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

Abstract

BackgroundResearch 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.MethodsWe 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.ResultsPerceived 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.ConclusionsUnderstanding 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 numberThis study has been registered with the International Standard Randomized Control Trial Number Register and assigned ISRCTN42520374.

Access, equity and social cohesion: evaluation of intersectoral strategies for people experiencing homelessness

“…These observations are in agreement with a study carried out in Toronto, Canada, indicating a greater perception of discrimination against the homeless with SMI and/or drug use in health facilities (20) .…”

O cuidado a pessoas em situação de rua: a experiência da Rede de Atenção Psicossocial da Sé

“…Esse grupo frequentemente é discriminado e tende a se distanciar de amigos e familiares (ZERGER et al, 2014). A discriminação também dificulta seu acesso a oportunidades de emprego (ZERGER et al, 2014) e a serviços de saúde (SKOSIREVA et al, 2014;CHRYSTAL et al, 2015;SARRADON-ECK et al, 2014).…”

“…Por apresentar dificuldades em acessar serviços de atenção básica e especializada, utiliza hospitais e prontos-socorros com mais frequência (CHRYSTAL et al, 2015). Muitos serviços não identificam suas necessidades (SKOSIREVA et al, 2014;CHRYSTAL et al, 2015) e frequentemente a discrimina (SKOSIREVA et al, 2014;CHRYSTAL et al, 2015;SARRADON-ECK et al, 2014), o que provoca impacto negativo na busca por ajuda e acesso a cuidado (SKOSIREVA et al, 2014).…”

“…Alguns estudos destacam as limitações nas Políticas Públicas voltadas para esse grupo (BORYSOW e FURTADO, 2013;2014;CHRYSTAL et al, 2015;SKOSIREVA et al, 2014 …”

“…Pode também trazer prejuízos ao cuidado, por afetar o processo de vinculação e não reconhecer o usuário como sujeito de direito (TORRICELLI, 2015;ZERGER et al, 2014;SKOSIREVA et al, 2014).…”