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In this occasional series we record the views and personal experiences of people who have specially contributed to the evolution of ideas in the Journal's field of interest. Monsignor Ignatius McDermott has spent a life in developing help for homeless or disadvantaged people with alcohol or drug problems.
We present the findings of a narrative approach to the evaluation of supportive housing for formerly homeless people who have experienced serious mental illness. According to the accounts of 11 men and 9 women, their youth and adult years were filled with personal problems, troubled relationships, and a lack of adequate social resources. Since entering supportive housing, participants noted more stability in their lives and the beginning of journeys to recover positive personal identities, restore or develop new supportive relationships, and reclaim resources vital to leading lives with dignity and meaning. The findings add to the literature on housing interventions for this population in suggesting many positive gains beyond reductions in homelessness and hospitalization.
Now that tuberculosis is well controlled in most segments of our society, it is all too often forgotten as a disease that still plagues its less fortunate members. Thus, it may break out wherever persons are housed together for extended periods: for example, naval vessels (not discussed herein), nursing homes, prisons, jails, mental hospitals, chronic disease hospitals, juvenile detention facilities, and shelters for the homeless. It is the responsibility of the authorities operating any such facility to take the necessary precautions to prevent spread of tuberculous infection. This requires more than just keeping the facility clean; it requires the use of some technology--in this instance, in the form of performing tuberculin testing, taking chest radiographs of those who react positively, and treating appropriately those who are infected, whether they are already diseased or merely infected. It should not be forgotten that tuberculosis in any segment of the population endangers all citizens. If this disease is to be eliminated in America, special attention must be given to the segments of society in which both prevalence of infection and incidence of tuberculosis are still high. Probably the most efficient way to stop the spread of infection is through better control of the infection in institutions such as those described in this article.
A symposium with "Medical Treatment Support to Tuberculous Patients--From the standpoint of community support" as its theme was held at the 76th Annual Meeting of the Japanese Society for Tuberculosis (April 20, 2001). "Once, It is infected with tuberculosis, one have to complete medication with a sensitive antituberculosis drug by observing the prescribed dose and duration for successful treatment". For this to be promoted community, it is necessary that (1) to manage patient's medication by medical facilities, (2) to support patient's medication by health center and (3) to support patient's living by welfare offices. Not that each facilities takes such responsibilities alone, but various community must fulfill them continuously in liaison with one another. On what measures should be taken to that end, reports based on practical examples from Nagoya City, Yokohama City and Kanagawa Prefecture have been compiled as follows. 1. It was in-office liaison by conference that supported the DOTS activities of health nurses. 2. It is cooperating, without health, medical treatment, and welfare going out, as follows. (1) A system for hospitals and clinics to carry out DOTS treatment consistently has been kept in good condition. (2) For a patient to take a drug in front of a nurse has become common, causing the patients to be motivated. (3) Assignment of MSW and nurses in charge of DOTS sent from hospitals has make it possible to offer or exchange information smoothly among those concerned. (4) A system for many persons concerned to support patients timely has been kept in good condition. This resulted in an increase in the cure rate of tuberculosis in the areas which have day laborers' lodgings. 3. By DOTS for in-patients, the number of self-discharges has decreased by 1/3, and the treatment completion rate was 94%. 4. In promotion of DOTS for the patients who have health problems other than tuberculosis, the role MSW plays is great. 5. As conditions for supporting DOTS promotion, it is necessary to create a system by which to stabilize the living of the patient himself, guarantee earnings to support it and dissolve the living problem faced by the patient. 6. Introduction of the "early guidance system for the patients in whom the treatment of tuberculosis" was discontinued has strengthened the liaison between health offices and medical facilities, has led to early detection in persons yet to receive medical treatment and resumption of medical treatment, making it possible to deal with problem cases effectively on a priority basis. It has been confirmed that liaison between health, medical service and welfare for community support of the treatment of tuberculous patients who live in that community resulted in improvement of clinical results of tuberculous patients. In this connection, Dr. Shirai advised "For a tuberculous patient to form a habit of taking a drug wherever he lives needs to be recognized as a major subject". He presented the forcible yell. "Any local government office has the homeless. I want you to make efforts so that DOTS be given to all the tuberculous persons. If there is any problem, I am ready to give advice."
