A Community-based Service Delivery intervention

One fine summer day 6 years ago, 2 mental health professionals – one a psychiatrist, the other a psychotherapist – were walking along the side of a lake in central Kolkata when they came across a bedraggled and dirty, man scrounging for a meal from deep within the local garbage refuse vats. Right opposite the street, was a Missionaries of Charity office, which provided free meals to the poor every day – and yet, here was this man who would not partake. Questions arose – Who was this man? Why did he refuse help/meals from outsiders? Where did he live? Where was his family/support system? And so on…

Only one answer appeared to adequately respond to the whole plethora of questions: He was a Nowhere Person – a homeless person with psychosocial disabilities lost to the world.

And so upon this fateful day, Iswar Sankalpa was borne with Outreach services – Project Naya Daur.

Initiated in June 2007, Outreach – Project Naya Daur is a mental health intervention project with a difference. It provides care and treatment to a population that is invisible to the rest of society – the homeless persons with psychosocial disabilities..

These people belong mainly to the economically backward and socially marginalised families. They are often seen, in various states of mental distress and physical abuse, around railway stations, bus stands, pilgrim centres and on street corners. They are the ‘invisible people’, separated from and/or abandoned by their families.

It is estimated that there are over 400,000 homeless persons with psychosocial disabilities in India, and amongst these, over 90% have diagnosable and treatable mental health conditions. Naya Daur’s team of mental health professionals works within the Kolkata Metropolis to reach out to a segment of society that the city of Kolkata has forsaken for far too long.

PHILOSOPHY

Who is a ‘Nowhere Person?
Lost within and without, the nowhere persons is a woman or a man with psychosocial disabilities who finds themselves out on the street all by her/himself, with no place to call home anymore.

S/he has to fend for themselves, completely and unabashedly alone – for they are feared and despised by the outside world, for what greater fear is there than that of the dark, the mysterious, the unknown.

With no one to help support them – every day is a struggle for these individuals; and consequently food, hygiene, shelter; the most basic of physical needs, become critical areas of negligence for them.

The nowhere person can be found loitering aimlessly on streets, deep in conversation with themselves or an imaginary someone, sometimes snatching and stealing food from a shop, sometimes scavenging though a garbage dump. Perhaps s/he is wearing the tattered remnants of some clothing article, or a self-made frock, or perhaps even nothing at all, or maybe tattered layers of multiple mismatching clothes on a hot summer day. They may be sitting remotely – not approached by anyone, in fact avoided by most – on a street side; lost in their own world of hallucinations and delusions, they may even rant and rave. Perhaps s/he is guarding her/his bundle of possessions – those small bits of plastic, torn clothes, bottles, etc – through which they now relate themselves to the world; sometimes they can even be found mute and impassable on a busy street corner, no word, no movement. And all this while, through all these moments, they fight, they struggle: with conflicts within and without.

Living in situations such as these allow for them to fall prey to abuse of every kind, at every moment. They are seen as threat to our social living, a menace to our environment, and a risk to our safety. But what about their safety, their living, their rights and dignities?

The wandering nature takes her/him to places far away from her/his known places and s/he ends up here in Kolkata which may be a city in a different state from where s/he belonged.

His illness often reaches a level where his ability to connect with the reality becomes impossible – the hallucinations makes him tread to situations which prove dangerous and even life threatening. For example, roadside accidents are very common for this section – leading to amputation of limbs and even death.

On the street living makes her come face to face with abusers every moment- resulting in unwanted sexual abuse and forced pregnancy and STDs.

He may take to addiction with the little money he would get from sympathetic passerby. She becomes susceptible to physical illness which remains untreated.

He happens to suffer from dog bites, wounds and cuts which he is not in a position to look after or even realize the pain owing to psychosocial disability.

Even if she musters courage to ask for help, it falls to deaf ears as no one would come near her owing to the odorous and mutilated wound.

He cannot even remember his name and thus reuniting him with his family seems very difficult.

They are Nowhere Persons, because in India, the entire public healthcare and related support systems depends on the institution of the family. An individual is defined by their familial status; that is, in cases of medical treatment their family name and address is compulsorily required to even admit a person. This would not be much of an impediment for the average family-bound person, however, for a homeless person with psychosocial disability, this criteria is tantamount to scaling Mount Everest. For this person, with no recollection of name or address, getting admission into a hospital or even availing basic healthcare thus becomes near about impossible. In such cases how can a HOMELESS PERSON WITH PSYCHOSOCIAL DISABILITY be expected to avail the most basic of rights, that is, healthcare?

Homelessness and Psychosocial Disability –

Iswar Sankalpa chose to work with the homeless persons with psychosocial disabilities – a population so marginalised that they are only referred to as vagrants in laws drafted in the 19th century with no mention in the current national developmental agenda – not even on paper.

To see and experience the appalling conditions under which this section of society exist has a profound impact upon us. Our natural reaction is to want to rectify the horrors of what we see with a quick, bold stroke. But for the chronically psycho-socially disabled, homelessness is a complex problem with multiple causative factors. In our analysis of this problem we need to guard against settling for simplistic explanations and solutions. We have to look at what conditions these persons must face in the community, what needed resources are lacking, and the nature of the disability itself.

Given the complexity of this populations’ health and living conditions – For a health issue where progress is dependent on innumerable factors, difficult to measure objectively, and where one step forward could be accompanied by two steps backward, a lot of work had to go into coming up with a holistic and empowering project model which would contribute to their over-all well being.

Dealing with the ultra-marginalized is not just ideological posturing from a human rights platform; it makes sound developmental sense. Mental health and illness and related psychosocial disabilities and homelessness are two pervasive issues that societies need to urgently address, for both have a negative impact on the lives of individuals