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As many as 66.1% of those worst affected in India during the Spanish Flu belonged to oppressed classes and suffered the consequences of multidimensional poverty. Similar trends persist 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.
Major cause that led to 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.
They are at risk of violent victimisation, assault and long-term incarceration. In India, 2 million individuals sleep rough; 35% of them live with one or the other mental health concern.
They are exposed to greater adversity against the backdrop of intergenerational social disadvantage and lack of social security.
Historically, some religious societies started to address the mental illness issue of homeless persons; 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.
In India, homeless persons with mental illness are also the largest number of long-stay patients in State mental hospitals. Besides a few exceptions, services for this group are scarce globally.
As 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, homeless persons find their longevity impacted.
Further, 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.
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.
Along similar lines, Tamil Nadu government, taking cognisance 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.
The Department of Health, the National Health Mission, the Institute of Mental Health in Chennai, and The Banyan, a mental health care establishment, 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.
Data suggest that deaths by suicide and common mental disorders have also been on the rise during the pandemic. Hence, states must consider relative poverty and its co-relation to mental health in their health policies.
Early enrolment in care centers may result in reduction of exposure to harm, injury and starvation, and better prognosis.
Additionally, facilitation of social needs care and livelihoods may reduce the recurrence of episodic homelessness, critical to sustaining and enhancing well-being gains.
The mental health team that anchors the Centre may should lend further support to District Mental Health Programmes, and should offer counselling support to address mental health issues in the context of the pandemic.
While efforts similar to Tamil Nadu government is a powerful start to acknowledge the need to focus on minority mental health, other governments should also take feedback to further build on care plans and mental health systems for the vulnerable.
We must remember that issues of homelessness and mental ill health even independently present intractable problems; in combination, one may confront ethical dilemmas and emerging constraints and challenges.
Also, the pandemic has made a sound case for increased investments in the health and social sectors.
Hence, three sectors — the government, development and corporate sectors — should partner to ensure that the lives of those who live on the fringes matter.
For this, an integrated approach will help address stigma associated with this group.
Source: The Hindu.