Tamil Nadu State Policy for Care of Homeless Persons with Mental Illness and Implementation Framework – 2024

HEALTH AND FAMILY WELFARE DEPARTMENT

CHAPTER

TABLE OF CONTENTS PAGE

List Of Abbreviations

1 Executive Summary 01

2 Present Scenario and the Stakeholders 05

3 Vision, Objectives and Approaches 11

4 Proposed Policy Framework 15

• Rescue and Acute Care

• Intermediary Care

• Long Term Care

• Social Re-Integration

5 Governance Structure, Monitoring and 31 Evaluation

6 Research 37

7 Annexures 38

LIST OF ABBREVIATIONS

BP Blood Pressure

CBO Community Based Organisation

CEO Chief Executive Officer

CMCHIS Chief Minister Comprehensive Health Insurance

Scheme

CSR Community Service Register

CWC Child Welfare Committee

DCC District Counselling Centre

DCPU District Child Protection Unit

DDAWO District Differently Abled Welfare Officer DHQH District Headquarters Hospital

DLSA District Legal Services Authority

DMHP District Mental Health Programme DMHRB District Mental Health Review Board DSP Deputy Superintendent of Police

ECRC Emergency Care and Recovery Centre FIR First Information Report

GH Government Hospital

HPWMI Homeless Person with Mental Illness ICD International Classification of Diseases IMH Institute of Mental Health

LTC Long Term Care

MCH Medical College Hospital

MHCA Mental Health Care Act

MHE Mental Health Establishment

MNREGS Mahatma Gandhi Rural Employment Guarantee Scheme MO Medical Officer

MSE Mental Status Examination

NGO Non-Governmental Organisation

OPD Out Patient Department

OSC One Stop Centre

PMI Person with Mental Illness

PMJAY Pradhan Mantri Jan Aarogya Yojana

PR Pulse Rate

RPwD Rights of Persons with Disabilities

SDG Sustainable Development Goals

SHG Self Help Group

SMHA State Mental Health Authority

TAEI Tamil Nadu Accident and Emergency care Initiative UDID Unique Disability Identity

EXECUTIVE SUMMARY

The Government of Tamil Nadu has brought out “Tamil Nadu Mental Health Care Policy” in 2019 to promote Mental Health, prevent Mental Illness and to enable recovery from Mental Illness and ensure socio economic inclusion of persons affected by mental illness by providing comprehensive mental health care. In spite of having an overarching State Mental Health Policy in place, the Government of Tamil Nadu has envisaged the need for bringing out a specific comprehensive policy for addressing the needs of Homeless Persons with Mental Illness (HPWMI) in Tamil Nadu. Addressing the intersection of Homelessness and Mental

illness is crucial in India, where 1.78 million are homeless which is further compounded by 21% of them experiencing Mental Health issues.

This document has been brought out after series of consultations and deliberations with multiple stakeholders both from the Government and Private which includes the Departments of Health & Family Welfare, WelfareoftheDifferentlyAbledPersons,Home, Child Welfare and Special services, Revenue Administration, Municipal Administration, Non-Governmental Organizations [NGO], Community Based Organizations [CBO], Psychiatrist Professional Organization etc., involvedinthedeliveryofservicesforHPWMI.

Tamil Nadu’s multi-pronged approach for HPWMI places on record duly acknowledging the longstanding and contributory role played by various stakeholders. The Proposed policy enhancements focus on required coordination, accessibility to Mental Health care, quality standards, tailored support, peer engagement and implementation research-based program refinement. This policy outlines a comprehensive framework for providing holistic care to HPWMI in alignment with the National and State Mental Health policies and Sustainable Development Goal 10.

The framework for ensuring holistic care essentially outlines four levels of care: Rescue and Acute Care, Intermediary Care, Long Term care and finally Social Re-integration with contribution in each level by the stakeholders. It aims to provide comprehensive support for the HPWMI including crisis intervention, medical care, family re-integration and long- term rehabilitation for HPWMI.

The Rescue and Acute care involves identification, protection, assessment and referral processes. Coordinated efforts by Police, NGOs, and local bodies aim to ensure timely rescue and access to medical and psychiatric care. Helplines, outreach programs and community engagement facilitate awareness creation and community participation that is of mutual benefit or assistance to the implementing agency.

The policy outlines detailed steps, including FIR registration, Emergency Care and Medical assessment, and referral protocols, involvingvariousstakeholderssuchasPolice, Healthservices,NGOsandlocalauthorities. Roles and responsibilities are delineated for effective implementation of the rescue processes emphasizing collaboration and adherence to legal frameworks.

The Intermediary care in the proposed policy framework focuses on Emergency Care and Recovery Centres (ECRC) for Homeless Persons with Mental Illness. ECRCs offer

It aims to identify, rescue, and support

HPWMI through person-centered, culturally

sensitive and protocol based care adopting comprehensive care, including Psychiatric rights-based, dynamic and adaptive&Medicaltreatment,familyre-integration approaches and strategies emphasizing and vocational training. Admission guidelines

on interdepartmental/inter-sectoral coordination, community engagement to ensurecomprehensive,effective,teambased continuum of care and integration.

ensure appropriate care, while discharge guidelines prioritize reintegration into the community or referral to other specialized care institutions.

The Long Term care and Social re- (ECRCs) with augmented and need based integration in the proposed policy framework funding support for all the key components outlinesRehabilitationservicesprovidingof the implementation framework. corresponding categorizations made for the Additionally, it is proposed to expand

patients at the time of discharge from ECRC. It emphasizes reuniting individuals with their families where possible, providing support forthoseunabletoreturnhome,andoffering long-term care options for those who show no progress or improvement.

Inter-sectoral co-ordination plays a very vital role in the smooth and seamless transition of the beneficiaries into the next possible phase of their adaptation to life and environment. Stakeholder departments also play crucial roles in facilitating access to Social Security Schemes and community integration for persons with mental illness.

The governance framework for the proposed policy involves the State Mental Health Authority (SMHA) overseeing the implementation with District Mental Health Committees monitoring the local delivery of services ensuring comprehensive care, review of disability benefits and providing Social Welfare assistance needed for the HPWMI and their families. Monitoring and evaluation employ the standard logic models, key indicators, review meetings, electronic HMIS, and periodic external and internal evaluations to guide effective program implementation and improvements. Research initiatives aim to understand and address the emotional, social, and physical needs of HPWMI in order to enhance the programmatic aspects for effective delivery of services.

This policy prioritizes scalability which is the need of the hour and stakeholder engagement, advocating for increased Emergency Care and Recovery Centres

appropriate human resources, establishing dedicated Social Welfare assistance centers, increasing government run service or care homes, and expanding the District Mental Health Committee to include additional stakeholders for comprehensive oversight, meaningful collaboration which is mutually complementing and beneficial.