OBJECTIVE: The present study examined the traumatic events and behavior symptoms of 46 unaccompanied refugee minors waiting for placement in an asylum center in Finland. METHOD: Using all the clinical information available information about the refugee children's experiences before and during their flight and after their arrival in Finland was gathered. Children were evaluated with the Child Behavior Checklist (CBCL). RESULTS: The refugee children had experienced a number of losses, separations, persecution, and threats. About half of the minors were functioning within clinical or borderline range when evaluated with the CBCL. Young age (< 15 years) was associated with more severe psychiatric problems. There was a lack of rehabilitative services, the staff ratio was very low and the time spent in the asylum center waiting for the placement decision was relatively long for these minors. CONCLUSIONS: Unaccompanied refugee minors are in a highly vulnerable situation. Younger refugee children are more vulnerable to emotional distress than older children. Current procedures for dealing with asylum-seekers may contribute to high level of stress and emotional symptoms in previously traumatized refugee children. A high level of social security and mental health care does not guarantee an appropriate level of care for unaccompanied refugee children.
BACKGROUND: There has been an increase in the numbers of homeless young people in Britain. Little is known of the health and social welfare needs of this population. METHOD: This case-control study compares a random sample of homeless people aged under 22 years recruited from consecutive attenders at two of London's largest facilities for homeless young people with a contemporaneous sample of domiciled young people recruited through general practice registration lists. The homeless and domiciled groups were compared on measures of childhood care, education and psychiatric disorder. RESULTS: One hundred and sixty-one homeless people (88% of those approached) and 107 domiciled subjects (60% of those approached) were interviewed. Sixty-nine per cent of homeless and a third of the domiciled subjects reported a childhood lacking in affection, with indifferent and often violent carers. Psychiatric disorder was identified in 62% of homeless respondents and a quarter of the domiciled population. A fifth of homeless and 5 domiciled respondents had attempted suicide in the previous year. Multivariate analysis suggest that childhood adversity, low educational attainment and the prior presence of psychiatric disorder all independently increase the likelihood of homelessness in a youthful population. CONCLUSIONS: The evidence presented in this paper supports the hypotheses that characterize the young homeless population as experiencing higher rates of childhood adversity and psychiatric disorder than their domiciled contemporaries. A tentative model is suggested whereby childhood experiences, educational attainment and the prior presence of psychiatric disorder all independently increase the likelihood of homelessness in a youthful population.
Maslow's contention that happiness includes striving and is more than a hedonistic construct was tested in a sample of 146 homeless men. Since all participants were homeless, environmental experiences can be considered as largely held constant, allowing an examination of personality and happiness under conditions of strain. Principal axis factor analysis with promax and oblique rotations placed scores from the measures Unhappy-Happy and the Brief Index of Self-actualization on the same factor which supported Maslow's idea. Humanistic-existential psychology has interest in the happiness construct particularly regarding the development of human potential.
Hypothermia is an underreported cause of death in the United States. The clinical presentation of hypothermia may include neurologic, cardiovascular and metabolic abnormalities. In severely hypothermic patients, evaluation may reveal no signs of life until the patient is rewarmed. Treatment is directed at restoring normal body temperature and attending to fluid resuscitation, electrolyte disorders, cardiac arrhythmias and associated disease states or conditions. Groups at particular risk for hypothermia include outdoor workers, the homeless, trauma victims and the very young or very old. Also at risk are persons with preexisting serious illnesses and those who are taking medications or abusing drugs. Cardiac arrest, hypotension, unresponsiveness and severe hyperkalemia portend a poorer prognosis.
Suicide, HIV infection, violent victimization, homelessness, and substance use are known to affect gay (gay males, lesbians, and bisexual persons of both genders) youths at disproportionately high rates. This article explores the difficulties gay youths experience in this society specific to their sexual orientation. These difficulties become internalized by many gay youths, leading to high rates of preventable morbidities and mortalities. Stages of the "coming out" process for gay persons are reviewed within the framework of child and adolescent development. Barriers within the health care system, as well as within other social systems, specific to gay youths are examined. Such barriers include language use by the provider, sexual and social history questions asked by the provider, environmental images in the health care setting, and the responses of the provider to the adolescent. Strategies such as the use of gender-neutral wording, homosexual inclusive questioning in history taking, and the use of inclusive environmental clues to allow gay adolescents to feel safe and accepted are discussed. Health care providers are encouraged to employ such strategies to help reduce these barriers within various health care settings.
Homeless young African American women and low-income, elderly African American women have housing needs specific to their age cohorts, yet they also have parallel and complementary housing, health, and personal needs. The young struggle to afford decent housing, while the old may have difficulty maintaining their homes. In this pilot study, intergenerational contact was established between young homeless women and elderly independently housed women through photovoice. Over six months, five African American women discussed photographs they had taken that focused on their current living arrangements and activities. Although the women spanned three generations, had different life experiences, and resided in a variety of home settings, the sharing of photographs revealed many commonalities. In the process of discussing photographs, the women established mutual respect, exercised reciprocal affirmation, and built alliances. The preliminary study is preparatory to exploring the feasibility of establishing house-sharing arrangements for mutual assistance between these cohorts.
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