Create a supportive network for mental health: Insights from a home visit

[Kasthuri Divya]

My colleague and friend, Syjo & I did not know what to expect when we started for the visit. This would be our first effort to using SALT in the community.  When we reached, I noticed that the neighborhood was quiet and physically close-knit, offering little privacy. The home was neat and minimalistic, containing only essential, functional items, with nothing to make it particularly pleasant or welcoming—no TV, for instance. The sole caregiver and the sibling of the client was in the middle of his workday when we arrived, but he paused to speak with us.

He mentioned that the client was taking a morning nap, and noted that she also typically had an afternoon nap. The caregiver spoke with ease and familiarity, as if he had known us for a long time. He narrated his experiences without much hesitation, showing only slight changes in his emotional state, as though he had shared these stories many times before.

When we met the client, she responded better than we expected. She answered questions with the caregiver's support, smiling appropriately and being shy at times. While she struggled to understand complex sentences, she could grasp simple, short ones and had reportedly shown improvement in communication. She was with us briefly before leaving to sleep.

Talking to the caregiver was easy because he was very responsive. I didn't need to think twice before asking a question; it felt natural to engage in conversation with him. While he spoke genuinely, giving us his full attention and seemed to be in control of his emotions, likely because he needed to be for the client's sake. He mentioned that his uncle, who lived with them, also had bipolar disorder, making him a caregiver for not just one person with lived experience but two. He mentioned in one of our conversations that he "can't afford to be depressive," as he is predisposed to having a mental illness and feels the responsibility to stay strong for his family.

After speaking with the caregiver and noticing how comfortably he referred to his neighbors by their first names, as if we were already familiar with them, it became clear how crucial their support has been over the years. His ease in speaking about his neighbors, without needing to explain who they were or where they lived, showcased the close-knit community around him.

Inspired by this interaction, Syjo and I felt we could organize a weekend gathering of the caregiver and his neighbors in their building. This would allow us to meet these supportive neighbors and understand what has motivated them to stand by this family. Such an event could provide insights into building and maintaining a supportive community. We plan to hold this gathering after the families have returned to their routines following the summer holidays.

So, what facilitated the building of this supportive community?

One thing that stood out to us was the family’s openness about their illness, both with the client and her uncle. The caregiver mentioned that he didn’t see mental illness as any different from a physical condition like diabetes, which encouraged him to disclose it within his community and workplace. This honesty, combined with living in the same home for 14 years and in the same gated community for about 16 years, played a major role in developing strong bonds with their neighbors.

The caregiver described his uncle as a friendly, polite, and resourceful person, viewed by others as kind and helpful. This positive perception might have influenced how accommodating the neighbors were during his uncle’s episodes of mania. The caregiver ensured that the community was aware of his uncle's condition and actively sought their assistance when needed. For example, he made arrangements with a local grocer to allow his uncle to purchase groceries on credit, with the caregiver settling the bill later. This understanding and accommodation allowed individuals with lived experiences to maintain a normal routine and interact socially within the community.

So, what went well? 

The meeting went well for several reasons. Despite being arranged on short notice, the caregiver was very accommodating, open to sharing his experiences, and even postponed an office meeting to ensure our conversation was uninterrupted and private. His willingness to set aside this time for us demonstrated his openness and the trust he has in us, likely stemming from the existing rapport we have built with him and his sister over the years. The 9 years of treatment they have received from SCARF have also played a significant role in fostering this trust.

Meeting the client was particularly insightful. Observing her progress was encouraging; her responses, though supported by the caregiver, showed significant improvement compared to when she was non-verbal. Both Syjo and I felt comfortable speaking with her, and seeing her progress made me happy.

An unexpected yet pleasant part of the visit was meeting the caregiver's neighbor. When he invited her over, we took the opportunity to introduce ourselves and explain our visit. We discussed how support from neighbors like her contributes immensely to the client’s treatment. This interaction was made possible by the caregiver's strong relationship with his neighbor and his trust in us to handle the interaction sensitively. When we expressed our appreciation for her efforts, she modestly replied that she was simply doing what she would do for her own children.

What could we have done better next time & how? Given how much the neighborhood meant to the family, including grocery shops and nearby hotels, I think we could have spoken to one of the grocery stores owners and to just simply walked around the neighborhood before we left, just observing and noticing.

This home visit provided key insights into the dynamics of a close-knit community supporting individuals with mental illnesses. The caregiver's openness and the community's accommodating nature show the importance of transparency and long-term relationships in fostering support networks. Inspired by this interaction, we plan to organize a gathering to further understand and strengthen these relationships, offering a model for building supportive communities that prioritize mental health and well-being.

[Kasthuri Divya]

@Rituu Thank you, Rituu, for encouraging us to do this visit. :)

[Rituu B. Nanda]

Superb Kasthuri and Syjo. SALT conversation with shopkeepers around is a great idea! Happy to learn this from you.