“Is Love Enough?” Full text of Alice Leahy’s Address to Pobal De Conference

Thank you for asking me to address you today on the topic “Is Love Enough? Action Makes Love Real”.

From the onset I should inform you that I am not here to lecture you on what you should do, rather to talk about what we see and do in Trust working with people generally treated and seen as outsiders and make some suggestions.

None of us asked to be born, we didn’t choose our parents or where we were born and I doubt if any of us here today chose the religion we believe in – so in some ways the words of Bob Dylan come to mind “we are all prisoners in the mystery of the world”.

I am not a theologian, I am not exercised in challenging theologians and I find the language of theology like law, medicine and spirituality etc. can appear to be at times elitist.

Institutions of all types alienate and stifle debate, and I think even growth and we can all be institutionalised in our thinking. We are here today to look at the basic values of justice and love, to look at the world and environment in which we live, andI suppose to ask ourselves – well, who is my brother?

Bishop Donal Murray speaking at the recent Bishop’s major Conference on “Who is my Neighbour?” said “Our society is becoming more complex and, some would argue, more remote. I believe – now more than ever – that the question ‘Who is my neighbour?’ poses a real challenge to all of us in the Ireland of 2008. Clearly greater debate and responsibility around this issue is now required by faith groups, public policy makers, media commentators…in truth each and every person in our society needs to ask, and answer, this question”.

Here today in this Jesuit Centre I am reminded of the words of Pedro Arrupé, the Great Jesuit Leader, born over a Century ago (1907) when he called for the education of men for others “men and women completely convinced that love of God which does not issue in justice for others is a farce”. This of course is implied in the title of this Conference.

Let me talk to you about our work in Trust – daily as we walk through the streets of Dublin, tripping over people sleeping in sleeping bags, dealing with extreme misery and pain, despair and hope. Recently, endless questionnaires in the post, invites to numerous conferences, media reports on our health service and education, one could be forgiven for thinking it is all a figment of our imagination, but no, it is real.

Trust founded in 1975, grew out of work I carried out in night shelters and with people sleeping rough with a group of doctors, all working in a voluntary capacity. That work, and the generosity of the late Ann Rush, led to the foundation of TRUST – a private charitable trust and our aims are:

“to serve homeless people in need by promoting human services which would meet their immediate and long-term needs and by these means to encourage their development and give their lives a dignity which is their birthright.” (…from the Deeds of TRUST.)

The service we set up was first of its type, and has been used as a model for services here and overseas. We are sandwiched between St. Patrick’s Cathedral and Christchurch Cathedral in the Liberties area of Dublin. We work in the basement of the Iveagh Hostel for which we pay a nominal rent.

The philosophy of TRUST is based on two central principles:

The recognition of every individual’s right to be treated as an autonomous and unique human being.
The need to restore the dignity of individuals whom society has labelled deviant and undesirable.
Our work would not be possible without the enormous generosity and support of people from all walks of life, rich and very rich, poor and very poor.
Everyday we meet over 50 men and women who sleep rough and meet with people as they present themselves to us – all outsiders in a city of plenty. Many come from outside the city, some from the remotest parts of rural Ireland, some returning to the land of their birth to be buried in the “old sod” and many from outside the jurisdiction, with increasing numbers from the EU Accession States and other countries. Some people we meet we have grown older with. We provide a health service, advice and dressings, but more important, human contact – sometimes it looks like a casualty department as many people we work with will not go to A&E, and if they do go they will not wait. As part of a holistic service we provide bath and shower facilities, a complete set of clothes and information on rights and entitlements. We seek to treat people as people recognising that they need help and have rights, especially their right to privacy and a right to be heard. Coming to TRUST we hope people can feel secure and are hopefully able to trust us. Hospitality is important – we provide tea and coffee as we would welcome visitors to our own home and provide a listening ear – now daily phone calls from prison from people we know with no one else to call. Many people we meet have no family contact, and often family members contact us about loved ones who have disappeared.

The people we meet are perceived by the wider society as being different and difficult and indeed many are difficult. They suffer from the effects of isolation, neglect and health problems, exacerbated by what are often described as chaotic lifestyles. Accessing mainstream services – particularly basic accommodation is a major problem. We meet increasing numbers of people who were ‘re-settled’ in totally unsuitable accommodation, and then find themselves homeless again.
I meet people homeless in Dublin whose heartbeat I listened to while working as a midwife in the Rotunda and consider it a sad reflection on our society that we are now meeting 2nd and 3rd generation homeless.

The people we meet everyday present with a wide range of medical problems including bodies that are ravaged by disease and violence, some with pressure sores from sleeping out in all weathers, sometimes sleeping in urine soaked clothes for weeks; infected and untreated minor skin conditions and major skin problems e.g. leg ulcers and gangrene; as well as lice infected heads and scabies. In addition we often meet people who are suffering from malnutrition and all of the medical conditions common to the general public but exacerbated by their living conditions. We are now coming across conditions long disappeared since the advent of good food e.g. trench foot and impetigo (wild fire) – conditions clearly associated with extreme poverty and many of these people are our new neighbours from Eastern Europe, like our own Irish who immigrated in the past. Racism is a new phenomena.

Some people we meet cope with very serious addiction problems, including drugs, alcohol and gambling, suffering from despair and the pain of loneliness, pushed from service to service, often unable to get relief for minds at breaking point and the only solution offered is a brown envelope of medication and often unable to read the directions – seen just as statistics in our increasingly bureaucratic world.

Many people we meet struggle to create a sense of normality after years locked away in institutions and others who have been relocated from one institution to another. Some people who are locked in prisons they have created for themselves, often out of the frustration of not being understood or ignored. Many people we know have attempted suicide, and many have died on the streets. Increasingly, young people are dying on the streets on in the homeless circuit and one never hears about it as families are ashamed.

This time last year, a woman in her 20’s known to us for years, from rural Ireland called to Trust. She had a shower, change of clothes, put on her make-up and as usual was so grateful – that night she died on the streets. Her body was brought from the hospital morgue to a well known City Centre church for the regular mass. There were a dozen people in the church and the only flowers – a small bunch of flowers from Trust on her coffin. Quite by chance we heard of her death from the paper vendor in Grafton Street. Her death outside a fast-food shop didn’t merit a mention, a non entity.

