A Qualitative Study to Understand the Nature of Abuse Experienced by Persons with Severe Mental Illness

Persons with Severe Mental Illness (PwSMI) living in the community are considered high-risk groups for victimization. However, the nature of violence experienced by PwSMI is not well understood in India, which limits the effectiveness of clinical interventions to prevent revictimization. The Key Informant Interviews (KIIs) and Focused Group Discussion guides were developed, content validated, and pilot tested. A total of 27 KIIs and 5 focus groups were conducted with 14 PwSMIs, 19 experts, and 18 caregivers. Thematic analysis was done using Braun and Clarke's six stages of thematic analysis. The saturation of themes was determined using the Comparative Method for Themes Saturation (CoMeTS). Some of the themes and subthemes that emerged were (1) Physical Abuse (physical restraining, hitting, spitting), (2) Psychological Abuse (living in a controlling environment, criticized, neglected, scapegoated, symptomization of emotions and behavior),(3) Sexual Abuse (sexual assault, reproductive coercion, sexual exploitation), (4) Social Abuse (teased or labeled, social deprivation, abandonment, discrimination, and exclusion), and (5) Trauma in formal care (Coercive treatment practices, seclusion, negative attitude of staff, surreptitious prescribing of medicines, patronizing behavior). Abuse experienced by PwSMI has significant treatment and health care costs and an increased burden on families and society, so comprehensive psychosocial care and support are needed to prevent revictimization.