(JANUARY 2015- DECEMBER 2015)

Tarasha

A Field Action Project of the Centre for Health and Mental Health

School of Social Work

Tata Institute of Social Sciences

Mumbai

PROGRESS REPORT

JANUARY 2015- DECEMBER 2015

“Recovery is a process, a way of life, an attitude,

and a way of approaching the day’s challenges.

It is not a perfectly linear process.

At times our course is erratic and we falter, slide back,

Re-group and start again . . . .

The need is to meet the challenge of the disability

and to re-establish a new and valued sense of integrity

and purpose within and beyond the limits of the disability;

the aspiration is to live, work, and love in a community

in which one makes a significant contribution.”

Patricia Deegan (1988)

OUR VISION

The creation of a safe, just, non-threatening and non- discriminatory society in which women

living with mental disorders can lead fulfilling and productive lives.

OBJECTIVES

To support women recovering from mental disorders in making a transition from

institutions back into the community through networking, capacity building and

sensitisation

To facilitate the process of recovery in women aimed at addressing issues related to

psychosocial well-being, shelter, sustainable livelihoods and economic independence

To shift society from a mind-set of exclusion and stigmatisation to inclusion and

acceptance, thereby supporting to create safe, non-threatening spaces for women

living with mental disorders

To influence policy through advocacy and networking

PROGRESS REPORT JANUARY 2015- DECEMBER 2015

Since our inception in 2011, we have been working with the women admitted to the Regional

Mental Hospital, Thane. In the last 4 years, we have moved 4 batches of women. We have

worked to identify asymptomatic women in consultation with the hospital staff and addressed

various psychosocial issues affecting women living with mental disorders within the hospital.

Across the last 5 years we have worked with more than 100 women and obtained discharge

for 15 women to help them rebuild their lives and identities beyond the diagnosis of a mental

disorder. Of these 15 women, 12 are currently maintaining their recovery successfully. Of

these 12 women, 2 women have been maintaining recovery since 2011. We adopt a

multidisciplinary lens and integrate biomedical and psychosocial aspects to facilitate recovery

and reintegration. This is achieved through linking up with the existing community resources,

including service providers within the hospital, working women’s hostels, vocational training

institutes, day care centres and employers. We facilitate vocational training, skill

development and job development and support for each of the women we work with. After

employment, we continue to work with the women to offer psychosocial support and

counselling services.

We consider the last four years to be our pilot phase, a phase in which we have watched our

intervention closely and explored the nature of recovery acutely. We have worked to

empower the women to begin a dialogue with their psychiatrist within the hospital, thereby

encouraging the women to be active participants in the decision-making processes of their

recovery to the point of medication. We assert that their monthly visits for medication are less

passive and the women now actively engage with their doctors, verbalising their experiences

of medication, and often, these discussions have led to changes in medication dosages. The

women we work with are able to monitor their own mood and the changes that come into

their lives - including sleep patterns, emotional changes and tolerance levels - with the

altering of medication doses, and also oft times monitor each other in the shared living space.

The rate of readmission to the hospital is very low; in four years, we have been required to

readmit only 3 women, of which for one of them the interval between readmission was 4

years. This year, we have moved out 4 women, each with very unique and fresh trajectories

that have proven to be both a challenge and a triumph to the project at times.

The sessions at the hospital attract an increasing number of women who voluntarily attend

group sessions we conduct at RMH, Thane, and more women are being referred to the project

by the professional staff at the hospital.

This year, we celebrated World Mental Health Day on October 10, 2015 in the hospital with

the staff members in order to stress upon the importance of livelihoods and shelter in

attaining and maintaining recovery. The place of addressing psycho-social issues that often

lead to mental disorders was emphasised. The staff members agreed that medication alone

helps little in long-term recovery and reintegration. The women we have worked with over

the last 5 years chose to participate in the event, sharing their stories of living within and

outside the institution with the larger audience.

A more detailed exploration of our work, our methods and resulting change is contained in

the following pages.

February 26, 2015:

This time, it’s different. The four women walking out of the gates have only the shared

experiences of illness in common – the experiences of trauma, violence, institutionalisation,

and abandonment.

The youngest, Marigold1is ecstatic, she’s laughing out loud, dreams of love and stardust in

her eyes. Next in line, Nandini2is also smiling, but nervously. It’s been some 12 years since

she was admitted here, and then, she was only a child. In many ways, perhaps, she still is.

Then comes Sonali, back straight, eyes unblinking, lips a tight line. She’s apprehensive, I can

tell. This isn’t how she planned her exit from this place. She expected her family here.

Next to her, clasping her hand is Kangana3, and probably the happiest and the most nervous

of the lot. She is 47 years old, much above our eligibility criteria for inclusion in Tarasha.

Her knees hurt, a result from the hard labour she has been accustomed to. She knows this

journey is going to be toughest for her. Who is going to employ a 47 year old ex-patient? But

no matter, she is free, after years, a new road has opened up for her, finally.

They stand outside the gates of the female ward, off to one side, close together. They’re

unsure of what to do now, what happens next. They look at each other, then at us.

