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Introduction

Homelessness is defined as the absence of a home, by 4 main concepts: Rooflessness (having no shelter), Houselessness (living temporarily in institutions or shelters), Insecure housing (where there are insecure tenancies, eviction, domestic violence), and Inadequate housing (living in temporary or non-conventional structures, unfit housing and extreme overcrowding). Homelessness can be caused by various individual factors such as mental health problems, drug and alcohol abuse, domestic violence, and the criminal offense, as well as structural factors such as shortage of affordable housing, low income, debt, and unemployment

As of November 2018, a total of 9,698 adults and children were registered homeless in Ireland This value has been increasing since 2014, as illustrated in the chart below This is a worrying trend as homelessness has a direct and established correlation with ill-health.

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Morbidity influenced by homelessness

Mental health

Homelessness has negative impacts on the mental health of individuals, due to the anxiety, stress, and loss of confidence that it causes.

According to a study carried out by Bergin for Simon Communities of Ireland (2010) on the users of their services, 52% of those who are homeless or at risk of homelessness have at least one diagnosed mental health condition. More than a quarter of them are medically diagnosed with depression. A significant percentage (9%) were diagnosed with schizophrenia. These mental health problems are more than twice as common among the homeless than among the general population Homeless children and young people are particularly vulnerable to depression and mental health problems, as they often face exclusion or bullying in school and lack emotional care from their parents. Many homeless people also resort to alcohol drugs, and self-harm. In the UK, 70% of homeless young people have mental health problems and 33% of them self-harm

Physical health

The homeless are often exposed to extreme weather conditions, leading to respiratory problems such as asthma which was reported in 26% of homeless individuals Coronary heart disease is also prevalent Improper hygiene and sanitation lead to significantly high rates of infectious diseases, particularly hepatitis C, hepatitis B, tuberculosis and HIV. Other diseases such as malnutrition, parasitic infections, and periodontal disease are also common among homeless populations

Furthermore, homelessness complicates the treatment of existing health conditions such as hypertension and diabetes, which require routine medication. In the case of diabetes, for example, homeless individuals would not have access to daily insulin injections due to lack of affordability and because some types of insulin require refrigeration. They have limited control over their diet and face a high risk of their medication being stolen. These factors cause many existing health conditions to be exacerbated.

Alcoholism and Drug Abuse

Bergin notes that 66% of the homeless use alcohol, with 30% of them having complications due to alcohol usage. The most common complications were falls and head injuries, liver damage, and memory loss. Other conditions include hepatitis, alcoholic cirrhosis, gastric problems, and seizures. A significant number (38%) use drugs, of which 40% use drugs intravenously. In Dublin, the number of active drug users among the homeless population had increased significantly from 23% in 2005 to 54% in 2013. Apart from the risk of overdose, IV drug use also exposes individuals to serious infectious diseases which can be transmitted through the sharing of syringes, such as HIV and hepatitis B and C. It also causes vein damage and abscesses. From 2004 to 2013, the number of alcohol or drug-related deaths among homeless people increased by 57%

Mortality influenced by homelessness

Higher prevalence of disease and limited access to healthcare results in a significant reduction in mortality among homeless populations. On average, the life expectancy of a homeless person is 42 years of age, compared to 82 years of age in the general population Additionally, the number of deaths caused by hypothermia among the homeless was thirteen times that of the general population

National policy

Homelessness has been an enduring problem in Ireland, and the government has responded with several policies, one of which is the Housing First National Implementation Plan 2018-2021 (). The Housing First approach aims to provide immediate, long-term, and affordable housing and also health and community support for the homeless, ensuring their reintegration into society and improvement in overall well-being. As of August 2018, the Dublin Region Housing First Service had created and managed 250 tenancies for 214 different homeless individuals in Dublin. The government has also committed €5.35 billion worth of funds to support the provision of 47,000 units of social housing and emergency accommodation by the end of 2021 ().

Providing homeless individuals with adequate and proper housing creates the supportive and stable environment necessary for their recovery.

At the same time, a team of healthcare workers comprising counseling psychotherapists, addiction support workers, and mental health nurses provides clients with support for problems such as addiction, depression, trauma, and suicidal tendencies. The reorienting of health services in this way provides the homeless with access to personalized healthcare, which is essential for tackling their multiple and complex needs.

As part of Rebuilding Ireland, the Government’s Action Plan on Housing and Homelessness (),

The Simon Communities of Ireland is a charitable organization that provides a range of services to the homeless, which includes classes and workshops that allow homeless individuals to develop personal skills and increase their chances of employability. Its Health and Well-being Service also provides sports training, and group exercise and organizes events to nurture a greater sense of community among its clients.

International Policy

Within Europe, the FEANTSA (European Federation of National Organisations Working with the Homeless) is a non-governmental organization focused on addressing homelessness. FEANTSA engages in constant dialogue with European institutions and governments to aid in the building of healthy public policy with regard to homelessness. FEANTSA also organizes seminars and workshops for policymakers and people working with the homeless for training and exchange of information between member organizations ().

At the 2015 UN General Assembly, a global commitment was also made ‘To reduce homelessness to functional zero (rare, brief and non-recurrent) in all member states by 2030’.

Conclusion

In conclusion, homelessness is a complex and multi-faceted issue that cannot be solved immediately, although Housing First policies are proving to be effective. There should be a continued and concerted effort between the government, community, and healthcare providers to reduce the health inequalities caused by homelessness.

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