Social capital and mental health in homeless people

虽然欧洲议会最近加大了努力，促进获得优质护理和减少保健不平等现象，但整个欧洲的无家可归现象呈上升趋势。无家可归包括：(a)无屋顶；(b)无家可归；(c)居住在没有保障的住房中；(d)居住在不足的住房中。据估计，在英国，2016年有4000人露宿街头，比2015年增加了21%。在伦敦，去年无屋率估计增长了3% - 7%。有充分的证据表明，无家可归对心理健康有不利影响。与一般公众相比，无家可归者出现抑郁、酒精/药物依赖和精神病等问题的比率较高。无家可归者的死亡率也大幅上升，这与心理健康问题有关。尽管他们需要照顾，但无家可归者在试图获得服务时遇到了许多障碍。由于无家可归的比率正在上升，制定一项有效的战略以减轻受影响者的精神痛苦和减少无家可归现象就变得越来越重要。一个创新的和未被探索的途径是通过社会资本理论的镜头来探索无家可归。社会资本是指群体和社区内部的社会关系。它包括：桥梁（同质群体中个人之间的联系），纽带（异质群体中个人之间的联系）和联系（与权威和权力机构（如政府）的联系）。联系有助于人们生存，并提供必要的社会凝聚力和支持；搭桥有助于人们取得成功，促进社会尊重和团结；联系有助于调动政治资源和权力。关于这一主题的现有研究表明，无家可归者往往是孤立的，社会支持和社会功能水平较低。它们可能有键合成分，但缺乏桥接和连接。然而，依赖于亲密关系可能会有问题。例如，从街头同伴那里获得工具性支持（建立联系）会降低一个人参与就业服务的可能性。精神疾病的高发率、缺乏住房、混乱的生活方式、缺乏动力和羞耻感可能会导致许多无家可归者难以与熟人和那些没有直接和密切社交圈的人保持社会联系（弱关系）。然而，有限的弱关系可能导致社会孤立和疏离感，缺乏归属感和降低幸福感。这项研究将重点关注那些无家可归的人。它旨在回答以下问题：1)无家可归者在多大程度上拥有社会资本？2)为无家可归者搭建桥梁、建立纽带和联系的优点/缺点是什么？3)社会资本在无家可归者心理健康中的作用是什么？第一阶段：将进行系统回顾，以帮助A)识别社会资本的研究；b)将这一研究综合到桥接、粘合和链接的框架中；c)探索社会资本每个组成部分的优势/劣势。第二阶段：分两组进行半结构化访谈；无家可归者和服务提供者（包括医疗保健专业人员和无家可归者组织的工作人员）。访谈将涵盖以下主题：1)社会资本2)心理健康3)服务使用。采访将被录音并逐字抄写，然后按主题进行分析。第三阶段：将制定一个主题指南，探讨A)前两个阶段的发现和b)社会资本和无家可归问题。将有三个焦点小组（n= 18,6）。第1组将包括直接经历过无家可归的个人，第2组是医疗保健提供者，第3组是无家可归者组织的服务提供者。这些讨论将录音并按主题进行分析。

Whilst the European Parliament have recently increased efforts to promote access to good quality care and to reduce health inequalities, homelessness across Europe is on the rise. Homelessness comprises: (a) rooflessness (b) houselessness (c) living in insecure housing and (d) living in inadequate housing. In England, estimates suggest that 4,000 people in 2016 were sleeping rough on any given night, up 21% from 2015. In London, rates of rooflessness have shown an estimated 3% - 7% increase over the last year. Homelessness has been waell documented to have detrimental effects on mental health. Homeless people display elevated rates comparatively to the general public, of problems such as, depression, alcohol/drug dependence and psychoses. Mortality is also substantially increased in homeless people and mental health problems are implicated in these high rates. Despite their need for care, homeless people experience many barriers when trying to access services. As rates of homelessness are rising, it is increasingly important to develop an effective strategy to alleviate mental distress in those affected and to reduce homelessness. One innovative and unexplored avenue is to explore homelessness through the lens of social capital theory. Social capital refers to the social relationships within groups and communities. It comprises: bridging (ties amongst individuals within a homogenous group), bonding (ties amongst individuals of heterogeneous groups) and linking (ties with institutions of authority and power e.g. the government). Bonding helps people to get by and provides essential social cohesion and support, bridging helps people to get ahead and promotes societal respect and solidarity and linking helps to mobilise political resources and power.The little existing research on this topic indicates that homeless people are often isolated with low levels of social support and social functioning. They may have the bonding component but lack bridging and linking. However, reliance upon bonding can be problematic. For example, receiving instrumental support from street-peers (bonding) can reduce one's likelihood of engaging in employment services. The high rates of mental illness, lack of housing, chaotic lifestyle, poor motivation and shame amongst many homeless people likely contribute to difficulties in maintaining social links with acquaintances and those not in immediate and close social circles (weak ties). However, having limited weak ties may contribute to feelings of societal isolation and alienation, lack of belonging and reduced well-being.This research will focus on those who are roofless. It aims to answer the following questions: 1) to what extent do homeless people have social capital? 2) what are the advantages/disadvantages of bridging, bonding and linking for homeless people? 3) what is the role of social capital in mental health amongst homeless people?Stage 1: A systematic review will be conducted to help a) identify research on social capital b) synthesise this research into the framework of bridging, bonding and linking c) explore the advantages/disadvantages of each component of social capital.Stage 2: Semi-structured interviews will be conducted with two groups; homeless people and service providers (including healthcare professionals and staff from homeless organisations). The interviews will cover the following topics 1) social capital 2) mental health 3) service use. Interviews will be audio recorded and transcribed verbatim and then thematically analysed.Stage 3: A topic guide will be developed exploring a) findings from the first two stages and b) social capital and homelessness. There will be three focus groups (n=18, 6 in each group). Group 1 will comprise individuals who have directly experienced homelessness, Group 2, healthcare providers and Group 3, service providers from homeless organisations. These discussions will be audio recorded and analysed thematically.