Raju, 14, lost his beloved aunt, the matriarch of their family of five, in November 2007. Just as life was slowly returning to its rhythm, one afternoon, when Raju came home from school with his brother and sister, he couldn’t find his mother, Lakshmi. Just a few months ago, she had taken her children and walked out of a violence-ridden home, where her husband beat her up regularly.
Not finding her at home, Raju decided to wait for his mother. But as the hours passed with no sign of her, the then Class IX student knocked on the doors of every house in his neighbourhood in Bhimavaram town of West Godavari district in Andhra Pradesh, with the hope that someone would know where she was. With his mother missing, he felt an overwhelming sense of desolation.
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Days turned into weeks, and there was still no trace of her. Raju’s sister, then 5, was put under the care of a relative in Hyderabad, while his younger brother, 11, found employment at a hotel. Raju was left to fend for himself.
“There were countless sleepless nights. I can’t explain the feeling in words. How can you, when you lose the only adult in your life? In just one week, I lost my aunt, my mother, and my siblings,” he recollects.
Now 33, and married with two children, Raju received a call from his cousin in July this year, telling him that his mother was alive. With bated breath, he rushed to the Government Mental Care Hospital in Visakhapatnam where Lakshmi, 48, had been admitted after being rescued from a street opposite the Mandal Revenue Office in Anakapalle, 24 km from Visakhapatnam. He finally saw her — the same face, the same voice.
“It was indeed my mother. To my surprise, she recognised me immediately,” says a teary-eyed Raju, standing outside his one-room house at Perupalem village, about 25 km from Bhimavaram, in the same district. He had moved there after his mother went missing, to stay close to his relatives. Raju and Lakshmi represent one of the rare events where a family is reunited.
According to the 2011 Census, there are nearly 17.72 lakh homeless people across the country, with more than 9.38 lakh people in urban areas and 8.34 lakh in rural areas. Uttar Pradesh tops the chart with 3.29 lakh living on the streets, followed by Maharashtra (2.10 lakh), Rajasthan (1.81 lakh), Madhya Pradesh (1.46 lakh), and Andhra Pradesh (1.45 lakh).
“The number must certainly have increased in the past 10 years. The incidence of homeless people suffering from mental illness is 50-60%,” says psychiatrist Indla Ramasubba Reddy, one of the trustees of Manobandhu Foundation in Vijayawada. Launched in 2021, the Trust focusses on rescuing homeless people in Andhra Pradesh and Telangana. Accessing mental healthcare is hard, say experts in the field, because Andhra Pradesh does not follow many guidelines of the Mental Heathcare Act, 2017.
Homeless and helpless
The homeless living with mental health conditions constitute those who have lost homes because of the illness and those whose hard circumstances on the street have pushed them into physical and psychological ill-health.
Incidents of sexual assault against homeless women often go unreported, says Dr.Reddy. He recalls a destitute mentally-ill woman who was pregnant when she was rescued, but couldn’t remember how she had got that way. Dissociative amnesia like hers, where survivors experience memory gaps due to the trauma, is common.
Raju’s mother, Lakshmi, who is now on the path to recovery (diagnosis withheld to protect survivor), manages to recall a few details. “I remember that day. I had stepped out thinking I would return in a while. Then I met some people who said I could earn money if I went with them, and so I did,” she says, now in the care of her son.
She continues: “I used to live on one meal a day. People used to donate generously. Sometimes, I would get ₹150 in a day. I would have one idli in the morning and a cup of coffee in the evening. I slept on railway station platforms. I travelled across the State, and lived for a long time in Visakhapatnam, Anakapalle, Rajahmundry, and Chodavaram. People took care of me wherever I went.” But she can’t remember why she never returned home.
Doctors say many of the mentally-ill destitute live with schizophrenia, a condition that “causes psychosis and is associated with considerable disability” and affects overall functioning, according to the World Health Organisation. While mental health conditions are multi-factorial, caused by both genetic and environmental factors, for those living on the street, harsh daily realities are major risk factors. They have little access to water, even for drinking, and will eat anything they find, even from dustbins.
“However, most of the mentally-ill we find on the streets recover with medical intervention,” Dr.Reddy says, adding that if the government, police and public did not turn their backs on their fellow citizens, many can live regular lives. Perhaps, life would have been easier for Raju, who spent a major part of his formative years alone, had someone brought his mother in for treatment when they found her on the street.
