|dc.description.abstract||Homelessness is a pressing social issue, and people who are homeless, in particular those who sleep rough, often experience a confluence of physical and mental health issues. Health problems experienced by homeless people can be more severe than those experienced by domiciled people. Such problems can contribute to homelessness, and be exacerbated by homelessness. Previous research has found that for various reasons, primary healthcare services can be inaccessible for homeless populations. More recent research explores the growing availability of accessible, non-threatening health services targeting homeless people, with humanistic approaches to care. This thesis draws on a case study of an NGO clinic providing population-based primary healthcare to homeless and low-income people. The case study is informed by the perspectives of two groups of participants; homeless clinic patients and clinic staff. Ten semi-structured interviews were conducted with homeless clients, and six semi-structured interviews were undertaken with clinic personnel. Social representations theory informs the interpretation, analysis and discussion of the participants' conceptualisations of health and wellbeing, illness and disease, homelessness, health services and the NGO clinic. Social representations from both participant groups (micro perspectives) inform shared social representations (macro perspectives) of the NGO clinic. This determines whether participants conceptualise the clinic as an 'ideal' health service for homeless people.
NGO clinic staff responses reveal that clinic staff have a personal and professional ethos to work with people in need and those that may have been stigmatised from society. This shared ethos has shaped the development of the NGO clinic, into its current structure of a holistic, population based primary healthcare for homeless people integrated within a wider social service structure. In this setting, relationships are developed between practitioners and homeless clients to ensure homeless patients healthcare needs are met. Also, practical needs are met as the clinic provides low-cost healthcare to homeless people within the context of an umbrella organisation that provides other much-needed social services. Collaboration is an important component to the efficacy of the NGO clinic, and meeting patient needs. However, clinic staff note that there are many dilemmas in providing healthcare to homeless people, and they can struggle to provide the service according to their vision, due to funding constraints. Nonetheless, NGO clinic personnel are committed to working with their patients, and find their jobs rewarding.
The responses from homeless clinic patients brought to mind a military metaphor, which was utilised to anchor the experiences of homeless people in a familiar concept - the military. Each homeless client that was interviewed at the NGO clinic is written about in the form of a health biography, which summarises current health issues, health histories, health related practices and conceptualisations of health. The severity of three major health issues experienced by the participants - addictions, mental health issues and foot problems - are then explored in terms of detailed perspectives from homeless participants, and clinic personnel conceptualisations of those particular health issues. Social networks are discussed as important to homeless people's health and wellbeing, particularly through resource and information sharing. The clinic setting is conceptualised by homeless participants as a caring, welcoming environment; which contrasts with some negative experiences reported by homeless participants in other health service settings.
This thesis explores the NGO clinic as a unique model for a health service that meets the various healthcare needs of homeless people. There is a need for more recognition from government organisations and policy makers of the impoverished life situations that many homeless people find themselves in - often without minimum standards of living, which jeopardises their ability to take care of their health. Appropriate health services need to be accessible to homeless people, in order for healthcare needs to be met.||en_NZ