Tag: 2019April

Brilliant white cinder-block walls and pastel-coloured floors. In between, lightweight partition walls carve up what is essentially a warehouse, and inspire confusion in short tangential corridors. Varying odours and temperatures permeate the air, where a multitude of individuals experiencing homelessness have the fortune of a roof over their head. Some move quickly, others slowly, some stagger.

It being my first day in this service, the four o’clock room check is an opportunity to familiarise with a few of the residents, and the complicated building. My colleague hands me the bed-list and a pen, and we make sure our walkie-talkies are working. He’ll check if they’re in, and I’ll mark the list accordingly.

‘You have to be careful with the women,’ so the warning goes. ‘Always go in pairs. If they accuse you of something and you’re alone, that kind of stuff can stick. Protect yourself.’

Announcing ourselves as, ‘male staff,’ we enter the first, and exclusively, female, corridor. As we move from room to room we check the toilets – each cubicle. We say ‘hi’ to a number of the ladies, my colleague checks my notations, and we move along to the next corridor.

I find myself standing away from the doors, clipboard in hand, behind my colleague. I feel an urge to be more visible to those in the rooms; I hardly want my presence to resemble some kind of warden.

Making things easy for me, my colleague introduces me to a number of the residents, which in many instances goes well. But, to complicate things further, I soon realise that I should avoid being too friendly.

Many are almost completely uninterested by my presence; I begin to feel I should have respect not so much for people’s privacy (largely non-existent), as more basically their space, my entry into which is that of yet another new face. It is, after all, their home.

Lying on a bed, in the corner of a square room, with partition walls which do not reach the high aluminium ceiling above, is a young woman, no more than twenty years-of-age, coming around from a worrying drug experience, initiated some days previously. At least she’s definitely breathing.

Sharing a room with a ‘crack-head’ must be difficult – just as sharing a room with someone who doesn’t appreciate your addiction to the substance may be.

I follow my colleague as we move from room to room, ticking the boxes and making brief greetings. Through a door bursts a notably thin woman, with a number of others behind her, electrifying the atmosphere as she confronts my colleague, keen to set the record straight.

Arms raised, she proceeds to direct our attention to the common area where, according to this woman, there is a ‘bitch,’ who needs to ‘shut her fucking mouth.’ I can’t help recalling the words of a member of management: ‘Many of our clients are seriously underdeveloped, cognitively. It is not unlike working with children.’

My colleague endeavours to calm the situation down, encouraging the woman to ignore others around her. She must focus on herself. The woman is responsive despite her warning that the ‘bitch’ inside had better keep out of her way. She relents: ‘I just need to get out of here.’

Another passing service user gets my attention: ‘It’s like Big Brother in here.’ The woman moves on hurriedly, the others behind her disperse, and we carry on with our checks. My colleague ensures I have ticked the right boxes, given the momentary commotion.

Prior to room checks, meal times had been a source of some controversy at handover. It being my first day, I had hardly contributed to the discussion. But now it comes up again with the colleague I am shadowing: ‘We don’t want to create a culture of smoking crack and eating cereal all day,’ she says. The service users are not to be provided with food, other than toast, before or after dinner. Staff are supposed to stick strictly to meal times. That means no pot noodles, soup, rice pudding, or cereal.

‘Right… so that’s the kind of thing we’re dealing with?’; ‘Yes, loads of crack in here, and spice.’

It is difficult to deny a person in this environment food – but telling them what time of the day they can have Rice Crispies makes sense. If I tell them it is twelve o’clock often some ask whether I am referring to day or night. Strict mealtimes encourage routine, a reason to get up in the morning and be somewhere in the evening – despite its illegality, many bedrooms don’t have windows. They are set to encourage people to be up during the daytime; a bedroom may be safer and more comfortable than a doorway on the street, but it can offer fertile ground for despair nevertheless.

Outside their bedrooms service-users are that bit more likely to avail of support from key workers or social workers. Of course when a physical environment inhibits anyone’s capacity to look outside – the inverse being an effort to inhibit others looking in – hope is a hard sell. But, in any case, that is why it is done.

