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 Table of Contents  
LETTER TO EDITOR
Year : 2021  |  Volume : 37  |  Issue : 1  |  Page : 115-116

Homeward bound; Reintegrating a homeless mentally III person and his family during the COVID-19 pandemic lockdown


1 Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India
2 Department of Psychiatry, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka, India

Date of Submission01-Sep-2020
Date of Decision01-Jan-2021
Date of Acceptance13-Jan-2021
Date of Web Publication31-Mar-2021

Correspondence Address:
Mrs. G G Gopika
Department of Psychiatric Social Work, National Institute of Mental Health and Neuro Sciences, Bengaluru, Karnataka
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/ijsp.ijsp_300_20

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How to cite this article:
Gopika G G, Vani P, Ithal D, Jayakumar C. Homeward bound; Reintegrating a homeless mentally III person and his family during the COVID-19 pandemic lockdown. Indian J Soc Psychiatry 2021;37:115-6

How to cite this URL:
Gopika G G, Vani P, Ithal D, Jayakumar C. Homeward bound; Reintegrating a homeless mentally III person and his family during the COVID-19 pandemic lockdown. Indian J Soc Psychiatry [serial online] 2021 [cited 2021 Jun 15];37:115-6. Available from: https://www.indjsp.org/text.asp?2021/37/1/115/312874



The emergence and spread of the COVID-19 pandemic has wreaked havoc in the lives of people worldwide. In India, to curb the spread of disease, a nationwide lockdown was announced in March 2020. These policy decisions have led to significant restriction of human movement throughout the country. The populations that have been disadvantaged the most by this are the migrant workers, nomads, refugees, daily wage laborers, and homeless persons with mental illness (HPMI).[1] Even before the onset of the pandemic, HPMI has been marginalized and neglected across India, which has been compounded by the gravity of the pandemic. These persons are usually brought to hospitals by the police, nongovernmental Organization (NGOs), or good Samaritans.

The current mental health act (2017) emphasizes on the equal rights of HPMI to live freely in the community.[2] Thus, once mental health condition of these HPMI patients are stabilized following treatment, the next crucial step would be reintegrating them back to community and facilitating long-term rehabilitation. Community shelters (such as Nirashritha Parihara Kendra in the state of Karnataka) facilitate this process for those without traceable family,[1] along with social work team working in mental health-care setups.

Tracing, locating, and contacting families of HPMI at the earliest will have the advantage of a permanent and safe residence for the HPMI, which has become challenging during the pandemic. This process has been elaborated elsewhere[3] on the procedures to be followed by a health-care setup in admitting, investigating, and treating an HPMI in the context of the pandemic. The current case focuses on the steps taken by the mental health team in a National Institute of Mental Health And Neurosciences (NIMHANS), a tertiary mental health-care center in Karnataka, India, to re-integrate a HPMI patient back to his family of origin and the novel challenges faced due to the pandemic and lockdown during this process.

Mr. X, a 25-year-old gentle man, was brought for treatment to NIMHANS by the local police with a reception order from the court of Judicial First Class Magistrate on May 7, 2020. He was found to be wandering in the streets with symptoms such as muttering, gesturing to self, and irritability. He was investigated for medical comorbidities and an reverse transcription-polymerase chain reaction test was done to rule out COVID-19 infection before admission. A detailed assessment led the team to diagnose schizophrenia and mild intellectual disability. Once he improved with injectable and oral antipsychotic medications, the social work team started to examine the options of reintegration back to the community. Attempts made to trace his family bore fruit with contact details of a relative given by the patient on May 28, 2020. Photographs of the patient were sent to the local police station, after taking his written consent.

The relative was contacted telephonically on May 29, 2020 and the team was informed that the patient hailed from a lower income family of rural Tamil Nadu, India and was working as a daily wage worker in a company at Bangalore, Karnataka. During the beginning of the COVID-19 pandemic, the patient lost his job, due to which he was distressed. Following this, the family lost all contact with him and lodged a complaint at the local police station.

The patient's identity was subsequently corroborated with proofs provided by the family on May 30, 2020. However, they could not come to the hospital due to interstate travel restrictions. Hence, they were advised to come until the state border with the help of a travel pass. On June 1, 2020, the team of social workers safely facilitated the travel of the patient until there, informed the border police, and ensured that he recognized his family and agreed to go home with them.


  Difficulties Faced by the Family Top


Getting an e-travel pass (electronic pass) was a hurdle to the family who hailed from rural Tamil Nadu, as was arranging transportation to ferry the patient till the border during lockdown due to unavailability and unwillingness caused by the fear of contracting the infection from hospital premises among those available.


