Uncertainty and inadequate means for effective care
In resource-constrained settings within low-and middle-income countries, institutions like mental hospitals, juvenile detention centres, and orphanages often lack the human and capital resources to provide an optimal level of care and support. As well, during the transition from life in an institution to life back in their local community, these women, men, boys, and girls are often met by their families and/or the wider community with uncertainty and inadequate means to effectively care for and integrate them back into community life. Moreover, the stigma which the community often associates with formerly institutionalized persons, further impedes their reintegration within society.
For vulnerable persons within and outside of institutions in East Africa, there are several factors related to institutions and communities which contribute to the challenges in providing them adequate care and support.
Factors contributing to inadequate conditions for persons receiving care in an institution:
- Very low staff-to-resident ratios in institutions with scarce financial and personnel resources to care for people
- Overuse of institutions because of a lack of alternative forms of care that are family- and community-based
- Negative effects on personal self-esteem and self-image associated with the loss of liberty and individuality that can be associated with some aspects of institutional life
Factors contributing to inadequate conditions for vulnerable persons to receive care and support within the community:
- High levels of poverty leading to extreme pressure for families of persons with mental illness, disability, or other vulnerable life circumstance to cope with their care and support at home
- High levels of unemployment, particularly youth unemployment, with consequent negative effects upon health, mental health, education, housing, family life, as well as disruption within the community, including increases in theft and other crimes
- High levels of drug and alcohol abuse, particularly home-made alcohol, resulting in related health and mental health problems
- High levels of stigma within the community associated with people emerging from institutional life, particularly mental institutions
- Challenges in reconnecting some persons leaving institutional life to their families, leading to situations of homelessness