Thursday, 24 March 2022
Saincheisteanna Tráthúla - Topical Issue Debate
Homeless Persons Supports
I thank the Minister of State, Deputy Smyth, who has stepped in at the last minute because the Minister of State, Deputy Burke, is detained elsewhere.
In 2019 and 2020 there was a significant increase in the number of media reports of tragic and premature deaths of people experiencing homelessness. As there is no count or record of such deaths, it was not clear whether those deaths represented an increase but, given the significant number of deaths, this House called on the then Minister at the time to commission a report to establish the extent to which this problem was growing, but also to try to understand the reasons for these premature deaths in order to try to ensure that, in future, the numbers would reduce, if not eventually be eradicated.
At the request of the then Minister, the Dublin Region Homelessness Executive commissioned an interim report on mortality among the single homeless population. Dr. Austin O'Carroll, who is one of the leaders in the field in terms of providing front-line supports to this cohort of very vulnerable men and women through his general practitioner, GP, practice in north inner city Dublin, produced the report. I have it before me. It is an important piece of work. I say this with no disrespect to anybody in the House, but we are talking about a group of people who, for the most part, the system does not care about. We need to be honest about that. These are single people, many of whom have severe levels of addiction, often interspersed with severe levels of mental ill-health. A significant number of them come from backgrounds of extreme poverty. That cycle of poverty, addiction, mental ill-health and homelessness has meant that, if we are brutally honest, they are at the very bottom of the list of political priorities for most people.
The publication of the report was groundbreaking because it acknowledged that although there were insufficient data to reach definitive conclusions, the age at which those in this group of people die is frighteningly young.
The deaths that have been occurring are, in many cases, eminently preventable if only we would learn from the mistakes of the past and improve the supports for this group of people into the future.
The report, I understand, created some considerable tensions between the Department of Housing, Local Government and Heritage, the Dublin Region Homeless Executive, DRHE, and the HSE, which led to it being downgraded to an interim report and a promise of a HSE-funded longer-term study that has never materialised and I am not even sure if it is being produced. That speaks volumes in itself.
There are very important recommendations in Dr. O'Carroll's report, such as, for example, an increase in trauma-informed care to ensure adequate supports for this very vulnerable group of people in great need and a far greater provision of appropriate step-down and move-on accommodation. It also crucially recommended that critical incident reports, or what some people call adult safeguarding reviews which look back at the circumstances that led to such untimely and premature deaths, are also carried out. This is not to apportion blame but to learn what failed in the systems to try to ensure that these types of deaths were reduced and, potentially, eradicated in the future.
Central to Dr. O'Carroll's report was a need for greater multidisciplinary interagency working. Very often the deaths that take place are in the transition of an individual from healthcare, to mental health care, to homeless services, and in those gaps, when there is a handover, the lack of properly co-ordinated and integrated interagency care led to crises and ultimately to deaths.
What provoked me to table this request was that at the very start of this week, as I am sure Members will know, there was yet another tragic death of a young man who died in a tent in the north inner city of Dublin. We still do not know the reasons for that individual's death but, like so many others, he died far too young. I want to express my condolences to his family and to his friends but let us take this opportunity to ask what we can do to tackle the causes of these premature deaths to try to ensure that they are reduced and, ultimately, eradicated into the future.
I thank Deputy Ó Broin for raising this particular matter. We should acknowledge that Dr. Austin O’Carroll has done a considerable service for the category of people referred to in this report. Any of us who are worth our salt as public representatives will have a fundamental concern for the people who are the subject matter of this report. I now call on the Minister of State to speak.
I thank the Ceann Comhairle. I thank Deputy Ó Broin for asking this question and it is a very serious matter. I am answering this question on behalf of the Minister for Housing, Local Government and Heritage. The Minister has asked me to express his sadness at the news of the death of a man who appears to have been sleeping in a tent in Dublin city centre. This is a tragedy and I extend my sympathies to his family.
The deaths of people availing of homeless services are of great concern and are being taken very seriously. It is important to establish the circumstances involved and that the response is based on the best knowledge and evidence available.
A review of homeless deaths was undertaken on behalf of the Dublin Region Homeless Executive by Dr. Austin O’Carroll and the review analysed the available data concerning deaths in homeless services for 2020, to identify learning for homeless and health services that could help tailor the provision of care to homeless people. Dr. O’Carroll notes that the most important step in reducing mortality among the homeless population is the reduction of long-term homelessness. The report notes that the Housing First model is the optimum approach to achieve this objective. Housing for All commits to the continued expansion of Housing First with more than 1,300 additional Housing First tenancies planned over the next five years on top of the 756 tenancies that have already been created. The report makes recommendations in the areas of data collection and analysis and a pilot study on data collection of homeless deaths nationally is being undertaken by the Health Research Board on behalf of the Department of Health. Dr. O’Carroll’s report also identifies that the co-operation between different agencies and service providers is of critical importance. Under Housing for All, a new national homeless action committee has been established with all of the key Departments, agencies and stakeholders involved. The overarching objective of the committee is to ensure that a renewed emphasis is brought to collaborating across Government to implement actions in Housing for All.
