Community safety nets: Inside The Banyan’s innovative approach to mental health
The Banyan completes 30 years of making the world an inclusive place for people with psychosocial distress. It does so by giving autonomy to people with mental health issues to choose their own road to recovery.
Three decades ago, 20-something Vandana Gopikumar, who studied mental health, and Vaishnavi Jayakumar, a management graduate, encountered a mentally ill, homeless woman on the streets of Chennai. Watching the woman in distress spurred their young minds to do something. Together, they rented a three-bedroom apartment in Anna Nagar to offer shelter to women with psychosis and severe mental health disorders.
Starting with 13 patients, today The Banyan has touched the lives of 3,481 people with mental illness through 13 Emergency Care and Recovery Centres (ECRCs) across India, and has impacted one million low-income households and homeless people in the states of Tamil Nadu, Kerala, and Maharashtra.
As per the NGO, 75% of its service users have returned to live with their families or independently within the community with their Centre for Mental Health and Inclusive Development (or Home Again) Programme, and 40% of them have found gainful employment with the help of their Centre for Social Needs and Livelihood or Nalam Programme.
With a person-centred approach for those living in poverty and homelessness, The Banyan looks at creating culturally resonant clinical and social care pathways for the most marginalised to integrate them into society.
“Our belief is in collectivising support and forming solidarity circles for those on the fringes,” says Gopikumar. “We also engage with the community—beyond the people that we care for—training people in health care, social care, self-help groups and youth clubs so that they are in turn able to influence or have conversations with others around these values,” she adds.
Building trust
Years before the Mental Healthcare Act (MHCA) of 2017 cemented a rights-based approach for patients with mental illness and discouraged long-term institutionalisation, The Banyan demonstrated successful models of care, treatment and rehabilitation. Its teams establish contact with the service user, engaging extensively with them, building trust, and only then enabling them to avail a service.
“The service here could be The Banyan itself or any other; like, say the Institute of Mental Health, or any NGO that follows protocols and systems that are embedded within a human rights-friendly ecosystem,” says Gopikumar, Co-founder and Managing Trustee at The Banyan.
In a country where only 0.75 mental health professionals are available per 100,000 people (according to the Indian Psychiatric Society), there are very few safety nets to ensure that violations don't take place.
The Banyan ensures these services are culturally-congruent, combine a consistent, multidisciplinary care team, and offer access to a safe space for its clients.
The ECRCs include a peer advocate, clinical social workers, nurses, trained healthcare workers, psychiatrists, general practitioners, psychologists, and if need be, an occupational therapist, along with a general healthcare team, which is supported by a hospital.
Their work focuses on building trust and rapport with the patient, before diagnosis.
“We start off with person-centred care to see what sort of medicine works best based on feedback from the client, what sort of therapeutic initiatives will the client likely be interested in, what sort of social care pathways we could explore—in terms of the food the person will eat, the friends the person will make, the solidarity circles they could be in touch with,” says Gopikumar.
Safety nets
The Banyan employs trauma-informed interventions and environments to develop its care plans, cognisant of barriers such as class, education, gender, caste, abuse, domestic violence, and access to support networks.
“There’s a great degree of epistemic injustice between the global south and the global north, and in most mental health settings where a treatment system is imposed on people who access it,” explains Gopikumar.
Vandana Gopakumar (above) and Vaishnavi Jayakumar started The Banyan in a rented three-bedroom apartment in Chennai in 1993, as a shelter for women with psychosis and severe mental health disorders.
“You really have to start from scratch in the case of people who have limited knowledge owing to limited exposure, so that they can make an informed choice and it becomes easier to co-develop a care plan,” adds Jayakumar.
Before discharge, patients are asked questions pertaining to their future: do they feel ready to become independent, go back to an environment of their choice, and protect themselves in triggering situations.
“In that sense, it’s not just about taking a pill and a reduction in symptoms, but also preparing yourself for what you have faced, and what you perhaps would continue to face, the decisions you’d like to make and the sort of control and agency that you’d like to exercise to be on top of the situation when you get out of here,” says Jayakumar.
Upon discharge, The Banyan ensures that even if the person is reunified with their family, or live in the community, safety nets are also available—“whether it’s a local pawn shop, the local district mental health programme, local social care systems, local self-help groups or neighbours who are friendly,” says Gopikumar.
These safety nets as part of its aftercare programme are focused on scaling, community inclusion, and targeted interventions. The NGO also works to empower individuals to get a basic income, help women develop a sense of autonomy, and provide support for caregivers.
“We have had our share of highs and lows,” says Gopikumar. “Some patients have walked out of their homes, become homeless again, or died by suicide. As per the National Mental Health Survey, 2015-16, there was a 13.7% prevalence of lifetime mental morbidity.
At every step along the way
The Banyan’s Nalam programme functions with a community mental health approach, combining clinical interventions with social entitlements, utilising grassroots action by locally recruited and trained mobilisers and multidisciplinary outpatient teams at proximal locations such as primary health centres. The initiative also offers job placements and social care packages to help those in extreme socio-economic distress.
The Banyan’s partners and donors include the Azim Premji Foundation, WHO and Give India, among other philanthropic partners and individual donors.
Its Home Again programme provides alternate and inclusive living options for women with mental health concerns and builds on the idea of a formed family wherein the person is provided with housing and continued care, depending on their level of disability.
“If the disability is severe, the person has on-site assistance to navigate their way through say, social transactions, visits to the neighbours, celebrating festivals etc. The idea is that you live in the community, participate in everything that the community brings your way, and therefore, have experiences where you are not excluded,” Jayakumar explains. “And as a consequence of these experiences, you are in a position to respond in a way that anybody else would.”
While communities today aren’t necessarily mental health-friendly, The Banyan has a greater vision for inclusivity.
“The foundational values of a mental health-friendly community would be to focus on being an ally, most importantly, to anybody who experiences distress. They lie in embracing the notion of differences and neurodiversity, and realising that people are different,” says Gopikumar, noting that all it takes is a basic sense of humanity.
(The copy was republished to correct factual errors.)
Edited by Kanishk Singh