Representative photo: Homeless men sit outside closed restaurants during a lockdown amid the COVID-19 outbreak in New Delhi, India, March 2020. Photo: Reuters/Adnan Abidi/Files.
World Mental Health Day is observed on October 10. The COVID-19 pandemic has adversely impacted the mental health of millions of people across the globe. As the world struggles to flatten the curve and find solutions to the pandemic, the anxiety, fear, isolation, distancing, uncertainty and emotional distress is growing in populations everywhere.
India accounts for 15% of the world’s mental, neurological and substance-use disorders burden. Simultaneously, the Union health ministry has admitted a treatment gap of 50-70%, and this gap has only been rising. To cater to the needs of patients, there are only 0.3 psychiatrists, 0.12 psychologists and 0.07 social workers for every 100,000 Indians.
In the Indian context, there are multiple intersectional vulnerabilities that block access to mental health services. A prominent one lies at the nexus of health, poverty and homelessness. Many persons with mental health concerns are often deprived access to mental health services, which aggravates their mental health condition, leading them to homelessness and destitution. Homelessness and mental health concerns are bidirectional in nature. Homelessness leads to deterioration of mental health and mental ill-health, together with stigma and societal discrimination, leads to homelessness. This vicious cycle is difficult to escape.
There have been some informal estimates that nearly one third to one half of persons experiencing homelessness suffer from a diagnosable mental disorder. As such, homeless persons with mental health concerns are a highly visible but poorly acknowledged population in the mental health and public health domain.
According to the National Mental Healthcare Act 2017, police personnel are responsible for taking any homeless persons with mental health concerns from the streets under their protection, and bring them to the nearest public health establishment within 24 hours. After due process and treatments, the station house officer has to repatriate the person.
These steps seem simple and direct on paper. But in reality, a large number of people – irrespective of their prognosis – are left behind in various institutions, especially government mental health centres, beggars’ homes and other public or private psychiatric and non-psychiatric institutions, for their lifetimes.
One person with whom I had interacted as part of my studies, who had spent 15 years of her life in a private long-stay home for women, shared her experience: “It was like a cage. A tiny cell with grills and 10-12 people packed inside. We never know when it is day and when it is night. We have to obey their instructions and remain silent. If we get angry or shout, they give us high dose medication. Disconnected from my family, my children… I spent a long 15 years of my life there.”
The highly gendered family response to repatriation, arising from the patriarchal framework, leaves homeless women with mental health concerns at a greater disadvantage.
There are a few NGOs, such as The Banyan in Tamil Nadu and the Aashray Adhikar Abhiyan in Delhi, that work with the government to offer comprehensive solutions for homeless persons or those living in poverty with severe mental health concerns.
As India observes World Mental Health Day today, it is especially crucial that we focus on our vulnerable communities – affected by poor health as well as by lacunae in the provision of care. Today also provides an important occasion to remember the struggles of the homeless population, and bring the stories and struggles of these people into the public domain.
Catherine Elisa John is currently pursuing an M.Phil in social work at the Delhi School of Social Work. Her research interests include mental health, disability and homelessness.