If any one single story dominated 2017, it was homelessness. It generated endless headlines, including the controversial claim by one official that homelessness was caused by ‘years of bad behaviour’. But according to a study at Cork Simon Community, it is most often caused by childhood trauma and awareness of this should inform homelessness services, writes Catherine Shanahan
DYLAN* had a crap childhood.
“I was beat at home, I was beat at school, and I was beat on the street by the neighbours,” he says.
“Like, you’d be walking down the street and you might do something wrong, and the neighbour would give you a clatter.
“In school, if you stepped out of line, you’d get a clatter, or they’d pull your locks. That went on an awful lot.
“Then, I had to go home and deal with it, as well, so everywhere I went. And it felt like the norm, y’know?”
I met Dylan (43) in the cosy foyer of a Cork City hotel. It was heaving with jovial Christmas party-goers, while, outside, a handful of homeless people huddled in doorways, not far from where Kathleen O’Sullivan died on the streets in early December, one of three rough-sleepers who died that week.
Dylan agreed to talk to me to illustrate how constant trauma in childhood eats away at our ability to cope.
He typifies the profile of the homeless person described in research conducted by Sharon Lambert, a lecturer and researcher in the School of Applied Psychology, University College Cork (UCC).
Based on a survey of 50 homeless people who use Cork Simon Community’s services, Lambert found that the homeless had been exposed to far higher levels of childhood trauma than the general population had and that this had affected their resilience and ability to engage with services when on the streets.
Homelessness services must recognise that the people they help are often traumatised. This should influence how services are delivered, says Lambert.
Her research, ‘Moving Towards Trauma-Informed Care’, measured the number of adverse childhood experiences (ACEs) in the lives of Simon’s homeless.
The ACE study asks if, before your 18th birthday, you were sworn at or insulted or humiliated by a parent or other adult in your household. It asks if you were afraid you would be physically hurt.
It also asks if you were pushed, grabbed, slapped or had something thrown at you, or hit so hard that you had the marks to prove it. It asks if an adult fondled you or touched you in a sexual way, or if you lived with someone who was a problem drinker or alcoholic or who used street drugs. It asks if a household member went to prison.
Dylan’s childhood ticks all of these boxes, giving him a score of five on the 0-10 ACE scale. He also answers ‘yes’, his mother was slapped, pushed, grabbed, had something thrown at her, or was hit with a fist; ‘yes’ to having no-one to protect him; ‘yes’ to a household member being depressed, or mentally ill or using street drugs. In fact, Dylan aces it on the ACE scale. The rest of us, the ‘general population’, are more likely to have experienced one, maybe two, negative childhood experiences. Simon service users averaged 5.15.
High ACE scores have long been associated with increased risk to health and well-being. Service-users with ACE scores of four or more reported worse outcomes. They first used alcohol and drugs at a younger age, they reported double the rate of overdose, poorer mental health, were more than twice as likely to have suffered critical illness, and three times more likely to report a history of domestic violence.
Cork Simon Community director, Dermot Kavanagh, says those working in homelessness services are aware “that many of those we work with have very difficult backgrounds”.
“What has come to the fore, in recent years, is the importance of what’s called trauma-informed support or trauma-informed care: that when you are working with people who have experienced a lot of trauma in their lives, it has an effect on what’s called their ‘window of tolerance’.
“Essentially, you can put up with X amount of stress in your life. If you’ve had no background trauma, you can put up with quite a lot, without getting into a traumatic response, without getting very upset or losing your cool. Or, you’ll be, in some way, able to cope.
“But if you’ve had a lot of adverse experiences, your window of tolerance becomes lower, your breaking point becomes lower — you will react to things that other people might be able to take in their stride, because this is just one more thing upon the umpteen things that might have happened in your life.
“So, if we are aware, now, that we are working with people, many of whom have had multiple difficult issues and whose windows of tolerance are quite low, the question for us is: what do we need to do to ensure our services are helpful to people, rather than triggering their trauma responses?