We meet some people who are so cut off from everything around them that they at times appear to be beyond reach. Others however challenge and inspire us everyday to look at the way we all live our lives, and indeed to pose the question – Who is my brother? I am reminded of Joe who one day with tears in his eyes told me that when attending morning mass the woman beside him refused to take his hand at the sign of peace – yes he had the weather beaten cigarette stained hand of poverty.

Sometimes the only hearing the people we meet ever get is when they are being researched – an issue we have grave reservations about because of the quality and quantity of research taking place today as well as the time and money spent on “evaluating outcomes and cost effectiveness” while ultimately making no difference to the lives of those who have been examined in the course of these expensive research exercises.

Some people feel pressurised to take part in research into homelessness in case they lose their hostel bed or their entitlements. We in Trust only become involved in research, when we believe the research design is sound, ethical and likely to provide useful information and would be concerned about the sharing and storage of confidential information without due regard to the rights of our fellow human beings.

Of course research is essential to plan services. “If we are to push for fundamental change in the whole area of homelessness, then a certain amount of constructive research is necessary. We feel strongly however that it must be pursued with the greatest caution. It is clear to us that the ‘research industry’ uses that section of our society, which is the most vulnerable and the least able to battle for its rights as its’ source of material. We must never forget that we are working with human beings, who for the most part have been battered by our society and who for so long have been pushed about as just another number in a cold inhuman bureaucracy”.

This last quote is from Leahy and Magee – Report on Broad Medical Services for Single Homeless People in the City of Dublin – March 7th 1976 – 30 years later, in a new millennium -what has changed?

We have met with the Data Commissioner about our concerns regarding the recent Assessment Forms people are now required to fill in. We should not allow ourselves to be blinded by statistics and jargon – we should be prepared to question what is happening, rather than facilitating reports to further distance people from people, or just support entrenched ideas. Homelessness is not just about housing alone, it is much more about not fitting in, being different, being an outsider.

“To be without a home is to be suspect. The homeless are easy targets. Their bodily integrity is constantly at risk. Their lives are an offence against the sacred canons of private property and consumerism. Their privacy is regularly intruded on as part of the price of being statistics in the poverty industry; their painful experiences are reduced to sociological research data. The true test of a civilised community is how people at the margins are treated. Not only must individual liberties be defended, but society should be educated and sensitised towards a broader vision of life and living.” – Dan Sullivan, then President of the Irish Council for Civil Liberties, describing what it means to be homeless in Ireland in a piece I asked him to write in 1995 for a book I co-authored.

Today many people including those in Church, State and Community groups who work hard in building and fostering community involvement are also beginning to feel disenfranchised by an increasingly insensitive bureaucracy and meaningless jargon, many of you I am sure fit into this category but I am sure we all need to ask ourselves – are people being treated equally?

Tom who looks seventy but is only in his mid fifties lives in Dublin 4. One day a week, before 8.00am he makes his way to Trust, along Patrick Kavanagh’s well worn path along Baggot Street, Stephen’s Green, and Grafton Street. He carries a large ESB golf umbrella which he got in Trust and carries all of his earthly possessions in a small plastic bag. He likes this time of year, the dark evenings mean he can go to bed early – his home is under the bushes in a park.

Some time ago a Welfare Officer, decided that his money, a meagre €165.00 a week (try living on it) should be stopped because he refused to move into a hostel. His medical card had run out and his doctor hadn’t signed a disability form even though he was not disabled! The Welfare Officer told me it was a ministerial order and that was that! Is this about playing about with numbers, not her fault perhaps – people need to be trained and informed about the complexities of homelessness as well as people’s rights.

We must be acutely aware of the social determinants of health and be prepared to discuss them and stop intimidating by our silence those who speak out. Mary Robinson, former President of our country, said in 2001 “Each time you speak out with a critical voice you pay a price”. On the other hand, if we are honest, we don’t encourage people to speak out at times because we all know the price to be paid.

Caring for people does require us to speak out if we feel people are being denied their rights. If anyone is not being treated with dignity or worse still being excluded from society or our world we have a big responsibility to be their voice if we claim to be truly Christian. The message of the Gospel is an inclusive one and silence in the face of people being excluded cannot be an option. We also need to care for each other and defend those who speak out or nothing will change. Care and love to my mind is about concern and about defending a person’s most basic rights. The mark of a truly caring society is one that respects everyone in equal measure.

I reflect often on the words of Pastor Martin Niemoellen in 1945 – “First they came for the Communists, but I was not a Communist so I did not speak out. Then they came for the Socialists and Trade Unionists. I was neither so I did not speak out. Then they came for the Jews, but I was not a Jew so I did not speak out and when they came for me there was no one left to speak for me”.

A Christmas morning a few years ago I happened to catch Eurovision Mass from Circus Pinter Top in Paris. Apart from the charm and artistry of Parisians I was struck by a few quotes from the Pastor: “Encounters with people move us” and I am sure the isolation of many at times does something to them and he further said “It is the blind application of the law which makes us inhuman”.

Article 1 of the Universal Declaration of Human Rights states that “all human beings are born free and equal in dignity and rights”. However, by looking at the conditions and the way in which those who are marginalised in our society — from those who are homeless on the street to people unable to care for themselves and those living lives of isolation in urban and rural Ireland – If we are not asking are their human rights being protected and respected, love is a meaningless word.

For over thirty years TRUST has been involved in advocacy work – trying to be a voice for the voiceless – as well as providing health and social services. Today through the development of human rights based approaches – which should be developed into a potential management philosophy in the health and social services, including all statutory and voluntary services – we have the potential to transform the way the most vulnerable are treated and in this I include all of us. However, it is vital that everyone becomes involved and it is not seen as a legalistic formula of how to deal with people but as the right way to treat people and each other.

The dignity of every individual should be at the very centre of everything we do.

Some years ago I met in the RCSI Phil Barker, former Professor of Psychiatric Nursing, who runs workshops on the premise that “Knowledge can only be gained through experience”. I once wrote to him for permission to use a quote and he replied: “Alice, people don’t remember what you say or what you do. They will remember how you made them feel” – this excellent advice comes to mind daily and is a quote from a well known Afro American female poet.

Love, I suggest means justice. In our rush to work with the poor, are we forgetting those providing love, care and hands on service daily who are doing just that. We should have the confidence to reflect on some of the wisdom and love from all over Ireland, rural and urban communities – not confining the debate to academic circles and visiting experts and new age thinking – we should not be afraid to pose awkward questions. If we don’t I suggest love is a meaningless word.

