Alice Leahy Trust News and Press, Sunday Tribune

New Approach Needed To Tackle Homelessness

Dear Madam

Your feature on the plight of those who find themselves homeless on the streets of Dublin was very timely. However, the very last paragraph of that two page spread was the most revealing in highlighting the very destructive effects of “increased bureaucracy” which explains to a great extent why we continue to fail so many of those who find themselves outsiders in Irish society.

The full implications of this bureaucracy needs to be understood. Having worked with people who are homeless for almost thirty years, and while acknowledging that some things have changed, it is also painfully true that much has remained the same; and this can be explained by a very serious management failure at the top. In short, those in overall charge appear to be out of touch with what is happening on the ground.

To underline that point it was very revealing that only one of the people involved in homeless services, the deputy chief executive of the Homeless Agency, the body responsible for overseeing policy in this area, agreed that it was possible to reach the government’s target of ending “rough sleeping” on the street, as it is described, by 2010. In other words, anyone involved in anyway in front line services knows that is impossible, given current policy and commitments, and shows a profound misunderstanding about the nature of the issue. One of the most serious issues at the moment is that there are not enough emergency beds – highlighting how far behind we are at the moment in attempting to meet that target.

Indeed, the need for a very different approach was clearly shown in the article.

However, there is a very practical way of making real headway even before investing more money – talk to those at the front line who know what is happening. Your paper presented a picture that is at variance with the official view. If we want a caring and inclusive society we must, like you did last Sunday, begin by acknowledging what is wrong and seek to address why people find themselves alone on the streets in the first instance.

Yours sincerely

ALICE LEAHY
Director & Co-Founder
TRUST

Alice Leahy Trust Irish Times, News and Press

Lots of vision, little change

by Carl O’Brien

Without proper funding or political will, the Government’s mental health plans will be just good intentions, writes Carl O’Brien , Social Affairs Correspondent.

Most mornings, in the brightly painted basement where she runs a homeless support service, Alice Leahy sees the casualties of the State’s chaotic mental health service.

Dozens file into the Trust centre where they can get breakfast, a shower, a change of clothes and help with practical issues, such as welfare, medication or job applications. For many, however, it is just a case of day-to-day survival.

“These are people clearly in need of some support, and who could be helped, but they’re not getting it,” says Leahy, who co-founded the service in the 1970s. “There’s no acknowledgement that this is happening. And there’s only so much we can do. We’re seeing these people going slowly downhill, becoming more neglected.”

As many as one-third of all homeless people have a mental illness. Most have ricocheted through a rough-and-tumble health system which more often than not hasn’t been able to offer any meaningful support or rehabilitation.

The closure of beds in old psychiatric hospitals and the limited number of secure beds mean many are discharged into the community with little or no support services. Like a giant pin-ball machine, they have bounced from service to service, but never long enough to get to grips with their illness.

And when things get really bad, they hit rock bottom, in services that were never designed to cope for them: remand prisons, overnight Garda cells, and homeless support services.

It’s the latest chapter in a long saga of neglect of our mental health services. For decades it has been one of the most neglected arms of the health services, with expenditure on the sector falling from 13 per cent of the health budget in the early 1980s to around 7 per cent today.

But, just two years ago, many campaigners for a better mental health service believed they had reached a turning point. For the first time there was a new blueprint for transforming mental health services, unprecedented resources at the disposal of the Government and, most importantly, apparent political will to implement the changes.

Today, though, most of the optimism has vanished. Campaigners say little has changed except that promises over funding have been broken, time-scales for developments pushed back, with no real improvements for those individuals and families who access the mental health services.

The Health Service Executive has also taken a pounding from psychiatrists who have accused them of asset-stripping the sector by selling land and buildings and not re-investing the money into mental health services.

So, where did it all begin to go so spectacularly wrong? And are things really as bad as campaigners and psychiatrists make it out to be? Is the Vision for Change plan already dead in the water?

No one is in dispute over the merits of the plan. Over the course of its 200 recommendations, the report proposes: establishing fully staffed community-based multi-disciplinary mental health teams to offer home-based services to people with mental health problems; closing down the 15 remaining psychiatric hospitals and using their funds to build new community mental health centres and residential units for those with chronic mental illness; that service-users and their carers would be involved in their day-to-day care.

The Government adopted the blueprint as official policy early in January 2006 and pledged it would be implemented in full over the next seven to 10 years.

The plan makes clear that institutional changes in the management of mental health are needed to drive the transformation of the service. Most of this essential framework is not in place, however.

