Architecture For Mental Health Anshikasrivastava

Halfway Homes for the
Deinstitutionalized
Facilitating healing of the healed
Healing the healed through

HalfwayArchitecture
Homes for the
Deinstitutionalized
Guide: Ar. Geevith Raghavan

Fifth Year Semester IX (Part 1)
Anshika Srivastava
Fifth Year B.Arch.
LS Raheja School of Architecture
CERTIFICATE
MUMBAI UNIVERSITY
L. S. RAHEJA SCHOOL OF ARCHITECTURE
This is to certify that Anshika Srivastava has successfully completed her design dissertation (Part 1) on
the topic ‘Halfway Homes for the Deinstitutionalized’ under the guidance of Ar. Geevith Raghavan.
The dissertation is undertaken as a part of academic study based on the curriculum for Bachelors of
Architecture programme conducted by the University of Mumbai, from
L. S. Raheja School of Architecture, Mumbai in the academic year 2018-2019.
Seat Number: OCT18-IX-033
Ar. Geevith Raghavan. :

Thesis Guide
[L. S. Raheja School of Architecture]
Ar. Mandar Parab :

I/C Principal
[L. S. Raheja School of Architecture]
External Juror 1 :
External Juror 2 :
DECLARATION
I hereby declare that this written submission entitled

“Halfway Homes for the Deinstitutionalized”
represents my ideas in my own words and has not been taken from the work of others (as from
books, articles, essays, dissertations, other media and online); and where others’ ideas or
words have been included, I have adequately cited and referenced the original sources. Direct
quotations from books, journal articles, internet sources, other texts, or any other source
whatsoever are acknowledged and the source cited are identified in the dissertation
references.
No material other than that cited and listed has been used.
I have read and know the meaning of plagiarism* and I understand that plagiarism, collusion,
and copying are grave and serious offences in the university and accept the consequences
should I engage in plagiarism, collusion or copying.
I also declare that I have adhered to all principles of academic honesty and integrity and have
not misrepresented or fabricated or falsified any idea/data/fact source in my submission.
This work, or any part of it, has not been previously submitted by me or any other person for
assessment on this or any other course of study.
Signature of the Student:
Name of the Student: Anshika Srivastava

Exam Roll No: OCT18-IX-033
Date: 1st November, 2018 Place: Mumbai
*The following defines plagiarism:

“Plagiarism” occurs when a student misrepresents, as his/her own work, the work, written or otherwise, of any
other person (including another student) or of any institution. Examples of forms of plagiarism include:
• the verbatim (word for word) copying of another’s work without appropriate and correctly presented
acknowledgement;
• the close paraphrasing of another’s work by simply changing a few words or altering the order
of presentation, without appropriate and correctly presented acknowledgement;
• unacknowledged quotation of phrases from another’s work;
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• “Another’s work” covers all material, including, for example, written work, diagrams, designs, charts,
photographs, musical compositions and pictures, from all sources, including, for example, journals,
books, dissertations and essays and online resources.
Acknowledgments
I take this opportunity to express my profound gratitude to the management of L. S. Raheja

School of Architecture for giving me this opportunity to accomplish the design dissertation.
I am grateful to my parents for being my backbone over the five years of this course. Without
their encouragement, guidance and support through all all-nighters, none of this would’ve
been possible.
I thank my friends Gargi Surwase, Savithri Vishnu, Tanvi Sinha, Kosha Shah and Hetvi Vora for
the emotional and academic support throughout this course. What I’ve learnt from you
transcends beyond academics. I thank Ishant Ghai for being an eye-opener about the gravity of
mental illness and suggesting this topic to me. I also thank Ar. Rucha Phadke and Ar. Akshay
Ankalgi for being a guiding light through all things stressful.
I thank my professors through the five years who have helped me build myself into a confident
person who is ready to face the profession.
I thank Dr. Krupali Shah and Vyshnavi Sundar Rajan for offering me insights about mental
health, and opening up about your own struggles. I thank the team of Project Tarasha,
Richmond Fellowship Society, and Dr. Himanshu Singh and Dr. Nimesh Desai from IHBAS,
Delhi for validating my ideas and helping me metamorphose my thesis into what it is.
I am also grateful to my Project Guide, Ar. Geevith Raghavan. for being resourceful, kind and
helpful. His positive attitude, unwavering faith in me helped me overcome all the difficulties
that I faced during the project.
I thank my thesis group- Savithri Vishnu, Purti Hardikar, Shouvik Maiti, Kshitij Janve, Shinaz
Hassan, Dhruvi Zobalia and Yash Munj, for being a great team that has helped time and again,
in making my thesis grow!
Anshika Srivastava| Design Dissertation Part 1

Table of Contents
ACKNOWLEDGMENTS 4
TABLE OF CONTENTS 5
TABLE OF FIGURES 8
PREFACE 9
ABSTRACT 10
AIM 11
OBJECTIVES 11
NEED FOR STUDY 11
RESEARCH METHODOLOGY 12
A. LIMITATIONS TO THE STUDY 13
CONCLUSION 13
CHAPTER-WISE SUMMARY 14
• MENTAL ILLNESS 14
• PERCEPTION OF MENTAL ILLNESS IN INDIA 14
• HALFWAY HOMES 14
• MENTAL HEALTH ADVOCACY THROUGH ARCHITECTURE 14
• EFFECT OF THE BUILT ENVIRONMENT ON THE HUMAN MIND 14
MENTAL ILLNESS 15
A. MENTAL HEALTH AND MENTAL ILLNESS 15

B. CAUSES OF MENTAL ILLNESS 19

• BIOLOGICAL FACTORS: 19
• PSYCHOLOGICAL FACTORS 20
• ENVIRONMENTAL FACTORS 21
C. EFFECTS OF MENTAL ILLNESS 22
• ON THE AFFECTED PERSON 22
• ON THE SOCIETY 25
D. TREATMENT OF MENTAL ILLNESS 26
E. MENTAL HEALTH FACILITIES 28
PERCEPTION OF MENTAL ILLNESS IN INDIA 29
A. STATE OF MENTAL HEALTH IN INDIA 29

• MENTAL HEALTHCARE ACT, 2017 29
• BUDGET ALLOCATION TO MENTAL HEALTH 31
• NEED FOR AN EFFICIENT MENTAL HEALTHCARE SYSTEM 31
• AVAILABILITY OF SERVICES 32
B. PERCEPTION ABOUT MENTAL ILLNESS 33
C. CAUSES AND ILL EFFECTS OF STIGMA ON MENTAL HEALTH 36
HALFWAY HOMES 39
A. DEINSTITUTIONALIZATION AND ITS EFFECTS 39

B. PROCESS OF PSYCHOSOCIAL REHABILITATION IN A HALFWAY HOME 41
• NEED 41
• AIMS 42
• APPROACH 42
O DEINSTITUTIONALIZATION AND RELOCATING. 43
C. CURRENT SCENARIO AND FUTURE PROSPECTS OF HALFWAY HOMES IN INDIA 45
• PROVISIONS FOR HALFWAY HOMES IN THE MENTAL HEALTHCARE ACT, 2017. 45
D. CASE STUDIES 47
• VISHWAS HALFWAY HOME, NOIDA. 47
• SAKSHAM, DELHI 53
• PROJECT TARASHA, TATA INSTITUTE OF SOCIAL SCIENCES, MUMBAI 57
ARCHITECTURE TO TACKLE STIGMA ABOUT MENTAL HEALTH 60
A. HOW ARCHITECTURE CAN HELP ADVOCATING THE CAUSE OF MENTAL HEALTH 60

B. PROGRAMMES TO FOSTER INTERACTION BETWEEN THE GENERAL PUBLIC AND MEMBERS 60
• PROVIDING SERVICES THAT EMPLOY MEMBERS. 60
• INVOLVEMENT OF GENERAL PUBLIC WITH THE VOCATIONAL SCHOOL AND YOGA THERAPY. 60

• PROGRAMMES TO DRAW IN THE PUBLIC TO THE SPACE 61
• TARGET USERS FOR THE PROGRAMME: 61
C. BENEFITS AND LIMITATIONS OF PUBLIC INVOLVEMENT: 62
ARCHITECTURE TO EVOKE MENTAL HEALING 63
A. URBAN ARCHITECTURE AND ITS LINK TO MENTAL ILLNESS 63

• ARCHITECTURAL EXPERIENCE AS A RESPONSE TRIGGER 63
B. USE OF ARCHITECTURAL PHENOMENA TO CREATE EXPERIENCES 65
• THEORY OF PHENOMENOLOGY 65
• PHENOMENOLOGY IN ARCHITECTURE 65
C. THE FIVE SENSES AS RECEIVERS AND GATEWAYS TO THE HUMAN MIND 66
• EFFECT OF COLOUR: 66
• EFFECT OF MICROCLIMATE: 67
• EFFECT OF NATURAL LIGHT: 68
• NATURE: 69
• FACADES: 69
• ORIENTATION: 69
• BUILDING TYPOLOGY: 70
• MOVABLE ARCHITECTURAL ELEMENTS: 70
D. A SALUTOGENIC APPROACH TO DESIGNING REHABILITATION SPACES 71
• SALUTOGENESIS IN ARCHITECTURAL DESIGN 72
• CASE STUDY OF A SPACE DESIGNED FOR PATIENT WELLNESS: KARUNASHRAY HOSPICE CENTRE, BANGALORE78
DESIGN INTENT 80
• DESIGN OBJECTIVES: 80
• CONCEPT 81
• SPACES 81
SITE 83
A. SITE SELECTION CRITERIA 83
BIBLIOGRAPHY 85

Table of Figures
Figure 1 Different brain disorders that require neurorehabilitation or treatment .................................. 15

Figure 2 Infographic by The Times of India about the prevalence of mental illness per lakh of population
in India. Mental Illness is prevalent, yet a highly stigmatized matter in India. Source: Times of India .... 18
Figure 3 Leading causes of suicide in 2013. Mental illnesses often have self-harming behaviour as a
symptom, which can be either physical or psychological self-harm. Source: scroll.in ............................ 21
Figure 4 Mental Healthcare burden on India in 2013. The numbers indicate the number of people with
the disease. Source: Scroll.in ................................................................................................................ 31
Figure 5 The figure of requirement vs availability of mental health services in India. India lacks the
infrastructure to efficiently treat mental illness Source: Ministry of Health, 2013 .................................. 32
Figure 6 Graph indicates how much of the public perception about mental illness is composed of
awareness and how much of stigma. The graph is a part of a survey about the perception of mental
health in India. Source: The Live Laugh Love Foundation. ................................................................... 34
Figure 7 The graph highlights the willingness of public to access the mental illness infrastructure of the
country. The graph is a part of a survey about the perception of mental health in India. Source: The
Live Laugh Love Foundation. ................................................................................................................ 35
Figure 8 The graph highlights the general attitude of the interviewed about mental illness. The graph is
a part of a survey about the perception of mental health in India. Source: The Live Laugh Love
Foundation. .......................................................................................................................................... 35
Figure 9 The findings of a study about the stigma surrounding mental illness. Source: The Hindu ........ 38
Figure 10 Five-Phase process of Psychosocial Rehabilitation ................................................................ 43
Figure 11 The comparison between rural and urban population and the prevalence of mental disorders.
It is clear that mental disorders affect the urban built environments more than rural. .......................... 64
Figure 12 Creating a cool microclimate in a courtyard using shading and vegetation. Comfortable
microclimates have positive effects on the mind. Source: Karl Boeing .................................................. 67
Figure 13 Effects of Sunlight on the brain. Natural light is an important feature in design. Source: All
American Window Tinting .................................................................................................................... 68
Figure 14 Positive effects of green cover on mental health. Source: Pathtomobility.com ..................... 69
Figure 15 The main difference between pathogenic and Salutogenic orientations of treatment.
Psychosocial rehabilitation is a pathogenic way of treatment. Source: Handbook on Salutogenesis .....71
Figure 16 A section showing how greenery and natural light can be included in a built space. Source:
Human Spaces-Interface....................................................................................................................... 72

Preface
"The mind is its own place, and in itself can make a heaven of hell, a hell of heaven." -John Milton,
Paradise Lost.
The past few years have seen a slew of suicides of notable public figures- musicians, actors,
politicians and many others. Their deaths triggered conversation about the gravity mental
illness among the people around the world, including my own. The question arose of how,
despite the success, these figures fall prey to depression. People then poured in with personal
stories of their battles against mental illness, a few admitted to still being afraid to seek help
owing to the society, while a few talked about how their illness always relapses despite
treatment. The things that intrigued me about this were,
-Why would individuals not seek help for their illness?
-Why, despite seeking help, individuals do not heal?
January, 2018 came with a personal diagnosis of mental illness, a symptom of which was
Anxiety. My triggers included a surprising range of some everyday objects and activities. As a
result of this, I started noticing that a certain type of space aggravated the effects of anxiety,
ensuring I escape the said space fast, while a certain type helped me calm down. While it is
known that built space affects the human psyche, the questions that I asked myself were,
-What quality of space brings about that calming effect, and what makes it a trigger?
-Can architecture eventually be used to heal the human mind?

