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The role of trusting relationships in temporary accommodation as a protective factor to suicide.

10 September 2018

Eoin Ryan, Head of Harm Reduction Services at Simon Community NI, writes a piece for World Suicide Prevention Day

Homelessness is a complex, often misunderstood, social issue. Mental health conditions can be a cause of someone’s homelessness, but the experience of homelessness can often have a significant impact on someone’s mental health. For those without a home, or fear of losing their home, there is often a lack of adequate social support and feelings of isolation. It’s widely documented that rates of suicide and suicidal ideation are more prevalent among homeless populations and this is something Simon Community NI support staff are encountering every day.

The most quoted and most authoritative source on the extent of mental ill health in the adult population in the UK suggests that the prevalence of common mental health problems is over twice as high and of psychosis 4-15 times as high amongst the homeless population compared to the general population. ‘A Picture of Health’ (NI) – A summary of findings from a survey exploring the health of people in temporary accommodation and other homelessness service settings – reported that 26% of clients indicated that they had suicidal thoughts when surveyed.

Home for many represents a place where they belong and without this feeling of belonging somewhere, our sense of self may suffer. Home is our base where we feel safe and secure and it is the place where we unwind and de-stress. Having a secure environment is a basic human need. Without a physical place where they feel safe, people feel under constant threat, stressed and scared. This enduring stress and fear can have a profound impact on both their mental and physical wellbeing.

There are many factors which can contribute to someone becoming homeless and there can be personal shame and social stigma around the theme – all of which can have great and lasting impacts on a client’s self-worth.

Eoin Ryan – Head of Harm Reduction Services at Simon Community NI
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The Client-Centred Preventative Approach

In my role, I am seeing an increasing number of clients coming through the Simon Community NI projects with multiple issues including mental ill health, substance use, trauma, long term unemployment, physical ill health, poor literacy, care leaver background, behavioural difficulties, history of offending, family breakdown, domestic violence, abuse, and neglect. What I’m also witnessing within my role is the feeling of hopelessness that many of our clients feel as a result of these issues – and for some, this they see no way out of homelessness other than through suicide.

This is where our Simon Community NI support staff come to the fore in suicide prevention by taking some steps.

  1. Identify mental health issues and history of suicidal thoughts. Building trust and reassurance is a vital stage in the suicide preventative and protective process. For many clients, this may be the first time in a long time that they have experienced someone telling them that they care – something that can be immeasurable to a person’s mental wellbeing. While this work will not necessarily take away their feelings of hopelessness, it can begin the process of providing some of society’s most vulnerable with positive alternatives and the knowledge that someone is holding onto hope for them.
  2. Recognising mental health deterioration signs. By developing a ‘safe plan’, which is developed between staff and the client, parties can initiate practical steps to reduce risks should an individual begin to consider suicide. The plan will often list those who should be contacted when their mood is low, possible diversionary activities and reminders of what has helped a person in the past as well as what to do in emergencies.
  3. Partnerships with other agencies. By working alongside specialist mental health agencies, support staff can develop agreements with organisations such as the PSNI that are utilised at times when an individual’s risk is deemed high. By notifying clients of these external agreements, they become part of the process and are fully aware that issues such as not returning to the hostel by an agreed time or levels of intoxication will result in external agencies being notified.

For many, the hostel is seen as a place of safety and it is relationships with staff that often keeps individuals from acting on suicidal thoughts. The challenge is moving them on from the hostel environment into independent living where the same level of support doesn’t often exist.

Eoin Ryan – Head of Harm Reduction Services at Simon Community NI
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Additional Preventative Measures

Sadly, homelessness is becoming more and more prevalent in Northern Ireland. It could be the neighbour who lost their job and are worried about mortgage payments. It could be the colleague who has been thrown out of their home after a relationship breakdown. It could be the family moving in with relatives because they can’t find a suitable home with reasonable rent. In fact, it could be any one of us in a situation where we are unable to maintain our own home – something that will have a negative impact on mental health.

The outcomes for homeless people who are mentally ill are particularly poor especially when substance use is present. Not only does the combination create major problems for treatment and rehabilitation but they are often associated with stigma and negative connotations.

There are many ways, some very easy to introduce, to prevent homelessness related suicides

  • Firstly, giving someone a house is only part of the solution. Instead we need to see a closer integration of housing, substance use and mental health provision alongside an assertive case management approach. By addressing the underlying causes of homelessness, we are moving towards a place where we can truly tackle homelessness and homelessness related suicides. To achieve this, we must create services that are flexible and able to meet the complex needs of homeless people with a dual diagnosis. Further to this, the services must provide integrated treatment and support pathways with end-to-end provision.
  • Secondly, the development of formal partnerships between drug and alcohol, mental health, and housing and homelessness service providers will result in clear multi-agency protocols that are developed in consultation with all stakeholders. These protocols will need to be more than just ideas on paper but rather widely promoted actions that are maintained and reviewed by all participating organisations.
  • Thirdly, as perhaps most importantly, is the role and responsibility of society in changing attitudes towards those experiencing homelessness. On the one hand, we see charities such as the Samaritans, Aware NI, Lighthouse make great strides in getting people to talk about mental health while elsewhere we see homeless individuals being criminalised for begging via public space protection orders (PSPOs). For some of the Simon Community NI clients who do beg, they speak of their feeling of invisibility when sitting on the street. By simply beginning to look down, smile and say “hello”, we can create potential opportunities to give hope to those who are homelessness, lonely and may be experiencing suicidal thoughts. Give it a try this Suicide Prevention Day, you just never know the impact it could have.

If you, or someone you know is in distress or despair, contact Lifeline on 0808 808 8000. This is a confidential service with trained counsellors who will listen and help immediately on the phone and follow up with other support if necessary. The helpline is available 24 hours a day, seven days a week.

To find a mental health organisation specialising in self-harm and suicide click here