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Homelessness and Mental Health: Challenging Issue in an Indian Context

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ISSN (Print): 2328-3734, ISSN (Online): 2328-3696, ISSN (CD-ROM): 2328-3688
American International Journal of
Research in Humanities, Arts
and Social Sciences
AIJRHASS 14-581; -© 2014, AIJRHASS All Rights Reserved Page 160
AIJRHASS is a refereed, indexed, peer-reviewed, multidisciplinary and open access journal published by
International Association of Scientific Innovation and Research (IASIR), USA
(An Association Unifying the Sciences, Engineering, and Applied Research)
Available online at http://www.iasir.net
Homelessness and Mental Health: Challenging Issue in an Indian Context
Pradeep Kumar (M.A., M.Phil., Ph.D.*)
Psychiatric Social Worker, State Institute of Mental Health,
Post Graduate Institute of Medical Sciences, Rohtak, Haryana, INDIA
“Everyone has the right to a standard of living adequate for the health and well-being of himself and of
his family, including food, clothing, housing and medical care and necessary social services, and the right to
security in the event of unemployment, sickness, disability, widowhood, old age or other lack of livelihood in
circumstances beyond his control.” (Universal Declaration of Human Rights, article 25, par. 1.)
In the above declaration, housing is reported as a basic right, but in India, number of people is unfortunately
deprived of it. Such people are commonly known as homeless people. Homelessness is the condition and social
category of people who lack housing, because they cannot afford, or are otherwise unable to maintain, a regular,
safe, and adequate shelter. These people either live on the streets, in jail, in an institution, or in other places not
meant to be adequate nighttime residences. The legal definition of “homeless” varies from country to country.
According to the census of India, the homeless people are those who do not live in census houses (a census
house is referred to a structure with a roof 1. Homelessness is a prevalent social problem throughout the world;
unfortunately the number of homeless people worldwide has grown steadily in recent years.2
The number of people living in slums in India has more than doubled in the past two decades and now exceeds
the entire population of Britain3. United Nations Commission on Human Rights in 2005 noted that an estimated
100 million people -one-quarter of the world's population- live without shelter or in unhealthy and unacceptable
conditions. The Action Aid in 2003 had found out that there were 78 million homeless people in
India alone. Child Relief and You (CRY) in 2006 estimated that 11 million homeless children live on the streets.
According to UN-HABITAT, India is home to 63% of all slum dwellers in South Asia. This amounts to 170
million people, 17% of the world’s slum dwellers. Number of factors contributes to this social problem. Low
per capita income is one factor that marks the sharp divide between India's wealthiest and poorest citizens.
Approximately 35 percent of India's 260 million people (a group almost equal to the entire population of the
United States) still earns $1 or less a day. And according to the United Nations, 70 million people earn less than
$2 a day. As India continues to grow in economic stature, there's much debate over the country's ability to tackle
poverty and urban homelessness 4. In a 1993 report, WHO offered the following list of causes for this
phenomenon called homelessness: “Family breakdown, Armed conflict, Poverty, Natural and man-made
disasters, Famine, Physical and sexual abuse, Exploitation by adults, Dislocation through migration,
Urbanization and overcrowding, Acculturation, HIV/AIDS”. Structural factors also contribute to homelessness
which include: Lack of affordable housing, changes in the industrial economy leading to unemployment,
inadequate income supports, the de-institutionalization of patients with mental health problems, and the erosion
of family and social support. These factors can be divided into following categories 5
Poverty: Homelessness and poverty are attached together. Poor people are not in a position to pay for
housing, food, child care, health care, and education. Researchers observed about 84 percents of
homeless individuals below 100 percent Federal Poverty Level, as compared to 50 percent of housed
individuals.6
Drug Addiction: Data indicates that alcohol and drug abuse are excessively high among the homeless
inhabitants. People who are poor and addicted are obviously at augmented risk of homelessness.