PRESENTSCENARIO& 2 THE STAKEHOLDERS

2.1 EXISTING SERVICES FOR THE HPWMI- a multi department approach

A brief overview of the present initiatives of Government of Tamil Nadu for Homeless individuals with Mental Illness operated through key players such as Departments of Health and Family Welfare, Welfare for Differently Abled Persons, Police, Child Welfare and Special Services, Tamil Nadu Corporation for Development of Women, Social Welfare, and Local bodies is presented here to highlight the longstanding and consistent services offered by these departments which are relevant in the areas of rescuing, sheltering, treatment and rehabilitation.

2.2 Home Department

Persons with mental illness found wandering in public places are safely rescued and taken to the nearest mental health facility for further care, with the coordinated support of the Health Department and the Department fortheWelfareofDifferentlyAbledPersons. In this regard, the in-charge officer of the Police Station initiates the safe rescue of the person with mental illness who is foundwanderingwithinthestationlimit,by registering a First Information Report (FIR) as per section 100 of Mental Health Care Act 2017 and with support from the District Differently Abled Welfare Officer [DDAWO] empanelled NGO, the police carry out the safe rescue and transfer of the individual to the nearest public health facility. In addition, Police officials subsequently trace the family and assist in the reunion of the HPWMI with the family.

2.3DepartmentofHealthandFamilyWelfare

Tamil Nadu has a robust health infrastructure offering Primary to Tertiary level Mental Health care to the Public through the seamless integration of all levels of healthcare, thereby ensuring a continuum of care free of cost. This integrated approach facilitates early detection, timely intervention and ongoing management of Mental Health conditions. Founded in 1871, the Institute of Mental Health (IMH) in Kilpauk, Chennai, with a capacity of 1,800 beds, is the State Apex Institute for Mental Health in Tamil Nadu. It runs an outpatient service for 550 patients a day and reaches around 350 to 400 Homeless people with Mental Illness per year on an average. A Halfway Home is also functional within the campus of IMH since 2022 with a capacity to accommodate 50 persons who

have improved from Mental Illness but needs supported supervision. The Department of Psychiatry in all the 36 Government Medical College Hospitals provide in-patient services for people with Mental Illness including Homeless persons.

The District Mental Health Programme [DMHP] which is the administrative and implementation unit of the Mental Health program operates across all 38 districts delivering comprehensive Mental Health services at various levels of health care. SocialwelfarebenefitslikeDisabilitybenefits, Housing, employment opportunities are facilitated through the District Mental Health Committee. As part of Mental Health Programme, Emergency Care and Recovery Centres [ECRC] were established in Tamil Nadu by the National Health Mission – Tamil Nadu in 2018 as a pioneering effort to provide services to homeless persons with mental illness at district level. These are intermediate care institutions that provide temporary shelter, medical and psychiatric care and rehabilitation services including social welfare support for homeless individuals with mental illness. These centres aim to stabilize the mental health conditions and facilitate their recovery and reintegration into society.

ECRCs are currently operational in 16 districts under a dual implementation model namely Government run and Government supported – NGO run Centres and have catered to more than 3000 persons since its establishment. The Government run ECRCs are operational in 8 districts while in the other 8 districts, they are operated in collaboration with NGOs. The Government provides support to the NGO- operated ECRCs in terms of infrastructure including linen and furniture, basic medical equipment, diet, HR support, General and

Psychiatric care, drugs and 102 services for rescue operations. The Government is also planning to upscale the number of ECRCs in the State by establishing at least one ECRC in every district.

2.4DepartmentfortheWelfareofDifferently Abled Persons

The Department for Welfare of Differently Abled Persons also plays an important role in the service of Homeless Persons with Mental Illness from rescue to rehabilitation. The department is coordinating rescue efforts through the empanelled NGOs, allocating Rs. 1500 per person rescued. The current annual budget allocation for rescue operations stands at Rs. 7.5 Lakhs which supports 500 rescued persons with mental illness every year. The department also funds 51 NGO run Rehabilitation homes for persons with mental illness to provide long term care including rehabilitation. In addition, the Department is running five Half Way Homes for improved and Homeless Mentally Ill persons at Tirupathur,Madurai,Trichy,Kanyakumariand Ramanathapuram.

2.5 Department of Child Welfare and Special Services [erstwhile Department of Social Defense]

The Department of Child Welfare and Special Services cater to the needs of ‘children in need of care and protection’ and ‘children in conflict with law’ by providing institutional and non-institutional services under the provisions of the Juvenile Justice (Care and Protection of Children) Act, 2015. The Department also provides after-care services and implements programmes for facilitating self-sustainability for those leaving institutional care. The Government has constituted 36 Child Welfare Committees

in 34 districts including 3 Committees in Chennai district. There are 834 Child Care Institutions functioning in the State and monitored by the department. Out of this, 59 Child Care Institutions are Government run, 166 Child Care Institutions are functioning under Non-Governmental Organizations with financial assistance [Rs.4000 per child per month] from Government including 6 homes for differently abled children while the remaining are fully NGO run homes. The following are the services provided to children through these homes: 1. Short term and Long term care 2. Basic needs like food, Clothing, Shelter etc., 3. Education 4. Medical Assistance 5. Vocational training 6. Rehabilitation services

2.6 Department of Social Welfare

One Stop Centres (OSC), operating in every district under the Department of Social Welfare & Women Empowerment, are primarily established to support women affected by violence in both private and public spaces, including within the family, community and workplace. OSC also extend their services to homeless women with suspected mental illnesses. The OSC supports all women including girls below 18 years of age, regardless of their caste, class, religion, region, sexual orientation or marital status. Various services provided at the OSC are: 1. Emergency Response and Rescue Services 2. Medical assistance 3. Assistance to women in lodging FIR/ DIR 4. Psycho- social support/counselling 5. Legal aid and counselling 6. Shelter 7. Video Conferencing Facility

2.7DepartmentofMunicipalAdministration

The Urban Local Bodies (Corporations, Municipalities and Town Panchayats) under

the administrative control of the department of Municipal Administration operates Shelter Homes for Homeless individuals in urban areas through Shelter Management Agencies. Currently, 312 Shelter Homes are operational to accommodate about 16,500 individuals, with each home having a capacity ranging between 30 and 100. These homes are categorized to cater to men, women, children, and transgender individuals.

Furthermore, there is a need to also scale up demonstrated interventions in existing services across the State with a more comprehensive approach through strengthening interdepartmental coordination for which this draft policy with an Implementation Framework has been developed and presented.

2.8 Challenges and Opportunities:

2.8.1 Strengthen Institutional Mental Health Care in terms of Infrastructure, Staffing, adequate Vocational and Occupational training, Rehabilitation measures, other resources and audit.

2.8.2 Filling of gaps in Access and Continuity of Mental Health Care in terms of adequate 24/7 services and effective referral systems and also bring in accountability and monitoring mechanisms for Rehabilitation homes

2.8.3 Strengthen inter-departmental coordination between health, social welfare, Welfare of Differently Abled Persons and other departments for providing Comprehensive Care

2.8.4 Streamline and Customize Long-Term Care Plan for Persons requiring High Support Needs including self-discharge options.

