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Monday 20 March 2023 Dublin: 14°C
TheJournal MQI's rough sleeper outreach team
# covid19
Lack of shower and toilet facilities exacerbating mental health issues for Dublin's rough sleepers
Dublin’s rough sleepers have been relying on the two public toilets locations in the city centre.

CONCERNS HAVE BEEN raised for the welfare of Dublin’s population of rough sleepers over the lack of toilet and shower facilities in the city since the outbreak of the pandemic last year.

Members of Merchants Quay Ireland’s (MQI) outreach team say the issue has been raised repeatedly by rough sleepers they interact with, with some forced to use the area where they’ve bedded down for the night as a toilet.

“Toilets are a basic amenity that we all need. I know certainly around some tents you can see evidence of where people have been going… it’s degrading for them,” a member of the MQI rough sleeper outreach team said. 

The outreach team says the lack of access to facilities over the last year is compounding the mental health impacts of the pandemic for the homeless population.

Dublin’s rough sleepers have been relying on the two public toilets locations in the city centre which are only open from 10am to 7pm. The facilities, which opened last June, are at Stephen’s Green and Wolfe Tone Square.

Early in the pandemic, measures were put in place to protect homeless people from Covid-19 as much as possible, including providing temporary accommodation, as well as a focus on testing vulnerable groups.

However, level five restrictions saw the shuttering of facilities at MQI’s Riverbank centre and other locations that would have been used previously by rough sleepers.

The lack of public toilets in the city for the general public has been raised regularly and is on the agenda again ahead of the summer, with over 750 people signing an online petition calling for more facilities.

More facilities

Dublin City Council said the toilets get an average of 1,500 users per day and are still fully operational.

“More such facilities are currently being considered for other parts of the city,” a council spokesperson said. 

Recommendations made by the UN Special Rapporteur on Housing at the beginning of the pandemic included providing access to public toilets, handwashing facilities and showers; ensuring homeless people were not criminalised or fined in enforcing Covid-19 restrictions; and providing up-to-date health information.

The Dublin Region Homeless Executive (DRHE) acknowledged that day centres for people who are homeless have been unable to operate their full range of services, including sanitary facilities, but said its primary response to meeting the needs of people who are rough sleeping throughout the pandemic is to provide them with safe, secure accommodation.

2644 Toilets Sasko Lazarov / RN The public toilets beside St Stephens Green: The petition is calling for more public toilets in Dublin city centre to prevent “unsightly and damaging public urination. Sasko Lazarov / RN / RN

Like MQI and other homeless charities, the Dublin region outreach service, run by Dublin Simon Community on behalf of the DRHE, engages with people who are sleeping rough from early morning to late at night.

“Outreach teams make contact and place people in accommodation where toilets, showers, meals and other supports are provided onsite on a 24-hour basis,” said the council spokesperson. 

“Throughout 2021, unused beds have been available every night.” 

On a recent walkabout with MQI’s outreach team, one team member told The Journal that a majority of rough sleepers they encounter would be regular clients who don’t want to access accommodation for a variety of different reasons – such as addiction issues, safety concerns, or simply because they have been disenfranchised by the “revolving door” system. 

“Unfortunately there’s only so much that they [DRHE] can do, it just means that the longer the restrictions are in place, the longer the clients have to deal without,” they said. 

“I think it just makes them feel even more marginalised in society that they don’t have a place to use the toilet.”

The Journal accompanied the MQI outreach team on Wednesday morning, stopping first on Henry Street which has seen a significant increase in rough sleepers bedding down due to the closure of non-essential retail.  

This team works primarily with rough sleepers and are most people’s only point of contact – particularly since the onset of the pandemic. Operating in tandem is a separate MQI outreach team specialising in addiction services. 

“Do you need anything from us today? Sorry to wake you,” they say from behind their masks tentatively approaching the tents, many of which are empty by late morning. 

The street was cleared by Dublin City Council, DRHE’s outreach team and gardaí in February. 

1156 Sleeping rough Leah Farrell / RN Some of the tents set up outside Debenhams on Henry Street, in late January. Leah Farrell / RN / RN

The DRHE said it worked in a “very sensitive way” and with a clear focus on the needs of the occupants to remove the tents from this location and to provide much more suitable accommodation to the couple and individuals involved.

“Our Outreach Team assisted and supported all the individuals back either to their tenancies or into emergency accommodation. They retained their belongings but the DCC Waste Management Division took away all the tents.”

This week, the tents were back as were the rough sleepers with just a sleeping bag. 

The MQI outreach team carefully and compassionately approached each person to offer them assistance and support.

They carry provisions such as underwear, clothing, socks, and toiletries should anyone need them – and many did. 

In response to a query from Sinn Féin TD Eoin Ó’Broin on February’s clearing of Henry Street’s tents, Minister for Housing and Local Government Darragh O’Brien said the policies of DCC and the DRHE are primarily a matter for them as the relevant authorities.

He said he understood they had issued a public statement outlining the operational reasons for their actions and the manner in which it was carried out.

“It is vital that we continue to deliver the appropriate measures to ensure that all individuals experiencing homelessness are supported to exit into permanent housing solutions and that those with complex health and mental health needs are provided with the supports they need,” said O’Brien.

Engaging directly with rough sleepers is vital and this engagement is first and foremost to encourage those rough sleeping to avail of shelter. Critically, it also allows their health needs to be assessed and provided for. Services operate throughout the year with an increased emphasis during cold weather periods. 

20210331_090725 TheJournal TheJournal

Mental health

MQI provides homeless outreach and drug rehabilitation services at every level of addiction, and it provides medical and counselling support for most-at-risk homeless people. 

