"We live in a stone cage where everyone wants to be a lion": A critical discourse-ethical study for homelessness nurse-led street outreach in Portugal.

Homelessness continues to be a pressing global health concern, intensifying vulnerability and health risks among people experiencing the phenomenon. Through in-depth storytelling sessions with ten homeless adult men, this qualitative study explored the lived experiences of homeless men residing in temporary tent shelters in Durban, South Africa. Thematic analysis revealed rich, personal accounts of the men’s experiences. Findings revealed a complex situation of resilience and vulnerability, with five key themes emerging: supportive brotherhood, increased health risks, difficulties with shelter maintenance, compromised privacy, and theft of personal belongings. This study highlights the urgent need for targeted interventions addressing shelter conditions, health services, and security measures in temporary homeless shelters. Interested stakeholders need to prioritise creating dignified, safe, and supportive environments that holistically address the needs of individuals experiencing homelessness.

This article draws on institutional ethnography to examine the austerity‐driven closure of a homeless care facility in Cologne, Germany. It expands debates on public urban cultures of care by highlighting the significance of spatially embedded institutional loops and their impact on malfunctioning care spaces from a multi‐level perspective. The article demonstrates that spatial loops and classifications within the framework of austerity politics undergo a transformation and directly affect spaces and cultures of homeless care. At the macro and meso levels, institutional actors (municipal administration, property committees, the head of the facility, and social workers) are engaged in negotiations over the acceptance and rejection of spatial responsibility. At the same time, at the micro level, homeless men themselves are required to navigate altered loops within various spaces of care, encountering highly paradoxical paternalistic cultures of care. The specific spatial context—shaped by political agendas, institutional structures, and the interplay of various spaces of care—is crucial for better understanding the dynamics of public urban cultures of care for the homeless and other marginalized communities.

The influence of community-centered design and design-build projects on architectural education has increased in the last decade. Including student-led community-engaged projects in the curriculum of architecture schools has shaped architectural education and influenced the profession. These projects provide a service to communities or non-profit organisations in need of design solutions. Engaging social responsibility and public interest design represents an ideological shift in the way that architecture schools are approaching education. There is often an intersection of public interest design and design-build in these projects. This paper explores the question, can an academic community-based design-build project provide a new transitional housing prototype for the homeless? And, do these projects fulfil the needs of students to provide effective learning experiences for promoting their desire to promote communities they serve?Architecture schools provide learning experiences through various initiatives. For example, Yale University’s “The Yale Building Project,”1 Auburn University’s “Rural Studio”2 and University of Kansas “Studio 804”3 have had long-running public interest design studios. These designbuild initiatives educate students outside the typical design studio. This article will provide an overview of public interest and design-build education in the United States to provide context for introducing this into the curriculum at an Australian university.The Prefab 21 design-build studio is a partnership between the Deakin University School of Architecture and Built Environment, FormFlow, and Samaritan House, a shelter for homeless men, that focuses on the design and fabrication of a prototype house. This transdisciplinary project was accomplished in design studio and workshop sessions that designed, documented, and built an Independent Living Unit (ILU) and created a microvillage of seven ILUs at Samaritan House. This prototype has an extensive impact through it providing a new typology for transitional homeless accommodation and jobs in the region. Cover image: Samaritan House Microvillage Aerial View

Both experiencing homelessness and having survived a violent firearm injury are well-known risk factors for being a victim of violence. Despite there being significant racial disparities in these factors, there is no qualitative research examining the experiences of Black men who survive a gunshot wound and were homeless after their injury. Drawing on over a year of ethnographic research at the two busiest hospital-based violence intervention programs in the state of Maryland, this research centers the experiences of violently injured homeless Black men to understand how to best support their health, healing, and social goals. Emergent themes from the research included the significant need for housing after injury, challenges with healing while homeless, and difficult experiences with housing institutions. The findings suggest that additional supportive care services for Black men who survive gunshot wounds are needed to increase access to safe and stable housing.