2.8.5 Encourage participation of Patient Support Groups to facilitate involvement of patients/ Patient support Groups in policy, service development and social audits.

2.8.6 Promote research for evidence based monitoring and programme improvement through longitudinal tracking of service user outcomes, impact assessments and feedback loops for evidence-based program refinement

0VISION, OBJECTIVES AND APPROACHES

This policy document outlines a broad Implementation Framework and guidelines to provide comprehensive services to HPWMI across Tamil Nadu. It reflects the Government of Tamil Nadu’s commitment to deliver quality services to this vulnerable segments of Society, aligning with National and State Mental Health policies, and advancing Sustainable Development Goals in alignment with the SDG 2,3,6 and 10.

3.1 Operational Definition

The term defined as “Homeless Persons with Mental Illness [HPWMI]” in this document would adhere to any of the following criteria:

a. Any person with Mental Illness found wandering in Public places

b. Homeless Person with Mental Illness without family

c. Person with Mental Illness abandoned by family/ Family unwilling to take care

d. Mentally Ill person whose family is ‘unable’ to take care

3.2 Vision:

To ensure every Homeless person with Mental Illness receives rightful and holistic care, support and opportunities for recovery, integration and empowerment through collaborative efforts, appropriate and scientific interventions for building a community that is inclusive, supportive and resilient, where every individual lives with dignity and hope.

3.3 Objectives:

1) Implement mechanisms and processes from the identification, rescue, treatment, rehabilitation to social reintegration of Homeless individuals with Mental Illness.

2) Establish person-centred, culture- sensitive, evidence based care models and responsive care systems that functions in the best interest of the homeless persons with mental illness and promote the Mental Health Care Services within the Framework of Human Rights.

3) Facilitate dignified transitions from institutionalized settings to their family or preferred residences or inclusive Long-Term Care [LTC] options, with in-built mechanism for accountability at every level of care and support.

4) Develop systems to ensure access to Rehabilitation services and requisite social welfare benefits and legal aid services by promoting interdepartmental and inter- sectoral coordination.

5) Establish mechanisms for dynamic monitoring, research, adaptive learning and feedback to inform care systems and drive ongoing policy refinement.

By embracing these approaches, the policy aims to create a comprehensive and integrated system of care that effectively supports Homeless individuals with Mental Illness on their journey towards recovery and social inclusion.

0PROPOSED POLICY FRAMEWORK

The proposed policy framework delineates the services provided to HPWMI into following four stages: 1. Rescue and Acute Care 2. Intermediary Care 3. Long Term Care 4. Social Re- Integration

This comprehensive approach aims to provide a continuum of support, ensuring both immediate assistance and sustainable solutions for long-term well-being and reintegration into society.

4.1 Rescue and Acute Care

This part of the chapter defines the roles of various stakeholders in rescuing Homeless Mentally Ill Persons from the place of identification. It describes the protocols to be followed during the rescue process and also the immediate care and services to be provided. This stage focuses on ensuring that urgent needs are met swiftly and efficiently.

4.2 Intermediary Care

Intermediary Care follows discharge from acute care settings and acts as intermediary stage between treatment of severe symptoms and significant functional impairment in acute care settings to long term care rehabilitation and social reintegration. Continued psychiatric care is provided along with initiation of rehabilitation services in a semi hospital setup of ECRC, to enhance symptomatic and functional improvement with support and guidance from Mental Health Care team. This chapter details the methods of categorizing the patients based on Mental Capacity and specifies the type of institution based rehabilitation care to be provided. It also mentions the protocols for admission, treatment, and discharge, including the required duration of stay and ensures that each person receives tailored psychiatric care based on Bio-Psycho-Social approach and continuous support during their recovery journey.

4.3 Long Term Care

This part details the processes and systems to be strengthened for providing long term care to the patients including Medical and Social care. It covers the reintegration of individuals with their families wherever feasible and the promotion of independent

living skills. During this stage, personalized rehabilitation plans tailored to the specific needs of each category of improved patients are emphasised. Ultimately, this stage aims to augment recovery through rehabilitation services for smooth transition to Social Re-integration.

4.4 Social Re-Integration

Social Re-integration signifies the comprehensive incorporation of fully rehabilitated individuals into society. This encompasses the promotion of community engagement, facilitating employment prospectsandfosteringself-sufficiencyand independent living in the community. This phase marks the culmination of the patient’s trajectory, transitioning from rescue to seamless societal Re-integration with the ultimate aim of enabling individuals to thrive autonomously within the larger society.

4.5 Comprehensive Implementation Framework

4.1. Rescue And Acute Care: Detailed Vision

As part of this service, homeless persons who are wandering in public places will be rescued safely and provided with basic needs and acute medical care services. These services will be provided through the coordinated efforts of Police, Health and Differently Abled Welfare Departments. Every rescue operation shall be done under the supervision of Police officer of the station limit.

4.1.1. Rescue operation in Tamil Nadu is currently done in the following ways under the supervision of Police:

a) Volunteers and members of Non- Governmental Organisations recognised by the Department for Welfare of Differently Abled Persons and Department of Health and Family Welfare.

b) Social workers and Health Workers engaged in Rehabilitation Homes and ECRCs.

c)AnyothermemberofPublicasagoodwill measure

This policy proposes a Standard Operating Procedure to be followed in rescue operations. The Chief Executive Officer, State Mental Health Authority [SMHA] shall be the nodal authority for empanelment of NGOs involved in rescue operations in every district. The Chief Executive Officer, SMHA shall empanel NGOs, Civil societies, Volunteers across all departments who, along with the Police, will be authorised to carry out rescue operations. The CEO shall verify the credentials of NGOs/CBOs or volunteers through the Police records before empanelment. The Proposal for empanelment of NGOs shall be routed through the District Mental Health Committee.

4.1.2. Standard Operating Procedures for Rescue Operations:

The State Government-run Toll Free “102” helpline is the designated helpline number for rescue of Homeless Persons with Mental Illness. In practice, the information about the Homeless person suspected for Mental Illness is being received through various helpline numbers across different departments including 100 [Police], 102, 104, 14416 and District Counselling Centres Mobile helpline numbers[Health],181[WomenHelpline],1800 4250 111 [Department for Welfare of Differently Abled Persons], 1098 [Child Helpline], 1077 [Disaster Management Helpline], 94447 17100 [Chennai Kaaval Karangal Whatsapp], 1253 [Elderly Helpline for Chennai] or directly through the service delivering units of the stakeholder departments- District Mental Health Programme, District Differently Abled Welfare Officers (DDAWO), Municipal Administration and empanelled NGOs.

Upon receiving an information about a Homeless person with suspected Mental Illness, the above helplines will intimate the details to 102 helpline and the SOPs to be followed by the 102 counsellors is detailed in the Annexure-I of this document.

