The National Institute of Mental Health And Neuro-Sciences, Bengaluru, India, has a long-standing experience in caring for homeless people with mental illness both during emergencies and in ensuring continuity of care. Homeless people with mental illness referred to mental health services at the institute are assessed by a service medical officer and a psychiatrist from emergency psychiatry and acute care. The confidentiality, rights, privacy, capacity for admission, and treatment of these homeless patients are ensured throughout their stay by adhering to the values of Mental Health Care Act, 2017. 1 Homeless people with mental illness are most often admitted under Section 89 of the Act, with each admission reviewed by the departmental review committee. Following treatment, the patients are transferred for ongoing care to community-based facilities supported by either state governments or nongovernmental organisations. The Government of India implemented a nationwide lockdown by invoking special provisions of Epidemic Disease Act of 1897 and Disaster Management Act, 2015 on March 25, 2020, to prevent spread of COVID-19. During the lockdown, in Karnataka state, homeless people with mental illness were identified by police personnel. Members of public and the police, sensitive to the plight of these individuals, promptly facilitated their placement in emergency temporary shelters, a truly commendable act and one that demonstrates societal empathy and support. Shelters were created by hiring chatras (choultries or ceremony halls), community halls, and unoccupied residential facilities. An unexpected outcome of this effort was increasing number of referrals of homeless people with mental illness to our centre for evaluations and further management. In addition to pre-existing complexities in managing these patients (lack of personal data, information on aspects of mental illness, medical comorbidities, or concurrent nutritional deficiencies), our centre faced the associated challenge to safely evaluate and manage them given their likelihood of being at high risk for COVID-19 consequent to impaired judgement resulting from mental illness. During the COVID-19 lockdown from March 25, 2020, to April 24, 2020, ten homeless people with mental illness presented to emergency psychiatry and acute care services at our institute, equalling the total number for the preceding 1 year. Emergency psychiatry and acute care management protocols were modified to address patients’ COVID-19 risk status. Homeless people with mental illness are often unable to provide details of personal identity, family information, and illness. Additionally, these patients demonstrated altered sensorium, impaired comprehension or concentration, thought and behavioural disorganisation, poor self-care, compromised nutritional status, and concurrent physical illnesses impacting immunity levels thereby enhancing risk of contracting COVID-19. They had severe mental disorders (schizophrenia, bipolar affective disorder), intellectual disability, and substance abuse. Poor awareness about preventive measures to reduce the likelihood of contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection make homeless people with mental illness additionally vulnerable to acquire and spread it. Furthermore, mental illness impacts awareness of vulnerability to infection, timely identification, and help-seeking when symptoms of COVID-19 develop. 2 The Indian Council of Medical Research formulated COVID-19 testing protocols for travellers, their contacts, and patients with