Mental health care: The Banyan shows the way forward

Advocacy for the rights of the mentally ill has been spearheaded by The Banyan


The Banyan began in 1993, as a daredevil idealistic plunge by two college girls, Vandana Gopikumar and Vaishnavi Jayakumar, to rescue homeless mentally ill women walking the streets of Chennai. Thanks to their readiness to experiment and innovate, with an enthusiasm and confidence that only youth provides, today The Banyan is an NGO with a pan-India vision for better mental health for the nation; and what is more, even the WHO and governments across the globe are taking note.

The Banyan’s founders were quick to realie that one Banyan could scarce solve the problems of India’s homeless mentally ill, who numbered 1.94 million as per the 2001 census. Working on raising awareness about mental health particularly in generation next, in 2007, they launched the Banyan Academy for Leadership in Mental Health (BALM), with the support of the Tata Institute of Social Sciences, offering masters courses and a PhD programme in mental health related subjects to train a generation of mental health professionals sensitized to the needs of the homeless mentally ill.

Next, extending to mental health care, the successful Sathya Sai healthcare model’s concept of ‘Triple S partnership of ‘sanstha-sarkar-samaaj’ ( dedicated institutions-government-civil society), to provide competent and compassionate care totally free of cost to the needy, The Banyan launched a blitzkrieg of successful networking; with like minded NGOs across the country, the state and central governments and mental health institutions like the IMH of Chennai, NIMHANS and IHBAS.

Innovative services for the homeless mentally ill followed. Addressing the lack of access to mental health services, free outpatient services; both in the rural and urban sectors were set up. A model urban outpatient service runs in partnership with the corporation of Chennai and a rural outreach service runs in the Kancheepuram District rural hinterland. The rural health centre has a small 12 bedded hospital attached as well. More such health centres are coming up in Kerala and Maharashtra where The Banyan has a presence.

The treatment of mental illness is also changing; confidentiality and secrecy are giving way to ‘Open Dialogue’ at the Chennai Banyan. The patient is king; no decisions are made without the patient’s consent. At the outpatient services provided, the entire gamut of family, neighbours, friends, The Banyan team of social workers, counsellors, clinical psychologists and psychiatrist form a support group for the patient and family. Treatment decisions are made by consensus and with the patient’s consent as far as possible except when the patient is a danger to his/her life or to others.

Advocacy for the rights of the mentally ill has been spearheaded by The Banyan. Thanks to The Banyan’s efforts mental disability has been included in the Disability Act and those with mental disability are eligible for benefits due to the disabled. The Banyan ensures that they have Aadhaar cards and bank accounts. Right now the residents of The Banyan are excitedly getting ready to vote in the Tamil Nadu assembly elections.

What next, after the homeless mentally ill got better, was the million dollar question. Determined to do away with institutionalisation, The Banyan went all out to reunite the mentally ill with their families; rehabilitating them, offering all support possible to the families, which included even sending them medicines free of cost. Many of the women were thus back home. However, over half had nowhere to go.

Two innovative and highly successful de-institutionalisation programmes have been The Banyan’s Cluster Group Homes (CGH-s) and Home Agains (HA-s). At a CGH, around 8 to 10 women who have recovered and need only maintenance therapy, stay together like a ‘family’ in premises rented by The Banyan for them. A trained volunteer social worker from the community doubles as a friend who drops in daily, ensures compliance with medication and is the hot line to The Banyan. Weekly visits by a psychiatric nurse and monthly reviews with the psychiatrist continue. Home Again is for those who need daily long term care; a live-in trained caregiver stays with 8 to 10 women in premises rented by The Banyan. The family spirit is maintained and the women end up looking after each other. The Banyan umbrella ensures regular monitoring and therapy.

The response from the neighbourhoods has been amazing. The women become part of the village, the festivals, shopping trips, wedding festivities what not. Inclusiveness happens naturally, when one has a home of one’s own, no matter even if it is rented. What is more, the village women welcome the employment opportunity. Young women opt to get trained and work as volunteers and community social workers. Along with Tata Trust institutions, courses have been worked out for young women who have studied up to class 10; vocational education and employment avenues open up for young rural women thanks to The Banyan, which has thus successfully demonstrated that de-institutionalised care works; even for the homeless chronically mentally ill.

The latest challenge taken up by The Banyan is the provision of emergency mental healthcare services to help the homeless mentally ill who wander our streets. Working again on the ‘Triple S' model, with the support of the National Health Mission and the state government and civil society ECRCs (Emergency Care and Recovery Centres) are coming up in every district of Tamil Nadu. Local youngsters trained in mental healthcare, handle acutely disturbed patients as well as patients with chronic mental illness out on the streets. In a very hands-on manner, The Banyan is creating awareness about mental health among the youth and providing training and employment to many rural young women and men. All services are provided free of cost to the patients.

Working seamlessly with law enforcement agencies, the police, local hospitals and local government and the judiciary, these trained rescue workers bring the mentally ill to the Emergency Care and Recovery Centre; and then the long process of treatment and rehabilitation begins.

The most enthusiastic supporters of The Banyan’s innovations are the students at BALM, who, like their mentors Vandana and Vaishnavi, dare to dream big; their vision is—ECRC-s , Mental Health Outpatient Clinics, CGH-s and HA-s—in every district of India in the next decade.

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