What constitutes bad behaviour?
Lambert says people working in services such as Simon must understand the impact of trauma. What might be seen initially as ‘bad behaviour’ can then be seen in a different light — perhaps as action to protect the individual.
Lambert says if staff see people struggling to engage, they need to ask ‘What can I do to make it easier?’ She disagrees with comments made recently by Dublin Region Homeless Executive official, Eileen Gleeson, who equated long-term homelessness with bad behaviour, saying that homeless people were “quite happy to continue with the chaotic lifestyle that they have”.
“Bad behaviour is not just people making bad choices. They are making the choices they need to make to stay alive. Some people take drugs to survive. They can’t live with what’s in their own head.
“People have this perception of ‘pull yourself together’. But they didn’t make bad decisions; they made the decisions that allowed them to be alive.”
Dylan had an alcoholic, verbally abusive father, who regularly beat up his mother. He was sexually abused by a local authority worker. His older brother ended up in jail for murder. He frequently took a beating on his mother’s behalf.
“I’d distract him from my mother, so that I could take the beatings. Full-fist thumps. I’d be kept out of school for days.”
Dylan’s dad never picked on his older brother, and this haunts Dylan.
“I can never get my head around that. I just think I look like my mother, that I reminded him of my mother so much.”
Eventually, the beatings stopped when Dylan was strong enough to take on his father. By now, he was dabbling in drugs. It started early: sniffing glue at age nine, sniffing petrol “just to deal with things”, drinking at age 10 and taking his dad’s benzodiazepines. Then, the rave scene came along.
“I was just after hitting 14 when I took my first acid tab; next it was ecstasy. At 16, I took my first line of coke.
“I’ve been, basically, on drugs all my fuckin’ life to deal with what happened in my childhood,” he says.
The sexual abuse took place in a park. He used to go there on the hop from school.
“This fella used to work there and he offered me money to take pictures of me in my underwear. He took me out to these woods a couple of times and he used to fondle me and stuff like that.
“I went with him for the money. He used to give me £20. Those big old blue notes. £20 was a lot of money at the time.
“Me dad used to take the money and drink it. He didn’t give a fuck. Like he drank my communion money, he drank my brother’s communion money. And then my younger brother was born and that’s when most of the trouble stopped, ’cos me and my older brother were fierce protective of him”.
Dylan’s father would keep Dylan out of school to mind his younger brother, “so that he could go to the pub”.
By now, Dylan’s older brother, once the quiet one in the family, had “gone off his game”. It culminated in him going to jail for murder. Dylan used to bring him parcels. He says he opened one of these parcels and found heroin. He started by smoking it, but then learned how to “do it on the foil”.
“Once I’d done it on the foil, that was it. I was hooked.” He describes himself as “a functional addict”, until a workplace accident led to an examination of his medical records.
It emerged he was on methadone — to stop using heroin — and he was put on six months of probation. He was clean for four months, “but I ended up relapsing and that’s how I ended up homeless.
“I started to inject and my girlfriend found me one day and I had overdosed. She knew I was on it and she’d tried to help me, but she’d had enough, at that stage,” Dylan says.
Dylan woke up in hospital. After he was discharged, he ended up homeless for 11 days — having robbed his mother and younger brother to pay for his drug habit, relationships had broken down.
“I’ll never forget walking around in my shoes, no change of socks, no clothes, the rain going through my runners, blisters on my feet. I actually slept under the bridge over there,” he adds, pointing out the window of the hotel.
“I got a sleeping bag off Simon and myself and another fella would sleep there. I’ll never forget sleeping there, one night, and waking up to see a fella pissing on top of us.”
Eventually, he got a bed in the St Vincent de Paul hostel. “I was there six or seven months, maybe longer. It’s all a bit hazy.”
Then, he got into treatment at St Francis Farm, in Co Carlow, a residential rehab. He thought, after completing the treatment, that there was a chance of getting back with his girlfriend, but it wasn’t to be.
