DISCUSSION:DISCUSSION:COMMUNITY HEALTH AND COMMUNITY HEALTH AND

SOCIAL CARESOCIAL CARE

MARIA FE BRAVO ORTIZMARIA FE BRAVO ORTIZPsychiatrist, M.D., Ph.D., Head of Psychiatric Psychiatrist, M.D., Ph.D., Head of Psychiatric

Department. Hospital Universitario La Paz (Area Department. Hospital Universitario La Paz (Area 5, Madrid). 5, Madrid).

Professor, Autonoma University. Professor, Autonoma University.

Dr Nat WrightDr Nat Wright

““How can the healthcare service be effective in How can the healthcare service be effective in the physical and mental health care of homeless the physical and mental health care of homeless people whilst also taking into account their social people whilst also taking into account their social care”care”

HeHe has described the principal needs of health of has described the principal needs of health of homeless people (Related to the dual diagnosis homeless people (Related to the dual diagnosis and higher rates of morbidity and mortality) and and higher rates of morbidity and mortality) and the different strategies of intervention that they the different strategies of intervention that they have demonstrated to be effective in each field.have demonstrated to be effective in each field.

He has underlined the importance to integrate He has underlined the importance to integrate housing and social support with health carehousing and social support with health care

SOME QUESTIONS (1)SOME QUESTIONS (1)

Seeking help behaviour usually Seeking help behaviour usually don’t exist. The problem is not only don’t exist. The problem is not only barriers to access to the servicesbarriers to access to the services

Perceived needs are different. Perceived needs are different. How to motivate to accept help.How to motivate to accept help. Harm reduction policyHarm reduction policy Why to intervene: health public Why to intervene: health public

reasons or individual reasons?reasons or individual reasons?

SOME QUESTIONS (2)SOME QUESTIONS (2)

Different phases in the process of Different phases in the process of intervention: First in the street. intervention: First in the street. Maintaining measures (medication, Maintaining measures (medication, cure, treatment...) cure, treatment...)

Always individualized and including Always individualized and including people in the process of taking people in the process of taking decisionsdecisions

Always outreachAlways outreach Always together with housing and Always together with housing and

social supportsocial support