A miniature squatter camp has sprung up on the grounds of the Castle of Good Hope near the Cape Town City Hall and the Grand Parade. Picture: David Ritchie
Everyone seems to have something to say about those living on the streets with mental health issues and most, especially the politicians, want to lay the blame on the individual experiencing mental health challenges, whereas most are there precisely because society rejected their uniqueness and decided that they are not worthy of more than their charity.
Mental health issues can put an individual at an increased risk of becoming homeless.
Likewise, the horrifying state of homelessness can, itself, create mental health conditions in the minds of individuals who were otherwise emotionally stable when they first became homeless.
There is a revolving door between the physical condition of being unhoused and the uncertain mental state of the person with no home, making it difficult to decipher which issue preceded the other.
The unfathomable psychological stress of not having a place to live can be unbearable, causing some homeless mental health patients to do drugs – but probably not for the reasons you would expect.
Most of the misuse of drugs or alcohol among people living on the streets with mental health conditions is an attempt to manage the distressing symptoms of a mental health disorder or other health condition.
Imagine waking each morning to the nightmare of having no home. This is the harsh reality you can never seem to escape. Perhaps you were assaulted the first night you slept outside. Now, that violent event keeps replaying every time you see a particular street sign or hear a specific sound.
Perhaps you’ve been ignored by everyone who walked past you for 10 years. Now, that isolation has given way to a deep state of depression.
Perhaps you are a homeless 16-year-old trying to keep the secret from your classmates, although you’re sure they can see it whenever they look down at your shoes.
Whatever you are feeling, you are probably going through it all alone, which means you might even resort to self-treatment (drug use).
When a mental health patient attempts to reduce their symptoms by taking substances such as supplements, alcohol, or illegal drugs without a doctor’s prescription, it’s referred to as self-medicating. It usually happens due to social system flaws.
These are the main reasons some homeless mental health patients try to ease emotional pain all on their own, often to their detriment and sometimes even to their demise:
One of the main and rarely spoken of reasons homeless mental health patients turn to self-help is that seeking mental health care while living on the streets can be triggering.
Many mental health patients endure a rigorous process of repeat questions that is so time-consuming it leaves them in limbo for months on end.
When they finally get access to health care, they don’t want to have to keep telling the story over and over again of why they need help. They don’t want to keep reliving the war they were in every time they fill out a form. It can be a very triggering experience for them.
A lot of patients get aggravated because the tedious process is wasting time. They start to think of how badly they need the medicine. The average wait time in Cape Town for someone on the streets to see a psychiatrist is anything between two and six months.
So, you have a lot of people waiting, and a lot of them are reliving the trauma while they’re applying for aid because they have to keep telling that story over and over
So, now, they’re triggered, and they have no prescription. So, what are they doing? In many cases, they’re self-medicating, because it numbs the anxiety.
In addition to the triggering routine often associated with seeking out help, unhoused mental health patients also self-medicate because they can’t access traditional counselling.
Some of the many barriers to care include: lack of access to transport, lack of documentation, lack of employment, lack of counsellors, lack of time, embarrassment about the way they look, and previous negative experiences
The political red tape can be intimidating for anyone, let alone a person who is living in a constant state of survival mode because they are homeless.
The road to traditional medication can take months to years for a person who lacks a stable residence. But there’s an even more heartbreaking trauma ahead because getting a prescription doesn’t mean you’ll get to keep it.
With homeless criminalisation on the rise, the odds are pretty high that the prescription they worked so hard to obtain will be tossed in the trash by a local law enforcement official.
If medicine or a script for medicine is trashed by law enforcement, a common practice during homeless encampment evictions, the individual has to start right back at square one.
This would be enough to deter anyone, let alone a person who has already reached the end of their rope.
Dignified accommodation is mental and physical health care. That’s why it must be a human right.
Self-medication does not necessarily equate to a lack of self-control.
When an unhoused individual attempts to address these mental health issues on their own, it is often due to flaws in the system. It should be duly noted that feeling anxious, isolated, traumatised, or depressed is an incredibly sane reaction to becoming homeless.
If you don’t want to see homeless mental health patients self-medicating in your neighbourhood, then talk to your ward councillor and enlighten them about the reasons this is happening and that it would not be happening if the government was informed on such topics and actually did something constructive about rehoming those living on the streets into dignified safe private accommodation, rather than throw them into prison-style dormitories at night and back on the streets in the morning.
For as long as people are without a place they can call home, they will be without the mental health care that they need.
* Mesquita is a previously homeless man and founder of Outsider an organisation focused on enlightening people on homelessness and on accommodating those living on the streets in a dignified and sustainable manner.
** The views expressed here are not necessarily those of Independent Media.
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