Sunday 25 February 2018

Homelessness – a story of sadness and desperation

Destitution is causing misery across the spectrum of social classes in Dublin, leaving many without a home

Homeless boy sleeps rough. Picture posed.
Homeless boy sleeps rough. Picture posed.

Patricia Casey

IN THE past four weeks, three of my patients have been added to the ever increasing list of those who are homeless. These three young men, all in their early to mid 20s, have been under my care for about six years. The fact of their becoming homeless leaves me vulnerable to the charge of not having looked after them well enough.

The truth is different – all three have major mental illnesses as a result of substance abuse and all have become homeless as a consequence. They become violent under the influence of these drugs and their families are unable to safely be with them. They have had to turn their children out for their own protection and for the welfare of younger children living at home.

These young men came under my care when they were in their teenage years and, by then, were dabbling in drugs with friends. Their future, even then, was writ large and now it continues to unfold as the members of my team and I predicted. They have refused to become involved with the services offered by the substance misuse treatment teams in Dublin. They seem not to care any more, being focused only on one thing, i.e., obtaining drugs. I fear for their future when I see them.

They are otherwise courteous young men, pleasant and boyish looking, although they're just beginning to acquire a few facial scars as a result of brawls. Promises that they will get their lives in order "this time" abound but, alas, the spirit is willing but the craving is strong.

I was recently on Bow Street in Dublin as the queue was forming for lunch at the Capuchin Day Centre. At about 12.30, it snaked out of the back entrance and round, onto the street. I was surprised to see a woman reading a story to her little daughter, who was about four. Some of the younger men looked like student types – clean, bearded with back packs. A man in a navy pin stripe, looking as if he had just walked out of one of the nearby Court Houses, was reading a thick book, resembling a classic novel, maybe Anna Karenina, but he, too, was hungry and in need of sustenance that he couldn't provide for himself. Then there were the people that are obviously either mentally ill or dependent on substance, or both. I wasn't surprised by the motley group, but saddened that children, so young and vulnerable, didn't have enough to eat at home. What will her memories of childhood be? Not of playing in a back garden or running through a field of daisies. She and her mother are probably one of the 500 families currently placed in hostels, having lost their homes.

The barristerial looking man didn't surprise me, since I have two other patients who also joined the ranks of the homeless in recent months. Both were doing very well until the Celtic Tiger died and, after that, coupled with relationship breakdowns, they lost their homes. They still had their pride and dignity though, and continued to dress well, even though they were now residing among the homeless.

In 2009 my colleague, Dr Aoife O'Neill and I carried out a study of the face of homelessness in Dublin and the manner of its presentation to the Mater Hospital. It was published in the Irish Journal of Psychological Medicine. We found that of the 900 plus emergency referrals from the Emergency Department to the psychiatric team, 34.8% were homeless. Substance misuse disorders were the primary diagnosis in 42.3% of these. Suicidal crises were given as the reason for attending in 26.6%. Two years later, that had all changed and by then just 12% of referrals to us psychiatrists were homeless and the proportion in suicidal crisis had become miniscule. This was attributed to some being housed and to the development of in-reach psychiatric and general practitioner services to the hostels.

Come 2013 through to 2014 and again the proportion of emergency cases with nowhere to live has rocketed to 33% of the total 1100 referred last year. Every night these men and women attend the Emergency Department, threatening suicide. What they, in fact, are looking for is a roof over their heads. Those who are admitted to the psychiatric ward usually leave the following day once they have procured a bed in a hostel for the following night. Emergency accommodation in hostels appears to be in greater demand than ever before as it outstrips supply.

Consequently more are sleeping on the streets and the pavements are not hospitable places. Sleeping bags, money, the meagre possessions are stolen in the wink if an eye. People are assaulted for their few possessions.

This is not a happy story but one of unmitigated sadness and desperation. The causes are multifaceted and relate to substance misuse, home repossessions, spiralling rents in the private sector and the cap on rent allowances. The political party that promises to tackle the homeless crisis will win my admiration and also my vote.

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