Abstract
The purpose of the study is to understand the importance of architecture in positively altering
the human psyche, by the means of a facility for mental health aftercare called a Halfway
Home, how transitional programmes are essential in the process of mental healing, and how
the public spaces can be vital in the process of psychosocial rehabilitation.
The society has an obscure perception of mental health- marred with misinformation, stigma
and severe ignorance. The lack of acknowledgement of brain as an organ that can malfunction
like any other, has taken a toll not only on individuals that make use of psychiatric facilities, but
also the ones afraid to seek help.
Mental health asylums are vital in treating mental illnesses, yet about 95% mental illnesses go
untreated. The 5% that seek help turn to psychiatric institutions for treatment. However, after
recovering from their illness, the road to societal reintegration is a rocky one. Not, everyone
who admits themselves into these institutions makes it back into the society as a healthy
human being, owing to a sudden change of environment and the stigma against mental health.
Transitioning from a safe, guarded haven to the harsh atmosphere of the world outside needs
time, training and care so a person won’t relapse into their illness. These transitional spaces,
meant as a buffer between the institution and the society are Halfway Homes.
Halfway Homes follow a carefully-paced approach in reintegrating a deinstitutionalized person

back into the society, by offering aftercare and acting as a buffer. These homes are a medium
to build a patient’s self-esteem, teach them valuable life skills, enable them to find jobs and
sustain themselves, and be accepted back into the society.
The social stigma about mental health is a major cause of the disuse of the mental health
infrastructure, hence stigma removal is an agenda of prime importance. Societal involvement
with the halfway home would work wonders in the healing process, in uplifting the self-esteem
of the patients, and in raising awareness about mental health, which contributes in breaking a
stigma about psychiatric institutions. The purpose is to identify the extent to which the public
can be safely involved with the process of psychosocial rehabilitation.

Aim
The following research aims to achieve the following.
• Identify the importance of a transitional aftercare programme for deinstitutionalised

patients from mental institutions and outline the programmes that constitute a
Halfway Home
• Identify the causes of stigma towards mental illness, the contribution of stigma in
hampering mental healing and how a public space can contribute for mental health
advocacy against stigma. Exploring the potential of public involvement in the
rehabilitation process, by the means of designing public space that fosters interaction
between the public and the members of the halfway home.
• To outline the impact of architectural design on the field of mental health.
Objectives
• Creating a prototype for a safe and psychologically sensitive Halfway Home as an

upgrade to the present situation of halfway homes.
• To design a healthy space conducive for psychosocial rehabilitation.
• To design a vocational centre to subtly involve the public into the healing process.
• To design a public space to attract crowds regardless of the presence of a halfway

house, to help beat the stigma about mental health.
• Use architecture to positively evoke the human psyche, that would accelerate mental
healing.
Need for Study
• Stigmatization of mental health. Society has a negative set of notions towards mental
illness and psychiatric institutions, which leads to social isolation of the mentally ill. This
gives rise to the need for Halfway Homes.

• Rapid urbanization is directly linked to an increase in the number of people affected by
mental illness. Awareness about the mental encourages more people to come face-to-
face with the issue and not treat it like a taboo, to reduce the stigmatization of mental
illness.
• Aftercare facilities for mental illness are still at a nascent stage, and need momentum
for growth.
• Facilities for mental healing need to have a spatial quality conducive for mental healing,
a quality lacking in the psychiatric treatment facilities in India. This problem can be
solved by architecture.
• Psychosocial rehabilitation works for societal reintegration of deinstitutionalised

patients. Community –based rehabilitation involves only social workers, trainers, and
people having careers in mental health. This range needs to be expanded to people not
involved in the mental health sector.
Research Methodology
• Study of data about the present scenario of mental health institutions in India through
newspapers, research papers and interviews.
• Study of causes that prevent a deinstitutionalized person’s re-entry in to the society

through research articles.
• Study of the current model of halfway homes through live case studies and interaction
with members and authorities of a halfway home.
• Study of methods that facilitate psychosocial rehabilitation.
• Study of the effects of architecture on the human mind, and how it can be used for
mental healing.
• Study of the extent of community-based rehabilitation when general public is involved.

a. Limitations to the study
• Effect of public involvement of public on the self-esteem of residents cannot be

gauged.
• Extent of working of public involvement for mental stigma not known.
Conclusion
The study starts with an understanding of the sequence of events of mental illness, the causes
that drive people into mental institutions, the aftercare after their discharge and the endless
loop of them returning to the institution because this cycle failed to heal them. This highlights
the importance of a halfway home, a transitional facility to heal the healed.
By the means of the live case studies, I was able to observe that presently, built form is not
given importance when constructing a halfway home. Patients accommodate any structures
originally built for a different purpose altogether, even if it overbearing and hence, not
conducive for mental healing. Concepts like natural lighting, interactive spaces and use of
green cover for creating habitable spaces are ignored. Even after healing, patients require
therapeutic spaces to ensure recovery and rehabilitation. Hence the study aims to create a
psychologically sensitive prototype of a halfway home, with therapeutic, residential and
vocational facilities which considers factors that support mental healing.
By the means of the study, I was also able to observe that stigma towards mental illness is vital
in the society not accepting the deinstitutionalized. In order to tackle the problem, the
program aims to harness a public space as a means of creating awareness about the issue. The
pre-conceived notion about mental health facilities is usually due to a ‘fear of the unknown’.
The design intends to bring the public face-to-face with the fact that the healed cause no harm
to them or the society- which helps in dispelling the stigma.

Chapter-wise Summary
• Mental Illness
To approach a design programme about mental healing, it is important to realize the need to
address mental health. The chapter discusses the importance of mental health, by outlining
the cause and effects of mental illness. Also, the fact that mental illness can be treated by the
use of mental health facilities is highlighted.
• Perception of Mental Illness in India
Mental health is highly stigmatized in India, and was an agenda of neglect even by the
government until the Mental Healthcare Act, 2017 was passed. The chapter highlights the
cause and effects of stigma on the mental health infrastructure of the country.
• Halfway Homes
Halfway Homes are spaces for mental health aftercare where a person discharged from a
mental institution can be rehabilitated and reintegrated back into the society. The chapter
highlights the need for a facility like this. It also highlights the government provisions that
could make halfway homes a norm for mental healing in the country.
• Mental Health Advocacy through architecture
One of the reasons for disuse of the mental health facilities in the country is the stigma, which
needs to be dispelled in order to create a healthy environment for the mentally ill to seek help.
The chapter explores an attempt the architecture and the subsequent design program makes
towards stigma-removal, by involving the general public into the rehabilitation process.
• Effect of the built environment on the human mind

To heal from an illness, one can either tackle the cause of the illness (Pathogenesis), or make the body
capable enough to tackle the illness with its own capacity (Salutogenesis). The chapter defines the
meaning of the word and the scope of making the architecture Salutogenic, so that a person can heal
better.

Mental Illness
a. Mental Health and Mental Illness

The function of the brain and the ways it can malfunction. The definition of mental health
and mental illness.
The brain is considered the CPU of the body, the organ that controls and co-ordinates the
function of other organs, ensuring their smooth performance. The brain is a complex organ
comprised of billions of cells called ‘Neurons’ that contain ‘neurotransmitters’ which help
neurons communicate among each other with electrical impulses and hence control memory,
senses, movement, learning and emotion of the human body.
However, just like any other organ of the body, brain

is susceptible to malfunction which can be
categorized as follows (Reed-Guy, 2017):
• Brain Injury
Brain injuries are a result of trauma (wounding) to

the head caused by accident, falls, assault, etc. that
damage brain tissue, neurons or nerves which in turn
hampers the brain’s ability to communicate with the
rest of the body. Examples of brain injuries are
concussions, stroke, hematomas, blood clots,
cerebral oedema, etc. The symptoms include nausea,
memory loss, paralysis, internal bleeding or death.
• Tumours
Tumours in the brain can be of two types- cancerous

(malignant) and non-cancerous (benign). Benign
tumours form inside the brain, whereas malignant
tumours spread from other cancer-affected parts of
the body. The causes of tumours are largely
unknown, but depend on the individual case. The
Figure 1 Different brain disorders that require
most common symptoms of tumours are headaches, neurorehabilitation or treatment

seizures, changes in personality, difficulty in movement, etc.
• Neurodegenerative Disorders
Neurodegenerative disorders cause the brain to deteriorate over time. They cause personality
and behavioural changes over time. Over time, neurodegenerative disorders cause damage to
brain’s tissue and nerves. They can be either genetic or develop over age. Common
neurodegenerative disorders are Dementia, Alzheimer’s disease, Parkinson’s disease, etc.
Common symptoms of such disorders are amnesia, apathy, anxiety, agitation and motor
difficulties.
• Mental Illnesses
Mental illnesses are a large group of mental disorders that affect behavioural patterns, which
causes distress, or impairment of personal functioning. The symptoms of mental illness are
subject to the disorder. Sometimes, the same mental disorder affects two people differently
and needs to be diagnosed by a mental health professional. Most frequently diagnosed mental
illnesses are depression, schizophrenia, bipolar disorder, borderline personality disorder and
anxiety disorder.
However, most of these disorders can be controlled, if not treated, with proper medical
attention. Psychiatry and therapy are
solutions for mental illnesses. Psychiatry
involves providing diagnosis and
medication as treatment. Therapy involves
psychological support and psychotherapy
for mental health and well-being.
Mental health is a level

of psychological wellness with an absence
of mental illness.
The World Health Organization defines

Mental Health as a “state of well-being in
which every individual realizes their own
potential, can cope with the regular
stresses of life, can work productively and
prolifically, and is able to make a contribution to her or his community.” The following
parameters define mental health: subjective well-being, autonomy, competence, perceived

self-efficacy, self-actualization and inter-generational dependence of one's intellectual and
emotional potential.
Mental health is a vital factor in functioning of the body, and the societal standing of a person.
Mental health enables a person to be a contributing member in a society which demands the
most from its members. However, the brain is also vulnerable to mental illness, which needs to
be treated in time to maintain mental well-being. The definition of mental illness is as follows:
“Mental health is an important factor in unhindered functioning of the body, and the societal
standing of a person. In the current fast-paced world, it is obligatory for a person to be a
contributing member to the society, and hence only a person devoid of disabilities, mental or
physical, of any kind are considered to be a person fit to contribute to the society. “ (American
Psychiatry Association, 2017)
Mental illness refers to a wide range of mental health conditions — disorders that affect mood,
behaviour and thinking. Examples of mental illness include anxiety disorders, depression,
schizophrenia, eating disorders and addictive behaviours. A person might have mental health
concerns from time to time, but a mental health concern becomes a mental illness when
ongoing signs and symptoms cause frequent stress and affect your ability to function.
The Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) is the
update to the Diagnostic and Statistical Manual of Mental Disorders, the diagnostic and
taxonomic tool published by the American Psychiatric Association (APA), which provides
classification to the types of mental illnesses (American Psychiatry Association, 2017):
The axes of classification are:
• Neurodevelopmental Disorders
• Schizophrenia Spectrum and Other Psychotic Disorders
• Depressive Disorders
• Anxiety Disorders
• Obsessive-Compulsive and Related Disorders
• Trauma- and Stressor-Related Disorders
• Dissociative Disorders
• Somatic Symptom and Related Disorders

• Feeding and Eating Disorders
• Sleep-Wake Disorders
• Sexual Dysfunctions
• Gender Dysphoria
• Disruptive, Impulse-Control, and Conduct Disorders
• Substance-Related and Addictive Disorders
• Neurocognitive Disorders
• Paraphilic Disorders
The mental illness that falls under these classifications may be varied in their symptom or
causes as there is no rigid set of causes and symptoms for each disorder. The disorder can only
be diagnosed through mental health professionals. Some of these illnesses can be treated
psychiatric and psychological support, yet some require hospitalization for treatment.
Figure 2 Infographic by The Times of India about the prevalence of mental illness per lakh of population in India. Mental
Illness is prevalent, yet a highly stigmatized matter in India. Source: Times of India

b. Causes of Mental Illness
The known causes of mental illness based on biological, psychological and environmental
factors
It is difficult to ascertain the exact cause of a mental illness, as each illness has a distinct set of
causes and effects, which can only be determined by a mental health professional. However,
the illness could depend on the following factors-biological, psychological, environmental.
(Smitha Bhandari, 2018)
• Biological Factors:
Neurotransmitters: Neurotransmitters carry electrical impulse from neuron to neuron,

through chemicals called neurotransmitters. Neurotransmitter, based on the nerve they carry
the impulse through, affect a person’s mood, memory and other physical processes. However,
a disruption to this mode of neural communication affects the purpose it is supposed to serve.
The following is the list of neurotransmitters and what their imbalance causes:
• Serotonin: Serotonin disruption or imbalance causes depression or anxiety disorders as

it is the mood-regulating hormone. For patients with depression, this neurotransmitter
may return to their original location, instead of sending the right impulse produced by
serotonin through a neuron.
• Dopamine: Interrupted passage of dopamine leads to schizophrenia and ADHD

(Attention Deficit/Hyperactivity Disorder). Tiredness, high levels of stress are also
linked to low dopamine.
Other biological factors that also contribute to mental illness are:
• Genetics (heredity): Mental illnesses often hereditary, suggesting that people who have
a family member with a mental illness are more likely to develop one themselves.
Susceptibility is passed over families through genes. Mental illnesses are sometimes
linked to abnormalities in many genes rather than just one or a few, genetic interaction
with the environment is unique for every person (even identical twins). This is the
reason why a person inherits a susceptibility to a mental illness and doesn't necessarily
develop the illness. Mental illness occurs from the genetic interaction of multiple genes
and other factors -- such as stress, abuse, or a traumatic event -- which can influence, or
trigger, an illness in a person who has an inherent susceptibility to it.

