Addressing the mental health needs of homeless persons

Addressing the mental health needs of homeless persons

Context:

• The article talks on the ground realities during the ongoing COVID-19 pandemic make a sound case for increased investments in the health and social sectors.

Issues:

• Among the most affected during the COVID-19 pandemic are homeless persons and the ultra-poor, many of whom are employed in the informal sector.  Oppressed classes suffer the most as a consequence of multidimensional poverty.
• They are exposed to greater adversity against the backdrop of intergenerational social disadvantage and lack of social security.
• There is plenty of evidence pointing to relative poverty and its co-relation to stress, mental health and well-being.
• Data suggest that deaths by suicide and common mental disorders have also been on the rise during the pandemic.

Homeless people with mental illness:

• Distinctly deprived are homeless persons living with a mental illness. They are at risk of violent victimisation, assault and long-term incarceration.
• In India, close to two million individuals sleep in uncomfortable conditions, typically out of doors; 35% of them live with one or the other mental health concern.
• Pathways into homelessness include abject poverty, conflict, natural or man-made disasters, lack of access to health and mental health care, social hardships, disruptions in care-giving and domestic violence.
• Historically, in a limited context of religiosity associated with renunciation and hearing voices (considered unique to the saint), a few were worshiped; however, the majority were feared, found to be repulsive and often treated as objects of ridicule.
• This has resulted in their occupying a lowly place in society’s hierarchical structure to date.

Issues:

• Inadequate care staff has resulted in a grossly underwhelming caregiving climate. Services for this under-served group are scarce globally.
• They are susceptible to physical co-morbidities and co-occurring substance misuse, and unshielded against the consequences of homelessness, malnutrition, sexual violation, loss of support networks and kinship.
• Their experience of loneliness and hyper-segregation contributes to their low sense of self-worth and shrunken group identity, weakening their collective ability to influence change.

Way forward:

1. A person-centric action plan:

• The UN set up a fund of $2 billion to alleviate the distress of the ultra-vulnerable, including those living with a disability or chronic illness.

2. Resistance to Parochial Practices:

• Strong resistance has been built against narrow-minded practices which are giving way to newer dimensions of therapeutic and social care. However, much remains to be done.
• States must re-examine the role of social determinants of health in perpetuating unjust structures that normalise deprivation.
• A person’s social context and health intersect to help achieve a better quality of life.

3. Early enrolment into care:

• Early enrolment into care may result in a reduction of exposure to harm, injury and starvation, and better prognosis.
• An integrated approach will help address the stigma associated with this group.
• Additionally, facilitation of social needs care and livelihoods may reduce the recurrence of episodic homelessness, critical to sustaining and enhancing well-being gains.

4. Partnering for alleviating the distress of the deprived:

• The government, development and corporate sectors must partner to ensure that the lives of those who live on the fringes matter.
• The mental health team that anchors the Centre may also lend further support to the District Mental Health Programme, and offer counselling support to address mental health issues in the context of the pandemic.