Homeless, mentally ill Indian women face vicious cycle: study

Homeless, mentally ill women in India are reunited with their families before undergoing sufficient psychosocial rehabilitation which causes them to suffer relapses and end up homeless again, an award-winning study by an Indian-American researcher has found.
Anita Rao, a third-year medical student from Loyola University Chicago Stritch School of Medicine, has documented how homeless, mentally ill women in India face a vicious cycle.
During psychotic episodes, they wander away from home, sometimes for long distances, and wind up in homeless shelters. They are then returned to their families before undergoing sufficient psychosocial rehabilitation to deal with their illness.
Consequently, they suffer mental illness relapses and wind up homeless again.

"The study illustrates how there must be a balance between reintegrating homeless, mentally ill women with their families and achieving a psychiatric remission first," said Rao, who has received the prestigious Lancet Psychiatry Poster Prize for her study.
Rao spent five months surveying 21 women in a residential facility for homeless, mentally ill women in Mysore, Karnataka. The surveys were prepared in conjunction with the Indian National Institute of Mental Health and Neurosciences in Bangalore.

Information was collected on the women's socio-demographic variables and psychosocial and familial conditions in four time periods: before the onset of illness, during the course of illness, during episodes of homelessness and after institutionalisation.

The study found that the two main developments leading to homelessness were death of a primary caregiver and abandonment by family members.
More than half of the women (52 per cent) came from states other than Karnataka, including Andhra Pradesh, Maharashtra and Tamil Nadu. This illustrates how mentally ill people have a tendency to wander, the study said.
However, Indian families are reluctant for moral reasons to accept a female family member who has wandered away for a long period of time, according to the study.
The women had relatively short stays in the facility: ten women stayed 1 to 10 months and eight stayed 11 to 20 months, while only three stayed 21 months or longer.

This indicates women were reunited with their families either before they had achieved remission from their illness or shortly thereafter - regardless of whether they had undergone sufficient psychosocial rehabilitation.
While typically the goal in India is to reunite mentally ill women with their families, the goal in the US is to find homeless, mentally ill women jobs and housing, the study said.
But in either case, it's critically important that women first receive adequate psychosocial rehabilitation.
Such rehab includes classes and group sessions to help patients and families understand the disease and learn skills to deal with stresses that can trigger mental illness episodes, Rao said.