The National Mental Health Service Directorate was seen as a foundation stone in the plans. Instead, the HSE has set up a less ambitious structure in which – as the independent monitoring group commented – the role and authority of staff are not clear in relation to the implementation of Vision for Change.

The formation of new mental health catchment areas with smaller populations and new management teams would help drive change at a local level. This has not happened. Indeed, as the Inspector for Mental Health Services noted in her most recent report, the “ad-hoc nature of mental health provision has been noted in the past and there is no sign currently that this will change”.

At a more local level, there are no figures available for the number of community-based mental health teams that have been established. Anecdotally, the recruitment embargo is hindering this process, although the HSE says it has appointed 200 “primary care” teams which can offer mental health support.

Perhaps most serious of all is the funding issue. Vision for Change states that an additional €25 million is required annually over the next six years to expand and improve mental health services.

While such money was provided in 2006 and 2007, no such funding has been allocated for this year. Furthermore, the Irish Mental Health Coalition has uncovered, under the Freedom of Information Act, that almost half of the money allocated for the plan in 2006 and 2007 has been spent in other areas.

The Minister of State with responsibility for mental health, Dr Jimmy Devins, has defended the withholding of funds this year on the basis that “it is appropriate to pause and review the situation to ensure consolidation of the investment to date”.

This seems to be code for the fact that there are alarm bells ringing in the Department of Health over money not being used for what it was intended for.

Just why it has taken more than two years for these concerns to be raised, or why services should suffer this year as a result, is worthy of an inquiry in itself.

For example, the national office responsible for tackling suicide will receive just half the funding it needs this year to implement a suicide prevention strategy which the Government has described as an “urgent priority”.

More than 400 people die by suicide each year, more than the number who die on the roads. Yet, the effect of the limited funding is likely to be a scaled-down national advertising campaign on positive mental health and less funds for developing prevention services around the country.

The HSE says it is inevitable that such fundamental changes will take time to implement, but insists there has been “steady progress” towards achieving the aims of the plan.

It points to the appointment of 23 consultant psychiatrists last year as a sign of its commitment. Additional funding has been provided to increase training places for psychologists and post-graduate training for psychiatric nurses in 2008.

It says a comprehensive programme for the valuation and sale of facilities previously used for mental health care is currently in progress, with a view to selling properties in the next two years. All revenue raised from these sales will be directed towards improving modern mental health services. The changes, however, can’t come quickly enough for those in need of mental health support.

Children are continuing to wait months, if not years, for psychiatric assessments. Young people are still being detained in adult psychiatric hospitals. Adults with chronic mental illness are being readmitted to psychiatric hospitals where there are no meaningful community-based services.

People such as Dr Serena Condon, clinical director of St Brendan’s Hospital in Dublin, see the effects of a neglected service up close. Some of the most vulnerable patients, however, are those who end up passing through Alice Leahy’s homeless service because there is nowhere else to go.

“There is a huge problem with the underfunding of community-based services that could help many patients,” Condon says. “We don’t have the old asylum any more – not that they were necessarily a good place – and we don’t have the range of services, so inevitably people end up on the streets or in prison.

“You try to patch people up, but it’s heart-breaking to discharge people back into the community when you know the services aren’t there.”

Alice Leahy Trust News and Press, Publications

‘Wasting Time with People?’ – New Book, Edited & Compiled by ALICE LEAHY will be published by Gill & Macmillan in 2008

TRUST announced today that a new book – ‘Wasting Time with People?’ – edited and compiled by its Director and Co-Founder, Alice Leahy will be published by Gill & Macmillan next year.

The main aim of our book, Wasting Time with People?, is to attempt to start a debate about why at a time of material success so many people complaining about being “time poor” and the implications of that for all of us. To address this very challenging issue, Alice Leahy invited a number of people from all sections of society to contribute their thoughts. Those who rose to the challenge include leading writers, artists, church leaders, sports personalities as well as people who are homeless in addition to doctors, nurses and those active in community groups in urban and rural Ireland.

Commenting about the book project, Alice Leahy said: “As the pace of life in Ireland has dramatically increased, and stress has become a fact of life for almost everyone, the amount of time people have, even for each other, seems to be harder and harder to find. In TRUST we meet the casualties, those who cannot fit in or keep up, and we know from our experience there is no hope of ever creating a society that will be a welcoming place for the outsider unless we can make time for others both in our families and communities. Indeed, that applies equally to people working in public service, where staff are sometimes made to feel they are “wasting time with people” when they give, even the most vulnerable, the time and attention they need.”

