key: cord-0935779-c6pmzin2 authors: Kar, Sujita Kumar; Arafat, S. M. Yasir; Marthoenis, Marthoenis; Kabir, Russell title: Homeless mentally ill people and COVID-19 pandemic: The two-way sword for LMICs date: 2020-06-30 journal: Asian Journal of Psychiatry DOI: 10.1016/j.ajp.2020.102067 sha: d7a1f3b89b512415b16d716d3b5f3724d7332b8d doc_id: 935779 cord_uid: c6pmzin2 nan Homelessness is a big challenge in low-and middle-income countries (LMICs) during the public health emergencies viz epidemics and pandemics. A significant number of homeless patients have some sort of mental illness and among the homeless mentally ill people (MHIP), considerable number have one or more medical co-morbidities. Majority of the homeless patients with mental illness have severe mental illnesses (Patten, 2017) . Currently, most of the countries across the globe are affected by a highly contagious novel coronavirus which was started from the Wuhan city of China and within months took the shape of pandemic (Lipsitch et al., 2020) . This article was aimed to draw attention regarding how MHIP affect the spreading the pandemic and how current pandemic affects them. 1 Easily get infected: As they are homeless, they pose the highest threat to be affected within the shortest possible time. Moreover, they also poor personal care as well as protective measure resulting in having the infection. 2 Spread the infection: as they roam most of the time to and from, they can be a potential spreader of the highly infectious viruses like COVID-19. 3 Difficult to identify and quarantine: If a homeless mentally ill person acquires COVID-19 infection, it is unlikely to catch public attention. As the identity (name, address) of these persons are mostly not known and they keep on roaming in the streets, roadside and may disappear, they are not easily traceable. Moreover, the LMICs usually lack of such specialized set up, attention and promise to isolate this group of people. 1 Medical and psychiatric morbidities: The COVID-19 infection possibility is higher among persons with medical co-morbidities (Jiang et al., 2020 (Gururaj et al., 2016) and it is likely to becomes further worse if the mentally ill person is homeless. 6 Increased Case Fatality Rate (CFR): Even without COVID-19 co-infection, the psychiatric patients suffered from premature death. In the countries with most accessible mental health healthcare system such as Australia and the Scandinavian, the mortality gaps accounted to 15-20 years compared to the normal population (Thornicroft, 2013) . The comorbidity between mental disorder and COVID-19 among MHIP leads to tremendous challenge in LMICs. There is a need to look into the health of this marginalized population for the possible spread of COVID-19 infection in the community. The government and other responsible stakeholders should take a lead to screen the health condition of these homeless mentally ill persons in the LMICs, which may be beneficial in reducing the community spread of COVID-19 infection. At the same time there is potential role of mental health professionals to address the mental health issues of these patients as they are often untreated (Banerjee, 2020) . As there is paucity of manpower in mental healthcare in developing countries, the mental health issues of homeless mentally ill can be addressed through online consultation liaising with general medical practitioners (Yao et al., 2020) . Early and adequate treatment of mental illnesses in these patients is likely to improve their general physical health and degree of adherence to the precautionary measures required during this COVID-19 pandemic. The COVID-19 outbreak: crucial role the psychiatrists can play National mental health survey of India Review of the clinical characteristics of coronavirus disease 2019 (COVID-19) Defining the epidemiology of Covid-19-studies needed Homelessness and mental health Premature death among people with mental illness Rethinking online mental health services in China during the COVID-19 epidemic Yasir Arafat b , Marthoenis Marthoenis c , Russell Kabir d a Department of Psychiatry The authors declare that they have no known competing interest. None