Huge level of trauma among people who are homeless, Dáil Committee told

Poverty and childhood trauma are among main causes of homelessness, the Dáil Committee on Housing, Local Government and Heritage was told on Thursday morning.

Dr Austin O’Carroll, a north-inner city GP in Dublin, who specialises in healthcare to marginalised groups, told committee members that studies had “identified that the more of these traumas that you are exposed to in childhood it causes a lower life expectancy.”

There were nine such specific traumas in childhood, he said, “physical abuse or physical neglect, emotional abuse and neglect, sexual abuse but also parental separation, parental illness, parental addiction.”

He continued “if you have more than five adverse childhood events your life expectancy is 20 years less. It also means you are more likely to smoke, be overweight.You are also more likely to be a perpetrator or victim of violence.”

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Evidence showed that childhood trauma “has actual effects on the way the brain chemistry works and that’s why the effect is quite so permanent of childhood trauma. The biggest determinant of childhood trauma is poverty,” he said.

“The level of trauma among people in poverty is very high. There’s a huge level of trauma among people who are homeless,” he said.

In the context “a trauma-informed care approach in services” would be “extremely welcome,” he said. It could also “apply to any service, from schools to colleges to health professionals, but it would be particularly useful in homelessness,” he said.

This was “because the trauma-informed care approach is about recognising that people’s behaviour is related to trauma and responding in a way that ensures connectedness rather than exclusion, and trying to react more empathically to these people,” he said.

The Committee was discussing Dr O’Carroll’s Interim Report on Mortality in Single Homeless Population 2020. It found that deaths in Dublin’s single homeless population increased by over 60 per cent last year compared with 2019, and almost doubled since 2018. He said that “the crude morality rate was not significantly higher in 2020 if you look over the past five years.”

His report found that 47 single adults known to homeless services died last year – an 80 per cent increase on the 26 who died in 2019 and a 147 per cent increase on the 19 homeless single adults who died in 2018.

“However, over that same period of time there has been an increase in the number of single people experiencing homelessness so one would expect more deaths,” he said.

Among rough sleepers there had been three deaths in 2020, one in 2019, one in 2018, none in 2017, and two in 2016, “not a huge variation as there has been an increase in numbers of homeless people,” he said.

Senator Mary Fitzpatrick asked about the preponderance of single males among homeless people. She found it "stark that three quarters of the homeless population is male, single males, including 33 of the 44 single deaths, 75 per cent". She wondered "if, as a society, we need to explore this issue more?"

Dr O’Carroll said poverty played a significant role. “Males in poverty are often isolated. They don’t have familial roles,” he said.

Asked by Eoin O Broin TD what he would recommend “as absolute priority, actions that have to happen and happen immediately, to see that mortality trend reduce,”

Dr O’Carroll said the most important one was “reduce the length of homelessness through Housing First.”

There were interventions “to reduce overdose that we know of. Make sure they happen, The third one would be increase support in private emergency accommodation in terms of health supports.

“Fourth, the mental health team, which we’ve been asking for for a long time,the critical incidents analysis.”

But “ if I was to concentrate on one area it would be drug addiction, and then after that it’s mental health and suicidality,” he said.