King's College London, Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental Health, London, UK.
King's College London, King's Global Health Institute, London, UK.
BMC Public Health. 2021 Mar 22;21(1):568. doi: 10.1186/s12889-021-10629-8.
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.
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.
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.
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.
在农村、低收入国家环境中生活的有严重精神疾病（SMI）经历的人，他们流浪和摆脱流浪的途径知之甚少。了解这些途径对于制定有效的干预措施以解决流浪问题和促进康复至关重要。本研究旨在探索埃塞俄比亚农村地区有 SMI 经历的人流浪和摆脱流浪的途径。
对 15 名有流浪经历的 SMI 患者和 11 名照顾者进行了深入访谈。研究参与者是通过他们参与 PRIME 项目确定的，该项目实施了一项多部分的区县级计划，以改善在初级保健中获得精神保健的机会，地点在埃塞俄比亚的 Sodo 区。在 PRIME 中登记的被诊断为 SMI（精神分裂症、分裂情感障碍或双相情感障碍）并在招募时报告有流浪经历的人构成了这项定性研究的抽样框架。我们使用 OpenCode 4.0 和 Microsoft Excel 进行数据管理。采用归纳法进行主题分析。
研究参与者报告了不同模式的流浪经历，有些是长期的，有些是间歇性的。流浪发生在家庭资源不堪重负或无法满足 SMI 患者需求时。流浪的最重要途径据报道是由于家庭冲突和精神健康恶化，在许多情况下与物质使用相互作用所致。参与者还提到逃避和/或想要改变环境、经济问题以及来自社区的歧视是导致他们离开家的原因。摆脱流浪的途径包括与（身心健康）保健接触，作为动员其他支持、家庭和社区干预以及自我发起返回的催化剂。
在这个农村环境中，SMI 患者的流浪反映了复杂的健康和社会需求，而这些需求并没有得到足够的照顾和支持。我们的研究结果表明，在这种和类似环境中预防和解决流浪问题的干预措施应该侧重于增加家庭支持，并确保获得可接受和合适的住房、精神保健和社会支持。
