Equality, Diversity and Inclusion: An International Journal, 2022
PurposeAfter being forced to flee their respective home countries, Sri Lankan Tamils and Rohingya... more PurposeAfter being forced to flee their respective home countries, Sri Lankan Tamils and Rohingya refugees resettled in the Indian state of Tamil Nadu. This study attempts to explore the extent to which the state has provided means for integration in the absence of refugee protection laws and citizenship.Design/methodology/approachA qualitative research approach was used, including in-depth interviews (IDIs) and focus group discussions (FGDs) with participants from both refugee groups between 2019 and early 2020. A representative sample of male and female Sri Lankan Tamils, living in or outside government camps, in urban and rural areas, was included (total number = 75). Similarly, a representative sample of the Rohingya refugee community was included for this study (n = 44).FindingsDespite constraints imposed by inadequate infrastructure, the study finds that Sri Lankan Tamils and Rohingyas both show to be progressively integrated in local society and have been capable of fulfillin...
This study aimed to address gaps in understanding of the lived experiences of caregivers of perso... more This study aimed to address gaps in understanding of the lived experiences of caregivers of persons with mental illness in low-income countries. It was conducted among caregivers of persons with mental illness making use of a free non-governmental clinic in and around Chennai, India. The study adopted a qualitative methodology, with semi-structured interviews and life history exercises (n = 29) and six focus group discussions with caregivers (n = 21) and mental health professionals and community-based workers (n = 39). The experiences of caregivers were analyzed in the framework of “The Banyan model of caregiving,” which identifies six phases. Major themes in caregivers’ experience were: embarrassment and losing honor; fear; awareness; stigma and social exclusion; and reduced social interaction and loneliness. Posttraumatic growth considered as the result of caregiver experiences was found to consist mainly of personal growth and focusing on positive life experiences. Lost opportunities particular to the context of Tamil Nadu were described as the inability to get married, obtaining less education than desired, and loss of employment. Siblings faced lower levels of burden, while elderly mothers experienced especially high levels of burden and lack of happiness in life. Caregiver gains were identified as greater compassion for other people with disabilities, resulting in a desire to help others, as well as increased personal strength and confidence. Understanding the nuances of the caregiving experiences over time can provide a framework to devise more fine-tuned support structures that aim to prevent reductions in social interaction and lost opportunities, and improve a sense of meaning, in order to assist caregivers to continue providing care for their relatives with mental illness in a context with scarce mental health resources.
The objectives of the study were to explore the experiences of school health officers in identify... more The objectives of the study were to explore the experiences of school health officers in identifying and managing mental health problems of secondary school students and to gather recommendations from the school officers for improving the effectiveness of mental health care in secondary schools in Can Tho City, Vietnam. We conducted a qualitative study based on in-depth interviews using a semi-structured guideline with 15 school health officers at 15 secondary schools in Can Tho City, Vietnam. Data were analyzed using content-driven analysis to identify recurring themes. The school health officers reported that stress, depression, suicidal ideation, and sexual orientation issues were the most commonly encountered mental health problems among their students. The officers worked with a limited range of interventions for helping these students, such as giving non-narcotic analgesics or advising students to take a short break at school or to go home. Most of them felt that their training was insufficient to deal with mental health problems in an optimal way. They recommended further training to improve their knowledge and skills in recognizing and managing mental health problems in students. They also considered a university-sponsored mental health website a good source of information on mental health care for students. School health officers reported that they did not feel well equipped to manage mental health problems because of insufficient training, lack confidence, and absence of an appropriate network for advice and referral. Updated policies and programs are needed for initial training and refresher courses, which will strengthen the role of school health officers as first line support for secondary school students with mental health problems.
Environmental innovation and societal transitions, Sep 1, 2015
Calls for sustainability have resulted in the initiation of many system innovation projects. Desp... more Calls for sustainability have resulted in the initiation of many system innovation projects. Despite the existence of several theoretical frameworks and principles on the governance of these system innovation projects, managers and participants still all too often feel at a loss for practical tools and guidelines to bring the project forward. This suggests that the current literature does not effectively support managers and participants during the governance of system innovation projects. This article aims to reduce this apparent gap by developing a systematic framework, based on both literature and practice, allowing project managers to enhance the adaptive capacity of system innovation projects. We propose an emergent design approach focussing on three main concepts: diversity, alignment and knowledge generation, and operationalise this framework into a coherent set of strategies and tools.