Homeless individuals reported more substance use problems than nonhomeless individuals, including
currently smoking (5 9 percent vs. 3 0 percent ), binge drinking in the past year (4 0 percent vs. 2 0
percent), being at high risk of alcohol dependence (12 percent vs. 1.1 percent), being at high risk of
drug dependence (15percent vs. 1.2 percent ), and ever injecting drugs (14 percent vs. 3 percent) .6
War: It causes unexpected homelessness. People who are in a good position suddenly loose their home
due to battle among countries. Apart from this, community violence’s which happen at times in India
has become one factor for homelessness. Recent riots in India, Muzaffarnagar, Uttar Pradesh and Bodo
tribes Assam, have led number of families homeless.
Unhealthy relationships between young people and their parents or guardians: It could be either
because some parents don’t give right of property to their children as a punishment for their
misbehavior or heinous crime and some adolescents run away from their homes for not being able to
adjust with the family or to live their life the way they want.
Pradeep Kumar, American International Journal of Research in Humanities, Arts and Social Sciences, 7(2), June-August, 2014, pp. 160-163
AIJRHASS 14-581; -© 2014, AIJRHASS All Rights Reserved Page 161
Unemployment: Due to rising problem of unemployement, some people are not able to afford to have
a house or to take a rented house leading finally to homelessness.
Divorce: Anyone in a family whether mother, father or child can become homeless due to separation.
Single parents with dependent children are mostly at risk of homelessness.
Natural disaster: Cyclone, Tsunami and other calamities totally destroy the region resulting in
homelessness of thousands of people.5 . In India, recent floods in Uttrakhand caused a lot of damage
and thousands of people have to get settled at other places as they were left homeless by the natural
disaster.
The relation of homelessness and mental health is bidirectional i.e., homelessness leads to deterioration of
mental health and in turn mental illness can also lead to homelessness. It forms a vicious cycle from which
escape of an individual becomes difficult. Some studies have been conducted to assess the prevalence of mental
illness in such population. For example in one study reported one hundred and forty homeless persons were
admitted to the department of psychiatry of a north Indian medical university from February 2005 to July 2011.
Of these, one hundred and twenty-seven (90.7%) had psychiatric illness and six had only intellectual disabilities.
Most of the patients (55.7%) had more than one psychiatric diagnosis. HMI had considerably high rates of co-
morbid substance abuse (44.3%), intellectual disabilities (38.6%) and physical problems (75.4%) 7 .In another
study carried out at Haryana homeless inmates indicate that the prevalence of depression and posttraumatic
stress disorder (PTSD) were higher followed by conversion disorder, mental retardation and panic disorder. The
results also show that more than 60% of inmates met the criteria for at least one psychiatric disorder 8 .People
who are homeless have high mortality rates than general population 9. Estimates indicate that at least 30 percent
of persons experiencing homelessness suffer from serious mental illness, and that 5 0 percent or more are active
substance abusers, with many having comorbid mental illness and sub-stance abuse conditions 10, 11 .
Mental illnesses bring a lot of challenges in the life of homeless people. Serious mental illnesses disrupt
people’s ability to carry out essential aspects of daily life, such as self care and household management. Mental
illnesses may also prevent people from forming and maintaining stable relationships or cause people to
misinterpret others’ guidance and react irrationally. This often results in pushing away caregivers, family, and
friends who may be the force and social support that keeps the person from becoming homeless. As a result of
these factors, people with mental illnesses are much more likely to become homeless than the general population.
A study of people with serious mental illnesses by California’s public mental health system found that 15%
were homeless at least once in a one-year period. Patients with schizophrenia or bipolar disorder are particularly
vulnerable. The stigma attached to such illness has always been a serious issue in India. Social isolation, stigma
and a perception of being displaced from society make it difficult for this client group to canvas for better
services.
