The Homeless Population and the limits of mental health care in Brazil
1
Research Group on Health and Social Protection Policies, FIOCRUZ - Oswaldo Cruz Foundation, Belo Horizonte, Brazil
Popul. Med. 2026;8(Supplement Supplement 1):A2720
ABSTRACT
BACKGROUND:
In Brazil, care for individuals with harmful use of alcohol and other drugs is provided through the Psychosocial Care Network (RAPS)¹. This research analyzes, from the perspective of the Homeless Population (PSR), barriers and facilitators to access to RAPS in Belo Horizonte, Minas Gerais, Brazil.
METHODS:
Exploratory research, conducted from May to July 2024. Of 343 people interviewed, 218 self-reported having harmful use of alcohol and/or other drugs and answered questions regarding access barriers. Facilitators were analyzed in a subgroup of 112 individuals who reported at least one episode of access to RAPS. Barriers and facilitators were categorized into the dimensions of “Availability,” “Acceptability,” and “Information”². Logistic regression was used to investigate associations between sociodemographic variables and the perception of these access dimensions.
RESULTS:
The sample (n = 218) was predominantly male (82.1%), Black (83.9%), and had low educational attainment (44%). Regarding barriers, 64.7% reported “Availability,” 39.9% “Acceptability,” 38.5% “Information,” and 17.4% reported no barriers. Regarding facilitators, 83.9% reported “Acceptability,” 67.9% “Information,” and 65.2% “Availability”. Within the “Availability” dimension, “waiting time” (31.6%; n = 69) and “difficulty attending scheduled appointments” (26.6%; n = 58) were the main barriers. “Respectful care” (59.8%; n = 67) and “awareness of the public care services available” (56.25%; n = 63) were the main facilitators of “Acceptability.” Recent access to services increased the likelihood of perceiving “Availability” barriers (OR = 2.66; 90% CI: 1.54–4.77). Black individuals were more likely to identify “Acceptability” facilitators (OR = 5.99; 90% CI: 2.04–18.54).
CONCLUSIONS:
Access to RAPS depends on overcoming bureaucratic barriers and adapting services to the ways of life of the homeless population. Requirements for documentation and rigid scheduling practices perpetuate exclusion. Ensuring access to RAPS requires breaking away from standardized, norm-driven logics and instituting practices that recognize the singularities of this population.
In Brazil, care for individuals with harmful use of alcohol and other drugs is provided through the Psychosocial Care Network (RAPS)¹. This research analyzes, from the perspective of the Homeless Population (PSR), barriers and facilitators to access to RAPS in Belo Horizonte, Minas Gerais, Brazil.
METHODS:
Exploratory research, conducted from May to July 2024. Of 343 people interviewed, 218 self-reported having harmful use of alcohol and/or other drugs and answered questions regarding access barriers. Facilitators were analyzed in a subgroup of 112 individuals who reported at least one episode of access to RAPS. Barriers and facilitators were categorized into the dimensions of “Availability,” “Acceptability,” and “Information”². Logistic regression was used to investigate associations between sociodemographic variables and the perception of these access dimensions.
RESULTS:
The sample (n = 218) was predominantly male (82.1%), Black (83.9%), and had low educational attainment (44%). Regarding barriers, 64.7% reported “Availability,” 39.9% “Acceptability,” 38.5% “Information,” and 17.4% reported no barriers. Regarding facilitators, 83.9% reported “Acceptability,” 67.9% “Information,” and 65.2% “Availability”. Within the “Availability” dimension, “waiting time” (31.6%; n = 69) and “difficulty attending scheduled appointments” (26.6%; n = 58) were the main barriers. “Respectful care” (59.8%; n = 67) and “awareness of the public care services available” (56.25%; n = 63) were the main facilitators of “Acceptability.” Recent access to services increased the likelihood of perceiving “Availability” barriers (OR = 2.66; 90% CI: 1.54–4.77). Black individuals were more likely to identify “Acceptability” facilitators (OR = 5.99; 90% CI: 2.04–18.54).
CONCLUSIONS:
Access to RAPS depends on overcoming bureaucratic barriers and adapting services to the ways of life of the homeless population. Requirements for documentation and rigid scheduling practices perpetuate exclusion. Ensuring access to RAPS requires breaking away from standardized, norm-driven logics and instituting practices that recognize the singularities of this population.
| eISSN: | 2654-1459 |
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