JOINT COMMITTEE ON HEALTH AND CHILDREN debate -
Tuesday, 18 Nov 2008

National Homelessness Strategy: Discussion with the Simon Communities of Ireland.

Chairman

I welcomethe delegates from the Simon Communities of Ireland: Mr. Patrick Burke, chief executive officer; Ms Colette Kelleher, chief executive officer for Cork; Ms Marlene O’Connor, chief executive officer for Galway; Mr. Sam McGuinness, chief executive officer for Dublin; and Ms Niamh Randall, chief executive officer and national policy and research manager. I understand Ms Randall must leave early during the meeting to do other duties.

Before we begin, I draw attention to the fact that members have absolute privilege whereas the same privilege does not apply to witnesses appearing before the committee. Members are reminded of the long-standing parliamentary practice to the effect that they should not comment on, criticise or make charges against a person outside the Houses or an official by name or in such a way as to make him or her identifiable.

We will first hear a presentation from the delegates and then take questions from the members. We will bank the questions and hear the answers at the end of the meeting.

Mr. Patrick Burke

I am thankful for the opportunity to make a presentation to the committee. The Simon Communities of Ireland is a national organisation representing eight local communities based in Cork, Dublin, Dundalk, Galway, the midlands, the mid-west, the south east and the north west. The national office, for which I work, performs a co-ordinating role, especially regarding research and campaigning in the areas of housing and homelessness policy. We provide best practice advice for all our communities in respect of service delivery and recruit approximately 50 full-time volunteers internationally who come to Ireland for one year to support the delivery of services in our communities nationally. We have been working since 1969 with people experiencing homelessness. Next year will be our 40th anniversary. Our services deal with an average of 3,500 individuals per year.

Our mission is to work with people experiencing homelessness and at risk thereof. We provide quality care and accommodation, carry out projects and deliver services that support people and enable them to acquire a home of their own or a suitable solution to their particular housing needs, with further supports if required. Our services include street outreach and emergency accommodation; day care services; transitional and supported housing; innovative detoxification and employment projects; and settlement and tenancy sustainment services. We work to prevent people becoming homeless in the first place and collectively work to promote legislative and policy changes to ensure those experiencing homelessness receive the best possible services.

We are delighted to have the opportunity to talk specifically about The Way Home, the new national homelessness strategy launched by the Minister of State, Deputy Finneran, in August 2008. We believe certain elements will be very helpful in preventing homelessness and assisting people already experiencing it to find an appropriate solution. We welcome in particular the Government's commitment to eradicate the need to sleep rough and reduce significantly the time people have to stay in emergency accommodation. The target date for achieving this is 2010, and it is very much to be welcomed.

We admit there is a clear commitment in the strategy to ensure the long-term housing needs of people experiencing homelessness are addressed in full. We very much welcome the locally and regionally based homelessness fora and local management groups with responsibility for devising local actions plans and ensuring they are implemented. However, we do have some concerns with the strategy, which can be addressed at this time. As we speak the Department of the Environment, Heritage and Local Government, which is leading the strategy, is devising an implementation plan. It is in this context we are present today because it affords an opportunity to ensure the health element of the strategy is addressed completely and adequately. In recent meetings with the Minister of State, Deputy Finneran, and his officials, we were very happy to be made aware that an additional 5% has been found to add to the homelessness budget for the coming year. This is very much to be welcomed.

The key point we want to make today is that the success of the strategy is contingent on the full and complete engagement of the Health Service Executive in terms of funding. It cannot be achieved without the critical care element being delivered. My colleague, Ms Niamh Randall, will highlight some of the real connections between homelessness and the health agenda.

Ms Niamh Randall

Members can see the statistics included in our submission. I will not address each of them owing to time constrains. If members have questions thereon, they can revert to us later.

I am anxious to demonstrate that homelessness is bad for one's health. This link is undeniable. We see every day the impact homelessness has on people's health. While there are many different reasons a person becomes homeless, poor physical and mental health are common factors. Once a person becomes homeless, the deterioration in his physical and mental health is rapid and debilitating. With regard to physical health, one study reported that 90% of participants reported having one or more physical health complaints, ranging from head injuries and respiratory problems to communicable diseases such as hepatitis. Between 25% and 50% of people who are homeless experience mental health problems. The study reported that between 25% and 50% have problems with drug dependency and drink at a level above that regarded as safe. Drug and alcohol users who are homeless tend to use drugs and alcohol more frequently, in increased quantities and in less safe ways then their housed counterparts.

Homeless people tend to have a range of complex or multiple needs. Consider the case of someone who is sleeping rough and who also has chronic physical health needs, a mental health problem and an alcohol problem. These needs are often interlocked and require simultaneous holistic responses. The stark reality is that those who are homeless die younger than the rest of the population. Unfortunately, 55 users of Simon services passed away in 2006, their average age being 42.

In the current economic climate, with increasing unemployment and poverty, both of which are risk factors for homelessness, more people will turn to our services for support, more will be at risk of homelessness and more will become homeless. In addition, reductions in contracting budgets across the public sector, including those for hospitals and prisons, will have a knock-on effect on the homeless and those who use our services.

Ms Kelleher will now give an overview of Cork's adult multidisciplinary team and discuss some of the gaps in the strategy that must be addressed in the forthcoming implementation plan.

