Stakeholders facilitating hope and empowerment amidst social suffering: A qualitative documentary analysis exploring lives of homeless women with mental illness

Background: Globally homeless mentally ill (HMI) individuals are considered one of the most vulnerable populations. An individual-centric, psychopathology-oriented focus of the existing mental health-care system limits the understanding of the HMI individuals through the disability lens overlooking their strengths and resilience that enable them to survive extremely hostile environments. Contemporary mental health research has embraced a paradigm shift that allows researchers to look beyond the predominant medical model to give precedence to a socio-culturally contexted and experientially firm understanding of human behaviour. Aim: Through the theoretical lens of social suffering, this article attempts to understand the lived experiences of the HMI women, the perspective of their caregivers and the standpoint of service providers in the context of homelessness and mental illness. Methodology: A documentary analysis as a qualitative research methodology has been used to reflect upon the concerns mentioned above. Following Figueroa’s approach to the analysis of audio-visual texts, the documentary Lapata Zindagi, directed by Radhika Lata Murthy, has woven the stories of four HMI women and their caregivers have been analysed. The two-phased analysis involved constructivist grounded theory procedures. Results: The methodological steps, rigour and the resulting categories (experience of social suffering associated with homelessness among HMI women, denial of care and rights within patriarchy, helplessness associated with the burden of caregiving and roles of NGO and community in building hope and empowerment) have been discussed through the lens of social suffering and how stakeholders might facilitate hope and empowerment amidst it. Conclusion: The article highlights the dire and urgent need to integrate mental health into primary health care and community-based intervention and move beyond clinical recovery to nurture ‘hope’ to enable recovery and empowerment for such marginalised populations.

Array of Services for Homeless Mentally Ill in Six Canadian Cities: Non-Governmental Organizations’ Contributions and Perspectives

During the period 2010–2011, when the At Home project was conducted, a questionnaire was sent to 420 non-governmental organization (NGO) key managers in six Canadian cities to enquire about their collaboration with public services and their perspective on the services for homeless people with serious mental illness (SMI). NGOs constituted a dense network of collaboration among themselves. With regard to public services, housing and shelters were two services that NGOs had frequent contact with, followed by the healthcare addiction sectors and, to a lesser extent, social service and the justice sectors. Education and employment were both located in the network periphery. In general, NGOs viewed housing availability and accessibility to health services as largely unsatisfactory. They called for better public support, coordination, and funding.

Deinstitutionalization and The Homeless Mentally Ill

According to the Oxford dictionary “Institution” is an important public body, a home providing care for people with special needs and ‘institutionalise’ is placing such persons in a residential institution. In the context of the topic being discussed, institution is a home for persons with special needs and similarly institutionalisation is placing the persons with serious mental illness, whether acute, subacute or chronic. Deinstitutionalisation is increasingly being projected as the most needed reform in the mental health care by many experts in our country, but the implications of this merit’s critical evaluation.

Deinstitutionalization and The Homeless Mentally Ill

According to the Oxford dictionary “Institution” is an important public body, a home providing care for people with special needs and ‘institutionalise’ is placing such persons in a residential institution. In the context of the topic being discussed, institution is a home for persons with special needs and similarly institutionalisation is placing the persons with serious mental illness, whether acute, subacute or chronic. Deinstitutionalisation is increasingly being projected as the most needed reform in the mental health care by many experts in our country, but the implications of this merit’s critical evaluation.

Comparison of homeless clinic attenders with and without psychotic illness

Aim: To compare the characteristics of clinic attenders in inner city homeless hostels with and without a diagnosed psychotic illness. Method: A cross-sectional study of homeless people attending psychiatric clinics in three inner city homeless hostels over a period of 8 years. The demographic characteristics, comorbid conditions, pathway to homelessness and pattern of homelessness of clinic attenders with a diagnosis of psychosis were compared with those who were not known to have psychotic illness. Results: 2389 homeless people attended one or more of the clinics in the 8 years of the study, of whom 1222 (51.2%) had a diagnosed psychotic illness, mostly schizophrenia. Those with psychosis were less likely to have been married (23.2% vs 45.5%), were less likely to have worked for more than a year (47.4% vs 74%) and were more likely to have been discharged from hospital to homelessness, to receive the Disability Support Pension (72.2% vs 38.3%), or be under financial management orders (12.0% vs 2.6%). Homeless people with psychosis were also more likely to have been homeless for more than a year, sleep in the open, and were less likely to have a current substance use disorder, problem gambling or a history of early life or recent trauma. A high proportion of those with psychosis (29.5%) had been released from prison to homelessness and a surprising number (22%) reported the loss of public housing tenancy. Conclusion: The results demonstrate the homeless with psychotic illness are particularly disabled and disadvantaged, often have multiple comorbid conditions, and many have been unable to maintain public housing tenancy. The inability of many of the homeless mentally ill to maintain public housing tenancy suggests the need for more supported housing to help the chronically homeless with psychotic illness maintain tenancy.