‘Kaisa lag raha hai?’(how are you feeling?) we ask. A Chorus of ‘Accha, bahut accha’,

(good, very good), ‘Azaad!’ (free) meet my ears.

‘Photo lun kya’(Can I take a photo?) I ask.

‘Haan, Haan,’ ‘Ruko, mein pose maarti!’ ‘Abhi? Kaise lag rahi hun main!’(yes, yes; wait, let

me pose; Now? How do I look?)

They pose twice. Once ‘normal style’, once, for freedom. Click, snap! The journey begins.

Meet the women:

Marigold is young, very young. Having never been able to trace her family, and she herself

having few memories of her age and life, we can only guess her age. She looks about 24, her

hospital file says that she was 21 at the time of admission, in 2011. The initial diagnosis

written in her file was Psychosis (Schizophrenia) and more recently, the tag of -Mild MR had

been affixed.

1 Names changed for confidentiality purposes. 2 ^id 3 ^idMArigold

Her file tells us that she had been brought to the hospital by the police, and that there are ‘no

contact details’ for her case, but for the number of the police officer bringing her in at the

time of admission.

Marigold was a helper-patient in the hospital, She was given tasks and responsibilities in the

hospital like getting and serving meals, gathering the other patients, etc. This came with

certain privileges, too. Marigold joined the Tarasha group of clients after having seen 3

batches of women move, after seeing the women who came back for their monthly check up;

the way they dressed, the way they spoke about their lives and their jobs was a motivating

factor for her to join the group. ‘Mujhe bahar jana hai, Khud ke pairon pe khada hona hai’.

She had only a vague idea of what ‘bahar jaana hai’ meant, and what it would entail. But she

was motivated to work, and motivated to leave the hospital. There was tremendous

improvement in her social skills and her ability to understand instructions, perform tasks and

activities, take up responsibility and see it through in the course of her participation in the

group process. Marigold’s case was compounded by her diagnosis of MR and the fact that a

several of the hospital staff members were against her discharge on account of the idea that

she would ‘run away and get married’. While we ourselves knew that there was a flight risk

involved in this particular case, there were no other reasons why she should not be

discharged. Marigold is one of the 2 youngest clients to be discharged under Tarasha.

Nandini is very young too, we have calculated her age to be between 23 to 25 years. She has

been in RMH, Thane for 9 years. As per her records, her diagnosis is Epilepsy with behaviour

disorder. Her history has been extremely traumatic from a young age. Her life has mostly

been in institutions. She was a helper patient within the hospital, working in the sick ward, to

assist the nurses and attendants and provide care whenever possible. She can’t even

remember the outside world as she steps out with Tarasha, and has many fears relating to the

opposite sex.

Sonali, at 37 years old, is different from these two. She has had access to the formal

education system, and has studied up to the 9th

std. She had experienced extremely traumatic

situations, including the death of both her young children and the disintegration of her family.

There was no one able to take her out of the hospital, even though she was asymptomatic, and

in the absence of her husband, the rest of the family had taken a step back. Sonali had been

diagnosed with Undifferentiated Schizophrenia. A large part of our therapeutic intervention

with Sonali involved addressing her past, and visualising a future, building an identity for

herself, questioning and challenging her notions of the role of a ‘woman’ in society,

deconstructing illness as well as nurturing her strengths. Initially, she did not want to be part

of the discharge process of the project, saying ‘Mera parivaar hai, mujhe thoda samay de

dijiye main sochke batati hun ’4. However, she continued to participate wholeheartedly in the

therapeutic sessions. When she met the clients from earlier batches and spoke to them, she

changed her mind saying ‘Mujhe khud ke liye kuch karna hai, abhi mujhe Tarasha ka raasta

mere liye sahi lag raha hai’5

4 I have a family, give me some time to think about it 5 I want to do something for myself, now I see Tarasha as the right path for me.

Kangana is the eldest of all the women who have been discharged under Tarasha. In fact, at

47, she is above the age criterion of the project. However, Kangana, was high functioning,

had insight into her illness, a hard worker, and asymptomatic. Her family consists of aged

parents who would not be able to support her for long. We knew that this could be her chance

to make a life for herself. We asked ourselves if there was any reason for Kangana to remain

in the hospital, aside from her age - and thus age related complication regarding livelihood

options available in society? Not really, was our answer. Tarasha’s principles are sound, and

firm and each one of us strive to uphold them in every decision we make. Asymptomatic

women have no need of a mental institution simply for lack of other options. And thus we

took up her case, understanding the challenges that we would have to take up during the

phases of vocational training, job development and job support.