Alice Leahy also said that like TRUST’s last book, With Trust in Place, published by Townhouse, we are once again seeking to show how anyone can make a difference if they are prepared to make time for others. “Indeed, it is remarkable how we often talk about what the State can do to help others, and often forget the most important catalyst in creating a better society — what each one of us can do in our way, especially in terms of helping those who are outsiders feel part of the community. Time is what is usually required and until we recognise that we have to invest times with others, in our families, in our communities and in helping those who are forgotten we will never make progress in creating a truly inclusive society “, she said.

Alice Leahy Trust News and Press, Press Releases

Call for Radical Change in Homeless Services

Alice Leahy, Director & Co-Founder, TRUST accepting the John Shelley Bursary 2007

The services for people who are homeless cannot be run like a business because of the complex nature of homelessness, and the failure to recognise that means the problem is getting bigger and more persistent, and the services are at risk of being transformed into “a homelessness industry”, ALICE LEAHY, Director and Co-Founder of TRUST, said today (Thursday, 06 December 2007) accepting John Shelley Bursary 2007 from the Environmental Health Officers Association.

“Services for people who are homeless are at risk of becoming a self perpetuating “homelessness industry” because the application of corporate style management techniques with an emphasis on benchmarks and performance indicators which place the emphasis on “moving people on”. In other words, each service, in both the public and voluntary sector, is perceived to be doing well if it passes a “client” to another service, regardless of whether that person has received any real help. However, the problem with this system is that people who are “difficult” get little or no help because they cannot fit in and often do not even make the official statistics. We know this because these people find themselves outsiders in our society and they come to our door everyday. Under this system there appears to be no real acknowledgement as to why people become homeless, and the very people the services should be helping are actually being further marginalised,” ALICE LEAHY said.

ALICE LEAHY went on:
“There is only one way the current trend will be reversed. We must ensure that all of the services adopt a culture or philosophy of caring that puts the person, the services are meant to serve, first and not the system. Indeed, in a business context everyone would agree you must put the customer first but this is not happening in the area of homelessness. Indeed, the person who becomes homeless, though called a client, must comply with the demands of the system and if unable to do so will find life very difficult. Evidence of that was provided recently when we had to make a complaint to the Data Commissioner about people who are homeless being apparently forced to answer a detailed and highly intimate forty page questionnaire before they received help. Obviously anyone with serious mental or psychological problems being put through that by an inexperienced person could suffer serious health consequences, of which no account appears to have been taken, let alone any consideration being given to the violation of the basic rights of the people subjected to that process.”

Alice Leahy in describing homelessness as a complex problem said that it required a commitment from all of the services to resolve, especially in terms of the way in which they treated people. Underlining that the reason many become homeless on the street is because they cannot fit in, she said that a sensitive and caring approach when a vulnerable person turned up at any service provider in the health, social or homeless area could actually prevent someone literally falling out of society.

“The key issue of course is time. You need to give time to people, especially people who are already marginalised because through out their lives they probably never enjoyed any caring relationship. However, the way the services are organised today, governed and operated according to budgets and quantitative measures, giving time to people can look like wasting time, and personal problems that lead to human tragedies go unanswered. This is what we mean when we say you cannot “manage” the so called “homeless problem” like a business because vulnerable and marginalised people are not machines. In other words, those who take time are deemed to be wasting time and the state goes on wasting money as people are constantly referred from one service to another never getting real help, often because they are deemed to be too “difficult”!” ALICE LEAHY said.

(Describing the situation as serious, ALICE LEAHY said TRUST felt compelled to have a book published to draw attention to this problem. Called “Wasting Time with People?” it will be launched in April 2008 and will be published by Gill & Macmillan.)

A culture of caring also implies listening to people in the frontline, as you cannot help people without organising services to meet their needs, ALICE LEAHY said. Indeed, the failure to respond appropriately to the growing numbers of people from the EU Accession States finding themselves homeless on our streets is because this does not happen.

“We owe it to the people from other countries who end up homeless on our streets to help them as their experience is very similar to that of our own people in former times who got into difficulties in other countries. Indeed, given the huge contribution workers from abroad are making to our economy, we also have a duty of care to respond to them as well. However, the failure of the Homeless Agency to acknowledge this growing problem is a good example of the unresponsiveness of the current system. This also explains why some of us have no confidence in current figures for the numbers sleeping rough on our streets as they simply are too narrowly defining the problem. A phrase such as “between the two canals” to describe the parameters of the recent survey sounds like something out of the 19th Century and completely fails to take account of the mobility or lifestyles of people who are homeless,” she said.