Sociodemographic and clinical profiles of homeless mentally ill admitted in mental health institute of South India: ‘Know the Unknown’ project

Abstract

Objectives:

A significant number of homeless mentally ill (HMI) patients without any personal, family or other identification details represent a unique problem in the psychiatric services of developing countries like India in the context of legal, humanitarian and treatment issues. These patients pose challenge to the mental health professional in diagnosis and management.

Aims:

To study the sociodemographic and clinical profiles of HMI patients admitted under psychiatry.

Methods:

We performed a retrospective chart review of ‘HMI’ patients from 1 January 2002 to 31 December 2015, who were admitted to the Department of Psychiatry at National Institute of Mental Health and Neurosciences (NIMHANS), Bangalore, India. Sociodemographic and clinical profiles of the patients were analyzed by descriptive statistics.

Results:

Mean age of the sample was 34.6 years (±12.21 years), 42 (53.8%) were females, 74 (94.9%) were registered as Medico Legal Case and 53 (80.8%) were admitted under reception order issued by a magistrate. HMI patients brought by police were 32 (41.0%), by the public were 32 (41.0%) and 14 (18.0%) by nongovernmental organization /ambulance/social worker. In total, 51 (65.4%) of them had schizophrenia and other psychotic disorders, 24 (30.8%) had mental retardation and 23 (29.5%) had a comorbid substance use disorder. The mean Clinical Global Impression severity at admission was 5.07 (±1.7), and the mean duration of inpatient care was 15 weeks. Anemia and malnutrition were found in 34 (43.6%) and 25 (32.1%) patients, respectively.

Conclusion:

This study shows that schizophrenia, comorbid mental retardation and substance use disorder are common causes of admission of HMI patients in psychiatry. It is an emerging problem, which needs urgent interventions, and there is a need for an efficient system, guidelines and collaboration with government and nongovernmental agencies.

Keywords

Unknown homeless mental ill psychiatry family integration India

Get full access to this article

View all access options for this article.

References

Abdul Hamid

Wykes

Stansfeld

. (1993). The homeless is mentally ill: Myths and realities. The International Journal of Social Psychiatry, 39, 237–254.

Beijer

Andréasson

(2010). Gender, hospitalization and mental disorders among homeless people compared with the general population in Stockholm. European Journal of Public Health, 20, 511–516. doi:10.1093/eurpub/ckq033

Edens

E. L.

Mares

A. S.

Rosenheck

R. A.

(2011). Chronically homeless women report high rates of substance use problems equivalent to chronically homeless men. Women’s Health Issues, 21, 383–389. doi:10.1016/j.whi.2011.03.004

Fazel

Geddes

J. R.

Kushel

(2014). The health of homeless people in high-income countries: Descriptive epidemiology, health consequences, and clinical and policy recommendations. The Lancet, 384, 1529–1540. doi:10.1016/S0140-6736(14)61132-6

Fazel

Khosla

Doll

Geddes

(2008). The prevalence of mental disorders among the homeless in Western Countries: Systematic review and meta-regression analysis. PLoS Medicine, 5, e225. doi:10.1371/journal.pmed.0050225

Fischer

P. J.

Breakey

W. R.

(1991). The epidemiology of alcohol, drug, and mental disorders among homeless persons. The American Psychologist, 46, 1115–1128.

Gelberg

Linn

L. S.

(1989). Assessing the physical health of homeless adults. Journal of the American Medical Association, 262, 1973–1979. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/2778933

Gowda

G. S.

Noorthoorn

E. O.

Kumar

C. N.

Nanjegowda

R. B.

Math

S. B.

(2016). Clinical correlates and predictors of perceived coercion among psychiatric inpatients: A prospective pilot study. Asian Journal of Psychiatry, 22, 34–40. Retrieved from https://doi.org/10.1016/j.ajp.2016.04.004

Greenberg

G. A.

Rosenheck

R. A.

(2010). Mental health correlates of past homelessness in the National Comorbidity Study Replication. Journal of Health Care for the Poor and Underserved, 21, 1234–1249. doi:10.1353/hpu.2010.0926

10.

Hwang

S. W.

(2001). Homelessness and health. Canadian Medical Association Journal/Journal De L’association Medicale Canadienne, 164, 229–233. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/11332321

11.