We should not rush to criticise our forefathers who had a tremendous faith, many now treated as outsiders – but many didn’t have the education or financial support we now have today. Everyone in their own way needs to consider where they stand and what kind of community they want. The power to change things is in our hands. At times we can be overwhelmed by what is required of us, we can loose confidence, our compassion can be taken for granted, our energy sapped, our vision destroyed – but if we are believers, if we have faith, we can be energised. You will note prophetic voices have been silenced by grant aid. Privatisation of services and State off-loading to the voluntary sectors makes it cheaper to run but there is a down side as referred to above.

Just a few questions to ponder and before you do just shut your eyes and be still.

Are we afraid to be unpopular by posing questions?
Have we ever the time to analyse what is happening in the world, in our community and in our Church?
Have we ever asked if Christ appeared to us in the form of the most excluded in our world, perhaps a homosexual, a drug addict, a recluse, a failure, a terrorist, an ex-prisoner – how would we react? It is only in asking this question can we reach an answer that might help us to see that love really is about justice.

Some time ago, a man known to us for years who calls to Trust daily was seriously assaulted, beyond recognition, outside a shelter at 7.00pm as he waited for a bed – he ended up on a life support machine – again, nothing in the papers. What about a man and woman sleeping in the sand dunes in North Dublin because it is too violent and unsafe for them in the City – do they matter? Meanwhile pages and pages and hours of air time about Britney Spears, cutting off her locks, and the hype around the diamonds and clothes worn by Oscar attendees. This is why reports, seminars and requests from Trust for something as basic as public showers are ignored. Incidentally, we have made a submission to Dublin City Council highlighting the need for public showers, for the use of all, see our website www.trust-ireland.ie, the least one would expect in a modern EU capital, where there is growing concern about the lack of social housing and poor quality private rental accommodation.

Is it not time we decided what type of world we want, indeed what kind of Church we want. In former times when Ireland was poor Churches provided services. Today people are entitled as a right to education, health and social services and the Church must ensure that they are not compliant in developing 2-tier services and letting the State off the hook.

We as Christians must ensure priests and nuns are not further isolated by recent events and must also ask why are so many young people ending their lives.

To love we so often say is about good works, of course important, but giving time to work with and give time to people it is important to question the balance of power in the relationship. It is just as important to ask ourselves “am I hear because it makes me feel good?” or “is it important because I will have a better standing in the community?” Am I here because I believe that love in action is about justice, justice often requires shifting ingrained thoughts and values, becoming unpopular, questioning the status quo relentlessly and often standing alone, supporting those who speak out, even if of a different faith or no faith. It is also important to ask the question – are we just talking the talk and afraid to walk the walk? Are “We Wasting Time with People?” Incidentally the title of a book I have compiled and will be published by Gill & Macmillan in April.

Accepting that we are all ourselves, vulnerable, as all humanity is. There is a tendency to think that Christians, and I guess all religions to think they are the only ones who care. On the contrary, there are many with no religious or dormant religious beliefs who fight injustice – On the one hand if one is seen as a religious person, they can be seen as superior or see themselves in a superior position, quite simply denying our shared humanity. Religious often exert power in agencies when their only expertise may be that their religious views are what count – this is an injustice of sorts. That power could be used to good effect, to ensure dialogue and debate around the privatisation of schools, housing and increasingly healthcare which is now happening – more than any other time in the history of this State.

Sometimes love comes across as a flowery concept. Just think how often we use that word during the day without thinking and all we have to do is look back at the materialism of St. Valentine’s Day.

Human rights is not just a concept drawn up by and for lawyers and academics, neither is love a meaningless romantic and flowery word. Human rights is about treating people with respect and dignity – so too is love and I suggest that if we believe that, we should have no problem answering the question posed – Is Love Enough?

Opening Address “Wasting Time with People” at 25th Annual Nursing and Midwifery Conference

25th Annual Nursing and Midwifery Conference
“Beyond Rhetoric: nursing and midwifery knowledge and research for a new healthcare system”

Wednesday, 22 February 2006, In Royal College of Surgeons in Ireland

Opening Address “Wasting Time with People”

Alice Leahy, R.G.N. R.M. F.F.N.M. R.C.S.I. (Hon).
Director and Co-Founder Trust

I would like to thank the Faculty for inviting me to deliver the opening address at your 25th Annual Nursing and Midwifery Conference especially on a topic that is so apt at a time when many of us are asking fundamental questions such as: What is health care and indeed nursing all about? And how do we as nurses make a contribution to the debate and help create a healthcare service we should be proud to be part of and where the patient is central to our concerns?

I want to begin by attempting to address those questions because I believe nurses can be powerful advocates for change if we are prepared to speak out, especially in defense of the most vulnerable. In my own role in TRUST, which I co-founded over thirty years ago, one of the most important roles we play for the many people who are homeless we meet everyday is to act as advocates on their behalf as they have no one to speak up for them. In that sense they are the voiceless or the outsiders in our society. This is the reason for the title of my address – “wasting time with people” – because one of the most important things we make for those we see everyday is time, time to treat them as human beings. And time to treat people properly as people is the one thing that is increasingly difficult in the modern health service because time is always reduced to a quantitative or monetary value. In a health service, which is increasingly governed by performance indicators and benchmarks, based on these quantitative measures is it possible to preserve even the concept of a philosophy of caring, which means fundamentally treating people as people?

This means that the focus on patients is being lost even as more resources are being deployed because it becomes almost impossible to advocate for a philosophy of caring when the pressure is on to treat more and more people in a given time frame.

We need a human rights based approach in the sense that the most basic human right is the right to be treated as a human being and not a statistic, as the award winning South African Satirist Pieter Dirk-Uys said so eloquently.

And last year another African voice was quoted in an article in the BMJ (British Medical Journal) by Simon Challand, a Medical Adviser working in Uganda, referring to the advice an African Bishop had given him with a smile -” “Waste time with people”… You Europeans are always concerned about projects and budgets. The African does not worry about them -just waste time with people”..He gave me this advice in 1996 shortly before I came out to work in Uganda. Since then his words have kept coming back to me, and I reflect on their truth and wisdom and how difficult it has been for me, as someone with European values and attitudes, to apply them.” However, what those so far removed from the frontline in the Irish health service fail to understand is that you cannot help people without taking time to do so. Time is much more productive in the long-term because by helping people properly today they will not become a bigger burden on the system in future years and will be spared the misery of not getting the real help they need.

