scholarly journals Pathways Into and Out of Homelessness Among People with Severe Mental Illness in Rural Ethiopia: A Qualitative Study

2020 ◽  
Author(s):  
Caroline Smartt ◽  
Kaleab Ketema ◽  
Souci Frissa ◽  
Bethlehem Tekola ◽  
Rahel Birhane ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Illness ◽  
Mental Health Care ◽  
Severe Mental Illness ◽  
Low Income ◽  
Community Intervention ◽  
Social Needs ◽  
Rural Setting ◽  
Study Participants

Abstract Background: Little is known about the pathways followed into and out of homelessness among people with severe mental illness (SMI) living in rural, low-income country settings. Understanding these pathways is essential for the development of effective interventions to address homelessness and promote recovery. The aim of this study was to explore pathways into and out of homelessness in people with SMI in rural Ethiopia.Methods: In-depth interviews were conducted with 15 people with SMI who had experienced homelessness and 11 caregivers. Study participants were identified through a larger project implementing a multi-component district level plan to improve access to mental health care in primary care (PRIME). Thematic analysis was conducted using an inductive approach.Results: Study participants reported different patterns of homelessness, with some having experienced chronic and others an intermittent course. Periods of homelessness occurred when family resources were overwhelmed or not meeting the needs of the person with SMI. The most important pathways into homelessness were reported to result from family conflict and the worsening of mental ill health, interplaying with substance use in many cases. Participants also mentioned escape and/or wanting a change in environment, financial problems, and discrimination from the community as contributing to them leaving the home. Pathways out of homelessness included contact with (mental and physical) health care as a catalyst to the mobilization of other supports, family and community intervention, and self-initiated return.Conclusions: Homelessness in people with SMI in this rural setting reflected complex health and social needs that were not matched by adequate care and support. Interventions to prevent and tackle homelessness need to focus on increasing family support, and ensuring access to housing, mental health care and social support.

scholarly journals Pathways into and out of homelessness among people with severe mental illness in rural Ethiopia: a qualitative study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Caroline Smartt ◽  
Kaleab Ketema ◽  
Souci Frissa ◽  
Bethlehem Tekola ◽  
Rahel Birhane ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Illness ◽  
Qualitative Study ◽  
Mental Health Care ◽  
Severe Mental Illness ◽  
Low Income ◽  
Rural Setting ◽  
Rural Ethiopia ◽  
Study Participants

Abstract Background Little is known about the pathways followed into and out of homelessness among people with experience of severe mental illness (SMI) living in rural, low-income country settings. Understanding these pathways is essential for the development of effective interventions to address homelessness and promote recovery. The aim of this study was to explore pathways into and out of homelessness in people with SMI in rural Ethiopia. Methods In-depth interviews were conducted with 15 people with SMI who had experienced homelessness and 11 caregivers. Study participants were identified through their participation in the PRIME project, which implemented a multi-component district level plan to improve access to mental health care in primary care in Sodo district, Ethiopia. People enrolled in PRIME who were diagnosed with SMI (schizophrenia, schizoaffective disorder or bipolar disorder) and who had reported experiencing homelessness at recruitment formed the sampling frame for this qualitative study. We used OpenCode 4.0 and Microsoft Excel for data management. Thematic analysis was conducted using an inductive approach. Results Study participants reported different patterns of homelessness, with some having experienced chronic and others an intermittent course. Periods of homelessness occurred when family resources were overwhelmed or not meeting the needs of the person with SMI. The most important pathways into homelessness were reported to result from family conflict and the worsening of mental ill health, interplaying with substance use in many cases. Participants also mentioned escape and/or wanting a change in environment, financial problems, and discrimination from the community as contributing to them leaving the home. Pathways out of homelessness included contact with (mental and physical) health care as a catalyst to the mobilization of other supports, family and community intervention, and self-initiated return. Conclusions Homelessness in people with SMI in this rural setting reflected complex health and social needs that were not matched by adequate care and support. Our study findings indicate that interventions to prevent and tackle homelessness in this and similar settings ought to focus on increasing family support, and ensuring access to acceptable and suitable housing, mental health care and social support.

scholarly journals Barriers to Family Caregivers’ Coping With Patients With Severe Mental Illness in Iran

2018 ◽  
Vol 28 (6) ◽  
pp. 987-1001 ◽  
Author(s):  
Hossein Ebrahimi ◽  
Naeimeh Seyedfatemi ◽  
Hossein Namdar Areshtanab ◽  
Fatemeh Ranjbar ◽  
Graham Thornicroft ◽  
...  
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Illness ◽  
Mental Health Care ◽  
Severe Mental Illness ◽  
Family Caregivers ◽  
Qualitative Content Analysis ◽  
Care Delivery ◽  
Interview Method ◽  
Bipolar Affective Disorders