Alongside social isolation and increased hardship, the lack of sanitary facilities is having a negative impact on rough sleepers’ mental health, the charity’s head of fundraising and communications Carol Casey told TheJournal.

“Many of our clients are outside all day, in all weather, with nowhere to go indoors for a warm meal, a shower, or a comforting conversation. There is no doubt that this social isolation and increased hardship is having a negative impact on our clients’ mental health,” she said. 

Prior to the pandemic, two hundred people a day would come into the riverbank centre, but with day centre doors shuttered its clients are missing out on a safe space in the city “where they’re not being judged and can let their guard down”.

Now, MQI says it is seeing more people present and “they’re presenting with more complex mental health issues at precisely the time when we’re finding it most difficult to actually provide that service”. 

Some of the mental health support solutions which work for the general population, such as tele-medicine or tele-psychiatry, don’t work for everyone on a practical level.

Most rough sleepers do not have phones that facilitate internet access, and for those that do, they often have no way of charging their phone, or no money for credit.

MQI still offers face-to-face mental health interventions to clients in crisis as well as an over the phone service. For those who have established relationships with the charity, MQI says the service works well, but less so for new service users.

“If you’ve never met the person that you’re trying to get a handle on where their mental health is at, over the phone is very difficult, and why it’s difficult is because if you’re doing an assessment as a mental health nurse for the first time with a new client, you’d be looking at all the physical cues as well as all the nonverbal stuff.

“They can be vital to your overall assessment of how that person’s doing,” said Casey. 

7335 Merchants Quay Ireland Leah Farrell / RN Leah Farrell / RN / RN

MQI was running an appointment-based shower service last year but had to pause due to Level 5 restrictions. Once they are eased later this month, the charity said it will be able to offer four showers a day on an appointment basis. 

“We aim to prioritise people sleeping rough. So our outreach team will identify those people most in need and link them back into the Riverbank centre,” said Casey. 

She noted that the absence of public bathrooms was not a new issue, but something that has caused great difficulty for rough sleepers during Level 5 restrictions:

“Coming into the summer months you’re so much more visible. Needing to use the toilet in public is something no one wants.”

Casey acknowledged that the provision of public facilities for rough sleepers is a complex issue as many also struggle with addiction, something which has long been “recognised as a reality” at the Riverbank centre. 

“Even though we have rules saying ‘do not under any circumstances consume drugs on the premises’ and we police it really tightly, people still overdose.

So we have to have staff members stand in our toilets, monitoring the situations, and we have specialised doors so that if somebody does inject and overdose we can lift the door and get to them and make sure that there is an appropriate health intervention taking place and their lives are saved.

“It’s not just a case of providing the toilet. You also have to provide the security and the supervision, and adequately trained staff to be able to intervene… that’s not to say we shouldn’t be doing it.

“We absolutely should have more readily accessible facilities for homeless people in the city.” 

Harm-reduction services were quickly expanded in Dublin at the start of the pandemic – including improved access to methadone treatment and naloxone (medication used to reverse the effects of opioid drugs like heroin), and the home delivery of prescription drugs.

A July 2020 report from the London School of Economics and the Ana Liffey Drug Project found that the extension of these services was significant in protecting homeless people from Covid-19. The authors noted that prior to the outbreak of the virus, these services were “limited by regulatory obstacles which were rapidly removed in response to coronavirus”.

Plans to build a Medically Supervised Injecting Facility (MSIF) at MQI’s Riverbank Centre were approved on appeal by An Bord Pleanála last December. But following further resistance by businesses and people in the locality the plans to build the centre are at the mercy of a judicial review, scheduled to take place on 15 June. 

Plans for the 18-month pilot scheme consists of seven injecting rooms where drug users can go to inject drugs under the supervision of a medical professional. Over 120 facilities exist in countries across the world, including Australia and Canada.

The 2016 Programme for Government contains a commitment to open an MSIF and laws were passed in 2017 allowing for such centres to open and be run legally. 

In recent years, drugs advocacy groups, like MQI, have called for a health-led approach to drug addiction in Ireland. 

The charity is hoping the outcome this June will be a positive one so they can start working on delivering the service, which will take time to get up and running. 

“Even if we go at full tilt, it’s still going to take time to renovate the basement, recruit and train the staffing team, and get it up and running,” said Casey.

“The MSIF will be a vital first step in reducing harm and supporting a person towards recovery. Staffed by experts with full nursing and medical services, it will provide opportunities for intervention, helping reduce the harms associated with injecting drug use and helping link vulnerable people in with drug treatment supports and health services.

“People are dying in the meantime, that’s the tragedy of it all.”

the-lived-experience-project PA Carol Casey, Head of Fundraising at Merchants Quay Ireland, pictured at the launch of the Lived Experience Project last year. PA

There was a slight decrease in the numbers of homeless people last month, according to figures from the Department of Housing, Local Government and Heritage.

The monthly homelessness report for February found that there were 8,238 people in emergency accommodation across Ireland, however, this figure does not include rough sleepers, something which has been criticised in the past by housing charities

The latest count of rough sleepers carried out by DRHE found 139 people on the streets in Dublin. This count was carried out over the course of a week in December and is not comparable with last year’s winter count, which found 92 people sleeping rough. 

The DRHE said because of Covid-19 it was not possible to carry out a single night’s count with over one hundred volunteers across Dublin and a seven-day assessment was carried out instead.

Despite the change of the counting method, the MQI outreach team believes the number is generally much higher, as many people “fall through the cracks”. 

“We know ourselves that today we might meet x amount of people, and tomorrow see double that. There are is a lot of hidden homeless,” they said, especially people sofa surfing and those outside city centre. 


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