Dr. Austin O'Carroll:

With regard to the four people sleeping rough, we do not know what the story was there. We probably have to wait for the coroner's report. If we had a critical incident review process, it would have answered that question. That is one of the reasons for having that incident review. My guess is people sometimes sleep rough because they meet friends and stay out as a couple or, in the scenario about which I would be more concerned, they were out with a group using drugs and stayed out to use drugs. We know overdose is one of the main causes of premature mortality. However, we do not know and that is why the critical incident review would make a big difference.

With regard to the causes of premature death, the biggest determinants are the social determinants. Of the ones we can prevent, that is the one we should focus on. The way we can prevent it is to stop homelessness. Drug addiction is the big one. If I was concentrating on the one area, it would be drug addiction and after that is mental health and suicidality because we have interventions that can help those.

As for the rapid review, for example, two people died in Phoenix Park last year and you would want to find out why two people died together and what was going on. You may find that people who are using drugs die at the same time. You may be worried there is a bad batch of drugs going around that needs to be identified.

They are probably the main types of things. There was an increase in the number of people getting infectious diseases such as HIV. While this is not death, it gives you an example. When we reviewed why they were getting HIV, we found out it was due to a change in the type of drug use at the time, especially with this drug called snow blow. We were able to identify that caused spread of infection. It would be a similar thing. You ask whether there is something happening that causes this increase in death amongst homeless people with drug addiction or the types of drugs being the main issue you would be trying to address.

The other one is suicidality. Sometimes if there is one suicide, there is a spate of suicides. That is something you would also want to be watching out for.

I welcome Dr. O'Carroll to the meeting. His interim report makes for fascinating reading. I do not believe there is anything particularly new in it that we would not have known but how it is presented is important as are the statistics, the charts and so on. It confirms what many of us already thought. I do not have questions as such but I have comments.

I note it is an interim report and a work in progress, which we should continue to track and engage on with Dr. O'Carroll. What jumped out at me most, and which I am always very conscious of, is the quote on childhood adversity. We all know this but to me it is the most important one in the report:

Most homeless people have been exposed to high levels of childhood adversity. Childhood adversity is predictive of a lower life expectancy.

Earlier we spoke about death, but the first point is to prevent homelessness. Why is it that so many people are single and homeless? Where is the sense of belonging and of connectivity, the sense of social bonds in formation? If one tracks many homeless people and if talks to them on the streets, as I and other members of the committee would do regularly, there is a sense that they are isolated. They have never been able to form bonds. Many of them have come from institutional care. Many of them have been rejected time and again. All of that bonding is critically important in early childhood. There is an expression that we see the world from where we stand and our experiences within it. Whether we like it or not each and every one of us brings to our daily life our experiences, be they good, bad or indifferent. Somehow we need to turn back the clock and go way back to find out why it is that so many people in institutional care become homeless. Why is it that so many people who have come from mental health services are homeless? Why does a high proportion of people who were in the Defence Forces and who left under certain circumstances become homeless? Issues around bonding, support, social support, care, affirmation, love and affection are way, way back there. This is important. I would like to hear more from Dr. O'Carroll on that aspect of his work. For me it is the most important aspect. It is something that we can do and we can change. It will take a long time but we can start now with our children and through how we can support them. Perhaps Dr. O'Carroll will share with the committee some of his own experiences in relation to those issues, especially around early childhood and how that impacts on homelessness.