I will focus on a specific issue, namely, the relationship between homelessness and mental health. Having a severe mental health difficulty can put people at risk of homelessness for various reasons. Without proper mental health support after discharge from hospital, a homeless person may fall out of treatment and end up relapsing. Mistrust or dissatisfaction with an overly medication-orientated treatment regime can put people off seeking report, leaving them to struggle alone. For those with an addiction and a mental health difficulty, there are often barriers to accessing mental health treatment until the addiction has been brought under control, putting this group in a potential catch-22 situation that can lead to homelessness. For others, the issue may be the need for support to maintain their housing situation and relationships in their community.
From the other direction, being homeless puts people at high risk of developing mental health distress. Homelessness exposes people to a risk of trauma, violence and lowered self-esteem, while the living conditions and chaotic lifestyle of the street make it difficult for people to access mental health services until they are at crisis point. Too often, homeless services are unable to get mental help support for clients in a crisis and are forced to turn to busy hospital emergency departments where the individual distress often cannot afford to wait the many hours it might take to get help. People with mental health difficulties are seen in greater numbers among the prison and homeless populations.
The high incidence of mental health difficulties has been documented by several organisations that assist the homeless. In 2014, Dublin Simon Community reported that 71% of people using its services had a mental health difficulty, while 22% reported a diagnosis of either schizophrenia or psychosis. These figures suggest that the move to community-based health services may have left some people without adequate follow-up support. A striking link between homelessness and acute mental distress is shown in an audit carried out between October 2012 and September 2013 by the acute mental health unit at Tallaght hospital. It found that 98% of long-stay or delayed-discharge patients had accumulated related needs during that period. Of particular concern was the finding that one person was discharged into the homelessness services every 9.5 days from Tallaght hospital alone.