Objectives This study aims to explore the psychological counseling experiences of homeless men to support their journey out of homelessness. Methods Data were collected through two in-depth interviews with eight homeless individuals, including both those under legal protection and those without it. The collected data were analyzed using Giorgi’s phenomenological research method, with both situational and general structural statements systematically presented Results The psychological counseling experiences of homeless individuals were categorized into four main themes: ‘counseling that facilitates transitioning out of homelessness,’ ‘challenges in counseling,’ ‘emotional experiences through life retrospection,’ and ‘personal transformation through counseling.’ Based on these findings, a four-stage psychological counseling process for supporting the transition out of homelessness was identified. Conclusions This study highlights the positive impact of psychological counseling on the self-reliance of homeless individuals by presenting specific counseling experiences and stages aimed at assisting their transition out of homelessness. The study also discusses its limitations and provides suggestions for future research.

Background: Diabetes lifestyle interventions can prevent type 2 diabetes (T2D), the leading cause of death and disability, especially among marginalized populations. Preventing or delaying the progression of T2D involves modification of high-risk behaviors. Peer educators and lay health workers can effectively implement Diabetes Prevention Program (DPP) interventions. Objective: The objective of the study was to adapt and deliver an evidence-based, nurse-led, peer-facilitated DPP for homeless men with substantial risks for T2D. Methods: This pilot project utilized a phased approach for implementation science. It was implemented with formerly homeless men enrolled in a residential employment center within an urban environment. Results: Significant improvements were observed for meal-time portion control, daily physical activity, replacement of sugar-sweetened beverages with water, cutting back on cigarettes, and weight loss from baseline to week 12. Conclusion: Despite significant achievements in meeting their personal health behavior goals, the men revealed serious competing concerns. The peer facilitators (PF) and participants were concerned about the need for sustained employment so that they could meet their basic needs (i.e., income, food, housing, etc.). Implications for Nursing: The men found performing as PF beyond 12 weeks without pay to be unreasonable, although they were enthusiastic about improving their own health, as well as the health of their friends and family.

A transdiagnostic approach is increasingly recognized as crucial in the prevention or treatment of child internalizing and externalizing mental health concerns. There is substantial overlap and comorbidity among various mental health concerns and the onset of one mental illness elevates the risk of others, underscoring the potential limitations of singular-focused mental health education or treatment. Meaning Mindset Theory (MMT) is a transdiagnostic framework developed and evaluated over the past decade in Canada as a promising new approach. MMT emphasizes agency over thoughts and behaviors, empathy and social competence skills, and meaningful engagement to enhance resilience for both internalizing and externalizing symptoms. The DREAM Program-Developing Resilience through Emotions, Attitudes, and Meaning is a mental health education program grounded in MMT principles. This program has enhanced meaning mindset-agency over thoughts and behaviors, hope for a future that is good, positive self-concept, and openness to learning, new experiences, and feelings-as well as both internalizing and externalizing mental health. To date, the DREAM program, as well as MMT more broadly, has been tested in diverse populations with school-aged children, families, neurodiverse and intellectually gifted young people, homeless men, and Black families, among others. Future research should explore the efficacy of an MMT in therapeutic settings compared to standard treatments, potentially enhancing mental health intervention strategies for Canadian children and families.

This article is devoted to housing exclusion and support for people experiencing homelessness in Poland. It presents the results of research aimed at discovering individual ways of entering this crisis (the causes of exclusion), as well as at getting to know the narratives of men living in shelters about housing support and the role of social workers in the process of getting out of homelessness. The research was conducted using the case study method, with the help of a narrative interview. The data obtained showed that various factors lead to homelessness, primarily family, institutional, fi nancial, housing, health, individual and systemic factors. The respondents expect social inclusion, especially housing, but they are accompanied by fears and uncertaintyrelated to change. They also see the many roles played by social workers withwhom they work on a daily basis. Above all they appreciate the counselling, material support, encouragement to do therapy, for socio-professional activation, personal development, contact with the loved ones and assistance in dealing with offi cial matters. The condition for preventing the petrifaction of homelessness is the help offered to people struggling with this crisis led by specialists and social workers. An important factor in the process of getting out of homelessness are housing programs, which not only give people experiencing homelessness hope to improve their lot, but above all, they are an important motivating factor for any changes.