Kangana told us recently ‘Kash Tarasha jaise kuch hota tha pehele toh main kahan- kahan

pahunchti thi abhi.’6

PHASE I: DE-INSTITUTIONALIZATION:

Phase I is a stage of screening, selection, capacity building and a move towards de-

institutionalization. Women are selected in consultation with the hospital staff on the basis of

their symptoms, behaviour in the hospital, eligibility and interest level. This is an ongoing

phase, but women who are being moved need to be part of the group process for a minimum

of 4 months. Selection of potential participants for the Project is based on certain assessment

criteria including:

i. Level of functioning

ii. Current symptoms

iii. Insight and acceptance

iv. Willingness towards adherence to medication

v. Age (upper age limit is restricted to 40 years given the employability opportunities for

women discharged from the hospital)

vi. Degree of family/social support

This year, we have increased the number of times we conducted group sessions at the hospital

to 3 days a week. Operating from a feminist, strengths - based perspective, the sessions

conducted have various therapeutic objectives. They are generally categorised as

Introductory, Informative, Exploratory and Reflective. Sessions are designed around

encouraging and initiating group participation and interactions, building trust, sharing,

assessing and enhancing strengths and capacities of the women as well as cognitive and body

6 If only there was something like Tarasha earlier, where I would have reached by now!

functioning, building awareness about the self, the other, and society; exploring boundaries,

emotions, reconnecting with the body. They are also encouraged to explore and redefine for

themselves the role of women in society, developing an understanding of gender and linkages

between gender and mental disorders. Discussions around adherence to medication, the role

of medication in maintaining recovery, handling stress resulting from emerging relationships

outside of the institution and dealing with conflict form an important aspect of group sessions

we conduct at the hospital. All the group sessions are experiential and participatory and the

women are encouraged to form and share their own opinions and listen to those put forth by

other group members.

Given that the group is not a closed group, the sessions are not linear and designed based on

expressed needs, agenda and feedback from women participants. During Phase I, the team

takes group sessions and simultaneously works with each prospective client on an individual

basis. Adopting feminist techniques in the therapeutic space, the team works towards building

an egalitarian relationship with the client, maintaining transparency at each stage of the

process and working towards the attainment of goals which are set through a collaborative

process. The team encourages the women to make an informed decision about participation in

Tarasha, clarifying expectations of life after discharge, while emphasising and defining

Tarasha's and clients' roles and responsibilities through the subsequent phases of the project.

The team also urges women to attend sessions regularly even if they choose not to leave the

hospital. Simultaneously, the team works with the hospital staff to gain feedback and insight

into clients’ progress and behaviour outside the therapeutic space.

The team also consistently communicates feedback to the clients individually. Every time a

batch moves, relationships that may have been very close end, and this causes anxiety within

the group. Sometimes, interested clients may not be selected for discharge, and the question

‘why not me?’ remains foremost on the mind. Tarasha works with clients individually at this

point as well, to track their progress and communicate the areas they need to focus on to be

ready for a life outside of the institution.

With this batch, we chose to work on deconstructing illness and diagnosis from the start, in

order to facilitate a deeper sense of self awareness, understanding and empowerment.

Our group of women at the hospital consists of approximately 20 - 25 women, all of whom

were in phase I, i.e. being screened for de-institutionalisation. The group sessions are

inclusive and open to all women who choose to be part of it.

PHASE II: PSYCHOSOCIAL RECOVERY:

Phase II of the project is marked by two events:

i) Moving into a working women’s hostel

ii) Beginning psychosocial recovery

Along with our newest batch of women, we wished to work on strengthening the existing

Day Care Centres in Mumbai, and chose to work alongside Kshitij Mental Health Centre, a

project of the Family Welfare Agency (FWA). As part of this endeavour, the women attended

the day care centre for 3 months. During this time, the Tarasha team also conducted sessions

at Kshitij, twice a week. Each session conducted at the day care was attended not only by

Tarasha clients but also by the clients who came to Kshitij on a regular basis. Each session

was designed as a stand-alone session to be empowering to the clients, and engaged their

cognitive and reflective skills. After these 3 months, the women moved to Manav, as part of

the due process of recovery followed by Tarasha.

This year we have continued our association with SukhShanti, a programme of the

Association for Social Health in India (ASHI) which runs a shelter home and a working

women’s hostel for women. It has been our experience that the working women’s hostel

provides a non-stigmatised, safe and secure environment that fosters our clients’ recovery.

This is also one of the first spaces wherein the clients begin to meet and interact with other

women from different avenues of life, as well as other clients in later phases of the project.

This is when the clients’ begin to shape an identity for themselves outside the bracket of a

diagnosis, and apart from their disorders. The idea of the ‘future’ starts to become more

concrete. A major challenge is readjusting to a life outside the hospital, follow a daily

schedule that includes attending the day care centre in another part of the city, negotiating

spaces and interacting with the social environment.

One of Tarasha’s broader objectives is the expansion of safe and legitimate spaces across

communities for women living with mental disorders. To this end, the team has spent time

locating and transacting with other community-based living spaces for women – exploring

new hostel spaces not only for new clients, but identifying spaces that the older clients who

are still at the project space in SukhShanti may occupy to underscore their autonomy and

fully embrace independent living.

