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The homeless should be included by the Department of Health in its new national mental health policy framework and strategic plan.

“The relationship between poverty and mental ill-health has been described as a ‘vicious cycle’”, is a statement made in the lapsed framework of 2013-2020. It says people living in poverty can fall into mental disorders through stress, whereas a person with mental illness can fall into poverty by losing income and experiencing social exclusion.

But the previous framework does not mention homelessness directly. There are many causes that lead to mental disorders on the streets, like drug abuse, the trauma of unsuitable living conditions for a long period, or the fact that the person might have landed on the streets through their psychosocial disability.

Mental health in relation to homelessness can’t be solved in a “send them to a psychiatric hospital” mindset. One such example was David (not his real name), whom I met while living in Stellenbosch Municipality’s Covid temporary shelter for the homeless.

On the streets of Stellenbosch, a scruffy-looking David would dance between cars as he begged with a takeaway cup in his hands. At the temporary shelter, he was well fed, had clean clothes, showered daily and danced not for money but to express his joy.

He did not speak, other than a very little in isiXhosa. Those that lived with him on the street said he read the English newspapers that were lying around. At the temporary shelter, he would occasionally have a manic outburst. He would hit himself in the face until his knuckles bled, and he had a swollen face.

Following a mental breakdown seven years ago, I was diagnosed as bipolar and used to go with David and other psychosocial patients to the local clinic on transport provided by the municipality. He would get his anti-manic injection, which made things easier for him.

At the temporary shelter, the other psychiatric patients would receive their medications from municipal officials. When the temporary shelter closed down – ironically two days after World Homelessness Day and the day on which World Mental Health was simultaneously commemorated – our night shelter fees were covered by the municipality for the first week.

Many went back onto the streets as they didn’t want to go through an emotional roller-coaster ride of having to leave if they couldn’t pay for their accommodation. David went with those of us who went to the night shelter.

From early morning till late afternoon, we were on the streets. David revisited his old hangouts. For more than seven months, he had not taken any alcohol, but some were malicious and gave it to him as a joke. He fell into the trap and was drunk when he got to the shelter. We told the supervisor he did not comprehend right from wrong and did not know what he was doing.

Our pleas were not heard, and David went back onto the streets. Daily, I would walk past David. He was back to begging on the streets and drunk on cheap wine. It saddened me that the system had failed him.

From David’s experiences and my own, it’s clear that more drastic measures need to be taken.

Shelters are not the solution for David and others like him. A safe environment is needed where they can be nurtured and not treated with prejudice but by caring health professionals with experience in psychiatry.

The new mental health framework should include organisations that empower the homeless, like U-turn Homeless Ministries, which create pathways out of homelessness through a phased programme. – Cathy Achilles, U-turn Homeless Ministries

Originally published in the Cape Times on 29 March 2023

Photo: Canva