Abstract

Young homeless people have mental health needs. Research and national policies have highlighted that accommodation providers need to offer holistic interventions to encourage this vulnerable group to break the cycle of homelessness. Currently no research literature documents how homeless shelters respond to mental health needs. This research was intended to address this research question.

A postal questionnaire was sent to 132 managers of homeless shelters, achieving a response rate of 64.4%. Frequencies and descriptive statistics were calculated, and written data was analysed using content analysis. Mental health problems were highly prevalent, and homeless shelters responded in a variety of ways (use of GP services, internal services, referring to external services, in-house outreach services, no service provision, etc). Only 27.1% of managers of homeless shelters reported that their services were sufficient to meet their young people's needs. These findings reflect the need for inclusion of mental health in homeless shelters' strategic objectives, and development of commissioning of local partnerships with health agencies. Previous research has consistently demonstrated the complex needs of young homeless people, identifying high levels of physical and mental health problems, substance misuse, and risk of serious injury and assault (Wrate a Blair, 1999; Commander et al, 2002; Vostanis, 2002). In particular, mental health-related problems experienced by young people have been found to be exacerbated by homelessness (Martijn ft Sharpe, 2006) and are likely to persist in the absence of support (Vostanis et al, 1998; Craig a Hodson, 2000; Power a Attenborough, 2003).

Since the 1990s there has been a significant increase in the number of homeless residents in supported accommodation who display mental health problems (Johnson, 2004). Although appropriate housing is undoubtedly an essential ingredient in the care of homeless young people, it is not enough on its own (Mental Health Foundation, 1996). Once young people reach crisis point, it becomes both more difficult and more costly to restore their lives and engage them in employment (Social Exclusion Unit, 2004), warranting the need for early intervention with this vulnerable group of young people. In England, research evidence (Holland, 1996) and recent national policies have acknowledged that homeless people need much more than just rehousing if they are to break the cycle of homelessness (ODPM, 2002, 2003a, 2003b, 2004).

A number of policies from the housing (ODPM, 2003a), social/educational (DfES, 2003) and health sectors (DoH, 2004) are underpinned by the same philosophy, that resettlement and re-integration in the community require a more holistic approach, integrating social and mental health services to meet the complex needs of this vulnerable group (Holland, 1996; ODPM, 2002).

Policy makers and programme planners in the field of homelessness may base their guidance on perceived client needs, without taking into account the organisational context of mental health-related service developments (Delany & Fletcher, 1994), for example the levels of mental health problems in residents in particular organisations, service models and clinical or cost-effectiveness of services. Such context-based information - on how homeless shelters are currently responding to mental health - is not directly available in the current research literature, and could be used as a useful knowledge base to facilitate emergence of new service models and policy-related guidance on how young homeless people's mental health needs can best be met.

The aim of this study was therefore to gain understanding of how homeless shelters which offer accommodation services to young people are currently responding to mental health needs. In particular, this research sought to understand:

* awareness of residents' mental health problems among homeless shelter staff

* perceived impact of mental health-related problems on homeless shelters

* level of responsibility considered by homeless shelters to address mental health-related needs

* what services (if any) homeless shelters provide in relation to mental health

* whether homeless shelters would like to offer additional services in relation to mental health in the future.

Methods

Service context

The UK Foyer Federation is a non-statutory service providing accommodation and related services to homeless young people aged 16-25 in 132 individual foyers (homeless shelters) in England, Wales, Scotland and Northern Ireland. Given the geographical spread of the Foyer Federation's homeless shelters, a postal questionnaire was both the most cost-effective methodological approach and one which offered increased anonymity to respondents (McColl et al, 1998).

To encourage an optimum response rate, the three-page questionnaire used a combination of closed and openended questions, and was designed to be short, clear and simple to complete (Sommer & Sommer, 1991; David a Sutton, 2004). The questionnaire was phrased neutrally, so as not to imply that homeless shelters should or should not be addressing mental health problems in their residents.

Gale Real Estate Services Company, a subsidiary of Mack-Cali Realty Corporation, has executed 23,252 s/f of office lease transactions within the award-winning Princeton Forrestal Village in Princeton, New Jersey.

Princeton Partners, Inc., a full-service marketing consultancy and advertising agency, has leased 17,832 square feet at Rockingham Row. Greg Lezynski of Equis Corporation represented Princeton Partners, Inc in this new lease transaction.

