Rehabilitation of homeless persons with mental illness

Rescue: On 10th November, 2014 a phone call was received from the Chandmari Police Station informing about an ill kempt man loitering around since a few days carrying bags of garbage. He, Ignacious Mundu, was eventually rescued by the Ashadeep staff and brought to Udayan later that day- with highly active symptoms of grandiosity, suspiciousness, irritability, emotional withdrawal, impaired self help skills, disorientation and irrelevant speech.

Intervention: Immediately after admission, Mundu’s basic physical hygiene was ensured and efforts were started to teach him self-help skills, and engage him to socially interact with others. Psychiatric treatment started from the first day itself and through Mental Status Examinations (MSE) every month, and quarterly assessments for disability (IDEAS) and global functionality (GAF), his behavior and thoughts were closely monitored and reviewed. Due to prominent delusions of grandiosity and suspiciousness, he often refrained from socializing or forming warm rapport with anyone. Psychologists and social workers carried out sessions at repeated intervals in order to establish a relationship of trust, and motivate him to look forward to recovery and work engagement.

As the active psychopathology symptoms started to decrease, and he was able to adequately engage in the activities of daily living (ADL), he was involved in paper bag making and household work that didn’t demand physical strain. By then he had also started to minimally socialize with other residents, but more often involved himself in taking care of those in need and would execute assigned responsibilities of household chores very sincerely. His cognitive capacities were intact, but he continually had a sense of hopelessness regarding his future which also resulted in suicidal ideation. The cognitive approach was taken up to reason out his faulty automatic thoughts and rectify the belief system that he held. Simultaneously, with token economy, behavioral activation was brought about, and Mundu was engaged in bamboo work as well.

Reintegration: Unlike the many that continually wait for the day when they return to their families, Mundu wished to stay back in Udayan. He had never married and his brother and sister-in-law were his only family members. After a recommendation of discharge was obtained from the psychiatrist, his reintegration plan was initiated. His functionality was devoid of any psychopathological symptoms, and despite his reservations, he was taken home. Contrary to his fears that his brother wouldn’t be welcoming, he was received with warmth, affection and gratitude towards the Ashadeep team. Mundu had not been in contact with his brother for over a decade after being transferred to Guwahati during his service tenure. Suffering from mental illness for over 20 years, Mundu had sought psychiatric treatment several times previously and was admitted at the hospital twice. He has been financially sound, and with medication he was successfully carrying out his job, but relapsed and was rendered homeless. At present, it can only be hoped that with continued medication and family support, Mundu goes back to finding the niche he lost, and reviving the good life he once lived.

Braiding hopes and dreams: Soniya Bind

Rescue: Soniya was rescued by the Noonmati police on 27th August, 2015 from Birkuchi Tiniali when she was abnormally loitering around the area, and couldn’t give any substantial or meaningful information about herself. Observing the irregularity in her behavior and speech, the police admitted her to Navachetana (Transit Care) with chief complaints of being ill kempt, disoriented, impaired judgment and social skills, and active auditory hallucinations.

Intervention: Immediately after admission, her hygiene and personal grooming was ensured. Given that her self-help skills were intact, with initial guidance she could take care of her hygiene habits without supervision. MSE, PANSS, IDEAS and GAF at the time of admission revealed a clinical picture of symptoms like flight of ideas, pressure of speech, self-smiling, increased psychomotor activity, exaggerated affect, irritability, tangential thought process and impaired cognitive capacities.

To enhance her cognitively, she was first cognitively retrained through grain sorting activities. Though her capacities of attention and concentration were satisfactory, she found difficulty in executing the information provided in a task- and would often be found day dreaming or disoriented. She was therefore engaged in play activities that required attending and executing information and was also entertaining so that she doesn’t lose interest. In the beginning, Soniya had no insight into her illness, and her memory of past illnesses was also faint. Over the course of insight development sessions whereby she gradually proceeded from Grade I to IV, she began to understand her symptoms, the reasons behind medication, and the importance of continuing the same.

On 28th January, 2016 Soniya was shifted to Navachetana Rehabilitation Home, Bamunigaon for engagement in vocational activities. She was trained in jute braiding and doormat stitching but was mostly interested in doing household chores. With continuous incentives for behavior engagement, she came forward to willingly participate in vocational activities and undertook them meticulously.

Reintegration: Soniya’s home was traced to be in a small village in Aurangabad, Bihar, and as time passed by she continually expressed her willingness to go back home to her daughter. Once a recommendation for discharge was received from the psychiatrist and her psychosocial status was assessed to be adequately functional, her discharge plan was initiated and eventually the journey to reintegrate her commenced on 18th of April, 2016. It wasn’t however the first time that Soniya was being brought home by an organization, it had happened twice already. The illness had started after her marriage due to repeated physical and mental harassment by her husband and in-laws. But due to their poor financial conditions and lack of resources in the remote area, they couldn’t afford to seek any help.

On 14th May, 2016, a phone call was received from her brother informing that though she was functioning well; the medication provided was getting over and they feared a relapse. Understanding their needs and limitations well, the medicines were therefore sent to her family by post- hoping that with continued treatment and care, she brings up her daughter to fulfill the dreams she once braided.