1. Introduction
Homelessness is a societal and global concern affecting the countries throughout the world and more of a bigger problem in people with mental illness.
A home is a place that includes elements of stability, privacy, safety, security and the ability to control living space. Homelessness is thus defined as lack of these elements in the living space or residence which is transient in nature, unsuitable and unstable for accommodations such as in shelters. Research has shown that homelessness may contribute to mental illness and vice versa, i.e. the people having poor mental health conditions are more than twice as likely to experience homelessness in their lifetime, compared with people who are not (Fazel et al., 2008, 2014).
Crowding, pollution, inadequate lighting, noise, poor hygiene and maintenance are usually associated with poor housing quality. Homeless conditions and slums can result in exacerbation of certain psychiatric disorders, like substance use, violence, depression, anxiety, and can lead to social, occupational, societal dysfunction. Psychiatric disorders in homeless individuals, for instance, psychosis (3–42 %) is estimated to be three times higher than in the population with a sheltered living (Fazel et al., 2014).
People living on the streetsare more than likely to suffer from poor health conditions like TB, DM, chronic cough. These conditions are generally neglected as far as treatment is concerned due to issues of poverty, ignorance. Increased prevalence of substance use in this population further adds to the concern of poor treatment outcomes. All these unmet needs, poverty, job concerns, poor access to food supply add to mental stress and burden. All these lead to poor immunity in this population cohort, in the background of poor hygienic conditions. Hence, if exposed, homeless people are much more at risk of developing illness due to COVID-19 than rest of the population. The other added personal vulnerabilities homeless people have to cope with are social isolation/exclusion and stigmatization, high rates of criminality and violence, lack of reliable and affordable health care systems. It is not very difficult to reason that homelessness and victimization associated with it, blocks the path to recovery. Other barriers like stigma, difficulty in assessing available treatment options further add to this already existing problem.
As such, all these factors result in the exponential rise in the risk of acquiring the corona infection resulting in more serious outcomes. And the persons with psychiatric disorders might have the added disadvantage of understanding about the infection, available treatment options and precautionary measures required to be taken to prevent the spread of infection and protect ownselves. Moreover, negative aspects of mental health facilities laid down by society, scientific papers, media have resulted in very low or non-existent availability of treatment and other facilities for them. Homelessness and mental illness add to each other's worries, thus, homeless persons with mental illness require more attention, care, sensitivity as compared to either population group alone.
Failure to provide adequate resources to homeless persons with mental illness is a sign of failure of the system of the country. Every society must care for other pesons in need, helpless individuals, persons with deficits and from trodden areas not able to fulfill basic necessities of life, for achieving the nation development as whole.
When this article was being written, 212 countries had already been affected by COVID-19 with infection among 17 million people and 600,000 deaths (Centre for Systems Science and Engineering, 2020). Though countries have taken medical measures to curb the spread, precautionary measures have been introduced, lockdown had been announced by many, but among all this somewhere mental well being of persons has mostly been neglected. Exact information although is not available, but number of psychiatric disorders is expected to rise exponentially in the coming future (Tandon, 2020). The homeless persons with mental illness are at the farthest of the receiving end. They have a very poor state of being. As per 2011 census of India, 1.7 million people are homeless in-country and around 47 thousand reside in Delhi (Census 2011) around 100,000 homeless persons with mental illness are in the country (Kaur and Pathak, 2016) and the number is increasing exponentially.
Patients with Mental illness especially when homeless need special care and designated hospitals should be made where testing for COVID-19 could be done in-situ and reports get available readily. So working for homeless persons with mental illness, seems morally compelling, ethically appropriate, scientifically feasible and legally mandated too. But is it possible and how much difference will it make…the question needs to be pondered upon and requires research.
Funding
The authors did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Declaration of Competing Interest
The authors report no declarations of interest.
Acknowledgement
None.
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