(1) Background: Suicide represents a critical global public health concern. In the majority of countries, men have higher rates of suicide completion, while women show higher rates of suicide attempts. Masculinity is a complex construct shaped by socialization processes that begin early in life. The aim of this study is to explore the influence of masculinity on suicidal behaviors among men. (2) Methods: This systematic review was conducted in accordance with the Cochrane and PRISMA guidelines. The review protocol was pre-registered in the International Prospective Register of Systematic Reviews (PROSPERO). (3) Results: This systematic review—which includes 18 studies—highlights the detrimental influence of hegemonic masculinity on both the occurrence and frequency of suicide among men, with a particularly significant negative impact on vulnerable men (e.g., homeless men; adolescents and young men; and men with addiction, depression, and/or other mental health issues), where the consideration of intersectionality is essential. (4) Conclusions: Men who strongly conformed to the norms and values linked to traditional masculinity were more prone to die by suicide and to report experiencing suicidal thoughts and attempts. Analyzing suicidal behavior from a gender perspective is critical for effective prevention and treatment, as gender disparities are clearly observed in both suicide fatalities and nonfatal attempts.

Despite the increasing substance use in Canada, our understanding of how substance use varies based on the intersections of gender, ethnicity/race, and income sources among preclinical populations remains limited. Thus, this study aimed to investigate, among clients of mental health and addiction (MHA) intake in Nova Scotia: 1) the prevalence of substance use by gender, ethnicity, and income source; 2) the routes of substance administration; 3) factors associated with substance use. Understanding how gender, ethnicity, and income sources intersect to influence substance use patterns is essential for designing prevention and treatment strategies tailored to an individual's unique needs. Additionally, exploring the various routes of substance administration can provide insight into potential health risks, helping to inform harm reduction strategies. This cross-sectional study included 22,500 adults who contacted MHA central intake in Nova Scotia in 2020 and 2021. Clients were assessed for substance use, substance use frequency, route of substance administration, and mental and physical health problems. The prevalence of substance use was examined as a function of gender, ethnicity, and income source. Multinomial logistic regression was used to investigate factors associated with substance use. Among the included MHA Intake clients, 36.1% reported daily substance use. The highest prevalence of daily substance use was identified among homeless (69.7%) and non-White men on social assistance/disability (60.9%). Also, non-White individuals on social assistance/disability were more likely to engage in frequent (aOR = 2.66, 95% =1.64, 4.30) and daily (aOR = 2.82, 95% CI: 2.08, 3.82) substance use compared to White individuals. Being young (aged 19-29), lack of access to private insurance, current/past mental illness, moderate/high suicide risk, and presence of two or more psychosocial stressors, were associated with occasional, frequent, and daily substance use alike. The high prevalence of daily substance use among MHA Intake service users in Nova Scotia highlights the need for prevention and treatment strategies to address individual and structural level factors contributing to daily substance use.

Roofless individuals represent the most severe category of homelessness. Their clinical characteristics and mortality patterns in Central and Eastern Europe are little known. A single-center retrospective case-control study at the internal medicine department in Bratislava, Slovakia was conducted. 5694 mortality records from 2010 to 2023 were screened, and 141 (118 men, 23 women) roofless individuals were identified. Patients were sex- and age-matched, with 141 patients from the cohort of non-homeless deceased patients. Compared to controls, roofless people had a higher incidence of immobility (p = 0.02) and hypothermia (p < 0.0001) at admission. 83% of the roofless people were men, and 59% of the roofless people died before reaching old age (60+). Homeless men died more often from infectious disease (p = 0.02), pneumonia being the most common one (60%). Men from the control group died more often from liver diseases (p = 0.03). There were no significant differences in the causes of mortality between women. These findings could help to reduce the invisibility of the issue of massive premature mortality amongst homeless populations and roofless individuals, in particular.

This paper is based on an ethnographic study of how domesticity is enacted and adapted at homeless shelters for determining which clients are “service worthy .” The study draws on nineteen placement meetings with homeless men and focuses on institutional mechanisms for encouraging homemaking skills or domesticity among clients. Adapting Robert K. Merton's typology of adaptations to social norms, as well as Jaber Gubrium's “task‐designated identity,” we showcase male clients' self‐presentation strategies for adapting to the institutional mandates of domesticity. Specifically, our qualitative analysis reveals four modes of task adaption: (1) task conformity by professing the desired norms in their service encounters, (2) task evasion to avoid conversations and related tasks, (3) task transformation by linking the task at hand with something other than originally intended, particularly by reframing biographies to meet the local goals of domesticity, and (4) task protestation, which involves questioning the rationale and necessity of assigned tasks.