When a rescuer finds any person who is found to be homeless and has reason to believe he/ she is suffering from Mental Illness/distress and/or incapable of taking care of themselves and/or harmful to self or others shall inform the nearest Police Station and assist the Police in rescue. The responsibility of safe rescue lies with the Police. The police with or without the assistance of NGOs shall take the person, at the earliest, to the Government Medical College Hospital or Head quarters Hospital for admission and further healthcare needs assessment.

4.1.3. Key Recommendations:

1) The Police shall lodge a First Information Report [FIR] of a missing person for tracing the family of such person and to inform the family about the whereabouts of person for reunion.

2) Point for discussion: The Policy recommends the creation of a system / process for the management of FIRs and thereby bringing in accountability from rescue to reunion with the family

Upon admission, necessary healthcare assessment including a detailed case history shall be done by the attending physician. The details of Medical Assessments are attached as Annexure-II. If emergency Medical, Surgical or Psychiatric treatment is required, the treatment shall be initiated and continued until the person is stable. The in-charge Medical Officer shall also arrange for detailed Assessment of Mental Health condition by a Government Psychiatrist.

Based on the Psychiatric evaluation,

• If the rescued Person does not have Mental Illness, the Psychiatrist shall inform his/her assessment to the Police officer, who in turn shall take the person to the person’s residence or in case of Homeless persons, to a registered establishment depending on the category of the person.

• If the rescued person is found to be suffering from Mental Illness and is unmanageable/ severely ill, the care givers shall continue treatment in Psychiatry department of Government Medical College Hospital of concerned district or District Headquarters Hospital

in Districts where there is no MCH.

• If the rescued person is found to be Mentally Ill, fit for discharge from MCH and is manageable, he/she shall be referred to ECRC or Rehabilitation homes for persons with Mental Illness.

4.1.4. Special Situation:

i. If the person is a minor (below 18 years):

The Medical Officer (Resident Medical Officer) shall inform 1098 Child helpline/ District Child Protection Unit [DCPU] and theminorshallalsobeattendedbytheChild Welfare Committee (CWC).

Further course of care shall be in compliance with the guidelines of CWC and MHCA 2017

ii. If the HPWMI has a Child:

The Medical Officer (Resident Medical Officer shallinformtheChildWelfareCommitteeand further course of action shall be in compliance with the CWC guidance.

iii. If the HPWMI is a Woman:

In case of a woman, the District Social Welfare Officer shall also be informed for further support.

In case of HPWMI is Pregnant, the Deputy Director (Medical and Family Welfare) should be informed for further pregnancy related health care support. Following Delivery of baby, the District Child Protection Unit [DCPU] should be informed and further course of action regarding care and safety of the new-born, as per the wishes of the mother, shall be carried out through the District Mental Health Committee.

iv. If the HPWMI is a Victim of Crime:

When the rescued person is a victim of a crime or harassment, then the Police should file a complaint suo-moto and proceed as per law. If the victim is a woman, then the District Social Welfare Officer shall also be informed for further course of action.

4.2. INTERMEDIARY CARE: Detailed Vision

Homeless persons with Mental Illness after being certified by a Government Psychiatrist and discharged from acute psychiatric care setting (MCH / GH) shall be transferred to ECRC for intermediary Care. The duration of intermediary care and stay in ECRC shall be upto 12 months or until reunion with family whichever is earlier. Here the duration of stay criteria is indicative only and can be determined based on the Mental Health condition of the inmate.

Emergency Care and Recovery Centres are established to provide Care and support to Homeless persons with Mental Illness from rescue to reunion or transfer to long term care options. In Tamil Nadu, there are two models of ECRC in operation namely, Government run ECRCs and NGO run ECRCs with Government support. The Government run ECRC is a 50-bedded facility staffed with 3 Psychiatrist, 1 Psychologist, 5 Social Worker, 15StaffNurse,2HospitalWorker,2Security, 1 Pharmacist and funding support for Diet, Self-care kit, drugs are provided from NHM funds.

The NGO run ECRCs are 20 bedded facility located either in Medical College Hospital or Government Hospital campus. The Government provides support to the NGO- operated ECRCs in terms of infrastructure including building, linen and furniture, basic

medical equipment, diet, Human Resource support, General and Psychiatric care, drugs and 102 services for rescue operations and NGO provides 3 social worker, 3 Health workers, 1 Staff Nurse to run the centres and also self care needs of patients.

4.2.1. Services at ECRC:

I. Welcoming Services and Accommodation II. Diet, Clothing and Grooming

III. Medical and Psychiatric Services

IV. Rehabilitation including Recreational services, occupational therapy and vocational training

V. Reunion with family whenever possible VI. Linkage to DMHP Clinics

VII. Referral services for tertiary care

4.2.2. The Mental Health team consists of Psychiatrist, Staff Nurse, Psychiatric Social worker, Psychologist, Multi-Purpose Worker and Security. The following services are provided by the team under the guidance of Psychiatrist as per standard guidelines.

i. Patient Management: Management includes detailed assessment of medical and Psychiatric condition, psychosocial assessments and treatment including individual and group therapy, counseling and problem solving, addressing trauma and adverse life events. In this way, comprehensive Medical and Psychiatric assessment will be done at admission and also subsequently, to provide individualized care by the Mental Health team.

ii. Provision of basic needs Self-care kit (dress, personal hygiene products) and support will be provided to the inmates, to help gain independence in care of self, activities of daily living and thereby improving functional status.

iii. Library Facility, Leisure and Recreational Activities.

iv. Occupational therapy: Occupational therapy will be provided for patients with reasonable improvement in symptoms to ensure they are engaged with some productive activity daily.

v. Vocational Training: Vocational training will be initiated for those with both symptomatic and functional improvement to improve their employability / income generation ability. This is followed by work and employment options that may be within the facility or mainstream, provision of reinforcements (Token economy) and wages for activities and products manufactured.

vi. Social Entitlement Facilitation: Identity card like UDID, Aadhaar, pensions and other social welfare measures under various government schemes will be made available for patients.

vii. Reintegration and Aftercare Services: Reintegration services for residents back with their families and/or communities of choice will be offered.

viii. Skills Development will be offered to residents of the ECRCs in keeping with their interests, aptitude and scope to engage in vocations and to enable them to earn an income post discharge. These may include setting up cafeteria, baking and cooking, tailoring, housekeeping, gardening, data

entry and management or any other activities suited to the pre-existing competencies, interests and aptitude of the residents.

ix. Referral to higher centre will be provided to patients requiring tertiary psychiatric care.

x. Linkage with DMHP for follow up to ensure continuity of care through Satellite clinics will be provided.

