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Winter in India: Mental Health from a Global Perspective
May 8, 2018
By: Aimee LaBrie
For Anna Tivade '18, the trip with her MSW classmates to Chennai, India came as somewhat of a surprise. A mother of five, she first didn't believe that studying abroad was a reality. With some inspiration from a fellow grad student and the support of her Indian-born husband, she applied for the winter term. When she arrived, she also wasn't met with what she expected.  I had heard many stories, done my research, and had the benefit of being a part of the culture through my husband, children, and in-laws," she explains. "However, my ideas were just ideas. The actuality of the country and all of its complexity and beauty deepened my understanding of our global culture"
After spending an intense two-week period traveling from numerous urban and rural centers dedicated to mental health care, Tivade has a new perspective. "I hadn't realized I would be interested in working with people with severe mental health challenges. I was mistaken. Getting involved with a non-profit organization that does work in India is something that’s now on my radar. This experience has impacted my skills for my chosen field by providing me with a new perspective on recovery and resiliency." 
The program, now in its second year, allows MSW students to study how poverty, social ecology, and culture affect mental healthcare delivery to a rapidly developing urban society. Students are able to see up close how another country manages and engages with mental health challenges, in one of the busiest and oldest cities in the world.  
Dr. Ramesh Raghavan, Professor and Associate Dean for Research at the School of Social Work, who accompanies the students, sees the trip as an opportunity to learn ways of managing mental health care within a developing country context. "Students invariably realize that we are more similar than we are dissimilar, and that human problems are roughly the same everywhere," he says. "People in less-developed contexts can do things worthy of emulation – it’s not like we have all the answers. The goal of a global education like this is to expose students to alternative views, to expand their horizons, to make them global citizens, and to give them the competencies to serve their communities in a more nuanced way."

Coursework and field visits are overseen by professors from Rutgers alongside experts from the Banyan Academy of Leadership in Mental Health/Tata Institute of Social Sciences (BALM-TISS). Rutgers MSW students, including a few selected students from outside the School of Social Work, meet with students in India, and travel to various centers to see how different programs manage mental health challenges. 

Linnea Luzzo '18, who went the first year of the program, found the collaboration with students studying at BALM (the Banyan Academy of Leadership in Mental Health) to be one of the most fulfilling aspects of the trip. "I was impressed with the organization’s creative approaches to social problems, specifically at the intersection of homelessness, mental illness, and poverty. For example, BALM has created a campus that is mutually-beneficial for clients and social work students. The students have the opportunity to learn about social work practice in the classroom and then walk down the hall to actually use what they learned by spending time with the clients. At the same time, the clients who live there gain a sense of belonging and inclusion through regular social interaction with the students."
This intersection of students and clients sharing the same space, sitting at the dinner table together, would be unheard of in the States.  "Students inevitably comment about the whole ethos of The Banyan---social inclusion, respect for clients, kindness and gentleness with which they are treated – the whole concept of boundaries can be very different, but in a therapeutically appropriate way," Raghavan says.

Kenneth Palmisano '18, an MSW student focusing on addiction and mental health therapy, remembers the juxtaposition between one area that was mostly a rural landscape and a jarring image of technology. "We walked past a village farmer on a wooden cart drawn by two oxen, like a scene out of the late 19th century… except that he was talking on his cell phone. You realize that, as a global society, we are more alike than we are different." 

Throughout their two week stay, students experienced a variety of scenarios and experiences. One day, they were at a surfing school dedicated to teaching local kids surfing as a way to get them off the streets. Another day, they visited a six month program for community health workers to train them to identify and help people with mental health issues. They visited a mausoleum of a companion of the Prophet Muhammed and a temple, both of which are known as healing sites for mental disorders, in order to see how mental health workers integrate care with the individual's religious belief, perhaps by having the medicine blessed by a priest. At an urban shared housing project in Chennai, they saw apartments that were part of Home Again, a model for care for those with long-term needs as well as those living with moderate to severe disabilities. These apartments are inclusive and promote participation and access to community living options. In a rural health care center in Kovalam, they saw clinics with medical care in the front, where an American internist volunteers each winter, and beds in the back for those without shelter. They also spent time at Adaikalam, an emergency care center and licensed psychiatric nursing home that provides initial care for those in need including clothing, food, shelter, and a place to bathe. It also offers longer term support including in-patient care, access to groups, counseling, and case management-based help.  

"What we try to do is expose students to the continuum of care needed in mental health," says Raghavan. "We observe street rescue, acute care services, medication management, psycho social services, a variety of housing options, vocational rehabilitation, occupational therapy, mental health education and community awareness…the works. If we had more time, we’d have students take a train with BALM’s community reintegration team as they locate and then reintegrate clients with their families of origin, if that is something the clients wish to see happen." 
What has stayed with Christina Bruce '17, who is focusing on clinical social work with an emphasis in violence against women and children, was a moment with an outreach worker at a local homeless shelter. They encountered a homeless man suffering from severe and persistent mental illness. For many years, the man has refused shelter, food, or mental healthcare. While they were visiting, the man became angry and refused to speak with the worker. Bruce wasn't sure why he was so upset, but the worker explained. "She said, 'The man was hurt and insulted because I had not visited with him in many weeks.' I asked the worker how she avoids burn out when working with such a vulnerable and at times volatile population. She said, 'I cannot get burned out. My clients are my family.' This was one example of the striking differences between practicing social work in a collectivist culture rather than the individualistic culture. We have much to learn from one another." 
 For more information on this program or other study abroad opportunities, please visit




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