National Association of Fleet Administrators, Inc. (NAFA), a not-for-profit professional society for the automotive fleet management profession, leased 5,420 s/f at 125 Village Boulevard. Jennifer Palestri represented Gale Real Estate Services Company in this new lease transaction. Bill Brown of Cushman & Wakefield represented NAFA.

"We're proud that Princeton Partners and NAFA have decided to join our growing office tenant roster at Princeton Forrestal Village," stated Fred Knapp, vice president of property and asset management at Gale Real Estate Services Company. "We value both companies as tenants, and their addition will continue to build on Princeton Forrestal Village's reputation as one of the area's leading office addresses."

Princeton Forrestal Village is located on US Route 1, just minutes from Interstates 95 and 295, Route 206 and the New Jersey Turnpike. The Village is an innovative mixed-use complex, consisting of 320,000 s/f of office space, approximately 93% leased, and 175,000 s/f of retail/service/professional space.

Built in 1987, Princeton Forrestal Village offers an exciting shopping experience in a charming village-style setting, complete with Main Street, Village Square Fountain and Market Plaza Courtyard, situated among beautifully landscaped grounds. The Village also features a 294-room Westin hotel and conference center and a fully accredited child care facility. In addition, The Village provides abundant parking and 24-hour security.

Princeton Forrestal Village's current repositioning initiative consists of reconfiguring 175,000 s/f of previously designated retail space into new layouts allowing for the accommodation of a variety of user groups.

Gale Real Estate Services Company is able to accommodate additional uses such as medical, professional, educational and personal services within the repositioned space. KSS Architects LLP of Princeton served as architect of record and Clive Samuels & Associates, Inc., also of Princeton, served as engineer of record for this repositioning program.

CB Richard Ellis recently announced that it has been appointed as the marketing and leasing agent in relation to the office tower within the Shangri-La Centre, the latest Grade A office development in Chengdu, Sichuan Province.

Located in the center of Chengdu, the office tower within the Shangri-La Centre will achieve new standards in terms of office specification and management. Situated overlooking the Fu Nan River, the office tower with a total gross floor area of 44,700 square meters and column-free floor layouts of 1,480 square meters is adjacent to the 5-star Shangri-La Hotel. The building is well-equipped with a wide range of facilities and represents the first truly Grade A office building in the city. The development is expected to become the new landmark within the office market in Chengdu.

"We are very honored to have the opportunity to work with the Shangri-La Hotel Group in connection with this project, and view this opportunity as part of a strategic partnership going forward. We believe that there is significant potential associated with high-quality office accommodation in second-tier cities such as Chengdu, as the availability of this type of space is very limited and tenants are increasingly seeking well-designed, high-quality premises managed to international standards. We believe this project will become a showcase and will help drive the development of office buildings in Chengdu as well as support the overall economic prosperity of the city and western China," said Chris Brooke, Managing Director, Greater China at CB Richard Ellis."Chengdu, as the capital city of Sichuan Province and 'Gateway to the West,' is one of China's most thriving and prosperous cities. Our Chengdu Office will leverage the combined capabilities of the global resources available to CBRE as well as local expertise in order to attract high quality occupiers to the project. We hope to play an integral part in contributing to real estate development in Chengdu," said Loh Siang Huei, Managing Director of CB Richard Ellis in Chengdu. CB Richard Ellis established an office in Chengdu in January 2006. The establishment of the office represented a further step in the expansion of the geographical coverage of the company in Greater China. As a market leader in every major real estate sector, the services provided by the Chengdu office include Asset Services, CBRE Consulting, CBRE Research, Investment Properties, Office Services and Retail Services. In addition, the Chengdu office, supported by a combination of people, service and knowledge, has quickly established itself as a comprehensive real estate services provider capable of meeting the needs of a wide variety of clients.

ON THE THIRD DAY of Easter, I stood in front of the Holy Trinity Cathedral in Kiev, Ukraine. With me was a prominent scholar of American religion who was visiting Eastern Europe for the first time. We were watching a priest and his flock process around the cathedral with icons, incense and crosses. "Have you heard that more Americans are becoming Orthodox?" she asked me, smirking slightly. "Smells and bells. One more way to have someone tell you what to do and what to think."

