most common mental health issues and challenges that young homeless people are facing and which...

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)

[email protected]

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

mailto:[email protected]



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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