International Journal of Mental Health Systems, Aug 18, 2015
Background: The convergence between mental ill health and homelessness is well documented, but cr... more Background: The convergence between mental ill health and homelessness is well documented, but critical events that precipitate the downward spiral into homelessness, and promote personal recovery remain only partially explored in India. Aims: To explore causative factors of the descent into homelessness, and gain insight into creative and innovative approaches that promote personal recovery, specifically in institutional care settings. Methods: This qualitative study used focus group discussions, detailed personal interviews and anonymised data drawn from patient files. The data were analysed using phenomenological approaches. Results: Findings suggest that besides poverty and deprivation, death of the primary caregiver is a critical event in precipitating distress and a breakdown in the family, leading to a loss of support systems and a sense of belongingness, and rendering persons with mental illness homeless. Social affiliations, kinship, congruence between the real and ideal self, and the drive to assume a more powerful identity and/or pursue self-actualisation emerged as key factors aiding personal recovery. In the absence of a family, mimicking its attributes appears to ground institutions and professionals in an ethos of responsiveness and user-centricity, thereby promoting personal recovery. Conclusions: This study highlights the critical need to further explore and understand the nature of distress and descent into homelessness, and gain insight into caregiver strain and strategies that can be developed to reduce the same. It further emphasizes the need to shed light on individual strategies that help pursue wellbeing, and delve deeper into the application of value frameworks in institutions and their role in promoting personal recovery among persons with mental health issues.
Journal of Emdr Practice and Research, Feb 21, 2022
During the period of the COVID-19 pandemic from the start of 2020 till late 2021, mental health s... more During the period of the COVID-19 pandemic from the start of 2020 till late 2021, mental health services—seeking and providing—have gone through various changes and adaptations. In this article, we report on eye movement desensitization and reprocessing (EMDR) psychotherapy service providers in India, and how they adapted to the changing circumstances during this time, using a narrative enquiry approach.
Background Although it is widely recognized that children are willing, capable and legally entitl... more Background Although it is widely recognized that children are willing, capable and legally entitled to be active participants in their health care, parents are generally invited to evaluate paediatric hospital care and services rather than children themselves. This is problematic because parents cannot serve as the only spokespersons for the perspectives and experiences of children. Objective To investigate children's experiences with and perspectives on the quality of hospital care and services in the Netherlands, and how they think care and services could be improved. Design A qualitative study incorporating different participatory data collection methods, including photovoice and children writing a letter to the chief executive of the hospital. Setting Paediatric departments of eight hospitals in the Netherlands (two teaching and six regional). Participants Children and adolescents (n = 63) with either acute or chronic disorders, aged between 6 and 18 years. Results The research results provide insights into children's health and social well-being in hospitals. Important aspects of health, like being able to sleep well and nutrition that fits children's preferences, are structurally being neglected. Conclusion The participatory approach brought children's ideas 'alive' and generated concrete areas for improvement that stimulated hospitals to take action. This demonstrates that participatory methods are not merely tools to gather children's views but can serve as vehicles for creating health-care services that more closely meet children's own needs and wishes. 2066
Discussion This realist review revealed that effective RPs depend largely on strong intersectoral... more Discussion This realist review revealed that effective RPs depend largely on strong intersectoral actions involving leadership shared among healthcare, workplace and insurance stakeholders. These findings confirm the complex nature of program implementation.
Due to barriers in accessing and using healthcare services, a large proportion of the care homele... more Due to barriers in accessing and using healthcare services, a large proportion of the care homeless populations receive comes from informal providers. In Delhi, one such informal programme, called Street Medicine, provides healthcare outreach to homeless communities. Clinical practice guidelines are set to be developed for Street Medicine teams in India and form the object of this research. This study uses a social-ecological model to understand the barriers facing Street Medicine teams and the homeless as they attempt to address the latter's healthcare needs; coupling it with an analytical approach which situates these barriers as the issues within practice through which standardisation can take place. A qualitative inquiry, comprising three months of observations of Street Medicine outreach and interviews with over 30 key informants, was conducted between April and July 2018. The analysis identified novel barriers to addressing the needs of homeless individuals, which bely a deficit between the design of health and social care systems and the agency homeless individuals possess within this system to influence their health outcomes. These barriers - which include user-dependent technological inscriptions, collaborating with untargeted providers and the distinct health needs of homeless individuals - are the entry points for standardising, or opening up, Street Medicine practices .
Cooperation between scientists and other groups in the conduct and direction of scientific resear... more Cooperation between scientists and other groups in the conduct and direction of scientific research has recently become the focus of much political and intellectual concern. This paper reports on the results of a study of how biologists managed such cooperations with a variety of external groups (1). The aim of this study was to acquire insight into the causes and consequences of cooperative relationships and thereby to throw light on the following two related questions.
