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      O cuidado a Pessoas em Situação de Rua pela Rede de Atenção Psicossocial da Sé Translated title: Health care for Homeless People by the Network of Psychosocial Attention of Sé

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          Abstract

          RESUMO Este estudo qualitativo teve como objetivos conhecer as ações dirigidas às Pessoas em Situação de Rua que apresentam transtorno mental, desenvolvidas por dois serviços da Rede de Atenção Psicossocial da Sé; identificar obstáculos e pontos de força presentes no cotidiano de trabalho; e conhecer a opinião dos usuários sobre o cuidado recebido. A maioria das ações oferecidas pelos serviços encontra-se alinhada às diretrizes das políticas públicas, considera as características da população e busca responder às suas necessidades. O vínculo entre profissionais e usuários foi compreendido como essencial, mas há sobrecarga e risco de adoecimento dos profissionais.

          Translated abstract

          ABSTRACT This qualitative study aimed to know the actions focusing on Homeless People that present mental disorders, developed by two services of the Network of Psychosocial Attention of Sé; identify obstacles and points of strength present in the daily work; and known the opinion of the users about the care received. Most of the actions offered by the services are in line with public policies guidelines, consider the characteristics of the population and seek to respond to their needs. The bond between professionals and users was understood as essential, but there is overload and risk of illness of the professionals.

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          Different faces of discrimination: perceived discrimination among homeless adults with mental illness in healthcare settings

          Background Research on discrimination in healthcare settings has primarily focused on health implications of race-based discrimination among ethno-racial minority groups. Little is known about discrimination experiences of other marginalized populations, particularly groups facing multiple disadvantages who may be subjected to other/multiple forms of discrimination. Objectives: (1) To examine the prevalence of perceived discrimination due to homelessness/poverty, mental illness/alcohol/drug related problems, and race/ethnicity/skin color while seeking healthcare in the past year among racially diverse homeless adults with mental illness; (2) To identify whether perceiving certain types of discrimination is associated with increased likelihood of perceiving other kinds of discrimination; and (3) To examine association of these perceived discrimination experiences with socio-demographic characteristics, self-reported measures of psychiatric symptomatology and substance use, and Emergency Department utilization. Methods We used baseline data from the Toronto site of the At Home/Chez Soi randomized controlled trial of Housing First for homeless adults with mental illness (n = 550). Bivariate statistics and multivariable logistic regression models were used for the analysis. Results Perceived discrimination related to homelessness/poverty (30.4%) and mental illness/alcohol/substance use (32.5%) is prevalent among ethnically diverse homeless adults with mental illness in healthcare settings. Only 15% of the total participants reported discrimination due to race/ethnicity/skin color. After controlling for relevant confounders and presence of psychosis, all types of discrimination in healthcare settings were associated with more frequent ED use, a greater - 3 - severity of lifetime substance abuse, and mental health problems. Perceiving discrimination of one type was associated with increased likelihood of perceiving other kinds of discrimination. Conclusions Understanding the experience of discrimination in healthcare settings and associated healthcare utilization is the first step towards designing policies and interventions to address health disparities among vulnerable populations. This study contributes to the knowledge base in this important area. Trial registration number This study has been registered with the International Standard Randomized Control Trial Number Register and assigned ISRCTN42520374.
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            Descartáveis urbanos: discutindo a complexidade da população de rua e o desafio para políticas de saúde

            A condição de precariedade da população adulta de rua é tratada no âmbito da saúde e das intervenções sociais visando levantar subsídios para a implementação de políticas públicas de saúde para essa população. A conceituação dessa população e sua relação com a exclusão social, a cidade, as economias paralelas, a globalização, as estratégias e os circuitos de sobrevivência desenvolvidos se inserem num contexto de oposição aos mecanismos de apartação social e rompimento dos vínculos familiares, bem como na forma de tratamento institucional. A precariedade e insalubridade das ruas, culminando em exposição e riscos cumulativos requerem intervenções e formas de tratamento orientadas, segundo a sua especificidade, desafiando os conceitos gerais de universalidade, integralidade e eqüidade do Sistema Único de Saúde.
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              Qualidade na pesquisa qualitativa

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                Author and article information

                Contributors
                Role: ND
                Role: ND
                Journal
                sdeb
                Saúde em Debate
                Saúde debate
                Centro Brasileiro de Estudos de Saúde (Rio de Janeiro, RJ, Brazil )
                0103-1104
                2358-2898
                December 2017
                : 41
                : spe3
                : 1130-1142
                Affiliations
                [1] São Paulo São Paulo orgnameUniversidade de São Paulo orgdiv1Faculdade de Medicina Brazil livia_bustamante@ 123456yahoo.com.br
                [2] São Paulo São Paulo orgnameUniversidade de São Paulo orgdiv1Faculdade de Medicina Brazil mangeli@ 123456usp.br
                Article
                S0103-11042017000701130
                10.1590/0103-1104201711511
                9b11b56e-dbbe-46a8-bbaa-53ce5118d562

                This work is licensed under a Creative Commons Attribution 4.0 International License.

                History
                : April 2017
                : September 2017
                Page count
                Figures: 0, Tables: 0, Equations: 0, References: 26, Pages: 13
                Product

                SciELO Public Health


                Mental health services,Pessoas em Situação de Rua,Saúde,Colaboração intersetorial,Serviços de saúde mental,Homeless People,Health,Intersectoral collaboration

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