The improvement of health outcomes for socially excluded groups in society is a key priority for the Government. The HSE, through its national service plan 2022, has identified priority action areas with regard to healthcare services for people who are homeless. Among these are the development of a single integrated homeless case management team in Dublin and the implementation of the health actions in Housing for All for people who are homeless in order to provide specialist addiction and mental health services that are appropriate to their needs. Further recommendations that are currently being implemented are the continued support for the roll-out of specific harm reduction approaches such as opioid substitution treatment and increased naloxone provision. The Department of Housing, Local Government and Heritage is working closely with the Department of Health, the HSE and local authorities to continue to deliver the appropriate measures to support all individuals experiencing homelessness, including those with complex needs.
I thank the Minister of State for his response. I will make just a couple of comments by way of reply and make a number of requests for him to raise with both the line Minister and also, possibly, with his colleagues who have responsibility for healthcare.
First, in respect of Housing First, the Minister of State is absolutely correct in that both the report and Government policy recognise the importance of Housing First. The difficulty is that the target for Housing First exits from homelessness has only been increased by 50 per year to 250. We have 3,000 single adults in our emergency accommodation system at present, not all of whom have the very high level of complex needs that we are talking about, but many do. Some 250 Housing First placements a year are nowhere near adequate. In many cases the support services being provided are not being adequately funded for long enough. That is important because there is a period of vulnerability for people who are going into Housing First in the period of time immediately after exiting either street homelessness, sofa-surfing or emergency accommodation because, in many cases, they are removed from what was their support and contacts network, and from their cultural capital. In many instances in other jurisdictions, that actually leads to an increase in potential mortality during that period of vulnerability and that needs to be addressed.
I welcome the fact that the Health Research Board is undertaking this work but I understand that it was meant to start this two years ago and it would be good to hear from the Minister for Health at some point about its progress.
Crucially, one of the great innovations that was made by the Dublin Region Homeless Executive and Dr. Austin O’Carroll during the Covid-19 period was the creation of medically supported shielding units, where those with the highest level of vulnerability to contract Covid-19 and, therefore, potential death, were put into new bespoke units. Not only were they protected from Covid-19, something I wish to commend the Government, the DRHE and the front-line staff on achieving, but what happened when we put these people into own-door accommodation? All aspects of their lives started to improve, not just their protection from Covid-19 but their physical and mental health, and addiction management also. These were temporary facilities and one of the things that the Government should urgently consider in the context of this debate is the making of permanent facilities as transitional accommodation, rather than moving people back into emergency accommodation.
I thank the Minister of State for his response urgent and I urge him to raise this very serious matter with the two line Ministers. I hope that we can return to this issue at a later stage for a further update. I thank the Ceann Comhairle.
I thank Deputy Ó Broin. From talking to people who work directly in homelessness services, I am told that while addiction is very commonly a factor in homelessness, it is not always the case. Sometimes it is mental health and sometimes it is simply losing one’s money and not being able to manage economically in a very expensive housing situation. On many occasions it is addiction and the way to tackle that is to address the causes of addiction and doing this requires further funding.
I will take the Deputy’s comments to the Minister of Housing, Local Government and Heritage on the need for more Housing First places which are not sufficient, given the number of people who are homeless. Additionally, I will also act on the Deputy’s request to ask the Minister for Health for a report on progress of the Health Research Board’s work in this area. I will also take on board the Deputy’s comments about the success of the shielding units and the own-door accommodation and will bring those to the Minister for Housing, Local Government, and Heritage. I thank the Ceann Comhairle and the Deputy very much.
It has literally dropped out of the sky. I will be writing to Departments to ask them to cop themselves on and to respond with a bit more respect to the Topical Issue matters that have been raised here. I inform Deputy Pringle that the Minister of State, Deputy Ossian Smyth, to whom we are grateful for being here, has just been handed a file which addresses the Deputy's question. Does the Deputy wish to proceed?
I mean no offence to the Minister of State, Deputy Smyth, but I am unsure if it is really worthwhile to proceed, a Cheann Comhairle. The Minister was present in the Chamber here this morning on questions so it is not that there is not a Minister about here. I agree with the Ceann Comhairle on the contempt the Government holds for Topical Issue matters. It calls into question whether such Topical Issue matters are seriously looked at. This is an issue which is of great importance for the country as a whole and, in particular, for my own constituency.
It could have huge implications.
I put it to you that the Opposition and the Government are provided with Whips who are remunerated from the public purse to do a particular job. One of their basic jobs is to follow the monitor and see what is happening-----
-----so I do not accept that people are not here. If I followed matters closely enough before lunch, the House suspended because there was no Minister present to deal with the First Stage of legislation.
We are now due to proceed to the Planning and Development (Protect Social Housing) Bill 2020. Is the Minister of State dealing with this?
I can be helpful on this. Before I came here for the Topical Issue, I received a telephone call from the secretary in the office of the Minister of State, Deputy Peter Burke, to say he was on his way here and the expectation was he would be here for the Bill if all the Topical Issues were taken. I was given advance notice that the Minister of State, Deputy Ossian Smyth, was to take my Topical Issue.