in human rights conceptualization with the mental health discourse: Voices of the Indian mental health service user Chapter 10 Narasimhan. L., Gopikumar. V., Sarin A., Regeer B., Bunders J., (under review) Human rights in the context of mental health: perspectives from service users of The Banyan, India Chapter 11 Gopikumar, V., & Parasuraman, S (2013). Mental Illness, care and the Bill. Economic and Political Weekly, 48 (9), 69-73. Chapter 12 Gopikumar, V., (2010) Comment on The Mental Health Act 1987: Quo Vadimus? Indian Journal of Medical Ethics, 8 (4), 234-236. Part 4 – Aligning strategies with diverse sectors and stakeholders: The role of policy, responsible business and education Chapter 13 Derges, J., Jain, S., Littlewood, R., Gopikumar, V., Dijkxhoorn, M., & Jadhav,S. (2013) Challenges of teaching clinically applied anthropology and cultural psychiatry in India: an 10 evolving partnership between a UK University and an Indian NGO. Teaching Anthropology, 2(2). Chapter 14 Mor, N., Gopikumar, V., & Venugopal