Sharon Lambert: Every homeless death leaves behind a family who couldn't access services

Nobody working in the area of homelessness would have been shocked by the recent RTÉ Investigates programme

People experiencing homelessness report that when attending mental health services, they are rejected due to a substance dependence issue and redirected to addiction services. At times, these people are also rejected from addiction services as their mental health needs are too complex for those services and directed back to mental health services. File photo: Larry Cummins

While many members of the public were shocked by what was uncovered by the recent RTÉ Investigates Sleeping in The Rough programme, those working in the area were not. 

The issues raised are neither new nor exclusive to the current pandemic. Numerous research reports have revealed huge issues in the way this country responds to homelessness.

On the programme, people witnessed the efforts made by people experiencing homelessness to secure a bed for the night, only to be told that they should return to the county they originated from. This “centre of interest” policy is applied nationally and does not deter homelessness in any way. 

An incorrect view prevails that if you provide homeless services to those outside your area that this contributes to homelessness in your city. People move to cities for a range of complicated reasons, some escaping trauma, some released from prison into homelessness and have nowhere else to go. 

Young care leavers, members of the Travelling community, and foreign nationals are particularly vulnerable. 

In truth, the outcome of this policy is that it excludes very marginalised people from services and increases their risks, including risk of death.

We pump huge amounts of money into private emergency accommodation, where marginalized people are left without sufficient psychosocial support. A large evidence base exists around the ‘housing first’ model. 

Not only is it less of a financial burden on the State and taxpayer, it also improves outcomes for people experiencing homelessness, reducing the hardships caused to those individuals and their families.

People experiencing homelessness can come from a background of severe psychological trauma and this has caused chronic mental health issues which are medicated by substance dependence. High levels of adversity during childhood have been identified in our research with the group. 

These individuals struggle to access the services they need, and report that when attending mental health services, they are rejected due to a substance dependence issue and redirected to addiction services. At times, these people are also rejected from addiction services as their mental health needs are too complex for those services and directed back to mental health services. 

It becomes the cycle of rejection and many people die as a result of the inability to seek help. 

Over a decade ago, a report was commissioned on “dual diagnosis”, where someone experiences both an addiction and mental health issue. To date, the recommendations of this report haven't been implemented. 

About four years ago, a dual diagnosis steering committee was established, it is my understanding that it has not met in the last couple of years.

There are a number of excellent small dual diagnosis services that emerged from grassroots organizations. I don't believe we should have separate dual diagnosis services, the existing services should operate an open-door policy to those who need it. 

Segregation causes further stigmatization.

Addiction is often a mental health issue, and should not be used as a criteria to exclude somebody from mental health services. The continued criminalization of people who use drugs is not in line with the national drug strategy which states that Ireland has a health-led approach to drug use. 

People experiencing homelessness because of psychological trauma present with complex needs and are viewed as having challenging behavior, while this behavior is very difficult to witness, it is an appropriate response for that person in their current mental health distress.

Many people who work in public services such as social protection and housing have no training about psychological trauma and struggle to manage these individuals. As a consequence, they are often treated badly and become further marginalized and unable to seek the help they require. 

This also has an impact on staff working in services, they deal with high-end complex needs on a daily basis with a limited understanding of what is presenting, and often perceive the challenging behavior as personally directed towards them, when it is not. This has an impact on the staff's wellbeing and puts them at risk for secondary traumatic stress. 

A consequence of secondary traumatic stress is dehumanization, where staff have to ‘other’ those individuals in order to keep themselves psychologically safe. We witnessed this on RTÉ Investigates where there was a deep lack of compassion for people trying to secure accommodation. 

I understand this from a psychological point of view, I do not blame the staff, it is a consequence of their exposure to the trauma behavior and an absence of appropriate training to understand what they are dealing with. 

Trauma awareness training for all staff in public services can mitigate against this, and improve outcomes for service users, the staff and the organizations. The Limerick homeless organisation Novas has successfully trialled a trauma-informed project.

People experiencing homelessness have to navigate a large number of services and often fall through the cracks. The national rehabilitation framework has a system of interagency case management and shared care planning. 

The system promotes one care plan for an individual, where all of the agencies input into the plan and communicate with each other. This is not difficult to implement; the framework has existed for about 10 years but is only used in a small number of services. 

Professor Jo-hanna Ivers from Trinity College evaluated the interagency case management in the Cork/Kerry region and identified a number of missing partners. In my experience of working in addiction services there were also missing partners, when we attempted to create shared care plans for young people. 

Mental health services and education were regularly unavailable to participate in those shared care plans. The care plan should be managed by a key worker and consistent key working reduces the burden on health care and associated services, improving outcomes for people with no housing.

There are a large number of children now living in emergency accommodation, a relatively new problem for Ireland. We know from international literature that those children may be at increased risk of adult homelessness. 

Research we conducted with families in homelessness revealed multiple systemic barriers to accessing services. We also interviewed statutory public service providers and were alarmed at the attitude that some staff had towards those experiencing homelessness. 

This is potentially due to staff burn out, with the consequence that they struggle to have compassion for those seeking support.

If we do not break the cycle of homelessness we will continue to perpetuate intergenerational cycles of homelessness which will have huge financial costs to the State in the areas of health, justice, social care and in personal costs to the individuals and their families. 

Every death that occurs in homelessness leaves a grieving family behind, not families who have abandoned their loved ones, but families who have tried desperately to navigate systems and services to access help. 

Ireland has the fourth highest rate of drug related death in the EU, almost two people per day. Our research shows the impact on many families is a complicated bereavement process causing further personal burdens and costs to the State.

A major concern is that we don't record ‘hidden homelessness’ in national statistics - that includes people living in squats, sofa surfing, women and children in refuges and rough sleepers. How can we know the scale of the problem and respond without the accurate data?

Homelessness in Ireland must be considered an emergency situation. Addressing this emergency will require due financial support, and evidence-based policies implemented at local and national levels.

• Dr Sharon Lambert is a lecturer in Applied Psychology at UCC and a member of the Cork Social Democrats.