Mental illness may cause people to neglect taking the necessary precautions against disease and can lead to
physical problems such as respiratory infections, skin diseases, or exposure to tuberculosis or HIV. Some
mentally ill people self-medicate using street drugs, which can lead not only to addictions, but also to disease
transmission. This combination of mental illness, substance abuse, and poor physical health makes it very
difficult for people to obtain employment and residential stability.12
The mentally ill because of their affected condition, are not only shunned but also receive no support or
sympathy of any kinds. They often face poor living condition, infection, inaccessibility to basic health services,
premature death and so on. Studies have shown that homeless women with schizophrenia are sexually assaulted
at alarming rates, which exposes them to all kinds of deprivation and infections including the HIV virus. A
systematic review of the twenty one studies and revealed that homeless adolescents are diagnosed with widely
varying rates of mental health disorders and high rates of sexually transmitted infection 13. Streets have become
home to the mentally ill in India due to lack of social support and care. Statistics suggest that 25% of the
mentally ill in India are homeless. Nimesh G.Desai, the director of Institute of Human Behavior and Allied
Sciences (IHBAS) at Delhi, India in an interview suggested that “Homelessness among mentally ill is growing
significantlyit has really become a major concern.” IHBAS also providing out reach service facilities (twice a
week) for the mentally ill homeless with the active collaboration of NGO Aasharay Adhikar Abhiyan (AAA)
and magistrate over 12 years at Jama Masjid, Delhi. Mukul Goswami of Ashadeep, a mental health society that
operates in Guhawati, Assam,India reported that 90% of the mentally ill homeless people are suffering from
Schizophrenia or an alternate mood disorder. These mentally ill people are capable of harming themselves or
those around them, most of the women are sexually abused and almost all have health issues like skin diseases
and respiratory problems. He further mentioned that locating and admitting homeless patients is a persistent
challenge. The ones that do get admitted are either found by the police authorities or volunteers from NGO. 14
The difficulties of addressing combined substance misuse and mental illness (dual diagnosis), which exists in
this group, has long been acknowledged 15. International evidence suggests homeless individuals often find it
difficult to access the health and social care they need 16 . The reasons for this include stigma, financial obstacles,
lack of knowledge about state entitlements, healthcare system barriers, the competing priorities of homeless
persons themselves and lack of community care. Homeless individuals face many challenges in accessing,
Pradeep Kumar, American International Journal of Research in Humanities, Arts and Social Sciences, 7(2), June-August, 2014, pp. 160-163
AIJRHASS 14-581; -© 2014, AIJRHASS All Rights Reserved Page 162
utilizing, and maintaining health care services, and report unmet health care needs for multiple types of health
care 10,17
Keeping in mind the mental health consequences of homelessness, urgent attention and steps to be taken in this
regard becomes compulsory for all concerned authorities and professionals. No doubt that already steps have
been taken in these lines by NGOs hospitals, professional but that is not yet adequate. A number of NGOs are
coming to the rescue of the mentally ill poor. The Banyan, a Chennai (India) based home for destitute and
mentally ill women has gained international attention for the model rehabilitation program. The program
extends its support beyond the treatment as it found that families refuse to accept the mentally ill once treated
owing to the stigma attached to mental ill-health. It has rehabilitated over 1000 people who are now leading
meaningful lives with economic activities10. Navachetna a home for homeless ill women is working on
rehabilitate the mentally affected homeless women ling on the streets of Guwahati from 2005. Their work has
become an inspiration for other professionals as they have reintegrated 362 with their families out of 401till
October 2012 14.
The media both in national and international level are giving much attention to the street children in recent years.
