A few years ago, I was just another face in a ward, confined within the four walls of the hospital. The ayahs would say that if I got out, I wouldn’t be able to survive,” says Purvi Khetan, 35, who spent six years at the Regional Mental Hospital in Thane. But she is out now, and earning a living on her own at a working women’s hostel in Mankhurd in Mumbai. She is still wary of strangers, but her face brightens as she talks about her job at a printing press, her “decent” savings from the last two years, and shopping trips with her friends. Six years ago, the Kanpur girl was picked up by the police from a railway station in Mumbai. She could not remember how she reached the city, and, initially, had no recollection of her family. She was taken to the Thane Mental Hospital and diagnosed with schizo-affective disorder, a condition characterised by abnormal thought processes and disorganised emotions. Today, she is one of 10 women reintegrated into society under Tarasha, a project of the Tata Institute of Social Sciences (TISS) that began in June 2011. The project works with women with mental disorders, many of whom have been abandoned by their families.
Tarasha emerged in response to the findings of a study conducted by Shubhada Maitra, professor at TISS and the project director of Tarasha, on the condition of women in mental hospitals in Maharashtra. The 2002 study showed that many of these women were growing old in institutionalised settings, despite no longer displaying any symptoms of illness, solely due to the lack of family support. The project aims to foster financial and emotional independence, and since its inception, 11 women from Thane Mental Hospital have been selected for the project. Ten have returned to mainstream life, all between 21 to 40 years of age, with little or no formal education and no family support. They had been diagnosed with schizo-affective disorder, chronic schizophrenia and bipolar disorder, among others.
The Tarasha staff came across Khetan in 2011. She had no formal education; she could just about read and write Hindi, and could understand a smattering of English. “Initially, we concentrated on building a rapport with her. It was followed by group sessions on communication and behaviour and several individual sessions on issues such as managing stress, anger and anxiety. The entire process took over a year,” says Ashwini Survase, her counsellor.
Khetan and two of her contemporaries undertook a six-month training programme at the School of Vocational Education, TISS, for printing technology. “It’s very difficult to come out of a (mental) institution. But I gradually started believing in the programme. I was encouraged to write about my emotions and that helped,” says Khetan. She also had to relearn social skills — make eye contact, learn to assert herself, negotiate space, manage money and personal hygiene and work on self-motivation. She stayed in one room at the hostel with five others, learning to adjust to a life outside a mental health institution. Khetan has recently received a pay hike at work. “I still feel unsure when I have to travel by train. The crowd can be unsettling, but I am gradually overcoming my inhibitions. I want a better job,” she says. In November 2014, at her behest, the Tarasha team accompanied her to Kanpur and traced her mother-in-law and son, who is now 10 years old. After an emotional reunion, she returned to Mumbai. “I want to earn for them and give them a better life. It feels good to be of use to my family,” says Khetan.
Meghna Verma, 36, is Khetan’s colleague at the printing press and lives in the same hostel. Verma too was found at a railway station with no memory of how she reached there. Diagnosed with mild MR (mental retardation), she spent nine years at the mental hospital before Tarasha offered her a way out. Verma says she needs more time before she is confident enough to meet her three sisters and two brothers in Delhi. She retains a memory of an abusive and alcoholic husband; neither he nor her siblings have ever come to meet her at the hospital. Social workers tried to contact them but found the house locked and no forwarding address.
Energetic and vivacious, Verma enjoys dressing up and is keen to better her social interactions. At the hospital, she utilised her time as a “helper patient”, by assisting other patients or helping the doctors or ayahs in distributing medicines. “At the hospital, one did not know what was happening outside. We could not do things of our choice and, most importantly, we had no support system,” she says.
When she was selected for Tarasha, Verma worked hard. With no formal education, she would spend hours learning how to read and write. Survase worked with her during a period of psycho-social intervention and through vocational training. “The written exam was the toughest hurdle, but I cracked it and got my certificate. I now earn Rs 6,000 per month and it feels good to pay for my own things. I can buy what I want to, eat what I want to,” says Verma.
The process of reintegration involves several stages. An initial rapport is established at the hospital, where the women are engaged through therapeutic group sessions. Later, women are shortlisted by the team and counselled individually on specific issues, while obtaining feedback from other stakeholders in the hospital. Once discharged, the women attend a day-care centre for “psychosocial rehabilitation”. The next stage is vocational training, after which the women look for work, and once financially stable, Tarasha slowly withdraws financial support. It continues to provide support if a woman requests it, and follows up with the older clients to check on their progress.
The transformation of 38-year-old Ramya Shukla — an introvert diagnosed with schizo-affective disorder to a worker in the hospitality sector — has been remarkable. Born and raised in Mumbai, Shukla was abandoned at the hospital after her parents’ death by her paternal aunt, who did not want to take charge of her and her two siblings, all of whom suffer from some degree of mental illness. Though she had passed Class X, Shukla did not talk much and did not have the necessary skills to communicate with others. “From such a situation, I have managed to stand on my own feet. I’ve been earning for nearly two years now. I don’t want to dwell on the years spent at the hospital. I am responsible for my own actions now and I want to do more and achieve more in life,” she said. She now lives at a Byculla hostel, and visits her brother and sister in Navi Mumbai.
The challenges that the world outside pose are numerous. How does a person used to a life in confinement travel in a local train? “When I joined the programme in July this year, I was scared to venture out on my own and board a local train. The team at Tarasha spent hours, teaching me how to board a train, drawing maps for me. Eventually, I was no longer scared. It has been my first step towards independence,” says Smita Mehra, 38, from Rajasthan, who has spent the last eight years at the Thane hospital, after being diagnosed with Brief Reactive Psychosis. She has recently completed a round of psychosocial rehabilitation and is currently undergoing vocational training. Mehra had come to Mumbai to earn a living and was found in an unconscious state near a medical shop before she was transferred to the hospital. While her parents and husband have passed away, she recollects that she has children, whom she had placed in a hostel with the help of her sister. Her sister, however, could not be traced at the address given by Mehra.
Like Mehra, 30-year-old Ritu Sharma says that even though she has come a long way from her hospital days, there are moments of uncertainty and a fear of getting lost in Mumbai. “I have learned how to travel short distances,” she says. Extremely shy by nature, Sharma now recognises some of the platforms, but still finds it difficult to read the boards on platforms. “I have to learn a lot, but I feel happy now. Though I am still unsure what vocation I want to learn, I am excited. I can’t wait to start earning,” she says.
They are some of the hundreds of women who lack adequate family and social support and, hence, spend years at the hospital, despite being declared asymptomatic. None of these women, say the Tarasha team, want to disclose their illness to their employers or peers for fear of discrimination. “Their challenges are many, and the lack of documentation, be it educational certificates or any identity proof, a pre-requisite for employment, is one of the biggest. Given years of institutionalisation and no family support, procuring any sort of documentation is exceedingly challenging,” says Rosanna Rodrigues, social worker from team Tarasha.
The women, however, believe that the biggest challenge is to convince society that those suffering from mental disorders should not be ostracised from the mainstream. “To all those who thought I would not survive outside the hospital, the fact that I am earning and own a mobile phone is the answer,” says Khetan.
(Names of the women have been changed to protect their identity)