Hwang

S. W.

Burns

(2014). Health interventions for people who are homeless. The Lancet, 384, 1541–1547. doi:10.1016/S0140-6736(14)61133-8

12.

Mental Health Act. (1987). Ministry of health & family welfare department, Govt. of India. Retrieved from http://www.wbhealth.gov.in/download/MENTAL%20HEALTH%20ACT%201987.pdf

13.

National Mental Health Survey of India . (2015-2016). Ministry of health and family welfare government of India. Retrieved from http://indianmhs.nimhans.ac.in/Documents/reports/Summary.pdf

14.

Nieto

Gittelman

Abad

(2008). Homeless mentally ill persons: A bibliography review. International Journal of Psychosocial Rehabilitation, 12(2), 1.

15.

Patel

Weiss

H. A.

Chowdhary

Naik

Pednekar

Chatterjee

… Kirkwood

B. R.

(2010). Effectiveness of an intervention led by lay health counsellors for depressive and anxiety disorders in primary care in Goa, India (MANAS): A cluster randomised controlled trial. The Lancet, 376, 2086–2095. doi:10.1016/S0140-6736(10)61508-5

16.

Patra

Anand

(2008). Homelessness: A hidden public health problem. Indian Journal of Public Health, 52, 164–170.

17.

Roy

Crocker

A. G.

Nicholls

T. L.

Latimer

Gozdzik

O’Campo

… Rae

(2016). Profiles of criminal justice system involvement of mentally ill homeless adults. International Journal of Law and Psychiatry, 45, 75–88. doi:10.1016/j.ijlp.2016.02.013

18.

Saddichha

Linden

Krausz

M. R.

(2014). Physical and mental health issues among homeless youth in British Columbia, Canada: Are they different from older homeless adults? Journal of the Canadian Academy of Child and Adolescent Psychiatry/Journal De L’academie Canadienne De Psychiatrie De L’enfant Et De L’adolescent, 23, 200–206. Retrieved from http://www.ncbi.nlm.nih.gov/pubmed/25320613

19.

Singh

Shah

Mehta

(2016). The clinical presentation and outcome of the institutionalized wandering mentally ill in India. Journal of Clinical and Diagnostic Research, 10, VC13–VC16. doi:10.7860/JCDR/2016/19497.8681

20.

Testa

West

S. G.

(2010). Civil commitment in the United States. Psychiatry, 7(10), 30–40.

21.

Thara

Patel

(2010). Role of non-governmental organizations in mental health in India. Indian Journal of Psychiatry, 52(Suppl. 1), S389–S395. doi:10.4103/0019-5545.69276

22.

Thirunavukarasu

(2011). Closing the treatment gap. Indian Journal of Psychiatry, 53, 199–201. doi:10.4103/0019-5545.86803

23.

Thompson

R. G.

Wall

M. M.

Greenstein

Grant

B. F.

Hasin

D. S.

(2013). Substance-use disorders and poverty as prospective predictors of first-time homelessness in the United States. American Journal of Public Health, 103(Suppl. 2), S282–288. doi:10.2105/AJPH.2013.301302

24.

Tripathi

Nischal

Dalal

P. K.

Agarwal

Trivedi

J. K.

… Arya

(2013). Sociodemographic and clinical profile of homeless mentally ill inpatients in a north Indian medical university. Asian Journal of Psychiatry, 6, 404–409. doi:10.1016/j.ajp.2013.05.002

25.

Umesh

Gowda

G. S.

Kumar

C. N.

Srinivas

Bharath

Botta

Math

S. B.

(2017). Unknown patients and neurology casualty services in an Indian metropolitan city: A decades experience. Annals of Indian Academy of Neurology, 20, 109–115. doi: 10.4103/0972-2327.205764

26.

Weller

M. P. I.

Jauhar

(1987). Wandering at Heathrow airport by the mentally unwell. Medicine, Science and the Law, 27, 37–39. doi:10.1177/002580248702700107

27.

Yim

C.-L.

Leung

C.-M.

Chan

W. C.

Lam

H.-B.

Lim

W.-M.

(2015). Prevalence of mental illness among homeless people in Hong Kong. PLoS ONE, 10(10), e0140940. doi:10.1371/journal.pone.0140940

28.

Zima

B. T.

Wells

K. B.

Benjamin

Duan

(1996). Mental health problems among homeless mothers: Relationship to service use and child mental health problems. Archives of General Psychiatry, 53, 332–338.