What about the right to care?
The homeless mentally ill may be invisible but they belong to society and society needs to take care of them.
Stigma, myths, lack of facilities and the nature of illness are sufficient problems; homelessness further compounds the problem.
Walking a tightrope: A balance has to be found between the needs of the mentally ill and the family. Photo: PARTH SANYAL
RUNNING a rescue and rehabilitation service for the homeless mentally ill brings me face to face every day with powerful instances of the struggle of the human spirit against all adversity.
I was walking past the Out-Patient Clinic at The Banyan, our NGO, a couple of weeks ago as per my normal routine. Some familiar faces, lots of hustle and bustle... all typical of a regular out patient day, quite a contrast from the transit and emergency care service that is our primary focus. It is a relief to watch family members participate in the treatment and care process at the clinic, as opposed to the total lack of support structures faced by the abandoned women in our emergency care. Due to force of circumstances, it has become a habit at The Banyan and I'm sure in other organisations working with the homeless to be the sole caregiver for homeless persons with mental illness rather than involve the families.
That day, Bharati caught my eye. Entirely preoccupied with managing her brother and two sisters all facing mental health problems Bharati seemed on the brink of a breakdown herself. I called her into my room for a chat and, despite the tears in her eyes, her sense of pride and self-esteem prompted her to talk in a very dignified manner. Her desperation, however, was quite evident. Her mother had a history of mental illness; her father had a cardiac problem. Both were in their seventies. Radha and Jamuna, her sisters, both in their thirties, had been ill for two years. Her brother was mentally retarded. The only support for the family, both emotionally and financially, was Bharati. She has had more than her share of problems to deal with. As if that were not enough, the community in which they lived had a freak accident in which 11 huts, including Bharati's, were burnt down.
With two sisters facing serious mental health problems and frequently turning suicidal, wandering away and disrobing, the street was obviously the last place to call home, but that was where they lived now. Bharati was at The Banyan to seek treatment for three members of the family. Questions that stare us in the face then: How does Bharati manage all these issues without even the semblance of a home? Are we driving her to a crisis situation herself by expecting that she tackle such complex, multiple problems single-handedly? Does she work to feed her family or does she stay at home to care for her sisters who need the focused provision of care and support at least for a certain period? If she has to stay at home, then who provides for them?
Vijaya is a homeless person with mental illness, rescued by the police from Parrys, in North Chennai. We have information from her that indicates that she sold her one-year-old child for a bowl of curd rice and Rs. 100.
Hasina is a homeless person with mental illness brought to The Banyan bound in chains. Eighteen years old; an innocent smile alternating with sudden traces of intense fear and anger.
Jennifer is a homeless person with mental illness abandoned by her alcoholic husband and devastated by separation from her school-going children.
These are real women, real situations and sadly, only the tip of the iceberg. The common factor is a mental health issue to deal with, coupled with homelessness, alcoholism, utter poverty, abuse, social inequality, stigma or a combination of all. Stigma, myths associated with the illness, lack of facilities and the nature of illness itself are sufficient problems to counter; the homelessness further compounds the problem. Mental illness leading to homelessness is not always as the result of abandonment. Often, the family is left with not too many options, especially among the lower socio-economic groups where access to care and support is minimal or non-existent. In most rural areas, the problem is often treated more as spiritual and less as a psychological issue.
Today, Bharati receives support from a few concerned individuals besides The Banyan, where two of her sisters live temporarily. Her sisters are on the road to recovery and Jamuna, a graduate, may even be able to earn a little for the family. Vijaya, now a lot more coherent, has filed a petition with the Legal Aid Clinic at The Banyan to trace her child. Hasina, now treated, is back home in Madhya Pradesh with her husband and child. She was chained to exorcise the evil spirits that they believed had possessed her. Her community was sensitised to mental health issues and they now recognise her behaviour as a psychological and medical problem. Jennifer is now an empowered individual, working in a beauty parlour, taking care of her children and proving a source of inspiration to others in similar situations.
It is usually a tight balance between the needs of the person with mental illness and the family. Often, the needs of the person are compromised and he or she leads a bleak life based on norms dictated by the family, care-giving organisation and society. Is our society comfortable with this inequality? Shouldn't every individual have the right to care, the right to freedom of choice and the right to dream?
To walk this path is to walk a tight rope that calls for a balance between the family's needs and the individual's. The only way ahead seems to be to increase stakeholders in this sector. Over 1,600 women from across the country have passed through the doors of The Banyan in the past 13 years, several hundred frequenting the out patient services. The collaboration between the Chennai City Police and The Banyan has seen 120 homeless persons rescued in the past six months. They are now being treated at the Institute of Mental Health, Chennai. While several have received the care and support that they need, many others have died on the streets, uncared for, lonely, abused and forgotten...
Combination of initiatives
The need for more transit care, emergency facilities to provide immediate access to treatment as in this case, we believe the right to care precedes the right to self-determination more rehabilitation programmes, more options for employment, more day-care centres, more hostel facilities, more community-based localised treatment programmes, more compensation schemes... a combination of all these initiatives needs to be undertaken immediately.
While I appreciate the effort from clinicians, social workers and activists, some strategic management inputs would add value to this sector. A few more action-oriented leaders may need to ponder over this as an issue of serious concern as the numbers we are addressing are by no means marginal. The Banyan has scaled up owing to the timely intervention and support of a sensitive and responsive Chief Minister, several funding organizations and numerous concerned citizens who have contributed their time, skills and funds based on their assessment that the need existed.
Finally, it is my belief that we, as a society, are responsible for every person and that we owe it to ourselves and to each other to work towards creating an equal, inclusive society. Invisible as the homeless mentally ill might be, they exist and they are certainly a part of our society.
Vandana Gopikumar along with Vaishnavi Jayakumar, founded The Banyan in 1993. The Banyan has grown from being a transit care centre for homeless persons with mental illness to a movement that now advocates rights for this group.
Names of persons and places have been changed to maintain confidentiality.
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