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'You may not smell too good, and if they smell drink off ye at all, they’ll label you straight away'

Marginalised groups often have difficulty in accessing services when they are struggling with mental health issues, writes Andrea Koenigstorfer.

Andrea Koenigstorfer Psychotherapist

SUICIDES ARE PREVENTABLE. Even so, every year, almost one million people worldwide lose their lives by suicide and many more attempt suicide.

Suicide affects the most vulnerable population groups and is highly prevalent in marginalised groups. The homeless are a relatively small, though particularly vulnerable group in our society.

22 times higher for the homeless

In Ireland, the risk of self-harm among people who are homeless is 22 times higher compared to those with a fixed residence. Between 2006 and 2011, the number of self-harm presentations by homeless people in Ireland increased by 66%, significantly higher compared to 22.6% among those with a fixed residence.

John* speaks about the effect homelessness had on his mental health:

I have been in some low places where you do feel like you have nobody, loneliest person on earth like. Homelessness as well has a big part to play in it. You wake up in the mornings and you’re on your own. God, I hate it, hate it. You feel like your family doesn’t want ye, and nobody else wants you either, ye know? It takes its toll on your brain like, it really does like, wears you out.

International studies among the homeless population corroborate these findings.

Mental and physical health issues

What these studies also highlight is that for this population group, most of the risk factors for suicidality tend to apply – they have a higher prevalence of mental and physical health issues, chronic illnesses, acute distress, and alcohol and substance use issues, they are affected by poverty and social isolation, and they are more likely to be affected by violence.

Mark* described how living on the streets impacted his health:

Drink took a hold of me at an early age and I used it as a way of coping with things that were happening in my life. Before I knew it, I became homeless and ended up on the streets. Living on the streets is not living, it’s an existence. You live from minute to minute. You walk with your head down. I didn’t want anybody to see me or notice me, I felt worthless. I remember the day I made the decision to get the help I needed. I was suicidal, I’d just had enough. I was drained, both mentally and physically. When I came to Simon I had no skin on the bottom of my feet from walking the streets, my body was totally shattered.

Dublin Simon Community internal statistics have also recorded year on year increases in reported suicide and self-harm attempts and suicidal ideation.

This indicates a distinct need to establish self-harm and suicide prevention and treatment strategies specifically for the homeless sector. Regrettably, there tends to be limited resources for early identification, treatment and support of people affected by suicidality.

While there is evidence that suicide is preventable, the stigma associated with self-harm and suicide results in many people feeling unable to seek help.

Suicide and self-harm a serious public health issue

Suicide and self-harm is a serious public health issue that needs to be tackled urgently in general, with the need to focus on measures to prevent and reduce self-harming and suicidal behaviour among the homeless population in particular.

Paul* spoke about the difficulty in accessing services:

Particularly if you’re homeless, you may look dishevelled, you may not smell too good, and if they smell drink off ye at all, they’ll label you straight away. You might have only have had a couple of beers, just to build up the courage to even go in and say ‘look, I want to see a psychiatrist’. You’re sitting there in the waiting room and you have someone or the security guard standing beside ye or a care assistant or a nurse or whatever, people are looking and saying, ‘what’s going on with this person? Is he a troublemaker?’ So yet again, there’s other people kind of watching ye. You go out to have a cigarette and the security person is following ye out, there beside ye. People do look. So there is a label.

Suicide is preventable by supporting the people affected by it in a coordinated manner. This includes a strategy to facilitate the identification of risk, and evidence-based interventions based on the population group’s particular needs.

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For the homeless population, who often have a co-occurring alcohol or substance use problem, such a strategy requires improved access to specialised mental health services and continuity of care, including after presentation to A&E or hospital admissions after a suicide or self-harming incident.

Dublin Simon Community’s Suicide Specific Treatment Track protocols

On Monday 20 November, Sure Steps Counselling, Dublin Simon Community’s counselling service for clients experiencing or at risk of homelessness, received the Animate Social Innovation 2017 Award for their recently introduced Suicide Specific Treatment Track protocols.

As the homelessness crisis worsens, for the people affected by it, life can often feel overwhelming and hopeless. Dublin Simon Community will now roll out this pilot project to other services within the organisation and thus provide an accessible, consistent model of care to more people, so that their overwhelming negative feelings can take a back seat to the power of hope.

*Names have been changed.

Andrea Koenigstorfer is an accredited psychotherapist working with Dublin Simon Community Sure Steps Counselling Service. She has been working as a psychotherapist in homeless and addiction services since 2010.

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About the author:

Andrea Koenigstorfer  / Psychotherapist

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