Mental Health and Homelessness - 16 November 2011


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Presentation by Jonathan Percale of Tara.

Published in: Health & Medicine
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Mental Health and Homelessness - 16 November 2011

  1. 1. Context: 16.5% of general populations has a 'mental illness' - 8 085 000 (but we have found figures as low as 5% and as high as 19 - 25%...) of those approx 26.5% are severely ill 2 118 270 Not able to function in their daily lives severe mental illness is chronic and progressive Many end up homeless...
  2. 2. <ul><li>Sources such as the California Psychiatric Association suggest that between 20-40% of Homeless people may be people suffering from 'severe mental illness' </li></ul><ul><li>and CBC news report on August 31st 2007 stated that: &quot; Homeless hospitalized more often for mental illness: study </li></ul><ul><li>10,000 people in Canada are homeless on any given night&quot; </li></ul>
  3. 3. <ul><li>There may be many reasons for this: </li></ul><ul><li>There was an international (USA & UK ) move to deinstitutionalise patients </li></ul><ul><li>- reduce hospital stay, provide community care... </li></ul><ul><li>Pressure on beds and </li></ul><ul><li>reduced resources directed to institutions </li></ul><ul><li>insufficient community based care </li></ul><ul><li>revolving door? </li></ul>
  4. 4. <ul><li>Dislocation </li></ul><ul><li>In a 1995 publication entitled &quot;World Mental Health&quot;, the authors suggest that there were 20 million refugees in the world at that time- most from Asia and Africa; </li></ul><ul><li>and another 20 million people displaced in their own countries. </li></ul><ul><li>The migration itself and the new environment can both contribute enormously to trauma, victimisation, lack of support & access to resources. </li></ul>
  5. 5. <ul><li>Stigma </li></ul><ul><li>Stigma of mental illness and prejudice of such patients renders them often even more isolated, and ridiculed in their communities - exacerbating their vulnerability, further impede their capacity to meaningfully participate in their social environments. </li></ul><ul><li>We often fear the mentally ill as dangerous and violent - this is largely inaccurate as a very small minority is dangerous and usually as a last resort - chronically untreated? isolated? ridiculed? </li></ul>
  6. 6. <ul><li>may be due to substances; </li></ul><ul><li>may be part of cognitive impairment... </li></ul><ul><li>Psychiatric symptoms may result from and mask a medical condition; </li></ul>
  7. 7. <ul><li>For these reasons, individuals displaying: </li></ul><ul><li>odd or bizarre behaviour; </li></ul><ul><li>having odd or bizarre beliefs, </li></ul><ul><li>poor self care </li></ul><ul><li>marked decline of previous functioning and behaviour </li></ul><ul><li>extreme and prolonged changes in mood, sleeping patterns, appetite ... </li></ul><ul><li>hear voices, excessive fear, rumination, withdrawal.... </li></ul><ul><li>constantly agitated and restless </li></ul><ul><li>victims of severe stress and trauma </li></ul><ul><li>Need to be assessed by a multi disciplinary team of mental health professionals in order to be diagnosed and receive the appropriate treatment.. </li></ul>
  8. 8. <ul><li>Members of the public may call an ambulance or the police ...and explain your concern - possibly a psychiatric patient. </li></ul><ul><li>To be taken to casualties- </li></ul><ul><li>Chris Hani Baragwanath Hospital </li></ul><ul><li>Charlotte Maxeke Hospital (previously JHB Gen) </li></ul><ul><li>Helen Joseph Hospital; </li></ul><ul><li>OR nearest, local Primary Health Care Clinic. </li></ul><ul><li>May be referred to Tara or Sterkfontein for further treatment if required. </li></ul>
  9. 9. <ul><li>Once in the system - how do we keep patients in the system... </li></ul><ul><li>Down refer back to the local Primary Health Care Clinic for follow up. </li></ul><ul><li>Down refer to a 'step down' facility for further inpatient care and rehabilitation. </li></ul><ul><li>Too Few and under-resourced </li></ul><ul><li>Without family and community support, poor adherence to treatment and relapse is more likely. </li></ul>
  10. 10. <ul><li>A thought... </li></ul><ul><li>It seems that psychiatric illness can lead to homelessness, </li></ul><ul><li>and homelessness may also lead to psychiatric illness </li></ul>