Ms Colette Kelleher

Ms Randall stated homelessness makes one sick. One of the more positive innovations arising from the first integrated strategy on homelessness was the establishment of a multidisciplinary team in Cork, comprising general practitioners, psychiatric health nurses and public health nurses, to deal specifically with people who are homeless. They are more unwell than most physically, mentally and in terms of addiction, yet they are not accessing mainstream services. The team, which makes a significant contribution, has proved very effective in this regard. The statistics on this are in our submission, so I will not elaborate on each one.

One of our desires is that the multidisciplinary team will have a place in the new Health Service Executive strategy and will not be lost in the move towards primary health care. We regard a targeted service such as the one in question as very effective in ensuring health care is available to those who need it most. It frees up time in accident and emergency units and other places where the population in question may consume time or be disruptive.

We welcome the strategy and are pleased the Minister of State, Deputy Finneran, announced it in August. We also welcome the commitment of the Department of the Environment, Heritage and Local Government to an increase of the order of 5%. This is unusual but it is necessary if we are to help the people about whom we are talking. Today we want to stress the link between ill health and homelessness and obviously gain access to the health budget. One of the strategic aims is to streamline funding because the different arrangements in different parts of the country can be confusing.

We want to say that health is a homelessness issue and our call on that strand of the public purse under the health area needs to remain. The strategy is contingent on that remaining in place. That is a critical point and we want the committee in its role as watchdog to help us with the implementation plan to ensure the funding under the health area continues in line with need.

Ms Marlene O’Connor

I thank the committee for seeing us. I want to talk about a service user in Galway who has been with the Simon Community for a number of years and who, thankfully, is making a success of his life. I met him on Wednesday night at a memorial service and he looked the picture of health, which is a good outcome. He is now in his early forties and was raised in a number of foster homes and in care. Shortly after leaving the care system when he was just 18, he became homeless and in due course was addicted to alcohol and drugs, with a consequent impact on his mental health. Having spent time in hostels and sleeping rough, he moved into a Galway Simon Community project, but, sadly, when the time came for him to move on, and he had made much progress, he again became overwhelmed by his family background, his mental and physical health deteriorated very badly and he was unable to take up the placement he had been allocated in the move-on accommodation.

In time he came to realise and agreed that his addictions and poor mental and physical health had to be addressed or he might never get his life back on track. However, as his mental health problems were not diagnosed at the time, he found it almost impossible to get treatment. We advocated with him and on his behalf, however, and finally he prevailed and is receiving treatment. He also has been successful in getting treatment for a very severe physical health problem that necessitated an operation.

Accessing detoxification and rehabilitation in the west is not simple, easy or cheap, especially for someone who is homeless. Tony's behaviour has, at times, been very challenging and that has made the accessing of services even more difficult, that is, the services that were available. Not wanting, or willing, to give up on him, we accessed a private detoxification and rehabilitation place for him for five months and funded the services from our resources.

Tony's case illustrates two points. There is a need for responsive and timely mental health diagnosis and treatment for persons with poor mental health. Initial labelling of such illness as a personality or behavioural problem does not assist in recovery but is a common response when people present at units with very challenging behaviour and who may be inarticulate about their condition. The other point is the extreme need for alcohol and drug detoxification services for people who are homeless. By definition, such services need to be residential because it is unrealistic and unreasonable to expect that someone who is accessing detoxification and rehabilitation services can return each evening to an environment such as a hostel for the homeless where alcohol and drugs may be freely in use or are freely available on the streets outside. This reduces their chances of a stable outcome. They need a stable place to be while they are being detoxed and rehabilitated.

Mr. Sam McGuinness

My case study is about Tom, 26 years of age, who has had a long history of injecting heroin. He has been injecting since he was 21. He has hepatitis C and is HIV positive. He has had one successful detox and a period of rehabilitation, but he relapsed in December 2007 and has been categorised as being homeless ever since.

He went into our hostel, No. 27 Harcourt Street, near the Garda headquarters, in February 2008. Categorised as "emergency", he was given a long-term bed. His presenting needs included housing issues, mental health, addiction and training. He linked with the nurse on this site, thankfully, and the visiting doctor. For him our mainstream services would be difficult in terms of medical attention. He expressed an interest in a methadone programme. Trinity Court is not an option for him as he has no fixed abode. Castle Street is not available because he is homeless. He therefore availed of the stabilisation room we have in Harcourt Street. That was a pilot programme we set up and this single room is providing an opportunity for him to stabilise his drug use.

Our visiting doctor started Tom on methadone and maintenance. This was with the help of a model programme involving primary health care intervention, called Safety Net, set up under the auspices of the Homeless Agency and intervention started last March. This has been a positive outcome for Tom. He resumed contact with his family and started literacy classes. Literacy, as any of us can assure the committee, is a big issue for a great many homeless people. He is working with his nurse. To put this in context, Harcourt Street is dormitory-style emergency accommodation. Ms Kelleher and I would vie for who has the best emergency shelter and I believe hers is better than ours. She has individual rooms in her accommodation while we have a dormitory. In any event, this man got an individual room and one could call the nurse an angel. She would have to be an angel to be there. She is a wonderful woman who helps keep his hospital appointments and everything. At this stage, Tom does not have worries. He has stability, is in good shape and is happier. He is now moving to a longer-term hostel and does not have his own place yet. However, I believe that to some extent his conditions are akin to a penthouse compared with where he was before.