• Substance abuse: Long term use of alcohol or recreational drugs is linked to
neurotransmitter disruptions. Patients with addiction are susceptible to disruption
gamma-aminobutyric acid, or GABA receptor. This neurotransmitter causes muscles to
relax by slowing the speed of nerve impulses.
• Infections: A number of infections have been linked to brain damage, the development
of mental illness or the worsening of its symptoms. For example, a condition known as
paediatric autoimmune neuropsychiatric disorder (PANDA) associated with
the Streptococcus bacteria has been linked to the development of obsessive-compulsive
disorder and other mental illnesses in children.
• Brain defects or injury: Defects in or injuries to areas of the brain associated with
neurotransmitter production cause a deficit, which causes mental illness linked to the
neurotransmitter.
• Other factors: People with vitamin deficiencies are more likely to experience disrupted,
deficient or ineffective neurotransmitters. Amino acids are the building blocks of
neurotransmitter production, but amino acids can’t be generated without first taking in
a broad range of vitamins and minerals. Diets that are too low in protein may also
contribute to impaired neurotransmitter function due to low production of amino acids.
• Psychological Factors
Psychological factors that may be a contributing factor to mental illness include:
• Severe psychological trauma suffered in childhood, such as physical, emotional or

sexual abuse affects emotions, cognition and decision-making through adulthood, if
not kept under check.
• An important early loss of a loved one, such as a parent, constitutes trauma and can
cause an emotional breakdown.
• Neglect, in childhood or adulthood can cause a feeling of loneliness and being

unwanted, which is linked to depression and suicidal tendencies.
• Poor ability to relate to others, which is a cause and effect of mental illness, is a result of
neglect, or lack of exposure to human interaction.

• Environmental Factors
Certain stressors in a person’s day-to-day environment can trigger an illness in a person who is
susceptible to mental illness. These stressors include:
• Death, divorce or any other traumatic event that can cause an emotional upheaval.
• A dysfunctional family life, neglect from parents or ‘protective figures’
• Feelings of low self-esteem, inadequacy anxiety, anger, or loneliness.
• Changing jobs or schools, the feeling of starting ‘from scratch’, fear of not being
accepted into a new environment.
• The pressure of social or cultural expectations, the obligation of being a ‘contributing

member’ to the society.
Figure 3 Leading causes of suicide in 2013. Mental illnesses often have self-harming
behaviour as a symptom, which can be either physical or psychological self-harm.
Source: scroll.in

c. Effects of Mental Illness
Emotional, Physical, and short-term and long-term effects of mental illness on a mentally
ill individual, their caregivers and society as a whole.
At the exterior, mental illness may seem to affect only the person suffering from it. However,
an individual does not necessarily exist alone in the society- they might have the support of
family, friends who care for a person’s wellbeing. Also, the person might be a contributing
member of the society- a person with jobs and responsibilities. Therefore, a person’s life, their
illness doesn’t affect them alone. This chapter highlights the effects of mental illness on the
person, their caregiver and the society as a whole.
• On the affected person
Effects of some common mental illness are as follows (Apollo Hospitals, n.d.):
Clinical Depression:
Mood: anxiety, apathy, general discontent, guilt, hopelessness, loss of interest, loss of interest
or pleasure in activities, mood swings, or sadness
Sleep: early awakening, excess sleepiness, insomnia, or restless sleep
Physical: excessive hunger, fatigue, loss of appetite, or restlessness, weight gain or weight loss
Behavioural: agitation, excessive crying, irritability, or social isolation
Cognitive: lack of concentration, slowness in activity, or thoughts of suicide
Anxiety Disorder:
Physical: fatigue, restlessness, or sweating
Cognitive: lack of concentration, racing thoughts, or unwanted thoughts
Behavioural: hypervigilance or irritability
Also, common: anxiety, excessive worry, fear, insomnia, nausea, palpitations, or trembling

Bipolar Disorder:
Whole body: fatigue, restlessness, or sweating
Cognitive: lack of concentration, racing thoughts, or unwanted thoughts
Behavioural: hypervigilance or irritability
Also, common: anxiety, excessive worry, fear, feeling of impending doom, insomnia, nausea,
palpitations, or trembling
Schizophrenia:
Behavioural: social isolation, disorganised behaviour, aggression, agitation, compulsive

behaviour, excitability, hostility, repetitive movements, self-harm, or lack of restraint
Cognitive: thought disorder, delusion, amnesia, belief that an ordinary event has special and
personal meaning, belief that thoughts aren't one's own, disorientation, memory loss, mental
confusion, slowness in activity, or false belief of superiority
Mood: anger, anxiety, apathy, feeling detached from self, general discontent, loss of interest
or pleasure in activities, elevated mood, or inappropriate emotional response
Psychological: hallucination, paranoia, hearing voices, depression, fear, persecutory delusion,

or religious delusion
Speech: circumstantial speech, incoherent speech, rapid and frenzied speaking, or speech
disorder
Obsessive Compulsive Disorder:
Behavioural: compulsive behaviour, agitation, compulsive hoarding, hypervigilance,

impulsivity, meaningless repetition of own words, repetitive movements, ritualistic behaviour,
social isolation, or persistent repetition of words or actions
Mood: anxiety, apprehension, guilt, or panic attack
Psychological: depression, fear, or repeatedly going over thoughts.
Borderline Personality Disorder:
Behavioural: antisocial behaviour, compulsive behaviour, hostility, impulsivity, irritability, risk-

taking behaviours, self-destructive behaviour, self-harm, social isolation, or lack of restraint

Mood: anger, anxiety, general discontent, guilt, loneliness, mood swings, or sadness
Psychological: depression, distorted self-image, grandiosity, or narcissism
Psychosis:
Behavioural: disorganised behaviour, aggression, agitation, hostility, hyperactivity,

hypervigilance, nonsense word repetition, repetitive movements, restlessness, self-harm,
social isolation, lack of restraint, or persistent repetition of words or actions
Cognitive: confusion, belief that an ordinary event has special and personal meaning, belief
that thoughts aren't one's own, disorientation, thought disorder, memory loss, racing
thoughts, slowness in activity, unwanted thoughts, difficulty thinking and understanding,
thoughts of suicide or false belief of superiority
Mood: apathy, excitement, feeling detached from self, anger, anxiety, general discontent,
limited range of emotions, loneliness, or nervousness
Psychological: hearing voices, depression, manic episode, fear, paranoia, persecutory

delusion, religious delusion, or visual hallucinations
Speech: deficiency of speech, excessive wordiness, incoherent speech, or rapid and frenzied
speaking
Picture 1 Brain scans of a normal brain vs. brain affected by mental illness. Areas affected by illness are most likely lack
blood flow, hence showing up in extremely dark colours in the scan. Source: https://olhscurrent.org/wp-
content/uploads/2017/01/mental-health-sidebar-900x252.png

• On the society
The social impact of mental illness varies among nations and cultures. However, untreated
mental illness has significant costs to the society. In 2001, the World Health Organization
estimated that mental health problems cost developed nations about 3%-4% of their GDP.
When mental illness expenditures and loss of productivity are considered, the WHO estimates
that national disorders cost national economies several billion dollars annually (World Health
Organization, 2013)
Also, despite majority of mentally ill individuals do not exhibit dangerous behaviour or
violence, incarceration among mentally ill individuals places a significant burden on
governments.
India however lacks in this front with just 0.07% of the 2017-2018 health budget, which totals
up to Rs.35 Crore being allocated to National Programme for Mental Health. (Yadavar, 2018)

d. Treatment of mental illness
Treatments available for various mental illnesses. Not classified under the type of illnesses
the treatment is used for.
The treatment of mental illness is subjective to the symptoms of the case. Mental illness
cannot be ‘cured’ like other illness, yet it can be treated to reduce its effects down to a
manageable level. Illnesses like depression have ‘episodes’ that can recur throughout the
person’s life. These episodes can be managed by treatment. The following are the ways mental
illness can be treated and managed.
• Psychotherapy –
Psychotherapy is
the therapy-based
treatment of
mental illness
provided by a
trained mental
health
professional. Psych
otherapy explores Picture 2 The concept of Art therapy as explained in the comic strip. Art therapy
thoughts, feelings, works on self-expression for diagnosis and healing of the mind. Source: Google
Images
and behaviours, and
seeks to improve an individual’s well-being. Psychotherapy concurrent with medication
is the most effective way to promote recovery. Examples include: Cognitive
Behavioural Therapy, Exposure Therapy, Dialectical Behaviour Therapy, etc.
• Medication – Medication helps with managing the symptoms of the illness. Medication
aids other forms of treatments. Sometimes medication for one illness also work for
symptom management of other illnesses. i.e. Seizure medication is sometimes used for
anxiety attacks. Medication occurring in simultaneity with psychotherapy is the most
effective way to promote recovery.
• Case Management – Case management is the organisation of community-based

services by a professional to provide people the quality mental health care that is
customized accordingly to an individual's setbacks or persistent challenges and help
them recover. A case manager can help plan, assess, and implement a number of
strategies to facilitate recovery.

• Hospitalization – In a few cases, hospitalization may be necessary so that an individual
can be closely monitored, accurately diagnosed or have medications adjusted when his
or her mental illness temporarily worsens. Psychiatric hospitals have the close and
controlled environment that is necessary for the treatment of the mentally ill.
• Support Group – A support group is a group meeting where members, usually suffering
from the same illness, guide each other towards the shared goal of recovery. Support
groups are often comprised of non-professionals, but peers that have suffered from
similar experiences.
• Self Help Plan – A self-help plan is a unique health plan where an individual address his
or her illness by applying strategies that promote wellness. Self-help plans may involve
addressing wellness, triggers, recovery or warning signs.
• Peer Support – Peer Support refers to receiving help from mentally ill or recovered
individuals who have suffered from similar experiences. The key of peer support is that
it is built on shared experiences and empathy (Mental Health America, 2015).

e. Mental Health Facilities
The types of facilities available in India for the treatment and aftercare of mental illness.
Psychiatric hospitals, also known as mental hospitals or mental asylums are hospitals or wards
that specialize in the treatment of serious mental disorders, such as clinical
depression, schizophrenia, and bipolar disorder. Psychiatric hospitals vary in capacity and
facility. The types of mental health facilities for treatment in India are as follows:
• Mental Health Clinic: Mental health clinics can be independent or attached to a general
or a psychiatric hospital. Mental health clinic usually consists of a psychiatrist and a
psychotherapist that administer medication and therapy to the patients.
• Mental Hospitals with outpatient facility: Mental hospitals take care of residents on a
temporary or permanent basis, who as a result of psychological disorder, require
routine assistance, treatment or specialized, controlled environment. Patients are
admitted voluntarily but the people who aren’t in a condition to take care of
themselves, or pose a significant danger to themselves or others may be subject to
involuntary admission. Outpatient departments in mental hospitals deal with patients
that cannot stay overnight. It functions similar to a mental health clinic.
• Mental health ward in a general hospital: A psychiatry ward is a sub-unit of a general

hospital, with a number of rooms and beds reserved specially for patients of that ward.
• Community Outreach Programmes: Community outreach programmes by psychiatric

hospitals, halfway homes and educational institutions have mental health camps set up
in areas that lack access to mental health services and therefore, act as a mobile health
clinic. Programmes are conducted in such areas on a weekly basis to encourage
participants. Also, these programmes spread awareness through street plays, games
and short movies. Community outreach programmes are vital in dispelling stigma
about mental health.
Aftercare of mental illness is as important as treatment of illness, to ensure recovery and

prevent relapse into the illness. Halfway homes are facilities that ensure aftercare after
treatment from a mental illness.

