Submission to the Dublin Region Homeless Executive on the Framework Statutory Homeless
Action Plan for the Dublin Region 2014-2016
Introduction
Mental Health Reform (MHR) is the national coalition of organisations working to improve mental
health services and achieve implementation of the Government’s mental health policy A Vision for
Change in Ireland. MHR welcomes this opportunity to contribute to the Framework Statutory
Homeless Action Plan for the Dublin Region 2014-2016.
A Vision for Change recognises that there is a high level of mental health difficulties among homeless
people. People with poor mental health are at higher risk of becoming homeless than those who
have secure housing. So too, homeless people are at higher risk of poor mental health. Among
Simon Community homeless services, 47% had at least one mental health diagnosis in 2011.1 Once a
person becomes homeless the impact on both their physical and mental health is significant. In the
Simon Communities’ most recent health ‘snapshot’ report the number of participants reporting
mental health conditions increased depending on their length of homelessness, with the highest
levels amongst those who were homeless for 5 years or more.2
The provision of secure permanent accommodation with appropriate supports is vital to enabling
recovery. So too, ensuring individuals are empowered with the skills to maintain their tenancy will
help to provide a stable platform for their own recovery. The Australian Human Rights and Equal
Opportunities Commission found that:
“One of the biggest obstacles in the lives of people with mental illness is the absence of
adequate affordable and secure accommodation. Living with a mental illness, or recovering
from it, is difficult even in the best circumstances. Without a decent place to live it is
virtually impossible.”3
Integrated approaches ensure people have access to the most appropriate healthcare, including
mental health services and support therefore improving diagnosis, interventions and outcomes.
A Vision for Change states that community mental health services should adopt practices to help
prevent service users becoming homeless.4 The policy makes seven recommendations to improve
outcomes for people with a mental health difficulty who are or are at risk of becoming homeless.
These recommendations centre around:
1
Walsh, K. (2011) Simon Snapshot Report: 2011, Dublin: Simon Communities of Ireland, p.18.
Ibid., p.21.
3
Human Rights and Equal Opportunities Commission (1993) Human rights and Mental Illness: Report of the
National Inquiry into the Human Rights of People with Mental Illness, Canberra: Australian Government, cited
in Department of Environment, Community and Local Government (2011) National Housing Strategy for
People with a Disability 2011-2016, Dublin: DECG, p.99.
4
Department of Health and Children (2006) A Vision for Change: Report of the Expert Group on Mental Health
Policy, p.145.
2

Ensuring that statutory homeless and housing services take responsibility for their duties to
provide housing for people with a mental health difficulty (Recommendation 15.2.3)

Ensuring that there is adequate affordable housing options to prevent people with a mental
health difficulty from becoming homeless (Recommendation 15.2.4)

Ensuring that community mental health teams take responsibility for providing mental
health services for homeless people within their catchment area (Recommendation 15.2.5)

Ensuring that the practices of community mental health services help to prevent
homelessness, including having guidelines on discharge and assessment of housing need
(Recommendation 15.2.6)

