Homelessness & Mental Health: More needs to be done……

I remember the first time when I saw people sleeping by the roadside at night. I was ten years old at the time, living in Pakistan.  I could not comprehend people not sleeping in the comfort of their homes. My father told me, “Son, they don't have a home. You are privileged to have a roof over your head.” 

I moved to the UK in the early 2000s, initially staying in East Ham, a socially deprived area of East London. I didn’t notice homelessness on the streets; obviously, UK was at the time the third biggest economy in the world, why would people be poor, I told myself.

Fast forward one and a half decades from then, I now work in a Mental Health Homeless team based in Manchester. And it breaks my heart to see homelessness everywhere, whether it be the affluent Deansgate or the hipster Northern Quarter of Manchester. 

While simultaneously living in the South West of London; every time I visit Central London, I am dumbstruck to see people sleeping outside and begging on Oxford Street. I couldn’t comprehend considering that’s one of the most affluent neighbourhoods of the world. 

One thing, I have observed about the Homeless population is that, nobody is vouching for them, no one has their back. If they slip through the net, they will be lost forever. Still, no one is bothered. 

When I was offered this job in Manchester at the beginning of the year, I was ecstatic and I am so glad I took it. I do five sessions with the team; a small team of 10 covering the whole of Manchester, a city of over half a million people. We work in collaboration with the Manchester Town Council’s rough sleepers team, drugs and alcohol team and the several homeless day centres.

There are interesting perceptions about the interface of homelessness and mental health; the cohort is stigmatised, when one thinks of a homeless person, one thinks  useless, drug addicts, disorganised, rejects, irresponsible, filthy and so forth. 

Our day starts on Monday with visits to the Cornerstone, a day centre for homeless with sleeping pods. The organisation funds 80% of their revenue by fundraising and by sleeping rough outside a designated area. They offer free breakfast and lunches to the homeless. The patients there recognise the homeless team; they high five us as they see us.

Barnabus is another homeless day centre in the city centre. They get input from the council, drugs and alcohol team and us. They start the day with a prayer and then open their doors to the needy. They also serve free breakfast and lunches and have a supply of clothes that are offered on the condition of taking a shower. 

I found the Booth Centre to be the most exciting. As I walked in, I saw a YouTube artist volunteering to perform an hour’s gig for the homeless, playing their favourite songs and later chatting away with them. They offer vocational courses to enhance their skill set; they have designated sessions for each day, involving a lot of arty activities. 

As a Consultant Psychiatrist, I have seen and dealt with a wide variety of cases in these six months. Let me share a few examples with you that should reflect the size of the problem we have on our hands.

I review people who are hooked on drugs, especially the well-known SPICE; it seems to have a special place in their lives as they smoke away from their worries evaporating with the smoke momentarily, they go through this time distortion effect. 

I have reviewed patients with chronic schizophrenias far away from their families, not seen them for years. 

I have seen people sofa surfing for years, not eaten for days as they have no money and no benefits for years, surviving on begging for which they are implicated.

I have met immigrants lost to the system, living as homeless. They don’t have the communication skills to interact, living a lonely life amidst a sea of people. 

I have seen severe and enduring mental illness being lost to the system because of their non-engagement, and reappearing after years with chronic deterioration.

We usually go to them; we don’t expect them to come to us, because if we do, we will lose them again. This is a very crucial point we all need to understand.

We deal with high-risk patients as well; there is always a fear of the unknown. I have seen people collecting barrels of Hydrochloric acid trying to make SPICE at home, carrying knives because the voices in their head are telling them to slay people. I have reviewed people in the homeless hotels as they barricade themselves in fear of the consequences of hurting others as the voices tell them to set fire to people outside.

A lot of effort needs to be put in to run the services in collaboration; the system treats them as normal persons, which they are not; they have deskilled over the years. They have been on the streets long enough to forget the social pleasantries; they are so distrustful of others as they have been violated of their dignities in the past. The only thing they have is their resilience, but that too is at the verge of breaking point.

I am sure this is the case throughout the country and all towns and cities are facing similar challenges. We need to own these people. This cohort needs help, not just fleeting political statements but real help. Multi-agency work is required to address this issue. We can do it as we are amongst the top 10 economies of the world, if we can’t, no-one can.

To put into context the urgency of the matter, we already have had 50 homeless deaths in Manchester in the past year; we don't want more!