Perception of Mental Illness in India
a. State of Mental Health in India
The modern model of mental health services has evolved from the ‘lunatic asylums’ and ‘mad
houses’ of the 18th and 19th century. These places were known to be dingy, inhumane spaces
that made confinement and restraint the basis of treatment, and mainly used shock therapy
(Electroconvulsive therapy) and lobotomy for treatment of mental illness. The first mental
hospital in India was Bombay Lunatic Asylum was built in 1750 A.D during the colonial era.
The first mental hospital in South India started at Kilpauk, Madras in 1794. During this period,
mentally ill patients were treated with opium, given hot baths and at times, leeches were
applied to suck their blood. Music was also used a mode of therapy to calm down patients in
some hospitals. (Goyal & Nizamie, 2010)
As the Government of India began work on an ambitious national health policy that envisioned
“health for all by the year 2000,” early drafts of the National Mental Health Program were
formulated and subsequently adopted by the Central Council of Health and Family Welfare, in
1982. Since its initiation, there has been growth of a model District Mental Health Program,
and development of training materials and programs for academicians and practitioners. The
first draft of Mental Health Act that subsequently became the Mental Health Act of India (1987)
was written at Ranchi in 1949.
• Mental Healthcare Act, 2017

The Ministry of Law and Justice passed the Mental Healthcare Act, 2017. The law is described
as “An Act to provide for mental healthcare and services for persons with mental illness and to
protect, promote and fulfil the rights of such persons during delivery of mental healthcare and
services and for matters connected therewith or incidental thereto”. This law nullifies the
previous Mental Health Act of India (1987).
Picture 3 A highlight of the Mental Healthcare Act 2017, which streamlines mental healthcare in India. Source: Google
Images
The provisions of the act are as follows:
1. The Mental Healthcare Act 2017 aims at decriminalising the “Attempt to Commit
Suicide” by seeking to ensure that the individuals who have attempted suicide are
offered counselling and opportunities for rehabilitation from the government as
opposed to being punished for the attempt.
2. The Act seeks to fulfil India’s international duty to the Convention on Rights of Persons
with Disabilities and its Optional Protocol.
3. It looks to empower individuals suffering from mental illness, thus marking a departure
from the Mental Health Act 1987. The 2017 Act recognises the agency of people with
mental illness, allowing them to make decisions regarding their health, given that they
have the appropriate knowledge to do so.
4. The Act aims to protect the rights of the people with mental illness, along with access
to treatment without discrimination from the government. Additionally, insurance

companies are now bound to make provisions for medical insurance for the treatment
of mental illness on the same basis as is available for the treatment of physical illnesses.
5. The Mental Health Care Act 2017 includes provisions for the registration of mental
health related institutions and for the regulation of the sector. These measures include
the obligation to set up mental health establishments across the country to ensure that
no person with mental illness will have to travel far for treatment, and then creation of
a mental health review board which will act as a regulatory body.
6. The Act has restricted the usage of Electroconvulsive therapy (ECT) to be used only in
cases of emergency, and along with anaesthesia and muscle relaxants. Further, ECT has
additionally been banned to be used as therapy for minors.
7. The responsibilities of other agencies such as the police with respect to people with
mental illness has been outlined in the 2017 Act.
8. The Mental Health Care Act 2017 has additionally vouched to tackle stigma of mental
illness, and has outlined some measures on how to achieve the same. (Ministry of Law
and Justice, 2017)
• Budget Allocation to Mental Health
Budget allocation to the National Programme for Mental Health has been stagnant between
2014-2017. At Rs 35 crore, the programme
received 0.07% of India’s 2017-18 health budget.
70% of the budget’s spending goes on mental
hospitals, while the rest is allocated for primary
care. (Yadavar, 2018)
• Need for an efficient mental

healthcare system
o 35 million, or 4.5% of the Indian

population suffers from depression.
o 38 million Indians suffer from Anxiety

Figure 4 Mental Healthcare burden on India in 2013. The
Disorder.
numbers indicate the number of people with the disease.
Source: Scroll.in
o 7.5% Indians suffer from major or minor

mental disorders that require expert intervention. (Iyer, 2017)
o Close to 95% of Indians requiring psychological treatment do not receive medical help.
(DHNS, 2017)
• Availability of Services
Figure 5 The figure of requirement vs availability of mental health services in India. India lacks the infrastructure to
efficiently treat mental illness Source: Ministry of Health, 2013
India lacks mental health manpower required to efficiently treat mental illness. This, in
addition to the lack of awareness about mental health leads to disuse of the mental health
services. The figure above explains the gap between the demand and availability of services.

b. Perception about Mental Illness
Mental Health, owing to the stigma and lack of awareness, is marred by different myths and
misconceptions that eventually hurt the mental health services of the country. The following
are the major misconceptions about mental health (Nayar, 2015):
• Psychiatric disorders are a personality flaw or a personal weakness
Neurotransmitters are impulse-carriers responsible for various neural functions. An

imbalance in these chemicals causes psychiatric disorders, with underlying physical and
psychological effects, and cannot be overcome entirely by will. Because these mental
illnesses don't always have visible physical manifestations, a sudden change in a
person's behaviour is dismissed as a flaw in their personality.
• Mental health disorders affect very few people
The National Institute of Mental Health and Neuro Sciences (NIMHANS) in Bengaluru
estimate that 20 million Indians (approximately 2 per cent of the population) need
professional help for serious mental ailments. An additional 50 million suffer from
minor and controllable mental illnesses, like mood disorders. People have a hard time
accepting that they could be suffering from a mental disorder, primarily because they
feel it is a weakness which will be frowned down upon by the society.
• Once a psychiatric patient, always a psychiatric patient
Medicines are not addictive, they are to tackle the imbalance of neurotransmitters in
your brain, and don’t always need to be prescribed by psychiatrists. Mental disorders,
just like any other physical illness are completely treatable.
• Children don’t suffer from psychiatric illnesses
Mental disorders can set in at a very early age. At least 20% of children in India suffer
from some form of mental illness, among which about 5% are serious illnesses. Most
parents refuse to accept that their child might be mentally ill out of fear of
embarrassment or social stigma. Mental health problems can't be ‘outgrown’
• Mental illness is a result of bad parenting
Parenting has nothing to do with mental disorders. Children hailing from so-called
'happy' families can suffer from psychological complications too. However, bad family

life or childhood abuse at the hands of a parent can cause serious implications to
mental health.
• Mental illnesses are contagious
Psychiatric disorders are medical conditions, which owe its cause to an imbalance in the
neurotransmitters in the brain. They are can be genetically passed on, but are in no way
contagious.
• Attempting suicide is a sign of cowardice
According to a WHO report (World Health Organization, 2014), most suicides in the
world occur in the South-Asia region with India accounting for the highest estimated
number of suicides overall in 2012. The average suicide rate in India is 10.9 for every
lakh people and the majority of people who commit suicide are below 44 years of age.
There are many clear warning signals that people contemplating suicide give, that
indicate their feelings of helplessness. It should not be considered a taboo.
Figure 6 Graph indicates how much of the public perception about mental illness is composed of
awareness and how much of stigma. The graph is a part of a survey about the perception of mental
health in India. Source: The Live Laugh Love Foundation.

Figure 8 The graph highlights the general attitude of the interviewed about mental illness. The graph is a part of a
survey about the perception of mental health in India. Source: The Live Laugh Love Foundation.
Figure 7 The graph highlights the willingness of public to access the mental illness infrastructure of the country. The
graph is a part of a survey about the perception of mental health in India. Source: The Live Laugh Love Foundation.

c. Causes and Ill Effects of Stigma on Mental Health
The dictionary defines stigma as “a mark of disgrace associated with a particular circumstance,
quality, or person.”. In India, mental illness is still looked down upon as a mark of disgrace and
dishonour. The following are the causes of stigma against mental health:
o Neglect from the government:

Mental Health is a topic that has
been neglected by the government
so far. The efforts made to
advocate and eventually treat
mental health have been abysmal.
o Mental illnesses used as insults or

slurs: Normalization of words like
“Pagal” and “retard” as insults
eventually trivializes the issue and
discourages people from getting
help.
o Depiction of mental health in

movies and TV shows: The
depiction of mental hospitals and
the mentally ill has been
irresponsible. Mental hospitals are
usually associated with the image
of a ‘haunted house’, or a
dangerous asylum (Arkham Asylum
Picture 4 An infographic released by the Ministry of Health, India
in the Batman Comics) and hence regarding the cure for depression. The infographic confuses depression
create the image that all psychiatric with general state of sadness and hence ignores 'seeking medical
treatment' as an important cure. Source: Twitter
hospitals are dangerous. Individuals
suffering from mental illness are usually the comic relief element, or the antagonist in
these movies, resulting in a false image being created of the mentally ill.
o Unorthodox treatments resulting from bizarre beliefs: Due to a lack of awareness about
the ways a mental illness can be treated, people resort to self-styled godmen that
promise to ‘cleanse their soul’ as a part of mental treatment. This has led to grave

repercussions. Moideen
Badusha Mental Home
was a faith-based mental
asylum in Erwadi Village,
Tamil Nadu, that had
chained about 28
inmates that eventually
were burnt alive as result
of a fire in 2001. The
hospital worked on the
belief that holy water Picture 5 The aftermath of the fire at Erwadi in 2001. The fire resulted in the
from a nearby mosque closure of such establishments in the area. Source: Google Images
and oil form a lamp

burning there are a cure for mental illness. Also, the hospital resorted to caning to ‘drive
away evil spirits. The fire resulted to the closure of the hospital and similar facilities in
Erwadi and nearby villages. (Bhattacharya, 2016)
o Society: The families of people mentally ill individuals are under constant pressure of
maintaining their societal image, as mentally ill individuals are considered tainted, and
hence cannot be married off. Also, given owing to the myth that mental illness is
contagious, the families too are considered mentally ill if one member suffers from it.
The ill effects of stigma on mental health are as follows:
o About 95% of mental illness go untreated due to a lack of awareness and stigma.
(DHNS, 2017) People suffering from mental illness do not want to be associated to it, as
it comes with the ‘damaged’ tag.
o Stigma lowers the self-esteem of the mentally ill, as it insinuates that they will be
rejected from the society because they no longer are ‘contributing members’ to it.

o Owing to the fact that the mentally ill are considered tainted, aftercare of the people
who have recovered from their illness becomes a difficult task. Rejection from the
family and lack of job opportunities are the main issues that the people who have
healed from their illness face.
Figure 9 The findings of a study about the stigma surrounding mental illness. Source: The Hindu

Halfway Homes
a. Deinstitutionalization and its effects
The process of release of long-stay patients from psychiatric hospitals to halfway homes is
called deinstitutionalization. The effects of deinstitutionalization emphasize the need of
halfway homes.
Deinstitutionalization is the process of replacing long-stay psychiatric hospitals with less

isolated community mental health services for those diagnosed with a mental
disorder or developmental disability. (Storman, 2003)
Deinstitutionalization in the context of the project is the discharge of the patients who have
healed from their mental illness back into the community or halfway homes. The patients that
have been discharged have been declared free from their mental illness, yet their symptoms
need to be kept under check through medication and aftercare.
The effects of deinstitutionalization cannot be gauged as it depends on a person’s psyche,

family and financial condition. However, the people who do not have the privilege of a safe
environment after deinstitutionalization face the following:
• Change of Atmosphere: Since people may become accustomed to highly structured

institutional
environments, they often
adapt their social
behaviour to institutional
conditions. Therefore,
adjusting to life outside
of an institution may be
difficult.
• Homelessness is a
persistent problem
among the discharged as
families usually disown
such individuals and do Picture 6 A comic about the persistent problem of homelessness among the
not take them back. The deinstitutionalized. Source: Monkey in the middle
time spent in the

institution might financially drain them as there was no source of income. They might
be rendered homeless as a result.
• Lack of Jobs: The time spent in the psychiatric unit usually leads the patients to lose
their employable skills. Also, the stigma against a person who has just been released
from a mental institution causes employers to not prefer such individuals for
employment.
• Lack of confidence for social interaction: Lack of self-esteem that the mentally ill
individuals face makes them lose confidence about interacting with anyone. Moving
from a closed and controlled environment also makes them lose confidence about
interaction.
• Relapse: Relapse into disease Is common among the discharged, as not everyone gets
accustomed to the atmosphere of the world outside the mental institution. Also, a lack
of discipline about taking medications adds to the problem.

