State is failing our homeless
'Many of the young I deal with are depressed' made headlines in this newspaper last week. It was a comment made by Fr Peter McVerry, the priest who has been championing the cause of those who are homeless for decades. In the week that saw three homeless people die, one by suicide, it was an unsurprising comment, but also a terrible indictment to Government for failing to address this spiralling accommodation problem.
The 'depression' he speaks of is not the type of clinical depression that responds to an antidepressant, although in my experience many of our homeless men and women are inappropriately prescribed these tablets. The mood he describes is best understood as hopelessness and helplessness due to the intractable life situation in which these people find themselves.
Almost one-third of psychiatric emergency attendances to the Mater Hospital at present are by homeless people. In 2009, my colleague Dr Aoife O'Neill, now consultant psychiatrist in St Vincent's Hospital in Fairview, and I carried out a study of the face of homelessness among those presenting to the Mater Hospital emergency department. It was published in the Irish Journal of Psychological Medicine. We found that of the 900-plus emergency referrals to the psychiatric team, 34.8pc were homeless.
Substance misuse disorders were the primary diagnosis in 42.3pc of these. Suicidal crises were given as the reason for attending in 26.6pc. Two years later, that had all changed, and by then just 12pc of referrals to us psychiatrists were homeless, while the proportion in suicidal crisis had become minuscule.
This was attributed to some being housed and to the development of in-reach psychiatric and GP services to the hostels. Post Celtic Tiger, the percentage of homeless people in Dublin has risen again to its former level, and suicidal thoughts are the most common reason.
People become homeless for various reasons, and each requires a different response from official Ireland. Substance misuse - alcohol and drugs - is by far the most common. Some have been made homeless through unemployment and mortgage arrears, and others because of the chaos of untreated or partially treated mental illness.
Among the group who misuse substances there is a definite link to childhood neglect and trauma. Many have parents who neglected them physically or emotionally. Many were the victims of childhood sexual abuse. Some were born to parents who themselves were alcoholic or drug addicts and some were taken into State care for their safety and protection. Their stories are tragic beyond words, and healing the scars of childhood trauma is extraordinarily difficult. Not surprisingly, they turn to drugs and alcohol to numb their pain and become hooked.
When they reach adulthood and have to leave State care, many have nowhere to go except the streets and the homeless hostels. These are the most vulnerable groups since they usually live rough on the streets and have to seek out a bed for the night on a daily basis. Sometimes a sleeping bag is all that can be offered. Due to the combination of past trauma, the absence of a guaranteed bed for the night and the substances they are taking, their desolation is unsurprising.
Like this group, others made homeless through unemployment, home repossessions or unaffordable rentals also feel dispirited and anguished at their situation, especially when they have known better times. Imagine a mother living in a hotel room with no play area for her children and helping them in their homework on the bed. Unlike those who misuse substances, their plight is arguably easier to resolve by providing more units of accommodation that are affordable. Moreover, they are unlikely to have experienced childhood adversity to the same extent.
The mentally ill who become homeless are another group whose homelessness is sometimes interlinked with substance misuse, causing them to abandon necessary medication to control their illness. Fortunately, this group is not large and most have permanent accommodation in hostels such as those run by Sr Stan, with designated care workers.
A further problem arises with the temporary-bed hostel in that alcohol and illicit substances are rampant, rendering attempts to stay 'dry' or 'clean' next to impossible. The Simon Community now has a residential substance misuse service with aftercare and this is a tremendous resource for this mobile group who often mistrust and feel misplaced in the more traditional treatment centres.
There are two in-reach psychiatric teams working with the homeless mentally ill in Dublin and this is also an excellent resource, although it needs to be expanded.
We are prospering again as a nation, and it is time that Government addressed this national disgrace by creating more hostel beds and providing more affordable accommodation for families.
And this should be more than the annual feel-good Christmas token.
Health & Living