Henrique Prata-Ribeiro António Bento 04.07.2015 Psychiatric disorders in the homeless population; group psychotherapy evaluation Henrique Prata-Ribeiro António Bento 04.07.2015

Homeless “A homeless person is an individual without permanent housing who may live on the streets; stay in a shelter, mission, single room occupancy facilities, abandoned building or vehicle; or in any other unstable or non-permanent situation.” Definition of homeless by the National Health Care for the Homeless Council of USA. National Health Care for the Homeless Council

Homeless internment – General and Transcultural Psychiatry Clinic (2014) Total Homeless 242 internments 219 patients 107 Women (49%) 112 Men (51%) Average Age – 44 years Average days – 21 days 39 internments 34 patients (17% total) 8 women (24%) 26 Men (76%) Average age – 43 years Average days – 22 days The second thing I find important is to try and characterize this specific population, so, here we have the numbers from the clinic I work in. These were recorded last year and they show that, although the age and the average permanence time does not change between non-homeless and homeless population, gender differs very much, with men being much more affected by homelessness in comparison to women. General and Transcultural Clinic Records

Clinic numbers Total Homeless 309 – Adjustment reaction (20%) 298 – Other nonorganic psychosis (14%) 296 – Episodic mood disorders (12%) 300 – Neurotic disorders (11%) 301 – Personality disorders (9%) 295 – Schizophrenic disorders (7%) 295 – Schizophrenic disorders (21%) 309 – Adjustment reaction (18%) 303 – Alcohol dependence syndrome (14%) 296 – Afective psychosis (14%) 298 – Other psychosis (11%) Continuing with this characterization, we find here, in the same clinic, the different diagnosis between homeless and non-homeless, uncovering substantial differences and showing that not only in the social situation is the homeless population different, but also in the pathological one. Therefore, other needs are demanded and attention should be paid to this fact. General and Transcultural Clinic Records

Psychotherapy Group 574 sessions 24-01-2002 to 26-03-2015 15.460 presences from 959 patients Data was collected in 4 sessions: Presences: 182 118 homeless (101M – 17W) 64 non-homeless (29M – 35W); 20 refugees, 11 countries (11M, 9W) Getting to the point of this presentation now, I want to introduce to you the psychotherapy group I’ve had the privilege to work in. Once again, the difference between gender in the homeless population is significant. General and Transcultural Clinic Records

Data collection This was the questionnaire me and Dr. António Bento worked in. As the homeless population was our target and it is a very sensitive population as I will show you, we worried about making it short and simple, occupying only one sheet of paper and containing a small informed consent and mostly yes/no questions.

Data Analysis N – 34 One of the things that shows just how sensitive this population is, is that in a ratio of almost 2:1, homeless people only account for 34% of the total data collected. 100% of patients told they feel heard in the group and that they feel the group helps people. Here we have to consider two bias; the fact that these are the ones that go to the group (so they ought to feel helped and heard); They know we, their doctors, are the ones asking the questions. Homeless at the present tim – 11 (34%) Feel the group helps people – 100% Feel heard in the group – 100%

Data Analysis Biased factors: They know they are answering to doctors They are the ones that go to the group

Data Analysis N – 11 Diagnosed after living on the street – 5 (45,5%) Not being able to try and get my first intention, of understanding if people would more often become homless as a consequence of mental ilness or mentally ill as a consequence of the homeless situation, knowing the diagnosis timing of this population gives me a tool to evaluate the portuguese healthcare system and how people are covered by it. All of the people standing in this graph are now covered by the system, but to some of them, it was only late in their path that this help reach to them. Mental Health Care should be rethinked in order to get to these patients on time. Diagnosed after living on the street – 5 (45,5%) Knew diagnosis before being homeless – 4 (36,4%) Could not remember diagnosis timing – 2 (18,2%)

Conclusions Homeless people are clinically different from the general population, needing a different kind of approach not only because of their social, but also because of their pathological circumstances. Men account for most of this population. The homeless population shows it is more sensitive than the non-homeless in what concerns approach. It is difficult to gain their trust and get them to lower their level of suspicion. The patients that answered the questionnaire all feel this kind of psychotherapy is helpful and provides them with a chance of being heard. It was not possible to conclude whether mental illness is diagnosed mostly before or after the homeless situation, but we can conclude that some patients only get to our HealthCare network after having nowhere to shelter. The approach of psychiatric care to the population should be rethinked.

References National Healthcare for the Homeless Council General and Transcultural Psychiatry Clinic of Centro Hospitalar Psiquiátrico de Lisboa’s records

Psychiatric disorders in the homeless population; group psychotherapy evaluation Henrique Prata-Ribeiro henriqueprata@gmail.com