Her remarks touched on a question of increasing importance in American Christianity. With trends toward mega-churches and worship as entertainment, and with heated debates in some denominations about the ordination of homosexuals, American Christianity seems to be moving in a less orthodox rather than a more orthodox direction. In the United States, Eastern Orthodox Christianity remains a very small religions group (just 1.3 percent of the population). To many American Christians, Orthodoxy is an obscure and foreign type of religion.

But the observation of the visiting scholar was not incorrect. The past several decades have seen an increase in conversions to Orthodoxy in the U.S. Frederica Mathewes-Green writes that nearly half the students in Orthodoxy's two largest American seminaries--Holy Cross and St. Vladimir's--are converts. The number of Antiochian Orthodox churches in the U.S. has doubled--to over 250 parishes and missions--in 20 years. The Antiochian Church, unlike most Orthodox organizations in the U.S., has committed itself to seeking converts in North America and sees itself "on a mission to bring America to the ancient Orthodox Christian faith." The missions organization of this branch of Orthodoxy estimates that 80 percent of its converts come from evangelical and charismatic orientations, with 20 percent coming from mainline denominations. In 1987, Peter Gillquist, a former leader in Campus Crusade for Christ, and 200 others in a single evangelical congregation made national headlines when they were chrismated (or confirmed) into the Antiochian Orthodox Church. In the ensuing years a slow trickle of converts has followed them. Daniel Clendenin suggests that while Or thodoxy may be too small to have an effect on American religion as a whole, conversions may be having a "seismic impact" on the way the faith is practiced in the U.S. In the context of American Christianity, Orthodoxy may seem archaic and irrelevant. Yet it has a strong appeal to many. The question is: why? Is it exoticism, as my colleague suggested? Is it a desire for stability in the midst of rapid culture change? Are conversions a form of protest or, as Gillquist writes, a form of homecoming?

In order to answer these questions, I decided to sit down with some converts and listen to their stories. What I learned is that converts find in Orthodoxy an antidote to American Christianity's individualism and commercialism. While some of them seem to be reinventing Orthodoxy in America's image, others are struggling to reinvent themselves in Orthodoxy's image. This contrast can be striking.

In central Colorado, far from the traditional centers of Orthodoxy in Constantinople, Moscow and Mount Athos, is a small monastery where five monks live together on the sagebrush foothills of the Buffalo Range. Their abbot, Archbishop Gregory, is a renowned iconographer and something of a renegade. The denomination to which he belongs, the Russian Orthodox Autonomous Church (ROAC), is not in communion with most other Orthodox, who it claims have strayed from the true faith via the evils of "ecumenism." Archbishop Gregory has joined and left several different groups on the fringes of Orthodoxy, and the Colorado monastery itself has changed hands more than once.

Brother John is a young monk who joined the monastery during his years at Trinity University, in San Antonio. A former Presbyterian, Brother John recounted to me his early dismay at the liberalism he saw in the Presbyterian Church. He felt that the church was in "open denial of Christ and the apostles" and not adhering to biblical principles, and had been corrupted through accommodation to the world. At the end of his first year of college, he was seeking to be baptized into the Orthodox Church. Not only had he found the Bible-adhering church he sought, but he was also convinced that it was the one holy church founded by Christ and the apostles.

Most Orthodox churches do not rebaptize converts from other Christian denominations since the Orthodox teach that baptism is a one-time-only sacrament. Those who have been baptized in the name of the Father, Son and Holy Spirit need only to be chrismated--anointed--to be received fully into the church. But Brother John felt that his baptism as a Presbyterian was not truly a baptism. His local priest in the Orthodox Church of America (OCA) refused to baptize him, and he grew frustrated. Much in the OCA seemed impure and wayward to him, and he began to look into groups farther from the Orthodox mainstream. His search for greater purity ended in an encounter with then Arehimandrite Gregory in the Russian Orthodox Autonomous Church. The leaders of the ROAC consider the Russian Orthodox Church to be apostate and have broken communion with all those whom they consider "ecumenical."