The issue of homelessness exists in every county and even the wealthiest have not managed to eliminate it. Countries with a highly-developed system of homeless people assistance record the largest number of them in their statistics. At the beginning of 2023, the number of homeless people in Germany amounted to 372,000. The purpose of the research was to diagnose the functioning of homeless people in Germany and to show their individual life experiences. The method used was a narrative interview according to Mayring. The research was carried out within the territory of Westphalia, and in the institutional meaning, the research area was the Social and Educational Care Home. As a result of the research, it turned out that the causes of homelessness, among others, include: arrears in rent payments and related evictions, unemployment, as well as divorces, death of a partner and addictions. Homeless people are rather satisfied with the fact that they live in the Social and Educational Care Home, which provides homeless men with food, housing and all kinds of support services.

ABSTRACT My Man Godfrey (Gregory La Cava, 1936) begins with a critique of Depression-era public relief efforts but then focuses for the remainder of the film on the attempts of one ‘forgotten man’ to restore patriarchal authority to a female-dominated household. In the substitution of disciplined women for politically resistant homeless men, the film maps the consent of the subject to sovereign rule onto the screwball comedy’s plot convention of female submission, thus naturalizing sovereignty, and feminizing the disciplined subject of the welfare state.

Mental health and substance abuse problems among homeless people are serious public health concerns that raise death and illness rates in the United States. We studied the mental health and substance abuse rates among homeless people to see their impact on their lives while looking at how states and federal authorities help tackle this problem. The team performed online database searches across Google Scholar, Science Direct, Medline, Embase, and Scopus databases from 1990 to 2023 for research material identification. Participants between 18 and 64 were studied for their mental health challenges, Substance Use, and homelessness and the research excluded interventional and rehabilitation data. Thirty scholarly works dedicated to understanding substance abuse and mental health problems among homeless Americans emerged from this research. We performed a systematic analysis of peer-reviewed publications using different academic databases. We collected data about how common mental health issues and drug use problems are among homeless people over time while looking at their age groups and results from treatment programs. We used statistical methods to find important relationships between study data. Our research combined statistical analysis with historical data evaluation and tested various intervention solutions. Studies found homeless men experienced more mental health and Substance Use-disorders including depression and anxiety than homeless females. Before 2018 alcohol posed the biggest substance abuse challenge in the region but methamphetamine use emerged as equally dangerous by 2018. The latest HUD and SAMHSA statistics reveal growing numbers of homeless people who have both mental health and Substance Use-disorders. About 60% of individuals experiencing homelessness develop both mental health disorders and substance addiction as their situation progresses. The evidence shows we should create united treatment systems and research how mental and substance abuse disorders affect people experiencing homelessness. Health care organizations and government officials need to design complete treatment plans that target both mental health and addiction disorders at the same time. We need different treatment methods that match each age group and their cultural background. Patients achieve better treatment outcomes when addiction and mental health treatment programs team up with access to housing. Research needs immediate attention to track mental health and Substance Use patterns of homeless individuals especially on new drugs and treatment availability. Data indicates mental health and Substance Use-disorders continue to worsen among people who experience homelessness. A successful program must bring together safe housing options alongside psychological care and drug recovery services. By developing targeted programs and improving access to care we can help homeless individuals who struggle with mental health and Substance Use-disorders.

Homelessness is considered to be a global problem, independent of the material situation of a given country and occurring in most societies around the world. Assessment of the preferred health behaviors of homeless people. The study covered 153 men who are homeless and 312 men who are not homeless. The original questionnaire of homeless, and validated the Satisfaction with Life Scale (SWLS), the Health Behavior Inventory (HBI), the General Self-Efficacy Scale (GSES) and the Multidimensional Health Locus of Control (MHLC) Scale were used. The research covered fully completed questionnaires from 153 homeless men staying in Białystok and Gdańsk homelss centers. On average, the homeless men assessed their health at 6.0 ± 2.7 points, and the non-homeless at 7.8 ± 2.2 points (p < 0.001). Significant differences were found between people experiencing a homelessness crisis and the control group in selected aspects concerning the everyday life hygiene of the respondents, health self-assessment, declarations of visits to a specialist and carrying out check-ups, level of satisfaction with life, coping with difficult situations, preferred pro-health behaviors and dimensions of health control. In the used scales, SWLS, HBI, GES, and MHCL, the majority of homeless men obtained average scores. They were rather dissatisfied with their lives, with a low level of effectiveness in coping with difficult situations and obstacles, a low level of health behaviors, and in the scope of health, control increasing the impact of chance. The level of the presented health behaviors showed statistically significant diversification with all dimensions of the health locus of control, and its internal dimension with age, homelessness phase, the respondents' criminal history, being under constant medical care, and self-assessment of health.

