António Marques

Cristina Queirós

Nuno Rocha

Sílvia Quintas

Repositório Aberto da Universidade do Porto

António Marques 1,2,3, Sílvia Quintas1,3, Cristina Queirós1,3 & Nuno Rocha 1,2,3Promoting mental health and preventing mental-ill health among the increasing groups of socially marginalized, in particularly homeless people, is a major challenge to European societies. There are various policies andservices to achieve this in Europe, but information on what constitutes best practice is fragmented. Moreover, consistent guidelines do not exist and the services provided not always respond adequately to the needs andcharacteristics of the homeless citizens. The overall purpose of this study was to identify the typical characteristics and needs of Portuguese homeless in urban area of Porto, to review existing models of rehabilitation that arerelevant to this client group and to characterise the support services that will assist intentionally this homeless in the rehabilitation and social integration process.F PCE U P FACULDADE DE PSICOLOGIA E DE CIÊNCIAS DA EDUCAÇÃOUNIVERSIDADE DO PORTOTable 3. Identified needs of homeless Participants: 60 Portuguese homeless in Porto urban area, Portugal; 12 institutions specifically targeted for homeless people in Porto.Methodology: The study was based in qualitative semi-structured interviews, using interviews guidelines specifically developed for and on the targeted study population. These were structured with questions aiming tocharacterize the homeless profile, their physical and mental health, typology and satisfaction with social support, and support needs. The interviews to the institutions coordinators concerned on characterizing the available typesof support and health care, as well as the articulation with other similar organizations Procedures: The interviews, both to the homeless and coordinators, were applied by the same researcher between April and October 2009, in a single contact. The majority of the interviews to the homeless were held onthe street and during the night, having a “street support service” as the privileged link. Some interviews were held in the homeless hostels of two associations (the Associação de Médicos Internacional (AMI) and theAssociação de Albergues Nocturnos do Porto). The researcher presented always briefly the study and referred the confidentiality and anonymity guarantees. Data Analysis:Descriptive analysis were developed using SPSS 15.0, and complementarily qualitative data was analyzed with the resource to content analysis technique.MethodsTable 1. Health condition of homelessResults and Conclusions1Psychosocial Rehabilitation Laboratory (FPCEUP-ESTSP), Portugal2 Porto Polytechnic Institute - School of Allied Health Sciences (ESTSP), Portugal3 University of Porto - Faculty of Psychology and Educational Sciences, Portugalajpmarques@estsp.ipp.pt; silvia_m_monteiro@hotmail.com; cqueiros@fpce.up.pt; nrocha@estsp.ipp.pt; 10TH World Congress of WAPRBangalore, India, November 2009PurposeCharacteristics, Needs and Care Services for Homeless Adults in the City of Porto, Portugal(N=60) %Unemployment 19 31,7(N=60) %Basic Without assurance of food and clothes 32 54Homeless sample (60 individuals):- age: mean = 44 years (range 17 to 69)- sex: 87% male (52) and 13% female (8)-marital status: 58% single (35), 8% married (5), 30% divorced (18) and 3% (2) divorced-deviant behavior: 3% prostitution (2), 30% delinquency (18), 47% aggressive behavior (28) and 38% victim of maltreatment (23)- nationality: 82% Portuguese (49), 12% Africans (7), 5% east Europe (3) and 2% Brazilian (1)- race: 87% Caucasian (52) and 13% black (8)- educational level: 90% minimum (54), 10% medium or higher (6) - last profession: 25% services or commerce jobs (15) and 75% non qualified workers (45)BibliographyBento, A. & Barreto, E. (2002). Sem - amor Sem - abrigo. Lisboa: Climepsi Editores.Cruz, S., Neves, M., Quintas, R, Quintas, A & Bastos, V. (2006). Vidas à parte – Passado, presente e futuro. Porto: Associação dos Albergues Nocturnos do Porto. Departamento