With this batch, we at Tarasha have had to question ourselves asking ‘what is it that women

truly want?’ ‘What is recovery to each individual woman?’ We understand recovery

triangulating Self, Shelter and Livelihood to build an environment conducive to recovery –

but how do the women see recovery? What are their needs? How do they understand the

same words – self, shelter and livelihood? We have been constantly evolving our approach

and understanding of recovery. This churning came out of the decision one of the women,

Marigold took, to leave the project without informing us. One evening, just about a month

after discharge, she went out to have tea, packing her bags, and taking all her money, and did

not return. For Marigold, Tarasha was a stepping stone to moving out of the hospital and

begin a new life. We understand and respect that however, but we wish we could have had

more time with her or that she would have allowed us to know what her other options were in

order to ensure her safety. In this case, we completed the follow up from our end

immediately, informing and following up with the necessary authorities, filing an FIR to

lodge a ‘missing person's complaint.

In addition, during this period, we began to intensify our search for vocational training

options, keeping in mind our women’s interests, capacities and strengths. It has been a real

task for us to find spaces open to receiving those who have no certification or formal

education.

PHASE III: VOCATIONAL TRAINING:

Kotak Education Foundation (KEF) has been our vocational training partner since 2011.

Once women complete their tenure at Manav Rehabilitation Centre and are ready to embark

on vocational training, they are placed with Kotak Education Foundation. KEF offers training

in retail and sales, housekeeping and hospitality sectors. The training typically lasts about 3

months. Following successful completion of training, women appear for interviews and are

selected for job placement.

This year, however, owing to the fact that two of the women were a little older, we decided to

explore new avenues for vocational training, and look for more suitable spaces for our current

batch of women to occupy. We faced many challenges, in spaces that look at age and external

appearance while offering jobs in particular sectors. Retail and sales and hospitality were thus

not tenable for some women from this batch as was conveyed to us by KEF. By the end of

this year we are looking at home care assistant training programmes for our women.

Besides vocational training, this phase serves to provide the women with an opportunity to

interact with other students in a learning environment, appear for job interviews and get

selected on a competitive basis. Just as opportunities open up in Phase III, it also brings

several challenges. Women have to go beyond their identity of a person with mental disorder

to someone who is a student-learner, a potential employee, a colleague and so on. It is at such

times that self-doubt and fear surface often. The women also re-learn and re-adapt their

understanding of boundaries and relationships here. Distinguishing between friends and

colleagues, identifying strengths that set them apart from the rest of the student-group,

learning new behaviours beneficial to the workspace and absorbing what is taught during the

training become important aspects of learning for the women.

PHASE IV: JOB DEVELOPMENT AND JOB SUPPORT:

During this phase, the project withdraws financial support for the women and continues to

provide psychosocial support to them. The team keeps in touch with the women at least once

a week. Step by step, the clients are encouraged to take control of the therapeutic sessions in

terms of scheduling and themes, thereby building ownership of the process of recovery.

Tarasha strives to be in touch with the client’s employers as well, there by obtaining

feedback from the workplace, while maintaining the clients’ dignity, confidentiality and

respecting the clients’ wishes.

Thus far our women are employed in / have received training in the following fields:

PHASE V: EXIT:

This year we instituted an exit procedure for the clients in batch 2. This stage has been

strategically instituted for the women participating in the project. This phase is to provide

closure to the process the women have been a part of for the last several months as well as to

represent the clients’ independence. In this process we provide the client with a written

document, quite like the one they signed upon participating in the project. The document

highlights the clients’ work and accomplishment in the time they have been a part of

Tarasha, acknowledging their participation, efforts and commitment to recovery. In addition

we include a maintenance plan based on our work with the client and usually including

insights that the client has provided through the counselling sessions. This document is

symbolic, a tangible way for the client to acknowledge contracting with themselves, and

taking up responsibility for their recovery, seeking help, and lifestyle. We constantly reiterate

during this process that we are always available for psychosocial assistance, and that the

client is responsible for seeking help.

This stage is more than just a document. Prior to the actual ‘ritual’ associated with exit, we

are in constant contact with the client, until she is ready to acknowledge her independence

formally. At all points however, we stress on the fact that exit doesn’t equal abandonment,

rather the acceptance of responsibility for oneself. In addition to this, however, the

Paraprofessional staff member keeps in regular touch with all the past clients, monitoring

their progress. In case of any 'back and forth' noted in terms of adherence to medication, or

Hospitality 10%

Housekeeping 30%

Retail and Sales 20%

Engineering 10%

Printing Technology

30%

Sectors

any anomalies in behaviour, the team as a unit works towards accessing medical help and

providing psychosocial assistance as required.

This year, one more of our women, from batch 2, completed this process. She, along with

another one of our clients, has moved out of the hostel and into their own rented spaces.

Readmissions:

A challenge for us this time was readmission and making a decision to move a client we have

been working with back to the institution. This year, one of the challenges we faced was in

the case of Nandini, especially in respect to her adjusting to living outside the institution that

she was so accustomed to being a part of. Travelling was a challenge, fear, especially of the

opposite sex, the need for belongingness and closeness in terms of a traditional family,

deconstructing the female body, and exploring sex, sexuality and reproduction were some of

the themes we worked through with Nandini.

Behaviourally, Nandini was extremely manipulative, and headstrong, all of this though is part

of the process. What was non-negotiable for us, was when, as a person living with epilepsy,

she started throwing out her medication.