The 2009 Oscar Award nominated movie Slumdog Millionaire by Danny Boyle have drawn much attention to
the life of homeless /street children in India. The efforts to increase awareness have led to several initiatives
involving numerous groups working with street children, the launching of specific schemes and programs at the
local, state and national level and the initiation of numerous studies on street children. A central scheme for the
welfare of street children has recently been initiated by the Indian Government’s Ministry of Welfare, which
gives funding to NGOs on programs related to street children.18
Author already worked with mentally ill homeless people when he was working as a psychiatric social worker
under District Mental Health Program/ National Mental Health Program at IHBAS, Delhi(January 2009 to
September 2011) and conducted (once a week) group therapy secession having 8-12 homeless people with poly
substance abuse at Jama Masjid,Delhi. He observed that lack of motivation for initiation and maintenance of
abstinence are common factors that make treatment difficult and challenging. Author has seen that most of the
homeless were found from the 3rd and 4th decade, started substance abuse in early childhood, harbored poor
knowledge about the risks involved with substance abuse and indulged in poly substance abuse. Majority was
either unmarried or was separated. Few had HIV positive status and involved in high risk behavior. The
individuals attending more than 40 to 60 % of the group interactive secessions showed perceptible reduction in
high risk behavior and showed positive changes in behaviors related to substance abuse.
Conclusion
The issue of mental health among homeless people is not only important but also serious issue. Mental illnesses
and homelessness is interwoven and forms a vicious cycle. The biggest challenge that Mental Health Care in
India face is the lack of awareness and social stigma attached to the illness. The menace of substance abuse,
sexually transmitted diseases and difficulty in accessing, utilizing, and maintaining health care services by such
people has been a great concern. In light of these challenges, community mental health programs in slums seem
to an option for combating the issue. The reliable estimates of the mental disorders among homeless would help
policy makers as well as mental health professionals in the development of psychiatric services. This article
advocates the human rights mainly of the homeless people with mental disorders .It are a great urgency to
eradicate mental illness in this comparatively more vulnerable population.
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... Salah satu kelompok yang rentan mengalami keterlantaran adalah Penyandang Disabilitas Mental karena gangguan fungsi pikir, emosi dan perilaku yang dialaminya. Kumar (2014) menyebutkan Penyandang Disabilitas Mental tidak hanya diasingkan, mereka melalui hidup yang buruk, tidak dapat menikmati akses kesehatan dasar, mengalami pelecehan seksual sehingga terkena HIV dan penyakit menular seksual lainnya, bahkan mengalami kematian dini (Kumar, 2014). Senada dengan pernyataan tersebut, Komisioner Pengkajian dan Penelitian KOMNAS HAM bahwa "Penyandang disabilitas mental adalah kelompok yang paling mendapat perlakuan tidak manusiawi. ...
... Salah satu kelompok yang rentan mengalami keterlantaran adalah Penyandang Disabilitas Mental karena gangguan fungsi pikir, emosi dan perilaku yang dialaminya. Kumar (2014) menyebutkan Penyandang Disabilitas Mental tidak hanya diasingkan, mereka melalui hidup yang buruk, tidak dapat menikmati akses kesehatan dasar, mengalami pelecehan seksual sehingga terkena HIV dan penyakit menular seksual lainnya, bahkan mengalami kematian dini (Kumar, 2014). Senada dengan pernyataan tersebut, Komisioner Pengkajian dan Penelitian KOMNAS HAM bahwa "Penyandang disabilitas mental adalah kelompok yang paling mendapat perlakuan tidak manusiawi. ...
... Due to its location and low-resource surrounding rural settlements, the city of Chennai, in Tamil Nadu, has the fourth highest homeless population rate in India with approximately 17,000 homeless individuals (Kumuda, 2014). With studies suggesting that a third of homeless populations worldwide suffer from some form of severe mental illness (Kumar, 2014;Levitt, Culhane, DeGenova, O'Quinn, & Bainbridge, 2009), and the consequent increased vulnerability to traumatic exposure, there is reason to believe that there may be gross under-reporting of trauma in this specific population. ...
... Study participants, who had experienced homelessness with SMI or who were considered at risk of homelessness with SMI, who were above the age of 18 and could comprehend interview instructions, were recruited in Tamil (the local language) from among Banyan service users by author SV. Those at risk of homelessness were determined as individuals who currently lived in their own homes but shared common sociocultural risk factors for homelessness including poverty, poor social/familial support, familial breakdown, and previous experiences of verbal or physical abuse (Caton et al., 1995;Kumar, 2014;Levitt et al., 2009). Usersurvivors were selected from various care networks within the Banyan (see supplementary material). ...
