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Dr Kathleen Stokes, Assistant Professor of Urban Geography, DCU.

Michelle Connolly, Research and Policy Manager, Dublin Simon Community.

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Eavanna Maloney RGN, BSC General Nursing.
Supervisor: Dr Briege Casey, Associate Professor. School of Nursing, Psychotherapy &
Community Heath.

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Connolly, M.; Casey, S.; Conroy, É.; Dempsey, D.; Frazer, K.; Kroll, T.; McDonnell Murray, R.;
Walshe, P. (2023). Co-Designing a Mental Health Support Programme with Young Adults
Experiencing Homelessness. Dublin Simon Community

An Analysis of Nurse-Led COVID-19 Interventions among Homeless Populations in Dublin, Ireland (2022)

COVID-19 presents healthcare challenges worldwide, including the imperative to protect people who have health related vulnerabilities and to limit contagion and further chronic illness among these populations. People who are homeless, particularly those with addictions and/ or sleeping rough, experience a range of health issues which are often undiagnosed or untreated because of poor healthcare access or uptake.

Contagion risks arise from poor access/ adherence to infection control measures among this often geographically mobile population. Refugees, asylum seekers and homeless migrants are also at greater risk of COVID-19 transmission. Congregated or unstable accommodation (e.g. hostels, asylum centres) inhibits social distancing and self-isolation. There is a significant knowledge gap concerning the multifactorial disease trajectories and care needs among homeless cohorts in pandemic contexts.

For those who are socially excluded, nurses are often the most accessible members of the healthcare team; planning, delivering and evaluating health promotion/ healthcare among hard to reach populations. Nurses constitute approximately 50% of the global healthcare workforce, delivering approximately 80% of routine prevention and treatment services and a large proportion of direct, pandemic-related patient care. COVID-19 demands evidence-based and rapid responses, yet knowledge concerning particular needs, effective infection control and treatment approaches among homeless people in pandemic contexts is still at an early stage of development.

Nurses, who are at the forefront of pandemic preparation and care interventions are well placed to observe and analyse structures, processes and outcomes of healthcare delivery and to identify challenges and improved ways of working.

This research, using case study methodology and healthcare quality evaluation frameworks, focused on the COVID-19 related practice of nurses and midwives in six Inclusion Health services for homeless people. Through capturing and sharing the characteristics of nurse-led COVID-19 interventions in Ireland and analysing their strengths and limitations, the research identifies what is most efficacious and recommends best practice in systematic healthcare planning and provision in pandemic intervention among homeless patient cohorts.

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Lead Investigators: Dr. Briege Casey (Dublin City University) and Dr. Fiona O’Reilly (Safetynet Primary Care)

Co-Investigators: Niamh Murphy and Michelle Connolly (Dublin Simon Community), Dr. Claire Cullen and Dr. Denise Proudfoot (Dublin City University)

Suicide Specific Intervention Programmes for People Experiencing Homelessness (2021)

Background: The homeless population are among the most vulnerable groups to experience suicide ideation and behaviour. Several studies have shown that people who are homeless experience more significant suicidal ideation and behaviour than the general population. However, there is limited information about what suicide interventions exist, to what extent they are grounded in robust research, and which intervention components effectively reduce suicidal ideation and behaviour in the homeless community. This research aimed to characterise the current evidence base in the area of suicide prevention for homeless individuals.

Methods: A scoping review guided by Arksey and O’Malley’s five-stage framework was conducted and a narrative synthesis was performed. Pubmed, EMBASE, PsychInfo, Cumulative Index to Nursing and Allied Health Literature (CINAHL), Open Grey, and Bielefeld Academic Search Engine were searched up to 8 May 2020.

Results: A total of 3209 records were identified through database and grey literature searching. Three studies are included in this review. Key outcomes identify suicide intervention prevention programmes; similarities and differences across interventions, and examples of staff training. A quality review of the studies was completed.

Conclusion: A stark gap in the evidence of suicide specific prevention interventions targeted at homeless populations.

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Murray, R.M.; Conroy, E.; Connolly, M.; Stokes, D.; Frazer, K.; Kroll, T. Scoping Review: Suicide Specific Intervention Programmes for People Experiencing Homelessness. Int. J. Environ. Res. Public Health 2021, 18, 6729

Blood Borne Virus and Drug Stabilisation Treatment Long Term Impacts for Individuals Experiencing Homelessness (2021)

Abstract

Homelessness is a growing human rights issue in Ireland. The route to homelessness often involves numerous societal and personal factors. The prevalence of multiple issues faced by homeless individuals is increasing, complicating their return to wider society.

Substance addictions, blood borne viruses, and mental health issues are all independently over-represented within the homeless community. Blood borne viruses are transmitted when body fluids pass from an infected to a non-infected person. In Ireland, people who inject drugs are some of the most at-risk populations for these viruses through needle-sharing. Mental ill-health is becoming increasingly recognised as a significant contributor to, and consequence of, substance addictions.

Those experiencing homelessness, addiction, or mental health difficulties struggle to adhere to medication regimens, which becomes more pronounced with co-morbidity of these issues. For BBV treatments, however, adherence is of paramount importance, as HIV can be suppressed to un-transmittable levels, and hepatitis C can be cured entirely.

Dublin Simon Community’s Blood Borne Virus and Drug Stabilisation Unit was established to support those experiencing homelessness and BBV treatment adherence difficulties to re-engage with their regimens. The programme further aims to address substance addiction, mental health, accommodation, civic, social, and physical health issues.

