Obdachlos, mittellos, hoffnungslos – Substanzkonsum, psychische Erkrankungen und Wohnungslosigkeit: ein Forschungsbericht aus den USA und Kanada

Zusammenfassung

Wohnungslosigkeit charakterisiert Lebensumstände, die ein extremes Ausmaß an Armut bedeuten. Die psychischen Folgen erstrecken sich über das ganze Spektrum. Depressionen und damit verbundene Suizidalität, Traumafolgestörungen und Angsterkrankungen, meist verbunden mit schädlichem Substanzkonsum, sind von besonderer Bedeutung wegen ihrer Häufigkeit und langfristigen Auswirkungen. So sind über 2/3 der Wohnungslosen in Vancouver Konsumenten mehrerer psychotroper Substanzen. Die Versorgung von Menschen am Rande der Gesellschaft stellt besondere Anforderungen an das Hilfesystem. Die Stigmatisierung und die hohen Zugangsschranken zur Hilfe machen es gerade den am meisten Hilfebedürftigen unmöglich, Zugang zu bekommen. Das Modell des „housing first“ ist die Antwort auf hochschwellige Therapiekonzepte, die erst nach einer psychischen Stabilisierung soziale Unterstützung bereitstellen. Kein therapeutischer Fortschritt ohne ein Dach über dem Kopf ist ein wesentliches Forschungsresultat im Falle von Wohnungslosigkeit. Besonders die Traumatherapie braucht den sicheren Ort als therapeutische Voraussetzung und Schutz vor Reviktimisierung. Ein Dach über dem Kopf alleine löst das Problem aber auch nicht. Es sind verschiedene psychotherapeutische Behandlungsmethoden evaluiert worden. Diese Behandlungskonzepte müssen der Lebenssituation der Wohnungslosen angepasst werden, um effektiv zu sein und der extremen Multimorbidität entgegenzuwirken. Soziale Marginalisierung und die gleichzeitige Multimorbidität sind interaktiv miteinander verbunden. Es gibt keinen Ausweg aus diesem Zirkel, ohne beide Probleme zu bearbeiten.

Abstract

Homelessness is typical for a life in extreme poverty. Psychological consequences are covering the full spectrum. Mood disorders and related suicidality, trauma related psychopathology and anxiety as well as severe substance use are especially important due to their harmful long-term consequences. In the homeless population in Vancouver more than two third were heavy users of psychotropic substances. Health care for individuals at the margins of society is challenging. Stigmatization and high thresholds towards the system of care makes it very often impossible especially for those with the highest needs to get access. No recovery without a roof over your head could be the summary in the case of homelessness. The “housing first” model is the answer of ineffective high threshold therapeutic programs, which only provide social support after stabilization and abstinence. Especially trauma informed care needs a safe home as therapeutic prerequisite and protection from the revictimization. But the roof is not the full story. A number of specific psychotherapeutic measures have been evaluated. These measures need to be adapted to the life circumstances of homelessness to address complex concurrent disorders effectively. Social marginalization and complex concurrent disorders are intertwined. There is no way out of that circle without addressing both.

Schlüsselwörter

Wohnungslosigkeit - Sucht - Trauma - psychische Erkrankungen - Housing first

Key words

homelessness - addiction - trauma - mental illness - housing first

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