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Exposure to violence, vulnerability due to lack of shelter, alienation due to stigma, the experiences of severe mental illness (SMI) and subsequent institutionalization, make homeless persons with SMI uniquely susceptible to trauma exposure and subsequent mental health consequences. This study aims to contribute to the development of culturally sensitive interventions for identifying and treating trauma in a population of homeless persons with SMI in Tamil Nadu, India by understanding the manifestations of trauma and its associated consequences in this population. Free-listing exercises followed by in-depth interviews were conducted with a convenience sample of 26 user-survivors who have experienced homelessness or were at risk of homelessness, and suffered from SMI. Topics explored included events considered to be traumatic, pathways to trauma, associated emotional, physical and social complaints, and coping strategies. Results indicate discrepancies in classification of traumatic events between user-survivors and the Diagnostic and Statistical Manual of Mental Disorders. Traumatic experiences, particularly relating to social relationships and poverty, mentioned by user-survivors did not match traditional conceptualizations of trauma. Positive coping strategies for trauma included being mentally strong, knowledge and awareness, whereas the main negative coping strategy is avoidance. User-survivors attributed their experiences of homelessness and SMI to past traumas. Differing views of trauma between user-survivors and mental health professionals can lead to misdiagnosis and under-recognition of trauma in this population of homeless persons with SMI.
... There are no specific, focused studies to understand these complex needs of HMI patients and effectiveness of multidisciplinary approach in family reintegration till date (Fazel et al., 2014(Fazel et al., , 2008Kumar, 2014;Thompson et al., 2013;Tripathi et al., 2013). Hence, there is an urgent need for studies on HMI patients in India and worldwide. ...
... We can hypothesize that severe mental illness and homelessness are bidirectional in nature. This hypothesis is supported by other existing studies on homelessness and mental illness (Fazel et al., 2014(Fazel et al., , 2008Kumar, 2014;Thompson et al., 2013;Tripathi et al., 2013). The prevalence of HMI patients is varied across the world and across cities. ...
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Objectives Homeless Mentally Ill (HMI) patients represent a unique global problem and pose a challenge in treatment, management and rehabilitation services. There is sparse data on HMI patients in India. The objective of this paper is to study the clinical outcome and rehabilitation of HMI patients. Methods We performed a retrospective chart review of ‘HMI’ patients from 1st January 2002 to 31st December 2015, who were admitted under Department of Psychiatry at National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India. Clinical outcomes were analysed by descriptive statistics and predictors of family reintegration were analysed by logistic regression model. Results Seventy-eight HMI (unknown) patients were admitted in fourteen years period. 54(82%) were completely improved at discharge, 40(51.3%) were reintegrated to the family; 15(19.2%) were sent to state home for women, and 17(21.8%) were sent to Non-Governmental Organization/Rehabilitation Centre and 6 (7.8%) required multispecialty care in general hospital or absconded from the hospital during inpatient care. The logistic regression model showed that mental retardation (B = − 2.204, P = 0.002) was negatively correlated with family reintegration and clinical improvement at discharge (B = 2.373, P = < 0.001) was positively correlated with family reintegration. Conclusions In our study majority of HMI patients improved at the time of discharge. Family reintegration was possible in about half of HMI patients after treatment. Mental retardation and clinical improvement are important predictors of family reintegration of HMI patients.
... There have been researches about homeless in India which have discussed the role of various interconnected factors contributing to homelessness in the mentally ill, homelessness in women, in particular, provisions of the Mental Health Care Act 2017, and pathways to care for them. [15][16][17][18][19] The homeless people tend to live on the streets, in the bus and railway stations, temples, open spaces without basic amenities like toilets, and get exposed to harsh weather conditions. Homeless people do tend to suffer from a range of mental health issues ranging from psychotic disorders to affective disorders. ...
