Open Access Research article

Burden of mental disorders and unmet needs among street homeless people in Addis Ababa, Ethiopia

Abebaw Fekadu1234*, Charlotte Hanlon13, Emebet Gebre-Eyesus4, Melkamu Agedew4, Haddis Solomon4, Solomon Teferra1, Tsehaysina Gebre-Eyesus5, Yonas Baheretibeb1, Girmay Medhin6, Teshome Shibre17, Abraham Workneh8, Teketel Tegegn1, Alehegn Ketema9, Philip Timms10, Graham Thornicroft3 and Martin Prince3

Author Affiliations

1 Department of Psychiatry, Addis Ababa University, College of Health Sciences, School of Medicine, Addis Ababa, Ethiopia

2 King’s College London, Institute of Psychiatry, Department of Psychological Medicine, Centre for Affective Disorders, London, UK

3 Health Services and Population Research Department, King’s College London, Institute of Psychiatry, London, UK

4 Amanuel Specialized Mental Hospital, Addis Ababa, Ethiopia

5 Department of Internal Medicine, St Paul Hospital Millennium Medical College, Addis Ababa, Ethiopia

6 Addis Ababa University, Aklilu Lemma Institute of Pathobiology, Addis Ababa, Ethiopia

7 University of Toronto, Ontario Shores Center for Mental Health Sciences, Toronto, Canada

8 Addis Ababa University, Ethiopian Institute of Architecture, Building Construction and City Development, Addis Ababa, Ethiopia

9 Mental Health Society-Ethiopia, Addis Ababa, Ethiopia

10 South London and Maudsley NHS Foundation Trust, London, UK

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BMC Medicine 2014, 12:138  doi:10.1186/s12916-014-0138-x

Published: 20 August 2014



The impact of mental disorders among homeless people is likely to be substantial in low income countries because of underdeveloped social welfare and health systems. As a first step towards advocacy and provision of care, we conducted a study to determine the burden of psychotic disorders and associated unmet needs, as well as the prevalence of mental distress, suicidality, and alcohol use disorder among homeless people in Addis Ababa, the capital of Ethiopia.


A cross-sectional survey was conducted among street homeless adults. Trained community nurses screened for potential psychosis and administered standardized measures of mental distress, alcohol use disorder and suicidality. Psychiatric nurses then carried out confirmatory diagnostic interviews of psychosis and administered a locally adapted version of the Camberwell Assessment of Needs Short Appraisal Schedule.


We assessed 217 street homeless adults, about 90% of whom had experienced some form of mental or alcohol use disorder: 41.0% had psychosis, 60.0% had hazardous or dependent alcohol use, and 14.8% reported attempting suicide in the previous month. Homeless people with psychosis had extensive unmet needs with 80% to 100% reporting unmet needs across 26 domains. Nearly 30% had physical disability (visual and sensory impairment and impaired mobility). Only 10.0% of those with psychosis had ever received treatment for their illness. Most had lived on the streets for over 2 years, and alcohol use disorder was positively associated with chronicity of homelessness.


Psychoses and other mental and behavioural disorders affect most people who are street homeless in Addis Ababa. Any programme to improve the condition of homeless people should include treatment for mental and alcohol use disorders. The findings have significant implications for advocacy and intervention programmes, particularly in similar low income settings.

Homelessness; Rooflessness; Mental illness; Severe mental disorder; Prevalence; Unmet needs; Low- and middle-income country; Ethiopia