Looking at the issues around Tom's case, obviously there is a requirement in a complex needs scenario such as this for an holistic solution along the lines applied at Harcourt Street. However, there are not enough resources and there is a deficit of residential detoxification and rehabilitation facilities. This is not new to the committee, I am sure, because there was a Health Service Executive working group report on this in May 2007 as well as the report on rehabilitation from the national drugs strategy task force, again in May 2007, that have highlighted the situation in this regard. Some 15 months ago we went to the Homeless Agency and applied for an extension to our Usher's Island facility, which probably is the only treatment service for homeless people in Ireland and certainly is the only one in the greater Dublin area. It is primarily focused on alcohol detox and rehab. We submitted an application for drug detox and have gone from pillar to post ever since. We have been to the various sections of the HSE as well as meeting the Minister of State, Deputy John Curran, who visited Usher's Island recently when we made a case to him. As the committee can see, many reports on different matters have stocked up over the past while but these are two more that suggest there is a dire need for further treatment services for alcohol and drug detoxification and certainly for rehabilitation beds. Thankfully, at least one person is doing all right in the process. I thank the committee for its help in that regard.

Mr. Patrick Burke

I thank the committee for hearing our submissions. The basic point is that we are requesting the committee's help in ensuring the health element is supported in the strategy. Any influence the committee can bring to bear to keep that on the table will be welcomed to ensure the resources we require are set aside for this important strategy. We are only too well aware of the economic climate but the commitment to the allocation for the strategy in meeting the needs of people sleeping rough and the homeless is in place for 2010 and can only be achieved with the full engagement of the Health Service Executive as well as a focused commitment by all the players. The Simon Community in Ireland will continue to work in partnership with the local authorities and the HSE in playing our part in the process.

Chairman

I thank everyone for their presentations.

Deputy Kathleen Lynch

I thank the delegates for their submissions. I am very aware of the work the Simon Community is doing in Cork. I was on the working group that put the present homeless strategy in Cork in place. It is not even completed yet but one of the recommendations to emerge from the strategy has been the need for a multidisciplinary team. Ultimately, it was felt that because of the relative chaos in the lives of the homeless, they tend not to go to mainstream services, attend hospital appointments and so on. Much depends on where a person who is sleeping rough will wake up on a particular day. It was important that the multidisciplinary team went to Mohammed, because Mohammed would never have come to the mountain in this case. It has worked extremely well.

I have great concerns about the target date of 2010 for ending homelessness on the street. I am not certain we will achieve that date. It is important that we keep pushing towards it, but I doubt it will happen. Even in Cork, there are more people on the streets in the past month than in the previous month. That is probably a consequence of the downturn in the economy and other things.

It would be outrageous if the progress made on the multidisciplinary teams and the provision of the service in locations where the homeless people gather is in endangered. We know this part of the system works, and up until its introduction, there was a great difficulty in getting homeless people into mainstream appointments such as psychiatric outpatients. That is why the system was put in place and the teams were sent into the various shelters.

I do not want to sound like the prophet of doom, but our experience on this committee tells us that we cannot guarantee that any money given to the HSE will be spent in a particular area, even if it is specifically itemised in the budget. Our experience has been that if there is a deficit in one area, the HSE will take money from somewhere else and use it to cover the deficit. The witnesses are quite right to be concerned about what will happen to the multi-disciplinary teams. We will see the Minister of State and try to make sure that the funding is maintained for that element, if not increased. However, it would be disingenuous of us to give the witnesses any guarantees on how we can safeguard that money. The only person who may be able to do it is the Minister of State, so we will approach him about it.

How many beds does the Simon Community have for detoxification? I am not talking about beds in detoxifcation centres, but about emergency beds to ensure that people who are still drinking or still taking drugs are brought in off the street. What is the connection to the main line services on detoxification? I do not expect the Simon Community to do that job, because it is very specific and very intensive, and the organisation has enough difficulties in putting a roof over people's heads. If the organisation succeeds in stabilising someone, then it must be able to hand them over to the experts. What access does it have to the experts?

Deputy Dan Neville

I welcome the group. We were with them in Buswells Hotel not so long ago, when we had a detailed discussion. I want to deal with the area of mental illness and homelessness. What is the group's experience of dealing with the services? What would it recommend should be done in the area? I want to talk about the person who becomes homeless because of his or her illness, and we know that such people are out there. The mental health services have let them down, and they have become homeless, or else they are directed to the mental health services and they become homeless as a result. How do the services respond to people who develop mental illness due to their homelessness? What do the witnesses recommend should happen to them?

What about the person who has been mentally ill and institutionalised, and later discharged onto the streets? At one stage, Fine Gael recommended that there should be a step-down facility for such people. How are they dealt with at the moment? How does the State respond and what do the witnesses recommend should happen?

Deputy Charlie O’Connor

I also welcome our visitors. It is very important that we have these sessions, because we are all concerned about homelessness. If it was a problem in the good times, then we will have to remain focused in more challenging times. The presence in the delegation from people in other counties such as Cork and Galway stresses that this is a nationwide problem. I would not know all that much about other counties, and I do not go to Cork that much. I am a native Dubliner and I do not have any country cousins. I walk around the streets of Dublin as much as anybody, and I am concerned about the problem on the streets of our capital city.