... There have been researches about homeless in India which have discussed the role of various interconnected factors contributing to homelessness in the mentally ill, homelessness in women, in particular, provisions of the Mental Health Care Act 2017, and pathways to care for them. [15][16][17][18][19] The homeless people tend to live on the streets, in the bus and railway stations, temples, open spaces without basic amenities like toilets, and get exposed to harsh weather conditions. Homeless people do tend to suffer from a range of mental health issues ranging from psychotic disorders to affective disorders. ...
... Living with intellectual disability may pose challenges in carrying out activities of daily living such as self-care, managing instrumental activities such as travel and cooking, maintaining safe relationships with others, and adapting to new challenges. Behavioural problems or comorbid mental illness may contribute to why family members abandon them [11]. Stigma or family burden are other factors which predispose someone to homelessness. ...
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... The biggest challenge that Mental Health Care in India face is lack of awareness and social stigma attached to mental illnesses. The menace of substance abuse, sexually transmitted diseases and difficulty in accessing, utilizing, and maintaining health care services by such people has been a great concern (Kumar P., 2014 ). ...
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Homeless mentally ill (HMI) people are a major social and public health concern worldwide. HMI people also represent a unique problem in developing countries like India in the context of treatment, medico-legal & rehabilitation issue. The De-institutionalization and their Community reintegration has not much research been carried out. The aim of the study was to assess the process of de-institutionalization and reintegration of the HMI into the community. This is retrospective review of case record file of HMI people, who were admitted at the State Institute of Mental Health, Rohtak, Haryana from the period of Jan 2014 to August 2018. The process of community reiterations was carried out by four (4) steps: (i) Enrollment for Aadhar Card (ii) Applied unstructured In-depth interview techniques using regional language for gathering qualitative information (III) Application of information communication technology like, multimedia, Google map, mobile phone, internet etc., for trace out their address (iv) Communication with local police, Zila parishad and Gram Panchayat to reach the family members. Forty Six HMI people were admitted in the Institute in last 4 years, out of which 31 (69%) were reintegrated into the community, 23 (50%) were reintegrated into the family residing in different states of the country (India) & 8 (17%) were shifted to the government / non-governmental organizations. Primary health and support for HMI is a major public policy challenge. The findings of the study show some strategies, which can help to reintegrate these people into the community. The process of reintegration of these into the community is a difficult task; we have planned to involve various stages, which helped us to reintegrate these people into the community.
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Mental illness and homelessness are interlinked and constitute a vicious circle. Persons who are suffering from mental illness may get separated from their families because of their psychopathology or cognitive distortion. Sometimes they may not be able to recall their names and family residential address and wander away to faraway places. Being part of society is the key to having the important things in life that everyone wants. A person who is suffering from schizophrenia or other psychotic disorder also needs good health, relationships, food, shelter, and employment. With the help of new technology, like Google maps, and Aadhaar fingerprint, we can decrease the time spent for tracing the families of persons with mental illness and reintegrate the patients with their family members. Here, through this case study, an attempt has been made to discuss the efforts made and challenges faced concerning the reintegration of mentally ill persons with a special focus on enhancing social networks by using newer technology.
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Background Homeless Persons with Mental Illness (HPMI) are the unique population to provide health care and rehabilitation services. Many factors contribute to homelessness among persons with mental illness, such as personal health, economic, social system, and changes in family compositions, and dynamics. Moreover, the inability to access appropriate housing that caters to an individual's particular social and cultural needs might impede capacity and day-to-day functionalities. In the Indian context, families play a vital role in people with severe mental illness in providing support and care within the family.Methods Six unknown patients admitted to the tertiary care psychiatric hospital were evaluated and managed by the multidisciplinary team. Apart from psychiatric evaluation, and treatment each patient’s family was traced using available resources (patient’s report of address, an advertisement for missing person, contacting nearest police station or post office or village panchayat or using social media networks).ResultsThe social re-integration of HPMI happened with intensive work and coordination with various community stakeholders by mental health professionals.Conclusion Family reintegration is possible with collaboration through the various stakeholders such as police, village panchayat, media, unique identity number, and social networks. There is a need to endow community facilities like halfway homes, day-care centres, home-based, and community-based rehabilitation to treat individuals with mental illness.