Ensuring adequate integration and coordination between statutory and voluntary housing
bodies and mental health services at catchment area level (Recommendation 15.2.7)
As the statutory body responsible for implementing policy on homelessness in the Dublin Region,
the Dublin Region Homeless Executive has a duty to seek to implement the Government’s mental
health policy as part of its Homeless Action Plan for 2014-2016.
Issues arising at the interface between homelessness and mental health
MHR has met with homeless sector NGOs on three occasions in 2012 and 2013. During
these meetings representatives have alerted MHR to a number of issues arising in trying
to get access to appropriate mental health support for individuals within the homeless
services. These issues are detailed below:
1. Gaps in availability of crisis support
While there are two dedicated mental health services for homeless people in Dublin, it can
be difficult to access services in a crisis. Homeless services are regularly dealing with
individuals with severe mental health issues. The Access Service requires 24-hour notice.
The Access Team also requires a client to fill out a form even when the individual is already
known to the service. The alternative in a crisis is access through A&E but it is unrealistic to
expect a homeless person who is unwell to sit in A&E for extensive hours before being
assessed.
2. Lack of follow up when individuals have been discharged from acute psychiatric units
Concern has been expressed about a lack of on-going support and follow-up for people who
have had contact with mental health services. There is a sense that individuals who are
known to mental health services are being discharged into homeless services without
adequate follow-up and in contravention of the Mental Health Commission’s guidance.
Furthermore, the mental health services seem to rely on GPs to dispense medication to
homeless service users rather than providing the service users with on-going mental health
support.
There are also a small number of individuals who have self-harmed and been discharged
from hospital into a ‘crashpad’. In the experience of homeless service providers there does
not seem to be any follow-up mental health support provided for these individuals.
3. Concerns about catchment area boundaries hindering access to services
Concern has been expressed about boundary barriers to mental health services in some
areas. It was reported that some mental health services will use the catchment area
boundary against providing treatment for a person.
4. Treatment that is not in line with the service user’s preferences
Homeless service providers find that there is a group of service users who do not want to
take depot medication because of its ‘zombie’ effect. Due to their antipathy towards depot
medication and the lack of alternatives these individuals are not engaged with mental health
services. There is a need to look at how outreach and involvement of the service user in
recovery planning can be used to engage the individual in mental health support that fits
with their values and preferences.
5. Dual diagnosis – mental health/addiction
The experience within homeless services has been that people who have problematic drug
and/or alcohol use alongside mental health issues and who are sent for mental health
services are being refused. People who are homeless and who also have problematic drug or
alcohol use may not be able to get vital assistance from homeless agencies or from other
centres (e.g. Pieta House) because of their dual diagnosis.
6. Lack of services for people with a diagnosis of personality disorder
Of particular concern is the lack of specialist mental health support for people
with a diagnosis of personality disorder who are homeless; this lack can leave
homeless services as the last port of call for an individual with complex needs, but
without adequate back-up to provide appropriate support.
Recommendations

Implement the protocol between local authorities and mental health services. The
Housing Strategy for People with Disabilities has already provided a framework for
the development of effective links between local authority housing officers and
community mental health team staff through the agreed liaison protocol. This
protocol needs to be brought to life in mental health services and local authorities
so that every person at risk of homelessness due to a mental health condition is
provided with well-coordinated access to housing supports. Equally, local
community mental health teams need to strengthen their communication
practices with local homeless services.

Implement the Housing Strategy for People with Disabilities recommendations
that concern people with a mental health disability. The implementation plan for
the Housing Strategy for People with Disabilities contains detailed commitments
that will improve access to local authority housing options for people with a
mental health disability. Implementation of the Strategy is likely to help prevent
homelessness of people with a mental health disability. The Dublin Region
Homeless Executive should ensure that its Action Plan contains actions to
implement the relevant mental health recommendations in the Housing Strategy
for People with Disabilities.

There is a need for a housing-led approach with appropriate support. Currently individuals
may end up long-stay in psychiatric inpatient units awaiting an appropriate housing option.
The evidence supports a housing-led approach, however it is important that adequate
mental health and tenancy sustainment support is provided. This support should be
provided in a ‘wraparound’ manner and with open-ended support dependent on need.

Mental health services in the Dublin Region should assess the need for and provide high
support housing for those who need more intensive, ongoing support.

A comprehensive care and case management approach which involves the individual closely
in decision making is in keeping with mental health policy.

Mental health services in the Dublin Region should ensure that they adhere to Part 5 of the
Mental Health Commission’s Code of Practice on being Admitted, Transferred and
Discharged to and from Hospital and provide adequate follow-up support including support
to individuals living in homeless service accommodation.

An on-call, out-of-hours mental health service should be established to be available to visit
and assess individuals in homeless services who are in crisis. Rapid access to mental health
services and other mainstream supports are necessary to meet the complex needs of people
accessing homeless services. This has been identified as an existing block to client’s
wellbeing, and requires dual working between specialist and mainstream services.

Rapid access to assessment in A&E should be available where this is the only option.

Mental health training should be provided for homeless sector staff.

Homelessness training should be provided for mental health service staff.

Mental health services should work with homeless services and addiction services to
establish effective referral pathways for people who have a dual diagnosis of mental health
and addiction problems.

Mental health services in Dublin should implement Recommendation 15.8.1 of A Vision for
Change to provide evidence-based interventions to people with borderline personality
disorder.