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PubMed2006

The healing circle: resiliency in nurses.

The concept of resiliency has been explored extensively in the fields of developmental psychology as an adaptive life process. Increasingly nurses have begun to study resiliency in a wide variety of settings and client populations. This article explores the concept of resiliency in nurses. Resiliency was described through the use of personal exemplar, tracing the author's odyssey of nursing homeless men in an emergency shelter. The author proposes that the traits of resiliency in nurses are widespread and largely unrecognized. There is a pressing need to cultivate and foster personal growth in nurses because we cannot give our patients what we do not possess ourselves.

Adaptation, Psychological↗

PubMed1997

Deinstitutionalization and criminalization: tinkering in the interstices.

The mental health service system has undergone continuous change for more than three decades. Undoubtedly, some of its problems are related to economic, social and political factors. This contribution discusses problems of deinstitutionalization, homelessness and criminalization of the mentally ill persons. To conclude, it proposes a number of ways by which better services could be rendered to the mentally disordered persons, particularly in areas that interface with the criminal justice system.

Criminal Law↗

PubMed1996

Seroprevalence to Bartonella quintana among patients at a community clinic in downtown Seattle.

In 1993, an outbreak of 10 cases of Bartonella quintana bacteremia occurred among homeless, alcoholic, human immunodeficiency virus (HIV)-negative persons in Seattle. To estimate the prevalence of past exposure B. quintana among this population, a serosurvey was conducted in 1994 among patients at a downtown Seattle clinic. Microimmunofluorescent titers to B. quintana in 192 clinic patients were compared with titers in 199 age- and sex-matched Seattle volunteer blood donors. Titers > or = 64 were detected in 20% (39/192) of clinic patients compared with 2% (4/199) of blood donors (P<.001). Among clinic patients, alcohol abuse was independently associated in multivariate analysis with titers > or = 64 (odds ratio, 3.3; 95% confidence interval, 1.6-6.9). Of the 39 patients with B. quintana titers > or = 64, 24 (62%) also had titers > or = 64 to Bartonella henselae, indicating serologic cross-reactivity between Bartonella species. These results suggest that a substantial proportion of this indigent, inner-city Seattle population was infected with B. quintana.

Adolescent↗

PubMed2004

Client and community services satisfaction with an assertive community treatment subprogram for inner-city clients in Edmonton, Alberta.

OBJECTIVES: To evaluate client and agency satisfaction with a specific assertive community treatment subprogram, known as inner-city support, developed in Edmonton to target the inner-city population, and to determine the demographics and potential needs of this population. METHOD: Clients were administered questionnaires based on the Client Satisfaction Questionnaire and the Satisfaction With Life Scale. We also conducted a face-to-face interview. We contacted and similarly surveyed 18 community agencies. RESULTS: The program was well received, although areas for improvements included dissemination of information and hours of operation. Clients also requested more input regarding the development of activities. Clients were predominantly male with a diagnosis of schizophrenia comorbid with substance abuse and antisocial personality disorders, a history of forensic contact, homeless, and dependent on social assistance. CONCLUSION: Among the population with serious and persistent mental illness, inner-city clients represent a particularly disadvantaged subpopulation that may benefit from specialized community programs.

Adolescent↗

PubMed1996

What have you learned from your homeless experience? A phenomenological approach for counseling unsheltered homeless men.

Field notes were obtained from 145 unsheltered homeless men regarding what they had learned from an experience of homelessness. Responses represented an aspect of each person's internal frame of reference. Statements about trust in self and an efficacy to survive were common themes. Findings were placed in a humanistic-existential model useful for counseling.

Adult↗

PubMed2003

Community care for people who are homeless and mentally ill.

This qualitative longitudinal study documents the experiences of 60 people who are homeless and mentally ill from their state mental hospital discharge through their first two years in community housing. The study explores the personal, cultural, and environmental contexts of life for adults who are homeless and mentally ill and examines the interaction between an individual's needs and community resources. The research identifies forces that perpetuate homelessness and traces the struggles that people who are homeless and mentally ill encounter during the transition from the streets to stable housing. The findings describe a culturally based pattern of mutual avoidance between homeless mentally ill clients and caregivers, which limits delivery of services to the population. Recommendations include development of alternative systems of care delivery, expansion of educational experiences with underserved populations, and increased funding for service or research with people who are homeless and mentally ill.

Adolescent↗

PubMed2001

Some perspectives on deinstitutionalization.

The authors discuss what can be learned from our experience with deinstitutionalization. The deinstitutionalization of mentally ill persons has three components: the release of these individuals from hospitals into the community, their diversion from hospital admission, and the development of alternative community services. The greatest problems have been in creating adequate and accessible community resources. Where community services have been available and comprehensive, most persons with severe mental illness have significantly benefited. On the other hand, there have been unintended consequences of deinstitutionalization-a new generation of uninstitutionalized persons who have severe mental illness, who are homeless, or who have been criminalized and who present significant challenges to service systems. Among the lessons learned from deinstitutionalization are that successful deinstitutionalization involves more than simply changing the locus of care; that service planning must be tailored to the needs of each individual; that hospital care must be available for those who need it; that services must be culturally relevant; that severely mentally ill persons must be involved in their service planning; that service systems must not be restricted by preconceived ideology; and that continuity of care must be achieved.

Criminal Law↗

PubMed1998

Correlates of early onset and chronicity of homelessness in a large urban homeless population.

This study examined temporal relationships between relative onsets of mental illness and homelessness in a cross-sectional study of 900 homeless people compared with a matched, never-homeless sample from the Epidemiologic Catchment Area study. All psychiatric disorders preceded homelessness in the majority. Only one disorder, alcohol use disorder (in men only), had significantly earlier onset in homeless subjects. Regarding number of symptoms or earlier age of onset of psychiatric disorders, earlier onset of homelessness was associated with several diagnoses: schizophrenia, major depression, generalized anxiety disorder, alcohol and drug use disorders, and antisocial personality. In multiple regression models, history of dysfunctional family background and maternal psychiatric illness were also associated with earlier onset of homelessness, whereas education was protective. Chronicity of homelessness was associated with number of symptoms of alcohol use disorder and earlier age of onset of drug use disorder, presence and number of symptoms of schizophrenia and antisocial personality, and earlier onset of major depression and conduct disorder. In multiple regression models, more education, but not family background problems, was associated with shorter lifetime duration of homelessness. These findings provide information relevant to the roles of mental illness and personal vulnerability factors in the onset and chronicity of homelessness.

Adult↗

PubMed2007