Within a few days, she began getting seizures in the hostel. We counselled her with regard to

the outcomes of not taking medication, and while in session she would agree to take her

medication, later she would not. The seizures became more violent, more frequent, and now,

while travelling as well. The seizures began to trouble the other girls in the hostel. We were

making near weekly visits to the hospital to consult with the psychiatrists by now. When

faced with the decision of her safety, the psychiatrists at the hospital strongly recommended

readmission at least until she was able to come to terms with her need for medication to

manage her epilepsy.

Nandini was one of two women who had required readmission, the other being Priti7. Priti,

was a first batch client, having moved out of the hospital in 2011. Through all the ups and

downs she had managed recovery beautifully for herself for 3 years. She had been made a

permanent employee where she worked and was up for a promotion. However, she slowly

began to avoid us, and stopped taking her medication as well. Her behaviour soon became

very erratic and she would not come back to the hostel till odd hours of the night.

At this point we began to receive calls about her behaviour from various places including the

hostel that evicted her. We were not able to get through her at all, and in the end, with the

alternative being that she was roaming around the place at all odd hours and had no place to

stay and most importantly was experiencing an episode of illness readmission was the only

option available. The psychiatrist meeting her and assessing her also recommended the same.

Making the choice for readmission is never an easy one for us, however faced with the dearth

of accessible structures in place to provide treatment in the absence of legal guardians and

7 Name changed to maintain confidentiality purposes

family, the only open choice for us is the hospital. We understand recovery isn’t a path that

moves linear, or solely forward, and yet the decision for readmission is taken only when all

other options are exhausted and the women may be at risk.

OUR THERAPEUTIC WORK:

This year, we have conducted a total of 156 therapeutic sessions – 39 group sessions and 117

individual sessions. We find that working in groups, using group process and experiential

methodologies is more meaningful in the pre-discharge phase while individual, one-on-one

sessions post-discharge make a greater difference to women and the recovery process. This

year as well, we find that our work within the hospital has focused largely on groups of

women of approximately 20-25 members.

Across the process, our themes/focus areas for counselling are SELF, COGNITION,

SOCIAL and BODY AND MOVEMENT; we find that all four areas require attention to

different degrees at different points of the therapeutic intervention.

Therapeutic group sessions:

The major chunk of our work in groups occurs within the hospital, at Thane. Below is a brief

snapshot of our work in groups:

Self Cognition

Body and movement

Social

Figure 1: Session themes across phases

This year, as part of our drive to strengthen community resources, we lent our support to

Kshitij, a Day Care Centre, of the FWA in Lower Parel, Mumbai. Towards this end, we not

only enrolled our women at the centre, but also went in to conduct therapeutic sessions during

the week.

Overall, when we look at our work this year, we find that at the hospital, during phase 1, the

themes we’ve worked with are rapport building and group bonding/dynamics, body and

movement, attention, focus, motivation, self-awareness and demystifying illness.

At Sukhshanti, the working women’s hostels where we work with women post-discharge, the

focus of group sessions shifts to relationships, anticipatory guidance related to the workspace,

highlighting behaviour and consequences, dealing with emotions like loss and grief, and

taking care of oneself.

At the day care centre we worked around themes like exploring power/powerlessness, and

taking charge of one’s life, making shifts and changes, goal setting and exploring strengths.

Individual Therapeutic Sessions:

This year, we worked to support our women individually post-discharge, as we found that a

large number of our women needed more therapeutic attention from us. In order to be able to

support the women in the best way, we took a break from going to the hospital for 3-4

months, before reinstating the group process at the hospital by November 2015.

In this time, along with our women we worked on various factors affecting recovery post-

discharge, when the women were transitioning from being supported entirely to being

independent.

Of the 117 individual sessions we conducted this year, we spent most attention on the Batch 4

women we discharged earlier this year.

The break up is given below:

At the hospital, most of our sessions revolved around looking at the individual needs of each

of the women who are ready for discharge; what does she need to bring into her

consciousness to ease into the process of discharge?

With our Batch 1 and 2 clients at this stage, primarily our work has involved looking into

building a career and support through workplace issues as well as to a large extent what it

means to take a step forward and exit the project. The focus is on – what next?

With our Batch 3 clients, the focus is currently only on the workplace, adjusting to work,

building healthy relationships and creating goals – What do we need to do to achieve our

goals?

Our most focused intervention this time was with our newly discharged batch of clients, as it

is every year. This year, we expanded our inclusion criteria by working with women in the

batch with diagnoses of Epilepsy and Mental Retardation along with psychosis, in addition to

pushing the age limit for the participants in the project to 47 years old. The reason behind

behind this shift was the recognition that these were women who were asymptomatic and had

nowhere to go as a result of the further marginalisation (due to diagnosis and higher age) as

compared to women we typically worked with in the past.

Before discharge, all the women had expressed similar goals of wanting to be independent.

