Homelessness is a major challenge during public health emergencies. Viewing from a sociopolitical scenario, COVID-19 pandemic and its prevention strategies, such as social distancing, stay at home, and personal hygiene measures, highlighted the helplessness of the homeless population and the violations of their rights. According to the 2011 Census Report,¹ there are 1.77 million homeless people in India, which constitute 0.15% of the country’s total population. Furthermore, there is a high proportion of mentally ill and street children in the homeless population.^1–3 The National Mental Health Survey (NMHS) guestimates the number of homeless patients with mental illness (HPMI) across various states to be “nil” or “almost minimal” to “1% of mentally ill.” The NMHS estimates the number of HPMI in some states to be as high as “15,000.” The estimates of HPMI varied across districts, cities, and states across India, according to the NMHS. Approximately one-fifth of this population has diagnosable severe mental disorders, which are severely incapacitating and result in a very poor quality of life.⁴ In the background of the pandemic spread, the combination of mental illness and homelessness adds to the pre-existing stigma and marginalization. HPMI are considered to be one of the most affected populations in this regard. The possibility of contracting COVID-19 is higher among persons with medical or psychiatric comorbidities. Homeless persons are often malnourished and have comorbidities that compromise their immunity and make them more susceptible to COVID-19.⁵ In Spain, a specialized on-site visit program for HPMI was initiated during the COVID-19 lockdown period. This resulted in continued psychiatric care during the emergency, prevention of drug default and relapse, reduced emergency hospital admission, and better utilization of state mental health resources.⁶

中文翻译：

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无家可归的精神疾病患者 (HPMI) 重新融入社区——COVID-19 大流行期间面临的挑战

无家可归是突发公共卫生事件期间的主要挑战。从社会政治情景来看，COVID-19 大流行及其预防策略，例如社会疏远、呆在家里和个人卫生措施，突出了无家可归者的无助感和对他们权利的侵犯。根据2011 年人口普查报告，¹印度有 177 万无家可归者，占该国总人口的 0.15%。此外，在无家可归的人口中，精神病和流浪儿童的比例很高。^1–3全国心理健康调查 (NMHS) 估计各州无家可归的精神疾病患者 (HPMI) 的数量为“零”或“几乎最低”到“精神病患者的 1%”。NMHS 估计某些州的 HPMI 数量高达“15,000”。根据 NMHS 的数据，印度各地区、城市和州的 HPMI 估计值各不相同。该人口中约有五分之一患有可诊断的严重精神障碍，严重丧失行为能力并导致生活质量极差。⁴在大流行蔓延的背景下，精神疾病和无家可归的结合增加了先前存在的污名和边缘化。在这方面，HPMI 被认为是受影响最大的人群之一。患有医学或精神疾病的人感染 COVID-19 的可能性更高。无家可归者往往营养不良，并有合并症，这会损害他们的免疫力，使他们更容易感染 COVID-19。⁵在西班牙，在 COVID-19 封锁期间启动了一项针对 HPMI 的专门现场访问计划。这导致在紧急情况下继续进行精神病护理，预防药物违约和复发，减少急诊住院人数，并更好地利用国家精神卫生资源。⁶