Mental Health, homelessness and MQI

Dr Joanne Fenton is a board member at Merchants Quay Ireland. She is a consultant perinatal psychiatrist at the Coombe Women’s & Infants University Hospital, Dublin and a consultant psychiatrist with homeless people in Dublin South City; a joint position she has held since 2004.

The population of those who are homeless in Ireland is rising over the past 10 years with the most recent figures of over 10,000 individuals. The causes of homelessness are multifactorial but the lack of sufficient affordable accommodation is key. Stable accommodation is a basic need which is essential to maintain ones’ mental wellbeing. It provides the gateway to access health services particularly mental health services which are catchment area based, that is, depending on where you live will dictate what community mental health service you are eligible to attend.

Homelessness and Mental Health often go hand and hand. An individual with a serious mental illness may leave their place of origin in an effort to escape their mental illness. They may end up in big cities without any supports and become homeless. They present to MQI for food and shelter. The staff will make efforts to engage them and identify if they have mental health difficulties that need to be addressed.

Homelessness itself causes an increase in psychological distress with a greater incidence of depression, anxiety, complex trauma and substance misuse in this group versus the housed population. Within Dublin 25-30% of the homeless population have serious mental illness. Of the patients I work with on the ACCES team 70-80% will have co-occurring alcohol and substance misuse problems. Homelessness has a stigma attached to it as does mental health so these individuals are very much excluded in our society.

The team in MQI aim to provide a safe and non- judgemental space for this group. Many homeless people will state mental health as a reason for their homelessness, the chicken or the egg phenomenon. But whether it is the cause or the effect we must make every effort to support our homeless population. There is an inclusion health team based in Riverside MQI which includes GPs, a social inclusion specialist, mental health nurses, a mental health support worker and addiction services. There are several hundred contacts per month.

The mental health team need to provide a safe and secure environment where an individual can tell his/her story. Supportive psychotherapy and medication management needs to be available to the individuals presenting and an ability to signpost, advocate and advise where best to continue to receive this care.

The trauma that many homeless people have endured is significantly greater than the general population. This can be from early childhood experiences to the most recent physical assaults. To offer an individual a safe and non- judgemental approach is key to build a rapport and ensure that the individual feels they can return. MQI staff aim to treat the individual as an individual and address all their needs whether it may be physical, mental or substance related.

The team need to be resourced adequately so that they may continue to provide the holistic care and social inclusion on site to empower service users to support each other. There is no simple measure to resolve homelessness but supporting an individuals’ mental health is key.

You can help support Merchants Quay Ireland’s mental health team here: https://mqi.ie/mentalhealth/