Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2024 Nov;70(7):1298-1310.
doi: 10.1177/00207640241264657. Epub 2024 Jul 31.

Fair space for life: A dynamic care monitor working up to growth and flourishing for all

Coline van Everdingen  1   2 , Peter Bob Peerenboom  3 , Irene van de Giessen  4 , Koos van der Velden  5 , Philippe Delespaul  1   6
Affiliations

Fair space for life: A dynamic care monitor working up to growth and flourishing for all

Coline van Everdingen et al. Int J Soc Psychiatry. 2024 Nov.

Abstract

Background: Mental health disparities persistently cause inequity and social exclusion. Extensive research underpins the need to embrace the social determinants of health and facilitate network learning at various ecosystem levels. Despite valuable quality frameworks and ratified conventions, local practices which counter health inequity are scarce.

Methods: The Dutch HOP-TR study collected health and needs of Homeless Service Users (HSU) in a rights-based, transdiagnostic, recovery framework. We assessed the survival modes and conducted a socio-ecological analysis, exploring what happened in care pathways at three ecosystem levels: individual HSU, caregiver networks, society. While documenting vital conditions for growth and citizenship, we explore major opportunities to develop 'fair space for life'.

Results: Under low distress levels, prosocial behavior is prominent (32.9%). High distress levels are found with an avoidant (42.0%) or aggressive mode (24.9%). Rising distress levels give more frictions in relations, psychiatric admissions, and police-justice contacts. The distress-induced descent in the social hierarchy causes social withdrawal, alienation, and marginalization. At society level, fair conditions for growth and citizenship are challenged by the cumulative impact of distress over the HSU' lives.

Discussion: This care monitor uncovers the impact of distress on caregiver interactions. The care pathways reveal that the survival strategies reflect a systematic, pervasive neglect. Unfair representations hold HSU personally responsible of their situation, disregarding the cumulative impact of environmental conditions over their lives. The diverse sources of unfairness are intrinsic to the health care system and culture. Therefore, the survival modes ask for profound culture transformations in a whole-system-whole-society approach.

Conclusion: Given the need for action on health equity and the social determinants of health, this paper provides an example of a dynamic care monitor. The actionable data elicit dialogs and stimulate to enrich opportunities for inclusion and growth in communities and societies.

Keywords: 4D recovery framework; Dynamic care monitor; conditions for growth; health equity.

PubMed Disclaimer

Figures

Figure 1.
Figure 1.
Social, personal, and symptomatic dimensions.
Figure 2.
Figure 2.
Guided survival mode assessments.
See this image and copyright information in PMC

References

    1. Aldridge R. W., Story A., Hwang S. W., Nordentoft M., Luchenski S. A., Hartwell G., Tweed E. J., Lewer D., Katikireddi S. V., Hayward A. C. (2018). Morbidity and mortality in homeless individuals, prisoners, sex workers, and individuals with substance use disorders in high-income countries: A systematic review and meta-analysis. The Lancet, 391(10117), 241–250. - PMC - PubMed
    1. Alegría M., NeMoyer A., Falgàs Bagué I., Wang Y., Alvarez K. (2018). Social determinants of mental health: Where we are and where we need to go. Current Psychiatry Reports, 20, 1–13. - PMC - PubMed
    1. Aubry T., Bloch G., Brcic V., Saad A., Magwood O., Abdalla T., Alkhateeb Q., Xie E., Mathew C., Hannigan T. (2020). Effectiveness of permanent supportive housing and income assistance interventions for homeless individuals in high-income countries: A systematic review. The Lancet Public Health, 5(6), e342–e360. - PubMed
    1. Benjaminsen L. (2016). Homelessness in a Scandinavian welfare state: The risk of shelter use in the Danish adult population. Urban Studies, 53(10), 2041–2063.
    1. Benjaminsen L. (2018). Housing first in Denmark: An analysis of the coverage rate among homeless people and types of shelter users. Social Inclusion, 6(3), 327–336.