b. Process of Psychosocial Rehabilitation in a Halfway Home
The basic concept of providing infrastructure for the process of psychosocial rehabilitation,
to facilitate and enhance the process.
Halfway home, also called residential treatment centre, are community-based psychiatric
facilities for aftercare and rehabilitation by offering transitional facilities, for individuals who
are attempting to return to society as healthy, law-abiding, and productive members of the
community after deinstitutionalization.
Halfway Homes come into picture after the healing process is complete, and has programmes
that prevents relapse.
Psychosocial rehabilitation is the process of psychological and social recuperation of a person

from a mental illness, along with skill-development to increase employability. Psychosocial
rehabilitation is essential for aftercare for a person that has healed from a mental illness
• Need
o According to the National Human Rights Commission (NHRC), there are only 43
government mental institutions in India, of which hardly six are in a condition fit for
treatment. At least 786 fully recovered patients have been living with hundreds of
mentally ill patients 14 out of 46 government-run mental hospitals of the country, data
obtained through multiple RTI applications by Advocate Gaurav Kumar Bansal. In most
cases, the families of the patients are not ready to take them back
There are also patients those who were picked up from the streets and admitted in
hospitals by the police and their addresses are not known. As a result, they could not be
sent back to their homes.
o Deinstitutionalization has adverse effects on the patients, as highlighted in point (a) of

the chapter. These effects need to be tackled in order for complete mental healing of
the individual.

• Aims
o Psychosocial Rehabilitation aims to build upon the assessed strengths of persons rather
than their deficits and problems. In other words, Psychosocial Rehabilitation
approaches are strengths based--they are based on the assessment of a person’s
strengths as the basis for individualized goal setting and recovery.
o They assist individuals in rediscovering skills and accessing the community resources
needed to live successfully and with a self-identified quality of life.
o Psychosocial Rehabilitation encourages people to have a meaningful life focus on the

determinants of good mental health, including employment, education, social
supports, basic living skills, leisure and wellness.
o Psychosocial Rehabilitation aims to place individuals in their chosen goal settings such
as jobs and housing and then train and support them in those settings. Similarly, other
training, such as social skills training takes place in the person’s natural environment.
o Psychosocial Rehabilitation aims to promote recovery with full community living and
improved quality of life.
• Approach
Psychosocial rehabilitation (also termed psychiatric rehabilitation or Psychosocial

Rehabilitation) promotes personal recovery, successful community integration and satisfactory
quality of life for individuals who had a mental illness. Psychosocial rehabilitation services and
supports are person directed and individualized, and an essential element of the mental health
aftercare. The focus is on helping individuals develop skills and access resources needed to
increase their capacity to be successful and satisfied in the living, working, learning and social
environments of their choice and include a wide range of services and supports. Psychosocial
rehabilitation is a five-phase process involving the following processes:

o Deinstitutionalization and
relocating.
Deinstitutionalization is the process of

removal of an individual who has been
deemed fit for discharge, from the
mental institution. The patients are
then trained on relocated to the
residential units of the halfway home,
beginning from rooms shared by two
people, then as the treatment
progresses, the number of people in the
room increases.
o Therapy
Figure 10 Five-Phase process of Psychosocial Rehabilitation
In order to prevent relapse into mental
illness, constant psychological support is essential. Psychological therapy is provided to a
person in order to give them a self-esteem boost, impart them with essential social skills, help
them get accustomed to the world outside, encourage them to follow a schedule, etc. The
rehabilitation of a person is taken care of by this phase.
The following are the kinds of therapy offered normally:
Art Therapy: A form of psychotherapy involving the encouragement of free self-expression

through painting, drawing or modelling, used as a diagnostic and remedial activity.
Yoga Therapy: Yoga therapy aims for self-awareness, spontaneity and intimacy to seek relief
from mental illness.
Talk Therapy: Talking-based therapy like Cognitive Behaviour Therapy is an important part of
treatment of depression, bi-polar disorder and other illness. The therapist helps a person cope
with their feelings, and causes change in their behaviour patterns that contribute to the
symptoms.
Group Therapy: Group therapy involved peer support in the process of rehabilitation. A
therapist sits among a group of people and encourages the individuals to speak up.
Occupational Therapy: This form of psychotherapy is the use of assessment and intervention
to develop and maintain meaningful activities to keep a person occupied.

o Vocational Training
Vocational courses are short courses and classes available in different career skills that offer
necessary skills and professional training for a specific job. This ensures quick employment.
Vocational training is essential for people from a halfway home these people have forgotten
their employable skills and hence face difficulties in finding jobs. Vocational training can be
provided in the following fields:
o Hospitality
o Computer Education
o Graphic Design
o Office Management Skills
o Nursing
o Sales
o Job Development and Support
This phase of psychosocial rehabilitation works towards helping the individuals find jobs in
their fields of vocation. The halfway home can have internal functions that employ the
members of the halfway home.

c. Current Scenario and Future Prospects of Halfway Homes in India
Halfway homes are at a nascent stage in India, with only a few Halfway Homes present for
psychosocial rehabilitation.
At present, the prominent halfway homes in India are as follows:
• Saksham, IHBAS, Delhi
• IHBAS Halfway Home, Dwarka
• Chaitanya, Pune
• Vishwas, Noida
• Paripurnata, Kolkata
• Tarasha, Mumbai
• Nav Kiran, Delhi
• NIMHANS, Delhi
• Schizophrenia Research Foundation (SCARF), Chennai
• Tulasi Home, New Delhi,
• Manashakti, Bangalore
‘Aftercare’ of the mentally ill has been a lesser-known concept in India so far, with no
regulations about setting up halfway homes, and no pressure from the government for
formulating regulations. However, the Mental Healthcare Act, 2017 has brought a fresh wave
of change that would improve the condition of mental health aftercare in India.
• Provisions for Halfway Homes in the Mental Healthcare Act, 2017.
Chapter 5- Rights of Persons with Mental Illness (Ministry of Law and Justice, 2017)
Section 18: Right to access mental healthcare
(b) provision of half-way homes, sheltered accommodation, supported accommodation as may

be prescribed;

(c) provision for mental health services to support family of person with mental illness or
home-based rehabilitation;
(d) hospital and community-based rehabilitation establishments and services as may be

prescribed;
Section 19: Right to community living
(1) Every person with mental illness shall, ––
(a) have a right to live in, be part of and not be segregated from society; and
(b) not continue to remain in a mental health establishment merely because he does not have a
family or is not accepted by his family or is homeless or due to absence of community-based
facilities.
(2) Where it is not possible for a mentally ill person to live with his family or relatives, or where
a mentally ill person has been abandoned by his family or relatives, the appropriate
Government shall provide support as appropriate including legal aid and to facilitate exercising
his right to family home and living in the family home.
(3) The appropriate Government shall, within a reasonable period, provide for or support the
establishment of less restrictive community-based establishments including half-way homes,
group homes and the like for persons who no longer require treatment in more restrictive
mental health establishments such as long stay mental hospitals.
These provisions work for streamlining the mental health aftercare in India, which will give
impetus to the growth of more halfway homes in India.

d. Case Studies
• Vishwas Halfway Home, Noida.
Site Analysis:
Postal Address: 30/3, Knowledge Park III, Greater Noida, Uttar Pradesh 201310
Location: Greater Noida, Uttar Pradesh, India.
Vishwas is 30km away from Delhi and can be accessed by Noida-Greater Noida Expressway.
Regional Analysis:
• The site is located at an

institutional zone of Greater Noida
• Only road connectivity.

Nearest metro station.
• Sharda University is located

500m away from the site.
• The south of the site is

agricultural land and River Hindon
passes through it.
Advantages and Disadvantages of

Picture 7: Location of Vishwas Halfway Home the Site Location:
Advantages: Distance from the urbanized Noida makes the area a peaceful one. Being in an
institutional zone, noise levels are regulated, hence a tranquil atmosphere aids the
rehabilitation process.
Disadvantages: Distance from Noida and Delhi leads to a reduced number of patients for the
Daycare centre.
About the Halfway Home:

Picture 8 Vishwas Halfway Home. The artwork on the walls has been done by the members of the home.
Located in Greater Noida, 40kms away from New Delhi, is the Vishwas Halfway Home owned by the
Richmond Fellowship Society.
The Richmond Fellowship Society (India) is a registered, charitable NGO providing

rehabilitation services to individuals with mental illness through its Branches operating at
Bangalore, Delhi, Lucknow, and a rural Branch at Sidlaghatta in the State of Karnataka. The
services include outreach programmes and rehabilitation activities through halfway homes,
long term care, day care with vocational training for persons with mental illness and Manpower
development and research in the field of Mental Health; advocacy and creating awareness,
organizing symposia and workshops and protecting the rights of persons with mental illness.
According the public opinion, the halfway home has created waves in terms of mental health
advocacy with their concern about the mentally ill. (its_gaargi, 2018)
Vishwas Halfway Home works on the following vision:
Persons with mental illness are entitled to equal rights to lead a life of good quality and live in a
community. This will be ensured by providing a suitable model of care that is aimed at equal
opportunity by means of affordable, acceptable and committed treatment options.
The model followed at Vishwas is as follows:

1. Day Care Centre:
Picture 9 Common Area for the Day care centre is used for group therapy sessions, board games and as a computer lab
Capacity: 40 members.
Functions: Used to enhance life skills- social skills, thinking skills

and self-management (emotional) skills.
The following is done by engaging them in various activities like:
• Vocabulary Classes
• Art and Craft Classes
• Music Classes
• Yoga Class
Picture 10 Computers and internet provided
to the members

• Games
• Visit to BIMTECH Library
• Visit to MyPerch Library in

Noida
• Computer Classes
• Socializing Activities
Teachers for these activities come

twice or thrice a week. A common
space is assigned for all these
Picture 11 Library and display board to showcase work done by the members
activities due to constraints on
space.
2. Community Outreach
Purpose of this programme is to provide free diagnosis and treatment for mentally and
emotionally disturbed persons, to create public awareness about mental health problems and
removing stigma, and to collaborate and network with other organizations having similar
objectives.
Community outreach services have been provided through the OPD of Najafgarh Primary
Health Centre. About 5000
patients have used the
service in five years. The
Number of Patients served
between April 2017 and
March 2018 is 1367. The
following are the statistics
that show the profile of
patients using the service.
3. Halfway Home:
Picture 12 Lawn used by the members of the Halfway Home. The lawns are used for
The Halfway Home is the various recreational activities by the members of the halfway homes
residential facility of

Vishwas. With a capacity of 20
patients (
members), the facility consists of
the following spaces:
• Bedrooms (Shared by 3)
• Dining Hall with

television.
• Kitchen
• Lawn
• Counselling Rooms (Two) Picture 13 Rooms used by the members of the HWH, shared by three
members
• Common Area for group

counselling.
The main focus of the Halfway Home is the psychosocial rehabilitation of its members. The
ideal duration of stay and rehabilitation is 18 months. The patients coming in usually used to
suffer from paranoid schizophrenia, bipolar disorder and depression. The members are
brought in by their families, through a recommendation of a psychiatrist. Vishwas Halfway
Home takes care of the patients from a psychological standpoint i.e. counselling and therapy.
The therapy aspect is taken care of by counselling, group therapy and cognitive behaviour
therapy.
Vocational Therapy is taken

care of by the daycare centre.
The members of the halfway
home become members of the
daycare centre by default.
This facility works on a fee

system, where the members
are charged a fee of Rs.28,000
per month, expenses borne by
their families.
Picture 14 Counselling Room used by the patients for individual sessions

4. Advocacy
Richmond Fellowship Society has partnered with academic institutions and NGOs working for
promoting mental health. The objectives were to break the silence and create dialogue on
mental health issues to dispel the stigma and myths related to mental health and to make
effective behaviour change communication.
The advocacy is done through the following:
• Youth Involvement
• Partnership with NGOs
• Networking
• Competitions
• Annual Day Celebrations