I would like to talk about Tallaght for a moment. The Simon Community has a particular relationship with Roadstone, which is a company in Tallaght. Through the Roadstone safety challenge, huge amounts of money have accrued to the Simon Community, which is welcome. I hope other companies do something similar, because companies that have made money should help such projects. I am proud of what Roadstone has done in that respect. Tallaght has the third largest population centre in the country, and we tend to send our homeless people on the bus into Dublin city. I remain committed to the view that facilities for people at risk should be provided in the local communities. It is not popular to say that in Tallaght village, because there will always be difficulties in this area. However, that is what we should do.

Recently, the body of an unfortunate homeless young man was taken out of the grounds of the priory in Tallaght. That brings home the seriousness of the situation. Not everybody dies like that, but I am not afraid on a day like today to remind myself of that. The Tallaght homeless advice unit does a tremendous job, even though it does not have the facilities to take people overnight. What sort of relationship does the Simon Community have with groups like these?

Homelessness is different to what it was in other times. Deputy Neville and the witnesses referred to the link with mental health issues. We did not always see homelessness in that way, and I presume that the link suggests that it is a far more serious business. Whatever about being homeless if one is normal, if one has serious mental health problems, it must be even more difficult. All the hospitals, including Tallaght Hospital, will do their best in that regard. Whatever about anything else the witnesses may have said, anyone listening to the presentation would be struck by that point. I have a sense this is different than it used to be.

It is important the work of the Joint Committee on Health and Children would not just be about groups coming in and giving their story and members responding, and then everybody goes home and does nothing about it. I would hope, under Deputy Ó Fearghaíl's chairmanship, that we have been ticking off issues. When the Minister and the Health Service Executive appear before us shortly, the subject matter of today's meeting should be brought up with them in a very definite way. It is important we would do that. We should be able to tell groups we are prepared, whatever our political affiliations, to respond to the serious matters which are brought to our attention.

Deputy James Reilly

I thank the Simon Community for attending. There is no doubt in anyone's mind that Simon provides a much needed service on a voluntary basis and is much appreciated by all sides. Deputy Neville said much of what I wanted to say about mental illness and how it impacts on homelessness. While I will not mention any names, I recall that somebody with a high reputation in this regard commented that when many discharges took place several years ago, many of those discharged turned up as homeless people on the North Circular Road. That is a damning indictment of the lack of facilities and the lack of continuity of care for people who have mental illness, especially chronic mental illness.

I studied the report, which refers to seven strategic aims, one in regard to preventing homelessness. Does the Simon Community have specific proposals in this regard? I understand we need more social workers, occupational therapists, community psychiatric nurses and so on to help people keep well enough to stay in some of form of accommodation. The same applies to eliminating the need to sleep rough. Reference is made to whether we have enough shelters and whether we have an estimate of how many shelters we need. In terms of homelessness in the long term, we need to know the stock of sheltered housing and how we will meet long-term housing needs. Has the delegation a view on this issue and has it figures and recommendations in this area?

On the need for better co-ordinated funding arrangements, I agree with the witnesses about the multidisciplinary team. I know some doctors involved in the care of the homeless and who do great work that many would not find very popular. As was mentioned, because these people, who are Irish citizens, have been away from proper care for so long, they can present very challenging behaviour and sometimes can be a danger to themselves and others. Has the delegation specific recommendations and specific timelines?

While it would be an aspiration to rid homelessness from our streets by 2010, I fail to see how it can be achieved with the current funding arrangements and, as Deputy Kathleen Lynch rightly pointed out, the current situation where funding is allotted to a specific area for a specific purpose but is then hijacked and used for other areas on which some people put a higher priority — that is the only explanation I can find for it. I would be grateful if the Simon Community representatives could answer those questions.

Deputy Paul Connaughton

The group is welcome. There is no doubt the Simon Community performs an outstanding service, which it is a pity more rank and file people do not understand. There is no question that were it not for the hugely positive influence of the Simon Community over the years, many people would have had a much more difficult path through life.

To return to a point raised by Deputy Reilly, on a number of occasions we tried to do the best we could for the down and out Irish in towns and cities in England such as Birmingham and London. We saw at first hand the problems that existed there, which were not that much different to those Simon is trying to solve in our towns and cities. Overall, is Simon winning the battle at present given all the effort it is making through its many helpers? With the economy in a downturn, if there was a withdrawal of funding or services by the Health Service Executive to any significant degree, how would this manifest itself and how much worse would the position become? The delegation asked us to try to copperfasten what Simon receives at present plus the 5% to which the Minister referred. If that does not happen, how bad would the position be and how might this manifest itself?

As the years pass, are people becoming homeless at a younger age? When I walk to my hotel when I am staying in Dublin, I see five or six people on the streets every night and I see Simon's volunteers helping them out, sometimes at 11 p.m. or midnight. Is there any connection between these homeless people and any family they may have? Have they got to the stage where they have disowned everybody and everybody has disowned them? While I am sure this has been tried many times, is there any way to try to connect them with those who might want to look after them?