The broad spectrum of problems caused by caring for a patient with mental illness imposes a high burden on family caregivers. This can affect how they cope with their mentally ill family members. Identifying caregivers’ experiences of barriers to coping is necessary to develop a program to help them overcome these challenges. This qualitative content analysis study explored barriers impeding family caregivers’ ability to cope with their relatives diagnosed with severe mental illness (defined here as schizophrenia, schizoaffective disorders, and bipolar affective disorders). Sixteen family caregivers were recruited using purposive sampling and interviewed using a semi-structured in-depth interview method. Data were analyzed by a conventional content analytic approach. Findings consisted of four major categories: the patient’s isolation from everyday life, incomplete recovery, lack of support by the mental health care system, and stigmatization. Findings highlight the necessity of providing support for caregivers by the mental health care delivery service system.

scholarly journals Next steps for meeting the needs of people with severe mental illness in low- and middle-income countries

2016 ◽  
Vol 26 (4) ◽  
pp. 348-354 ◽  
Author(s):  
C. Hanlon
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Illness ◽  
Human Rights ◽  
Mental Health Care ◽  
Severe Mental Illness ◽  
Mental Health Professionals ◽  
Task Sharing ◽  
Middle Income ◽  
Middle Income Countries

The explicit inclusion of mental health within the Sustainable Development Goals is a welcome development, borne out of powerful advocacy using public health, economic and human rights arguments. As funding comes on line for scale-up of evidence-based mental health care by task-sharing with primary care, it is time to take stock about care for people affected by severe mental illness (SMI). The existing evidence base for task shared care for SMI provides an imperative to get started, but is skewed towards relatively more affluent and urban populations in middle-income countries where specialist mental health professionals provide most of the care. Randomised, controlled trials and rigorous implementation research on task shared service models are underway which will go some way to improving understanding of the quality, safety, effectiveness and acceptability of more widely generalisable care for people with SMI. A sub-group of people with SMI have more complex and long-term needs for care, with a high risk of homelessness, imprisonment and human rights violations as family and social supports become overwhelmed. Case studies from non-governmental organisations provide examples of holistic approaches to rehabilitation, recovery and empowerment of people with SMI, but rigorous comparative studies are needed to identify the most efficient, effective and scalable approaches to care. Health system constraints are emerging as the over-riding barriers to successful task-sharing, highlighting a need to develop and evaluate chronic care models for people with SMI that succeed in reducing premature mortality, improving wellbeing and achieving better social outcomes. Addressing these evidence gaps is essential if task-sharing mental health care is going to deliver on its promise of promoting recovery for the full range of people affected by SMI.

Strengthening mental health services in Sierra Leone: perspectives from within the health system

2020 ◽  
Vol 35 (6) ◽  
pp. 657-664
Author(s):  
Jessica J Fitts ◽  
Fatmata Gegbe ◽  
Mark S Aber ◽  
Daniel Kaitibi ◽  
Musa Aziz Yokie
Keyword(s):  
Mental Health ◽  
Health Care ◽  
Mental Illness ◽  
Mental Health Services ◽  
Health Services ◽  
Mental Health Care ◽  
Health System ◽  
Sierra Leone ◽  
Low Income ◽  
Health Initiatives

Abstract Though mental and substance use disorders are a leading cause of disability worldwide, mental health systems are vastly under-resourced in most low- and middle-income countries and the majority of people with serious mental health needs receives no formal treatment. Despite international calls for the integration of mental health into routine care, availability of outpatient mental health services and integration of mental health into the broader healthcare system remain weak in many countries. Efforts to strengthen mental healthcare systems must be informed by the local context, with attention to key health system components. The current study is a qualitative analysis of stakeholder perspectives on mental health system strengthening in one low-income country, Sierra Leone. It utilizes locally grounded knowledge from frontline healthcare providers to identify constraints and opportunities for strengthening mental health care within each component of the health system. In-depth semi-structured interviews were conducted with 43 participants including doctors, nurses, community health workers, mental health advocates, mental health specialists, and traditional healers recruited from the Bo, Moyamba and Western Area Urban Districts. Interview transcripts were content-coded in NVivo using both a priori and emergent codes and aggregated into broader themes, utilizing the World Health Organization Health Systems Framework. Participants described an extremely limited system of mental health care, with constraints and obstacles within each health system component. Participants identified potential strategies to help overcome these constraints. Findings reinforce the importance of factors outside of the healthcare system that shape the implementation of mental health initiatives, including pervasive stigma towards mental illness, local conceptualizations of mental illness and an emphasis on traditional treatment approaches. Implications for mental health initiatives in Sierra Leone and other low-income countries include a need for investment in primary care clinics to support integrated mental health services and the importance of engaging communities to promote the utilization of mental health services.

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