Purpose/Aims: Although a great deal of study has contributed to the body of knowledge regarding adult victimization, little is known about victimization among homeless women living with serious mental illness (SMI) (Council of State Governments Justice Center, 2007). The purpose of this pilot study was to provide a description of victimization as perceived by those who have lived the experience. The specific aims are to describe the perceptions of homeless women with SMI of the risks of victimization, the resources homeless women with SMI use to avoid victimization, the relationship of resources, risks and health status to victimization as perceived by homeless women with SMI and to identify prevention strategies that these women believe may help women like themselves avoid victimization.
Rationale/Conceptual Basis/Background: In 2008, The National Association for State Mental Health Program Directors reported that people with SMI die, on average, 25 years earlier than the general population. Excess morbidity caused by SMI, victimization, substance abuse, and untreated medical conditions place homeless women with SMI at greater risk of mortality as compared to their housed counterparts (Caton et al., 2007). Clinical correlates of victimization in women with SMI include substance abuse, risky sexual behaviors and increased chances of revictimization (Caton et al., 2007). The disabling symptoms of SMI often make maintaining employment difficult resulting in financial difficulties that compromise living conditions (Caton, Dominguez, et al., 2005). To the extent that most interventions are designed for women without SMI, it is imperative to develop trauma informed interventions based on the lived experience of the culture of unsafe streets.
Methods: Based on a Vulnerable Populations framework (Flaskerud & Winslow, 1998), 15 participants living in a homeless shelter for women with SMI engaged in this qualitative descriptive study. All participants engaged in an in-depth semi-structured interview designed to describe their perceptions of victimization. Qualitative content analysis was used to analyze the transcribed audio-taped interviews.
Results: Participants identified victimization within the context of multiple losses including both physical and psychological resources. For this population, the diagnosis of SMI emerged following the onset of homelessness. Additionally, participants discussed the paradox of homeless shelters as safe havens and the need for hypervigilence in order to avoid victimization. The very strategies used to avoid victimization increased the participant’s feelings of isolation and exacerbated their psychiatric symptoms. Poor health status was perceived to be a direct result of homelessness. Personal strengths emerged as a resource as the participants identified concern for others, reconnection, and interdependence in light of victimization and SMI.
Implications: Nurses need to be alert to the possibility of victimization among homeless women with SMI. Nursing research that further explores personal strengths as a resource for victimized homeless women with SMI is needed. Findings will provide evidence for specific nursing interventions that may reduce the risk of victimization.