Entering the next hallway, I see shower curtains draped over the doorways – that morning another staff member, who had greeted me, apologised for the doorways, something she felt made the place feel like a Concentration Camp. The council, she said, are yet to install the doors.

We knock on the partition walls before announcing ourselves: ‘Staff. Hi fellas. How are you doing today?’ My colleague’s admirable rapport with the residents takes the edge off his gallows humour. How does a person perceive an authority manifested in a prohibition on Corn Flakes?

The drunk or ‘crack-head’ stereotype loses relevance when the service user has a job, whose hours are such that they get home(?) after dinner time. The person may just want a bowl of cereal before bed, as I surely would, importantly, on getting home. What about the person who fancies a bowl of cereal at any time of the day?

Homeless is an umbrella term used to classify thousands of individuals who don’t have their own front door. But exactly why a person ends up in that situation varies widely. There is a Homelessness Crisis, meaning identifying and ordering the different classifications of homeless individuals relative to their needs is a luxury – we are led to believe – the country cannot afford. All kinds of people – highly dependent and highly independent – are lumped together. When someone asks for cereal, it is perhaps best to suspend judgement. There is not necessarily a negative consequences to a bowl of cereal at midnight.

It is suggested by a new member of staff that a particular client may be on the autistic spectrum, as his social etiquette is deeply lacking. It is something my colleague thought we should consider. That colleague had worked with autistic individuals in the past, so it seems plausible. But following conversation with another member of staff, who had known the client since he first entered the service – over ten years previously – another probable explanation turned up: the client had entered the service in his early twenties when his social interactions were far from a central concern. Ten years on, having spent a decade in a shelter, his capacity to interact with the outside world has been all but destroyed.

You often think of elderly men, savvy in the ways of surviving as rough sleepers, as those to whom the epithet ‘entrenched homelessness’ applies. But this is a young man who doesn’t sleep rough, whose home is the homeless services.

Another client argues given that he has lived in the country for over twenty years he should not have to listen to people asking him whether he would like to go home. He cannot go home: actually Ireland is home. We are discussing his recent transfer from the social housing list into a relatively new scheme called HAP (Housing Assistance Payment), whereby the government subsidises rent payments to private landlords, on behalf of HAP-approved tenants. That he should be continually asked to return home is a worrying reflection on the HAP scheme, packaged as an opportunity for the service user, but subject to the arbitrary decisions of private landlords, who often reject aspiring HAP tenants precisely for being aspiring HAP tenants.

He has been given a number of months to find a landlord who will accept him as a tenant. His more immediate concern, however, is his cancer, for which he really needs employment so he can look after himself.

The government policy which focuses on the one thing all homeless people by definition lack, has repercussions for those with complex needs. One might argue that housing this particular individual in private rental accommodation would have the beneficial consequence of increasing his chances of attaining employment, and maintaining good health, and avoiding the stress of being moved from accommodation to accommodation.

The stress of sharing a room with strangers, sleeping on his valuables is effecting his mental health he tells me. I’m struck by the reasonably well accredited hypothesis linking mental ill-health with physical infirmity, and I think once more of his cancer. Arguably, this emphasises the importance of getting this person housed, but my client is cynical, has little money, and potentially little time. He is frightened of adding to the statistic of homeless fatalities in 2019.

His immediate need is money. He needs prescribed medication, healthy food, and perhaps a counsellor or psychotherapist. That people aren’t being housed is disgraceful in itself, but in the interim they are suffering, deteriorating mentally and physically, and potentially dying. People suffer in the services, as they wait, often hopelessly. These are the vicious consequence of being unable to live independently.

Later, we discover a client rolling uncontrollably on the floor, experiencing what appears to be a seizure. He’s banging his head, and almost frothing at the mouth. We calm him, briefly, before he wriggles out of our control and continues. His head is our primary concern, which we endeavour to get a pillow underneath of. I get on the phone to my colleague who is down in reception. She gets on to the emergency services. They want to know if he is experiencing breathing difficulties. As far as I can tell he is breathing relatively normally. To make sure, I ask him directly. Managing to control him, I gain his attention and ask. Rather than responding verbally, he proceeds to demonstrate what sounds like incredibly strained breathing –  as though on cue. He looks directly into my eyes and begins to cough in between episodes of holding his breath. Although we continue to calm him and inhibit self-harm, I am now less fearful for his well-being.

