Medical Student Studies Homeless Women in India | Loyola Medicine
Thursday, December 11, 2014

Loyola student documents how homeless, mentally ill women face a vicious cycle in India

MAYWOOD, Ill. - An award-winning study by a Loyola University Chicago Stritch School of Medicine researcher has documented how homeless, mentally ill women in India face a vicious cycle:

During psychotic episodes, they wander away from home, sometimes for long distances, and wind up in homeless shelters. They then are returned to their families before undergoing sufficient psychosocial rehabilitation to deal with their illness. Consequently, they suffer mental illness relapses and wind up homeless again.

“The study illustrates how there must be a balance between reintegrating homeless, mentally ill women with their families and achieving a psychiatric remission first,” said study author Anita Rao, who presented her findings to the University of Oxford’s 2014 Mental Health Conference: A Global Focus.

Rao, a third-year medical student at Loyola University Chicago Stritch School of Medicine,
received the prestigious Lancet Psychiatry Poster Prize for her study. Lancet is one of the world’s leading medical journals.

The combination of homelessness and mental illness is a global phenomenon, occurring in rich and poor countries alike. India has a total homeless population of 78 million. It’s unknown what percentage of India’s homeless population is mentally ill. But in the United States, an estimated 20 to 25 percent of the homeless population has a mental illness.

Rao, an Indian American, spent five months studying mentally ill homeless women in the city of Mysore in the state of Karnataka, India. Rao is fluent in Kannada, a language spoken in Karnataka.

Survey findings

Rao surveyed 21 women in a residential facility for homeless, mentally ill women. The surveys were prepared in conjunction with the Indian National Institute of Mental Health and Neurosciences. Information was collected on the women’s socio-demographic variables and psychosocial and familial conditions in four time periods: before the onset of illness, during the course of illness, during episodes of homelessness and after institutionalization. Among the findings:

  • Four women had bipolar disorder, seven had schizophrenia and 10 had psychosis not otherwise specified.
  • The two main developments leading to homelessness were death of a primary caregiver and abandonment by family members.
  • More than half of the women (52 percent) came from states other than Karnataka, including Andhra Pradesh, Maharashtra and Tamilnadu. This illustrates how mentally ill people have a tendency to wander. However, Indian families are reluctant for moral reasons to accept a female family member who has wandered away for a long period of time.
  • The women had relatively short stays in the facility: 10 women stayed 1 to 10 months and eight stayed 11 to 20 months, while only three stayed 21 months or longer. This indicates women were reunited with their families either before they had achieved remission from their illness or shortly thereafter -- regardless of whether they had undergone sufficient psychosocial rehabilitation.

While typically the goal in India is to reunite mentally ill women with their families, the goal in the United States is to find homeless, mentally ill women jobs and housing. But in either case, it’s important that women first receive adequate psychosocial rehabilitation. Such rehab includes classes and group sessions to help patients and families understand the disease and learn skills to deal with stresses that can trigger mental illness episodes, Rao said.

After graduating from medical school, Rao would like to do a dual residency in neurology and psychiatry. Her father, Murali Rao, MD, is chair of the Department of Psychiatry and Behavioral Neurosciences at Loyola University Medical Center.

“He is a role model of the type of physician I would like to become,” Anita Rao said. “He’s very humanistic in his approach to medicine. The patient always is at the center of his practice.”

About Loyola Medicine and Trinity Health

Loyola Medicine, a member of Trinity Health, is a quaternary care system based in the western suburbs of Chicago that includes Loyola University Medical Center (LUMC), Gottlieb Memorial Hospital, MacNeal Hospital and convenient locations offering primary and specialty care services from 1,877 physicians throughout Cook, Will and DuPage counties. LUMC is a 547-licensed-bed hospital in Maywood that includes the William G. and Mary A. Ryan Center for Heart & Vascular Medicine, the Cardinal Bernardin Cancer Center, a Level 1 trauma center, Illinois's largest burn center, a certified comprehensive stroke center and a children’s hospital. Having delivered compassionate care for over 50 years, Loyola also trains the next generation of caregivers through its teaching affiliation with Loyola University Chicago’s Stritch School of Medicine and Marcella Niehoff School of Nursing. Gottlieb is a 247-licensed-bed community hospital in Melrose Park with 150 physician offices, an adult day care program, the Gottlieb Center for Fitness, the Loyola Center for Metabolic Surgery and Bariatric Care and the Loyola Cancer Care & Research at the Marjorie G. Weinberg Cancer Center at Melrose Park. MacNeal Hospital is a 374-bed teaching hospital in Berwyn with advanced inpatient and outpatient medical, surgical and psychiatric services, advanced diagnostics and treatments. MacNeal has a 12-bed acute rehabilitation unit, a 25-bed inpatient skilled nursing facility, and a 68-bed behavioral health program and community clinics. MacNeal has provided quality, patient-centered care to the near west suburbs since 1919.

Trinity Health is one of the largest multi-institutional Catholic healthcare systems in the nation, serving diverse communities that include more than 30 million people across 22 states. Trinity Health includes 92 hospitals, as well as 109 continuing care locations that include PACE programs, senior living facilities and home care and hospice services. Its continuing care programs provide nearly 2.5 million visits annually. Based in Livonia, Mich., and with annual operating revenues of $18.3 billion and assets of $26.2 billion, the organization returns $1.1 billion to its communities annually in the form of charity care and other community benefit programs. Trinity employs about 129,000 colleagues, including 7,800 employed physicians and clinicians. Committed to those who are poor and underserved in its communities, Trinity is known for its focus on the country's aging population. As a single, unified ministry, the organization is the innovator of Senior Emergency Departments, the largest not-for-profit provider of home health care services—ranked by number of visits—in the nation, as well as the nation’s leading provider of PACE (Program of All Inclusive Care for the Elderly) based on the number of available programs.