16 Simon Communities of Ireland the breakdown of social relationships, to unemployment and to eventual homelessness, which in turn may lead to worsening mental health, as well as complicating factors such as problematic drug and /or alcohol use. Mental illness frequently presents as schizophrenia, depression and other affective disorders, psychoses (including drug-related psychosis), anxiety states or personality disorder.34 Among rough sleepers, the prevalence of severe and enduring mental health problems is particularly high, with problems such as depression, anxiety and learning difficulties extremely widespread.35 Many people who are homeless with mental ill-health issues are also often problematic drug and/or alcohol users which in turn may aggravate existing mental health problems. Research indicates that experience of trauma (sexual and/or physical abuse) is very high among people who are homeless, particularly among those suffering from dual diagnosis. This has major implications for their state of mental health and well being. It can lead to mental vulnerability and play a role in tenancy breakdown.36 Recent research from the US37 postulates that trauma rates are high enough among this part of the homeless population to warrant the inclusion of trauma and counselling services in the care packages available. This type of support is seen as an important part of treating mental problems and helping the individual overcome drug and or alcohol related issues. 2.8 Problematic alcohol and drug use and dual diagnosis Holohan (1997)38 estimated that the prevalence of use of alcohol amongst people who are homeless ranges from 29% to over 50% while other studies suggest it could be as high as 70%. Chronic alcohol use takes its toll on the cardiovascular system and greatly weakens a person’s overall state of health over time. It causes severe damage to the liver and can lead to cirrhosis. Over 50% of 2011 Simon National Health Snapshot survey respondents indicated that they were current alcohol users, while alcohol had generated health issues for about 28% survey respondents. A problem drug user has been defined by the UK Advisory Council on the Misuse of Drugs as “any person who experiences social, psychological, physical or legal problems related to intoxication and/or regular excessive consumption and dependence as a consequence of his or her use of drugs or other chemical substances”. Research39 has found problematic drug use more prevalent among younger age groups with heroin the most frequently used drug amongst survey respondents. Cannabis was the second most commonly used drug with growing numbers using benzodiazepines. The majority of intravenous drug users report problems related to scarring and bruising, infections and accidental overdose. Many drug users are also hepatitis C positive (See also, Drugscope, 2000). Problematic drug and alcohol use may contribute to homelessness and to health problems; but it may also be that problematic drug and alcohol use are a consequence of a person’s homelessness. 20% of the people who were homeless involved in the 2011 Simon National Health Snapshot study cited personal alcohol use as the most common reason for becoming homeless while 13% reported personal drug use as one of the two key reasons for becoming homeless. Over 50% of respondents in the most recent Simon National Health Snapshot in 2011 reported that they were drug users, while 31% identified themselves as current drug users40. The on-going University of Sheffield study41 on mortality among people who are homeless has identified drugs and alcohol as major causes of death amongst people who are homeless. 34 World Health Organisation 2004: “Review of Evidence on Housing and Health” Fourth Ministerial Conference on Housing and Health, background document, pg 11. 35 C. Frankish, S. Hwang and D. Quantz: “Homelessness and Health in Canada: Research Lessons and Priorities”, Canadian Journal of Public Health, Ottawa, Marc/Apr 2005. Vol. 96, pg 27 36 AHURI Research and Policy Bulletin: “Cycles of Homelessness” Issue 39 March 2004, www.ahuri.edu.au 37 R. Christensen, C. Hodgkins, L. Garces, K. Estlund et al: “Homeless, Mentally Ill and Addicted: The Need for Abuse and Trauma Services” Journal of Health for the Poor and Underserved, Nashville: Nov 2005, Vol 16, Iss 4 pg 620 38 Holohan, T. (1997) Health status, health service utilisation and barriers to health service utilisation among the adult homeless population of Dublin. Dublin: EHB 39 The 2010 and 2011 Simon Health Snapshot’s 40 Simon Communities of Ireland(2011) Simon Heath Snapshot 2011 41 Crisis (2011) Homelessness: A silent killer: A research briefing on mortality amongst homeless people
Homelessness, Ageing and Dying
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