Homelessness is a significant and increasing problem in modern Russia, which is admitted mostly by NGOs. In addition, in academic, media and state discourses, homelessness is traditionally viewed as a male phenomenon, and there is a lack of research focused on the gender aspects of homelessness in Russia. Therefore, the underrepresentation of homeless women’s experiences and their comparison to homeless men’s experiences, in academic and policy research in Russia, influence the diversity and quality of services provided to homeless people. Based on an analysis of 60 in-depth qualitative interviews conducted with homeless men and women in Saint Petersburg, this article compares men’s and women’s coping strategies in the situation of homelessness. Research shows that the homeless experience is gender-specific. When lacking resources, women use a special gendered form of capital—‘feminine’ capital—while men utilise more masculine coping strategies. The patriarchal traditions and values of Russian society also play a significant role in the paths of people experiencing homelessness.

The purpose of this commentary is to update social workers about the evolution of Mindfulness-Oriented Recovery Enhancement (MORE) since the publication of the book Mindfulness-Oriented Recovery Enhancement for Addiction, Stress, and Pain (Garland, 2013, reviewed in Martin, 2022) and to provide a succinct overview of MORE’s clinical outcomes and mechanisms. MORE is an evidence-based social work intervention that unites mindfulness training, cognitive–behavioral therapy (CBT), and positive psychology into an integrative treatment for addiction, stress, and chronic pain. Across weekly MORE sessions, participants learn mindfulness, reappraisal, and savoring techniques to alleviate symptoms, enhance well-being, and strengthen their recovery. MORE draws on principles from social–behavioral learning theory to enhance motivation to practice, maximize therapeutic expectancy, and positively reinforce success experiences to increase participant engagement. Since 2013, MORE has been tested in 11 clinical trials, demonstrating efficacy for clients struggling with addiction and related issues (e.g., psychiatric disorders, chronic pain). The first Stage 1 randomized controlled trial (RCT) of MORE was conducted in a sample of people with alcohol use disorder (many of whom had co-occurring cocaine use disorder) residing in a long-term therapeutic community. This pilot (N = 53) provided an initial indication of MORE’s potential treatment value, demonstrating effects on addiction risk mechanisms including alcohol attentional bias and autonomic recovery from alcohol cue exposure—indicators of the extent to which a patient was “triggered” by addiction cues (Garland et al., 2010). Subsequently, my colleagues and I launched a five-year Stage 3 RCT (N = 180) of MORE at the same therapeutic community in a sample of formerly homeless men with co-occurring substance use disorders, trauma, and psychiatric disorders. MORE outperformed both trauma-focused CBT (a program based on Seeking Safety) and usual care in reducing drug craving and PTSD symptoms (Garland et al., 2016). For these first two trials of MORE, the treatment was targeted for clients in the “action” and “maintenance” stages of change (Prochaska et al., 1992).

"Sleeping Rough" was shot during the summer of 2001 among a group of homeless men and women in the city centre of Hamburg after six months of ethnographic fieldwork. While the homeless are often represented as outcasts of society, this film shows critical and self-reflexive people who master their lives in public with an undefeated spirit. The cohesion of the group provides the matrix through which individuals in varying stages of liminality can find solace and support. The camera offers a privileged view of daily routines and work as well as leisure time which is spent socialising in a public square equipped with a container for luggage. Intimately and sometimes with disenchanted frankness the protagonists reflect on the circumstances of their situation, between romance and tragedy, past disappointments and future ambition. More than 20 years after the production of the film, the situation of homeless people in Germany has not improved. The number of rough sleepers in Hamburg has increased from roughly 1000 in 2009 to almost 2000 in 2018. The city centre of Hamburg is still a highly contested space.