• Saksham, Delhi
Location: Institute of Human Behaviour and Allied Sciences, Dilshad Garden, Delhi.
Regional Analysis:
• Saksham Halfway House is situated

within the IHBAS Campus, which is an
institute for mental health as well as a
psychiatric hospital.
• Dilshad Garden is situated 15km away

from New Delhi city centre,
connected to the metro network at
Dilshad Garden Station.
• The surrounding region is a mixed-use

development.
Picture 15 Proximity of the Halfway Home to the main
campus of IHBAS
Located at the IHBAS Campus in Dilshad
Garden, Delhi, Saksham is a model halfway home and a long-stay home for the patients at
IHBAS. The building was converted from a teacher’s hostel to a halfway home due to a lack of
use.
Institute of Human
Behaviour and Allied
Sciences is an institute
studying psychology
and mental illness. The
mental health asylum
attached to IHBAS.
IHBAS Hospital has a
care facility of 346
patients.
Saksham functions to
separate out the
Picture 16 Saksham Halfway Home
patients who might not
have healed from their illness but are independent enough to carry out their own activities. The
patient types are as follows:

• Patients healed from their mental illness and are bound to go home
• People healed from their mental illness but have no home to go back to.
• Patients not healed, but are independent enough to carry out their own daily activities,
who also have no home to go to eventually.
So far, there is no success story of any patient making it back home after psychosocial
rehabilitation, as long stay is the main focus of the facility.
The home is divided into two separate

factions- for men and women. The spaces
include the following:
• Occupational Therapy Room
• Bedrooms (shared between two or

three people)
• Nursing Station
• Waiting Area/TV Area/Activity

Area
• Offices
The home provides rehabilitation facility

for long-stay patients, who require being
in the hospital for more than two years.
Picture 17 Occupational Therapy Room
Staffing: The doctors, psychologists are a
part of IHBAS who also take care of Saksham. Saksham also has full-time caretakers. The food
is sourced from the main hospital hence there is no need of a kitchen.
About Occupational Therapy:
Occupational Therapy at Saksham consists of activities like exercise, making artwork, talking
therapy, etc. The occupational therapy helps in confidence-building of a patient.
Future of Halfway Homes in Delhi

The Delhi High Court had given directions to the
government to establish such homes on March 12,
2009, after public interest litigation (PIL) was filed in
this regard. Consequently, five such homes — three in
Rohini, one in Dwarka and one in Narela were readied
by 2012.
At present, mentally ill patients are sent to

government-run homes such as Asha Kiran and Asha
Jyoti. Doctors at Asha Kiran in Rohini, however, said
these homes were equipped to cater to mentally
challenged patients only. While mental illnesses can
be cured, mentally challenged people have
permanent impairment. However, five new halfway
homes have been sanctioned by IHBAS in Delhi, one
in the IHBAS Campus itself.
Picture 18 Common dining area for the members
Picture 19 Common waiting and TV area

Picture 21 Interactive Spaces inside the HWH Picture 22 Rooms inside the HWH, shared by 3-4
members
Picture 20 Presence of a lawn inside the halfway home gives the members an opportunity to interact

• Project Tarasha, Tata Institute of Social Sciences, Mumbai
Project Tarasha is a field-action project by the Tata Institute of social sciences, run by students
and counsellors hired especially for this project.
The process of psychosocial rehabilitation followed by project Tarasha
Their objectives are as follows:
• To support women recovering from mental disorders in making a transition from

institutions back into the community through networking, capacity building and
sensitization
• To facilitate the process of recovery in women aimed at addressing issues related to

psychosocial well-being, shelter, sustainable livelihoods and economic independence.
• To shift society from a mind-set of exclusion and stigmatization to inclusion and

acceptance, thereby supporting to create safe, non-threatening spaces for women
living with mental disorders.
• To influence policy through advocacy and networking
Project Tarasha follows the model for psychosocial rehabilitation based on the following:
Deinstitutionalization: This phase is a stage of screening, selection, capacity building and a

move towards deinstitutionalization. Owing to a partnership with the Regional Mental
Hospital, Thane, patients below the age of 50, healed from their mental illness, are screened
with the following criteria: Level of functioning, Current symptoms, Insight and acceptance,
Willingness towards adherence to medication, Age (upper age limit is restricted to 40 years
given the employability opportunities for women discharged from the hospital), Degree of
family/social support.
This is an ongoing phase, but women who are being moved need to be part of the group
process for a minimum of 4 months.
Psychosocial Recovery:
Phase II of the project is marked by two events:
i) Moving into a working women’s hostel

ii) ii) Beginning psychosocial recovery
The women are moved into the Working Women’s Hostel in Kalina, where the
deinstitutionalized patients stay for through the duration of the rehabilitation process. Project
Tarasha, while it doesn’t have an infrastructure for the activities for psychosocial rehabilitation,
outsources these programmes to different locations.
First three months into their stay at the working women’s hostel, the women attend the
Manav Rehabilitation Centre, Grant Road which is a daycare centre that takes care of the
therapeutic aspect of rehabilitation. The types of therapy offered by Manav Rehabilitation
Centre are as follows:
• Vocational Therapy
• Animal Assisted Therapy
• Drama Therapy
• Dance Therapy
• Self-Defence Therapy
• Bowen’s Therapy
These therapeutic exercises are for psychological healing- boosting self-esteem, accustoming
the patients to the outside world, helping them follow a daily schedule, etc.
Vocational Training:
Once women complete their tenure at Manav Rehabilitation Centre and are ready to embark
on vocational training, they are placed with Kotak Education Foundation. KEF offers training in
retail and sales, housekeeping and hospitality sectors. The training typically lasts about 3
months. Following successful completion of training, women appear for interviews and are
selected for job placement.
Besides vocational training, this phase serves to provide the women with an opportunity to
interact with other students in a learning environment appear for job interviews and get
selected on a competitive basis. Women have to go beyond their identity of a person with
mental disorder to someone who is a student-learner, a potential employee, a colleague and so
on. It is at such times that self-doubt and fear surface often. The women also re-learn and re-
adapt their understanding of boundaries and relationships here. Distinguishing between

friends and colleagues, identifying strengths that set them apart from the rest of the student-
group, learning new behaviours beneficial to the workspace and absorbing what is taught
during the training become important aspects of learning for the women.
Job Development and Job Support:
During this phase, the project

withdraws financial support for the
women and continues to provide
psychosocial support to them. The
team keeps in touch with the women
at least once a week. Step by step,
the clients are encouraged to take
control of the therapeutic sessions in
terms of scheduling and themes,
thereby building ownership of the
process of recovery. Picture 23 Women employed by Tarasha in the above fields

Architecture to tackle stigma about Mental Health
a. How Architecture can help advocating the cause of mental health
A well-designed open space encourages outdoor activity and social interactions in a

community. A space, when made inclusive and accessible, equipped with facilities that
generate interest, could be vital in drawing in a significant amount of footfall to the space.
Facilities in a public space that encourage active use, such as seating areas, food markets, pop-
up stalls, etc are a part of this user-oriented design. Facilities like these also require interaction-
it can be between two fellow users of the public space, or employees of the food stalls. The
idea is to harness this interaction into breaking the stigma about mental health.
b. Programmes to foster interaction between the general public and

members
Community involvement into the field of mental health helps raising awareness about the
issue
The public involvement at varying levels might benefit the cause of mental health advocacy.
Users and members can be involved in the programme in the following ways:
• Providing services that employ members.
One of the vocational classes proposed is of hospitality, the students of which will be trained
on catering, cooking and management of restaurants, cafes and hotels. Hence, the presence of
a café in the public space makes it an employment opportunity for the members, and creates
interaction between the users and the members, causing an overall increase in self-esteem of
members.
• Involvement of general public with the vocational school and yoga

therapy.
The process of vocational training in five-phase process of psychosocial rehabilitation involves

skill-building in fields that would increase employability.

Skills imparted in a vocational school are sought-after even by the general public. Hence the
vocational school can have both, the members and the public as student. This creates
opportunities for communication and dispels the notion that even the healed individuals are
harmful to them. The vocational classes that can have an intake of general public are computer
education, graphic design and sales. Also, yoga therapy can also be opened up to the public as
yoga is a sought-after practice for wellness among urban population.
• Programmes to draw in the public to the space
A public space consisting of a park, amphitheatre and food stalls can act as a pause point for
the people who want a break from the fast pace of urban life. The very presence of the space in
the premises of a mental healthcare facility helps break the stigma about these spaces being
‘haunted’. The food stalls can generate revenue for the halfway home and can employ its
members. The amphitheatre can also be rented out for different activities.
• Target Users for the Programme:
• Students studying in nearby colleges.
• People looking to spend leisure time at a public space.
• Senior citizens and the middle-aged (For Yoga)

c. Benefits and Limitations of Public Involvement:
Initiatives for Psychosocial Rehabilitation taken across the country are funded by individual
donors, government mental institutions or CSR Initiatives. The volunteers involved hands-on
with the residents of a Halfway Home are trained mental health professionals, who are
conscious of the nuances of psychiatric treatment.
Yet, exposure to psychiatric treatment processes at a basic level to the non-professional, i.e.
the ‘general public’ is essential for the following reasons:
The benefits of the programme on the residents of the Halfway Home are as follows:
• Exposure to the general public, hence an increase in self-esteem.
• Establishing a network and relationships outside the halfway home, which eases
residents’ lives after their exit from the halfway home.
• Awareness about psychiatric treatment eliminates the notion of incurability of mental

illnesses.
• Breaking the myth of ‘Once a patient, always a patient’
• Eliminating the ‘fear of the unknown’, which in this case are the half-truths about
mental health and psychiatric treatment.
However, there are limitations to involving the general public in the process of psychosocial
rehabilitation:
• Possibility of lack of users for the vocational programmes owing to the stigma
• Abandonment of the public space due to the stigma surrounding psychiatric

institutions.

Architecture to evoke Mental Healing
a. Urban Architecture and its link to mental illness

Urban environments are designed as a whole to affect the human mind. The following
explores its adverse effects
The regions that are defined as ‘Urban’ are non-agricultural human settlements with a high
density of population and man-made infrastructure such as residences, commercial buildings,
transportation, etc. Urbanization is the growth of such settlements due to a population influx
from rural areas. To meet the demands of the increasing urban population, the infrastructure
development is rampant in these regions. Urbanization is good for the country as it adds to the
economy, increases productivity of a region. However, it’s impact on the human psyche is
immeasurable. The link between mental illness and urbanization is as follows:
Because the designed environment is

universal in urban contexts, the impact
of the urban setting on an individual’s
psyche is both pervasive and intense.
Urban environments are created over
the space left by the destruction of
natural environments. Needless to say,
a major part of urban environments is a
result of man-made design, usually
conceived by architects and urban
designers. In the city, even the speck of
dust that flies around the streets is
designed— from bits of packaging, Picture 24 The designed environment of Times Square, New York,
which focuses on advertising to manipulate crowds and extract their
mass media, food, cigarette butts, and purchasing potential. Source: Flickr
the litter from landscape to designed street planting and gardens; nearly every bit has had a
human hand with some kind of design intention at some point and nearly every object is
loaded with identifiable meaning. Even the microclimates are affected, with phenomena like
heat islands and wind turbulence. (Golembeiski, 2016)
• Architectural experience as a response trigger
Nothing is experienced by itself, but always in relation to its surroundings, the sequences of
events leading up to it, the memories of past experiences. (Lynch, 1960) Science explains that

experience affects the human brain. All we experience affects the brain and eventually, the
mind. Certain familiar stimuli will activate instinctive processes before any voluntary
processes. Hence this abundance and variety of ‘experience’ that an urban built environment
offers is linked to the stress-related activations of the amygdala, the source of
dopamine, norepinephrine, epinephrine and serotonin, and the anterior cingulate cortex, the
control centre of blood pressure and heart rate.
An urban amygdala is likely to be more sensitive to the designed world, because design is
deliberately intended to trigger human responses, whereas the reactions that people have
toward nature may have evolved through the millennia but are not intentionally designed and
have formed a part of our evolutionary psychology. (Golembeiski, 2016)
The designed world is a set of

triggers for mental illness. The
attention that we pay to predictable
and non-aversive surroundings is
minimal, hence our mind has the
opportunity to relax, with an ease of
attenuation to the environment.
This is a significant neurological-
environmental reaction because a
failure to adjust to the environment
is a symptom of mental illness. An
environment that creates a fight-
and-flight response does not give
the mind an opportunity to
attenuate, and engages the
amygdala and the hippocampus. As
useful as these reactions are,
automatic reactivity causes
disorganized behaviour, which also
features in mental illness. Over
time, this excitatory response
translates into mental illness.
(Golembeiski, 2016)
Figure 11 The comparison between rural and urban population and the
prevalence of mental disorders. It is clear that mental disorders affect the
urban built environments more than rural.