Post discharge, however, clients vocalised different goals, as in the case of Marigold, who

wanted to find love as soon as possible, Kangana’s wish to find her daughter, Nandini’s wish

to have a child of her own. Coupled with this was the additional logistical challenges we

faced in terms of finding vocational training and job spaces for Kangana and Sonali who

were older (both being above 35 years of age, and had no experience working in the formal

sector) and overcoming Nandini’s extreme fear of men. All the women wanted very strongly

and openly to build ‘family’ relationships and that seemed to take precedence over economic

independence.

These experiences made us reflect upon our own approach to recovery - how do we as

service providers sustain the client’s motivation to be part of a recovery-based programme?

We have had to ask ourselves continuously –What is in it for them? What do women really

want? Why? Is is only about economic independence? What are the thoughts, feelings and

situations that stifle hope, and the willingness to commit to one’s own recovery? With this

batch, recovery for us has moved beyond mere discharge, job development and support and

independence to also more closely encapsulate what the women want/ need for the

development of meaning and purpose in their lives. We have, with this batch moved beyond

what we understood once as essential to recovery, to include what the women wanted to and

needed to know about; discussing topics of sex, sexuality, gender, oppression, biology,

reproduction, family as a concept, a construct, a need; illness and diagnosis – what does it

actually mean? What happens to me when I ‘flip’? Together, we have explored topics like

mental illness and gender, mental illness as a continuum, and not an end in itself. The women

chose to explore what Advocacy would mean for them - how does my voice become

powerful? How do I bring a change in society? Where do I share my story? Time and time

again the women have asked us – ‘ Is this all that I can expect to have in my life?’ (Kya

humare zindagi mein yahin hona hai?) This is response to failing relationships and non-

acceptance; this with regard to their struggle to stay afloat, earn and save in a society that

values looks, certificates, and family above all else. The struggle is for the women, to

continually work towards what they have absorbed to mean for their ‘ideal’ self

With the Global Mental Health summit held at TISS in November 2015 by the Centre for

Health and Mental Health, some of our women who attended met more people from within

the user-survivor movement, and heard them share their stories of recovery. This was an

‘aha!’ moment for them - Can it really be that mental illness can happen to ‘bade log’?

(roughly translated it means ‘big people’- the term is used to mean the rich, or educated;

people with an advantage) Can mental illness happen to people who have never gone to the

Regional Mental Hospital Thane? And mostly, there was this feeling that ‘I’m not alone,

others have done this. I can do this’.

Just observing and listening to other people talk about surviving psychiatry, and

homelessness made a huge dent in stigma that day – the stigma internalised by the women,

that feeds their negative self talk.

From this experience alone, we see the need for a coalition or united front for

consumers/users/survivors of psychiatry, that being part of a larger identity could be

empowering to the women to turn over social constructs in their head and stand atop them, to

be tall and straight and confident.

With Batch 4, we have grown, our understanding of service provision in mental health

recovery has deepened and widened. The questions remain though – how do we bring in

concepts of recovery that are part of academic and global discourse into the realm of service

provision? With Batch 4 we also understand the need to invest in a human resource for

mental health interventions, to build a solid team in order to truly meet the needs of all the

clients.

OUR OTHER ENDEAVORS:

Snehasmaelan at RMH, thane:

This year, our women were felicitated at the Annual

Day event at RMH, Thane on 25th

February 2015.

The chief guest at the event was Mr. Sushant Shelar,

a popular Marathi actor. The women were thrilled to

have the chance to meet Mr. Shelar and speak

openly about their journeys in front of such a large

audience. The women were invited by the hospital

staff, particularly the Occupational Therapists. We

worked to prepare each of our women to stand in

front of a crowd. An important theme that we

discussed was the nature and politics of disclosure and empowerment.

This was a wonderful opportunity for our women to begin exploring their role as role models,

and mental health advocates in the field.

World Mental Health Day: 10th

October 2015:

The theme for the Mental Health Day was Dignity.

Tarasha believes in upholding the dignity of each

woman we work with and this was a wonderful

opportunity to talk about dignity within the

community in which we work, with other service

providers.

The questions we wished to pose was ‘What does

dignity mean to the women we work with’? ‘How

do we bring in dignity in the process of recovery

through our work?’ ‘How do we as service

providers

understand Mental Health and Mental illness?’

‘What does recovery for us truly involve?’

We began the day by talking about our partnership

with the Regional Mental Hospital, Thane, and by

talking about our work. The participants were

representatives of all service provider groups in the

hospital, including psychiatrists, occupational

2The plant, presented to Dr.Shirsat, the

Superintendent at RMH, Thane, is a symbol of the partnership between Tarasha and the hospital.

3 Can you hear the Beat?

therapists, social workers, ayahs, ward attendants and nurses.

We facilitated discussion and interaction amongst the group using the tools we use in the

therapeutic space, including a drum circle for forty participants, art and drama.

Dr. Shubhada Maitra, the Project Director of

Tarasha also talked about the work leading to the

genesis of Tarasha, and the importance of

incorporating and maintaining dignity in the process

of recovery as service providers.

The women also talked openly about what mental illness meant to them; their journeys and

experiences with psychiatry and mental health services. Many of them highlighted the

experience of lack of control and voicelessness.