4.2.3. Workflow of INTERMEDIATRY CARE (from Admission to ECRC till Discharge)

Phase

Crisis Intervention

Admission to ECRC and initial Care

Engagement

Preparation for Discharge

Discharge, after Care and Follow up

Services

• Identification, Safe Recue, and moving to nearest Government Mental Health Facility (MCH / GH)

• Attending to basic needs (Dress, food, water) at rescue spot

• Acute care and certification for Mental Illness by Government Psychiatrist

• Admission to ECRC

• Attend to Basic needs

• Initial assessment and treatment initiation • Other specialist opinion (as required)

• Optimization of treatment

• Referral to MCH /IMH if response to

treatment is poor (in 10 – 12 weeks)

Detailed assessment and Personalized Care including provision of Recreational activity, occupational therapy, vocational training

• Facilitate tracing of family

• Facilitate for Social Welfare Benefits • Free Legal Aid services

• Developing social roles

• Plan Discharge

• Discharge

• Link With DMHP Satellite Clinic / MCH OP of

Patients Choice

• Reunion With Family through District

Mental Health Committee

• If unable to reunite with family – Offer the

choice to move / transfer to Rehabilitation Home / Half way home / Referral to IMH

Time Duration

1 to 14 days

2 to 12 weeks

on going (Upto 12 Months)

4.2.4. Admission Guidelines

i. The admission of homeless persons with mental illness to ECRC shall be done in accordance with the relevant provisions of the Mental Health Care Act 2017 and appropriate care shall be provided as per established evidence-based guidelines and protocols.

ii. When admitted to ECRC directly, if the person is found to be suffering from any physical illness requiring medical / surgical care, appropriate referral shall be made to nearby Medical College Hospital.

iii. If the individual is found to be Mentally Ill and without significant physical complications, he/she is subjected for mental capacity assessment. If the patient has mental capacity to decide for treatment and willing for admission, then he / she is admitted under section 86 (MHCA 2017) as independent patient and treatment can be initiated.

iv. If the rescued individual lacks capacity to decide for treatment, the accompanying NGO representative or any other worker from the DDAWO empanelled NGO can be engaged to be a nominated representative. This is an interim arrangement until the District Mental Health Review Board appoints a Nominated Representative at the earliest as per MHCA 2017

v. The patient is admitted under section 89 of the Mental Health Care Act up to 30 days. When the person regains capacity to decide for treatment, the admission can be made as an independent admission [under section 86]. If the person requires supported admission beyond 30 days, then the Mental Health Review Board must be requested for extension of stay in Hospital.

vi. Patients in ECRC, who do not improve in Twelve weeks shall be taken to the nearest Department of Psychiatry in the Government Medical College for further evaluation and intensive Psychiatric treatment.

vii. Diagnosis shall be made as per the ICD-11 and the process shall be documented.

viii. Admission of minor: A minor shall be admitted to a Mental Health Establishment only by following the procedure laid down in the relevant sections of MHCA 2017 and the details of the minor admitted shall be shared to the District Child Protection Officer to provide care and protection to the child.

4.2.5. Treatment guidance

i. Detailed Psychiatric assessment and Treatment shall be provided as per widely accepted International, National Guidelines published by professional bodies like Indian Psychiatric Society and standard Textbooks.

ii. Medical and Surgical co-morbidities shall be taken care of adequately by referring them to other relevant specialists.

iii. Disability Certificates shall be issued and efforts to be made to get other Disability benefits/ social welfare benefits to the eligible persons.

iv. Sustained efforts shall be taken by the health care team to collect information from the patient about their family and assist the police, in tracing the family for reunion.

v. If the individual is from other State or country, reunion must be arranged following due procedures laid down in the State Mental Health Rules and Regulations.

vi. Individualized Care including Occupational

Therapy and Vocational Training shall be provided.

4.2.6. Rehabilitation package:

As part of comprehensive Mental Health care services, every inmate shall be provided with the following Social Welfare benefits as rehabilitation package:

Aadhaar, PM-JAY/ CMCHIS cards, UDID, Family card

Access to Public Distribution System.

Access to Social Care support such as disability benefits, financial inclusion including banking support and other welfare schemes available under different Government departments, based on scheme eligibility criteria.

Livelihood access through the attainment of job cards for MNREGS-type schemes and/or another skilling, social enterprise- type arrangements – to avail reservation in employment opportunities as per the RPwD Act 2016.

Access to support groups through local networks such as panchayats, SHGs, client and caregiver groups.

4.2.7. Discharge Guidelines

i. When the individual is“fit for discharge”and the family has been traced then the individual shall be reunited with the family, irrespective of duration of stay in ECRC. All reunion shall be carried out through District Mental Health Committee of the concerned district. Further follow up of the reunited person shall be done by the DMHP team.

ii. The person who is fit for discharge but has

no family or the persons whose duration of stay exceeded 12 months shall be discharged and transferred to a registered rehabilitation home for the Mentally Ill persons.

iii.Thepersonwhoisfitfordischargebuthas no family and if found to be ‘capable of living independently with minimal supervision’ shall be transferred to Half Way homes directly from ECRC. Halfway Home Fitness form- Annexure III

iv. Following discharge from ECRC, the line- list shall be shared with the DMHP team in the districts to ensure continuum of Psychiatric care through the nearby satellite clinics.

v. If the patient, by the completion of 12 months, has not improved and unmanageable, the patient shall be referred to Institute of Mental Health, Kilpauk, Chennai for admission and further management

vi. No inmate shall be transferred to any other facility without prior intimation to the Police and Department for Welfare of Differently Abled Persons

4.2.8 Key Recommendation:

The Psychiatrist/ Medical Officer of the ECRC shall intimate the discharge detail of individual to the Police station in which FIR/CSR is filed at the time of admission of the Homeless/ Wandering person with Mental Illness, as per Section 100 of MHCA 2017. [Intimation format is attached as Annexure IV]

4.2.9. STANDARD OPERATING PROCEDURES FOR INTERMEDIARY CARE

4.3. LONG TERM CARE: Detailed Vision

Following discharge from the MCH/ ECRC the patients shall be admitted to Long Term Care institutions [Rehabilitation Home/ Halfway Home] for further rehabilitation services and reintegration into the society thereby enabling them to lead an independent life.

4.3.1. Categorisation of Patients

The patients who are reasonably recovered [reasonable recovery refers to symptomatic improvement with minimal functional improvement] but not capable of independent living are admitted to the Rehabilitation Homes and are assessed for their functional status and then classified into two categories;

i. Those who are less likely to show functional improvement and need assistance to maintain self-care.

ii. Individuals who are more likely to demonstrate consistent improvement in their functional status.

Patients in Category (i) require long term stay in the rehabilitation homes and shall be provided accommodation, food & basic needs, medical care, Occupational Therapy and recreational activities. The visiting Psychiatrist shall carry out periodical medical and psychiatric evaluation and when required they shall be referred to nearest Public Health establishment for any emergent medical conditions. Disability benefits and other entitlements like UDID card, Aadhaar Card, savings bank account, CMCHIS card, etc., shall be provided.

In addition to the above services, patients who are in Category (ii) shall be provided

with Vocational training / Skill training in order to empower them financially to lead an independent life as part of reintegration with the society. Agencies involved in livelihood activities shall be roped in to provide their expertise in devising training programs which would be sustainable and financially remunerative to the patients being trained in the same. The in-charge person of the Rehabilitation Homes shall take sustained effort to trace the family for reunion with the helpofPolice.Noinmateshallbetransferred to any other homes / facility without prior intimation to the Police and Department for the Welfare of Differently Abled Persons.

