Abstract
BackgroundThe impact of mental disorders among homeless people is likely to be substantial in low income countries because of underdeveloped social welfare and health systems. As a first step towards advocacy and provision of care, we conducted a study to determine the burden of psychotic disorders and associated unmet needs, as well as the prevalence of mental distress, suicidality, and alcohol use disorder among homeless people in Addis Ababa, the capital of Ethiopia.MethodsA cross-sectional survey was conducted among street homeless adults. Trained community nurses screened for potential psychosis and administered standardized measures of mental distress, alcohol use disorder and suicidality. Psychiatric nurses then carried out confirmatory diagnostic interviews of psychosis and administered a locally adapted version of the Camberwell Assessment of Needs Short Appraisal Schedule.ResultsWe assessed 217 street homeless adults, about 90% of whom had experienced some form of mental or alcohol use disorder: 41.0% had psychosis, 60.0% had hazardous or dependent alcohol use, and 14.8% reported attempting suicide in the previous month. Homeless people with psychosis had extensive unmet needs with 80% to 100% reporting unmet needs across 26 domains. Nearly 30% had physical disability (visual and sensory impairment and impaired mobility). Only 10.0% of those with psychosis had ever received treatment for their illness. Most had lived on the streets for over 2 years, and alcohol use disorder was positively associated with chronicity of homelessness.ConclusionPsychoses and other mental and behavioural disorders affect most people who are street homeless in Addis Ababa. Any programme to improve the condition of homeless people should include treatment for mental and alcohol use disorders. The findings have significant implications for advocacy and intervention programmes, particularly in similar low income settings.Electronic supplementary materialThe online version of this article (doi:10.1186/s12916-014-0138-x) contains supplementary material, which is available to authorized users.
Highlights
The impact of mental disorders among homeless people is likely to be substantial in low income countries because of underdeveloped social welfare and health systems
Our study demonstrates the high burden of mental disorder and unmet health and social care needs of the street homeless in Ethiopia
This is the first study in Africa, or any other low income country, attempting to determine the prevalence of mental disorders among street homeless people, or to estimate the unmet needs of street homeless people with psychosis
Summary
The impact of mental disorders among homeless people is likely to be substantial in low income countries because of underdeveloped social welfare and health systems. As a first step towards advocacy and provision of care, we conducted a study to determine the burden of psychotic disorders and associated unmet needs, as well as the prevalence of mental distress, suicidality, and alcohol use disorder among homeless people in Addis Ababa, the capital of Ethiopia. More historical description of homeless people may be tracked in legislative documents from the UK dating back to the late 13th century [2]. Some link the onset of homelessness as a problem in Africa with the disruption of the kinship networks and loss of land ownership during colonialism: ‘As Europeans built their estates, expanded their market places, and planned their public squares, indigenous communities were left homeless and were pushed into the peripheries of urban and commercial life’ [6]
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