1 HOMELESSNESS AND MENTAL HEALTH IN HILLBROW, SOUTH AFRICAby Unotida Moyo, Leila Patel & Eleanor Ross CSDA, 11 June 2014
2 RATIONALE FOR THE STUDYCentral Gauteng Mental Health Society identified a need for the research as they experienced challenges in dealing with homeless persons with mental illness. They therefore approached the Centre for Social Development in Africa (CSDA) at the University of Johannesburg. The topic resonated strongly with Unotida Moyo who had the personal experience of living with a brother with mental illness who nearly landed up on the streets of Johannesburg. Uno responded to the challenge by conducting the study for her master’s degree in Social Work and was awarded a distinction for her dissertation.
3 BACKGROUND Homelessness is a worldwide problem and there has been substantial research on homelessness in South Africa. Factors contributing to homelessness in this country include Apartheid policies e.g. Influx Control & the Group Areas Act which led to forced removals, the creation of townships far from sources of employment and Bantustans which could not support all their inhabitants. Labour migration caused fragmentation of families. Inferior health, welfare and education to the black population exacerbated poverty, unemployment & inequality. With the dismantling of Apartheid there was widespread migration across borders & from rural to urban areas leading to a mismatch between demand for housing & employment and availability of these resources, further exacerbating homelessness.
4 The juxtaposition of poverty & affluence
5 BACKGROUND (CONT.) Very little is known about homelessness & mental illness. Seager and Tamasane (2010:72) estimate that 58% of adults in the general South African population experience symptoms of depression while 6% of adults with severe chronic psychiatric illnesses are homeless. This is likely to be an undercount. What we do know is that mental illness can increase the risk of homelessness, while the harsh conditions on the streets are likely to produce and aggravate symptoms of mental illness. The nature of mental illness also makes it “difficult for homeless persons to negotiate street life and meet needs for food, safety, shelter and treatment” (Ambrosino et al., 2008: 223). Despite progressive social policies and legislation such as the SA Constitution and the Mental Health Care Act of 2002, the rights of many homeless persons with mental illness are violated as implementation in the field of mental health often lags behind policy and legislation (Freeman , 2013).
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7 METHODOLOGY The study used a qualitative, ethnographic approach to explore the social situation of homeless persons with mental illness in Hillbrow. Interviews and observations were conducted with three groups, namely, six homeless persons, six homeless persons with mental illness and six service providers. The Mental Status Examination (MSE) and the Mini Mental State Examination (MMSE) were used to identify homeless persons with mental illness. The study was approved by the UJ Ethics Committee and data were analysed using thematic content analysis.
8 FINDINGS
9 Reasons for homelessness
10 Health & Exposure to violenceDue to their harsh & unhygienic living conditions, their health was compromised. “We used to go out on the streets to their hotspots and ask their friends. Sometimes we could find out they are sick with HIV/AIDS. They could not move and we called an ambulance or we called the hospices and took them there”. (Service provider) They had all experienced violent assaults. “There is no life here, we stab one another. We will kill one another and the SAPS they arrest us all the time” . (Homeless person)
11 Relations between homeless persons & those with mental illnessBoth the homeless and those with mental illness generally related well to one another and shared a common sense of identity. “We live well together, for example, when there are functions on the streets we invite each other and then we go together. Some of the guys I know them from before in other shelters and some we met at school”. “Sometimes we get along sometimes no, because some will tell you they have been long on the streets and you will be new, and we harm each other in such cases”.
12 However, the homeless persons with mental illness appeared to be more vulnerable and more dependent on other homeless persons for their survival. “We live very well because we are now used to him. He makes us laugh. Sometimes he is in the right senses”. “When they inhale glue they become worse”. “We communicate well with them, even though I cannot help them because we all need help. I can’t focus on somebody else to help me”.
13 Survival strategies Despite adverse living conditions, they revealed a sense of agency and resilience by developing different survival strategies e.g. washing, parking and guarding cars; use of alcohol and drugs to de-stress; deriving support from relationships with partners; compliance with treatment and medication; and reliance on spiritual beliefs. “It is difficult for the homeless mentally ill persons to survive on the streets because they can’t even help out with parking. They do nothing all day”. (Homeless person)
14 Services provided Psychiatric assessments & psychotropic medicationCounselling & psychosocial support Follow-ups Outreach activities Accommodation, food, clothes & blankets Referrals Family re-unification Assistance with grants & documentation Recreation programmes Education & training in computer literacy & life skills e.g. hygiene & sexually safe behaviour.
15 Perceptions of service delivery & service providersWhen the homeless participants and those with mental illness were asked about their views on service delivery and the attitudes of service providers, some were positive & appreciative while others complained about the hostility of some professionals & having to wait longer periods than other patients to be attended to at clinics. “They take care of me well. For example, when I was stabbed they brought me back to life”. “If they see you are from the streets they do not help you immediately until they are done with their other patients”.
16 Challenges experienced by service providers
17 CONCLUSIONS Results would appear to reflect the failure of housing welfare, education and health care policies and need to be viewed against the backdrop of poverty unemployment and violence in South Africa.
18 RECOMMENDATIONS Department of Social Development needs to continue funding NGOs for providing outreach services. More residential facilities are needed for homeless youth, adults and older persons. SAPS, Home Affairs, Social Development, community health services & civil society need to work together to address problems of homelessness from prevention, early intervention through to dealing with manifestations of homelessness. Causal factors such as family breakdown, poor parenting, poverty , unemployment & other factors affecting family functioning & school attendance need to be addressed timeously. Issues of alcoholism & drug abuse as well as the dangers of street life need to be included in school curricula. Epidemiological data are needed in respect of homeless persons with mental illness to assist with policy formulation & implementation.
19 Thank you.