(WITHDRAWN) Reintegrating Women Living with Serious Mental Illness from Institutions to Communities: Current Strengths and Challenges

Background: In India, the growing number of women living with serious mental illness (SMI), abandoned in psychiatric institutions is alarming. Research cites limited social supports as the most common reason for women spending prolonged years in these institutions. In the absence of family support halfway homes support women in transitioning from institutions to communities. However, there is limited research on the effectiveness of halfway homes in reintegrating women into communities. More research is needed to assess strengths and challenges of current integration programs that cater to the needs specific to Indian women living with SMI with limited social supports. The study addresses this crucial gap by critically examining a community integration program offered at a halfway home in an Indian urban city. I use a feminist lens to explore how the program supports women with limited family support to reintegrate with community.

Methods: The present study was guided by theories of institutionalization and intersectionality and examined how the halfway home functioned and supported women to reintegrate with community. Guided by a narrative approach, 34 in-depth interviews (in participants’ native language) with 11 women were conducted to elicit narratives related to illness, institutionalization, and community reintegration. In addition, ethnographic data (five key informant interviews with mental health providers and over 400 hours of documented participant observations and interactions between providers, women, and families), examined how gender and illness-related awareness among providers impacted the delivery of care.

Findings: The halfway home offered adequate basic services (i.e., clean environments, nutritional food, and regular medical follow ups) but imposed several institutional constraints such as regimented routines, restricted spaces, limited outside contact, paternalists care, and residents’ limited say in treatment and discharge related decisions. Different elements of the halfway home program were rife with gender and mental illness stereotyping. Staff followed an illness-oriented model of care, mostly delivered pharmacological interventions, and used a language of ‘cure’ over ‘recovery’. Instead of imparting skills that could facilitate women’s independent living, the halfway home placed an irrational dependence on families to take women home. The program taught women domestic skills such as running the kitchen, sewing, and stitching, and other occupational therapy classes that by nature were gender normative. Staff highlighted that while the halfway home should not be a long-term solution for women, they experienced several challenges to successfully reintegrating women. These included, 1) families not cooperating and refusing to support women, 2) case overload among providers and burnout, and 2) funding shortages that limited diversifying their program to offer more structural supports.

Implications: Current research in India lays greater emphasis on developing community mental health services. However, because mental health care is predominantly institutional in India, further research should examine how these institutions can be upgraded to better serve women’s needs, particularly those who lack family support. Research should also explore providers’ perspectives and personal motivations that shape their work. This will shed light on potential challenges that come in the way of mental health providers delivering gender-sensitive and less stigmatizing approaches to mental health care.