b. Use of Architectural Phenomena to create experiences
Architecture has long-term and short-term effects on the human psyche. The following
factors create an impact.
Any definition or description of the environment has to be with reference to something

surrounded by either nature or manmade. It is also said that “architecture is the third skin” of
the human body, since the first skin is the real skin, which acts as the outer envelope to the
body, the clothes act as the second skin. So, people’s third skin would be the next layer out -
usually the building they are in. (Elyacoubi, 1999)
The architectural environment, where activities that give life to any society take place, has a
dominant and permanent influence on the user of this environment. Nevertheless, people do
not only try to cope with their environment passively, but they modify it actively to match their
needs by acting individually or collectively, “leading to characteristic interaction effects which
vary over time, situations and persons.” (Sommer, 1996)
The surrounding environment is considered the context of behaviour and reactions. So, the
human behaviour in any space has to be tested and carefully studied by designers in order to
be taken into consideration during any future design process.
• Theory of Phenomenology
Phenomenology is the philosophical study of the structures of consciousness, experience and

human perception. It is based on the premise that reality consists of objects and events
(phenomena), that are perceived by the human consciousness and nothing independent of
that. Experience, is not consisted only of the passivity of sensory perception, but also thought,
imagination, desire, conviction and action. Thus, we may observe and engage with the world
around us, and then our consciousness experiences it. Phenomenology is the study of
experience and how we experience things. (Phenomenology, n.d.)
• Phenomenology in Architecture
The theory of phenomenology acknowledges the responsibility of an architect to design an

experience by implementing sensory design in order to establish an experiential, architectural
space. The theory encourages the inculcation of sensory perception as a function to the built
form, by manipulating space, material, light and shadow. This creates an intangible experience
best described as abstract, observed and perceived. (Kraus, 2011)

Architecture is designed to serve the needs of human activity and therefore creates a
relationship between the building and the human’s senses to transform emotion and
perception. The dynamics of human perception, communal or individual, should influence
architectural form and function in terms of circulation and organization of and elastic, supple
programme to produce sensory architecture. Architecture hence influences the community
through incorporating human activity with adapted site context, organized programmatic and
interstitial space and an in-depth exploration of material. (Kraus, 2011)
The compositions and beliefs of phenomenology theorists Alberto Pérez-Gómez, Steven Holl,
and Peter Zumthor emphasize the power of phenomenon in their theoretical constructs. They
reason that the sensory experience between an architectural object and those who encounter
it should be critical and complimentary. They work of these theorists determines to revive
emotion-evoking design through space, material, and light and shadow through expression of
these features into both, a larger context and intimate human perception. A common theme in
each phenomenological approach to design is the management of space, material and light
and shadow, regardless of the function the space serves. Hence phenomenology in
architecture can be used to evoke healing through experiences. (Kraus, 2011)
c. The Five Senses as Receivers and Gateways to the Human Mind
The main function of our senses is to enable us to sense the world around us. When we enter a
new space and human mind begins to notice it, recognize it, and then evaluate it. This process
of discovering affects our sensation in the space and influences our opinion about it.
Design, when taking into consideration the five senses enables it to affect the physical and the
psychological state of the user in a positive way. The following are the parameters that affect
Human Behaviour:
• Effect of Colour:
Colour strongly influences human emotions and physiology. Red stimulates the
sympathetic nervous system, increases brain wave activity, and sends more blood to
the muscles, thus accelerating heart rate, blood pressure, and respiration. Blue triggers
the parasympathetic nervous system and is credited with a tranquilizing effect. Colour
has a great effect on perception. Warm colours seem to advance and cool colours to
recede. With the use of cool colours, time is underestimated, weights seem lighter,
objects seem smaller, and rooms appear larger. The opposite is true for warm tones.
Thermal comfort is also affected by colour; people feel cooler in cool-toned rooms and
warmer in warm-toned rooms, although the actual temperature may be the same. A

well-known colour study was conducted in 1958 in which researchers conducted
different physiological tests to investigate the brain´s activity during exposure to
different colours When the participants were exposed to the colour red, their brain
activity increased more than when exposed to the colour blue. The results showed
differences in blood pressure, breathing, and blinking frequencies
Picture 25 Effects of different colours on the human psychology. Different colour

associations can be used to alter the mood of the space. Source: Verywell Mind
• Effect of Microclimate:
The climatic conditions of this

space need to be considered
while designing a space.
Researches have proved that
the human behaviour in any
space can be affected by the
abnormal levels of heat, cold
and wind. The human skin is
the sense that is responsible
for that kind of stimulus and
that the human body needs
Figure 12 Creating a cool microclimate in a courtyard using shading and
for these different stimuli to vegetation. Comfortable microclimates have positive effects on the mind.
Source: Karl Boeing
be in the comfort zone. When
the human body is in

discomfort it behaves abnormally.
There is a strong relation between the ambient temperature of any space and the
behaviour of the user inside this space. Any activity is going to be enhanced at first
when the temperature is being raised and then it gets worse. Heat and aggression are
related (Environmental Psychology 4th Edition, 1996). Temperature is not the only
stimulus that affects the human behaviour, but also the barometric pressure and
altitude has a tremendous effect on it too. Temperature effect includes both physical
and psychological components. The main physical component is the heat degree in the
surrounding environment. One psychological component is centred on the internal
temperature of the human body, the core temperature (deep body temperature), which
affects the mood and the feeling of stress.
• Effect of Natural Light:
Natural light from the sun is considered to be the best source of light for the human
health physiologically and psychologically. The human system evolved under the
influence of the sun - light spectrum to which particular light-sensitive and light-
modulated organ systems are specifically adapted. It has been proved scientifically that
the cases of depressions are much more (about 200%) during the autumn and winter
season than during the spring and summer season. After several researches,
psychologists found that light is the main reason behind that.” It also enhances the
visual perception in the environment for both form and colour, and provides a pleasant
feeling. (Elyacoubi,
1999)
Figure 13 Effects of Sunlight on the brain. Natural light is an important

feature in design. Source: All American Window Tinting

• Nature: Immersion in
greenspace in cities, even when it is
modest (a community garden in the
city) or complicated by potentially
unpleasant connotations (a garden in a
psychiatric hospital or a cemetery)
exerts a profoundly positive effect on
emotional state and a lowering of
physiological arousal. (Ellard, 2017).
When perception to the surroundings
deteriorate, the interconnections
between neurons are thinned, leading
to difficulties with learning, spatial
cognition, information and logic
handling, as well as other cognitive
functions. Similarly, a socially and
materially deprived environment has
also been shown to cause the same
symptoms – at least in rats, with similar
effects on humans. And any positive or
neutral enrichment of the environment
should improve the interconnections
between neurons. If this proves to be
the case, environmental richness will
directly assist recovery (Golembiewski,
2013)
• Facades: Street-level facades

that are low in visual complexity not
only cause participants to self-report
Figure 14 Positive effects of green cover on mental health. lower levels of interest and pleasure, but
Source: Pathtomobility.com their levels of autonomic arousal
become low. The biometric signature of
a low-complexity street looks very much like the signature shown by participants in
laboratory studies who are experiencing states of boredom. (Ellard, 2017)
• Orientation: In order to feel connected to a place, the knowledge of how things

relate to each other spatially is important. In other words, a sense of direction provides

an essential grounding, in order to not make the space confusing. Spatial arrangement
within an environment is important because it has a direct effect on how people
navigate and use the space. This becomes increasingly important as skills and cognitive
abilities deteriorate in mental illness. For best effect, space should be logical, non-
repetitive and well-marked with memorable objects and functions. (Golembiewski,
2013)
• Building Typology: the main function of typology is information: it informs people

about the nature of the place they are visiting. Strong typology simplifies
understanding, orientation and way-finding (Lynch, 1960). But not all typology is equal.
Typology is symbolically and phenomenologically loaded, and so sensitivity needs to be
given to types that may have negative meanings. Negative typologies may include
prisons, hospitals, schools, courts, psychiatric facilities, seclusion rooms and other
institutional buildings.
• Movable
architectural
elements:
Opportunities for
engagement that exist at
a smaller scale can be
created by inclusion of
objects in the
architectural elements.
Movable objects or
ordinary life like movable
furniture, switches,
blinds etc are regularly
engaged with.
Translation of this into
architecture, like
movable elements in the
façade, etc. can foster
engagement from the
Picture 26 Elements in architecture that can be engaged generates interest users. (Golembiewski,
about the structure. When used in facades, it breaks the monotony. Source:
Manuel Herz Architects 2013)

d. A Salutogenic approach to designing rehabilitation spaces
The concept of fighting the root of illness rather than merely treating the ailment
The term Salutogenesis describes an approach focusing on factors that support human health
and well-being, rather than on factors that cause disease (pathogenesis). More specifically, the
"Salutogenic model" is concerned with the relationship between health, stress, and coping.
Coined by Aaron Antonovsky, a professor of medical sociology, the term combines the words
‘salus’ which means health and ‘genesis’ which means origin. This alternative model of
care deals with the relationships between stress, wellness, and human health. Salutogenic
design focuses on the positive impact of design on human health. It’s a measurable aspect of
design that can help a building’s inhabitants operate at their peak performance. Additionally, it
can help them maintain physical and mental well-being, actually helping them lead
healthier and potentially longer lives.
On the most basic level, certain environmental factors are universal, like circadian rhythms.
Morning light is blue spectrum light that cues our bodies to release cortisol and wakes us up;
evening light, conversely, is red spectrum light that causes our bodies to release melatonin,
preparing us for sleep and physical restoration. In other cases, these environmental factors are
very personal and specific, based on our genetic wiring that sets the stage and the
environment
activates those genes
in different ways. Our
evolutionary memory
responds to biophilic
elements, like plants
and natural materials.
These factors can be
considered and used
to design spaces that
support the well-
being of the user to
Figure 15 The main difference between pathogenic and Salutogenic orientations of
aid healing. (Maurice treatment. Psychosocial rehabilitation is a pathogenic way of treatment. Source:
B. Mittelmark, 2017) Handbook on Salutogenesis

• Salutogenesis in Architectural Design
The central idea of Salutogenesis is a ‘Sense of Coherence’ which is defined as- “The extent to
which one has a pervasive, enduring though dynamic, feeling of confidence that one’s
environment is predictable and that things will work out as well as can reasonably be
expected”. There are three resources that combine to provide a Sense of Coherence—a forward
push that resists the entropic forces of illness. The sense of coherence is made up of resources
that improve (Maurice B. Mittelmark, 2017):
• manageability—the capacity to maintain physical function;
• comprehensibility—an ability to negotiate circumstances in order to maximize their

benefit;
• sense of meaningfulness—the desires, causes and concerns that give us the need to
resist illness in the first place. (Maurice B. Mittelmark, 2017)
Picture 27 Attributes that can be categorized based on Aaron Antonov sky’s sense if coherence factors
The three pillars of sense of coherence can be

translated to architectural design using the
elements of nature, authenticity, variety and
vitality.
• Nature: Spaces inspired by nature and

natural elements invoke the evolutionary
memory of a person, making a space
seem more comfortable and relaxing, as
one would feel surrounded by nature. Figure 16 A section showing how greenery and natural light
can be included in a built space. Source: Human Spaces-
Natural environments often offer an Interface

atmosphere where the individual´s needs for harmony and compatibility are met. It is
therefore very important that natural environments are accessible at the rehabilitation
space.
o Healing Gardens:
The term healing garden is used
for green spaces in healthcare or
therapeutic facilities that aim to
improve health outcomes
specifically. Gardens are
particularly able to promote
healing more than any built
space because humans are
hard-wired to find nature
engrossing and soothing.
Healing gardens aim for a
Picture 29 A healing garden at Florida Hospital Celebration Health unit. passive involvement and are
Source: Wikipedia
designed to provide benefits to
a diverse population with
different needs. The important
factors in a healing garden are
real nature- flowers, green
vegetation, and water elements.
It is important to avoid abstract
art and sculpture which may be
subject to negative
interpretation. Healing gardens
also need to be situated where
the sounds of the city do not
disrupt peace. In case of the
Picture 29 Artificial daylighting in places with no windows also helps
in boosting a person's mood
location being an urban area,
sound barriers need to be in
place to maintain silence.
(Kreitzer, n.d.)
o Sunlight: Lack of daylight can lead to both physiological and psychological

difficulties. A window is an opening in the built form that allows the light in. The
placement of windows can have positive health outcomes on patients, by
allowing fresh air and daylight to enter, providing a view and a link to the outer

world. A research conducted in a correctional institution in Michigan proved
that inmates who had their windows facing the prison yard visited the
healthcare facility more than the ones with their walls facing the forest. Rooms
without a window can affect human health and wellbeing negatively. Since
daylight positively impacts human physiology, it preferred over artificial means
of lighting. However, artificial daylight claims to have similar effects on humans
as natural light, with research proving that it can positively affect a person’s
cortisol levels. (Dilani, 2014)
• Colour: Colours can affect and individual’s brain activity and create a sense of well-
being. It adds an element of originality to the built form- they contribute to a building’s
identity or help it fit within the local context. Perception of colours and the experiences
that come after contribute in creating a sensory identity of a place in a person’s mind.
This creates a sense of coherence to the space owing to past experiences with the
colour or the space itself. Warm colours like red, yellow and orange are considered to
have an activating effect, increasing hunger and enthusiasm. Pizza Hut, KFC
restaurants have red-themed interiors for the same reason, increase in hunger
translates to an increase in sales. Cool colours like blue, purple and green have a
calming effect, and are mainly the reason humans find wilderness to have a calming
effect and natural elements and colours need to be included in spaces that require a
calming effect.
Picture 30 Cool colours like blue and green used in the waiting area in the left picture bring out a calming effect,
while warm colours like red used in the therapy room in the right picture radiates energy, making therapy more
effective.
• Landmarks: Serving as reference points within the building, Landmarks such as

paintings, sculptures, etc. help create cognitive maps of the environment that help a
person identify the space and find their way through it. Landmarks in a building act as
foci of acquaintance to a space, making wayfinding easier with time, and are
responsible for reducing stress that comes with an exposure to unfamiliar environments

