Problems in providing medical and psychological help to the homeless

From hospital straight onto the street: Problems involved in providing medical and psychological help to homeless people




Major issues involved in providing palliative and medical care to the homeless have been discussed in the Federation’s Public Chamber,


Health centres


Of the at least 250,000 people living on the streets in Russia, more than 15,000 can be found in Moscow and the Moscow Region, said Ilya Kuskov, Director of the Warm Welcome centre for the homeless and head of the Helper and Patron charity.


Homeless people’s lives are constantly under threat from things such as exposure to cold weather and lack of basic hygiene. The situation is made worse by the fact that they cannot access emergency medical care, says Kuskov. In order to get such help, a person must have a health insurance policy for which a passport is required (which homeless people often don’t have), a National Insurance Number and temporary registration document.


Low-threshold health centres for disease diagnosis, prevention and modern-day treatment could partially resolve this problem, the expert says, According to him, Moscow and St Petersburg have the only two free health centres for homeless people in the whole of the country. The establishment of such centres would help save Government money which would otherwise be spent in the treatment of neglected diseases.

The Minister of Health, Veronika Skvortsova, has sent letters suggesting that Khabarovsk, Irkutsk and Cheboksary organise these centres. Although the local authorities are supportive, centres have yet to appear in these cities.


Chronic illnesses


The main problem is providing help to homeless people suffering from chronic conditions, says Olga Demicheva, a Board Member at Doctor Liza’s Fair Help charity and endocrinologist.


“The emergency care system works, albeit not generally very transparently or quickly. The issues are about hospitalisation and the level of help that should be provided. Then the problems begin. In many cases, homeless people have chronic conditions but once their symptoms have been treated they are discharged from hospital and back on the streets again. An agreed medical support plan that includes palliative care isn’t universally available. There is, of course, a social adaptation centre in Lublin which provides beds for palliative care and chronically ill patients but this is just a drop in the ocean”, said Demicheva.


Once a patient has received emergency care he or she is discharged with a recommendation to undergo treatment at their place of residence. However, a homeless person won’t be able to do this. “I have seen with my own eyes what happened to one person. A woman with cancer had a tamponade and had been discharged with a recommendation for her tumour to be removed. She was homeless with nowhere to go which, in effect, meant she had been discharged to die”, said Semyon Halperin, Director-Coordinator at Dr Liza’s Fair Help.


“Only State or private medical institutions are qualified to provide medical care as NGOs don’t have the appropriate licence. In this regard, NGOs that provide such help are often operating outside the law”, said the doctor.


Experts are also unhappy with the help being provided to those suffering from tuberculosis, hepatitis and HIV. Homeless people very often have no idea where to go for help. They turn up at all the usual places such as railway stations and NGO support centres. Experts say that it is here that people need to be told where to go if they have health problems.


Psychological help


Homeless people need psychological as well as medical support. This is provided by the homeless services service organisation Caritas, who have opened a help centre on Derbenevsky Street in Moscow where people can receive support from a trained psychotherapist. Homeless people are welcome individually or in groups.


“A group is a simpler and more inclusive format. You can say to the homeless – come in, have some tea and have a chat, and it works. They are attracted by the idea of free tea, the chance to spend some time in the warm and talk about anything to take their minds off things”, said Nadezhda Klyuyeva, Coordinator at Caritas. The centre has several psychotherapists giving up some of their free time to help the homeless during the week.


According to a psychologist, Viktor Gulyayev, the mental rehabilitation of homeless takes time.


“Once a homeless person’s basic needs have been fulfilled, the question arises: What next? Social workers often invest a considerable amount of time in these people, but after a while the homeless person leaves and disappears. At best, they will come back, at worst they will die. This year, we set up a 24-hour helpline offering psychological help to the homeless”, said Gulyayev.


By the end of February, the helpline had dealt with more than 170 calls, with some people ringing in to ask for help two or three times a day.


However, support also needs to be given to the professionals working on the helpline. According to Gulyayev, there are not enough textbooks or leaflets for those working with homeless people. The burn-out rate among volunteers and staff at these centres has so far been very high.


A round-table event was recently organised by the Public Chamber’s Commission for the Development of the NGO sector and Support to SONGOs and the Dr Liza’s Fair Help international charity. A report of the meeting can be accessed via



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