DT Panorama | Lost and Found, Reunited with Care

CHENNAI: Thousands of foreigners visit Chennai, and many more live here due to their jobs, businesses and other needs. The State government has a record of almost every foreigner visiting, leaving, staying and living in the city, and some of its neighbouring districts. However, police officials rescue only those who are found wandering on the streets showing signs of mental distress. More often than not, such people are also found to be homeless and/or address-less.

Notwithstanding the myriad problems facing homeless people, one of the most prevalent is mental illness. Recently, three foreign patients, who were brought to the Institute of Mental Health (IMH) with mental health issues, after being identified by police officials as homeless wanderers, were reunited with their families after being treated at the institute.

This is the first time in Tamil Nadu that homeless foreigners, found wandering on the streets, were rescued by the police, formally admitted for treatment for mental illness at the IMH, and reunited with their families abroad by the Institute.

Back to Rwanda

Last year, a 45-year-old man was found on the streets of Puducherry and living on the roadside. He was taken to a government healthcare facility in Villupuram as he showed symptoms of mental distress. After treating for around 1.5 years, the hospital authorities found that he was from Rwanda, and was a student at Annamalai University, Chidambaram.

After falling victim to substance abuse, he was diagnosed with cannabis-induced psychosis, which required close monitoring and care. However, after the treatment, it was impossible for him to return to Rwanda, as his visa had expired. He also required police clearance to apply for a visa.

IMH initiated the process of getting police clearance and granted him a certificate to be able to return home. Volunteers communicated with the patient to help him connect with his family. After the legal paperwork was obtained, he was finally able to board the flight to his hometown in Rwanda.

A lot of foreign tourists and workers who need mental health support due to psychosis or other related concerns, are treated at the IMH and also reunited with their families abroad.

From Kovai to Sudan

A 32-year-old nurse from Sudan was working at Isha Foundation in Coimbatore. When she was taken to Coimbatore Medical College and Hospital for a check-up, she showed signs of being mentally disturbed.

Since she required specialised mental health care, she was brought to the IMH for treatment at the beginning of this year. After six months of treatment, she could recollect contacts of some of her loved ones.

The staff at the hospital contacted her sister in Sudan, who helped with sending the patient’s documents that confirmed her ID, nationality and the purpose of visit. This enabled the hospital volunteers and staff to obtain a new visa, after which, she was sent back to her country recently.

Far from Finland

Another 32-year-old woman from Finland was reunited with her family after a month-long treatment for schizophrenia at the Institute of Mental Health. Police officials found her wandering on the streets, talking to herself. Since she showed several signs of mental disturbance, they brought her to the IMH, where her symptoms were monitored.

She was diagnosed shortly thereafter, and treated for schizophrenia at the hospital. After considerable recovery, the hospital staff was able to contact her sister in Finland, who came to the Institute and took her back home.

Lot of paperwork

Reuniting such patients with their families abroad is no mean task, as most of them, due to their illness and the nature of dwelling, would not have proper documentation such as ID proof, passport, visa etc.

“It involves a lot of paperwork. Some of these patients would be overstaying their visa and would not even know of it. They wouldn’t even have their original ID proof, documents or even a passport. We try to obtain these papers after they become responsive to treatment, and are willing to communicate with our staff,” explained Dr M Malaiappan, director, IMH. “We inform the respective embassy about the patient, and urge them to legally assist and support them. We also connect with their families to be able to send them back and reunite them with their loved one.”

Currently, two more foreigners are being treated at the IMH. One is a 35-year-old Russian woman with bipolar disorder and cannabis-induced psychosis is being treated at the hospital. After hospital authorities informed the Russian embassy, they visited the patient and are processing the paperwork. IMH staff have also sought the help of the police to obtain clearance for a visa application, so that the patient can be reunited with the family.

Another is a 32-year-old woman from Uganda, who had been living in Guduvanchery for a few years, is being treated for psychosis. After further recovery, her passport details would be verified to reunite her with her family.