4.3.2. Key Recommendation:

The number of Government Service Homes under the Department for WelfareofDifferentlyAbledPersons can be increased for expansion of Long-term care services to Homeless Person with Mental Illness.

4.4. SOCIAL RE-INTEGRATION – Detailed Vision

Social reintegration refers to a personal journey rather than a set outcome and indicates the ability of the Persons with Mental Health conditions to engage, independently, in social relationships with ease [friend, family, coworker, etc.,] and to maintain meaningful interpersonal relationships with their peers and community members so as to actively participate in various social roles and regain their social lives.

The Government of Tamil Nadu is steadfast in its commitment to integrating Homeless individuals with Mental Health conditions into society, empowering them to lead an independentanddignifiedlifeoftheirchoice. As part of this commitment, Homeless individuals with Mental Illness are reunited with their families and provided with rehabilitation services and entitled social benefits.

In cases where family reunification is not possible, individuals may be transferred to Supported accommodation (Halfway Homes / Inclusive living options with support services) overseen by the Department for WelfareofDifferentlyAbledPersonsthrough NGOs and District Mental Health Programme Officersandtherebyencourageindependent living through Community integration.

4.4.1. Reunion with Family

The Homeless individuals with Mental Illness shall be reunited with their families at any point along the continuum of care, spanning from their rescue and admission in MCH/ ECRC to their eventual discharge from long-term care facilities like Rehabilitation Homes, Halfway Homes, etc. Upon returning

to their families, these individuals will continue to receive Medical and Psychiatric support through nearby DMHP clinics, as well as access to various social entitlements provided under different schemes.

4.4.2. In cases where Reunion with Family is not possible

After being discharged from Rehabilitation Homes or ECRCs, individuals with mental illness who have recovered sufficiently and are capable of living independently but whose family is not traceable, shall be given the Supported Accommodation in the form of 1) Half Way Homes and 2) Inclusive Living and support services .

Here, they will receive guidance on independent living under the supportive supervision of caretakers employed by the relevant NGO which is managing the supported accommodation homes. These individuals will continue to receive medical and psychiatric follow-up at the nearest DMHP satellite clinics, in addition to receiving disabilitybenefitsandotherentitlementslike the UDID card, Aadhaar Card, savings bank account, CMCHIS card, etc.

As part of social reintegration, active community participation of residents of these supported accommodation facilities is also encouraged through participation in community activities like festivals, functions, etc., and thereby cultivating a sense of belonging and connection with neighbours and the broader community.

4.4.3. Halfway Home

A Halfway Home is a semi-institutional cum residential facility intended to support individuals who need minimal assistance in

transitioning to independent living within society. These homes serve as “halfway” points between rehabilitation homes and full reintegration into community to lead an independent life. Halfway homes are established under the Department for WelfareofDifferentlyAbledPersonsforthose who have been improved, cured, homeless and long staying in rehabilitation homes, through NGOs.

The inmates of Halfway Homes shall be provided with necessary social support, safe accommodation, vocational training, social skills training and self-employment opportunities, all closely supervised by the service provider. Essentially, Halfway Homes function as both night shelters and rehabilitation facilities, providing residents the flexibility to go out of these Homes and engage in recreational activities, pursue livelihood opportunities and attend to other needs thereby preparing them for independent living in the future.

Currently, there are five Halfway Homes run by Non-Governmental Organisations, with financial aid from Department for Welfare of Differently Abled Persons and one Half Way Home run by Institute of Mental Health, Kilpauk. This policy envisages the State will promote Half-way Homes in every district through NGOs.

4.4.4. Inclusive Living and support services

The concept of Inclusive Living option in the community embodies a framework for aiding individuals with “functional and symptomatic recovery” from mental illness, offering them a supportive and inclusive residential setting conducive to their well-being and active participation in community, serving as a penultimate stage towards leading a fully independent life on their own. This approach

promotes the provision of choice-driven, inclusive living spaces through residential homes situated in either rural or urban neighborhoods accommodating a few people [3-4 persons per home].

The rehabilitation program for inmates in these supported accommodation homes shall include social skill development for orientation to the living environment in a community setting, basic home management, pre-employment preparation, tracking of health and follow up treatment, will be provided by a team of social workers and personal assistants from implementing NGO. Employment opportunities shall also be facilitated through skills assessment, job placement assistance, and encouragement of entrepreneurship. Access to social security schemes and benefits shall also be facilitated by NGO managing the Homes.

V. GOVERNANCE S5TRUCTURE, MONITORING AND EVALUATION

5.1. The Tamil Nadu State Mental Health Authority for implementation of this Policy

Authority (SMHA) is a statutory Governing

body established by Government of Tamil

Nadu to oversee and regulate mental health

services in the state. The SMHA functioning

under the chairpersonship of Secretary, decisions adopted by the state SMHA. Health and Family Welfare, plays a crucial role

in ensuring that mental health services are 5.3. In this context, the CEO’s role in accessible, of high quality, and aligned with overseeing all types of mental health the best interests of individuals with mental establishments involved in the care of health conditions. homeless individuals with mental illness

is vital. In this regard, regular review and 5.2. As such, the State Mental Health monitoring mechanism is crucial to ensure Authority [SMHA] is the Apex Monitoring accountability and provide comprehensive

in the State. As the legal representative of the SMHA and responsible for its day-to-day administration, the Chief Executive Officer (CEO) is tasked with implementing the

care for homeless individuals with mental illness, from rescue to reintegration with their families.

5.4. The CEO is entrusted with the following responsibilities in the care of homeless individuals with mental illness:

Developing quality and service provision norms and specifying standards of care for various categories of mental health establishments involved in serving homeless individuals with mental illness in the state.

Overseeing the inspection, registration, and overall monitoring of all mental health establishments providing services to homeless individuals with mental illness.

Conducting periodic inspections of these mental health establishments to assess compliance with minimum standards and ensure that quality services are being provided to homeless individuals with mental illness.

Empanelment and registration of NGOs, CBOs, and volunteers (good Samaritans) approved by the district mental health committee to participate in the rescue activities for homeless individuals with mental illness. An annual list of these entities shall be published.

Periodic reviewing and monitoring the rescue activities and overall functioning of the ECRCS and rehabilitation homes for individuals with mental illness in the state. ProvisionofTrainingforallofficials,including law enforcement, Health, Social Welfare and other departments, on the procedures to be followed and service provisions available for the care of homeless individuals with mental illness.

Addressing and investigating grievances or complaints about deficiencies in service provision or non-adherence to minimum standards in these centers. Additionally, the CEO oversees the audit of mental health establishments providing care to homeless individuals with mental illness on a regular basis.

