Most homeless people suffer from mental health problems, but there’s little help for themThe stigma against mental illness has meant that people with psychosocial problems are often neglected and abandoned, ending up on the streets.
On a cool winter morning, Richa was going through her slides before taking a lunch break. As the fundraising officer for an advocacy organisation, she had a presentation on mental health in the next two hours. It is difficult to imagine that just two years ago, Richa was living on the streets of Kathmandu, mentally ill and homeless.
In 2018, Richa, who asked that she only be identified by her first name for fear of stigmatisation, was rescued from the streets of Jawalakhel by Koshish, an organisation that works with mentally ill homeless people. After being trafficked to India as a child by her step-father, Richa had been rescued, gotten an education and had grown up to work as a tour guide, travelling back and forth between Nepal and India. But a mishap with the law involving drugs had landed her in prison for nine years. In prison, she had developed various forms of mental illnesses and after being released, with nowhere to go and no family to turn to, she had ended up on the streets.
“People called me pagal and baula and left me on my own,” said the 38-year-old. “I would spend nights outside the police station in Jawalakhel and would wander around the streets of Kathmandu during the day.”
She spent nine months on the streets of Kathmandu, between Gongabu and Jawalakhel, before she was discovered by Koshish and taken in for treatment.
Although there isn’t any data on the number of homeless people with mental illnesses, almost every Kathmandu street is home to at least one person with some form of mental illness. In 2017, when the Kathmandu Metropolitan City rescued the homeless people from the streets, a staggering 80 to 90 percent had some form of mental health problems.
The prevailing stigma attached to mental illness has meant that people with psychosocial problems are often ignored and abandoned. However, with proper medical treatment and rehabilitation, these people can lead largely productive and dignified lives.
“People on the streets often suffer from severe mental illnesses like schizophrenia, bipolar disorder and severe depression, all of which are manageable with the right medication and counselling,” said Matrika Devkota, founding chairman of Koshish.
After being rescued, Richa was diagnosed with a non-psychotic mental disorder, a condition of the mind that causes depression, panic attacks, suicidal thoughts, social withdrawal, compulsive behaviour, irritability and restlessness.
Although Richa developed mental health issues while in prison, her problems exacerbated during her time on the street.
“I was constantly hungry, and it was difficult to find a safe place to sleep. I never knew if I would wake up alive,” she said.
In one horrific incident, Richa was gang-raped and left to die in a Gongabu gully, she said.
Across the world, homeless people on the street are more vulnerable to sexual violence. A 2017 report by the District of Columbia in the United States found that 54 percent of homeless women had experienced different forms of sexual violence, ranging from stalking to rape. In a 2015 study conducted on homeless women in Los Angeles in the United States, 13 percent reported rape.
“When she was brought in to the residential treatment centre, Richa was in trauma. She had withdrawn from reality and didn’t talk to anyone,” said Sangeeta Laudari, a psychologist who is in charge of the Koshish transit home for rescued people with psychosocial problems.
After a 10-month therapy, which included counselling and medical treatment, Richa began to recover steadily and was able to recall bits of information about her background.
“Richa began to talk about her life prior to ending up on the street. We found out that she worked as a tour guide and used to travel to India and back. She also has impeccable leadership and English-speaking skills,” said Devkota, who offered Richa a job at Koshish.
However, Richa still can’t recall her family and where she grew up. According to Devkota, the biggest challenge lies in rehabilitating homeless people who have recovered from mental illness.
“There are people like Richa who genuinely cannot track the addresses of their families. However, there are also cases where the families don’t take them back although they have recovered,” said Devkota.
According to Devkota, along with the lack of a budget for the rescue and rehabilitation of people with mental illness from the streets, there is also the stigma that continues to persist even after they’ve recovered.
“Discharging people who have recovered back into a society that isn’t ready to receive them is fraught with evil consequences,” said Devkota. “A family that isn’t ready to accept the person is unlikely to ensure adherence to treatment and regular follow-ups. Thus, the person is at risk of relapse.”
According to psychologist Laudari, mental health is affected by a lack of social support and attention from friends, family and society. With the right care and a supportive environment, people can usually overcome mental disorder and lead productive lives.
“There are many reasons why people with mental health problems end up on the street. However, it is the duty of society and the government to provide them with basic rights and security to recover and live a dignified life,” said Laudari.
A 2019 pilot study for the National Mental Health Survey estimates that 2.2 million Nepalis, aged between 16 and 40 years, suffer from some form of mental illness. Despite mental health emerging as a health priority, for the fiscal year 2018-2019, the government only allocated 4.29 percent of its total budget to the ‘health and population’ category.
There is also a severe shortage of trained professionals like psychologists and psychiatrists to deal with mental health, especially in rural areas. According to estimates, there are an estimated 130 psychiatrists in the country, with less than 30 working in government hospitals.
According to Gyanendra Karki, spokesperson for the Kathmandu Metropolitan City, although the city has started to rehabilitate people begging on the streets, there isn’t any rehabilitation programme as such for homeless people with mental health issues.
As for Richa, she said she feels blessed to have been found by people who treated her with empathy and love.
“The medical treatment and support system I received after being rescued have given me a new life,” she said.
Richa now wants to devote her life to advocating against the stigma attached to mental health.
“I know that I am among the lucky few who got proper care and support,” she said. “When I talk about mental health issues, people still roll their eyes. They are often taken aback when I say that I have a mental illness.”