Psychosis, Schizophrenia, Bipolar disorder

Psychosis describes a collection of symptoms that show a loss of touch with reality. It’s a legitimate reality for some medical and mental health conditions, including bipolar disorder.

However, treatment and coping tools can help manage episodes of psychosis. Two main symptoms of psychosis:

· Hallucinations and delusions

· Difficulty concentrating or thinking clearly

· A noticeable drop in performance at a job or in school Increased suspiciousness or uneasiness

· Withdrawal from others

· A decline in personal hygiene

· Trouble distinguishing between reality and fantasy

Schizophrenia is one of several psychotic disorders that may include symptoms such as disorganised thinking, difficulties in speech and movement, changes in emotional responding, like flat affect, etc.

Sometimes, a person with bipolar disorder may experience symptoms of psychosis. This often occurs during a severe episode of mania or depression.

What is cannabis-induced psychosis?

It’s a disorder where hallucinations or delusions develop during or soon after ingestion of cannabis.

Common symptoms are paranoid delusions, suspiciousness, a sense of grandiosity, hallucinations, dissociation or a feeling of detachment and unreality, disorganised and disturbed thoughts, inappropriate emotional responses, and unusual changes in behaviour.

Not every patient wants to return to loved ones: Institute of Mental Health

Not every homeless patient who has been treated and rehabilitated wants to be reunited with their families, as they fear stigma and societal alienation, opined experts at the Institute of Mental Health (IMH), Chennai.

There are about 30 people who have recovered significantly but don’t want to leave the IMH as the fear of stigma and lack of family support is real. So, they request to stay at half-way homes or as wards at the hospital.

“We don’t force them to leave. They help us take care of other patients with basic tasks and management,” said Dr M Malaiappan, director, IMH.

As many as 788 homeless and wandering mentally-ill persons, rescued by the police and NGOs, who have been treated at the government-run Emergency Care and Recovery Centres (ECRC), were reunited with their families in 2023-2024. A total of 1,032 patients have been admitted to the ECRCs in 2023-24.

There are many NGOs and social workers who also admit patients to ECRC centres. Around 252 patients were admitted to NGO-run ECRCs, of which 149 were discharged in 2023-24.

“We collaborate with NGOs to reunite patients with their families across the country. Even our healthcare workers travel with them to drop them off in their hometown,” he stated. “But follow-up care is difficult. More needs to be done to ensure that they are taken care of even after discharge.”

For patients who struggle with memory loss and have no ID, the IMH collaborates with social workers and volunteers to gain documentation and other details to be able to reunite them with the family. A senior professor at the IMH explained, “The biggest challenge in treating them is not the language but communication. Not all mentally-ill patients are violent, but many don’t have the motivation to talk, or have the natural drive to even take care of themselves. Such patients need to be assisted with everything.”

Those who display violent behaviour can be treated and managed with medications. But if they are not violent, and withdraw into themselves, they have, what the experts call, ‘negative symptoms’ such as the inability to show emotions, apathy, difficulties talking, and withdrawing from social situations and relationships.

“We don’t have active medicines to treat negative symptoms. Patients with negative symptoms require a lot of support and reassurance. We have patients who have been staying with us for five years. Most of them have chronic mental illness and intellectual disability. We cannot send them to self-help homes or other places for rehabilitation because those places cannot take care of them,” he elaborated.

The only way a mental health institution can trace the family of patients, who fail to communicate or remember their address or name, is through Aadhaar. However, the already-registered patients cannot obtain a new one if they do not have the old details.

“We cannot find the credentials even if the biometrics registration says that the patient has an Aadhaar card. We’ve requested the government to help us retrieve Aadhaar without the OTP sent to the mobile number as patients do not have any phones. This will help us to trace their families. The UIDAI has accepted the request but we’re awaiting implementation,” pointed out a senior IMH official.