Conduct regular review of the District Mental Health Review Board functions and services and submit the report to the chairman SMHA on a monthly basis

Discharge such other functions with respect to the care of Homeless persons with mental illness as per the decision of the Government of Tamil Nadu

5.5. District Mental Health Review Board (DMHRB)

The District Mental Health Review Board (DMHRB) is established by the State Mental Health Authority (SMHA) under the Mental Healthcare Act of 2017 (MHCA 2017) in 13 locations across the state to cover all districts.

The DMHRB is a quasi-judicial body chaired by a retired district judge, and includes a psychiatrist, a medical practitioner, a representative of District Collector’s office, and two representatives either from individuals with mental illness, their families or caregivers, or NGOs working in the field of mental health. The DMHRB operates in a democratic manner, making decisions based on consensus or by majority vote of the members present.

With regard to the care of Homeless persons with mental illness, the DMHRB shall have the following responsibilities:

i. Appointment of Nominated Representative:

The DMHRB is responsible for appointing a nominated representative for homeless individuals with mental illness who are rescued from the streets and admitted to mental health establishments to ensure prompt psychiatric treatmentasperMHCA2017.

ii. Compliance Monitoring:

The board monitors compliance with relevant rules, regulations, and guidelines governing the operation of ECRCs and rehabilitation homes for mentally ill individuals. The board ensures these facilities adhere to specified standards and protect the rights and safety of homeless individuals with mental illness through regular inspections and evaluations and ensure residents of these Homes receive appropriate treatment, support, and services according to their needs.

iii. Investigation of Complaints:

The DMHRB investigates complaints or concerns regarding the treatment or conditions within these ECRCs and rehabilitation homes and takes appropriate actiontoaddressanyviolationsordeficiencies identified during such investigations.

5.6. District Mental Health Committee:

District Mental Health Programme (DMHP), a public health approach to Mental Health Services is being implemented in all District in the state and the District Mental Health Committee is established under the DMHP in all districts to oversee the effective implementation of Mental Health Programme activities [G.O. (Ms) No. 99, Health and Family Welfare (EAPI/2) department dt.:27.03.2015]. This committee convenes every month to review the progress of DMHP implementation, including services provided to homeless persons with mental illness. At the district level, the District Mental Health

Sl. No

1 2 3

6 7

MEMBERS

District Collector

Chairman Secretary Convener Member

Member

Member Member

Joint Director of Medical and Rural Health Services

District Psychiatrist [Programme Officer of DMHP]

Deputy Director of Health Services [renamed now as District Health Officer]

Dean of the Government Medical College in the District

District Differently Abled Welfare Officer District Social Welfare Officer

Committee shall serve as the monitoring body for the State Policy for the care of HPWMI, playing a vital role in ensuring their well-being from rescue, admission until social reintegration. Currently, the District Mental Health Committee comprise of the following members:

The following officials shall be included as Members:

1. Legal Officer of District Legal Services Authority DLSA

2. Representative from the Office of Superintendent of Police (in the Cadre of DSP)

3. District Backward Class welfare, Adidravidar Welfare officer

4. Project Officer, Mahalir Thittam – Rehabilitation in terms of Loans, Micro entrepreneurship facilitation.

5. Any other special invitees (Department officials such as Lead Bank Manager of the District, District Employment Officer, Representative from any reputed NGOs / CBOs in the field of Mental Health etc.,)

The District Psychiatrist (Convenor), in consultation with the Chairman and Secretary of the committee, shall convene the committee for meeting and prepare the agenda for discussion. The agenda shall include topics such as the review of rescue services, Medical and Psychiatric services, Rehabilitation services, status of Social Welfare benefits, and Reintegration services, including reunion with family.

5.7 Role of DMH Committee in the care of HPWMI:

Responsibilities of the committee in the care of homeless persons with mental illness

I. Monitoring and supportive supervision:

In this regard, the District Mental Health Committee will closely monitor the services provided to homeless individuals with mental illness. Additionally, the committee will offer guidance and supportive supervision to various departments involved in delivering comprehensive care to persons with mental illness, following a Bio-Psycho-Social approach

Periodically inspect and regularly review the rehabilitation homes, supported accommodation homes, and day care centers that provide mental health services to homeless persons with mental illness in the district. This includes assessing the condition of these Mental Health Establishments (MHEs), ensuring compliance with standards, evaluating available facilities, and verifying licensing/registration as per the MHCA 2017.

Monitor and review the rescue of homeless persons with mental illness who are wandering in public places.

As part of rehabilitation and reintegration, homeless persons with mental illness (HPWMI) shall be transferred from hospital setups to rehabilitation homes or supported accommodation homes. The committee shall closely monitor these transfers to ensure safety and will review the list of such individuals to ensure accountability of these homes.

Monitor and review the reunion of HPWMI with their families. The committee, in collaboration with the police and revenue department, shall trace the families and ensure that all reunions occur in the presence of committee members. Also shall monitor transfer of inmates from one facility to another and ensure that no inmate shall be transferred from one home to another home without prior intimation to the Police and Department for the Welfare of Differently Abled Person.

II. Facilitation of Rehabilitation Package:

The District Mental Health Committee shall ensure that persons with mental illness receive rehabilitation (social welfare) packages as part of comprehensive mental health care services.

The Committee shall provide necessary social welfare assistance to persons with mental illness (PMI), including homeless persons with mental illness (HPMI), and their families, utilizing existing schemes available under various departments according to scheme eligibility criteria.

The committee shall regularly review the status and progress of disability benefits provided to persons with mental illness, including Disability certificates, Aadhaar cards or other ID cards, CMCHIS cards, UDID cards, and the opening of bank accounts.

5.8. Key Recommendation

1. At the District level, a dedicated facilitation desk (Social Welfare Assistance Centre) may be set up to sensitize and create awareness to care providers about the Social welfare benefits available under various government schemes. This Centre under DMHP will play an active facilitatory role to enable HPWMI access these Social Welfare benefits as per the schemes’ eligibility criteria.

2. The Location of the Centre shall be decided by the District Committee

0RESEARCH

6.1. Considering the extremely vulnerable due focus on taking up qualitative and nature of homeless individuals with mental quantitative research pertaining to HPWMI in illness and the significant research gaps in collaboration with esteemed academic and the areas of burden, determinants (including research institutions.

social determinants), effective interventions

and implementation strategies, especially 6.3. It is essential to document models, in our settings, it is imperative to prioritize experiences, and best practices out of the scientific understanding supported by ongoing program to assess the impact, reliable research. effectiveness and lessons to be learnt.

Operational research, through the process 6.2. The policy therefore prioritizes the need of problem identification and dissemination for a comprehensive research on clinical, of the findings within the programme ambit, epidemiological, and operational aspects of would help in utilizing the data for choosing homeless individuals with mental illness. The or adopting a useful strategy for intervention, research component will be instrumental making mid-course corrections for making in identifying specific needs, developing necessary improvisations. The routine targeted public health interventions, and program monitoring indicators will guide the evidence-based strategies for effective identification of priority based operational program implementation. The National researchareaswhichwillleadtoeffective

Health Mission-Tamil Nadu shall give implementation of the policy.

