Pathways into and out of homelessness among people with severe mental illness in rural Ethiopia: a qualitative study
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 h...
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| Format: | Article |
| Language: | English |
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BMC
2021-03-01
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| Series: | BMC Public Health |
| Subjects: | |
| Online Access: | https://doi.org/10.1186/s12889-021-10629-8 |
| _version_ | 1818415557218664448 |
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| author | Caroline Smartt Kaleab Ketema Souci Frissa Bethlehem Tekola Rahel Birhane Tigist Eshetu Medhin Selamu Martin Prince Abebaw Fekadu Charlotte Hanlon |
| author_facet | Caroline Smartt Kaleab Ketema Souci Frissa Bethlehem Tekola Rahel Birhane Tigist Eshetu Medhin Selamu Martin Prince Abebaw Fekadu Charlotte Hanlon |
| author_sort | Caroline Smartt |
| collection | DOAJ |
| description | 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. |
| first_indexed | 2024-12-14T11:36:53Z |
| format | Article |
| id | doaj.art-3ba411959c904137b1587cb7ecd6a335 |
| institution | Directory Open Access Journal |
| issn | 1471-2458 |
| language | English |
| last_indexed | 2024-12-14T11:36:53Z |
| publishDate | 2021-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Public Health |
| spelling | doaj.art-3ba411959c904137b1587cb7ecd6a3352022-12-21T23:02:58ZengBMCBMC Public Health1471-24582021-03-0121111310.1186/s12889-021-10629-8Pathways into and out of homelessness among people with severe mental illness in rural Ethiopia: a qualitative studyCaroline Smartt0Kaleab KetemaSouci Frissa1Bethlehem Tekola2Rahel Birhane3Tigist Eshetu4Medhin Selamu5Martin Prince6Abebaw Fekadu7Charlotte Hanlon8King’s College London, Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental HealthKing’s College London, Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental HealthKing’s College London, Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental HealthAddis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-BuildingAddis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-BuildingAddis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-BuildingKing’s College London, Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental HealthAddis Ababa University, College of Health Sciences, School of Medicine, Department of Psychiatry, WHO Collaborating Centre for Mental Health Research and Capacity-BuildingKing’s College London, Institute of Psychiatry, Psychology and Neuroscience, Health Service and Population Research Department, Centre for Global Mental HealthAbstract 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.https://doi.org/10.1186/s12889-021-10629-8HomelessnessSevere mental illnessLow- and middle-income countriesGlobal mental healthPsychosisSubstance use |
| spellingShingle | Caroline Smartt Kaleab Ketema Souci Frissa Bethlehem Tekola Rahel Birhane Tigist Eshetu Medhin Selamu Martin Prince Abebaw Fekadu Charlotte Hanlon Pathways into and out of homelessness among people with severe mental illness in rural Ethiopia: a qualitative study BMC Public Health Homelessness Severe mental illness Low- and middle-income countries Global mental health Psychosis Substance use |
| title | Pathways into and out of homelessness among people with severe mental illness in rural Ethiopia: a qualitative study |
| title_full | Pathways into and out of homelessness among people with severe mental illness in rural Ethiopia: a qualitative study |
| title_fullStr | Pathways into and out of homelessness among people with severe mental illness in rural Ethiopia: a qualitative study |
| title_full_unstemmed | Pathways into and out of homelessness among people with severe mental illness in rural Ethiopia: a qualitative study |
| title_short | Pathways into and out of homelessness among people with severe mental illness in rural Ethiopia: a qualitative study |
| title_sort | pathways into and out of homelessness among people with severe mental illness in rural ethiopia a qualitative study |
| topic | Homelessness Severe mental illness Low- and middle-income countries Global mental health Psychosis Substance use |
| url | https://doi.org/10.1186/s12889-021-10629-8 |
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