Homeless and Mentally ill - Masked identities, Obscured faces

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The Tipping Point

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International statistics estimate that close to 30 to 40% of the homeless population suffers from some form of mental illness. Based on The Banyan's experience, on an average, 30 people are admitted in any given month because they have been found wandering on the streets with some form of mental illness. The Banyan started as a small home that rescued, cared for and restored homeless women with mental illness to their families all over India from where they had wandered away and out of premises that could accommodate not more then 30 such women. With increasing numbers it grew into a home for 100 people. While The Banyan stretched itself further and built a new home that could accommodate about 250 women, there was no parallel response that was looking at this client population. The result was a huge dependency on The Banyan, as the sole player in the sector. In October 2004 the numbers spilled beyond their individual resources, at a staggering floating population of 420 women.

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The tipping point for The Banyan had arrived. And the crucial move to collaborate with different stakeholders who need to deliver action for the sector was made. After two months of active deliberations between the Department of Health and Family Welfare, Government of Tamil Nadu (GoTN), the Commissioner of Police (Greater Chennai), the Institute of Mental Health (IMH) (government psychiatric facility) and The Banyan, a model for appropriate crisis intervention materialized.

Dial 100 - Mental Health Helpline is that model for crisis intervention that emerged between the three parties involved in the exercise - The Institute of Mental Health (IMH), Department of Health and Family Welfare, GoTN, the Chennai City Police and The Banyan, a civil society actor who was engaged in service delivery in the sector for the last thirteen years.

Context of Launch - the need for innovation

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There were four defining reasons that set the ground for the launch:

1. Invisibility of the issue and the lack of Stakeholders leading to a lack of services and pressure on resources.
   
   
2. Procedural Obstacles in Outreach with legal procedures that included the filing of a first information report at the nearest police station from spot of rescue and the procurement of reception order from the district magistrate. Lack of clarity of where the person was to be sheltered during this process - in jail or another facility, on what kind of first contact needs to be made to make the process a human response and so on further compounded the issue of procedural obstacles.
   
   
3. Challenges in providing care, treatment and reintegration options for homeless persons with mental illness. To enable a journey towards the right to a free life of choice after recovery from the illness for a person who has been involuntarily committed is a challenge and ethically a difficult path to tread. Reintegration with families is a logistical challenge considering the fact that most clients have wandered away from homes in the remotest parts of the country.
   
   
4. Need for Holistic Response to address the three key dimensions - rescue, care and treatment and reintegration in a way that combined the best of skills and expertise of multiple stakeholders - the government, the law machinery and civil society actors.

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Dial 100 Mental Health Helpline - An experiment in crisis intervention

There are three parties involved in the exercise:

1. Institute of Mental Health (Department of Health and Family Welfare) - a 150 year old government institution with 1800 psychiatric inpatient beds
2. The Chennai City Police - the key agency for maintenance of law and order in Chennai City
3. The Banyan - an NGO working in provision of crisis intervention services and rehabilitation options for homeless women with mental illness for the last three years

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Four elements sum up the project:

1. Any member of the general public makes calls for rescue of a person with mental illness wandering on the streets to the Helpline that is located at the Police Control Room.
   
   
2. The Banyan along with the Police coordinates and conducts the rescue of a person wandering with mental illness based on calls received at 100 (the Police call center) routed to The Banyan social worker seated at the Police Control Room. The Reception Order is given by the Commissioner of Police.
   
   
3. The Institute of Mental Health (IMH), the government psychiatric facility provides care and treatment.
   
   
4. The Banyan collaborates with IMH by appointing two social workers who will work on reintegration of all clients admitted through the Police.

Cornerstones of the programme

1. Multi faceted intervention that recognizes and provides for many dimensions of the issue through synergistic action that pools in expertise and resources of many stakeholders.
   
   
2. Recognition of Intersection - Homelessness and Mental Health and putting the same on the agenda of multiple stakeholders - the general public, the state government, the police and civil society actors.
   
   
3. Demonstration of 'political will' being translated into action.
   
   
4. Interventions based on evidence through client and care giver experiences, through service provider experiences and through empirical research.
   
   
5. Humanizing the process by introducing innovations in practice.
   
   
6. Action based on premise of freedom and dignity of every individual with a focus on giving the person options for rehabilitation of one's own choice post recovery.
   
   
7. Model that incorporates social, medical and legal aspects.

Milestones and Statistics

1. Public participation in movement - As on March 2006, 642 people have made calls for rescue since December 2004. Callers across different sections of society and age groups have reached out by making calls for rescue of a homeless person with mental illness they have spotted
2. 229 people rescued through the process as on March 2006
3. 275 Police personnel involved in sensitization and training exercise for rescue of homeless people with mental illness in October 2005
4. Unprecedented police support in rescue - hassle free and efficient filing of First Information Reports (FIRs), timely issue of Reception Orders by Commissioner of Police, logistical support in the form of police vehicles and so on
5. Government Order (GO) for IMH to collaborate with The Banyan for reintegration of police admissions
6. Unique tripartite project institutionalized in the form of a MoU between the Police, the Department of Health and The Banyan that institutionalizes the process signed in January 2006
7. Process for discharge and reintegration of all people admitted through Police rolled out at the Institute of Mental Health from January 2006. 19 people reintegrated from January 2006 to March 2006
8. Historic reintegration of a person institutionalized in the state facility for five years even after recovery from illness with the family in Orissa in March 2006

Strategic Direction for the future

Expansion in major cities and district headquarters through local NGO implementing partners By widening the base of action and creating a cluster of similar initiatives across the country, the model will impact numbers across the country and add to responsiveness of stakeholders to the sector. Leads with four current and potential partners have been established.

Policy and System for larger sector impact

The second strategic direction is for policy level change that will result in the creation of a system. The vehicle that will promote this kind of revolution is built into the model because it involves the participation of different stakeholders of the sector of Mental Health Care for the homeless. The partnership mode of functioning across different levels has promoted and is expected to promote greater ownership of the cause - whether amongst the public, the police, the government or civil society, leading to increased demand for services and visibility. This will automatically translate into greater action and accountability of the same.

Write-up and photographs courtesy 'The Banyan'