We men don't want to wear condoms, we want the West to find a cure.' This dilemma, faced by HIV counsellors at the Mildmay Centre near Entebbe, mirrors that experienced by those hoping to help Uganda financially. Mukasa, a handler at the chimpanzee sanctuary on Ngamba Island, 45 minutes from Entebbe by speedboat, gives me the analogy: the chimps there are hand-reared orphans. Five times a day food for them is tossed over the fence. A Pavlovian response has developed: they come whooping through the undergrowth at set times -- and can never be released into the wild, as they would not survive. They are literally sustained by handouts.

The other problem with handouts is that 'the Big Men eat all the money', a reference to high-level corruption heard all over Uganda -- earlier this year Britain redirected £15 million of aid away from President Yoweri Museveni's government and into the humanitarian agencies. And sometimes it's not just the Big Men eating all the money; the pilot of the light aircraft flying me out of Entebbe to trek for gorillas tells me of a colleague who used to transport payroll cash for workers on the tea plantations. One day, on landing at the airstrip, he was surrounded by heavily armed bandits who forced him to hand over the money. Today the same pilot flies low and drops sacks of money out of the window; he is the proud owner of a certificate, hanging in the private airline's clubhouse, for 'retaining sphincter muscle control in the face of automatic gunfire and grenades'.

Tomost British people over the age of 40, Entebbe is synonymous with hijacking. In July 1976 Israel conducted a daring raid to rescue hostages from an Air France plane which had been hijacked by Palestinians and forced to land at Entebbe. The episode marked the beginning of the end for Idi Amin, who supported the hijackers, and his ruthless regime. As such, 'Entebbe' is still a defining moment for many Ugandans today.

Thirty years on, the old airport is home to the UN, which uses it as the logistical base for peacekeeping operations in the Congo, Sudan and Burundi. Across the road is the new airport. With its cluster of duty-free shops well stocked with international liquor and perfume brands, it is the gateway to the industry that is being groomed to play a major part in landlocked Uganda's economic renaissance: tourism. The past year has seen an 18 per cent increase in international passenger numbers through Entebbe compared with roughly 5 per cent growth for the rest of Africa, with revenues of dollars-22.5 million. President Museveni's vision is to turn Entebbe into a logistical centre for Africa's cargo traffic; there is talk of increasing the retail and recreational areas to bring it closer to the standards of modern international airports.

With increased air traffic comes a need for additional accommodation. Hotels are springing up all along the tarmac road from Entebbe to the capital, Kampala. Part of this construction boom is linked to Uganda's role as host of the 2007 Commonwealth heads of government meeting, for which the government estimates it needs an additional 3,000 hotel rooms. Some Ugandans remain to be convinced. So adept has Museveni's government become at selling off land to foreign investors and developers (who can form 100 per cent foreign-owned companies, or joint ventures with local investors with no restrictions) that ordinary people have taken to putting hand-painted signs on their one-storey brick homes saying: This Plot Is Not For Sale.

Uganda's economic revival depends above all on one thing: security. Along its Western border, Uganda has suffered from a continuing power vacuum in the Democratic Republic of Congo, while its north-eastern region has been terrorised for two decades by the Lord's Resistance Army, infamous for its use of children as fighters and sex slaves. This civil war has resulted in a humanitarian crisis thought to have displaced 1.8 million people; the LRA's territory is now a wasteland -- its once-thriving agricultural base destroyed. A recent truce is proving fragile.

Newly discovered oil deposits near Lake Albert to the east of the country (30 million recoverable barrels, apparently) need to be protected, as does the workforce. And in the major tourist attraction of gorilla trekking, every group of tourists is accompanied by Ugandan army soldiers, AK-47s slung over their shoulders -- a practice put into place following the killing in 1999 of eight tourists, including four Britons.

Many ordinary Ugandans are finding out for themselves that increased tourism brings benefits. People who previously eked out a living on the banana plantations are establishing new communities around the national parks, home to the endangered mountain gorillas. In Bwindi, fledgling entrepreneurs offer a nice line in freshly baked cakes and wooden gorillas: the splash of white on the back to denote the rare Silverback males is done with Tippex. The strongest men in the village act as porters to trekking tourists; mine earned £40 for a day's work, a month's wages for a farm labourer. But he earned it, carrying me piggy-back for four hours in humid temperatures after I'd injured myself, up near-vertical inclines, hacking at the jungle as he went -- the park is not called the Bwindi Impenetrable Forest for nothing.