key: cord-0841701-uvuwbe2u authors: Sharm, Mohit; Aggarwal, Shivali title: Homeless persons with mental illness during COVID-19 date: 2020-09-01 journal: Asian J Psychiatr DOI: 10.1016/j.ajp.2020.102408 sha: 72724f6c5f0c2e5f656f53345e5b5d7d6c66e410 doc_id: 841701 cord_uid: uvuwbe2u nan Homelessness is a societal and global concern affecting the countries throughout the world and more of a bigger problem in people with mental illness. A home is a place that includes elements of stability, privacy, safety, security and the ability to control living space. Homelessness is thus defined as lack of these elements in the living space or residence which is transient in nature, unsuitable and unstable for accommodations such as in shelters. Research has shown that homelessness may contribute to mental illness and vice versa, i.e. the people having poor mental health conditions are more than twice as likely to experience homelessness in their lifetime, compared with people who are not (Fazel et al., 2008 (Fazel et al., , 2014 . Crowding, pollution, inadequate lighting, noise, poor hygiene and maintenance are usually associated with poor housing quality. Homeless conditions and slums can result in exacerbation J o u r n a l P r e -p r o o f of certain psychiatric disorders, like substance use, violence, depression, anxiety, and can lead to social, occupational, societal dysfunction. Psychiatric disorders in homeless individuals, for instance, psychosis (3-42%) is estimated to be three times higher than in the population with a sheltered living (Fazel et al., 2014) . People living on the streets are more than likely to suffer from poor health conditions like TB, DM, chronic cough. These conditions are generally neglected as far as treatment is concerned due to issues of poverty, ignorance. Increased prevalence of substance use in this population further adds to the concern of poor treatment outcomes. All these unmet needs, poverty, job concerns, poor access to food supply add to mental stress and burden. All these lead to poor immunity in this population cohort, in the background of poor hygienic conditions. Hence, if exposed, homeless people are much more at risk of developing illness due to COVID-19 than rest of the population. The other added personal vulnerabilities homeless people have to cope with are social isolation/exclusion and stigmatization, high rates of criminality and violence, lack of reliable and affordable health care systems. It is not very difficult to reason that homelessness and victimization associated with it, blocks the path to recovery. Other barriers like stigma, difficulty in assessing available treatment options further add to this already existing problem. Patients with Mental illness especially when homeless need special care and designated hospitals should be made where testing for COVID-19 could be done in-situ and reports get available readily. So working for homeless persons with mental illness, seems morally compelling, ethically appropriate, scientifically feasible and legally mandated too. But is it possible and how much difference will it make...the question needs to be pondered upon and requires research. Coronavirus COVID 19 Global Cases The health of homeless people in highincome countries: descriptive epidemiology, health consequences, and clinical and policy recommendations The prevalence of mental disorders among the homeless in western countries: systematic review and meta-regression analysis Census of India Homelessness and mental health in India COVID-19 and mental health: Preserving humanity, maintaining sanity, and promoting health None. None declared. None declared. The authors did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.