Stigma, shame and fear are key issues preventing women from engaging with services to address substance abuse, particularly those who are homeless, according to a new report.
The report, conducted in partnership with the UCD Community Drugs Programme, shows that 42% of people in homelessness are female, the average age at death of women who are homeless in Ireland is 38 years, while for men it is 44.
It also found that in 2017, there were 211 female drug-related deaths – a 7% increase on 2016.
The briefing paper by Dr Sarah Morton, Dr Steve Macdonald and Lauren Christophers was led by Merchants Quay Ireland (MQI) in partnership with the UCD Community Drugs Programme as part of the MQI initiative to explore the issues and challenges surrounding access to homeless, addiction and health services for women.
It looked at the experiences of practitioners providing frontline services and the evidence from previous studies and found a range of factors were at play.
It said some women can have difficulty getting to know what services are available to them, and that coercion, abuse, and domestic, sexual, and gender-based violence are safety concerns for women attempting to access services.
"Fear of physical harm from abusive partners can act as a barrier to women accessing homeless or substance misuse services or leaving a relationship," it said.
It also cited other issues such as the barring of women with histories of anti-social behaviour, active drug users, and migrant women who do not satisfy the habitual residency condition, alongside child-specific issues and the stigmatisation of homeless or substance-using women as “bad mothers”.
"It was highlighted that in many ways it was easier for men to access services if they were a father than it was for a woman who was a mother or caregiver," the report said.
One practitioner asked: "Why are we not seeing women before they get to these levels of trauma and trouble? Women are hugely under-represented at the start of their difficulties, they present when something drastic has happened, a hospitalisation, an overdose, the loss of children. Why are they not asking for help way before that?"
Another said: "They are running on fear. We need to stop treating homelessness and addiction as separate issues . . . most women in treatment are fleeing something – there is very little self-referral."
The study found that addressing structural inequalities was one way of increasing engagement with women in services, alongside building trust, attending to their safety, speedier access to more inclusive services, which would include addressing waiting lists for detoxification services and absence of such services in particular regions.