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

在过去的十年中，国际精神卫生政策已经从传统的临床模式转变为以康复为导向的模式。为了反映这一变化，印度引入了借鉴以种族为中心的欧美复苏模式的精神卫生政策（Slade，2009年）。它在以社会为中心和以生态为中心的印度的适当性受到质疑。不加批判地采用这些模式可能会掩盖印度多元精神卫生系统及其交叉性的重要性。印度的喀拉拉邦被称为“替代医学的麦加”，是一个著名的网站，在三个治疗系统（Halliburton，2009年）精神病学，阿育吠陀和信仰治疗下的一系列疗法。虽然基于不同的本体论和认识论，这些系统之间存在一个接口。在喀拉拉邦寻求健康是多方面的，人们同时诉诸多种治疗系统。关于交叉性，妇女，特别是处于精神病-贫困-无家可归关系中的妇女（Gopikumar等人，2015年，基本上无人看管。他们大多是制度化的长期资源不足的精神病或非精神病设施，乞丐之家，或living on streets.This研究将捕捉无家可归的妇女的“征服的知识”，以揭示白话概念化的动态，并促进从女权主义的角度对恢复的文化重新定义。这些不同的定义将反映社会和物质力量在塑造复苏中的交叉点。印度的精神卫生系统是高度性别化的（Anand，2020）。无家可归妇女在这一系统中的可见度不断提高。然而，这三个治疗系统之间的接口及其对妇女康复的影响并没有出现在心理健康的讨论中。关于恢复的研究（Mathias等人，2018年），多重治疗系统（史密斯，2006年）及其接口（哈里伯顿，2009年; Chakravarty，2015年），没有解决这些系统的性别性质。关于无家可归妇女的文献探讨了个人治疗系统（达瓦尔，2020）。它揭示了精神疾病-贫困-无家可归之间的联系（Gopikumar等人，2015年），妇女缺乏机构，面临人权侵犯（人权观察，2014年）。然而，这些妇女在折衷治疗系统中的康复在很大程度上没有得到解决。如何无家可归的妇女与心理健康问题概念化的心理健康恢复他们的生活经验，因为他们从事与折衷主义的心理健康系统在喀拉拉邦？2.有心理健康问题的无家可归妇女的生活经历如何（a）影响和（B）受心理健康政策的影响？目标1.从三个治疗系统的这些妇女和从业人员使用的心理健康问题和恢复的本土概念;2。从这些妇女和三个治疗系统的从业者的角度探讨三个治疗系统中使用的方法之间的接口;3。透过女性主义生活史的观点，了解这些介面如何影响这些女性的复原叙述。从女性主义的角度批判性地探讨无家可归妇女在印度精神卫生政策中的历史和当代表现;制定建议，告知恢复为导向的政策和做法，以帮助无家可归的women.MethodologyThe研究采取建构主义的方法来了解无家可归的妇女在喀拉拉邦的心理健康系统中的心理健康问题和恢复的意义。实地工作将由学生在印度的喀拉拉邦进行。在实地工作期间，将使用多种方法（第一人称叙述式访谈、非正式对话、观察）来适应侧重于依赖于背景的调查结果的多种现实。

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 Questions1. 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?Objectives1. 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.MethodologyThe 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.