• Variety: Range of experiences and a sense
of discovery adds to the positive
experience of a space. Visual and
experiential monotony can contribute to
physiological and emotional stress. Even a
building façade, if monotonous, makes it a
dead zone and doesn’t elicit interest of any
kind. Aesthetic and functional monotony
should be broken in order to generate
positive passive responses towards the
built form. Picture 32 Decorated tree outside the Rotorua
Cultural Centre, New Zealand, that acts as a
landmark.
Picture 31 Hejmdal Hospital makes use of these seating pockets throughout the hospital for
people to interact
• Vitality: Regenerative space facilitates a flow of people and ideas to regenerate a

person’s mental and physical energy by making the space as interactive and engaging

as possible. Examples of regenerative spaces include entertainment areas, lawns, atria,
cafés, gyms, group therapy areas and any other area that requires congregation for the
space to fulfil its function. Such areas work towards engaging a person, hence reducing
their stresses and help boosting self-esteem.
Picture 33 Interactive space proposed at the Belfast Mental Health Centre promotes interaction and has
a regenerative quality.
Crowding is closely linked to social support, defined as the number of individuals in a certain
area. Crowding is described as a condition where a person’s private sphere is trespasses, or a
person is exposed to more social interaction than desirable. On the flip side, a person exposed
to too little contact may be on the risk of feeling too lonely or isolated. Crowding can be
regulated by creating buildings and space where an individual can control and decide if they
would like to participate in social interactions or be in privacy. Thus, by regulating crowding,
experience of stress can be reduced and social interaction is promoted. (Dilani, 2014)
Picture 34 Spatial factors like ceiling height and area per occupant are important to reduce the sense of crowding. The
dormitory on the right is percieved as more spacious, inviting and relaxing than the one on the right.

Materials and Textures: Materials and textures have a significant role in influencing the way we
feel, act and interpret a space, and they should reflect familiar and homely environments that a
person is accustomed to. The aesthetic and the tactile perception, and the ease of
maintenance are factors that are considered while choosing a material.
Picture 36 Tactile exteriors of the Yale School of Picture 36 Hejmdal Counselling centre makes extensive use of the wooden
Architecture enhance the perception of space. texture to establish an earthy feel to the structure

• Case Study of a space designed for patient wellness: Karunashray
Hospice Centre, Bangalore
Location: Bangalore, Karnataka, India.
Function: Karunashray is a palliative care home for advanced stage cancer patients. The motto of the
hospice centre to add ‘years to life’ of people that may not come out of their illness. Even if the patient
may die under hospice care, the caregivers aim to make the members’ stay as comfortable as possible.
Picture 39 Layout of the hospice. The layout makes it clear that the structure makes use of interstitial spaces for different
functions.
Picture 38 Well-lit, semi-open paths make wayfinding easier Picture 38 The wards face the artificial water body, providing a
and a more relaxing process. change of experience as a person comes out of a ward.

Picture 40 Use of landscaping within the interstitial spaces have a calming effect on the patients
Picture 41 Use of courtyards throughout the structure ensures natural

sunlight and air flow, making the space breathable.
Picture 42 Use of stone cladding as a

material for the exterior makes it an object
of tactile perception, making patients
connect to the space, and also adding an
aesthetic value.

Design Intent
• Design Objectives:
• To design a psychologically sensitive Halfway Home for psychosocial rehabilitation of

the deinstitutionalized mentally ill individuals.
• To design a therapeutic space for the members, to aid mental healing.
• To design vocational classes that the members build employable skills.
• To design a healthy living environment for the members of the halfway home.
• To design a public space that has establishments that employ the members of the
halfway home, and vocational classes that the members and general public can use.
The public space is to force interaction between the general public and members of the
Halfway Home to dispel the stigma about mental health.
• To design a Salutogenic environment for the rehabilitation of the people free from their
mental illnesses.
• To influence the psyche of the users using responsible architecture.

• Concept
Salutogenesis: Salutogenic design aims to ‘cause health’ and well-being rather than tackle the
causes of mental illness. Psychosocial rehabilitation focuses on the mental illness over general
wellness, and a combination of Salutogenic design and the programmes that constitute
psychosocial rehabilitation will cause healing at a holistic level. The design will incorporate
elements of Salutogenesis to improve overall well-being of a member undergoing psychosocial
rehabilitation.
Spaces that foster interaction: Even beyond the scope of mental healing, interaction with
fellow humans always brings about a positive effect on a person. In isolation, a person’s growth
remains stunted, hence a space that foster interaction among members and between the
members and the public will help in the rehabilitation of the members and dispelling the
stigma about mental health among the users.
• Spaces
The design proposal for this project has the following spaces:
• Residential Units:
o Rooms shared by 2,3 and 4 people: At the beginning of the rehabilitation

process, people are allotted rooms that are shared by two people and the
number or roommates increases according to the progress a member makes.
o Common Kitchen
o Spaces for washing clothes/utensils
o Entertainment Area
o Common Interactive Spaces and Activity Areas: Interactive spaces form pockets
of activity within the residential space and help break monotony.
• Rehabilitation Unit
o Talk-therapy room: A talk therapy room is a spacious, well-lit room for

conversation-based therapy like Cognitive Behaviour Therapy.
o Art Therapy room: An art therapy room is a space for therapy through artistic
expression, and is conducted in a group.

o Yoga Therapy Area: Yoga therapy is best conducted in a semi-open space, and is
conducted in a group.
o Occupational Therapy room: Occupational therapy is conducted individually,

and aims to keep a person occupied with various activities.
o Common hall for group therapy
o Computer Room
o Library
• Vocational School
o Hospitality
o Computer Training
o Graphic Design
o Sales
• Public Space
o Café: To employ members of the halfway home.
o Amphitheatre: For performances or can be a seating space.
o Lawn/Park (shared used with the members of the halfway home)
o Food & Beverage Stalls: To employ members of the halfway home.

Site
a. Site Selection Criteria
Based on program:
• The program consists of a halfway home and a space for public interaction.
• The public space needs to attract users from the nearby metro to achieve the aim of
mental health advocacy.
• The therapeutic nature of the halfway home requires it to be situated away from chaos,
pollution and noise, a quality that lacks in a metro like Mumbai.
• The vocational school and the public space need to have accessibility in order to
function.
Based on user:
The main target users for the halfway home are individuals ready to be released from mental
institutions in Mumbai. These individuals need to be in a space that is not isolated from an
urban metro as after psychosocial rehabilitation, they will be released back into an urban
society. Proximity to the mental institution is not necessary.
The user of the public space are the people residing in Mumbai that need a recreation space.
The space needs to be close to the metro, yet not be within the metro as it needs to be away
from chaos.
Accessibility:
• The site needs to be in the outskirts of an urbanized metropolitan region, like Mumbai.
• The site being in the outskirts ensures accessibility to the site by the target users, yet it
is away from the influence of rapid urbanization.
• The site needs to be connected to the national highway or an expressway to act as a

pause point that attracts the users of the highway. It can also be close to an already
well-establish public space like a lake, public park, etc to attract footfall.

Conclusion: The site needs to balance chaos and accessibility. The necessity of the site to be in
the satellite cities of Mumbai, like Navi Mumbai or Thane, ensure that it is away from the
chaotic nature of Mumbai, yet is accessible by local trains and roads. Accessibility enables the
members of the halfway to have an access to employment opportunities outside the halfway
home. It also enables users from Mumbai to access the site.

Bibliography
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Architecture For Mental Health Anshikasrivastava

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Halfway Homes for the

Healing the healed through

Guide: Ar. Geevith Raghavan

Seat Number: OCT18-IX-033

Ar. Geevith Raghavan. :

Ar. Mandar Parab :

I hereby declare that this written submission entitled

Signature of the Student:

Name of the Student: Anshika Srivastava

Date: 1st November, 2018 Place: Mumbai

*The following defines plagiarism:

I take this opportunity to express my profound gratitude to the management of L. S. Raheja

Anshika Srivastava| Design Dissertation Part 1

NEED FOR STUDY 11

A. LIMITATIONS TO THE STUDY 13

A. MENTAL HEALTH AND MENTAL ILLNESS 15

Anshika Srivastava| Design Dissertation Part 1

PERCEPTION OF MENTAL ILLNESS IN INDIA 29

A. STATE OF MENTAL HEALTH IN INDIA 29

A. DEINSTITUTIONALIZATION AND ITS EFFECTS 39

ARCHITECTURE TO TACKLE STIGMA ABOUT MENTAL HEALTH 60

A. HOW ARCHITECTURE CAN HELP ADVOCATING THE CAUSE OF MENTAL HEALTH 60

Anshika Srivastava| Design Dissertation Part 1

ARCHITECTURE TO EVOKE MENTAL HEALING 63

A. URBAN ARCHITECTURE AND ITS LINK TO MENTAL ILLNESS 63

A. SITE SELECTION CRITERIA 83

Anshika Srivastava| Design Dissertation Part 1

Figure 1 Different brain disorders that require neurorehabilitation or treatment .................................. 15

Anshika Srivastava| Design Dissertation Part 1

-Why would individuals not seek help for their illness?

-Why, despite seeking help, individuals do not heal?

-Can architecture eventually be used to heal the human mind?

Anshika Srivastava| Design Dissertation Part 1

Halfway Homes follow a carefully-paced approach in reintegrating a deinstitutionalized person

Anshika Srivastava| Design Dissertation Part 1

The following research aims to achieve the following.

• Identify the importance of a transitional aftercare programme for deinstitutionalised

• To outline the impact of architectural design on the field of mental health.

• Creating a prototype for a safe and psychologically sensitive Halfway Home as an

• To design a healthy space conducive for psychosocial rehabilitation.

• To design a public space to attract crowds regardless of the presence of a halfway

Need for Study

Anshika Srivastava| Design Dissertation Part 1

• Psychosocial rehabilitation works for societal reintegration of deinstitutionalised

• Study of causes that prevent a deinstitutionalized person’s re-entry in to the society

• Study of methods that facilitate psychosocial rehabilitation.

• Study of the extent of community-based rehabilitation when general public is involved.

Anshika Srivastava| Design Dissertation Part 1

• Effect of public involvement of public on the self-esteem of residents cannot be

• Extent of working of public involvement for mental stigma not known.

Anshika Srivastava| Design Dissertation Part 1

• Perception of Mental Illness in India

• Mental Health Advocacy through architecture

• Effect of the built environment on the human mind

Anshika Srivastava| Design Dissertation Part 1

a. Mental Health and Mental Illness

However, just like any other organ of the body, brain

Brain injuries are a result of trauma (wounding) to

Tumours in the brain can be of two types- cancerous

Anshika Srivastava| Design Dissertation Part 1

Mental health is a level

The World Health Organization defines

Anshika Srivastava| Design Dissertation Part 1