Mental Health recovery Narratives among Homeless Women in Eclectic Mental Health System in Kerala, India: A Feminist Inquiry

Over the past decade, international mental health policies have seen a paradigm shift from the traditional clinical to a recovery-oriented model. Reflecting this change, India introduced mental health policies that draw on an ethnocentric Euro-American recovery model (Slade, 2009). Its appropriateness in a socio-centric and eco-centric India has been questioned. Uncritical adoption of these models may occlude the significance of India's pluralistic mental health system and its intersectionalities.
The Indian State of Kerala, known as 'the Mecca for alternative medicine', is a prominent site with a range of therapies under three healing systems (Halliburton, 2009) psychiatry, Ayurveda and faith healing. Although based on different ontologies and epistemologies, an interface exists between these systems.
Health seeking in Kerala is multifaceted with people resorting to multiple healing systems simultaneously. In relation to intersectionality, women, especially those within the mental ill health-poverty-homelessness nexus (Gopikumar et al., 2015), are largely left unattended. They are mostly institutionalised in chronically under-resourced psychiatric or non-psychiatric facilities, beggars' homes, or live on streets.
This study will capture homeless women's 'subjugated knowledges' to reveal the dynamics of vernacular conceptualisation and facilitate cultural redefinition of recovery from a feminist perspective. These alternative definitions will reflect the intersections of social and material forces in shaping recovery.
The Indian mental health system is highly gendered (Anand, 2020). Homeless women's visibility within this system has been increasing. However, the interface between the three healing systems and their implications for women's recovery has not featured in mental health discourse. Studies on recovery (Mathias et al., 2018), multiple healing systems (Smith, 2006) and their interface (Halliburton, 2009; Chakravarty, 2015), have not addressed the gendered nature of these systems. Literature on homeless women has explored individual healing systems (Davar, 2020). It reveals the mental ill health-poverty-homelessness nexus (Gopikumar et al., 2015) where women lack agency and face human rights violations (Human Right Watch, 2014). However, these women's recovery within the eclectic healing system is largely unaddressed.
Research Questions
1. How do homeless women with mental health issues conceptualise their lived experiences of mental health recovery as they engage with the eclectic mental health system in Kerala?
2. How do the life stories of homeless women with mental health issues (a) influence and (b) be influenced by mental health policy?
Objectives
1. To characterise vernacular concepts of mental health issues and recovery used by these women and practitioners from the three healing systems;
2. To explore the interface between approaches used in the three healing systems from the perspective of these women and practitioners from the three healing systems;
3. To understand how these interfaces influence recovery narratives of these women through a feminist life history perspective;
4. To critically explore the historical and contemporary representation of homeless women in Indian mental health policy from a feminist perspective;
5. To formulate recommendations to inform recovery-oriented policies and practices to aid mental health recovery of homeless women.
Methodology
The study takes a constructivist approach to understand the meanings of mental health issues and recovery among homeless women in Kerala's mental health system. The field work will be conducted overseas in Kerala, India by the student. During the field work multiple methods (first-person narrative interviews, informal conversations, observations) will be used to accommodate multiple realities focussing on the context-dependent findings.