An Academic Discourse to Understanding and Addressing Psychological Trauma in a Population of Homeless Persons with Severe Mental illness in India

This thesis addresses an important, yet neglected topic of the experience of trauma in vulnerable populations with severe mental illness and how to address it in a culturally sensitive means that is appropriate for the local context. Using a case study of the Banyan, a mental health NGO based in Tamil Nadu that provides mental health services to populations of destitute men and women with severe mental illness across India, the study takes a transdisciplinary--Interactive Learning and Action approach to unravelling the complex unstructured problem of understanding and addressing trauma in this population of user-survivors. The thesis consists of five articles that have either been published or are under review for publication in peer-reviewed academic journals. The first is a systematic review that provides an overview of PTSD in India, which highlights the gaps in the research, including a focus on vulnerable populations. The second paper addresses user-survivor conceptualizations of trauma, discussing types of events considered traumatic, associated symptoms, and coping mechanisms of trauma-- revealing an important notion that while there is overlap with DSM criteria for PTSD, the experience of trauma in the local context goes beyond the DSM categorization. Paper 3 discusses the different perspective of mental health professionals on addressing trauma in vulnerable persons with severe mental illness, ending with a design workshop that prioritizes the steps needed to make an institution such as the banyan more trauma informed. Paper 4 is the focal point of one of these prioritizations, which is the development of culturally sensitive means to asking about trauma. More specifically, this paper discusses the steps taken to culturally adapt the commonly used Trauma History Questionnaire for use in vulnerable persons with severe mental illness in Tamil Nadu. Paper 5 extends this discussion further by presenting the results of piloting the newly adapted screening tool in a population of user-survivors, and provides provider and user-survivor feedback on the applicability, usability and acceptability of the newly adapted tool. The thesis concludes by highlighting six key findings and a discussion on the learnings made in regards to making an institution more trauma informed in the context of homelessness and severe mental illness in India.