In case you missed it, this is the article we had published in the Irish Times last month.
Homeless people with mental health difficulties need more than key in the door
Mon, Jan 12, 2015, 00:01
My office sits in the shadows of the now closed St Brendan’s Hospital, Grangegorman, which at its peak housed over 2,000 people. This 19th-century psychiatric institution finally closed its doors, and many applauded the end of the Victorian approach to mental health care it symbolised. Yet in 21st-century Ireland, one of our worst fears for de-institutionalisation has come to pass – while inpatient beds have fallen, lack of appropriate accommodation alongside shortages in community-based mental health services have left some people with severe mental health difficulties with nowhere to go for a safe home.
Recent events have cast a spotlight on homelessness. And the new year calls for a fresh approach. While the lack or loss of a home has complex roots, systemic weaknesses in mental health and related housing and social supports can increase the risk of homelessness for people with both mental health difficulties and housing needs.
The relationship between mental health difficulties and homelessness is multidirectional. Having a severe mental health difficulty can put people at risk of homelessness for various reasons. Without prompt mental health support after discharge from hospital, they may fall away from treatment and end up relapsing. Mistrust or dissatisfaction with an overly medication-oriented treatment regime can turn people off seeking support, leaving them to struggle alone. For those with an addiction and a mental health difficulty, there are often barriers to accessing mental health treatment until the addiction has been brought under control, putting this group in a potential Catch-22 that can lead to homelessness. For others, the issue may be the need for support to maintain their housing situation and relationships in their community.
From another direction, the very fact of being homeless puts people at high risk of developing mental distress. Homelessness exposes people to the risk of trauma, violence and lowered self-esteem, while the living conditions and chaotic lifestyle of the streets make it difficult for people to access mental health services until they are at crisis point. Too often I have heard about staff in homeless services unable to get mental health support for clients in a crisis, being forced into busy emergency departments where the individual in distress can’t wait the many hours it might take to get help.
As institutions have closed down, people with mental health difficulties are seen in greater numbers among the prison and homeless populations. A high incidence of mental health difficulties has been reported by homelessness groups, with Dublin Simon Community reporting in 2014 that 71 per cent of people using their services had a mental health difficulty. Worryingly, 22 per cent reported a diagnosis of either schizophrenia or psychosis, suggesting that the move to community-based mental health services may have left some people without adequate follow-up support.
A striking link between homelessness and acute mental distress is shown in an audit carried out between October 2012 and September 2013 in the acute mental health unit in Tallaght Hospital, which found 98 per cent of long stay/delayed discharge inpatients had accommodation-related needs. During this period, someone was discharged into homeless services every nine and a half days from Tallaght Hospital alone. This is unacceptable and completely at odds with the Government commitment that nobody be discharged into homelessness from the care of the State.
Although most people who use mental health services live independently, there will always be some who need social support. There is currently a critical lack of adequate accommodation to enable these people to move through the stages of recovery and live independently, resulting in some people remaining in high-cost hospital beds longer than necessary. Some will need more than a key to the door. Providing follow-on social support to deal with rent, arrears, bills, housekeeping and interacting with the local community can be central to preventing future homelessness.
This vital support is provided by many of Mental Health Reform’s members. Nationally, there has long been a need for dedicated funding for medium and long-term tenancy sustainment support for individuals with long-term mental health difficulties. A difficulty has been that responsibility for this has fallen between the HSE and local authorities. The Government would do well to invest in tenancy sustainment to prevent people with mental health difficulties from becoming homeless.
It might be tempting in the current homeless crisis to think that the answer lies only in more housing. While more homes must be the major part of the solution, and will, in and of themselves, ease mental distress, the flow of people into homelessness won’t end until we address the underlying gaps in the mental health system that are leading some people with mental health difficulties to end up homeless.