Nurses in the community have a very special opportunity to help people both to avoid becoming homeless and to help them back into society if they are able to recognise the problems that drive people out and force them to become outsiders in the first instance. Society imposes a stigma on those who become homeless in the same way that people who experience mental or psychiatric illness often endure. Slowly attitudes are changing but that sense of exclusion and isolation is a real problem and must be addressed. Nurses as frontline care workers in the community can make a difference be being vigilant and taking a stand when necessary to help those who are often in no position to speak up for themselves.

A good example of where a stand needs to be made now is in relation to the proposal to close the mental hospitals – a reform measure which everyone here I am sure warmly welcomes. However, no proper provision – and I emphasise the word proper – appears to have been made for housing those who are to be treated in the community when the strategy – “A Vision for Change” – was published a few days ago. Only after some of us protested loudly did the Minister respond with the proposal that when the Mental Hospitals are sold for development, each developer will have to give an undertaking that a certain amount of housing will be provided on each site for those affected. This was revealed exclusively on the front page of The Irish Times on Saturday the 11th of February but sources suggested that it would be several months before the tender documents appear and we know the full details of what is proposed.

Now we are all aware what happened regarding the proposal that a percentage of each new housing development had to be made available for social housing. Developers were allowed to buy their way out of that responsibility by making a contribution to the local authority. Will the same be allowed to happen in respect of people with mental and psychiatric problems?

Many of the people we meet who are homeless on the streets of Dublin have been patients in mental hospitals. They are living proof that the plan to close the mental hospitals and move services into the community over twenty years ago has not been a resounding success to date because inadequate services were provided in the community. Will we allow the same thing to happen again?

Nurses have a unique opportunity to make a difference on this issue as they are going to be redeployed from the mental hospitals into community care teams. In other words, in these front line caring roles it will be very apparent if the housing needs of psychiatric patients are being properly met before, during and after the mental hospitals are sold off. However, an additional safeguard is necessary. Independent advocates should be appointed to look after the interests of patients during the transition to ensure that they do secure their right to appropriate accommodation and to prevent the closure of the mental hospitals leading some to become homeless as happened in the past.

In the meantime we must be vigilant. We have not seen the small print yet, as I have pointed out, as the tender outlines for the sale of the hospitals will not be published for some months. Furthermore, the interim accommodation needs also need to be considered in the light of past experience. All of which are even more important considering that even the government’s recent ‘Review of the Implementation of Homeless Strategies’ criticised the failure to address the distinctive accommodation needs of people with mental and psychiatric problems. In other words, we already have an acknowledged problem of meeting the housing needs in this area and only after some questions did the Department come up with the idea of insisting that special accommodation must be made available by developers. One practical way to ensure that the patients involved will not be forgotten is to also insist that they should be consulted about the design of these developments as well.

The belated announcement of the transfer of responsibility for housing the patients affected to developers reveals seriously flawed thinking from the beginning. The accommodation needs in the community of those with psychiatric illnesses should have been the first priority of the recently published strategy and not simply dismissed as being the responsibility of the local authorities at a time when there are already 40,000 on the waiting list for housing.

Nurses can help ensure the plan to close the mental hospitals and their replacement by a successful programme of community care is successful but only if adequate accommodation is made available for former patients in the community. Nurses and doctors can also play a major role in reassuring communities that maybe fearful about the location of services in their areas by becoming directly involved in those communities as advocates for those patients under their care.

My first contact with the Royal College of Surgeons in Ireland was as a young student nurse attending lectures here and later in the early seventies becoming involved in the Nursing Research Interest Group. My contacts continue through the ongoing support TRUST receives from the College, including facilities which were made available recently for a very important seminar we hosted on the roots of homelessness, many of which can be traced to the failure to take time to treat people as people when they seek help. This is the point when those who ultimately become homeless first become outsiders. This in essence is the challenge for the nursing profession; how can we ensure that in our work that those who maybe outsiders in society find a welcome when they seek help in the health service?

Trust, which is in existence since 1975, was set up following clinics held by a group of doctors working voluntarily with me in hostels and night shelters and people sleeping rough.

In 1974, I carried out research based on a questionnaire and clinics held in night shelters with a group of doctors working in a voluntary capacity. Based on this work, and the generosity of the late Ann Rush, TRUST – a private charitable trust – was set up in 1975. The organisations’ aims are:

“to serve homeless people in need by promoting human services which would meet their immediate and long-term needs and by these means to encourage their development and give their lives a dignity which is their birthright.” …from the Deeds of TRUST.

The service set up subsequently, the first of its type, was a model for services here and overseas. We are sandwiched between St. Patrick’s Cathedral and Christchurch Cathedral in Dublin in the Liberties area of Dublin, 5 minutes from here. We work in the basement of the Iveagh Hostel and are grateful to the Iveagh Trust who only charges us a nominal rent.

The philosophy of TRUST is based on two central principles:

The recognition of every individual’s right to be treated as an autonomous and unique human being.
The need to restore the dignity of individuals whom society has labelled deviant and undesirable.
Daily we meet over 50 men and women who sleep rough and deal with people as they present themselves to us – all outsiders in a city of plenty. Many come from outside the city and many from outside the jurisdiction, now increasing numbers from the EU Accession States. Some people we meet we have grown older with, meeting them first in the early 70’s – and of course we meet new people every day. Our services include the provision of shower / bathing facilities, a change of clothes – as part of an holistic health service, information on their rights and entitlements, meeting people on the level they are at, to address their more complex needs. The people we meet are perceived by the wider society as being different and difficult. They suffer from the effects of isolation, neglect and health problems, exacerbated by lifestyle. Accessing mainstream services – particularly basic accommodation is a major problem. We meet increasing numbers of people who were ‘re-settled’ in totally unsuitable accommodation, and then find themselves homeless again.

The people we meet everyday present with a wide range of medical problems including bodies that are ravaged by disease and violence and suffering with: pressure sores from sleeping out in all weathers, sometimes sleeping in urine soaked clothes for weeks; infected and untreated minor skin conditions and major skin problems (e.g. leg ulcers and trench foot), and 3 cases of gangrene in the last two years; as well as lice infected heads and scabies. In addition we often meet people who are suffering from malnutrition and all of the medical conditions common to the general public but exacerbated by their living conditions. And feelings of despair and inadequacy.

