Why are we implementing INCENSE?
Historically, mental hospitals have been isolated and stigmatised. There is a broad consensus that they need to adapt, making them serve people better by helping them to integrate into the wider community.
However, there is no acceptable and feasible framework to guide this change. Through this program, we hope to address the gap between what ‘should happen’ and actual implementation by developing a blueprint for action for mental hospitals across India to redesign their roles and become an integral part of a holistic, community based mental health care systems in India.
Whom do we intend to work with?
The INCENSE programme will focus on two key groups of vulnerable persons with severe mental disorders.
The first group comprises persons who have been in hospitals for long periods of time due to lack of appropriate community discharge options or access to community services.
The second group comprises persons who are not in receipt of any care. Here we will focus on those who are homeless and those who are untreated and, sometimes, physically restrained at home.
Why work with these persons?
The consequences for people in these situations are catastrophic from both health and human rights perspectives.
These individuals comprise an ultra ‘high risk’ group for experiencing multiple adverse health consequences (high mortality and morbidity due to malnutrition, infectious disease like TB and HIV/AIDS, reproductive health problems, other disabilities etc).
Equally importantly, they are subjected to extreme forms of violation of their human rights in the form of verbal, physical and sexual abuse, exclusion from social structures and the denial of their rights of citizenship.
Principles of the programme
  • To provide the conditions and capabilities to promote recovery for vulnerable persons with severe mental disorders
  • To promote social inclusion and empowerment of persons the program will work with
  • To promote human rights and dignity for all persons with severe mental disorders through appropriate support and services
Goal and objectives
The goal is to systematically develop and implement a framework for an integrated community based approach for vulnerable persons with severe mental disorders around two of the largest and oldest mental hospitals in India – in Pune, Maharashtra and in Tezpur, Assam.
The main objectives of the programme are:
  • To develop an effective coalition of partners, from various sectors, at both sites for implementing the program with increasing local ownership
  • To carry out a systematic situation analysis, involving a wide and representative range of stakeholders, to determine the needs and available resources of vulnerable people with SMD
  • To develop a comprehensive package of social and clinical interventions based on scientific evidence and the findings of the situation analysis
  • To implement and evaluate the feasibility and impact of the interventions
How will we realise these objectives
The INCENSE programme is being developed in phases. In the first phase, we developed the programme human resources and partnerships with local agencies in the government, non-government, academic and corporate sectors. Key network partners were then be invited to be part of the local advisory and implementation groups at each site. We also conducted a situation analysis of the needs, aspirations and resources for persons with severe mental disorders as the basis for developing the framework of the interventions.
In the second phase, we implemented the collaborative interventions to promote independent living capabilities, moved persons with severe mental disorders who were ready to supported community housing, developed livelihood options in collaboration with programme partners, promote social inclusion and citizenship rights as well as provide community based services.
In the final phase, we wish to evaluate the impact on the intervention, disseminate the findings widely and make the necessary arrangements for the sustainability of the program.
The project is working with an increasing number of people with severe mental disorders to aid their social and economic empowerment. It has developed a comprehensive package of social and clinical interventions to address the needs of chronically institutionalised patients and the homeless mentally ill.
The package is being implemented at both sites, with around 646 people with severe mental disorders having received services so far. It has been evaluated by independent external reviewers as in compliance with the project’s stated goals.
Anticipated outcomes
Through this programme, we will learn important lessons on how to address the needs of the most vulnerable persons with severe mental disorders and how mental hospitals can transform into community oriented institutions which actively promote inclusion and recovery.
Ultimately, these lessons will offer a blueprint for action for mental hospitals across India to redefine their roles within a public health, and social inclusion and justice framework.
For more information, contact:
Dr Sudipto Chatterjee, Sangath Centre, Porvorim, Goa 403521, India