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

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 homelessn...

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Autores principales: Smartt, Caroline, Ketema, Kaleab, Frissa, Souci, Tekola, Bethlehem, Birhane, Rahel, Eshetu, Tigist, Selamu, Medhin, Prince, Martin, Fekadu, Abebaw, Hanlon, Charlotte
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2021
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7986271/
https://www.ncbi.nlm.nih.gov/pubmed/33752638
http://dx.doi.org/10.1186/s12889-021-10629-8
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author Smartt, Caroline
Ketema, Kaleab
Frissa, Souci
Tekola, Bethlehem
Birhane, Rahel
Eshetu, Tigist
Selamu, Medhin
Prince, Martin
Fekadu, Abebaw
Hanlon, Charlotte
author_facet Smartt, Caroline
Ketema, Kaleab
Frissa, Souci
Tekola, Bethlehem
Birhane, Rahel
Eshetu, Tigist
Selamu, Medhin
Prince, Martin
Fekadu, Abebaw
Hanlon, Charlotte
author_sort Smartt, Caroline
collection PubMed
description 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-021-10629-8.
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spelling pubmed-79862712021-03-24 Pathways into and out of homelessness among people with severe mental illness in rural Ethiopia: a qualitative study Smartt, Caroline Ketema, Kaleab Frissa, Souci Tekola, Bethlehem Birhane, Rahel Eshetu, Tigist Selamu, Medhin Prince, Martin Fekadu, Abebaw Hanlon, Charlotte BMC Public Health Research Article 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. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1186/s12889-021-10629-8. BioMed Central 2021-03-22 /pmc/articles/PMC7986271/ /pubmed/33752638 http://dx.doi.org/10.1186/s12889-021-10629-8 Text en © The Author(s) 2021 Open AccessThis article is licensed under a Creative Commons Attribution 4.0 International License, which permits use, sharing, adaptation, distribution and reproduction in any medium or format, as long as you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons licence, and indicate if changes were made. The images or other third party material in this article are included in the article's Creative Commons licence, unless indicated otherwise in a credit line to the material. If material is not included in the article's Creative Commons licence and your intended use is not permitted by statutory regulation or exceeds the permitted use, you will need to obtain permission directly from the copyright holder. To view a copy of this licence, visit http://creativecommons.org/licenses/by/4.0/. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated in a credit line to the data.
spellingShingle Research Article
Smartt, Caroline
Ketema, Kaleab
Frissa, Souci
Tekola, Bethlehem
Birhane, Rahel
Eshetu, Tigist
Selamu, Medhin
Prince, Martin
Fekadu, Abebaw
Hanlon, Charlotte
Pathways into and out of homelessness among people with severe mental illness in rural Ethiopia: a qualitative study
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 Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7986271/
https://www.ncbi.nlm.nih.gov/pubmed/33752638
http://dx.doi.org/10.1186/s12889-021-10629-8
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