Municipal de Desenvolvimento Social (2001). Sem-Abrigo na cidade do Porto. Estudo Exploratório. Porto: Câmara Municipal do Porto.M.T.S.S. (2009). Estratégia Nacional para Integração de Pessoas Sem-Abrigo - Prevenção, Intervenção, Acompanhamento. Lisboa: Ministério do Trabalho e da Segurança Social.Table 2. Homeless history and survival strategiesQualitative data characterized the Portuguese homeless profile in urban area of Porto: single (Portuguese) men, around 40 years, low educated, long-term unemployed; the majority come from families that have beendisruptive or dysfunctional in some way; underutilization of public entitlements; isolation from family, friends, and other support networks; and with a mix of addiction, mental and/or physical health problems. The Portospecialized homeless support system has articulation problems, insufficient resources and is organized to satisfy essentially basic needs (92% institutions guarantee meals and clothing; however, only 47% individuals havethese basic needs assured). Strategies to improve treatment adherence, psychological support and rehabilitation are necessary to redesign lifestyles and to promote the effective social integration of these Portuguesecitizens. This conclusion strengthens the Portuguese National Integration Strategy for homeless, established in March 2009.(N=60) %Physical HealthCardiovascular diseases 6 10Infectious diseases 6 10Orthopedic conditions 8 13,3Metabolic Diseases (Diabetes…) 2 3,3Dermatologic disturbances 2 3,3Gastrointestinal disturbances 2 3,3Various diseases 10 16,8None 24 40Mental HealthMood disorders 15 25Anxiety disorders 7 11,7Schizophrenia and other psychotic disorders 5 8,3Sleep disorders 3 5Cognitive disorders 1 1,6None 29 48,3AddictionTobacco 8 13,3Tobacco + alcohol 20 33,3Tobacco + drugs 9 15Tobacco + alcohol + drugs 18 30None 5 8,3CausesFamiliar rupture 11 18,3Drug abuse 9 15Familiar rupture + unemployment 11 18,3Familiar rupture + drug abuse 4 6,7Unemployment + drug abuse 6 10Street permanency Less than 1 year 25 41,71 to 5 years 19 31,76 to 17 years 6 10More than 18 years 3 5Don’t answer 7 11,6Survival strategiesHelping car parking 7 11,6Begging 7 11,6Thieving 2 3,3Doing small non formal tasks 13 21,7None 31 51,7Table 4. Characterization of institutionsneeds With food and clothes assured 28 46HousingLiving on the street 21 35Institutionalized 28 46,7Rented room 11 18,3EconomicsNo income 33 55Social insertion subsidy 18 30Unemployment allowance 4 6,7Retirement pension 5 8,3Familiar supportContact with family 23 38,3No contact with family 37 61,7Social networkStreet colleagues 11 18,3Techniques + street colleagues 28 46,7Techniques + street colleagues + family 21 35(N=12)Institution providesMeals 11 92Clothes 8 67Personal care – including clothing management3 25Nursing care 2 17Housing 4 33Professional and psichossocial inclusion 9 75Team includesPsychologist 7 58Social worker 7 58Doctor 5 42Mental health nurse 1 8Jurist 2 16cooperation between institutionsSocial well-fare 5 42Hospitals 2 16Local authorities 1 8religious 1 8Other institutions 3 25Type of institution Private 5 42Religious 5 42Private health 2 16Professionals’ considerations on needs: - it should exist an articulated network ( 12 institutions in a city with 10.0000 habitants with 2000 homeless estimated)- there should be created multidisciplinary teams focused only on motivating leaving streets life- there should be created more familiar, social, and professional reintegration support systems- it should be created specific support on psychopathology treatment- the existentialist perspective should be overcome, since it only sustains the problem- it is a very difficult phenomena to eradicate since it has multiple causes- homeless people have more needs than the answer capacity of the institutions- autonomy it’s not always a possibility to all the individuals

Characteristics, needs and care services for homeless adults in the city of Porto, Portugal

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Repositório Aberto da Universidade do Porto