Homeless people are falling through the cracks due to gaps in the delivery of basic health services, especially mental healthcare, in South Africa. Figures from 2020 suggest that at least 15 000 people don’t have a roof over their heads in Johannesburg. Numbers for the rest of the country remain unknown. Access challenges Michael Wilson, executive director of the Advanced Access and Delivery South Africa organisation, highlighted some of the obstacles the unhoused face when accessing healthcare. “Traditional healthcare service delivery is just not convenient for people who are experiencing homelessness or transitioning in and out of homelessness.  Transport, getting time off, because a lot of them work informal jobs and interacting with staff that stigmatise them are some of the challenges to access,” he said.  Wilson said that it is important to ask whether or not the systems that are there to provide medical care and psychosocial support are flexible in terms of where they meet people who are experiencing homelessness. Advances Access and Delivery  is an organisation that provides medical care to people who are experiencing homelessness, substance users, and other socially marginalised groups. Their medical program includes services like regular screenings for TB, HIV, and Hepatitis, provision of free and clean injections and assessments. ‘Clinics that won’t chase us away’ *Thabiso Mametja, 27, originally from the North West, currently lives on the streets of Winterveldt, Pretoria North. Mametja came to Pretoria to look for a job when he was 21 years old, but fell into a life of drugs after failed attempts and ‘bad influences’. He has not gone back home in the 6 years since.  “I spend most of my time on this side and other times, I hustle in town or in the suburbs. I pick up plastic and cans, that’s how I make money,” said Mametja, who sleeps wherever he finds himself.  Mametja admitted to using nyaope and drinking alcohol. He said he has tried going to a local clinic in Winterveldt, but was chased away. The second clinic he tried required a clinic book which he did not have.  “There are days when I see taxi-like cars parked at random places – testing people, handing out medicine like panado, masks, and condoms. I always go and check it out because I need these services. Just because I look like this, it doesn’t mean that they should not help me. I am sick every day because of these drugs. I might get sick because I share injections with different people all the time, they think I don’t know that. We need clinics that won’t chase us away so that they can help us, like the mobile clinics,” he explained. Homelessness and mental health  Mary Gillert-De Klerk is the CEO of the Johannesburg Organisation of Services to the Homeless (JOSH) and also the Vice Chair of the Johannesburg Homelessness Network. She has been a social worker serving the homeless sector since 1982.  Gillert-De Klerk noted that in some circumstances, mental illness can contribute to the reason why some people experience homelessness because the the person’s mental illness affects their ability to understand their surroundings and to be understood by their family members. Research has shown that homelessness and mental illness are interdependent variables. This means that one could be responsible for causing the other and vice versa.   Addressing the difficulties that homeless people go through when trying to access mental healthcare services, requires a combination of resources and services as well as a system that enables people to exit the street sustainably.  “We’ve had over 15 000 people who are experiencing homelessness in Johannesburg before the pandemic, with shelter space for less than 1 000 people. We have critical bed shortages in shelters. This also affects the psychiatric institutions when patients have to go in for assessments, because there is no space to keep them there. So, it takes longer for them to get help, to get better, because they don’t have access to an entire range of services,” said Gillert-De Klerk. “There is no known research that proves that people who are experiencing homelessness are more prone to mental disorders. The homeless are no different to any other population or grouping in society that we have. They are just people who don’t have homes, job and family support systems. Some have possibly resorted to substance use because of their life circumstances, but they are also just people,” said Gillert De-Klerk. Discrimination at public health facilities Similarly to other policies and legislation, there is a disconnect between what is written and the reality of service delivery.  The South African Mental Health Care Act No 17 of 2002 states that the rights of persons with mental illness are to be protected from discrimination and that they are to receive care and services in the communities where they reside.  The Disability Rights Charter of South Africa (2008) and the Bill of Rights of the Constitution of the Republic of South Africa (1996), also protect the rights of everyone to basic health care services. According to a report compiled by Unotida Moyo and others titled “Homelessness and mental illness in Hillbrow, South Africa: A situation analysis”, the lack of access to service provision for homeless persons with mental illness is often related to the unwillingness of health care professionals to treat homeless people because they are ‘dirty’.  The report cites a study that was conducted in South Africa by Zrinyi and Balogh which showed that student nurses would decline to care for homeless people in various situations. This reaction was the result of the way the homeless body has been stereotyped as unworthy and undeserving of medical services. This result supports that conclusion that “the inaccessibility of health care services is a key issue in understanding the high mortality rate among homeless people”. The failure of homeless persons with mental illness to provide an address and to keep appointments was another alienating factor.  Extra difficulties Raymond Perrier is the Director at the Denis Hurley Centre. He said that people … Continue reading Healthcare: Homeless people falling through the cracks