Homelessness, Ageing and Dying 17 Problematic drug and alcohol use are both a mental and physical health issue. One research study went as far as attributing 30% to 70% of the deaths of their study participants to alcohol related causes.42 Alcohol use is identified in ‘A Vision for Change’ (2006) as the single most prevalent health problem for people who are homeless with frequency of consumption varying by gender and age. 2.9 Complex Needs Turning Point43 defines people with ‘complex needs’ as individuals with multiple interconnecting needs that span medical and social issues. Individuals with ‘complex needs’ may have mental health issues, combined with substance misuse problems, and learning disability. At the same time they may experience social exclusion, such as living in poor housing, with few opportunities for meaningful activities and leisure”. There are also significant numbers of people who are homeless that experience the coexistence of mental health issues and physical health issues which may or may not be complicated by problematic drug and/or alcohol use. The term “complex/multiple needs” refers to the fact that people who are homeless will have ‘and will often present to services with’ more than one serious problem. These multiple and complex needs often aggravate each other. A useful extract from a definition of complex/multiple needs ‘developed by NGOs in the UK’ is where a person who is/was homeless ‘presents with three or more of the following’: • mental health problems; • misuses various substances; • personality disorders; • offending behaviour; • borderline learning difficulties; • disability; physical health problems; • challenging behaviours; • vulnerability because of age. ‘If one of these needs were to be resolved, the others would still give cause for concern.’44 A more detailed discussion on meeting complex needs within a general social care setting can be found in Rankin & Regan, 2004. 2.10 Barriers to Accessing Health Care Among the key barriers for people who are homeless to accessing the medical and health care services45 and supports they need, is that meeting basic needs in relation to food, shelter, employment and safety are often perceived as of higher importance than healthcare. Competing needs is a term used to describe 42 Larimer, Mary, E. PhD. et. al, Health Care &Public Service Use &Costs Before & After Provision of Housing for Chronically Homeless Persons with Severe Alcohol Problems in Journal of American Medical Association, April 1, 2009. Vol. 301, No. 13, Pp. 1349-1357 43 Rankin, J. & Regan. S. (2004) Meeting Complex Needs: The Future of Social Care. Turning Point & The Institute of Public Policy Research: London. 44 Multiple Needs Briefing, Bevan P, Homeless Link 2002 45 The 2008-2012 Adult Homeless Strategy indicated that the following health services were in place for saults who are homeless: multidisciplinary teams in Dublin, Cork, Limerick and Waterford (These were all resourced at different levels with some subsequently subsumed into Primary Care Teams (eg. Dublin Inner City), GP clinics in hostels and day centres; funding to NGOs to employ nurses, chiropodists and counsellors; improvements in access to medical cards for homeless people; an outreach mental health team in Dublin; a dedicated alcohol detoxification and rehabilitation service; dental surgery in a day centre for homeless people; an outreach needle-exchange service; protocols developed with both acute and mental health hospitals to prevent inappropriate discharges into homelessness , (communication with the HSE Suggests that these protocols are due to be reviewed in 2012 as part of the National Service Plan), as well as SafetNet services in Dublin. The reality is now that funding and support particularly for the NGO sector has because of the current economic climate been cut, thus reducing the levels of services available generally.
Homelessness, Ageing and Dying
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