ANNEXURE-I

SOP for 102 Vehicle In The Rescue Of Homeless Person with Mental Illness

1. Call received by the 102 Call Centre

a. Call made by Public/ Good Samaritan/ Volunteer

b. Call made by any department official/ Healthcare worker c. Call made by empanelled NGO

2. 102 counsellor collects the following details to locate the HPWMI: i. District

ii. Taluk

iii. Village/ Town

iv. Street/ Landmark

ASSESSMENT

I. Short history

II. Physical and mental health condition [General condition]

III. Contact District counselling centre [DCC] mobile helpline and discuss about the need of HPWMI with the DMHP team* if needed connect the caller to DMHP team for further needs assessment and planning of further care

IV. Needs Assessment for further care – Decide about allotment of vehicle

3. Locate the available vehicle and share the contact information and location details to the driver

4. 102 Vehicle reaches the spot for rescue activity

5. Police along with empanelled NGO worker rescue the individual and take the HPWMI to the Mental Health Establishment [MCH] in the vehicle (* in districts where there is no MCH, the individual maybe taken to DHQH)

6. After dropping the individual at the health facility, vehicle returns to the base

7. Call closed.

102 contd.

I. Short history

Name, if available

Age/ Sex

Reason for the call

How long the HPWMI is found to be wandering?

Whether the individual dressed appropriately?

Whether the individual gives relevant reply to the caller? Whether the individual appears to be mentally disturbed? Whether the HPWMI has family?

II. Physical and mental health condition [General condition]

Whether the individual is conscious and able to sit/stand/walk without support? Whether the individual is talking to self/ laughing to self?

Whether the individual appears to be irritable/ violent/ abusive?

Any external injury with active bleeding?

ANNEXURE II

Details of Medical Assessment to te done by the Medical Officer at Public Health Establishment after Rescue

Once a person is rescued from the streets, their basic needs are to be attended to – food, clothing and then he/ she is taken to the nearby Government Hospital. The OPD MO shall provide quick clinical assessment, immediate treatment and refer to higher centre (MCH).

OPD No.:

Date & Time of consultation:

Name: mention as unknown if name is not known Age:

Sex:

Source of referral:

Informant (mention the details of the Police official / rescue NGO worker)

PRESENTING COMPLAINTS

HISTORY OF PRESENT ILLNESS:

(Describe the presenting complaints in 2 or 3 lines including relevant positive and negative symptoms. MO shall use Tamil words to describe the psychiatric symptoms/ problems)

EXAMINATION Physical examination:

General:

Look for dehydration, injuries, skin infections, anemia, fever, asthenia [wasting]

Systemic including vitals: BP, PR, Temperature, SpO2, weight and Quick assessment of cardiac, respiratory and neurological systems

Mental State examination

S. No Details Notes

General appearance and behavior: Describe the patient: built, appearance, age group, grooming, hygiene, dress, level

of cooperation, level

of communication, psychomotor activity, talking / laughing to self, over all behavior during interview, catatonic features, or any other abnormal movement

Speech

(Spontaneous or non- spontaneous; whether patient replies to the questions asked by the Doctor). If so mention, relevant / irrelevant

Content of Thought – Delusion

Perception: Auditory hallucination [Talking/ laughing to self, muttering, etc.,]

Conscious and Oriented to time, place and person

Provisional Diagnosis:

Management:

Investigations – Haemoglobin, Blood sugar-random, any other investigations as decided by the doctor Treatment

Specialist Opinion and Referral details

In MCH, further assessment of the patients’ clinical condition and treatment shall be provided as per the existing Treatment guidelines for both physical and mental health conditions.

ANNEXURE III

From ——————- ——————- ——————-

Inspector of Police, ——————– ————- District.

Sir / Madam,

Sub: Homeless Person with Mental Illness (HPWMI) – Discharge & Transfer intimation – reg.

The following person who was rescued from Public place / streets and admitted to our ECRC on _______________ (Mention date of admission to ECRC) is discharged and referred to Rehabilitation home / Half Way home as per the details given below.

Name of the Homeless Person with Mental illness:

Age / Sex:

ID Marks: 1) 2)

ID Proof of the above individual (if available):

Details of FIR / CSR at the time of admission to ECRC (enclose a Photocopy):

Date of Discharge from ECRC:

Details of Rehab home / Half Way home to which the individual is now transferred to:

This is for your kind information, Thank You

Photo of patient

(To be attested by in charge Person of ECRC)

Name and Signature (with date) of the in-charge person of ECRC

ANNEXURE-IV

From ——————- ——————- ——————-

Sir / Madam,

Inspector of Police, ——————– ————- District.

Sub: Homeless Person with Mental Illness (HPWMI) – Details collected from patient and other sources – regarding the family – shared – to assist tracing the family – reg.

The following person who was rescued from Public place / streets and admitted to our ECRC on _______________ (Mention date of admission to ECRC) and is on treatment at our centre. In this regard, the details given by the inmate and details collected by Social Worker are shared to your office, for assisting in your efforts to trace the family of the individual and further reunion efforts.

Name of the Homeless Person with Mental illness: Age / Sex:

ID Marks: 1) 2)

ID Proof of the above individual (if available):

Details of FIR / CSR at the time of admission to ECRC (enclose a Photocopy):

Date of Discharge from ECRC:

Details of Rehab home / Half Way home to which the individual is now transferred to:

This is for your kind information, Thank You

Photo of patient

(To be attested by in charge Person of ECRC)

Name and Signature (with date) of the in-charge person of ECRC

ANNEXURE-V

From ——————- ——————- ——————-

Sir / Madam,

Sub: Homeless Person

The following person _______________ / Half Way home as per

Name of the Homeless Age / Sex:

ID Marks: 1)

Inspector of Police, ——————– ————- District.

with Mental Illness (HPWMI) – discharge and Reunion – intimation – reg.

who was rescued from Public place / streets and admitted to our ECRC on (Mention date of admission to ECRC) is discharged and referred to Rehabilitation home the details given below.

Person with Mental illness: 2)

Photo of patient

(To be attested by in charge Person of ECRC)

ID Proof of the above individual (if available):

Details of FIR / CSR at the time of admission to ECRC (enclose a Photocopy):

Date of Discharge from ECRC:

Details of Rehab home / Half Way home to which the individual is now transferred to:

Police Verification Report ( lorem ipsum ): Available (Yes/No) – (enclose a Photocopy)scscsc Details of family members (Attach support documents):

This is for your kind information, Thank You

Name and Signature (with date) of the in-charge person of ECRC

ANNEXURE-VI

“ With the introduction of the Tamil Nadu State Policy for Care of Homeless Persons with Mental Illness and Implementation Framework, the Government of Tamil Nadu is dedicated to protecting the rights and interests of this highly vulnerable population, thereby enhancing their well-being. The policy also aims to raise community awareness and promote broader societal engagement which will include amongst others shielding these vulnerable individuals from discrimination and abuse “

by strengthening support networks and facilitating their integration into society to foster a meaningful life with dignity.