People coping with very serious addiction problems, including drugs, alcohol and gambling.
Pushed from service to service, often unable to get relief for minds at breaking point and the only solution usually offered is a brown envelope of medication and some even unable to read the directions.

Some trying to create a sense of normality after years locked away in institutions and others just relocated from one institution to another.

Many who have attempted suicide, and many we have known have died on the streets.

We meet some people who are so cut off from everything around them that they at times appear to be beyond reach. Others who daily challenge and inspire us.

We attempt as best we can to meet people as they are, listen and do what we can as fellow human beings – it’s not easy. Sometimes the only hearing the people we meet ever get is when they are being researched – which is why we have grave reservations about the quality and quantity of research taking place today.

We feel some agencies involved with people who are homeless may not respect their rights to the confidential use and storage of information. Some people who are homeless feel pressurised to take part in research into homelessness in case they may lose their hostel bed or their entitlements. We only become involved in research, when we believe the research design is sound, ethical and likely to provide useful information.

This is of course fundamentally about human rights in the sense of respecting people as people and refusing to see them as mere statistics to be measured and researched like inanimate objects. We have been concerned for sometime about the way in which the people we meet everyday are forced to trade the most personal information for help – for example a hostel bed. Often the questioning is done by people with little or no training so that it can be damaging for people already reduced to sleeping on the streets precisely because they cannot cope with the rigours imposed by society, the form filling and other demands the rest of us take for granted. But the benchmarks and performance indicators cannot be seen to be achieved unless the information is harvested. Who benefits from this?

Our frontline service providing care to the most disadvantaged people in Dublin has given us some unique insights into the way in which the health, social and homeless services operate in Ireland. We all need to look at the serious issues confronting the services today, namely the failure of the current management philosophy to nurture and advance a culture and a philosophy of caring.

For most people their only experience of how time and human contact is undervalued in the health service is the way many GPs and nurses are forced to meet very heavy demands with less and less time spent with each patient. However, that management philosophy imposed on people who are homeless on the street and vulnerable people, many with serious addictive and mental health problems means they are reduced to being constantly referred on and on in a painful and ironically very uneconomic cycle from the point of view of the state.

Joe is a dapper man from the inner city. He is in his mid-50s with an acute sense of injustice. Listening to him telling his life story one is struck by the power and brutality of psychiatry and the narrow definition of health care, his hard working life and the pain he experiences after his youth spent boxing and playing soccer. Life at times drains from him, the pain of living etched on his face, his distrust of professionals and his efforts not to respond to children who call him “mad” and throw stones at his window. His brutal honesty in ensuring bills are paid, his love of his dogs and all nature mask his extreme isolation and loneliness, even the local pub no longer the safe friendly place to sit and chat.

Like many men of his generation, housekeeping is not his forte. He called to Trust a few years ago. He had accommodation, but having a house is not the same as having a home.

My nurse colleague, Geraldine McAuliffe, attended a case conference called to look at “a case management plan” – incidentally a definition of case conference I remember is “An excuse to do nothing”, was re-enforced after the events that followed. DCC gave him a flat to allow for redecoration of his house. His dogs were placed in care with an assurance that they would not be put down. Weekly he borrowed €5.00 from Trust to visit them and had a shower and change of clothes beforehand. The local psychiatric hospital allowed him to stay overnight until his flat was ready – many would say inappropriate use of a hospital bed – but the staff knew him and were kind to him.

Now 3-4 years on where are we? Nothing has changed for Joe . He continued to get an ESB bill for a previous occupier, who died many years ago. Numerous calls and no action. Each bill added to his pain and frustration. A gas bill and telephone bill were received regularly for a non-existent service. His rent was deducted from his U.B. but when his entitlement changed his rent was not deducted and he was not informed. A demand notice added to his misery. His arthritis got worse and not trusting doctors or nurses he refused to take medication and his medical card was as useful as a lotto ticket.

This Christmas (2005) we decided in Trust something had to be done. Geraldine (nurse) and Patrick visited his flat with him. It is not possible to fully describe the stench and the squalor of a small flat with the only heat coming from the 4 rings of an electric cooker, occupied by one man and his dogs. Complete cleaning of the flat was organised. New furniture installed. All donated by friends of Trust. All bills sorted out which entailed hours of phone calls, repeating messages often to answering machines. A G.P. Maurice Gueret, who is one of our Trustees, met Joe and both got on well. Maurice had won his trust and even escorted Joe with his dogs to a vet to have the dogs’ toenails cut. The vet had reassured us previously that Joe loved and cared for his animals, which was obvious to all of us. He would go without food himself to ensure they were fed. Joe had refused to take all medication in the past but because he trusted Maurice it allowed him to administer a monthly anti-inflammatory injection.

Joe is now a new man. The ESB installed a new meter (pay as you go). He pays his TV and rent weekly. He now takes medication, first taking 2 Panadol with a glass of milk. If Maurice doesn’t call he asks us to ring him. He continues to stop us in our tracks and remind us how little we all know about the deficiencies in our services. Joe is not going to change. His quality of life is a little better but in these days of ticking boxes and moving people on, opportunities to see someone blossom is getting rarer leaving us much poorer. Time spent with Joe was and is immeasurable and none of us in Trust would call it wasted. No reports could describe the time, energy and above all commitment involved. Joe continues to challenge and indeed inspire us and to pose the question why is it seemingly so difficulty to understand that caring for people involves much more than theory and nurses should be to the fore in highlighting this fact.

“We know the price of everything and the value of nothing” as Oscar Wilde said, and a comment that appears to have some relevance to the way in which our social services are run today.

“Tracking People” has become a much abused word and is currently seen as best practice. Tracking people through the system smacks of Big Brother as more and more vulnerable people are forced to trade personal information to get a very basic service. Of course research is essential to plan services. “If we are to push for fundamental change in the whole area of homelessness, then a certain amount of constructive research is necessary. We feel strongly however that it must be pursued with the greatest caution. It is clear to us that the ‘research industry’ uses that section of our society, which is the most vulnerable and the least able to battle for its rights as its’ source of material. We must never forget that we are working with human beings, who for the most part have been battered by our society and who for so long have been pushed about as just another number in a cold inhuman bureaucracy”.