The women highlighted their journey with

Tarasha, how the power dynamics have changed in

the course of their recovery and talked about how

dignity has come into the process of recovery and

deconstructed what dignity meant to each one of

them.

5Exploring treatment options, dignity - through drama.

6How does Dignity translate into Service Provision

on field?

4Enacting: How do we understand Mental Illness?

7What does Dignity mean to me?

FIELD PLACEMENTS AND INTERNSHIPS:

In the long run, Tarasha strives to address stigma attached to mental disorders, through a

comprehensive, community-based recovery programme. This model emphasizes capacity-

building of existing institutions and networking and partnering with NGO’s. To this end, the

project provides internship and fieldwork placement opportunities to students of various

institutions. The main aim is to create a space and platform for learning, development,

sensitization and growth of young professionals in the field; A space where they can

contribute their skill and explore the idea of reintegration, mental disorders and

institutionalisation from a gendered perspective.

This year we had two groups of fieldwork students from TISS, second year students of the

School of Social Work, pursuing their M.A. Social Work in Mental Health. The students

were given an opportunity to understand the importance of social support, the environment,

and identity and citizenship rights in the process of recovery.

ACHIEVEMENTS:

When we look back at the last 5 years, which we consider the pilot phase, we find it

necessary to explicitly list our achievements during this period:

➢ Establishing proof of concept: Over the last few years we have shown that women

who have been living in mental health institutions needn’t remain there on account of

having no family support, we have shown that these women can rebuild their lives,

when the three cornerstones of psychosocial support, shelter and livelihoods are

linked

➢ Meaningful partnerships with community-based organisations: We have built strong

relationships with the Directorate of Health Services, Maharashtra, The Regional

Mental Hospital, Thane, day care centres, vocational training centres and working

women’s hostels in Mumbai, which add to our primary therapeutic intervention

➢ The therapeutic intervention: Over the years, we have learned much about recovery,

from a rights-based, client-led perspective. We have worked through group and

individual sessions with approximately 100 women

➢ Facilitated the discharge of 4 batches of women since inception

➢ Twelve of the 15 women discharged are maintaining recovery over the last few years,

and are still supported by the project in terms of psychosocial needs

➢ The women are currently employed in hospitality, house-keeping, printing

technology and retail and sales sectors

➢ The women are living in mainstream spaces, managing their own cost of living

➢ They have moved from ‘persona non-grata’ / undocumented persons to persons

having an identity beyond a diagnosis and case number

➢ Tarasha has managed to procure Aadhar cards, PAN cards and bank accounts for all

our women

CHALLENGES:

➢ ‘UNDOCUMENTED PERSONS’ AND CITIZENSHIP: Perhaps the biggest

challenge that we face is in terms of acquiring any sort of legal documentation. The

women we work with are most often picked up by the police and admitted to the

RMH, Thane and have spent years away from their families. If at all they do

remember their addresses, the relatives have either moved or have removed their

names from documents like ration cards or misplaced them. Thus our women end up

with no legal identity, no permanent address proof and no certificates. Already in a

marginalised, stigmatised group owing to their mental disorders, recovery and access

to social institutions and benefits dwindle due to the lack of documentation. Job

procurement is tough in this situation, as is the process of opening bank accounts.

Housekeeping is one rare sector that did not require any minimum educational criteria

for employment and does not demand educational documents. However even they are

beginning to ask for educational certificates making procuring employment

opportunities for our women more difficult. In addition, we do not want it to seem

like the only avenue available to our women exists in the housekeeping sector.

➢ EDUCATION: Most of our clients have had no formal education to speak of. In this

case, the entire process of reintegration is compounded by the clients’ inability to

read. However, to mitigate this we are creating in-house curriculum/ modules to build

literacy. However, there is a need to have more spaces where women can learn and

grow at their own pace.

➢ STIGMA: The central tenet of psychosocial and vocational support and development

is clients’ choice and shared decision-making. But in the Indian context, women are

often deprived of the right to voice opinions and make independent choices. Once

diagnosed with a mental disorder, the culture of silencing them and not letting those

articulate concerns is only amplified in psychiatric practice. In the later years of their

lives, when the label of a mental disorder segregates the women and robs them of

social supports, the women are suddenly expected to choose a vocation that will make

them independent. Such a decision is then seen by them as more of a burden than

liberating. Autonomy and the power to take decisions independently cannot be

achieved overnight. It is a process that needs constant guidance, support and

encouragement from the professionals. In Tarasha, it starts with small steps like

allowing the women to take charge of their daily lives by performing routine activities

like travel and money management.

Our women do not wish to disclose their histories to their employers. They feel that

sharing their history of the disorder at work place will continue the stigma and

discrimination that they have been subjected to over the years. This is because not all

employers are well informed about the realities of living with mental disorders and

disclosing the disability often leads them to attribute clients’ behaviour at workplace

to symptoms rather than attributing it to the situational context.