“My younger brother never returned. I did not just lose my people in quick succession, but I also lost the opportunity to study further. I lost my childhood. Nothing that I lost is ever going to come back,” he says.
The 2017 Act mandates the constitution of a separate Central and State authorities. The ones at the State level are directed to set up a Mental Health Review Board at State and district levels. The board members, including those from the Collectorate and medical fields, are given the responsibility of protecting the rights of mentally ill people, among other duties.
The Andhra Pradesh Commissioner of Medical, Health and Family Welfare, J. Nivas says while there is a State Authority in Andhra Pradesh, review boards at district levels are in the pipeline.
Manobandhu managing trustee B.Ramakrishna Raju says such a board is coming up in only four of 26 districts in the State: Visakhapatnam, NTR, Tirupati, and Kadapa. “The decision to set up such boards was taken after we sent many requests. We have been told that they do not have enough funds to set up boards in all districts,” he says.
The Act also mandates having an emergency service number at every district headquarters, but other than ‘108’ for ambulances, there is none specifically for mental health distress calls.
Andhra Pradesh has only one government mental care hospital in Visakhapatnam. Another hospital, with 100 beds, is coming up in Kadapa, but it is grossly insufficient.
“For the population that Andhra Pradesh (post bifurcation) has today, it should have a minimum of three such government hospitals dedicated to mental care. For a mentally ill person in Nellore or Kadapa to be treated, they must travel all the way to Visakhapatnam [over 600km and 700 km away respectively], which translates to a lot of expenditure,” says Dr. Bharat Vatwani, a Ramon Magsaysay award winner, whose Shraddha Rehabilitation Foundation near Pune facilitates the rehabilitation of mentally ill people after treatment and reunion with their families. He says Tamil Nadu stands as a role model for other States in terms of following the guidelines of the Act.
“People generally have this misconception that mentally ill persons are not cared for by their families, but the truth is that they cannot afford care, either financially or physically. If a person is left untreated for a long time, they will wander out and end up on the streets,” he says.
It is the responsibility of the police to take a mentally ill person to the nearest hospital for treatment. But this does not happen anywhere, he says.
To this, Commissioner of Police-Vijayawada, Kanthi Rana Tata has said that they take mentally-ill people to hospitals only when they behave violently. He said the police organise periodic surprise drives as part of ‘Operation Muskaan’ across the State to identify homeless people and rehabilitate them.
Explaining the process of admitting a mentally ill person to a hospital, Pragada Vasu, who runs three shelter homes in Visakhapatnam under Association for Urban and Tribal Development (AUTD), says, “Every time we take a patient to the government hospital in Visakhapatnam, we are asked if we have filed a complaint at the police station. Filing an FIR is a lengthy process. It discourages many good Samaritans from helping homeless people because no one wants to be held responsible should anything happen to them. We are also asked to produce a reception order, which is in contravention of the 2017 Act.”
Vasu says there are 89 shelter homes in Andhra Pradesh where the patients, after being provided adequate treatment, are given boarding and lodging until they are reunited with their families. “The Supreme Court guidelines say that we need to have one shelter home for every 1 lakh population. We do not have that many. The ones that we have are not fully functional,” he adds.
In one of Manobandhu’s drives organised in Kadapa district, 32 people were rescued. “Thankfully, the District Collector arranged a government bus to take them to the hospital in Visakhapatnam. This involves a lot of risk, as earlier there were cases of patients trying to run away or jump out of the vehicle,” says K. Venkata Krishna, a researcher working with Manobandhu, from LibTech India, an organisation of professionals aiming to improve public service delivery in India.
There are four steps involved in helping a person off the street: rescue, treat, rehabilitate, and reunite with families. But there are obstacles at every step. “Rescuing includes earning the trust of the person, which itself is a big task. Then, they have to be taken all the way to Visakhapatnam. After treatment, one has to try to ascertain details. If they remember their address or loved ones, take them home. Or if they fail, take them to a shelter home,” says Krishna.
It would not be such a struggle if all tertiary hospitals in the State had a functional psychiatric ward, he adds.
As per an official in the Directorate of Medical Education, only 12 districts have a district hospital. The new districts are yet to have one. “Every district hospital must have a psychiatric ward. But many hospitals neither have a ward nor a psychiatrist to treat them.”
A concerted effort is needed to address the problem, and unless all stakeholders join hands, mentally ill people will continue to suffer on the streets, they say.