This last quote is from Leahy and Magee – Report on Broad Medical Services for Single Homeless People in the City of Dublin – March 7th 1976 – 30 years later, in a new millennium – and what has changed?

Recently we got an early morning call from another agency to bath a woman before she could be referred on to “a multidisciplinary team”. The same agency when contacted to know if a man known to us was there, as he had allegedly taken another man’s coat containing his dentures, told us they couldn’t tell us as it was confidential. However, the following day they ‘phoned back for detailed information on him for their files. Which prompts the question what are they using this information for? Maybe Andrew Lang summed up the reason over a hundred years ago when he said: “He uses statistics as a drunken man uses a lamppost – for support rather than illumination”.

Until those in positions of power and influence are prepared to sit with people in their misery and poverty, feel their pain, smell the smell of human misery and waste, feel the trembling body and listen to the cries of frustration rather than looking at statistics in neat boxes with grandiose titles nothing will change. If they cannot do it they should listen to those who can and do everyday or the poor and sick will continue to suffer pain and those of us working with them are left with the feeling we are only adding to their misery through our silence.

Changing health policy without changing social policy does not make sense, ticking a box isn’t sufficient to explain the living conditions of many we come in contact with. It is too easy to discuss people coming from outside the jurisdiction of this State looking at maps – do we ever get to know how people live near us?

We must be acutely aware of the social determinants of health and be prepared to discuss them and stop intimidating those who speak out and forcing them to remain silent and conform. Mary Robinson, former President of our country, said in 2001 “Each time you speak out with a critical voice you pay a price”. Today speaking out means exclusion, no promotion and a lonely existence – a situation that a philosophy of caring would simply prohibit and make impossible. Nurses must be at the forefront as advocates for the most vulnerable and in helping to reverse the present situation and a very practical step would be to seek the implementation of strong whistle blower protection for everyone in frontline caring roles in the health, social and homeless services – something we have advocated in TRUST for years. Legislation let it be emphasised that would help prevent the scandals we have witnessed in the nursing home sector.

An interesting observation worth reflection from “Not Just a Bed for the Night”, which I co-authored with Anne Dempsey (1995), published by Marino Books and delivered by Judith Chavasse, Director the Department of Nursing, University College, Dublin:

“Nurses are the only professional group trained exclusively within the health service. Most student nurses enter straight from school into a hierarchical training system. To survive, they rapidly learn to conform. Hospital research in the 1980s found that student nurses’ experiences encouraged adaptation to the system, an adaptation seldom reflected on and usually internalised by the end of training.

Most nurses are women. It has been argued that, out of mistaken loyalty, women often support structures and practices which are oppressive to others. Alternatively, the internalisation may have been refined to the extent that nurses have ceased to see injustice and have identified with the oppressive system. Anyone who demonstrates against this may provoke a storm of protest, as happened when research showed that some patients are treated differently if they are unpopular with nurses.

Rebels, whether patients or staff, have a hard time in hospitals. Many nurses who maintain a rebellious streak leave the hospital system and exercise their caring role to great effect in a different environment”.

Of course nursing has changed. There are more men now in nursing but we have met young men and women who left nursing because of bullying.

Just one month ago reading An Bord Altranais advertisement featured in an Education Special Report on Irish Times I was left wondering how easy it is perhaps to present a very rosy picture. “Do you like to be at the very centre of things? Are you interested and involved in life around you? Do you care about what happens in your community? Do you notice the great changes that are taking place in Irish society? Do you sometimes desire to improve the quality of life – your own and that of others?

This at a time when our health service appears at times to be floundering around us and many nurses appeared to be demoralised with rampant MRSA, patients on trollies and spin to deny same the order of the day

“Were Florence Nightingale to walk the wards tonight in any of Ireland’s modern day hospitals, she would be astonished at the high levels of responsibility and extensive skill-sets of the nursing and midwifery teams”. (Irish Times 2006).

I suggest it may be difficult to find a nurse.

The following quote from Sunday Independent 30th January 2005 by Theodore Dalrymple, a GP in England:

“Doctors are now a deeply disgruntled and disillusioned lot; when I started out, their first talk when they met in the corridor or the coffee room was of patients and their illnesses, but now it is of the evils of management, government directives, bureaucratic takes imposed upon them and so forth.” I think many of us could agree.

“I had the privilege of spending one week with Alice Leahy and her team in ”Trust”: that experience has taught me that the work is not only with ‘the outsider’, it is also with ‘the invisible’ and is invisible. After a week … Dublin becomes a very different and much more uncomfortable city. Familiar shops, offices, streets and parks become a place to
sleep and torrential August rains are more than a nuisance. After a week in ”Trust” Dublin is awash with familiar faces, however, the people behind these faces know that they have achieved invisibility: a reality that is summed up in the words of one woman in her 50s, in response to my flippant “see you around” -she answered “but you won’t know us out there – we are very different people out there.”
Una Lynch, Lecturer (Public Health), Queen’s University Belfast (2004)

(The young woman referred to died during the year, one of many to die on the streets unnoticed).

Many nurses now see themselves as technicians and we have been very slow to articulate what nursing care really is and it is obvious that this needs to be done. We need to confront the challenge in formally articulating a philosophy of caring in all of the health, social and homeless services for the 21st Century.

How much time do you spend writing reports compared to the amount of time spent delivering care to patients? When was the last time at local level you got a chance to analyse what is happening around you?

Many nurse managers have been distanced from patients and colleagues. They have to because of the amount of bureaucracy required – but how much of this is necessary? Does it in any way reflect the needs of patients and staff?

Do we ever get the time now to wonder how those we care for feel about meeting us? Caring for people does require us to speak out if we feel people are being denied care, are not being treated with dignity or worse still being excluded from society or our world. We also need to care for each other because if we allow those who speak out to become outsiders nothing will change.

I reflect often on the words of Pastor Martin Niemoellen in 1945 – “First they came for the Communists, but I was not a Communist so I did not speak out. Then they came for the Socialists and Trade Unionists. I was neither so I did not speak out. Then they came for the Jews, but I was not a Jew so I did not speak out and when they came for me there was no one left to speak for me”.