Deputy Margaret Conlon

I welcome the delegation and thank them for their presentation. To begin where Deputy Connaughton left off, my question relates to young people who are homeless. I came across Molesworth Street during the day some weeks ago and saw a young fellow lying in a doorway. A man and woman had stopped to ask him why he was not at school and he replied that he did not go to school. They asked him why he was not at home and he said he had been kicked out. I thought it was a sad state of affairs when a young child, no more than 14 or 15 years of age, was lying in a doorway telling two strangers he had no school or home to go to, and that this was his fate. I wonder about the young people on the streets. For many of them, school is a difficult challenge and many are early school leavers. What future is there for these young people?

Deputy Kathleen Lynch spoke about the hopes that homelessness will no longer be a problem by 2010. I share her concerns. I feel that with the change in the economic climate, there are people who will not be able to cope. For them, homelessness may become a fact of a life because they will not be able to cope with the rent or mortgage they have to pay, and they may find themselves in a very dark place. I have a major concern in this regard.

Nobody starts off homeless. There is a connection in the very early stages with family but where does it all go wrong? The delegates spoke about children in care or those who perhaps have a succession of homes and feel no real affinity with anybody. Are there other reasons young people in particular become homeless? Added to this, the delegates have mentioned that there is a greater tendency for them to abuse drugs and alcohol. Do they have any figures in regard to crime and the homeless? If they are dabbling in these activities, they will require some income. Are there any statistics for the numbers of foreign nationals who are homeless?

What struck me most about the delegates' presentation was the reference to the need for balance. For people being cared for in a facility, whether in an emergency bed or a more long-term facility, independent living may not be an option. For perhaps the first time in their lives, they have somebody who cares about them, a place they can call home and a routine. It is like the child with the soother and the comfort blanket — one does not take both away at once. Housing with supports is very important in order to give the people concerned a reasonable standard of living.

Deputy Bobby Aylward

I welcome the delegates and compliment them on the work they have carried out since 1969. As a member of a local authority before being elected to the Dáil, I have been involved with homeless persons in Kilkenny through various groups, including the Health Service Executive, the county council and the Simon Community. I am aware of the work done by the latter during the years. It has been at the forefront in trying to solve the problem of homelessness.

Many of the questions I wished to ask have been put by colleagues. The new homeless strategy rolled out in August is the latest of a series during the years to tackle homelessness. However, the Simon Communities of Ireland will provide assistance for 3,500 individuals this year. Given the downturn in the economy and with drugs cheaper and more freely available than heretofore, will the challenge become even greater? Mental health and alcohol addiction problems have always been an issue but the difficulties experienced by the homeless are made worse by the scourge of drugs. Alcohol and drug abuse problems are difficult to control because people fall by the wayside easily. For those who feel they have little to live for, attempts to redeem themselves may fail when they fall back into old habits.

How many are in emergency accommodation? The Minister for the Environment, Heritage and Local Government addressed our parliamentary party meeting last week to tell us about a strategy to take people out of emergency accommodation and place them in long-term accommodation. Will this be administered by local authorities or through the voluntary housing sector? There may be a helpful aspect to the economic downturn in this regard in that accommodation is getting cheaper in cities and it costs less to build individual houses. How will we achieve the target of placing an average of 3,500 people into long-term accommodation? There will always be a core of people who cannot be brought into normal society, but we must seek to reduce that number substantially, to hundreds rather than thousands.

Deputy Caoimhghín Ó Caoláin

I apologise to the delegates for missing their presentations. I had business in the Chamber and a job to do afterwards. I thank the delegates for their useful parliamentary briefing in Buswell's Hotel early last month. I record my appreciation of their work, both nationally and locally. In my own electoral area the nearest Simon Community presence is in Dundalk. I met the chief executive officer in the course of the Buswell's Hotel briefing. I commend the organisation's work throughout the island of Ireland.

In the course of my role as a Dáil Deputy I worked with colleagues to develop a proposal which we brought forward as a Private Members' Bill during the last Dáil. This sought to enshrine the right to housing in the Constitution, which would create an imperative on which the Government would have to act. As it stands, we have seen a significant drop-off in local authority social housing provision in the form of new, stand-alone houses. There has been a dependence on Part V of the Planning and Development Act since its introduction. The amendments to this provision represent an abrogation of one of the key responsibilities of the Government, namely, the provision of housing infrastructure to meet the needs of the population. While the focus of this debate is homelessness, it is another factor in regard to the significant waiting lists for housing recorded throughout the State, comprising some 40,000 family units of varying sizes.

Do the delegates have a view on enshrining the right to housing as a distinct article in the Constitution? Do they consider this likely to have a positive impact in terms of Government responsibility into the future? I am interested in their comments on this. I am of the view that it is an important matter which I raised again with the Taoiseach in recent weeks. My conscience finds it impossible to ignore the current situation. As my constituency colleague, Deputy Conlon, observed, one only has to walk to within a small radius of Leinster House on any night before one comes upon numerous people living in wholly inappropriate circumstances.

I refer back to the delegates' report of last August which indicated the greater pressures on the services, with particular emphasis on the position in Cork and Dublin. The report also indicated increasing numbers of homeless people being turned away from emergency accommodation. I apologise if the delegates have addressed this point in their opening address. It would be helpful to have an update since the report was issued in August.

The lack of services for young people who are homeless is of great concern. Many become homeless as a consequence of abuse within their domestic environment. Young people who leave home to enter in a period of homelessness are vulnerable and open to a range of predators. Drugs, crime and the attentions of sexual predators are some of the threats that present immediately. It is an horrendous scenario. This was brought home in the most recent exposé, in The Irish Times, on the death of a young person who had become homeless at the age of 14 years. This disturbing story highlighted the reality of young people’s experiences of homelessness.

