Most common mental health issues and challenges that young homeless people are facing and which treatment to apply: the case of Portugal

European Conference on Youth Homelessness Prague, 8/11/201 Most common mental health issues and challenges that young homeless people are facing and which treatment to apply: the case of Portugal
ANTÓNIO BENTO
Director of General and Transcultural Psychiatry Office
Psychiatric Hospital Centre of Lisbon (CHPL)
abento@chpl.min-saude.pt
Investing in young people to prevent a lost generation in Europe: key policy and practice in addressing youth homelessness
8th November 2013, Prague, Czech Republic

1st national study of homeless in Portugal (Institute of Social Security, ISS, IP) 2005
Count of rough sleepers: 467

Homelessness National Strategy 2009
It holds on a rights-based approach, including the right to housing and equal opportunities as well as other basic rights.
The goals are framed upon two basis axes:
Information; combat against discrimination, education
Qualification of intervention
Special importance is given to the implementation of local diagnosis including risk indicators and local homelessness plans within the social network program and homelessness strategy ‘s framework and to an integrated and client centred approach, with individual insertion contracts

Homelessness National Strategy Definition of Homeless Person
A person who, regardless of nationality, age, gender, socio- economic and health and mental condition, finds herself:
“roofless” - living in public spaces, emergency shelters or in precarious stopping-place (cars,stairs, building entrances,etc), or
“homeless” – in temporary housing centres for homeless
(These two categories follow the FEANTSA- ETHOS definition)

1988-1989 Psychiatric patients in a shelter of Lisbon
•Psychiatric diseases: 83%
•History of psychiatric consultations: 78%
•History of psychiatric inpatients: 34%
•34% psychosis (24% schizophrenias)
•20% personality disorders
•12% depressions
•10% drugs dependence
•(Bento et al, 1989)

2002 –Lisbon
In a sample of 1000 street homeless in Lisbon:
 - 58% with alcohol abuse/dependence
 - 27% with drug abuse/dependence
(Bento et al, 2002)

2002 – Lisbon
In a sample of 1000 street homeless in Lisbon:
Alcohol (F 10) ……………………………... 34 %
Drugs (F11-12) ………….…………….…… 15 %
Schizophrenias (F20) ……….………….…. 9 %
Other psychosis (F22-29) ……..…….….... 12 %
Personality disorders (F60-69) …..….….. 9 %
Others …………………..…..………………. 17 %
Without diagnosis ………..…….……..…… 4 %
(Bento et al, 2002)

2002-2013 Psychotherapeutic group in a psychiatric hospital (CHPL)
N= 791patients
(301 homeless + 490 other patients)
(Bento et al, 2013)

2002-2013 Psychotherapeutic group in a psychiatric hospital (CHPL)
301 homeless:
• Alcohol (30%)
• Schizophrenia (19%)
• Other psychoses (9%),
• Post Traumatic Stress Disorders (14%)
• Personality disorders (9%)
• Drug abuse/dependence (6%)
• Mental retardation (4%)
• Other disorders (9%)
(Bento et al, 2013)

Youth homeless in a shelter of Lisbon (1988-1989, N= 44)
5 (10,1 %)
2 Schizophrenia
2 Personality disorders
1 Mental retardation
(Bento et al, 1989)

Youth homeless in the streets of Lisbon (1994-2002, N= 1000)
66 (6,6%)
34 drugs dependence
8 alcohol dependence
6 schizophrenias
5 other psychoses
5 mental retardation
2 personality disorders
6 other diagnosis
(Bento et al, 2002)

Youth homeless in a psychotherapeutic group (2002-2013, N= 301)
16 (5,3 %)
6 post traumatic stress disorders
3 drugs dependence
3 personality disorders
2 schizophrenias
2 others psychoses
8 (50%) foreign refugees
(Bento et al, General and Transcultural Psychiatry Office/CHPL)

Youth homelessness
10,1 % in a sample of 44 homeless in a shelter in Lisbon (1989)
6,6 % in a sample of 1000 street homeless in Lisbon (2002)
5,3 % in a sample of 301 homeless in a psychotherapeutic group (2013)

?
“ In NL,the UK and PT, respondents (young homeless) rarely have no roof over their heads; they manage to find (temporary) shelter with friends, family or in social service facilities.”
(Combating Social Exclusion among Young Homeless Population, 2011)

Why so few youth homeless?
The key-workers that were interviewed (under a general remark “we have no persons around those ages”-16-25 years old) highlighted that administrative records do not allow capturing young people in homeless or social exclusion situations, since the process is usually submitted by identifying the household member responsible for the assistance request, mainly the mothers. This means that only from adult ages, after living the household, that people assume themselves as applicants, especially from 30 years old up “
“Part of the youth universe is invisible at the administrative records”
Source: National Report on Youth Homelessness and Youth at risk of Homelessness in Portugal (CSEYHP project), april 2009, CIES-ISCTE

The law n.º 147/99 for the Protection of Children and Young People at Danger
The law n.º 147/99 defines as a child or youth :
the person with less than 18 years old.
However, a young person institutionalised may ask for a prorogation of stay up until reaching 21 years old.

21
Child and Youth Protection System
Relevant entities in childhood and
Youth issues and Community in
general
CPCJ/CPEJ
Court
MP
Family
The principle of subsidiarity (art. 4º): level of interventions
DANGER
CNPCJR/CNP
EJR

CPCJ- Commissions for the Protection of Children and Young People
These Commissions have the goal to prevent and stop situations susceptible to endanger the physical and moral integrity of the child or young person.
They are based at a municipal council’s level and unite representatives from diverse local institutions, such as health care centres, schools, police, neighbourhood's citizens.

23
CNPCJR/CNPEJR 98/98DL , April 18 th
Article 2º (Constitution)
Representatives of entitees :
a) Presidency of the Council of Ministers;
b) Ministry of Justice;
c) Ministry of Labour and Solidarity;
d) Ministry of Education;
e) Ministry of Health;
f) General Procurator of the Republic;
g) Provider of Justice;
h) Secretary of State for Youth;
i) Government of the Autonomous Region of the Azores;
j) Government of the Autonomous Region of Madeira;
k) National Association of Municipalities;
l) Union of Institutions of Social Solidarity;
m) Union of “Misericórdias”;
n) Union of Mutualities .

MEASURES FOR THE PROMOTION OF RIGHTS FOR CHILDREN AND YOUNG PEOPLE
•I – Family replacement
 a) Social counselling and accompaniment for the child and the family
 b) Placement with another member of the family
 c) Delivery of the child or the young person in the care of a suitable person
 d) Support for independent living
• II – Institutionalisation

1988-2013
What has changed:
More research and knowledge on homelessness
Homelessness is today a triviality for many people
Several outreach multidisciplinary teams
Homelessness National Strategy
Local plans for homelessness
More involvement of social and health partners, public
and private
Participation at international networks

Portugal census - 2011
696 homeless in Portugal!

2013 What can and should absolutely change today?
Political commitment is absolutely needed
Implementation of Common policies measures (with different sectors commitment)
More resources are needed
Efective input from research at the development of policies

Homelessness National Strategy
•Full Implementation!
•Examples:
•Prevention
•Case managers for all homeless people!
•That no one has to remain in the street after release of an institution
•Assessement of mental health problems

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