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Introduction: Mental illnesses are continuing to spread worldwide. There is no society and strata that are immune to mental illness; homeless population is also not an exception. The present study estimates the prevalence of psychiatric illnesses in homeless girls who are presently living as inmates. Thirty six girls (aged 14-17 years) who are homeless (either runaway or throwaway) were interviewed along with their primary caregiver. Data were gathered through both a structured interview with the girls and their present caregiver at institute. Tools: The Mini-International Neuropsychiatric Interview for Children and Adolescents (MINI-KID) was used for assessing psychiatric illnesses. Before administering the MINI-KID, their intelligence quotient (IQ) was also measured to assess their intellectual functioning. Results and conclusion: Findings indicate that the prevalence of depression and posttraumatic stress disorder (PTSD) were higher followed by conversion disorder, mental retardation and panic disorder in present sample. The results also show that more than 60% of inmates met the criteria for at least one psychiatric disorder. Overall, estimates of psychiatric morbidity in the inmate girl are higher than those reported in Western World. The most striking finding of the present study is that more than 80% were classified as runaway and the majority of mentally ill inmates required specialised mental health housing. These findings suggest future challenges not only for mental health professional but also for policy makers.
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We assessed the prevalence and predictors of past-year unmet needs for 5 types of health care services in a national sample of homeless adults. We analyzed data from 966 adult respondents to the 2003 Health Care for the Homeless User Survey, a sample representing more than 436,000 individuals nationally. Using multivariable logistic regression, we determined the independent predictors of each type of unmet need. Seventy-three percent of the respondents reported at least one unmet health need, including an inability to obtain needed medical or surgical care (32%), prescription medications (36%), mental health care (21%), eyeglasses (41%), and dental care (41%). In multivariable analyses, significant predictors of unmet needs included food insufficiency, out-of-home placement as a minor, vision impairment, and lack of health insurance. Individuals who had been employed in the past year were more likely than those who had not to be uninsured and to have unmet needs for medical care and prescription medications. This national sample of homeless adults reported substantial unmet needs for multiple types of health care. Expansion of health insurance may improve health care access for homeless adults, but addressing the unique challenges inherent to homelessness will also be required.
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This study compared health and social characteristics of two groups of homeless adults in Manhattan--those who were chronically unsheltered and those who were not. Outreach workers conducted brief, structured interviews with 1,093 unsheltered homeless adults. Respondents were later categorized as being chronically unsheltered on the basis of New York City criteria (sleeping without shelter at least nine of the previous 24 months). The sample had high rates of substance abuse (65%), serious medical issues (42%), and repeated trauma (51%) and low rates of medical insurance (47%) and income entitlements (26%) entitlements. Sixty-seven percent were chronically unsheltered, and these respondents had significantly higher rates on several measures, including military service, incarceration, and mental illness. The sick and aged nature of this population suggests that more aggressive efforts are needed to enroll unsheltered homeless people in income and health benefits and to create adequate housing opportunities with appropriate support services.
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Homeless mentally ill (HMI) persons are a highly vulnerable and socially disadvantaged population, deprived of even the basic minimal human rights. Data on HMI in India is scarce. This retrospective chart review aimed to evaluate socio-demographic, socio-cultural and clinical profile of HMI patients, and to study reasons of homelessness and outcome related variables in these patients. One hundred and forty homeless persons were admitted to the department of psychiatry of a north Indian medical university from February 2005 to July 2011. Of these, one hundred and twenty-seven (90.7%) had psychiatric illness and six had only intellectual disabilities. The majority of HMI persons were illiterate/minimally literate, adult, male, and from low socioeconomic and rural backgrounds. Most of the patients (55.7%) had more than one psychiatric diagnosis. HMI had considerably high rates of co-morbid substance abuse (44.3%), intellectual disabilities (38.6%) and physical problems (75.4%). Most (84.3%) were mentally ill before leaving home and 54.3% left home themselves due to the illness. Most HMI responded to the treatment. After treatment of mental illness, it was possible to reintegrate about 70% of the patients into their families. Families were willing to accept and support them. Untreated/inadequately treated mental illness was the most common reason for homelessness. Easily accessible treatment and rehabilitation facilities at low cost can improve the plight of such patients. Further research in this area is required.