I join colleagues in focusing with great concern on young people who are forced into homelessness. The delegates should elaborate on the specific commendations on this subject the Simon Communities of Ireland would make to Oireachtas Members as messengers of the people operating in their respective Houses. Are there particular actions the delegates would ask members to take to help them to address this serious subject?

Chairman

Many questions have been asked but before asking the delegates to respond, I support members in congratulating the Simon Communities of Ireland for the work it does nationwide. I seek clarification on one or two points. The strategic aims outlined include engaging with local authorities to secure a quota of housing units for those who are moving from homelessness. One would have thought that had local authorities a proper list of letting priorities, homelessness would warrant priority, by virtue of the circumstances of those affected, and that a quota should not be needed. In County Kildare which had many Army overholders the county council operated a formal policy as part which of which 10% of housing units were allocated to people who still remained in Army accommodation. However, I wonder why such a quota should be necessary in respect of homelessness and why a scheme of letting priorities should not work on its own merits.

What percentage of the current cohort of clients would be in a position to move to social housing, albeit with supports, if this could be achieved? The delegates also should clarify whether there is a further group who refuse to avail of services or take accommodation and who are even outside the system operated by the Simon Communities of Ireland.

Mr. Patrick Burke

I thank members for their wide-ranging questions and we will do our best to answer them as best we can. If we do not get around to any of them, we will follow up individually afterwards, as we have taken notes.

Ms Colette Kelleher

We were asked whether we were winning the battle. My view is we are winning it and that it can be won. One point we are trying to make to members is that because there are health issues in this regard, there is a reasonable call on the health budget. This means that the health funding being spent on homelessness must be ring-fenced to ensure it stays within the system. While I am aware that everyone is making a similar case, homelessness funding should be index-linked. In a way, our funding should rise rather than fall during an economic downturn because of the increased pressures on us. While I am sure many other groups will make this point, it is persuasive in our case.

As for numbers, we have made major strides in Cork, even within the last couple of months, because we have managed to open a new service which has had a major impact on the number sleeping rough. There is no magic to it. As one of the Deputies noted, one needs to have the right housing at the right threshold. The type of housing available is important, which is the reason local authority lists do not work very well. A particular form of housing is required, usually in single units. Locations in the middle of estates miles from the city centre are not good. In Cork we have found that small units of accommodation close to the city centre work better than a block. While such units are housing, they are of a particular order.

Moreover, homelessness does not simply pertain to housing which is the first step, but also to supports. Health supports are critical both in respect of people who may have mental health issues that cause homelessness and to prevent people from becoming homeless because of mental health issues. For example, the Simon Communities of Ireland has a team of people who provide visiting support. One individual had been very stable and was living in a flat, paying his own bills and doing very well. Last Christmas however, the holiday was too long for him. He needed a week, rather than two, off and became unwell. However, this was picked up quickly because of the availability of visiting support and he did not end up being obliged to spend a spell in a psychiatric hospital. The Simon Communities of Ireland would have ensured this person did not lose his flat. Were he in the private sector, however, one could see how he might experience an episode and consequently, because he would not be paying the rent, lose his flat and hey presto, he would be back at the door of the emergency shelter, which would not be a very effective use of resources.

We are winning the battle and have seen huge strides since 2000. However, although the Simon Communities of Ireland has 600 active volunteers in Cork and raises €2 million in funds to add to what it receives from the State, we need that State slice, from both housing and health, to continue winning the battle. This is the point we are trying to make to members today.

Ms Marlene O’Connor

On the mental health status of people who are homeless, in my experience it is approximately 50:50. Some become homeless because of their poor mental health. This often causes an inability to maintain relationships. Consequently, whatever natural supports they might have had become fractured and the relationship with the family breaks down because they can no longer cope with the poor mental health of the person affected. However, many also become mentally ill, or at least mentally unwell, because they are homeless and use unsafe levels of alcohol and drugs, because they are not able to establish and maintain relationships or because their physical health deteriorates. For instance, homelessness is very bad for one's feet. It is not just bad for one's mental health as it is absolutely a killer on one's feet.

As for what would help, the multidisciplinary team which is in full flight in Cork and in nucleus in Galway has made tremendous efforts. In Galway we have a substance misuse counsellor for homeless services who provides a service out of our day centre, conducts outreach clinics in the homeless hostels and is familiar with the circumstances and background. Moreover, the counsellor can be recommended by both staff and other service users, which is a major advantage.

Another potential benefit would be a community mental health nurse who, in addition to the Simon Communities of Ireland advocating on someone's behalf for admission, treatment, respite care or a diagnosis within the mental health service, could liaise with teams within the mental health service to smooth the path and recognise in a timely way the signs of poor mental health and the available treatment options. Moreover, a community mental health nurse would provide an invaluable service in this regard by having professional standing and status. Many mental health practitioners are somewhat inclined to question what one might know about the subject. As one is considered to be an amateur, they do not believe one knows anything, even though one could be reporting on behaviour with which one is familiar. For instance, one could be aware that someone was not taking sufficient medication, that the medication was no longer working or that it was no longer appropriate and the person in question was manifesting different behaviours. However, it sometimes can be extremely difficult to persuade health professionals of this, although I do not wish to be overly critical of anyone.