The breakdown in this relationship is an obvious source of regret.
“She was a lovely girl. She’s the mother of my child. Like, marriage was on the cards,” Dylan says.
These days, he says he’s clean. He has casual work on a building site. His mother is talking to him. His ex-girlfriend is due to marry someone else, but he says he’s happy for her.
“I’m actually happy that she will be in a stable relationship.” His son, now aged 7, is his rock, Dylan says.
“I was always afraid to have a child, I was always afraid. We didn’t plan the pregnancy. But he’s my rock. He’s the reason why I’m here. I wouldn’t be here without him.”
Dylan has found it difficult to engage with homelessness services. His experience, he says, is a lack of co-ordination between accommodation, training, and addiction counselling.
He gets frustrated at having to retell his story to the different services.
Lambert is hoping that her recommendations will address some of these difficulties.
These include setting up a trauma-change team to implement informed care; engagement with external agencies to modify intake paperwork to include trauma-screening; reducing paperwork for services-users and and making it more universal between centres, with an emphasis on people’s strengths.
In the long-term, Simon needs to advocate for additional resources to address building issues, such as beds in offices and a larger site for the day service, she says.
During her research, Lambert visited Simon’s Anderson’s Quay shelter, in Cork, as a “secret shopper”, to see if the service was trauma-informed. Simon fared well.
“The staff were absolutely incredible,” she says. “Aspects of the service that were not trauma-informed were linked to a lack of resources, such as single-occupancy rooms, lack of staff rooms, waiting list for the counselling service, a day service that is now too small for demand.”
Dermot Kavanagh says that Simon has implemented the recommendations. One of the first things they did was to engage in staff training.
“Sharon came in and did training with staff and volunteers. It was right across the board, so people would be aware of trauma and how it impacts on people, and so on.
“We did research with staff, as well, on the issue of vicarious or secondary trauma. When you work with the long-term homeless, as you build a relationship, people tell you things that happened in their lives and this has an impact on you, the listener, and it might trigger things for you.
“So, we have just started mindfulness training with staff. It’s a method of stress-reduction, a programme of relaxation that helps people deal with the stresses that could come with working in this kind of environment, and to be able to leave them behind.
“We have also looked at the physical infrastructure of the shelter. One of the core things is that people need to feel safe in the service — and what we learned from Sharon is that this can be highly individualised. What makes one person feel unsafe may have no effect on another,” Dermot says.
“In tackling the physical infrastructure, we have removed the partitions in our day room, so that there’s a lot more light coming through and it’s a lot more airy, a more pleasant environment, rather than small, narrow corridors.
“And in designing our winter initiative this year — which means using the day room as a space to provide extra beds for people sleeping rough — we modelled it, so that there are two waking staff in the room at all times, so that people feel absolutely safe.
“Some people wouldn’t normally come into a shelter, because they might feel that their belongings or they themselves might be at risk, but this particular initiative provides reassurance and safety, and it also allows people to come in and get sleep and, of course, getting a good night’s sleep is essential for coping with life’s difficulties.”
Tracey Johnston, assistant shelter manager at Anderson’s Quay, says they have made other changes, such as revising their paperwork, again on the recommendations of Lambert’s report.
This includes using a one-page profile, initially asking people what they see as their strengths and qualities and what others appreciate about them, rather than filling out reams of sheets, “where you are at risk of defining people as a series of risks and diagnoses”.
Focusing on the positive has also carried over into the use of signage — prior to Lambert’s visits, notice boards were dominated by leaflets advertising services to address addiction and mental health difficulties. Now, the focus is on training and employment opportunities.
Lambert’s recommendation that Simon establish a trauma-change implementation team, with service-user involvement, is already underway.
Dermot says they are “already hitting a lot of what Sharon identified, but in every area there is room for improvement and that’s what we are targeting.” *Name changed to protect identity.
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