Aspirations, from the seemingly mundane to more substantial plans, reveal what may be the architecture of hope in mental health recovery.
| Photo Credit: SREEJITH R. KUMAR
In a small house in western India, shared by a group of people once homeless and living with mental illnesses, a woman dreams of cooking ragi mudde, a ball of finger millet flour cooked in salt and hot water, served with a side of lentil stew. This moment of happiness evokes feelings of home for her. Originally from Karnataka but now settled in this new reality, she yearns to integrate the cultural familiarity of her past into her present without returning to a background of abandonment and turmoil.
Another dreams of running a lemon-juice cart and becoming self-reliant, tapping into her entrepreneurial spirit to plan how she will strategically place it near the bus stand that might entice people to refresh themselves on hot summer days. A third speaks of wanting to make an offering of a coconut in the temple nearby to wish for the well-being of everyone around her, not just family and friends — a gesture that reflects her belief that all people matter in this interconnected world. These are not inert wishes — they are expressions of hope from people living with serious mental illness, and they tell us something vital about what is often missing in conventional mental healthcare approaches.
Mental healthcare systems increasingly focus on protocols, evidence-based interventions and task-shifting to expand service delivery, crucial especially in India where 83% of people with mental health conditions remain out of care. While these establish the basics of access, our experiences point to a crucial element — nurturing hope through everyday experiences that give people’s lives meaning and make well-being more collaborative and self-directed.
Between 2020 and 2023, our implementation of “Home Again” and associated research across 10 Indian States and in Sri Lanka, supported by Grand Challenges Canada, interrogated hope among those with serious mental illnesses who exited long-term institutionalisation into homes in the community. Our observations and data from the study offer insights into how hope manifests in people with serious mental illness and how it evolves as they transition from hospital settings to homes in the community.
What emerges is not a story of grand, therapeutic breakthroughs but an expression of the essentiality of simple human desires. When participants spoke about their hopes, they did not focus on standard clinical recovery parameters. Instead, they talked about wanting to dance, listen to music, travel, own new clothes, reconnect with family, speak up about the bad road conditions at the grama sabha, cook a recipe from childhood or engage in daily namaz. These aspirations, from the seemingly mundane to more substantial plans, reveal what may be the architecture of hope in mental health recovery.
Deeply contextual
Quantitative data from the research tell us that hope is not static — it responds to environment and opportunity. Our data show that people experience significant improvements in hope scores across multiple dimensions over 12 months following their exit from institutions, particularly in areas related to goal-setting and reducing feelings of isolation. But more tellingly, these improvements varied by region and were higher for those who moved out of state-run psychiatric facilities, suggesting that hope is deeply contextual to histories and local support systems.
What do we take away from these experiences and data? Robust clinical protocols and evidence-based interventions are essential, but mental healthcare may need to prioritise what we term the “hope infrastructure” — the systematic creation of opportunities for everyday experiences with personal meaning that nurture hope. If person-centered care is truly about the whole person, then understanding that person in context is key, and recognising that care cannot focus solely on clinical and psychological interventions or even social care and human rights.
Perhaps care protocols need to integrate dimensions beyond symptoms and explore therapeutics focusing on social architecture and engagement pathways, including recognising the role of human service professionals who understand, engage, and build relationships — where practitioners and service users engage in shared reflection, and concerns and solutions extend beyond the individual.
But there is a cautionary note here. The study revealed that some participants, particularly those with more severe disabilities, struggled to maintain hope in the face of societal barriers. As one participant observed, “In movies we see beautiful heroes and heroines but in real life it’s not like that, we don’t even have enough money. People don’t have good hearts” — an important reminder that building hope is not just about individual intervention but it requires addressing broader social determinants and structural barriers that will create the space for neurodiverse expressions to thrive in the community. We live in a world far from ideal, where notions of beauty and success are riddled with colourism, casteism, classism, and segregation. In such a society, to hold on to hope and find it in small yet significant ways become key to building optimism and resilience.
Can nurturing hope as a foundational element in mental health systems translate into ripple effects across psychological, social, sociological, cultural, and philosophical dimensions of community wellbeing? This is a question that demands attention and soaking our feet as a community of practice and research into the possibility and potential of hope-fostering interventions, also in contexts besides serious mental illnesses and homelessness. For instance, integrating these into child and youth mental health programs, may perhaps foster endurance that can withstand the inevitable storms of adversity. Children navigating complex family dynamics, traumatic experiences, or systemic disadvantages may develop not just coping mechanisms but genuine pathways to thriving when hope infrastructure supports their journey.
The woman dreaming of cooking ragi mudde, the aspiring lemon juice stall owner, the lady who desires to make a coconut offering — their hopes aren’t peripheral to their recovery; they are central to it. Perhaps, it is time for mental health systems to catch up with this reality and integrate hope-based approaches into services, research and education, identifying effective elements across diverse cultural contexts. By studying hope-centered methodologies systematically across various settings, we may be able to develop more holistic, culturally responsive mental health practices.
Published – April 20, 2025 04:52 am IST