An influential psychiatric study in 1978 considered that a homeless person was "not simply one who happens not to have a home, he is also a man who is incapable of sustaining one, and may be incapable of any other way of life than that which he has adopted" (see Further Reading below). While the crudity of this formulation may have been superseded, the spirit of it – that ‘the disorder is responsible for the displacement’ – remains very much part of contemporary thinking about the mental health of homeless people.

Sushrut Jadhav wants to know how, and why, we have arrived at such a peculiar attitude towards homeless people. And why our current social policies are failing them so badly.

A psychiatrist, Dr Jadhav has first-hand experience of the failure of current policy, as he works in a mental health clinic for homeless people in the King’s Cross area of London. "This piece of research is a very logical progression from my work at the clinic. I am working with people whose main problems stem from social and economic poverty – is it therefore appropriate to translate this into a psychiatric diagnosis? And my vocabulary has changed – from a psychiatric one to an administrative one: it became all about ‘managing someone’s risk’, ‘transferring someone from here to there’ and writing ‘care programmes for clients’. That’s not what we as psychiatrists have been trained in. We are interfacing here with social care work, with social policy, and we have imported its vocabulary and its practice. Suddenly, instead of asking a patient about their internal world, we are thinking about how to get them money, meals, clothing and accommodation."

His research will focus on three key groups: homeless people themselves, healthcare professionals – psychiatrists, social workers and nurses – and social policy makers. "I have a background in medical anthropology, so rather than trawling through all those dusty social policy tomes I will be gathering oral histories. I will be talking to all three groups about how they view changes in homelessness and social policy since 1960."

Dr Jadhav has a novel way of conducting his work as a street psychiatrist – from a black cab. "I ‘went native’ when I was doing my PhD research on depression amongst white Britons in London. I talked to a lot of cabbies and I liked their world. The ‘Black Taxi’ articulates many key cultural values of Englishness – they are traditional, sentimental, reliable, punctual – and you can break the rules in them! And then when I was doing clinical assessments on footpaths I kept getting parking tickets in my old car, so I got a black cab so I could pull over to talk to people more easily. It moves you out of the position of being an ordinary civilian, being in a cab. It puts you at the margins, and things appear so different from there."

Being at the margins is a consistent theme in Dr Jadhav’s work. "I was born in India to parents who were ‘untouchables’. I think the homeless are in some way the modern Western equivalent. I feel I have a personal connection to people in minority groups, and I also think affinity with outcasts is very important for a psychiatrist to understand the stigma of oppression."

Dr Jadhav has several aims in his research. One is to reframe social policy for psychiatrists. Social policy is not considered part of psychiatric training, which Dr Jadhav, who is also a clinical lecturer, considers a weakness: "We need to introduce social science to psychiatrists early in their training. What little standard literature we do have on community psychiatry is rather sanitised, and doctors must have models rooted in history to make sense of their current practice, and to critique it. This is crucial if psychiatrists have to learn how to reverse the current situation at the clinic. It will help us reframe psycho-pathology as social and economic pathology." This could impact on both social policy and clinical work; psychiatrists, he feels, can have some influence over what is happening, but only if they are informed about how social policy comes about and what its effects are.

Finally, he wants to understand why, in a country with such a rich economy, some people in the UK are still so profoundly impoverished: "As Gandhi said, the mark of any civilisation is how it treats its dispossessed."

Sushrut Jadhav is in the Department of Behavioural and Social Sciences, University College London. (Information correct as of issue Q2 2000)

See also

• Indian psycho: Article describing (history of medicine fellowship) research on the portrayal of mental illness in Hindi cinema
• Casualty cases: Article describing (history of medicine fellowship) research on the history of A&E

External links

• Dr Sushrut Jadhav at University College London

Further reading

Lodge Patch P (1978) Homeless men: a London survey. Journal of the Royal Society of Medicine 63: 441–5