If we want to address complex social issues like addiction and homelessness, we need the activity of frontline services to match the vision of high level policy.
Despite public concerns and significant effort from both statutory and voluntary agencies, there is still a significant number of people living on the streets, living with an addiction and who are isolated from support services. Why is this?
Consider the case of Joe, a young man who regularly sleeps rough in Dublin city centre. Joe attends a mental health service for support. He is assessed, and it transpires that he has a drug addiction. The service declines to treat his mental health issue on the basis that Joe needs first to address the addiction before meaningful work can be done regarding his mental health.
So, Joe attends an addiction service, where he is told that he can’t access the service until he has dealt with his underlying mental health issue. Despite having both issues, he receives limited support. It’s not hard to see how Joe can enter the revolving door scenario of street homelessness, hostels, hospitals and prisons. Not only are we letting him down, but we are not using the State’s limited resources efficiently.
There are other scenarios and there are many gaps in accessing housing, health and social services for those with complex needs.
‘Person centred service’
If we want to address complex social issues like addiction and homelessness, we need the activity of frontline services to match the vision of high level policy. At policy level, there has long been a commitment to providing a ‘person centred service’, in which the service adapts to meet the needs of those that present, rather than forcing the person presenting to conform to the requirements of the service.
However, this has never fully translated to front line service delivery. Across Ireland, there are still many people on homeless lists; there are still many people who cannot access timely addiction treatment; there are many people who are isolated and not reached by existing services. People ‘fall through the gaps’.
The solution, of course, is to be truly person centred and to expect cases with multiple and complex needs. Instinctively, we know that many social problems are intrinsically linked. When we start to think about visible heroin use on the streets, for instance, we know that issues like homelessness may be linked in some way. Nobody wants to inject heroin on the street.
Nobody wants to be homeless. People who are homeless and living life with an addiction have the same hopes and dreams as everyone else – family, security, stability. But the milieu in which their lives are lived are different to that of many of the people reading this. Many have mental health issues. Many have life histories that are marked by abuse, neglect and isolation. Many also have negative experiences in their histories of their own making – of violence that they have perpetrated, of acquisitive crime, of drug dealing.
In addressing social issues, we need to be prepared to deal with these issues in their totality. This means supporting people to get the help they need, while being prepared to challenge those behaviours which are problematic and antisocial, and to support those behaviours which are prosocial. And it means challenging public perceptions too – as much as someone using heroin intravenously down a lane is an inappropriate behaviour which needs to be challenged, so is the act of simply labelling that person a ‘junkie’ and mentally assigning them to a preformed stereotype. Both behaviours are inappropriate and need to be challenged.
Source: Tony Duffin, thejournal.ie, 29/09/14
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