While we believe that the ‘Personal is Political’, we do not want to violate women’s

right to confidentially. Disclosing clients’ disability to the employer can be carried out

only with the clients’ consent. Therefore, we find it essential to engage with our

women on the issue of disclosure of disability at work place and discuss the pros and

cons of it. Clients are also informed that disclosure can be done in varying degrees.

Employers may be given partial information and not necessarily complete details of

the disorders. Disclosure of disability becomes important because it allows mental

health issues to take centre-stage in the outside world; for co-workers to challenge

their own myths about people with mental disorders and extend support and empathy

to facilitate acceptance and recovery. It also gives an opportunity to educate

employers by clarifying myths and misconceptions of mental disorders and help them

make the work environment supportive and nurturing. Feedback from employers to

review clients’ progress is valued and clients are encouraged to make a constructive

use of the feedback given.

Tarasha is working towards raising awareness among the women, as well as the

larger society, for the need to take a political position on mental disorders. The

women are beginning to realize that their journey of personal empowerment has the

power to challenge and change societal myths related to mental disorders and

therefore need to be highlighted and spread across the macro level. However, it will

take time for the women to get comfortable in sharing their histories with the society

and showcase that experiencing mental disorder has not been a deterrent in achieving

a healthy and productive life.

➢ FUNDS: Given the limited amount of funding for mental health in general in India,

funds of Tarasha are also limited. Meeting the basic needs of our women with the

existing resources of the Project is quite a struggle, not to mention our plans for

expansion and making the work meaningful at a larger level.

ACKNOWLEDGEMENTS:

As reintegration into the community and employment is known to promote mental health, it

is necessary to help women recovering from mental disorders to make their transition from

mental health institutions into the community through a gradual process that requires constant

support and cooperation from diverse stakeholders at different stages.

We acknowledge the support and valuable contribution of our partners and our advisory

board in this journey over the last two years.

Our Partners

1. Directorate of Health Services, Maharashtra

2. Regional Mental Hospital, Thane

3. Nagpada Neighbourhood House, Byculla

4. Sukh Shanti Hostel, Association for Social Health in India

5. Manav Foundation

6. Kotak Education Foundation

Advisory Board

1. Dr.Anuradha Sovani, Psychologist and Psychotherapist, Professor and Head,

Department of Psychology, SNDT Women’s University, Mumbai.

2. Dr.Nilesh Shah, Head, Dept. Of Psychiatry, L.T.M.G. Hospital

3. Ms.Binaifer Jesia, Director, MANAV Foundation.

4. Prof. Surinder Jaswal, Professor , Dean, Centre for Health and Mental Health,

Research and Development, School of Research Methodology, School of Social

Work, TISS

5. Dr.Monica Sakhrani, Associate Professor, Centre for Social Justice and Governance,

School of Social Work, TISS.

6. Prof. S. Parasuraman, Professor, Director, TISS.

Our heartfelt thanks to:

❖ Dr. P.S. Jhaver, our primary donor

❖ Ms.Poornima Nasare, for her generous donations to Tarasha

❖ Director, Health Services

❖ Dr. S. Kumawat (Retired, Deputy Director, Director of Health Services, Maharashtra)

❖ Dr. R. Shirsat, Medical Superintendent, Regional Mental Hospital, Thane

❖ Staff of the Regional Mental Hospital, Thane

❖ Ms.Vidya Bhambhal, Director, Nagpada Neighbourhood House

❖ Ms.Maharukh Adenwalla, Lawyer

❖ Ms.Preeti Shah, Committee member of ASHI

❖ Ms.Anjali Gokarn, Committee member, ASHI

❖ Ms.Rajeshwari Panickar , Superintendent, Sukh Shanti Hostel

❖ Ms. Suchita Rege, Cluster Co-ordinator, Kotak Education Foundation

❖ Mr. Michael D’souza, Centre Co-ordinator, Kotak Education Foundation

❖ Ms. Nisha, Centre Co-ordinator, Kotak Education Foundation

OUR TEAM

Shubhada Maitra, Ph.D - Project Director, Professor, Centre for Health and Mental Health,

School of Social Work, TISS.

You can e-mail her at: shubhada@tiss.edu

Ashwini Survase – Counselor

Ashwini has a Master’s degree in Counselling from Tata Institute of Social Sciences,

Mumbai. She has been working in the field of Mental Health for the last 3 years. Prior to

Tarasha, she has worked as a counsellor at Kshitij Mental Health Centre, a day care setting.

Her interest areas include mental health, gender, and marginalization.

Rosanna Rodrigues – Social worker

Rosanna has completed her Masters in Social Work from Tata Institute of Social Sciences,

Mumbai. She is also a certified Arts-based Therapist, having trained with WCCLF, Pune. Her

interest areas include Mental Health and Gender.

If you want to contact us, donate towards the project or need more information about

our work, you may contact us at tarasha2011@gmail.com. Donations could be made in

cash/ cheque in favour of Tata Institute of Social Sciences. You can also donate towards

our women in terms of their monthly supplies/clothes. Please ensure that the products

you wish to pass on are new, and in good condition.

Visit our facebook page at: www.facebook.com/TarashaFAP

We look forward to hearing from you!