Introduction: Section 5(ii) of The Hindu Marriage Act, 1955 (HMA) states that under certain circu... more Introduction: Section 5(ii) of The Hindu Marriage Act, 1955 (HMA) states that under certain circumstances, mental illness is accepted as a ground for the annulment of marriage, while Section 13(1) (iii) states that mental illness is a ground for divorce. There is little data on how this provision is used and applied in matrimonial petitions. This paper assesses judicial practices in divorce cases, exploring the extent to which gender and the diagnosis of mental illness affect the decision to grant annulment or divorce. Methods: The paper analyses judgments related to annulment and divorce at the Family Court in Pune and at the High Courts in India. Results: In the Family Court at Pune, 85% of the cases were filed by husbands, who alleged that their spouse was mentally ill. Medical evidence of mental illness was presented in only 36% of the cases and in many cases, divorce/nullity was granted even in the absence of medical evidence. In 14% of the cases, nullity/ divorce was granted even when both spouses were not present. Of the Family Court cases reaching the High Court, 95% were filed by male petitioners. The High Courts reversed the lower courts' judgments in 50% of the cases. Discussion: Our analysis highlights the need for standardised guidelines for lower courts on what constitutes adequate medical proof of mental illness when hearing a petition related to nullity or divorce under HMA. It also provides a critical review of Section 5(ii) of HMA.
In the summer of 1983, when we started to formulate our ideas about a comparative study of the “b... more In the summer of 1983, when we started to formulate our ideas about a comparative study of the “bottom up” initiatives of scientists who wanted their research to be more socially relevant and hence had sought collaboration with non-scientific groups, we acted primarily from our concern with social reform, having both been active members of the science shops movement in the Netherlands. We knew from these experiences that the process of translating social demand from public interest groups into the science system, the feedback of expertise on social action, and the resistance and receptivity of the science system to such demands were aspects of a much more complex and multiform process than had previously been described in the literature. The available models had either taken a linear perspective (1) — allowing sometimes for feedbacks as well — or had then been elaborated into an inter-actor perspective (2). In other cases the relations of the science system with its environment had been conceptualized as resource-relations among which the researchers involved had to make selections (3).
Equality, Diversity and Inclusion: An International Journal, 2022
PurposeAfter being forced to flee their respective home countries, Sri Lankan Tamils and Rohingya... more PurposeAfter being forced to flee their respective home countries, Sri Lankan Tamils and Rohingya refugees resettled in the Indian state of Tamil Nadu. This study attempts to explore the extent to which the state has provided means for integration in the absence of refugee protection laws and citizenship.Design/methodology/approachA qualitative research approach was used, including in-depth interviews (IDIs) and focus group discussions (FGDs) with participants from both refugee groups between 2019 and early 2020. A representative sample of male and female Sri Lankan Tamils, living in or outside government camps, in urban and rural areas, was included (total number = 75). Similarly, a representative sample of the Rohingya refugee community was included for this study (n = 44).FindingsDespite constraints imposed by inadequate infrastructure, the study finds that Sri Lankan Tamils and Rohingyas both show to be progressively integrated in local society and have been capable of fulfillin...
This study aimed to address gaps in understanding of the lived experiences of caregivers of perso... more This study aimed to address gaps in understanding of the lived experiences of caregivers of persons with mental illness in low-income countries. It was conducted among caregivers of persons with mental illness making use of a free non-governmental clinic in and around Chennai, India. The study adopted a qualitative methodology, with semi-structured interviews and life history exercises (n = 29) and six focus group discussions with caregivers (n = 21) and mental health professionals and community-based workers (n = 39). The experiences of caregivers were analyzed in the framework of “The Banyan model of caregiving,” which identifies six phases. Major themes in caregivers’ experience were: embarrassment and losing honor; fear; awareness; stigma and social exclusion; and reduced social interaction and loneliness. Posttraumatic growth considered as the result of caregiver experiences was found to consist mainly of personal growth and focusing on positive life experiences. Lost opportunities particular to the context of Tamil Nadu were described as the inability to get married, obtaining less education than desired, and loss of employment. Siblings faced lower levels of burden, while elderly mothers experienced especially high levels of burden and lack of happiness in life. Caregiver gains were identified as greater compassion for other people with disabilities, resulting in a desire to help others, as well as increased personal strength and confidence. Understanding the nuances of the caregiving experiences over time can provide a framework to devise more fine-tuned support structures that aim to prevent reductions in social interaction and lost opportunities, and improve a sense of meaning, in order to assist caregivers to continue providing care for their relatives with mental illness in a context with scarce mental health resources.
