It sounds simple, but the event that has the single biggest impact on the health of a person who is homeless is exiting homelessness. That is one of the reasons why Budget 2014 is damaging to the Government’s commitment to end long-term homelessness by 2016.
We know that, with appropriate housing and support, people can, and do, leave homelessness behind. However, there are major concerns about housing supply and accessible housing options available for people to leave homelessness.
Homelessness is not just about housing; health and social care are significant factors which need to be addressed alongside housing. Cutbacks to funding for health services, education and training, as well as drug and alcohol services, will have repercussions which contribute to the numbers of people becoming homeless but also prevent people from moving on to independent living.
A study carried out by the Simon Community in 2011, among people using our services, found that 65 per cent of those people were experiencing at least one diagnosed physical health condition and 47 per cent were experiencing at least one diagnosed mental health condition.
There are many different reasons why a person becomes homeless, but generally the explanation lies in a combination of structural factors such as poverty or unemployment and personal factors such as family breakdown or health problems.
What is clear is that once a person becomes homeless, the deterioration in their physical and mental health can be both rapid and debilitating.
The medical card review is particularly worrying
Budget 2014 will push more people into homelessness. The Government’s decision to save €113 million from a review of all medical cards is particularly worrying. The proposed review to remove any ‘redundant or ineligible cards’ means there are real fears that cards may be removed from people who need and depend on them. We in the Simon Communities had already asked the Government to reverse the increase in prescription charges for medical card holders, which had increased in Budget 2013.
However, they have now been increased again, this time by 66 per cent, for each item on the prescription. This will hit people who can least afford to pay the most. Given the high levels of complex needs amongst people who are homeless, we are asking the Government for a commitment that medical cards for people who are homeless will be protected. Without them, we are condemning people who are homeless to little or no essential medical care.
How can you recover and participate in society if Government won’t give you a helping hand when you most need it?
Risk to services
The Government’s decision to save €666 million (although there is now concern that these cuts may rise to €1 billion) in the HSE budget next year will undoubtedly mean that many people will not get the medical attention that they desperately need.
Tackling poor health and well-being are all imperative in helping people move out of homelessness. Therefore, further cuts to funding for services such as those provided by the Simon Communities must be avoided to ensure effective services are available to the people who need them, when they need them.
The HSE budget has not yet been confirmed but we are asking that the ‘social inclusion’ budget is protected and in particular, the homeless budget within this. Demand for our services continues to rise and we are only beginning to feel the impact of 2013 cuts. We are well beyond the point of being able to do more with less. The number of people sleeping rough in Dublin alone at the last official Dublin Regional Homelessness Executive count was 94, an increase of 28 per cent on the same period in 2012. With the cold, dark nights of winter closing in, it is a stark reminder that this situation cannot be allowed to escalate further.
Almost half of those using our services who participated in our health snapshot study had a mental health issue, with rates of depression being highest at 34 per cent. Mental health has rightly received extensive media coverage in recent times and there is a growing awareness of how important an issue this is to overall general health and well-being.
It is therefore baffling to think that the Government would renege on their commitment, in the Programme for Government, to provide €35 million for Community Mental Health Services. Mental Health Services are under massive strain with the promise of 477 posts in Budget 2013 remaining unfulfilled. Integrated approaches are most effective when working with people who are homeless with mental health issues improving diagnosis, interventions and outcomes. This is critical to ensuring that people move out of homelessness and remain safe and well.
Short-sighted cuts to drug projects
The Department of Health and Children has announced that as part of Budget 2014, there will be a 7 per cent cut in the Drug Initiative. This fund goes to drug projects and has been cut by €2 million in the Budget, adding up to a 40 per cent cut since 2008. This approach is short-sighted in the extreme. There has been a rapid growth in opiate use amongst people who are homeless, especially outside of Dublin. In addition, problematic alcohol use continues to be an issue.
It is vital that sufficient supports are in place aimed at reducing drug and alcohol related harm and offering pathways to treatment nationwide. Alcohol and drug services need to be expanded, not restricted. Housing led approaches are based on a harm reduction philosophy and ensuing that there is adequate linkages and referral into treatment.
Access must be provided to substitution treatment, detoxification, rehabilitation and aftercare all around the country. These should be tailored and targeted to the needs of people who are homeless.
Homelessness, health and 2016
We believe that every person in the State has the right to the highest possible standard of health. The experience of homelessness can result in a persistent violation of this fundamental human right but this does not need to be the case. The commitment of the Government to ending long-term homelessness by 2016 cannot be fulfilled without access to housing and support in housing and sustained political will.
We are calling on the Government to ensure that the supports that are so necessary for ending long-term homelessness are protected and that people who are homeless are supported by any means necessary, to move on from a situation that nobody ever chooses.
Niamh Randall is the Head of Policy and Communications with the Simon Community. Follow her on Twitter @NiamhRandallAlso Read