homelessness mental illness people care model

 An outline of a care paradigm and shift in mindset that advance the rights of homeless persons with mental illness

rescue missions that are  focused on transferring 

them, to mental hospitals, shelter homes, beggars’ homes and even prisons. 

what we done 

limiting over two decades ago, when we prioritised shelter and treatment over agency, choice and place-making. 

Challenging notions, efforts at integration

 Often, homeless persons form affiliations with 

local support circles that include fellow homeless persons, local eateries and pets, that offer them a self-curated sense of belongingness. 

what they feel 

 is the narrative of oppression, scarcity, abuse, exposure to inclement weather conditions, and an exacerbation of symptoms associated with psychoses. 

 few efforts in India that have supported several HPMI reenter communities 

1 is the collaboration between the National Health Mission, the Tamil Nadu Department of Health, the Institute of Mental Health, The Banyan, the Azim Premji Foundation and local civil society organisations. 

2 This has resulted in access to emergency care and recovery centres (ECRCs) within district hospitals. This integration serves two purposes.

3 सबसे पहले यह बड़े आश्रय-शैली वाले उपचार स्थानों के आधिपत्य वर्चस्व को तोड़ता है जो एक रोगग्रस्त दिमाग की रूढ़िवादी पहचान को कायम रखता है। 

इससे भी महत्वपूर्ण बात यह है कि यह बड़ी संख्या में लोगों को अधिक तात्कालिकता के साथ सेवा प्रदान करता है, अंतिम छोर तक निकटस्थ देखभाल सुनिश्चित करता है और बिखरे हुए भौगोलिक क्षेत्रों में संकट प्रतिक्रियाएँ सुनिश्चित करता है।

what tranfermation need in our policy  ? 

care in smaller units, are reasonably staffed, and mandate personal attention and better medical care to address comorbidities commonly found among those exposed to enduring adversities.

While recent policy shifts represent progress, they also demand deeper engagement and longer term commitment.

 We must also critically examine when and why rights are stripped away, examine the attitude and practice of society and care professionals and develop leadership and governance systems that are adaptive, dynamic, reflective and address intricate dilemmas and contested issues.

Our approach, therefore, must be to be in continuous engagement, drawing frameworks for admission that respect individual agency. While the gains of intervention can be significant and the hardships of street life are real, coercive care often yields poor outcomes.

Problems with institutional spaces

people living in State psychiatric facilities  

Meanwhile, about 37% of people living in State psychiatric facilities and other care homes experience long-term needs, with a median duration of stay of six years. 

Most of them have histories of homelessness and have been typically brought into the system as a result of police and judicial intervention.

 In 2017 the Supreme Court of India

 in response to a public interest litigation, mandated that State governments undertake rehabilitative measures. 

In this context, the Department of Empowerment of Persons with Disabilities, under the Ministry of Social Justice and Empowerment, had filed guidelines for rehabilitation homes.

some efforts in the world 

1 Globally and in India, large-scale housing initiatives such as Housing First and Tarasha 

2 offer comprehensive social and clinical care and demonstrate the feasibility of such groundbreaking options for those with a range of disabilities and clinical needs. 

3 ‘Home Again’ programme

Similarly, over 700 people have accessed housing support and social care through the ‘Home Again’ collaborative across nine States in India, piloted first in 2018 as a research trial with support from Grand Challenges, Canada, and scaled up in partnership with the Rural India Supporting Trust. 

4 This has also been adopted by the Government of Tamil Nadu and other stakeholders nationally. For those transitioning from hospitals, with mild to moderate disabilities, hostel-like co-living facilities that symbolise enhanced social capital and security, rather than rehabilitation homes, may be considered.

Reframe support measures

what require 

1 a radical shift and a reframing from paternalistic interventions to liberatory-focused strategies. 

2 A monthly priority disability allowance or out of work allowance of ₹1,500, while modest, could serve as a critical lifeline for those pushed to the margins of social hierarchy. 

3 financial inclusion and economic empowerment 

By addressing the bureaucratic hurdles of securing Aadhar and facilitating banking access for HPMI, we pave the way for financial inclusion and economic empowerment.

4 more imaginative and holistic approaches 

These documentation and financial scaffolds, however, must be complemented by more imaginative and holistic approaches

 In parallel, structural issues such as discrimination and violence, segregation and deprivation, need to be emphatically addressed. 

 5 social care and post-discharge support 

must be strengthened and integrated within the District Mental Health Programme. 

As a result of initiatives led by state and non-state actors

 service engagement among 800 mental health service users who exited the ECRCs over a three-year period is at 75% post discharge, which is higher than the global experience.

Advancing economic justice demands 

1 confronting systemic barriers, elevating insights from marginalised groups, and creating transformative models that accelerate inclusion. 

2 Workforce participation, when thoughtfully facilitated, becomes a powerful tool for reappropriating economic space. 

3 Traditional employment models and vocational training initiatives are often not only disconnected from contemporary economic realities but they fail to account for individual agency, strengths and aspirations. 

 social cooperatives

 where groups of individuals drive the exchange of their labour, offer a promising avenue for meaningful engagement, which fosters a sense of community and purpose. 

cultivating social capital and implementing affirmative action 

policies that spur substantive socio-economic, cultural and political inclusion of HPMI. 

Tamil Nadu will be the first State that will soon release a policy that will integrate many of these pragmatic and studied approaches.

It is our hope that this multifaceted approach will challenge the reductionist view of HPMI as mere recipients of charity to be extricated from their circumstances. Instead, it advocates for a framework that honours their agency, respects their choices, and supports their right to claim a place in society on their own terms.

source the hindu