Sociodemographic and clinical profile of homeless mentally ill inpatients in a north Indian medical university A. Tripathi *, A. Nischal, P.K. Dalal, V. Agarwal, M. Agarwal, J.K. Trivedi, B. Gupta, A. Arya Department of Psychiatry, King George Medical University, Shahmeena Road, Chowk, Lucknow 226003, UP, India 1. Introduction ‘Homelessness’ is generally associated with high rate of mental disorders. Psychosis, alcohol/drug abuse, depression and person- ality disorders are significantly more prevalent among homeless persons when compared with the general population, both in Western and Asian countries (Han et al., 2003; Timms and Balazs, 1997; Zima et al., 1996; Abdul et al., 1993; Fischer and Breakey, 1991). Prevalence and the strength of association of homelessness with mental illness varies across nations, ethnic groups and service systems (Schutt et al., 2009; Ran et al., 2006; Folsom et al., 2005; Montross et al., 2005). The Mental Health Act (MHA, 1987) of India has provisions for the treatment and rehabilitation of homeless mentally ill (HMI) persons. A National Mental Health Program is operational in India and many institutes have established sophisticated treatment modalities for the mentally ill. In spite of this, the reach of these provisions remains limited and a majority of the population does not have satisfactory access to mental health facilities (Thirunavukarasu, 2011). The willingness to ignore the existence of HMI is common amongst not only policy makers and law enforcing agencies, but among the health-care agencies and public too. HMI have received increasing attention from Non Government Organizations (NGOs) in India in the last decade. NGOs like Banyan and Anbagam in Chennai, Ashadeep in Guwahati and Samarpan in Indore have developed comprehensive services for the HMI. However, services from NGOs remain available to a very limited region in India and are almost nonexistent in the northern part of India. Moreover, services provided by NGOs may be difficult to sustain over time and on larger scales. Effective provisions in a national plan are required to care for the homeless and wandering mentally ill individuals whose plight is borne out of a combination of health, socioeconomic and human right issues (Thara and Patel, 2010). Although there is extensive research on HMI individuals in developed and some Asian countries, scientific data is woefully scarce in India (Patra and Anand, 2008). Only one descriptive study published by an NGO, working for wandering seriously mentally ill women in India, could be found (Rao, 2004). Many practical obstacles to research among HMI have been reported. Populations are often physically, linguistically, and culturally inaccessible to researchers, and humanitarian aid usually takes precedence Asian Journal of Psychiatry 6 (2013) 404–409 A R T I C L E I N F O Article history: Received 14 October 2012 Received in revised form 21 April 2013 Accepted 12 May 2013 Keywords: Homeless mentally ill Homelessness Co-morbidity India Socio-demography of homeless Reasons for homelessness A B S T R A C T 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. ß 2013 Elsevier B.V. All rights reserved. * Corresponding author. Tel.: +91 9651970700/9415769817. E-mail address: dradarshtripathi@gmail.com (A. Tripathi). Contents lists available at SciVerse ScienceDirect Asian Journal of Psychiatry jo u rn al h om epag e: ww w.els evier.c o m/lo cat e/ajp 1876-2018/$ – see front matter ß 2013 Elsevier B.V. All rights reserved. http://dx.doi.org/10.1016/j.ajp.2013.05.002