  Process of Reintegration: A Multisectorial Approach Top


The Superintendent of Police in Tamil Nadu helped the family avail a interdistrict travel pass. The assistance by helplines of both states and that of the nodal officers were utilized in coordinating the travel to the border. The local police helped to travel till the interstate border. Although the volunteers in the COVID helpline under the government of Tamil Nadu offered to assist with COVID-19 testing for the family members and arrange a vehicle to the hospital, a mandatory quarantine regardless of the result status made this logistically impossible. Considering the stringent requirements for travel across state borders, the patient was tested with a nasopharyngeal swab that reported negative. The necessary medications were provided, and a plan for telephonic follow-ups in the future was made, and the family was educated about the illness. The local government volunteers were involved as well for better community acceptance of the HPMI and alleviating the fear among them.


  Future Directions Top


It is thus necessary to have protocols in place for the process of identification, discharge, and integration of HPMI. At present, state-wise online portals such as the Zonal Integrated Police Network, a collaborative online initiative by the Delhi police, and the citizen portal by the Gujarat government provide up-to-date information on missing persons in each state, thereby simplifying the search process.[4] NGOs such as Banyan, Shraddha foundation, Ashadeep mission, Neptune foundation, and New Hope charitable society have been actively involved in the tracing of families and reintegration of HPMI as well as providing helpline facilities.[5],[6],[7],[8],[9] A countrywide registry such as those available in countries such as the United States and recently launched in India by the National Crime Records Bureau containing details of missing persons will benefit in expediting the process of tracing and placing. The availability of dedicated state-wise helplines will aid in the reintegration process of HPMI. Reverse identification of these individuals with the assistance of available AADHAR (Unique Identification Authority) data is another alternative that benefits exploration.

Thus, there is a need for a holistic and collaborative effort from all authorities in reintegrating the homeless mentally ill back to their families. More studies focusing on these processes during pandemics and disasters are warranted.

Declaration of patient consent

The authors certify that they have obtained all appropriate patient consent forms. In the form the patient(s) has/have given his/her/their consent for his/her/their images and other clinical information to be reported in the journal. The patients understand that their names and initials will not be published and due efforts will be made to conceal their identity, but anonymity cannot be guaranteed.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Gowda GS, Chithra NK, Moirangthem S, Kumar CN, Math SB. Homeless persons with mental illness and COVID pandemic: Collective efforts from India. Asian J Psychiatr 2020;54:doi:10.1016/j.ajp.2020.102268.  Back to cited text no. 1
    
2.
Swaminath G, Enara A, Rao R, Kumar K, Kumar C. Mental Healthcare Act, 2017 and homeless persons with mental illness in India. Indian J Psychiatry 2019;61:S768-72.  Back to cited text no. 2
    
3.
Naik SS, Gowda GS, Shivaprakash P, Subramaniyam BA, Manjunatha N, Muliyala KP, et al. Homeless people with mental illness in India and COVID-19. Lancet Psychiatry 2020;7:e51-2.  Back to cited text no. 3
    
4.
Zonal Integrated Police Network (zipnet.delhipolice.gov.in). Available from: http://zipnet.in/index.php?page=missing_person. [Last accessed on 2020 Dec 31].  Back to cited text no. 4
    
5.
10 NGOs Helping Mentally Challenged Live Normal Life in India - GiveIndia's Blog. Available from: https://blog.giveindia.org/mental-health/10-ngos-helping-the-mentally-challenged-lead-a-normal-life-in-india/. [Last accessed on 2020 Dec 28].  Back to cited text no. 5
    
6.
Shraddha Rehabilitation Foundation for Mentally-Ill Roadside Destitute, Mental Rehabilitation Centre, Schizophrenia Patients Treatment, NGO for Wandering Insane, NGO for Wandering Mentally Ill, Donation for Schizophrenia Patients, Psychiatric Rehabilitation Center, NGO, Charitable Institution. Available from: https://www.shraddharehabilitationfoundation.org/. [Last accessed on 2020 Dec 28].  Back to cited text no. 6
    
7.
Narasimhan L, Kishore Kumar KV, Regeer B, Gopikumar V. Homelessness and women living with mental health issues: Lessons from the Banyan's experience in Chennai, Tamil Nadu. In: Gender and Mental Health. Singapore: Springer; 2020. p. 173-91.  Back to cited text no. 7
    
8.
Neptune Foundation | Non Governmental Organization | Mumbai. Available from: https://www.neptunefoundationindia.org/. [Last accessed on 2020 Dec 29].  Back to cited text no. 8
    
9.
Missing Person Helpline. Available from: http://www.missingpersonhelpline.org/. [Last accessed on 2020 Dec 29].  Back to cited text no. 9
    




 

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