A Christmas morning a few years ago I happened to catch Eurovision Mass from Circus Pinter Top in Paris. Apart from the charm and artistry of Parisians I was struck by a few quotes from the Pastor: “Encounters with people move us” and I am sure our isolation in offices at times does something to us too and he further said “It is the blind application of the law which makes us inhuman”. I suggest much of what is presented we accept blindly and perhaps knowing the cost of speaking out. It is often not rooted in reality and it is debatable if humanity benefits as a result – only debate and reflection can answer this.

I strongly believe nurses, doctors and frontline care workers must have confidence to defend the most vulnerable and society must support them in that role and that we must resist being treated as invisible because we work with society’s invisible people. Health care surely is not about curing the disease but about caring for the person.

Some years ago I met here in RCSI Phil Barker, former Professor of Psychiatric Nursing, who runs workshops on the premise that “Knowledge can only be gained through experience”. I once wrote to him for permission to use a quote and he replied: “Alice, people don’t remember what you say or what you do. They will remember how you made them feel”.

Annex to Paper Delivered by ALICE LEAHY

TRUST Education Programme

All our education initiatives are aimed at affecting change through awareness. All projects are on the theme of “The Outsider”:

One day Training Day on “The Homeless Experience”:
This programme aims to raise awareness on the issue of homelessness and to help focus individuals and organisations on their responses and possible interventions.

The programme is aimed at individuals and organisations who want to deepen their understanding of the issues relating to homelessness. Many who come in contact with people who are homeless may have concerns that need to be explored and understood, and this programme provides a forum for this process.

A video documentary “A Fragile City” made by Esperanza Productions on Trust:
Was shown on RTE and distributed to all schools as part of our educational projects.

National Essay Competition for Transition Year Students:
Trust National Essay Competition on the theme “Outsider” which was co-sponsored by Dept. of Justice Equality and Law Reform and The Irish Times with prizes presented by the Dublin Rotary Club which ran over the last Transition Year. We had a major response and it was so encouraging to read the essays from young people. Information on this competition and prize-winning essays can be seen on our web site www.trust-ireland.ie.

National Art Competition for all second level students:

Our book “With Trust in Place”:
This had 40 contributors including Judge Michael Moriarty, Christy Moore and Tony Gill, a man who was homeless and died last year, published at the end of 2003 by Townhouse, now available from Trust.

A Seminar in RCSI in October 2004:
Entitled “Is the management philosophy of benchmarks and performance indicators incompatible with a philosophy of caring?”

DVD
“Building Trust in the Community”:
The DVD features two documentaries, the latest – Building Trust in the Community – produced specially for this initiative; and, A Fragile City produced six years ago about our work in TRUST, and was broadcast on RTE 1 Television and generated quite a reaction in terms of feedback at the time. However, the really interesting thing is how little has changed for the outsider in between the making of these two films.

Building Trust in the Community features interviews with people who have unique perspectives and insights on Irish society and into the work of TRUST such as Vincent, a man who is homeless; Rev. Olive Donohoe, Church of Ireland Rector in Mountmellick; John Lonergan, Governor of Mountjoy Prison; and Gerard Byrne, better known as Malachy in the RTE television soap Fair City. TRUST’s Alice Leahy and Geraldine McAuliffe also participate.

The aim of the documentary is to raise the issues and questions that must be addressed. However, there are no easy answers. Everyone in their own way needs to consider where they stand and what kind of community they want. The power to change things is in our hands and this short film poses the questions in a way that may helps us to at least think about the issues involved.

Building Trust in the Community was also made by award winning documentary filmmakers Anne Daly and Ronan Tynan of Esperanza Productions who also produced A Fragile City.

Check our website “https://aliceleahytrust.ie”

Submission from TRUST – Review of Government’s Homeless Strategy

Background

TRUST has been active in a front line capacity providing health and social services for people who are homeless on the streets of Dublin for the last 30 years.

The philosophy of TRUST is based on two central principles:

The recognition of every individual’s right to be treated as an autonomous and unique human being.
The need to restore the dignity of individuals whom society has labelled deviant and undesirable.
TRUST was founded with the aim of seeking to ensure that one day we would be put out of business when we helped the State to find a way of accommodating those who cannot fit it and are forced to eke out an existence on our streets as outsiders.

However, TRUST was forced to intensify its campaigning activities 6 years ago and began an Education/Awareness Programme to create greater understanding about what it means to be homeless on the streets. This decision was motivated by real concern about the way in which official policy was tending to create outsiders rather than helping people to find a welcome and a place in society. (SEE APPENDIX 1 for a list of recent Education/Awareness Initiatives).

At present there is a major campaign underway to “professionalise” the voluntary sector with the provision of large grants to independent organisations, once staffed almost exclusively by volunteers, to undertake services that were previously provided exclusively by the State. While this looks like a form of privatisation and partnership, it is probably more correctly described as a form of “nationalisation” of the voluntary sector because it effectively silences once prophetic voices in defence of the most vulnerable in Irish society. We believe that this must be challenged because these bodies are being forced to adopt a management philosophy which is often contrary to the original ethos that informed the establishment of these organisations.

In short, the implications of the Government’s current strategy is the effective obliteration of the once prophetic voices in defence of the outsiders on our streets instead of reforming and expanding the State’s own social and welfare services. In other words, when the organisations that once offered support and understanding become part of the bureaucracy, and must operate according to the performance indicators and management philosophy of the State’s social and welfare services, where does that leave the outsiders in our midst – those who cannot cope and find great difficulty dealing with that system in the first place?

Introductions

We have only one main recommendation in this document and it is aimed at helping to create fundamental reform, especially in the management philosophy that currently prevails in the running of the homeless services, but is equally pervasive across all of our health and social services.

We recognise that there are many people working long hours, under pressure, doing their best against the odds in an atmosphere where those who advocate reform and change tend to be seen as the problem instead of part of the solution. We have had so many reports and consultative documents without meaningful reform that a catalyst to facilitate change in a constructive and realistic way we believe is the best approach now, especially when the resources are available to effect real reform.

