“My mental illness got a lot worse on the street, there were times when I woke up at night with 15-year-old kids hitting me and dousing me with gasoline.”

When his great-grandmother died in 1989, Daniel Sousa, who lived with her, became homeless. “The landlord kicked me out of the house and rented it to other people.” She went to live on the street and remained there for 12 years. Among the countless problems she faced during that time, the lack of health care and insecurity stand out. “There were some kids who beat me and poured gasoline on me.” She later joined one of the shelter centers for the homeless that exist in Lisbon, but the situation did not improve, on the contrary.

The times set for entry and exit at the center were not compatible with his work in the restaurant sector, which he ended up having to abandon. But the reception structure was “problematic” for other reasons as well: “Many of the people there had drug problems or other dependencies and pathologies. Sometimes there would be arguments, robberies, we would wake up in the morning and someone had gone through our closet, which caused me a lot of stress.” The nights were noisy, either because “someone would snore, or get up and slam the closet door, or I heard music blaring.” Daniel Sousa couldn’t rest.

Only around four years ago, after joining the AEIPS (Association for Study and Psychosocial Integration) Housing First project, which provides access to housing for homeless people and people with mental health problems, is that his life has improved, as he says in an interview with the podcast “Que Voz é Esta?”, whose most recent episode is about poverty, homeless people and mental illness. “With all the health problems I have, if I was still in the reception center I would have died a long time ago,” he says at 57 years old.

There are no national data on the prevalence of mental illness in the homeless population. The various studies carried out over the last few decades “indicate disparate prevalence”, explains José Ornelas, full professor at ISPA, in Lisbon, where he is director of the master’s and doctorate in Community Psychology. In any case, it is estimated to be around 30%. “Living on the street is very difficult. Even if you do not have a mental illness, it is likely that symptoms of pathology will appear. And if the disease already existed, it will possibly become more serious.”

The most important thing is to guarantee safe, stable and comfortable housing for these people, says José Ornelas, founder of AEIPS, an association that created, in 2009, the first Housing First program in Portugal. The transition process to new housing is monitored by teams from the association, which, in addition, also facilitate integration into the community and the job market, as well as these people’s access to healthcare.

The results, guarantees José Ornelas, could not be better: “90% of people keep their home, regardless of the diagnosis of serious mental illness, and hospitalizations are practically zero. There is also a reduction in symptoms, which demonstrates that mental illness has a lot to do with contexts.”

“What voice is that?” is the name of the Expresso podcast dedicated to mental health. Every week, journalists Joana Pereira Bastos and Helena Bento give voice to those living with anxiety, depression, phobia or other mental health problems, also listening to the most renowned experts in these areas. Without stigma or fuss, we talk about diseases and symptoms, treatments and therapies, but also about prevention and the best strategies to promote psychological well-being. The podcast has scientific support from José Miguel Caldas de Almeida, psychiatrist and former national coordinator for mental health.