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Homeless persons are at higher risk for morbidity and mortality from both chronic and episodic illness than the general population. Few data are available on the prevalence of these conditions and uptake of vaccination for prevention. In March 2007, we administered a cross-sectional survey to a convenience sample of homeless persons in Atlanta. Approximately half (46.2%) of the survey participants reported at least one chronic medical condition. Acute respiratory symptoms within the previous 30 days were reported by up to 57.7% of survey participants. Receipt of influenza vaccination was reported by 31.9% of survey participants, receipt of pneumococcal vaccine by 18.7%. Vaccination rates varied by age and risk group. The survey demonstrated high rates of morbidity in this population. Influenza and pneumococcal vaccination rates were suboptimal. Culturally appropriate interventions must be developed to prevent respiratory and other diseases in this important group.
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Many factors contribute to the health problems of homeless persons, including exposure to adverse weather, trauma and crime, overcrowding in shelters, unusual sleeping accommodations, poor hygiene and nutritional status, alcoholism, drug abuse and psychiatric illness. It is common for homeless adults to have skin ailments, respiratory infections, traumatic injuries and chronic gastrointestinal, vascular, dental and neurologic disorders. Homeless children may have respiratory, ear and skin diseases, as well as special problems, including failure to thrive, developmental delay, neglect and abuse. Important questions to ask during history-taking include questions about sleeping conditions, sources of food, past psychiatric problems and substance abuse, and sources of social support. Special attention should be given to examination of the skin, teeth and feet. Supplemental food, immunizations, psychologic counseling and social service referrals should be considered for homeless pediatric patients.
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We identified substance use patterns and factors associated with increased substance use after users become homeless. We carried out a 2-city, community-based survey that used population-proportionate sampling of 91 sites with random selection at each site. Five hundred thirty-one adults were interviewed; 78.3% of them met Diagnostic and Statistical Manual of Mental Disorders, Revised Third Edition criteria for substance abuse or dependence. Most of those who met the criteria reported using drugs and alcohol less since they became homeless, commonly because they were in recovery. Factors independently associated with increased use were no health insurance (odds ratio [OR] = 1.6; 95% confidence interval [CI] = 1.02, 2.58), alcohol abuse or dependence (OR = 3.5; 95% CI = 1.85, 6.78), and selling plasma (OR = 2.6; 95% CI = 1.32, 5.14) or panhandling (OR = 3.0; 95% CI = 1.65, 5.55) to acquire drugs. Becoming homeless plays a role in self-reported substance use. Multiservice treatment programs and tailored interventions for homeless persons are needed.
Human rights: more than 100 million homeless worldwide
  • G Capdevila
Capdevila G (2005). Human rights: more than 100 million homeless worldwide. http://www.ipsnews.net/2005/03/human-rightmore-100-million-homeless-worldwide.
Health Status and Health Care Experiences among Homeless Patients in Federally Supported Health Centers: Findings from the 2 00 9 Patient Survey
  • Lydie A Lebrun-Harris
  • P Baggett
  • Darlene M Jenkins
  • Alek Sripipatan A
  • Ravi Sharma
  • A Seiji
  • Charles A Hayashi
  • Daly
Lydie A. Lebrun-Harris, Travi s P. Baggett, Darlene M. Jenkins, Alek Sripipatan a, Ravi Sharma, A. Seiji Hayashi, Charles A. Daly, a n d Quyen Ngo-Metzger. Health Status and Health Care Experiences among Homeless Patients in Federally Supported Health Centers: Findings from the 2 00 9 Patient Survey. Health Research and Educational Trust D O I : 10.1111 /14 7 5 -6 77