Just like home – mental health and homelessness - a short comparison between the British and Australian experience
Homelessness in Britain has some significant variances both within the country itself and in comparison with Australia.
The most striking difference is that homelessness strategies are developed and funded by local authorities which means that in a city like London you can be provided with one type of service on this side of the street and be treated completely differently on the other. I assure you that this does in fact happen. As a consequence, one of the favoured homeless strategies is diversion. This is based on the spurious notion of local connection which means that if you’re last place of abode was in the borough of Camden (this counts even if you were sleeping rough there) and you slip over the border into the City of Westminster, you will be diverted back to Camden rather than being offered a service.
Similarly, although mental health has increasingly become a major public issue it still is approached in an extremely piecemeal fashion due to the differences between the priorities and resources of local authorities. For homeless people the system is unnecessarily complex with most of the responsibility falling on their shoulders. The sense that if you are homeless and suffer from mental health difficulties it is basically your own fault, seems to have greater currency here than I remember was the case in the land of Oz. Although, like the memory of perfect weather, this may be a myth brought on by extended absence.
The first British homeless agency I visited on my study tour in 2001 was The Passage in London. The Passage operates the largest day centre for homeless people in Europe with anywhere between 200 and 300 individuals accessing services daily. What struck me on my first visit was the similarity between the group of (mainly) men using the day centre and the men seeking assistance at The Matthew Talbot in Sydney. The clothes and baggage and general demeanour were the same. Since then I’ve returned on a number of occasions to The Passage and have, in fact, been employed by the organisation to help them re-develop the services they are offering. Part of this work has been to constantly review those participating in the services so as to respond more effectively to any emerging needs.
So who comes to The Passage? As I found with my work in Sydney the age group of the homeless population has steadily decreased over the past 15 to 20 years. The average age at The Passage is early to mid thirties. Very few of the older men or women who used to constitute the street homeless population are still around, either they have died or they have been successful in obtaining accommodation from the ever-diminishing supply of social housing. It’s worth noting that The Passage has recently discontinued a project aimed at working with those over 55 because there weren’t enough people who needed the service.
Another point of similarity is the fact that only 10% of those coming to The Passage are women. This is because those sleeping rough in London overwhelmingly tend to be men and, as a result of this, their presence dominates the service.
In turn this may act as a disincentive for women who may not be actually on the street but living in poor quality and inappropriate accommodation. A group of workers at The Passage are currently examining this phenomenon to see if a greater balance can be achieved.
One of the projects I draw most satisfaction from in my years of work in Australia was convening the steering committee that oversaw the production of Down and Out in Sydney. This well respected and groundbreaking report gave clear evidence that 75% of those using inner city Sydney homeless services either had or had experienced a significant mental health problem. Those of you familiar with the findings of that research would also remember the startling percentage of those interviewed who had suffered from trauma. 93% had experienced a serious traumatic event usually involving violence of one kind or another.
Whilst there have been some in-depth studies of mental health and homelessness in Britain none has been as detailed as Down and Out in Sydney. As a consequence, and as a result of my own observations, I doubt the current London estimates of the percentage of street homeless who have mental health difficulties. Generally the figure of 35% is given, but this seems low in the same way that the notorious street counts that are conducted to ascertain the numbers sleeping rough in Britain, seem to be artificially low.
The services provided to homeless people experiencing mental health problems vary considerably. While they are not completely inadequate neither could they be described as comprehensive. Somewhat like the situation, as I remember it, in Sydney. Too often appropriate and timely support fails to materialise. Community mental health teams are run off
their feet and can only attend in the direst emergencies. Personality disorder? Let’s leave that one over here shall we in the too hard dustbin.
Despite a variety of systemic problems like the aforementioned drying up of social housing, there are some very good, on the ground projects aimed at those with mental health problems. The Passage, for example, has been running an excellent dual diagnosis programme bringing together a range of individual and group activities and therapies but, wouldn’t you know it, the funding has run out and nobody, especially not the National Health Service (NHS) seems to be prioritising funding in this incredibly important area.
Another service that works with The Passage provides much needed counselling particularly to those experiencing depression. As is clearly obvious to anyone who has worked with homeless people depression and anxiety are epidemic. And why wouldn’t they be depressed or anxious given the daily circumstances a homeless person has to face. This, on top of the often-traumatic events that led to their homelessness, makes it surprising that more homeless people don’t choose to give the game away completely.
Counselling, or more simply to provide opportunities for people to have positive and friendly engagement, can do wonders for anyone’s mental health. Yet it has traditionally, in Britain at least, been a low priority for homeless services and the treatment of mental health problems.
Increasingly in my work with homeless people in Britain I believe it is this positive and personal engagement coupled with stimulating and challenging activities that can do most to improve a person’s chance of surviving homelessness and building a new life in an often hostile environment. I think this is particularly true if mental health problems are part of the story. To many this may sound overly simplistic but it’s amazing how often this basic, warm and welcoming engagement can work. Depression and anxiety, loneliness and lack of confidence need to be addressed much more effectively than they are currently if homelessness is to be eradicated.
Colin Robinson © 2008
This article was originally published in the magazine Parity produced by the Australian Council of Homeless Persons.