The objectives of the study were to explore the experiences of school health officers in identify... more The objectives of the study were to explore the experiences of school health officers in identifying and managing mental health problems of secondary school students and to gather recommendations from the school officers for improving the effectiveness of mental health care in secondary schools in Can Tho City, Vietnam. We conducted a qualitative study based on in-depth interviews using a semi-structured guideline with 15 school health officers at 15 secondary schools in Can Tho City, Vietnam. Data were analyzed using content-driven analysis to identify recurring themes. The school health officers reported that stress, depression, suicidal ideation, and sexual orientation issues were the most commonly encountered mental health problems among their students. The officers worked with a limited range of interventions for helping these students, such as giving non-narcotic analgesics or advising students to take a short break at school or to go home. Most of them felt that their training was insufficient to deal with mental health problems in an optimal way. They recommended further training to improve their knowledge and skills in recognizing and managing mental health problems in students. They also considered a university-sponsored mental health website a good source of information on mental health care for students. School health officers reported that they did not feel well equipped to manage mental health problems because of insufficient training, lack confidence, and absence of an appropriate network for advice and referral. Updated policies and programs are needed for initial training and refresher courses, which will strengthen the role of school health officers as first line support for secondary school students with mental health problems.
Environmental innovation and societal transitions, Sep 1, 2015
Calls for sustainability have resulted in the initiation of many system innovation projects. Desp... more Calls for sustainability have resulted in the initiation of many system innovation projects. Despite the existence of several theoretical frameworks and principles on the governance of these system innovation projects, managers and participants still all too often feel at a loss for practical tools and guidelines to bring the project forward. This suggests that the current literature does not effectively support managers and participants during the governance of system innovation projects. This article aims to reduce this apparent gap by developing a systematic framework, based on both literature and practice, allowing project managers to enhance the adaptive capacity of system innovation projects. We propose an emergent design approach focussing on three main concepts: diversity, alignment and knowledge generation, and operationalise this framework into a coherent set of strategies and tools.
International Journal of Mental Health Systems, Aug 18, 2015
Background: The convergence between mental ill health and homelessness is well documented, but cr... more Background: The convergence between mental ill health and homelessness is well documented, but critical events that precipitate the downward spiral into homelessness, and promote personal recovery remain only partially explored in India. Aims: To explore causative factors of the descent into homelessness, and gain insight into creative and innovative approaches that promote personal recovery, specifically in institutional care settings. Methods: This qualitative study used focus group discussions, detailed personal interviews and anonymised data drawn from patient files. The data were analysed using phenomenological approaches. Results: Findings suggest that besides poverty and deprivation, death of the primary caregiver is a critical event in precipitating distress and a breakdown in the family, leading to a loss of support systems and a sense of belongingness, and rendering persons with mental illness homeless. Social affiliations, kinship, congruence between the real and ideal self, and the drive to assume a more powerful identity and/or pursue self-actualisation emerged as key factors aiding personal recovery. In the absence of a family, mimicking its attributes appears to ground institutions and professionals in an ethos of responsiveness and user-centricity, thereby promoting personal recovery. Conclusions: This study highlights the critical need to further explore and understand the nature of distress and descent into homelessness, and gain insight into caregiver strain and strategies that can be developed to reduce the same. It further emphasizes the need to shed light on individual strategies that help pursue wellbeing, and delve deeper into the application of value frameworks in institutions and their role in promoting personal recovery among persons with mental health issues.
Journal of Emdr Practice and Research, Feb 21, 2022
During the period of the COVID-19 pandemic from the start of 2020 till late 2021, mental health s... more During the period of the COVID-19 pandemic from the start of 2020 till late 2021, mental health services—seeking and providing—have gone through various changes and adaptations. In this article, we report on eye movement desensitization and reprocessing (EMDR) psychotherapy service providers in India, and how they adapted to the changing circumstances during this time, using a narrative enquiry approach.