Deputy Dan Neville

If they do not liaise with families, they will not liaise with the Simon Communities of Ireland.

Ms Marlene O’Connor

Yes, which can be very difficult. Consequently, a dedicated team can work in this regard.

Another step that can be of enormous benefit is the meaningful use of daytime activities that can keep people engaged and occupied and which sometimes can be extremely useful in dealing with, for instance, literacy difficulties.

As for the changing face of homelessness to which Deputy Connaughton referred, I can provide an example from my own experience. I first worked with the Simon Communities of Ireland as a volunteer in a hostel in Limerick in the mid-1970s. At that time the classic person was male and 50 years old or more, in poor mental health and with an alcohol problem. Such a person was unemployed with poor education skills and often had returned from working in the United Kingdom, or had gone back and forth for periods. In the late 1980s and early 1990s I again worked with the Simon Communities of Ireland, this time in Galway. The profile had not changed substantially, except those affected tended to be younger. I returned to Galway in 2004 or 2005.

Our youngest service user is 18 1/2 years of age, while our oldest is 85. One third of our clients are women. The same factors present — family breakdown, relationship breakdown, being raised in care or institutions, being discharged from institutional care, frequently long-term psychiatric care, into grotty bedsits without supports, unless we have been informed, in which case we find another bedsit and provide supports.

Cross-generational homelessness is now evident. We are working with the children of those with whom we worked 20 years ago because interventions were not appropriate, timely or sufficient. Families fractured and children were raised in care, leading to poor mental health, psychotic episodes and a dependence on drugs and alcohol. This is my experience of the changing face of homelessness.

Deputy James Reilly

I apologise, but I mentioned that I needed to leave by 4 p.m.

Ms Niamh Randall

It is important that I highlight the considerable data deficit. While we know much from our experience and some research, there are sizable gaps. For example, we are awaiting the latest tri-annual assessment's figures. While there are issues around the methodology, it will give us an idea of the numbers involved. However, it will not tell us anything about the experience of being homeless, health issues or trying to raise a family in bed and breakfast accommodation.

I am disappointed that Deputy Reilly has left, as I am about to revert to some of his questions. We are at this meeting because we are focusing on the implementation plan to accompany the new homeless strategy and the devil is in the detail. We hope it will contain the level of detail sought by the Deputy. We are anxious to partner statutory organisations and the Government in the development of the plan, but we are only part of the jigsaw. Others include the HSE, the Department of the Environment, Heritage and Local Government, the statutory and other service providers. Most of the other issues raised have been eloquently addressed by my colleagues.

Deputy Dan Neville

I want to respond on the issue of homeless people being discharged from psychiatric institutions. When I reviewed the issue some years ago, I was appalled that people went straight out onto the streets. Has any progress been made?

Ms Marlene O’Connor

Yes, there have been advances in that some people progress from institutional care to training hostels. Sometimes, they can progress further. Without wishing to scaremonger, we work with a man who had been in a psychiatric hospital for 11 years before being discharged three years ago. It was to his case that I was referring. We received a telephone call three or four weeks after he had been discharged to see how he was getting on, but we did not know who he was. Owing to an opinion that he was no longer sufficiently ill to be in hospital, he was discharged into a bedsit but no one visited him. He had suddenly moved from a rigid institutionalised set-up with supports to a grotty bedsit. The protocols for discharging people from mental and primary health care facilities must be activated. A protocol is all very well, but unless practice permeates through the health care system, people will still be discharged.

Recently I had cause to take someone to hospital late at night. The person concerned was subsequently admitted for medical and surgical treatment. When I visited the man in hospital, the staff nurse told me of her concerns about "John". When I asked whether his condition had deteriorated, she said no, but that he was listed as homeless and because he was ready to be released, the hospital did not know what it should do with him. I told her that it was not a problem and that we had a place for him, as he had come from one of our houses. The incident cheered me considerably because someone cared and the system worked. However, it often depends on the person who is present.

Deputy Kathleen Lynch

It is hit and miss and depends on the generosity of individuals instead of being a process.

Ms Marlene O’Connor

Yes, instead of practice permeating the whole of the system. That I was surprised was frightening.

Mr. Sam McGuinness

I shall respond to a number of questions, including those asked by Deputies Lynch and O'Connor.

Regarding how we are dealing with the problem, I am a member of the board of the Homeless Agency and chairman of the Homeless Network in Dublin. Some members may know that we are considering a "key to the door" strategy to determine what action plans can work. Given our work and the critical priorities, it is clear that we are managing homelessness but will be unable to solve the problem by 2010. The counted-in numbers total just over 2,000, a figure that has not changed since the last count in 2005. The improvement is to the number sleeping rough, but one would not believe so when looking at the streets of Dublin city, particularly between St. Stephen's Green and Parnell Street in the morning. The number, approximately 110 or 115, has grown in the past year, but only marginally. When I say "managing homeless", I mean many are now off the streets and have been warehoused in emergency accommodation. Between 55% and 60% are in private or emergency accommodation. Some 70% to 80% of that number have been there for more than six months, while more than 50% have been there for two years. It is a strange environment. Of those in question, 155 are in night shelters, which means that they return to the streets the next morning.