Once the paramedics arrive they work out quite quickly there isn’t much wrong, at least with what they can help with. They sit him up, holding him still from beneath the arms and probe him with questions. He manages to ignore them until they, somewhat more hands on, start pinching him somewhere around the chest. This certainly gets his attention and he finally blurts out: ‘fuck off.’ There’s a pause as we all come to understand that whatever is wrong with this service-user, it does not require emergency medical attention. He needs to go to bed and sleep it off.

A few weeks later, at a staff outing, I converse with a colleague who understands that despite the somewhat theatrical nature of the episode, there was, below the surface, a man reaching out for help, however desperately. It seems his only way of having his suffering recognised was to act out the part, blurring the lines between reality and fiction. He was not suffering in the way his behaviour suggested, but that is not to say he wasn’t suffering, as he drunkenly played out the part on an otherwise uneventful night in another homeless service.

Homelessness is complicated. These three words cannot do justice to what they purport to express. We are dealing with thousands of different lives under the umbrella term. What is at issue are the needs of individuals; and you can be sure these will multiply the longer one remains homeless. Whilst housing people is a reasonable objective, we cannot obscure the compelling needs of each individual.

Most homeless services adopt the Housing First approach. Of American origin, the original idea was that individuals experiencing homelessness should be placed automatically into independent living, bypassing temporary accommodations such as hostels. Once the client is established in their home, so it goes, outreach services will work on supporting individual needs. The initiative has a track record of success, and been adopted by a number of the leading services in Ireland. The issue today, however, is the vast numbers of those experiencing homeless who, after not being offered their own accommodation, end up in temporary accommodation.

Is there not a paradox to services advocating Housing First when the existence of those very services demonstrate the shortcomings of the Housing First approach? More worryingly perhaps: does it potentially license those who could otherwise support people in these services to delimit their support, on the basis that they can, in accordance with the Housing First approach, legitimately claim it is better to wait until those in need of such services are housed? Focus on permanent housing, and permit short-term suffering.

Inasmuch as a singular vision for the future is something to be celebrated amongst policy makers, public services, charities and NGOs, we cannot allow it to obstruct recognition of current needs. Most homeless services additionally advocate the person-centred approach. Better to consider the individual where they are at, and offer support accordingly. If a service user’s mental health deteriorates, we abide by the person-centred approach insofar as we have compassion and understand that person’s particular state of mind, and support them accordingly. The trouble is that in our current situation, the Housing First approach, is, arguably, in contradiction with the Person-Centred Approach, as it draws attention and resources away from individual needs.

As I’m covering a shift in a family accommodation unit. Over a cigarette break I take the opportunity to find out more about the service. ‘Many of the families don’t like HAP. They don’t want to be at the mercy of a private landlord, who could sell up next year,’ my colleague begins. ‘They wait on the social housing list. Could be years. Mental health begins to really suffer. Lots of them smoke a lot of cannabis. And then the children suffer.’

I tell him about some of the men I am more familiar with, from another service, and how a number of them grew up under child protection services: ‘You can see the cycle.’ To reiterate, I am hardly opposed to housing the homeless. People should be getting housed. But at issue is meeting the varied needs of the many people experiencing homelessness, at a time when the prospect of finding private rental accommodation is remote. Numerous individuals have many and complicated needs, and these should be considered simultaneously.

Homelessness is indeed a challenging issue. People’s many basic needs are complicated by the experience of homelessness. There is no universal panacea. We should be housing the homeless. But whether a young woman out of her mind on street drugs, an exhausted shift worker unable to get a snack before bed, a cancer patient with no money, or an alcoholic despairing at six o’clock in the morning, I cannot help but think that a slogan more fitting would be: ‘listen to the homeless.’