Homelessness & Mental Health

“The homeless population has always experienced difficulty accessing mainstream mental health services, partially due to many of them presenting with dual diagnosis: ie. a mental health condition together with an addiction problem which the Irish mental health system traditionally sees as two separate problems to be treated in two separate systems, either of which can make the other an exclusion criteria for access.”

Mental health is central to all our well-being, helping us contribute actively to our communities. That said, many of us face challenges in life that can take a toll on our mental well-being: The report “Health at a Glance: Europe 2018” says that mental health problems, such as depression, anxiety disorders and alcohol and drug use disorders, affect more than one in six people across the European Union in any given year. Besides the impact on people’s well-being, the report also estimates the total costs of mental ill-health at over 600 billion Euro – or more than 4% of GDP – across the 28 EU countries. World Mental Health Day, on 10th of October, was put in place by the World Health Organization (WHO) to raise awareness of mental health and mental health problems. The chosen focus of this year is Mental Health for All – Greater Investment – Greater Access.

Incidentally, World Homeless Day also falls on 10th of October, with the aim of drawing attention to people experiencing homelessness and their needs. Putting homelessness into the context of the importance of mental health, the recently published Dublin Simon Community Annual Report highlighted that a staggering 53% of our emergency accommodation residents require mental health support, the large majority of whom also have physical health or addiction issues. Our Sure Steps Counselling Service have been experiencing a steady year-on-year increase in referrals since its inception in 2012, with a nearly 700% increase in referred clients between 2012-2019. About a fifth of all referrals are related to clients presenting with suicidal ideation or self-harm.

High quality, accessible mental health care should be the foundation stone of our society. Yet the reality is, that many such services are not easily accessible, be it that there may be long waiting lists, that services might not exist in certain locations requiring long journeys to attend appointments, or that available services do not cater for the complex needs some people may be presenting with. The nationwide lockdown earlier this year has highlighted the issue of connectivity and privacy, as most mental health services moved online – a situation often not suitable for those living in shared or crowded accommodation or those without the necessary devices or broadband to access online support. Similarly, many of these mental health services were not prepared for this switch to online working, in particular around the availability of secure online tools and the ethics of working with clients in an online environment.

The homeless population characteristically has always experienced difficulties accessing mainstream mental health services, partially due to many of them presenting with a dual diagnosis, i.e. a mental health condition together with an addiction problem, which the Irish mental health system traditionally sees as two separate problems to be treated in two separate systems, either of which can make the other an exclusion criteria for access. The often chaotic living circumstances of clients experiencing homelessness, coupled with a history of trauma, can also make it very challenging for them to attend sessions on a regular basis.

The emotional impact of feeling brave enough to ask for help and not receiving it in a timely manner or at all is devastating, whether one is homeless or not. Clients feel let down, forgotten or rejected by society and often interpret the lack of available help as not being worthy of help.

There is therefore a need to make mental health a reality – for everyone, everywhere. This requires a greater investment of governments in the mental health field, financially as well as in time and efforts put aside for it. It requires an overhaul of traditional thinking and trying approaches and ways of working that are new, and often appear daring or unconventional. It requires decision makers taking the time to learn more about mental health, people’s wellbeing, and the services in our community that support particular population groups. It requires the availability of resources, support groups or activities to improve mental and physical wellbeing.

Dublin Simon Community put in place Sure Steps Counselling, the first homeless-specific general counselling service in Ireland, to enable a client group with a high prevalence of mental health as well as dual diagnosis issues access a low threshold as well as trauma-aware service with almost no waiting times initially. However, to date the service receives no statutory funding for its general counselling service, and the increased demands on the service have led to much longer waiting times in recent times. Unfortunately, what could have been early intervention counselling on point of referral, at times now becomes a crisis intervention if a client deteriorates while waiting.

But mental health as a reality for everyone also requires all of us, individually, to learn more about mental health and wellbeing, so that we can ourselves become empowered to take charge of our own mental wellbeing. Opening up the discussion about mental (ill) health helps create an environment where people feel more comfortable discussing their own struggles. Speaking openly about mental health will increase people’s help-seeking behaviours, in turn reducing the need for substances and alcohol to cope. Transparency around mental health awareness helps people with mental disorders find resources, support groups, or activities to improve their wellbeing and teaches us how to effectively help and support those in need. As difficult as the last 6 or 7 months have been for us as an organisation and the country as a whole, the community has rallied around our clients, recognising the need for these mental health and wellbeing supports and providing essential items like laptops, arts and crafts materials, bicycles, Perspex screens and air purifiers for counselling rooms, as well as design skills and free printing of mental health materials during the lockdown.

What we cannot forget in the overall goal for mental health as a reality for all is the need for hope. Mental Health and Wellbeing providers need the hope that there are treatment and support options that can work for our most complex client needs, and that such treatments receive the appropriate financial and logistical governmental support to be accessible for all. Clients in turn need the hope that the treatment and support they receive will be effective. Mental Health is a process, not a destination. We all, governments, organisations, and individuals alike, need to look at ourselves in terms of how we are getting there.

By Andrea Koenigstorfer