Chairman

Are they all persons who, with support, would be capable of moving to permanent accommodation?

Mr. Sam McGuinness

The information with which we are working indicates that 73% could live in mainstream accommodation with short-term or long-term supports such as housing support teams, while 27% would need residential accommodation with supports. Of the total, 16% could live independently, whereas 84% would need some level of support.

We have seen miracles and believe people can find their independence. The format is shifting towards the fact that people can survive independently with supports. We do not need to keep them warehoused in emergency accommodation. As Ms Kelleher will agree, emergency accommodation is much more expensive than community schemes involving mainstream accommodation with supports. While there is hope, members know as well as I do that when we supposedly had money, we were unable to step into great places. Now that there is less money available, we are still expected to step in. We are considering schemes that might help. Approximately 20% of those in the shelter on Harcourt Street are between the ages of 18 and 24 years, 50% are under 35 years of age and 80% are under 44 years of age. That is the stark reality we face. Approximately 70% are drug dependent, 40% are alcohol dependent, while 20% have been diagnosed with a mental illness. However, a number remain undiagnosed. Everywhere is not like this. There is a belief in the greater Dublin area that homelessness should be dealt with as part of the local area plans. Of the people in Harcourt Street, 15% are from south Dublin where there is no support. There is support available in Dún Laoghaire and other places. A hostel is assigned to Neilstown.

We work in partnership. Mr. Burke has alluded to the fact that there are eight Simon communities, as well as the national office. We also work with MakeRoom. I work with Focus Ireland and Depaul Trust all the time. However, sometimes we cannot get two pillars of the State to work together. This part of the organisation has not opened up because in south Dublin we need an understanding between the HSE and the local authority. Perhaps others who have more funds could open it up without one or the other.

On the previous occasion I was here I stated the interest, enthusiasm and recognition of the committee for our work were extraordinary. I have been asked more questions than I can answer. In tough times we need partnership everywhere. We are asked to share services. However, we also need partnership with the Government and all of the other organisations with which we work. In tough times little money is available. In Tallaght we have someone working with Coolmine and the Tallaght advisory unit. However, we cannot get going on something critical such as an emergency hostel to take in people from the Priory. This has been an issue for months.

Deputy Caoimhghín Ó Caoláin

Some of my questions have not been answered. Perhaps it was intended to offer an opinion in writing subsequently, as Mr. Burke stated.

Mr. Patrick Burke

If time permits, I will be happy to do so.

Deputy Caoimhghín Ó Caoláin

That is okay.

Deputy Bobby Aylward

Mr. McGuinness stated 24% were capable of moving to individual or private accommodation. Do the rest have to live in community facilities with supports? Will they ever be able to go out on their own?

Deputy Kathleen Lynch

I am not certain that research has been done but it strikes me that the longer one stays in an institution the more institutionalised one becomes. This is common sense. Is there an optimum period in which someone should stay in a hostel? Should a person move on after six months or one year? I know Foyer in Cork which deals with potential homelessness of very young people has a two year period. However, the aim is to get them ready for independent living.

Ms Colette Kelleher

For emergency cases, the received wisdom is six months but I would say less, if one could manage it. In our strategic plan in Cork we set a target of three months. However, it depends on the availability of move-on options, of which a mix is required. Approximately one third of our beds are in emergency accommodation, one third are in group homes in the community and one third are in stand-alone housing. We need these various types to meet the needs of individuals. There is no one answer. An emergency shelter is no place for anybody to live in the long run. However, it serves a need and if we are to meet the targets on sleeping rough, we need emergency accommodation.

Our group homes are homes for life. Once people go there, they can stay there. In the main they are elderly people with high health needs. This security is important. I do not see why people who move into a flat and settle well should have to move. We need to increase the supply and be creative, as mentioned, with regard to using the many empty properties for people who need them.

Mr. Patrick Burke

As I know the committee is tight for time, we will respond more fully to members by letter in due course if we have not been able to do so today. I thank the committee for meeting us. I stress that the link between health and homelessness is critical and we would appreciate members' support in making this point. The proposal made by members of the committee to meet the Minister on the points we raised is welcome. If it were possible to do so, we would like to come before the committee again after a year to report on how the new implementation plan is progressing. We hope this would be of benefit to the committee in its deliberations and its role as watchdog.

Deputy Bobby Aylward

That is very welcome.

Chairman

On behalf of members, I thank the delegation for its presentation. I would like to think this is part of a process and we may not want to wait one year to engage. A challenge has been set for us. We can lobby the Department of the Environment, Heritage and Local Government and the Minister on the implementation plan. Next week we will have an opportunity to engage face to face with Professor Drumm and the Minister for Health and Children, Deputy Harney, and we will raise these matters on behalf of the delegates.

Mr. McGuinness has made an interesting point on the requirement for joined up thinking on a properly integrated approach. Having listened to him, I believe strongly that if local authorities are not fully engaged in the process, we will not achieve the solutions we need. Perhaps members will consider inviting the County and City Managers Association to come before the committee to discuss the issue of homelessness with them and take on board some of the points made today. We need a supply of the right type of accommodation and proper priority to be given at local level to the client group with which the delegation works. This may not be happening to the extent it should be.

The joint committee adjourned at 4.40 p.m. until 2 p.m. on Thursday, 27 November 2008.