On the Way Up? : Exploring homelessness and stable housing among homeless people in the Netherlands

Around 31,000 people in the Netherlands were literally homeless in 2015. This thesis focused on the situation of homeless people in the Netherlands and into developments in their situation over time. More insight into the situation of homeless people and into developments over time is relevant for practice and policy making and to improve the quality of life of homeless people. This thesis aimed a) to explore factors - substance use, intellectual disability and care needs - related to homelessness and their development over time among homeless people in the Netherlands, b) to investigate predictors of stable housing, and c) to explore changes in indicators of social exclusion and the association between changes in indicators of social exclusion and psychological distress. A cohort consisting of 500 homeless people in the Netherlands who reported to a central access point for social relief was followed for a period of 2.5 years. Around two-thirds of this cohort were stably housed at 2.5-year follow-up. Although being housed is an important step forward, it is a first step. To maintain a stable housing situation, progress and stability in other life domains is important. The results of the studies presented in this thesis show that the participants are on the way up, but also that ongoing support is still required

Predicting homeless people’s perceived health after entering the social relief system in The Netherlands

Objectives: We explored whether changes in the perceived health of homeless people after entering the social relief system (SRS) in The Netherlands were predicted by housing, income, hours of work, social support, unmet care needs, arrests, physical and mental health, substance use, and experiences of autonomy, competence and relatedness, in addition to perceived health at baseline, demographics, suspected intellectual disability, the duration of homelessness and the company of children in the shelter facility. Methods: A hierarchical regression analysis was used to explore the significant predictors of the perceived health of 344 homeless persons 18 months after entering the social relief system. Results: A decrease in psychological distress and an increase in hours of (paid/voluntary) work as well as competence predicted a better perceived health. Conclusions: Perceived health is not only influenced by objective circumstances related to work and mental health, but also self-determination, as shown by the influence of competence. Services should aim to reduce psychological distress of homeless people, support them in increasing their working hours and focus on strengthening their competence

Changes in Social Exclusion Indicators and Psychological Distress Among Homeless People Over a 2.5-Year Period

Although homelessness is inherently associated with social exclusion, homeless individuals are rarely included in conventional studies on social exclusion. Use of longitudinal survey data from a cohort study on homeless people in four major Dutch cities (n = 378) allowed to examine: changes in indicators of social exclusion among homeless people over a 2.5-year period after reporting to the social relief system, and associations between changes in indicators of social exclusion and changes in psychological distress. Multinomial logistic regression analysis was applied to investigate the associations between changes in indicators of social exclusion and changes in psychological distress. Improvements were found in various indicators of social exclusion, whereas financial debts showed no significant improvement. Changes in unmet care needs, health insurance, social support from family and relatedness to others were related to changes in psychological distress. This study demonstrated improvements in various indicators of social exclusion among homeless people over a period of 2.5 years, and sheds light on the concept of social exclusion in relation to homelessness

Intellectual disability among Dutch homeless people: Prevalence and related psychosocial problems

Background: There is a higher prevalence of intellectual disability (ID) among homeless people than in the general population. However, little is known about the additional psychosocial problems faced by homeless people with ID. We describe the prevalence of ID in a cohort of homeless people in the Netherlands, and report relationships between ID and psychosocial problems in terms of psychological distress, substance (mis)use and dependence, as well as demographic characteristics in this cohort. Methods: This cross-sectional study is part of a cohort study among homeless people in the four major cities of the Netherlands. Data were derived from 387 homeless people who were interviewed and screened for ID six months after the baseline measurement. Multivariate logistic regression analyses and χ2 tests were performed to analyze relationships between ID, psychosocial problems and demographic characteristics. Findings: Of all cohort members, 29.5% had a suspected ID. Participants with a suspected ID had a higher mean age, were more likely to be male and to fall in the lowest category of education than participants without a suspected ID. Having a suspected ID was related to general psychological distress (OR = 1.56, p<0.05), somatization (OR = 1.84, p<0.01), depression (OR = 1.58, p<0.05) and substance dependence (OR = 1.88, p<0.05). No relationships were found between a suspected ID and anxiety, regular substance use, substance misuse and primary substance of use. Conclusion: The prevalence of ID among Dutch homeless people is higher than in the general population, and is related to more psychosocial problems than among homeless people without ID. Homeless people with a suspected ID appear to be a vulnerable subgroup within the homeless population. This endorses the importance of the extra attention required for this subgroup

Uit de schulden:Wat werkt voor mensen met een verslaving?

Dit artikel beschrijft de resultaten van een kwalitatief onderzoek naar de situatie van mensen met schulden en verslavingsproblematiek. Door het vergroten van inzicht in hun kenmerken en problematiek kan de hulpverlening aan deze doelgroep verbeterd worden. Het onderzoek laat zien dat er sprake is van een wederkerige relatie tussen schulden en verslaving: schulden lopen op door de verslaving en de verslaving wordt versterkt door de oplopende schulden. De volgende drie elementen zijn essentieel in de hulpverlening aan mensen met schulden en verslavingsproblematiek: a) goede aansluiting bij de specifieke doelgroep (laagdrempeligheid, expertise van schulden en verslaving), b) aandacht voor het versterken van eigen kracht, en c) aandacht voor het inzetten van het sociale netwerk van de cliënt of van vrijwilligers

Uit de schulden: Wat werkt voor mensen met een verslaving?

Dit artikel beschrijft de resultaten van een kwalitatief onderzoek naar de situatie van mensen met schulden en verslavingsproblematiek. Door het vergroten van inzicht in hun kenmerken en problematiek kan de hulpverlening aan deze doelgroep verbeterd worden. Het onderzoek laat zien dat er sprake is van een wederkerige relatie tussen schulden en verslaving: schulden lopen op door de verslaving en de verslaving wordt versterkt door de oplopende schulden. De volgende drie elementen zijn essentieel in de hulpverlening aan mensen met schulden en verslavingsproblematiek: a) goede aansluiting bij de specifieke doelgroep (laagdrempeligheid, expertise van schulden en verslaving), b) aandacht voor het versterken van eigen kracht, en c) aandacht voor het inzetten van het sociale netwerk van de cliënt of van vrijwilligers