Ms Majella Darcy:

I work with Dublin Simon Community. For the past 15 years I have worked with homeless clients, first with the HSE and then with Dublin Simon Community for the past ten years. Senator Dolan asked about causes and consequences. While I do not have empirical evidence to support this, over the past 15 years, 90% to 95% of adults I have seen come from a background of severe social deprivation, such as poverty, not having access to education or not having access to health care. I have seen people who became homeless at the age of 13. There are many social causes, such as poverty and social exclusion. If a person enters homelessness at 13 years of age, by the time the person reaches 18, he or she already has lots of other consequences that add trauma to the original reason for becoming homeless. Looking at the social dimensions of health for the homeless population is key.

The issue of bedsits was raised. One's environment is extremely important in terms of one's physical, mental and social health. I lived in a bedsit when I moved to Dublin first and it was appalling. I could afford to live in a very expensive bedsit but it was appalling. I did not want to live there so I do not expect that homeless people should have to live there either. That adds to the social exclusion. I do not think returning to bedsits is appropriate at all. Homeless people are entitled to the same as the rest of us in terms of the type of accommodation we have.

Senator Dolan asked about health services and how the system works. Dublin Simon at Usher's Island has 64 beds. Those 64 beds are there as a consequence of trying to plug the gaps that have existed in addiction and health services for the homeless population. In 2004, we started off with eight detox beds and we had 12 recovery or rehab beds. Since then we have expanded to meet need and we could expand even further. We have plans in for a 100-bed unit on that site. It is a medical facility for detox and recovery. We have a HIV unit for homeless people who are living with blood borne viruses such as HIV or hepatitis C. We only exist because we take 64 people off the street every night. If those 64 people did not have access to that service, they would be on the street or they would be dead. That is the reality of the situation.

Phase one of our plans for Usher's Island is planning permission for 70 beds. Phase two will be an additional 30 beds. We will expand what we currently do and work with other colleagues in the sector such as SafetyNet and St. James's Hospital to look at facilities such as a step-up, step-down unit. We are working with Merchant's Quay to set up a rapid access detox unit. It is something that has not happened in Ireland to date. There are examples of variations of it in Scotland in Turning Point and in City Roads in London. It is to address the issue that has been raised already of people who are not able to access methadone or addiction treatment centres because their lives are quite chaotic on the street. They are not even able to get to a methadone clinic. The idea is to initiate the methadone on the site or stabilise the person. It comes back to the question of how we meet people where they are at. It is something that Deputy O'Reilly mentioned. With rapid access as an example, we meet people where they are. We do not know what will come through the door. We have to see the person and their myriad issues, whether those are physical health, mental health, addiction issues or other social issues. We have to take them as they come through the door and try to deal with it. It takes a lot of innovation and flexibility. That is what is probably not in the mainstream - the level of flexibility to adapt to what homeless people need. There are other groups who would also experience that exclusion or lack of access to services. There is not an equality of access to health services for people who are marginalised or socially excluded.