Background Although it is widely recognized that children are willing, capable and legally entitl... more Background Although it is widely recognized that children are willing, capable and legally entitled to be active participants in their health care, parents are generally invited to evaluate paediatric hospital care and services rather than children themselves. This is problematic because parents cannot serve as the only spokespersons for the perspectives and experiences of children. Objective To investigate children's experiences with and perspectives on the quality of hospital care and services in the Netherlands, and how they think care and services could be improved. Design A qualitative study incorporating different participatory data collection methods, including photovoice and children writing a letter to the chief executive of the hospital. Setting Paediatric departments of eight hospitals in the Netherlands (two teaching and six regional). Participants Children and adolescents (n = 63) with either acute or chronic disorders, aged between 6 and 18 years. Results The research results provide insights into children's health and social well-being in hospitals. Important aspects of health, like being able to sleep well and nutrition that fits children's preferences, are structurally being neglected. Conclusion The participatory approach brought children's ideas 'alive' and generated concrete areas for improvement that stimulated hospitals to take action. This demonstrates that participatory methods are not merely tools to gather children's views but can serve as vehicles for creating health-care services that more closely meet children's own needs and wishes. 2066
Discussion This realist review revealed that effective RPs depend largely on strong intersectoral... more Discussion This realist review revealed that effective RPs depend largely on strong intersectoral actions involving leadership shared among healthcare, workplace and insurance stakeholders. These findings confirm the complex nature of program implementation.
Due to barriers in accessing and using healthcare services, a large proportion of the care homele... more Due to barriers in accessing and using healthcare services, a large proportion of the care homeless populations receive comes from informal providers. In Delhi, one such informal programme, called Street Medicine, provides healthcare outreach to homeless communities. Clinical practice guidelines are set to be developed for Street Medicine teams in India and form the object of this research. This study uses a social-ecological model to understand the barriers facing Street Medicine teams and the homeless as they attempt to address the latter's healthcare needs; coupling it with an analytical approach which situates these barriers as the issues within practice through which standardisation can take place. A qualitative inquiry, comprising three months of observations of Street Medicine outreach and interviews with over 30 key informants, was conducted between April and July 2018. The analysis identified novel barriers to addressing the needs of homeless individuals, which bely a deficit between the design of health and social care systems and the agency homeless individuals possess within this system to influence their health outcomes. These barriers - which include user-dependent technological inscriptions, collaborating with untargeted providers and the distinct health needs of homeless individuals - are the entry points for standardising, or opening up, Street Medicine practices .
Cooperation between scientists and other groups in the conduct and direction of scientific resear... more Cooperation between scientists and other groups in the conduct and direction of scientific research has recently become the focus of much political and intellectual concern. This paper reports on the results of a study of how biologists managed such cooperations with a variety of external groups (1). The aim of this study was to acquire insight into the causes and consequences of cooperative relationships and thereby to throw light on the following two related questions.
Introduction: Section 5(ii) of The Hindu Marriage Act, 1955 (HMA) states that under certain circu... more Introduction: Section 5(ii) of The Hindu Marriage Act, 1955 (HMA) states that under certain circumstances, mental illness is accepted as a ground for the annulment of marriage, while Section 13(1) (iii) states that mental illness is a ground for divorce. There is little data on how this provision is used and applied in matrimonial petitions. This paper assesses judicial practices in divorce cases, exploring the extent to which gender and the diagnosis of mental illness affect the decision to grant annulment or divorce. Methods: The paper analyses judgments related to annulment and divorce at the Family Court in Pune and at the High Courts in India. Results: In the Family Court at Pune, 85% of the cases were filed by husbands, who alleged that their spouse was mentally ill. Medical evidence of mental illness was presented in only 36% of the cases and in many cases, divorce/nullity was granted even in the absence of medical evidence. In 14% of the cases, nullity/ divorce was granted even when both spouses were not present. Of the Family Court cases reaching the High Court, 95% were filed by male petitioners. The High Courts reversed the lower courts' judgments in 50% of the cases. Discussion: Our analysis highlights the need for standardised guidelines for lower courts on what constitutes adequate medical proof of mental illness when hearing a petition related to nullity or divorce under HMA. It also provides a critical review of Section 5(ii) of HMA.
In the summer of 1983, when we started to formulate our ideas about a comparative study of the “b... more In the summer of 1983, when we started to formulate our ideas about a comparative study of the “bottom up” initiatives of scientists who wanted their research to be more socially relevant and hence had sought collaboration with non-scientific groups, we acted primarily from our concern with social reform, having both been active members of the science shops movement in the Netherlands. We knew from these experiences that the process of translating social demand from public interest groups into the science system, the feedback of expertise on social action, and the resistance and receptivity of the science system to such demands were aspects of a much more complex and multiform process than had previously been described in the literature. The available models had either taken a linear perspective (1) — allowing sometimes for feedbacks as well — or had then been elaborated into an inter-actor perspective (2). In other cases the relations of the science system with its environment had been conceptualized as resource-relations among which the researchers involved had to make selections (3).
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Papers by Joske Bunders