This study investigated the impact of unit admission on these compounding issues. Mixed-methodologies were used with a gender-balanced sample of 13 participants across four time-points from pre-admission to six months post-discharge. Key results include: BBV treatment adherence, improved physical health, the impact of loneliness and mental health service availability for mental health, improved accommodation, post-discharge substance use regression, better outcomes for alcohol- than cocaine-dependent clients, and a correlation of self-belief with outcomes. Implications are discussed and recommendations offered.

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Mapping restrospective outcomes and existing processes of the Dublin Simon Community Detoxification Unit in order to inform client needs and future service developments

Prof Catherine Comiskey, Karen Galligan, Dr Sonoma Banks, Linda Earls

This report was commissioned by Dublin Simon Community management to objectively assess the future service needs from the perspectives of the clients, staff and governance and procedural processes.  It was conducted by a research team in Trinity College Dublin with funding from the Hospital Saturday Fund.

It was a mixed methodology research project with quantitative analysis of client needs, care pathways and outcomes over 5 year period 2015-2019 and qualitative interviews with clients and relevant staff.

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Opening the Door to Hope 2 (2020)

This report is set against the background of the Opening the Door to Hope report launched by Sure Steps Counselling in June 2018. Little did we all know then, that since that time the world would be in the grip of a pandemic, impacting on the physical, mental and social health of society.

Since June 2018, Sure Steps Counselling with the support of our partners in National Office For Suicide Prevention, extended our suicide prevention service to provide much-needed support seven days a week, 365 days a year to clients across a wide range of homeless services, mainly in the greater Dublin area. The extended service went live in September 2018 and since that time has demonstrated an increasing need for mental health support to one of the most at-risk groups in society. When Covid-19 forced a national lockdown in March 2020, Sure Steps Counselling established a Freephone support line, and continued supports through phone and video until we in June 2020 could again meet with clients face to face.

This report provides an independent evaluation of our suicide prevention service over an 18 month period. It also analysis the clinical data from interventions utilising the Collaborative Approach Managing Suicidality (CAMS) within homeless services and a comparative analysis of data with a community mental health service, and finally the report contains a published report on counsellors’ experience of utilising CAMS in the homeless sector.

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Adult Autism in Homelessness: Prevalence, Experiences and Support Needs in an Irish Context – A Mixed Methods Study

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The report is an evaluation of the implementation of the Collaborative Assessment and Management of Suicidality (CAMS) Approach within Simon’s homeless services to provide additional support to clients who may be experiencing suicidal ideation. Click here to view the full report

Homelessness and Mental Health: Voices of Experience (2017)

This study grew out of a Dublin Simon Community Client Action Group (CAG) event on mental health which took place in November, 2014. The CAG’s Speak Outon Mental Health event showed that there was a strong interest among homeless people in having improved mental health services. Click here to view the full report. 

Living in Limbo: Homeless Young People’s Paths to Housing (2017)

This longitudinal research study followed 40 young people over a two-year period in order to examine the factors, experiences and circumstances that impact their homeless and housing situations over time. The research was carried out by Dr. Paula Mayock and Sarah Parker, School of Social Work and Social Policy, Trinity College Dublin and the Simon Communities of Ireland, Focus Ireland, Threshold, Peter McVerry Trust and Society of St. Vincent De Paul collectively funded the research. Click here to view the full report. 

Empty Homes: Unlocking Solutions to the Housing and Homelessness Crisis (2017)

The Government has committed in Rebuilding Ireland: Action Plan for Housing and Homelessness to developing an overall National Vacant Housing Re-use Strategy, due out in the second quarter of 2017. The Simon Communities have developed a 10 Point Empty Homes Plan, Empty Homes: Unlocking Solutions to the Housing and Homelessness Crisis with a range of solutions that we believe should be included in this Strategy. Click here to view the full report.

Women Homelessness & Service Provision (2015)

Women’s experience of homelessness can differ significantly from their male counterparts in terms of the causes of their homelessness, their experiences while homeless and their pathways out of homelessness. This report aims to explore some of these themes in the Irish context as well as looking at some of the risk and vulnerability factors more generally. Click here to view the full report.

Which Way Home? The Experiences of the Simon Communities Introducing Housing Led Services (2015)

As a follow up to our Finding the Way Home research and in light of the Government’s commitment to end long term homelessness by implementing a housing-led approach, the Simon Communities in Ireland commissioned a piece of research to explore the experiences of the Simon Communities introducing housing-led services.  The research was undertaken by Mark Bevan with Nicholas Pleace of the Centre for Housing Policy in York University and was designed to help inform and critically assess the use of housing-led services as a response to homelessness at both a national and local level. Click here to read the full report.

Left Out In The Cold: A Review of Rural Homelessness In Ireland  (2014)

The key aims of the paper were: To explore the experience of rural homelessness in Ireland especially among the eight Simon Communities in Ireland. To explain how rural homelessness can differ from urban homelessness and some of the challenges that arise, both for people experiencing homeless and those at risk, and service providers. To explore Government Commitments in relation to homelessness and the current policy context. Give recommendations addressing the issues identified. Click here to read the full report.

Homelessness, Ageing and Dying: Exploratory research looking at the needs of older people, who are homeless, as they age, and are faced with the serious issues of ill health and dying (2014)

There is a lack of information about the exact number of people who are homeless and the nature of the homelessness at any one point in Ireland. There is also a lack of information on the physical and mental health needs of people who are homeless and particularly among older people who are homeless or formerly homeless. The overall aim of this study was to explore the needs of older people who are homeless as they age and are faced with the issues of serious ill health, dying and death. Click here to read the full report.