DESPITE PUBLIC CONCERNS and significant effort from both statutory and voluntary agencies, there is still a significant number of people living on the streets, living with an addiction and who are isolated from support services. Why is this?
Consider the case of Joe, a young man who regularly sleeps rough in Dublin city centre. Joe attends a mental health service for support. He is assessed, and it transpires that he has a drug addiction. The service declines to treat his mental health issue on the basis that Joe needs first to address the addiction before meaningful work can be done regarding his mental health.
So, Joe attends an addiction service, where he is told that he can’t access the service until he has dealt with his underlying mental health issue. Despite having both issues, he receives limited support. It’s not hard to see how Joe can enter the revolving door scenario of street homelessness, hostels, hospitals and prisons. Not only are we letting him down, but we are not using the State’s limited resources efficiently.
There are other scenarios and there are many gaps in accessing housing, health and social services for those with complex needs.
‘Person centred service’
If we want to address complex social issues like addiction and homelessness, we need the activity of frontline services to match the vision of high level policy. At policy level, there has long been a commitment to providing a ‘person centred service’, in which the service adapts to meet the needs of those that present, rather than forcing the person presenting to conform to the requirements of the service.
However, this has never fully translated to front line service delivery. Across Ireland, there are still many people on homeless lists; there are still many people who cannot access timely addiction treatment; there are many people who are isolated and not reached by existing services. People ‘fall through the gaps’.
The solution, of course, is to be truly person centred and to expect cases with multiple and complex needs. Instinctively, we know that many social problems are intrinsically linked. When we start to think about visible heroin use on the streets, for instance, we know that issues like homelessness may be linked in some way. Nobody wants to inject heroin on the street.
Nobody wants to be homeless. People who are homeless and living life with an addiction have the same hopes and dreams as everyone else – family, security, stability. But the milieu in which their lives are lived are different to that of many of the people reading this. Many have mental health issues. Many have life histories that are marked by abuse, neglect and isolation. Many also have negative experiences in their histories of their own making – of violence that they have perpetrated, of acquisitive crime, of drug dealing.
In addressing social issues, we need to be prepared to deal with these issues in their totality. This means supporting people to get the help they need, while being prepared to challenge those behaviours which are problematic and antisocial, and to support those behaviours which are prosocial. And it means challenging public perceptions too – as much as someone using heroin intravenously down a lane is an inappropriate behaviour which needs to be challenged, so is the act of simply labelling that person a ‘junkie’ and mentally assigning them to a preformed stereotype. Both behaviours are inappropriate and need to be challenged.
So, how does society best address these issues? There needs to be empathy, pragmatism and challenge. Empathy, because life on the streets is not easy – there are threats, intimidation, violence, sexual assault and exploitation. There are health repercussions – premature death, malnutrition and overdose, for example. It can be degrading, humiliating and frightening. It can be difficult to see a way out, much less to find one. Passing judgment is easy, but it does not address anything. We also need to be pragmatic.
It’s important to remember that breaking the cycles of homelessness and addiction is not as simple as someone getting their own accommodation or completing a treatment programme. Coming out of addiction and homelessness is a major life event, and like all major events, it is a challenge to adjust. A homeless lifestyle has its day-to-day patterns and support networks. For some these can be hard to leave behind, especially when faced with the potential isolation and loneliness of moving into a property in a community you don’t know. A property in itself is not a home, there is much work besides getting a set of keys before a person feels at home.
Falling through the gaps
Finally, we need to be challenging – both to help people recognise and change negative behaviours, and also to ensure that people in need of support are given that support and not allowed to ‘fall through the gaps’.
Positively, services are moving in this direction. Dublin has adopted a ‘Housing First’ approach to homelessness, seeking to deal with providing accommodation and support as a matter of priority for people with complex needs, rather than allowing issues like addiction to act as a barrier to tenancy sustainment. This approach should be expanded across the country so there is a move towards providing intensive support to those that are most isolated, through assertive services which engage on an outreach basis.
There is a need to ensure similar services are provided on the addiction side – that people can access treatment and rehabilitation services with a minimum of red tape and barriers. As it stands, there are very few treatment options for people who want to get away from drugs and the street. There are too few treatment beds, and those that are available tend to have entry criteria which mean that practically no-one on the streets and actively using drugs is eligible for entry. This is not putting the person at the centre, and it is not conducive to positive change.
Ultimately, if we wish to seriously address issues of addiction and homelessness, we need to ensure that the services on offer are easily accessible and lead to a life better than intoxication on the streets.
Tony Duffin is the Director of the Ana Liffey Drug Project, a national addiction service working to reduce the harm caused by drug use in Ireland. Ana Liffey provided direct services to over 3,500 clients in 2012, many of whom are among the most marginalised from mainstream service provision. To find out more about the Ana Liffey’s services visit www.aldp.ie/services or visit their Facebook or Twitter page.