Addressing the mental health needs of homeless persons

Paper:

Mains: General Studies- II: Governance, Constitution, Polity, Social Justice and International relations

Context:

Globally, unpreparedness to handle the pandemic and near collapse of the health systems denudedour ability to focus on health.

Background:

  • Multidimensional poverty persists today.
  • The inability to adhere to public health protocols that prescribe distancing and use of hygienic products, the absence of private toilets and basic amenities, and the lack of adequate nutrition are all realities in lower- and middle-income countries.
  • Amongst those most affected are homeless persons and the ultra-poor, many of whom are employed in the informal sector.
    • They are exposed to greater adversity against the backdrop of intergenerational social disadvantage and lack of social security.
    • Oppressed classes suffer the most as a consequence of multidimensional poverty. 

Distinctly deprived

  • 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.
    • The presence of homeless persons with mental illness elicits a range of responses from a desire to help, triggered by evocation of pity or sympathy, to wilfully wishing them away or shunning them from mainstream society.
  • 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 even today.

Grossly underwhelming caregiving climate

  • In India, homeless persons with mental illness are also the largest number of long-stay patients in State mental hospitals.
  • 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.
  • Services for this under-served group are scarce globally, homeless persons find their longevity impacted as they are:
  • susceptible to physical co-morbidities and co-occurring substance misuse,
  • 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.
  • Unfortunately, the inherited a legacy of name-calling and large and unwieldy lunatic asylums and poor houses from the colonial era which got off to an altruistic start but were later ridden with inadequacies and often deployed as punitive measures to initiate ‘reform’.

Way forward:

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.
  • The Tamil Nadu government, taking cognizance of the mental health needs of homeless persons, will take to scale Emergency Care and Recovery Centres (ECRC) that will support the treatment and community inclusion of this vulnerable section in 10 districts.
  • Various government departments and NGOs will together pursue the goal of improving mental health access and mitigating social and opportunity losses.
  • 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.
  • Early enrolment into care may result in a reduction of exposure to harm, injury and starvation, and better prognosis.

Conclusion:

  • Emergency Care and Recovery Centres (ECRCs) are not a panacea to all distress undergone by homeless individuals.
  • An integrated approach may also help address stigma associated with this group.
  • facilitation of social needs care and livelihoods may reduce the recurrence of episodic homelessness, critical to sustaining and enhancing well-being gains.
  • Three sectors — the government, development and corporate sectors — must partner to ensure that the lives of those who live on the fringes matter.