Homelessness as experienced by those living rough on our streets is a complex problem and is not the same as “houseless ness” or a lack of accommodation. In tackling this problem it is very easy to forget that the people involved have rights and deserve to be treated first and foremost as human beings who have as much right to determine their way they live as anyone else. At present, we are heading, especially through the “nationalisation” of the voluntary sector, towards a situation like that which applies in the UK and is very succinctly summarised in the following brief quotation from the Economist (14 August 2004)

“Rough sleeping becomes rarer and tougher”
“Waterloo’s Cardboard City” which blighted London in the 1980-90s have been harried out of existence an outreach worker Mr Barquinha on spotting a man sprawled drunkenly near the back of the Savoy Hotel said “He won’t sleep for long”. There’s always going to be someone in their face, whether it’s us (outreach workers) or the police. Local Authorities are undeterred; they even blame church groups who distribute soup and kind words for sustaining chaotic lifestyles.

For a decade, the objective has been the same; ending rough sleeping in Britain. It’s a brave campaign that has stabilised thousands of lives. But as the homeless become fewer and more intransigent, eradication seems less realistic. It’s hard to see how it could be done without sending many of them to jail; and even this Government may not want to be that tough”.

Dramatic solutions that ignore people’s rights, apart from being morally wrong, will not “solve” the problem it will only serve to move people on.

People do not decide to become outsiders – they are made to feel excluded. Something radical is certainly needed, not to make them feel more isolated or put under pressure, but a mechanism or a facilitator that will make them feel welcome and part of society.

Recommendations

An “Advocate” should be appointed to represent the interests of people who are homeless to cover every institution and service provider both in the State and voluntary sector working with people who are homeless.

The “Advocate” would have to be proactive and constantly test the quality of the service being provided by challenging procedures and practices if they appear onerous or insensitive – he or she would not wait to receive complaints.
—This approach would formally recognise that many of the people who are homeless do not or feel they often cannot complain.

The “Advocate” must be completely independent of the management structure of each organisation or service provider.
—Ideally each “Advocate” should be appointed independently and not paid out of the budget of the organisation he or she serves. In terms of ensuring cost effectiveness a single “Advocate” could easily cover a number of organisations e.g. specialising perhaps in a single service category such as hostel accommodation.

The “Advocate” would also have responsibility to help enhance the culture of service in each organisation by focusing all energies on the people for whom it was established.

The “Advocate” must also be charged with encouraging a climate where people working in each service provider are encouraged to speak out and not be afraid of making suggestions to reform or alter procedures and practices to make each organisation work more effectively.
—At present the tendency is that those who speak out are perceived as part of the problem which is not unusual in any bureaucracy.

The Advocate – Further rationale

1. Undervaluing Personal Contact and Frontline Caring

At present, the “professionalisation” of services with the emphasis on status and higher remuneration for those in management i.e. those further away from frontline caring and interpersonal contact with those who are homeless inevitably leads to a downgrading of the very functions that actually can transform the lives of the people who the organisation is meant to serve.

In TRUST the value of even talking to people as people, while providing services
to those who maybe afraid in some instances to go elsewhere is invaluable in helping
to bring them back into society – often a very slow process.

However, through a proactive “Advocate”, independent of the management structure,
it is inevitable that more value and status will be invested in frontline care and
interpersonal contact because these are the points of contact where the person
who is homeless on the streets interfaces with any organisation.

In summary, the role of the “Advocate” will act as an institutional reminder to
everyone about what any service provider should be about – making life better for the
people it was set up to serve.

2. Unsuitability of B&B compared to hostel accommodation

Bed and Breakfast accommodation while generally unsuitable is sometimes the only
accommodation available to people perceived as the most difficult and vulnerable.
Privately run B & Bs while unsuitable are now more flexible, non-intrusive and
accepting than most hostels, where admission procedures and requirements, often
imposed on them to comply with grant aid requirements, have become onerous
and difficult for the most vulnerable to avail of.

3. Overemphasis on highly intrusive research and large form filling

This can deter many people from seeking help. For most of us, surveys may be an
irritation but even one badly executed survey on a person with a serious mental
health problem rooted in a traumatic experience e.g.child abuse etc. can have painful
and serious consequences.

4. Use of technology such as voice mail services.

The increased use of technology in statutory and voluntary agencies, e.g. voicemail,
together with strict appointment rules for consultations are tending to create greater
distance between the service providers and the vulnerable users of these services.

5. “Medicalisation” of social problems

It is increasingly common when someone seeks emergency, or any kind
accommodation, that a medical pretext is created to assist them. This only serves
to underline how the current system is failing.

6. Too much emphasis on changing people and too little on altering services to meet people’s needs.

In a business context no one has any difficulty in saying the customer must come first and everything in the business must constantly turn on its head to ensure the customer is king. People who are homeless have no resources and often do not even have the ability or the will to speak for themselves. Hence, the “we know what is best” attitude quite naturally is pervasive – almost unwittingly so on the part of many well meaning people in the services.

Conclusion

The “Advocate” or a similar concept offers a real opportunity to improve the quality of the services for people who are homeless on the street – perhaps the most vulnerable group in Irish society. However, its ultimate value is that it offers a mechanism to help change attitudes and keep all of us alert to the needs of the people we are seeking to help on a daily basis and where possible help them back into society.

We also recognise given the radical shift implied in the current management philosophy of the homeless services, without which this idea will not work, there are a number of ways in which the concept of the “Advocate” could be implemented. In that context, we would be very happy to discuss this idea with you in the light of your on-going consultations.

ALICE LEAHY
Director & Co-Founder
TRUST

11 February, 2005

Appendix 1

The TRUST Education & Awareness Programme:

The TRUST Education & Awareness Programme is aimed at changing attitudes and making people more sensitive to the needs of those who feel themselves outsiders around them.

All projects are on the theme of “The Outsider”:

The Homeless experience, a Trust initiative, is a one day resource programme
for service providers in statutory and voluntary organisations at national or local level. Financial assistance was given by Dublin Corporation (now DCC). This programme aims to raise awareness on the issue of homelessness and to help focus individuals and organisations on their responses and possible interventions;
A video “A Fragile City” made by Esperanza Productions;
National Essay Competition for Transition Year Students;
National Art Competition for all second level students;
Our book – “With Trust in Place”, with 40 contributors including Judge Michael Moriarty, Christy Moore and Tony Gill, a man who was homeless, published at the end of 2003 by Townhouse;
A seminar in RCSI in October 2004 entitled “Is the management philosophy of benchmarks and performance indicators incompatible with a philosophy of caring?”
Our website www.trust-ireland.ie which as well as being a vehicle to advance understanding of the outsider also provides information about all of our projects and activities.