The Banyan began in 1993 in Chennai (capital of Tamil Nadu State in India) as a humanistic response to the needs of homeless women with mental illness—a unique Transit Care facility for psychiatric treatment and rehabilitation. In the 1990s, the dominant paradigm on mental illness in India was a treatment pattern where the focus in mental health institutions went seldom beyond the realms of institutionalized care coupled with pharmacotherapy with very little focus of rehabilitation, mainstreaming and a non custodial approach.  The Banyan’s innovation in institutional care focused on treatment with a foundation on a strong therapeutic base where pharmacotherapy addressed the clinical state but other forms of skills training and therapeutic programmes focused on the person, building her insight and preparing her to accept and be part of a reintegration programme that concluded in a reunion with her family/ society or placement in a job outside of The Banyan with independence as focus.

The Banyan’s Transit Care is run by social workers, therapists and health care workers along with clinicians as consultants. Operations are structured to give importance to consumer choice and empowerment. The focus therefore is not on mere symptom reduction but on facilitating a recovery where a person is able to take charge of her life.  Holistic care is provided by training grassroots workers as nurse aids is an innovation that efficiently utilizes resources for delivery of cost effective care. The Transit Care facility has four departments: Primary Care, Medical & Psychiatry, Occupational and Psychological Therapies and Social Interventions. The Transit Care facility has reached out to over 2000 women affected by homelessness and mental health. A large proportion of clients in the Transit Care have been diagnosed with severe mental disorders—56.9% are placed in the diagnostic category ‘Schizophrenia’ and 28.9% in the category ‘Mood disorders’ and the remaining fall in the category of mental retardation, dementia, or undiagnosed mental illness. Among the 1000 women who have been reintegrated with their community, nearly 46% lead meaningful lives.

After 10 years of catering to inpatient care requirements of homeless women, it was recognized that the important causative factors of homelessness among persons with mental illness were barriers in access to mental health care due to low priority by the government and high level of socioeconomic burden among families. The Banyan also recognized and responded to the need for an open long term facility in community settings to provide a therapeutic community environment for persons with chronic mental disorders showing poor prognosis. This resulted in the Community Living project of The Banyan which currently houses 60 women with mental health issues. In 2005, the District Mental Health Programme of the Government of India was implemented in only 8 of the 31 districts of Tamil Nadu not including Kancheepuram (total population of 28,77,468) and Chennai districts (total population of 43,43,645). The Banyan started outreach programmes—outpatient clinics, day care centres and access to entitlements like employment and income assistance—to people (both men and women) from the lower socio-economic groups in Kovalam village (rural) and in two satellite centres in Chennai (urban).  The rural and urban mental health outreach clinics have made a difference to the lives of 3500 people in the context of larger community development. More than half (57%) of the clients at the psychiatric outpatient clinic in the urban outreach were diagnosed with common mental disorders, 27% with severe mental disorders, 7% with substance use disorders and 9% with mental retardation.

Examining The Banyan model one could observe that the response mechanism has addressed emergency/acute services, family support services, employment assistance, community-based services and long term services—the entire context of mental health care for lower socioeconomic groups, who comprise nearly one-third of the population of India. Research at The Banyan focuses attention on capturing these dimensions of care which would aid in replication of best practices in mental health. Advocacy at The Banyan is centre stage today with focus on working with Government agencies and other network partners to impact policy changes to promote access to care for the marginalised across the country.

For more information on The Banyan, please visit www.thebanyan.org